Cutaneous findings are not uncommonly a concomitant finding in patients afflicted with gastrointestinal (GI) diseases. The dermatologic manifestations may precede clinically evident GI disease. Part I of this 2-part CME review focuses on dermatologic findings as they relate to hereditary and nonhereditary polyposis disorders and paraneoplastic disorders. A number of hereditary GI disorders have an increased risk of colorectal carcinomas. These disorders include familial adenomatous polyposis, Peutz–Jeghers syndrome, and juvenile polyposis syndrome. Each disease has its own cutaneous signature that aids dermatologists in the early diagnosis and detection of hereditary GI malignancy. These disease processes are associated with particular gene mutations that can be used in screening and to guide additional genetic counseling. In addition, there is a group of hamartomatous syndromes, some of which are associated with phosphatase and tensin homolog (PTEN) gene mutations, which present with concurrent skin findings. These include Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, and Cronkhite–Canada syndrome. Finally, paraneoplastic disorders are another subcategory of GI diseases associated with cutaneous manifestations, including malignant acanthosis nigricans, Leser–Trelat sign, tylosis, Plummer–Vinson syndrome, necrolytic migratory erythema, perianal extramammary Paget disease, carcinoid syndrome, paraneoplastic dermatomyositis, and paraneoplastic pemphigus. Each of these disease processes have been shown to be associated with an increased risk of GI malignancy. This underscores the important role of dermatologists in the diagnosis, detection, monitoring, and treatment of these disorders while consulting and interacting with their GI colleagues.

https://www.jaad.org/article/S0190-9622(12)01171-1/pdf

Cutaneous manifestations of gastrointestinal disease

Androgenetic alopecia (AGA), or pattern hair loss, is a common disorder in Asian men and women, with a reported incidence of up to 73% among general population. There are several descriptions regarding the characteristics of AGA in patients of European descent. Asian patients with AGA have different types of hair loss and family histories from Europeans, which may affect treatment response. Therefore, in this review, prevalence, hair loss patterns, familial factors, androgen receptor gene polymorphisms of Asian AGA patients, and management based on algorithmic guidelines for AGA are discussed. This review may be useful for dermatologists in clinical practice for diagnosing and designing management approaches for Asian patients with AGA.

/pdf/characteristics-of-androgenetic-alopecia-in-asian-1o56tig5p0.pdf

Characteristics of androgenetic alopecia in asian.

Argyria is a rare cutaneous discoloration caused by the intake of silver or various compounds containing silver. We report a case of argyria in a 73-year-old male following ingestion of colloidal silver as an alternative medicine over 5 years. He had a diffuse, slate gray discoloration of his face and hands. A biopsy specimen from the face revealed brown-black extracellular granules in the upper dermis and between collagen bundles. We also found silver particles in the mucous of the colon. The ingestion of colloidal silver appears to be increasing among patients using alternative health practices. We report this case to bring people's attention to the problems associated with the ingestion of colloidal silver.

/pdf/a-case-of-argyria-following-colloidal-silver-ingestion-3fu1y535ni.pdf

A Case of Argyria Following Colloidal Silver Ingestion

Lentigines, nevi, and melanomas

Idiosyncratic generalized skin disorders complicated by hepatitis, which resemble severe drug hypersensitivities, occur sporadically in workers exposed to trichloroethylene (TCE) in China. However, it has been a matter of controversy whether the solvent itself, not its impurities or stabilizers, can cause hypersensitivity reactions or not. This study aimed to characterize the exposure of hospitalized patients and their healthy colleagues. TCE metabolites were measured in urine of 19 hospitalized patients suffering from the disorders. To assess the exposure of patients' healthy colleagues, on-site surveys were conducted in 6 factories where the disorders occurred and in 2 control factories without such occurrences despite TCE use. Urinalysis of the patients detected trichloroacetic acid (TCA) in all of them. Its average concentration in the end-of-shift urine was estimated to be 206 mg/l. On-site survey of healthy exposed workers revealed that the maximum urinary TCA concentrations and the maximum time-weighted average concentrations of personal TCE exposure were 318-1,617 mg/l and 164-2,330 mg/m3, respectively. There was no common impurity in TCE used in the factories. These results suggested that TCE itself caused the skin hypersensitivity disorders, and that the disorders occurred in factories where TCE metabolites could be extensively accumulated, possibly due to long working hours. Since the lowest TCA concentration in the end-of-shift urine of the patients was estimated to be 72-80 mg/l, it is recommended to control TCE exposure to keep the urinary TCA concentration below 50 mg/l to reduce the disease risk.

http://joh.sanei.or.jp/pdf/E50/E50_4_04.pdf

Trichloroethylene causes generalized hypersensitivity skin disorders complicated by hepatitis.

Neurofibromatosis is a systemic hereditary disorder with varied manifestations in bone, soft tissue, the nervous system and skin. Cutaneous manifestations of neurofibromatosis are characterized by cafe-au-lait macules, multiple neurofibromas, Lisch nodules and intertriginous freckling. Some benign or malignant tumors such as juvenile xanthogranuloma, pheochromocytoma, and malignant melanoma can accompany neurofibromatosis. But, in the English literature, no case of eccrine spiradenoma associated with neurofibromatosis has been reported. Eccrine spiradenoma is a benign uncommon neoplasm of skin adnexa. It presents as a painful, slow-growing and solitary nodule on the head or upper trunk. Here, we report a rare case of eccrine spiradenoma in a patient with neurofibromatosis.

/pdf/a-case-of-eccrine-spiradenoma-in-a-patient-with-jhmbcksj5h.pdf

A Case of Eccrine Spiradenoma in a Patient with Neurofibromatosis

Trichloroethylene (TCE) is a chlorinated hydrocarbon that is widely used as a degreasing agent in industry. Systemic absorption of this chemical can result in neurological, hepatic and cutaneous toxicity. Several cutaneous manifestations of TCE-exposed patients have been reported, including Stevens Johnson syndrome, subcorneal pustular eruption and generalized pustular eruption. We report here on an unusual case of TCE hypersensitivity syndrome in a 38 year old man after occupational exposure to TCE. (Korean J Dermatol 2008;46(11):1561∼1563)

A Case of Trichloroethylene Hypersensitivity Syndrome

Renal cell carcinoma (RCC) is well known for its frequent metastasis and particularly to the lungs, liver, bones and brain, but metastasis to the skin is rare. We report here on a case of metastatic RCC in a 73-year-old man who presented with a 1.5 cm sized, moist, beefy-red and exophytic nodule on the scalp. The lesion had grown rapidly for 2 months and it clinically mimicked granuloma pyogenicum. A skin biopsy revealed a solid mass composed of clear cells with clear cytoplasm and oval hyperchromatic nuclei, and they were arranged in an alveolar pattern. As skin metastasis from renal cell carcinoma signals widespread systemic metastasis and a poor prognosis, clinicians should conduct a careful inspection of the skin of a patient with RCC and they should also have a high index of suspicion for finding a primary internal organ malignancy in the RCC patients who present with a skin lesion.

/pdf/a-case-of-metastatic-renal-cell-carcinoma-mimicking-2sf8r1net5.pdf

A Case of Metastatic Renal Cell Carcinoma Mimicking Granuloma Pyogenicum.

Argyria is a rare skin discoloration caused by silver deposition We report a case of generalized argyria caused by ingestion of silver solution in a 63-year-old man He had diffuse slate gray discoloration of sun-exposed skin, prominent face, neck and V of the chest The histopathologic findings showed brown black granules deposited in the basement membrane zone of eccrine glands, pilosebaceous units, arteriolar wall and dermal elastic fibers (Korean J Dermatol 2007;45(10):1087∼1089)

A Case of Generalized Argyria Caused by Ingestion of Silver Solution

Background: The androgen receptor (AR) is a conserved member of the nuclear receptor superfamily Differences in the AR gene sequence are characterized mostly by a highly polymorphic trinucleotide repeat (CAG) encoding a polyglutamine stretch in the N-terminal domain The transactivational activity of the AR might be inversely associated with the numbers of this CAG repeat chain, and the smaller numbers of CAG repeats are believed to be associated with androgenetic alopecia? (AGA) Objective: The purpose of this study was to investigate a possible etiologic association between Korean AGA and CAG repeat numbers in the AR gene Methods: We compared CAG repeat numbers within the AR gene of 64 male Korean AGA patients with those of 40 normal male controls Results: There was no significant difference in the number of CAG repeats between the Korean AGA patients and controls There were no robust or significant correlations between (i) CAG repeat numbers and (ii) age of onset or severity of AGA in Korean AGA patients Conclusion: This study suggests that AR receptor CAG polymorphisms in the Korean male population might not have a major role in susceptibility to AGA expression

A Study on CAG Repeat Polymorphisms of the Androgen Receptor in Korean Androgenetic Alopecia - Preliminary Report -

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