Interventions for chronic pruritus of unknown origin (Review)

Parry-Romberg syndrome (PRS) is characterised by progressive but self-limiting facial hemiatrophy. We describe a 48-year-old woman with a 3-year history of gradually worsening right facial hemiatrophy on a background of scleroderma. Her initial primary concern was alopecia. Within the last year, there was greater prominence of her right zygoma and hyperpigmentation on her forearms and left neck. She also had worsening headaches and neck stiffness in the mornings. A clinical diagnosis of PRS was made and she was subsequently treated with a course of methotrexate. She is due to be followed up by dermatology, rheumatology and maxillofacial surgery with the aim of reconstructive surgery once her symptoms stabilise.

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We report a case of a 25-year-old male with primary hidradenocarcinoma arising from the medial aspect of the left metatarsophalangeal joint who presented with palpable inguinal lymphadenopathy. The patient was able to give a corroborated history of the primary lesion being present for 4 years prior to the development of his groin swelling. Initial biopsy of the primary lesion suggested a malignant adnexal tumour. He underwent wide local excision of the primary lesion and therapeutic inguinal lymph node dissection. Review of the excision specimens established the diagnosis of hidradenocarcinoma. We discuss this case due to the rarity of the site of the tumour and demographics of the patient. There is limited data available on hidradenocarcinoma and there is no consensus on what should constitute standard identification and management.