[Melanocytoma, an intermediate entity between nevus and melanoma: implications of the WHO classification of melanocytic skin tumours].

The WHO classification of melanocytic skin tumours published in 2018 describes a new classification with nine different pathways based on molecular driver mutations, localization, clinical context and solar damage. The dichotomous concept of benign (nevus) versus malignant (melanoma) is replaced by a gradual concept starting with a benign nevus with progression into low to high grade intermediate melanocytic lesions, called melanocytoma, and ending at melanoma. The current European recommendation is (re-)excision with 2-5mm margin of low grade melanocytoma and with 5-10mm margin of high grade melanocytoma.

[A man with discoloration of his lower legs].

A 73-year-old man consulted his general practitioner with a non-itchy rash on his lower legs, which developed a few hours after golfing. We saw a blotchy, red, non-blanchable discoloration with some blisters. Microscopic examination showed dermal inflammatory infiltrate with minor vessel wall damage and extravasation of erythrocytes.

[A woman with discoloration of her fingernail].

A 34-year-old woman visited the general practitioner with a longitudinal brown pigment stripe on her fingernail (melanonychia striata). Histopathological research revealed melanin pigment increase based on lentigo (benign).

[A girl with brownish grey macules on and around the lips].

A 14-year-old girl presented with brownish grey macules on and around the lips. Genetic testing revealed a mutation in the LKB1 tumor suppressor gene. The diagnosis made was Peutz-Jeghers syndrome, a rare inherited disease that is characterized by gastrointestinal polyps and an increased risk of cancer.

[Fever with a rash caused by chronic meningococcemia].

Background: Fever with a rash is a common clinical presentation, which can be caused by various medical conditions.

Case Description: A 14-year old boy presented at the outpatient clinic with a two-week history of fever, myalgia and purpuric skin lesions. Blood cultures showed an infection with Neisseria meningitidis.

Effectiveness and safety of fumaric acid esters in children with psoriasis: a retrospective analysis of 14 patients from The Netherlands.

Background: Fumaric acid esters (FAE) are used as an effective and safe oral treatment for plaque psoriasis in adult patients, but little is known about their efficacy and safety in children with psoriasis.

Objectives: To assess the effectiveness and safety of FAE in the treatment of paediatric psoriasis.

Methods: This is a retrospective analysis of 14 paediatric patients with psoriasis (age <18 years) treated with FAE between 2004 and 2012 at several Dutch university and regional clinics.

Predictors of the post-thrombotic syndrome with non-invasive venous examinations in patients 6 weeks after a first episode of deep vein thrombosis.

Background: Post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) affecting a large number of patients. Because of its potential debilitating effects, identification of patients at high risk for the development of this syndrome is relevant, and only a few predictors are known.

Objectives: To assess the incidence and potential predictors of PTS.

Bullous lesions in Henoch Schönlein Purpura as indication to start systemic prednisone.

Unlabelled: Henoch Schönlein Purpura (HSP) is usually mild and self-limiting, but it may be accompanied by severe complications such as bullous lesions. We describe the use of systemic prednisone in two patients with bullous lesions in HSP. The first patient presented with progressive bullous lesions distributed on the limbs that evolved into painful ulcers and necrosis.

Narrowband ultraviolet B and medium-dose ultraviolet A1 are equally effective in the treatment of moderate to severe atopic dermatitis.

Background: Phototherapy may be effective in atopic dermatitis (AD). Medium-dose (MD) ultraviolet (UV) A1 was introduced for the treatment of AD. Few immunohistochemical data are available pertaining to phototherapy in AD.

Imatinib-induced pseudoporphyria.

Imatinib, a synthetic tyrosine kinase inhibitor, is used as first-line therapy for chronic myeloid leukaemia. Imatinib treatment is associated with a variety of adverse effects, most of which are mild to moderate and generally abate after the first months of treatment. Cutaneous adverse reactions are often encountered in patients using imatinib.

Two cases of spontaneous stellate scars.

Scar formation is a physiologic reaction to dermal injury. We describe a 11-year-old girl and her 15-year-old cousin, who both presented with stellate scarlike lesions primarily located on the hands. Histopathologic examination confirmed scar tissue formation.

[Blue toe syndrome; a sign of end-arterial occlusion].

Three patients, two women aged 66 and 43 years, respectively, and a man aged 76 years, presented with sudden, painful, blue areas in the toes with intact peripheral pulsations. One patient had a myeloproliferative syndrome due to essential thrombocytosis, the second patient had thromboangiitis obliterans, and the third patient had a cholesterol embolism, possibly due to the use of oral anticoagulants. After treatment, one patient recovered fully and the other two improved significantly.

Blue rubber bleb nevus syndrome co-existing with celiac disease.

Background: Anaemia caused by iron deficiency is one of the most common disorders in the world. We describe a patient with iron deficiency anaemia in whom absorption was limited due to celiac disease, superimposed to chronic blood loss due to the blue rubber bleb nevus syndrome, a rare syndrome characterised by multiple cutaneous venous malformations in association with visceral lesions.

Case Report: A 54-year-old patient with severe iron deficiency anaemia showed marked rubbery cutaneous lesions on the body surface, extremities, under and on the left side of the tongue as well as in the stomach and duodenum.

The prevalence and incidence of pressure ulcers in hospitalised patients in the Netherlands: a prospective inception cohort study.

Background: Pressure ulcers frequently occur in hospitalised patients. The prevalence of pressure ulcers grade 2 or worse varies from 3% to 12% in hospitalised patients. Incidence figures are not frequently reported.

Prediction of pressure ulcer development in hospitalized patients: a tool for risk assessment.

Objectives: To identify independent predictors for development of pressure ulcers in hospitalized patients and to develop a simple prediction rule for pressure ulcer development.

Design: The Prevention and Pressure Ulcer Risk Score Evaluation (prePURSE) study is a prospective cohort study in which patients are followed up once a week until pressure ulcer occurrence, discharge from hospital, or length of stay over 12 weeks. Data were collected between January 1999 and June 2000.

[Women with pelvic complaints and atypical varicose veins, varicose veins of the vulva and insufficiency of the pelvic veins; treatment with embolisation].

In three women, aged 34, 52 and 30 years, respectively, who suffered from chronic pelvic symptoms such as a heavy feeling and abdominal pain, atypical varicose veins were observed on the medial side of the upper thighs together with varicose veins of the vulva; these are indicators of insufficiency of the pelvic veins. The symptoms were reduced following embolisation of the insufficient pelvic veins. These symptoms are also known as the pelvic congestive syndrome.

Predicting pressure ulcers: cases missed using a new clinical prediction rule.

Aim: The aim of this paper is to report a study describing patients with pressure ulcers that were incorrectly classified as 'not at risk' by the prediction rule and comparing them with patients who were correctly classified as 'not at risk'.

Background: Patients admitted to hospital are at risk of developing pressure ulcers. Although the majority of pressure ulcers can be predicted using a recently developed prediction rule, up to 30% of patients with pressure ulcers may still be misclassified.

Potential effect of patient-assisted teledermatology on outpatient referral rates.

We carried out a pilot study on the feasibility and accuracy of store-and-forward teledermatology based on patient-provided images and history as a triage tool for outpatient consultation. Patients referred by their general practitioner provided a history and images via the Internet. The information was reviewed by one of 12 teledermatologists and the patient then visited a different dermatologist in person within two days.

Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers.

Objective: To evaluate whether risk assessment scales can be used to identify patients who are likely to get pressure ulcers.

Design: Prospective cohort study.

Setting: Two large hospitals in the Netherlands.

Extensive capillary malformation with a compensated coagulopathy.

A 79-year-old male patient had an extensive vascular malformation, a thrombocytopenia and a low survival half-time of the thrombocytes without a bleeding problem. Recognition of this compensated coagulopathy is important, as it may become exacerbated into a bleeding disorder during periods of stress.

Treatment of erythropoietic protoporphyria with hydroxyethylrutosides.

Background: Assuming that flavonoids have anti-oxidative properties and may protect against abnormal skin reactions in erythropoietic protoporphyria (EPP), we investigated whether systemic treatment with hydroxyethylrutosides (2.7 g/day) could decrease skin sensitivity to blue light in a 37-year-old female patient who suffered from EPP.

Design And Results: Before treatment, skin exposure during 5 min to a xenon high-pressure gas discharge lamp with filter was sufficient to produce intense erythema, irritation and later swelling.

Venous hypertension of the hand caused by hemodialysis shunt: immunofluorescence studies of pericapillary cuffs.

Background: Venous hypertension of the hand is an unusual complication of an arteriovenous shunt in patients receiving dialysis.

Objective: We investigated whether in venous hypertension of the hand pericapillary cuffs are present and whether they consist of fibrin and other components.

Methods: Biopsy specimens were taken from three patients with a side-to-side shunt and venous hypertension of the hand, from three patients with an end-to-side shunt without venous hypertension, and from three control subjects.

Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study.

Background: Promising results have been reported from treatment with oral retinoids in patients with severe lichen sclerosus et atrophicus (LSA) of the vulva.

Objective: The aim of our study was to determine the efficacy of acitretin (20 to 30 mg/day) for 16 weeks in LSA.

Methods: Seventy-eight patients were enrolled into a multicenter, randomized, placebo-controlled, double-blind trial.