Lichen myxedematosus (LM) is an idiopathic cutaneous mucinosis, commonly described as localized scleromyxedema. In contrast to scleromyxedema, there is typically no systemic involvement. Treatment options are limited and spontaneous resolution has been reported.We present the case of a 66-year-old Hispanic male referred by his primary care physician for evaluation of asymptomatic dark spots on his trunk and extremities present for about one-year. Physical exam revealed smooth, brown hyperpigmented papules coalescing into plaques on the trunk. Multiple well-demarcated oval dark brown plaques measuring 3 cm in size were located on the upper back, periumbilical area, bilateral lower extremities, and buttocks. A diagnosis of lichen myxedematosus was made based on histologic features observed in the dermis.There are 5 subtypes of LM: a discrete papular form, acral persistent papular mucinosis, self-healing papular mucinosis, papular mucinosis of infancy, and a pure nodular form. Occasional patients with LM have atypical features or features intermediate between scleromyxedema and localized LM. We present a case of atypical LM with mixed features of the different subtypes. Herein we will review the varied clinical presentations of LM and highlight the distinguishing features of scleromyxedema.

A 60-year-old man presented to the emergency department with slowly progressing edema of the lower legs of 3 months' duration. In the week prior to presentation to the emergency department, he noticed a sudden eruption of vesicles and bullae on the right leg that drained clear fluid and healed with brown crust. The lesions were associated with mild burning, pruritus, and pain. He denied fever, chills, recent travel, or injury. His medical history was notable for poorly controlled diabetes mellitus, congestive heart failure, hypertension, chronic kidney disease, hyperlipidemia, and chronic anemia. Physical examination revealed multiple scattered erythematous vesicles and bullae on the right leg on a background of hyperpigmentation. Bilateral 2+ pitting edema of the legs also was present. A punch biopsy of a lesion was performed. WHAT'S YOUR DIAGNOSIS? a. bacillary angiomatosis b. cutaneous B-cell lymphoma c. elephantiasis nostras verrucosa d. filariasis e. Kaposi sarcoma Dr.

Background: Submental fullness has been a concern for patients in dermatology for years. Liposuction and cosmetic surgery were considered the mainstay for elimination of unwanted submental fat. However, these procedures are invasive and associated with major complications like prolonged recovery times, and the risk of contour irregularities. In 2015, Kybella (deoxycholic acid) was approved as a first-in-class injectable agent for the treatment of submental fullness. Although, it is non-invasive and has less complications than plastic surgery, it is still associated with adverse effects such as pain, swelling/edema, and bruising. The most concerning adverse effect for patients is the prolonged inflammation that may occur for up to 2 weeks post-injection. Objective: This is a comparison trial of deoxycholic acid injections with or without triamcinolone acetate for the reduction of submental fat in one patient. The study will also assess the effect of triamcinolone acetate on post-injection inflammation associated with deoxycholic acid injection in the treatment of submental fullness. Method: A 35-year-old female presented for evaluation of submental fullness and opted for treatment with Kybella. Her right submental treatment area was injected with 2ml of deoxycholic acid 10mg/ml plus 0.2ml triamcinolone acetate. The left submental treatment area was treated with 2ml of deoxycholic acid 10mg/ ml alone. The patient was observed over a duration of 3 months to evaluate inflammation and treatment response between the two treatment zones. Results: This split-neck study resulted in decreased postinjection swelling. However, at 3-month follow-up, there was no clinical improvement to the submental fullness bilaterally. Limitations: Small sample size, lack of objective measures, possible diffusion between treatment zones, and prior deoxycholic acid treatment. Conclusion: Triamcinolone can decrease post-injection swelling if given as an adjunct to Kybella treatment.

Subcorneal pustular dermatosis (SPD) is a rare neutrophilic dermatosis. SPD most commonly presents as a serpiginous pattern of pustules on the trunk or intertriginous areas of middle-aged females. It tends to have a chronic disease course and patients may experience relapses. Dapsone currently remains the treatment of choice for SPD. However, in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency, alternative therapies are required. We report a case of subcorneal pustular dermatosis in a G6PD deficient patient successfully treated with acitretin.

Linear porokeratosis is a rare variant of porokeratosis that most often presents in newborns and children; development of this porokeratosis variant in adulthood is far less common. We report the case of a 25-year-old female who presented with a progressive eruption on the proximal upper extremity of 6-year duration, which was ultimately diagnosed as adult-onset linear porokeratosis and safely treated with oral isotretinoin. We propose that a sporadic mutation resulting in mosaicism after birth may explain the development of linear porokeratosis in adulthood, although the exact trigger of such a somatic mutation is not known. This case also describes a unique clinical presentation, with linear porokeratosis lesions originating on the proximal extremity rather than on the more common distal extremity. This demonstrates a distinctive clinical presentation not seen in the pediatric forms of disease.