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Within the last 50 years, the pharmacologic market for gastric disease has grown exponentially. Currently, medical management with histamine 2 receptor antagonist and proton pump inhibitors are the mainstay of therapy over surgical intervention. These are generally regarded as safe medications, but there are growing numbers of cases documenting adverse effects, especially those manifesting in the skin. Here we review the pharmacology, common clinical applications, and adverse reactions of both histamine 2 receptor antagonists and proton pump inhibitors with a particular focus on the potential for allergic reactions including allergic contact dermatitis.

Capecitabine is a 5-fluorouracil basedchemotherapeutic drug widely used in the treatmentof solid tumors, especially colorectal and breast. Someof the most common side effects of capecitabine arecutaneous in nature, including hand-foot syndrome(palmar-plantar erythrodysesthesia). Several reports inthe literature link capecitabine use with photosensitivelichenoid eruptions. Herein, we present a case ofcapecitabine-induced lichenoid eruption in an elderlyfemale with metastatic breast cancer and discuss ourfindings in relationship to previously reported cases ofthis and other capecitabine-induced skin pathologies.

Keratoacanthomas (KAs) are common skin lesions known for their rapid growth and spontaneous regression. Keratoacanthomas also can occur in sites of prior trauma, such as surgical scars. We report a case of multiple KAs occurring in the site of trauma from a prior surgery and de novo as well as the response to treatment with intralesional methotrexate (MTX).

Capecitabine is a 5-fluorouracil basedchemotherapeutic drug widely used in the treatmentof solid tumors, especially colorectal and breast. Someof the most common side effects of capecitabine arecutaneous in nature, including hand-foot syndrome(palmar-plantar erythrodysesthesia). Several reports inthe literature link capecitabine use with photosensitivelichenoid eruptions. Herein, we present a case ofcapecitabine-induced lichenoid eruption in an elderlyfemale with metastatic breast cancer and discuss ourfindings in relationship to previously reported cases ofthis and other capecitabine-induced skin pathologies.

Various substances of abuse are known to cause specific cutaneous manifestations. In this review, we highlight the cutaneous manifestations associated with the use of cocaine, heroin, marijuana, methamphetamine, alcohol, and anabolic steroids. Cutaneous signs of tanning addiction are also discussed, as tanning bed use is a particularly relevant and growing problem in Dermatology. We also provide examples of general signs of drug abuse, including stigmata of injection drug use, vascular complications, and infectious complications. This review aims to make clinicians more aware of these signs in order to better recognize substance abuse disorders and guide effective treatment.

Porokeratotic Eccrine Ostial and Dermal Duct Nevus (PEODDN) is a rare disorder of keratinization characterized by the presence of cornoid lamellae and association with eccrine sweat ducts. These lesions are usually benign and asymptomatic, so treatment is often for cosmetic purposes. Current therapies for PEODDN are either insufficient or impractical. We present a case of PEODDN treated with topical tretinoin 0.05% cream and 5-fluorouracil 5% cream with the hopes of providing an efficacious, financially relevant, and well-tolerated treatment regime for PEODDN. The combination of topical tretinoin and 5-fluorouracil did not provide substantial improvement in the lesions of a patient treated with this therapy for 6 weeks, and further studies are needed to identify an efficacious treatment for PEODDN that is both well-tolerated and economically feasible for patients with this condition.

Background The time period between onset of depigmentation around the halo nevus (HN) to complete resolution of the nevus and halo has not been well studied. Objective We sought to better understand the natural history of the HN. Methods A retrospective chart review of patients with a clinical diagnosis of HN selected from a private practice database (1994-2010) was performed. In all, 52 patients with 80 HN were identified. The current stage of the HN was determined by a follow-up questionnaire and physical examination of 36 patients with 56 HN. Results Seven HN were excised. Of the remaining 49 HN, 51% (25) demonstrated no change in the halo or nevus after an average of 4.2 years; 14.3% (7) demonstrated partial nevus regression with persistence of the halo after an average of 6.7 years; 4.1% (2) demonstrated complete involution of the nevus with persistent halo depigmentation after an average of 7.7 years; 8.2% (4) demonstrated complete nevus involution with some repigmentation of the halo after an average of 11.8 years; 22.4% (11) demonstrated complete resolution of the nevus with complete repigmentation of the halo after an average of 7.8 years. Limitation Some subjects were lost to follow-up. The time of initial HN onset was dependent on patient recall. Conclusion These results demonstrate that HN typically persist for a decade or longer. A subgroup may progress through stages of involution with a return to normal-appearing skin, but even these lesions persisted for an average of 7.8 years. Education about the prolonged natural history of HN may reassure patients and avoid unnecessary excision.

From In ic m D M M Fund A 55-year-old man presented with a pruritic rash on the chest and abdomen that had been present for 6 months. It waxed and waned but never cleared completely. His medications included hydrochlorothiazide 50 mg daily for elevated blood pressure and aspirin 150 mg daily. The physical examination revealed 20 pruritic, erythematous papules ranging from 0.5 mm to 1.0 mm in diameter, surmounted by a hard scale, scattered on the chest and back (Fig 1). Treatment with ketoconazole 2% shampoo overnight three times a week, permethrin 5% cream overnight twice a week, and moisturizing lotions twice daily proved ineffective. A 4-mm punch biopsy specimen was obtained (Figs 2 and 3).