No abstract

No abstract

Curvilinear incisions are prone to dog-ear formation because of unequal wound lengths. This wound length discrepancy is traditionally corrected with a Burow triangle. One alternative to using a Burow triangle is the standard rule of halves, in which excess tissue is evenly distributed along the length of the wound edge by repeated placement of buried dermal sutures to sequentially halve the remaining defect. 1 This method carries the disadvantage of occasionally yielding a lateral standing cone, requiring further extension of the wound. A modification of the standard rule of halves redistributes the length discrepancy medially, thereby avoiding lateral dog-ear formation.

Microsporum canis cutaneous infection mimicking histopathologically a cutaneous T cell lymphoma is discussed. A 63 year old male presented with pruritic, erythematous thin annular, scaling plaques localized to the forearms, abdomen and left hand. A primary care physician’s biopsy raised concern for a cutaneous lymphoma. At the Dermatology clinic, a KOH and fungal culture suggested a dermatophyte infection caused by Microsporum canis. The patient was treated with oral fluconazole with resolution of most of the lesions and symptoms. This clinical improvement supported the diagnosis of tinea corporis instead of a cutaneous lymphoma. To the best of our knowledge, this is the first reported case of Microsporum canis mimicking cutaneous T-cell lymphoma.

Multicentric reticulohistiocytosis (MRH) is a rare, histiocytic disorder that primarily affects the skin and joints. This disease can have systemic involvement of various organ systems and has been associated with underlying malignancy. Middle-aged, Caucasian females are the most commonly affected demographic group in this disease. We present a case of a 56-year-old African American male with debilitating joint pain and a papulonodular rash on his face, chest, arms, and hands. Biopsy of skin lesions confirmed the diagnosis of multicentric reticulohistiocytosis. Histological findings revealed dermal infiltrate composed of glassy histiocytes and giant cells with eosinophilic cytoplasm. The patient was started on 15 mg of methotrexate weekly, 1 mg of folic acid daily, and 60 mg of prednisone daily with mild improvement of skin lesions at one month followup. He expired from other comorbidities before long term treatment could be achieved. The potential for disfiguring skin lesions and debilitating arthropathy emphasizes the importance of early recognition and treatment of MRH. Corticosteroids and methotrexate are recommended for patients with moderate to severe disease and have been shown to be successful in some cases. More studies are needed on patients with MRH to further elucidate the etiology and pathogenesis of this disease.