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Elastosis perforans serpiginosa (EPS) is a rare skin disorder in which there is transepithelial elimination of elastin fibers. It belongs to a group of perforating disorders of which there are four classic types. The EPS type is extremely rare. There have been no previous reports of elastosis perforans serpiginosa occurring as a paraneoplastic phenomenon. We report a case of paraneoplastic elastosis perforans serpiginosa in the setting of stage 4 ovarian cancer.

Anti-tumour necrosis factor (anti-TNF) therapies have been associated with neurological complications, including in rare cases demyelinating disease. It is currently unknown whether patients who have received more than one immunosuppressive agent or anti-TNF have a greater risk of demyelination. We report the case of a 37-year-old woman with psoriasis who presented with an acute episode of demyelination while on anti-TNF therapy. This case was complicated by the fact that progressive multifocal leukoencephalopathy was considered the likely diagnosis initially and was only definitively excluded by brain biopsy. This case demonstrates the difficulty establishing the correct diagnosis in patients with atypical presentations on immunomodulating therapies. We present this rare case of demyelination in a patient who received multiple immunosuppressive therapies to highlight this challenging clinical situation and discuss management with a literature review.

We report the case of a 53-year-old man who presented with multiple large areas of thickened, hyperkeratotic, papillomatous filiform fissuring plaques involving multiple fingers consistent with severe palmar warts (Fig. 1). The lesions had been present for 6 years, and were recalcitrant to previous topical treatments. The lesion had previously been smaller and managed with cryotherapy in primary care but this approach was no longer effective. The patient was otherwise generally well and was not immunosuppressed.We performed two 4-mm punch biopsy incisions in the central area of the plaques. Approximately 2 mL of 1% lidocaine with no epinephrine was used as local anaesthetic. The incisions were made to the depth of the dermis until a small amount of bleeding was elicited while the punch incision 'plug' was left in situ. The wound was covered with petroleum jelly and a self-adhesive absorbent dressing, which was kept in place for 48 h and then removed to allow for wound cleaning with cooled boiled water. A new dressing was replaced daily until the wound was dry and scabbed (7-10 days). The patient reported minimal pain during recovery and noted remission beginning from Week 2 with clearance of the large plaques by Week 6 after the procedure (Fig. 2a,b). There had been no recurrence of the large plaques at the 6-month follow-up.Verruca vulgaris (common wart) is a benign hyperkeratotic proliferation of the epidermis caused by the

Background Renal transplant recipients (RTRs) are at increased risk of keratinocyte cancer (KC), especially cutaneous squamous cell carcinoma (cSCC). Previous studies identified a genetic variant of the Methylenetetrahydrofolate Reductase ( MTHFR ) gene, C677T, which conferred a risk for diagnosis of cSCC in Irish RTRs. Objective We sought to find further genetic variation in MTHFR and overlap genes that may be associated with a diagnosis of KC in RTRs. Methods Genotyping of a combined RTR population ( n = 821) from two centres, Ireland ( n = 546) and the USA ( n = 275), was performed. This included 290 RTRs with KC and 444 without. Eleven single nucleotide polymorphisms (SNPs) in the MTHFR gene and seven in the overlap gene MTHFR Chloride transport protein 6 ( CLCN6) were evaluated and association explored by time to event analysis (from transplant to first KC) using Cox proportional hazards model. Results Polymorphism at MTHFR CLCN6 (rs9651118) was significantly associated with KC in RTRs (HR 1.50, 95% CI 1.17–1.91, p < 0.00061) and cSCC (HR 1.63, 95% CI 1.14–2.34, p = 0.007). A separate SNP, MTHFR C677T, was also significantly associated with KC in the Irish population (HR 1.31, 95% CI 1.05–1.63, p = 0.016), but not American RTRs. Conclusions We report the association of a SNP in the MTHFR overlap gene, CLCN6 and KC in a combined RTR population. While the exact function of CLCN6 is not known, it is proposed to be involved in folate availability. Future applications could include incorporation in a polygenic risk score for KC in RTRs to help identify those at increased risk beyond traditional risk factor assessment.