Mucocutaneous Manifestations of Recreational Drug Use.

Recreational drug use is increasingly common in the dermatology patient population and is often associated with both general and specific mucocutaneous manifestations. Signs of substance use disorder may include changes to general appearance, skin, and mucosal findings associated with particular routes of drug administration (injection, insufflation, or inhalation) or findings specific to a particular drug. In this review article, we provide an overview of the mucocutaneous manifestations of illicit drug use including cocaine, methamphetamine, heroin, hallucinogens, marijuana, and common adulterants to facilitate the identification and improved care of these patients with the goal being to connect this patient population with appropriate resources for treatment.

Dermatographism with vulvar symptoms.

Dermatographism (DG) is characterized by a localized, inducible, wheal-and-flare response along the distribution of mechanical pressure. We report an illustrative case of DG with vulvar symptoms (DG-VS) and review the literature on this rarely recognized but easily treated etiology of vulvar complaints. A 35-year-old woman presented with a 1-year history of vulvar pruritus unresponsive to antifungal, antibacterial, and steroid treatments.

Diseases of the lips.

Heath care providers should be comfortable with normal as well as pathologic findings in the lips, because the lips are highly visible and may display clinical manifestations of local, as well as systemic inflammatory, allergic, irritant, and neoplastic alterations. Fortunately, the lips are easily accessible. The evaluation should include a careful history and physical examination, including visual inspection, as well as palpation of the lips and an examination of associated cervical, submandibular, and submental nodes.

Lichen sclerosus and lichen planus in women and girls.

Lichen planus and lichen sclerosus are common, chronic inflammatory vulvar dermatoses with significant morbidity. The course may wax and wane but disease often persists for decades. These autoimmune diseases have varied clinical presentations that extend beyond the genitalia.

Cutaneous vulvar streptococcal infection.

Objective: This study aimed to determine the etiology of fine superficial fissures in women with vulvar pain.

Materials And Methods: The charts of women with vulvar complaints seen in the Mucosal Disorders Clinic at Northwestern University between April 2006 and May 2008 were reviewed. Outcome measures included mucocutaneous examination findings and results of microbiological swab cultures in the presence of fine, superficial, vulvar and/or perianal fissures.

Oral manifestations of hematologic and nutritional diseases.

Oral manifestations of hematologic and nutritional deficiencies can affect the mucous membranes, teeth, periodontal tissues, salivary glands, and perioral skin. This article reviews common oral manifestations of hematologic conditions starting with disorders of the white blood cells including cyclic hematopoiesis (cyclic neutropenia), leukemias, lymphomas, plasma cell dyscrasias, and mast cell disorders; this is followed by a discussion of the impact of red blood cell disorders including anemias and less common red blood cell dyscrasias (sickle cell disease, hemochromatosis, and congenital erythropoietic porphyria) as well as thrombocytopenia. Several nutritional deficiencies exhibit oral manifestations.

Treatment of vulvovaginal lichen planus.

Vulvovaginal lichen planus is a chronic condition characterized by complex mucocutaneous findings. Patients may be asymptomatic or may have severe pain and itching. Findings vary from erythema, erosions, and white striae to severe scarring.

Approach to the patient with vulvovaginal complaints.

Although vulvovaginal diseases may seem daunting, dermatologists possess all of the requisite tools and skills necessary to comprehensively assess and accurately diagnose primary cutaneous, systemic, and inflammatory diseases that affect the vulva. A simple but comprehensive dermatologic approach to the patient with a vulvovaginal complaint is presented. We begin with a review of the normal vulvar anatomy and normal variants and proceed to the clinical approach with special emphasis on the history, physical examination, and common diagnostic procedures.

Nutrition and oral mucosal diseases.

Oral manifestations of nutritional deficiencies can affect the mucous membranes, teeth, periodontal tissue, salivary glands, and perioral skin. This contribution reviews how the water-soluble vitamins (B(2), B(3), B(6), B(12), C, and folic acid), fat-soluble vitamins (A, D, and E), and minerals (calcium, fluoride, iron, and zinc) can affect the oral mucosa.

The art and science of oral examination.

Performing an accurate oral examination is an integral part of a complete dermatological evaluation. As dermatologists, we are frequently asked to assess and treat numerous oral pathologies, which include, but are not limited to, normal variants, infections, ulcers, granulomas, lymphomas, as well as primary and metastatic tumors of the mouth and lips. The oral mucosa can be the window through which one can see and make numerous systemic diagnoses.

Herpetic geometric glossitis in an immunocompetent patient with pneumonia.

Herpetic geometric glossitis is an uncommon, clinically distinctive presentation of oral herpes simplex virus infection that affects the tongue. All published reports have been in patients who are immunocompromised. We present an immunocompetent woman with viral pneumonia who developed painful linear fissures on the back of the tongue suggestive of herpetic geometric glossitis.

Clinical spectrum of vulva metastatic Crohn's disease.

Crohn's disease is a chronic granulomatous disorder that may involve any segment of the gastrointestinal tract. Extraintestinal manifestations of Crohn's disease such as erythema nodosum and pyoderma gangrenosum are well recognized and appreciated. However, metastatic Crohn's disease (MCD), defined as the same granulomatous inflammation seen in Crohn's disease but at a skin site distant to the gastrointestinal tract, is less well recognized.

Histological evaluation of acute mucocutaneous graft-versus-host disease in nonmyeloablative hematologic stem cell transplants with an observation predicting an increased risk of progression to chronic graft-versus-host disease.

The incorporation of nonmyeloablative conditioning prior to the transplantation of allogeneic hematopoietic cells has emerged as an alternative to myeloablative chemo- and/or radiotherapy for the treatment of hematologic malignancies. Graft-versus-host disease (GVHD) remains a significant complication of both types of hematopoietic cell transplantation (HCT). The clinical phenomenon of late-onset (>100 days after HCT) acute GVHD recently has been described following nonmyeloablative allogeneic transplantation (NMAT); however, there has been no detailed histologic description of acute GVHD in this setting.

Treatment of glossodynia with olanzapine.

A 73-year-old white male with a 6-month history of glossodynia, unresponsive to clotrimazole troches, cevimeline, triamcinolone dental paste, paroxetine, and lorazepam presented to the dermatology clinic for consultation. Work-up revealed no oral abnormalities and no underlying systemic disorder. He denied symptoms consistent with a psychiatric disorder.

White lesions of the oral cavity.

White lesions are frequently found during the examination of the oral cavity. Although some benign physiologic entities may present as white lesions, systemic conditions, infections, and malignancies may also present as white oral lesions. An appreciation of the many clinical entities that white lesions may represent is necessary if a differential diagnosis of white lesions is to be elucidated.