Tattooing has become quite popular in Western countries. With the increasing prevalence, there is also an increased risk of adverse effects. We describe a 17-year-old female patient with a black and red-colored tattoo, who developed immediately after red tattooing general malaise with fever, nausea, and vomiting. A bullous reaction was temporarily seen within the red part of her tattoo. The reaction later shifted to a subacute dermatitis with bacterial superinfection. Two months later, she felt ill again. She developed painful tender nodules on the anterior aspect of both lower legs identified as erythema nodosum without sarcoidosis. Is this is a unique case of adverse reaction to tattoo pigments with a type I and a type IV reaction, or is this a coincidence? The treatment was initiated with systemic and topical corticosteroids and topical antibiotics combined with compression bandages for the legs. After 3 weeks of treatment, the erythema nodosum completely resolved and did not reappear during a 1-year follow-up. The treatment of the local reactions, however, was unsatisfactory without complete response. There is an indispensable need for regulation of tattoo pigments and tattooing to improve consumer safety.

Impaired wound healing is a feature of Werner's syndrome. Treatment of one such patient with painful chronic leg ulcers included topical application of PDGF-BB. Granulation increased slightly, enabling full-thickness skin grafting to take place.

Background: The plexiform schwannoma, a peripheral nerve sheath tumor, is a very rare entity. But dermatologists should be familiar with since they may be the first who make diagnosis possible by taking a deep biopsy.Main observation: A 24-year-old male presented with multiple asymptomatic subcutaneous nodules of the palmar side of his right hand. Histologic investigations revealed a plexiform schwannoma with numerous Antoni-A areas. There was no evidence of neurofibromatosis type 1 or 2.Conclusions: Plexiform schwannoma of the hand is a rare nerve sheath tumor. In individual (symptomatic) cases hand surgery is an option that needs a critical indication. In every case histologic investigations are mandatory to confirm the diagnosis and not to overlook the malignant variant of this disease. Imaging diagnostics like 3-dimensional ultrasound and MRI do not allow a sufficient discrimination of schwannomas form other nerve sheath tumors. 4 The only way to confirm the diagnosis is by histopathology. Isolated plexiform schwannoma of the handWe present an unusual case of a large unilateral plexiform schwannoma of the hand in a young male patient. Case ReportA 24-year-old male patient experienced asymptomatic subcutaneous nodules of his right hand since 2000. There was a slow progress in size and number.On examination we found soft, yellowish subcutaneous nodules of variable size of the volar site of the fingers and the palm of his right hand ( Fig. 1A and B).Histology of two biopsies showed spindle-shaped cell proliferations in the dermis and upper subcutaneous tissue with a capsule formation. Cells were characterized by neurogenic differentiation like Antoni-A-areas (Fig. 2).Clinical examination and consiliae did not reveal any sign of neurofibromatosis type 1 or type 2.After confirmation of the diagnosis of a plexiform schwannoma of the right hand the patient was referred to the hand surgeon. He advised not to intervene by surgery because of the risk of paresis and the completely asypto- DOI: 10.3315/jdcr.2008DOI: 10.3315/jdcr. .1011 28 matic course without functional handicap in this patient.Follow-up has been recommended by us. DiscussionSchwannomas are benign tumors of the nerve sheath occuring either peripheral, visceral, intraspinal or intracranial. Peripheral schwannomas represent as asymptomatic and painless papules or nodules. Their colour can be yellowish to light brown. Cysts and haemorrhages may occur. Schwannomas of the hands are rare. Patient's mean age at diagnosis is 38.4 years. 5 Histology is characterized by a biphasic pattern with tightly packed spindle-shaped cells (Antoni A area) and with loose, less cellular patterns with myxoid areas with thickened "hyalinized" vessel walls (Antoni B) and lipidcontaining cells. 3 Mitoses are usually absent but pleomorphism of nuclei is common. Immunohistochemistry is helpful in differential diagnosis ( Table 1). The tumor cells express S-100 protein. 1,2 Complicating in differential diagnosis is the observation of collision tumors like schwannoma and peri...

Chronic ergotism is a rare cause of limb ischemia. In this case report, the authors present a 62-year-old woman with history of long-term use of ergotamine alkaloids for the treatment of menstrual pain, who developed a severe painful disease initially misdiagnosed as systemic sclerosis (scleroderma) for 3 decades. She presented with a combination of acral gangrene, foot ulcer, renal obstruction, mild pulmonary fibrosis, and reduced esophageal motility. Right-sided renal obstruction was evident. The condition was extremely painful and had led to muscular contractions and immobility, drug abuse, and anemia. After establishing the diagnosis of chronic gangrenous ergotism, changing drug therapy, mobilization, and treatment of chronic wounds, she showed a remarkable recovery. Eventually the foot ulcer was closed successfully using a mesh graft transplantation, and the patient was able to walk alone. Chronic ergotism is rare but has to be taken into account when presented with painful chronic digital and foot ulcers.

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