Everyone, old and young, is concerned about skin aging, a complex process that can be caused by both intrinsic (chronologic), and extrinsic (environmental) factors. The formation of free radicals is a widely accepted mechanism leading to aging. Free radicals are highly reactive molecules with an odd number of electrons that are generated from oxygen; they cause easy oxidation of other molecules (can extract electrons or hydrogen from, or add oxygen to, another substance). Reactive oxygen species (ROS) initiate signal transduction cascade resulting in up-regulation of AP-1, NF-kB, and down-regulation of transforming growth factor (TGF)-b. Downstream, NF-kb signals increase in interleukin-1 and tumor necrosis factor-alfa levels, and AP-1 activates matrix metalloproteinase (MMP). Decrease in TGF-b expression leads to decrease in collagen synthesis. Cumulatively, these changes lead to increase in collagen breakdown, and increase in elastin production in extracellular matrix, and eventually manifest as the clinical signs of photoaging such as solar elastosis, wrinkles, coarse textures, telangiectasis, and pigmentation.

Human ; Male ; Female ; Collagen ; Elastin ; Matrix Metalloproteinases ; Nf-kappa B ; Pigmentation ; Reactive Oxygen Species ; Skin Aging ; Telangiectasis ; Tumor Necrosis Factor-alpha

This is a case of an 11-month-old male who presented with multiple scattered mildly pruritic brown macules, papules and patches on the face, trunk and extremities, sparing the palms and soles. Darier sign was positive. Patient did not present with hepatosplenomegaly, lymphadenopathy and gastrointestinal symptoms. He was treated with emollients, potent topical steroids, antihistamines and a mast cell stabilizer with clinical improvement of cutaneous lesions after two weeks.

Human ; Male ; Infant ; Urticaria Pigmentosa ; Anti-allergic Agents ; Emollients ; Extremities ; Histamine Antagonists ; Lymphadenopathy ; Mast Cells ; Torso ; Mastocytosis ; Darier Disease

We describe a case of a 57 year old female who presented with multiple papules on bilateral extremities with no other systemic findings. Skin lesions consisted of multiple hyperpigmented scaly papules in a rippled pattern some coalescing into plaques. Histologic examination showed deposits of amorphous eosinophilic materials in the papillary dermis. The diagnosis of lichen amyloidosis was made. Treatment with high potency topical steroid in combination with salicylic acid ointment, emollients, and systemic antihistamine which afforded improvement after 2 weeks. There was 90 percent clearance of lesion within 5 months of therapy. The origin and clinical features of papular primary localized cutaneous amyloidosis (PLCA) are reviewed.

Human ; Female ; Middle Aged ; Amyloidosis, Familial ; Dermis ; Emollients ; Histamine Antagonists ; Histamine H1 Antagonists ; Lichens ; Salicylic Acid ; Skin Diseases, Genetic

Verrucous carcinoma of the penis is a rare invasive carcinoma that originates from squamous epithelial cells. It comprises 5 to 24 percent of all penile malignancies and 5 to 16 percent of all squamous cell carcinoma. In 5 % of cases, it is associated with human papilloma virus (HPV). We describe a case of a 42 year old male, with a I year history of a slowly enlarging verrucous mass which initially presented as a warty papule on the penile shaft.

Human ; Male ; Adult ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous ; Epithelial Cells ; Papillomaviridae ; Penile Neoplasms ; Penis

Localized scleroderma, otherwise known as morphea, is a rare fibrosing disorder of the skin and underlying tissues with equal prevalence in adults and children. It is a distinct and separate disease entity from sytemic sclerosis. Although the etiology and pathogenesis have not been identified, the clinical manifestations are due to the thickened collagen bundles infiltrating the entire dermis and extending into the subcutaneous fat. This condition is self-limiting and may last for 3 to 5 years. We report a case of a 45-year-old man who presented with multiple, ill-defined, warm, indurated, slightly erythematous to hyperpigmented plaques with central atrophy on both thighs and lower legs of five months' duration. He was successfully treated with colchicine and sytemic corticosteroids.

Human ; Male ; Middle Aged ; Adrenal Cortex Hormones ; Atrophy ; Colchicine ; Collagen ; Dermis ; Fibrosis ; Leg ; Prevalence ; Scleroderma, Localized ; Sclerosis ; Skin ; Subcutaneous Fat ; Thigh ; Skin And Connective Tissue Diseases

We report a case of a 55-year old sexually active homosexual male who presented with one month duration of erythematous, non-pruritic papules on the forehead, nape, scalp, chest, back, extremities and genitals and the presence of coppery-red, slightly scaling macules on the palms and soles. RPR (>1:16 dilution) and TPPA were reactive. A 4-mm skin punch biopsy revealed hyperplasia of the epidermis, focal areas of erythrocytic exocytosis with mild spongiosis and vacuolar degeneration of the basal cell layer, and many superficial and deep moderately dense perivascular granulomous inflammatory infilitrates consisting of histiocytes, lymphocytes, many plasma cells, some neutrophils, nuclear dusts and few eosinophils. The patient was given a single dose of 2.4M units of benzathine penicillin G, divided into each buttock. A repeat quantitative RPR was scheduled after 6 and 12 months to monitor the patient's titer.

Human ; Male ; Middle Aged ; Buttocks ; Eosinophils ; Epidermis ; Exocytosis ; Histiocytes ; Hyperplasia ; Neutrophils ; Penicillin G Benzathine ; Plasma Cells ; Scalp ; Sexual Minorities ; Skin

Familial combined hyperlipidemia, otherwise known as type IIb hyperlipoproteinemia or multiple lipoprotein-type hyperlipidemia is an inherited disorder of high serum cholesterol or high blood triglycerides. This disease is genetic and inherited, although the specific defective genes have not been identified. The person's cholesterol or triglyceride become elevated during the teenage years and continue to be high throughout life. The types of elevated lipoproteins may vary between affected family members. Its clinical manifestations include lipid disposition on the skin or tendons called "xanthomas" as well as on the arteries. People with this condition have an increased risk of cardiovascular disease so that it is essential to recognize early this type of disorder. We report a case of a 37 year-old male who presented with a bilateral yellowish to reddish nodules on the elbows, knees, ankles, malleoili, ventral aspect of both hands, fingers, feet and toes, metacarpophalangeal & proximal interphalangeal joints, back and buttocks of six years duration with an elevated levels.

Human ; Male ; Adult ; Ankle ; Arteries ; Buttocks ; Cardiovascular Diseases ; Cholesterol ; Hypercholesterolemia ; Hyperlipidemia, Familial Combined ; Hyperlipoproteinemias ; Lipoproteins ; Tendons ; Toes ; Triglycerides ; Xanthomatosis

We describe a case of a 10-year old female who consulted at our institution with plaques on the scalp, neck, trunk and extremities. The lesions were multiple, erythematous to violaceous, flat-topped papules and plaques with Wickham's striae. The nail involvement showed thinning of the nail plate, onycholysis, onychodystrophy, longitudinal ridging, and starting pterygium. Biopsy showed orthokeratosis, wedge-shaped hypergranulosis, irregular acanthosis and lichenoid pattern (mostly lymphocytes). Focal vacuolar alteration is also noted with few melanophages present and few Civatte bodies are noted. Negative HBsAg, anti-HBs and HCV were noted. The patient was treated with clobetasol dipropionate ointment,prednisone 10mg/day, oral antibiotic and antihistamine with marked clinical improvement after 2 weeks.

Human ; Female ; Child ; Anti-bacterial Agents ; Clobetasol ; Lymphocytes ; Nail Diseases ; Nails ; Prednisone ; Pterygium ; Scalp ; Skin Diseases

We describe a case if a 4 year-old girl who consulted our institution because of multiple tense vesicles and bullae on the perioral area, trunk, elbows, knees and dorsum of hands and feet. Biopsy of the lesion revealed subepidermal cleft with few ill-defined acantholytic cells and patchy areas of vacuolar degeneration showing infiltration with numerous neutophils and occasional eosinorphils. There was linear deposition of C3, IgG and IgA on basement membrane zone. The diagnosis was epidemolysis bullosa acquisita, IgA bullous dermatosis-like presentation. The patient was treated with topical corticosteroid for 1 1/2 months with complete resolution of lesions and appearance of milia on the perioral area and dorsum of hands and feet. Patient remained in remission.

Human ; Female ; Child Preschool ; Adrenal Cortex Hormones ; Biopsy ; Blister ; Elbow Joint ; Immunoglobulin A ; Immunoglobulin G ; Skin Diseases, Vesiculobullous ; Histiocytosis

We report a case of a 9-year old male who presented with 2 months history of well-defined keratotic follicular papules on an erythematous base located on the scalp, face, trunk and extensor aspects of the extremities. Of the 5 clinical types of pityriasis rubra pilaris (PRP), our patient was classified as type III or the classical juvenile pityriasis rubra pilaris. Treatment modalities focused on the giving of topical corticosteroids, emolients and keratolytics which showed marked improvement on the cutaneous lesions.

Human ; Male ; Child ; Adrenal Cortex Hormones ; Extremities ; Face ; Keratolytic Agents ; Pityriasis Rubra Pilaris ; Scalp ; Torso