The Journal of DermatologyVolume 37, Issue 4 p. 378-380 New-onset psoriasis associated with etanercept therapy Lu-An CHEN, Lu-An CHEN Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorLin-Hui SU, Lin-Hui SU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYing-Jui CHANG, Ying-Jui CHANG Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYu-Ling HSU, Yu-Ling HSU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorTsung-Hua TSAI, Tsung-Hua TSAI Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this author Lu-An CHEN, Lu-An CHEN Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorLin-Hui SU, Lin-Hui SU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYing-Jui CHANG, Ying-Jui CHANG Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYu-Ling HSU, Yu-Ling HSU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorTsung-Hua TSAI, Tsung-Hua TSAI Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this author First published: 25 March 2010 https://doi.org/10.1111/j.1346-8138.2010.00789.xCitations: 4 Lin-Hui Su, M.D., M.Sc., No. 21, Sec. 2, Nan-Ya S. Road., Pan-Chiao, Taipei, Taiwan. Email: sulh1129@ms1.hinet.net Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume37, Issue4April 2010Pages 378-380 RelatedInformation

Unilateral nevoid telangiectasia (UNT) is a rare disease characterized by punctuate and stellate telangiectasias that follow dermatomal distribution.1 Its etiology remains elusive; no standard treatment currently exists. We describe a 14-year-old Asian female (skin type IV) with UNT, who underwent treatment with long-pulsed 1064-nm Nd:YAG laser and 595-nm pulsed dye laser for her disease. The patient came to our clinic with linearly arranged, punctate telangiectasias over right side of back, shoulder, and arm (Figure 1). The lesions appeared at the age of 10. The diagnosis of UNT was made based on the clinical manifestations and telangiectasias in superficial dermis (as shown on a histologic exam done previously at another hospital). Angioma serpiginosum is an important differential diagnosis of UNT in this case. Three sessions of treatment with long-pulsed 1064-nm Nd:YAG laser (GentleYAG Laser; Candela Laser, Wayland, MA, USA) were given with parameters (fluence-spot sizepulse width) of 240 J/cm2-3 mm-10 ms (first week), 240 J/ cm2-3 mm-10 ms (second week), and 280 J/cm2-3 mm-10 ms (third week). The interval between each session was 4 weeks. However, there was only slight improvement. Histologic exam performed 2 weeks after the third session revealed marked telangiectasias in papillary dermis (Figure 2). Next, two sessions of pulsed dye laser with 595 nm wavelength (Vbeam Perfecta; Candela Laser) were given with parameters of 13 J/cm2-7 mm-40 ms (fluence-spot sizepulse width) for both sessions. Significant lightening of lesions (> 90%) was observed after the second session (Figure 3). The only adverse reaction was transient purpura that lasted for approximately 2 weeks. There was no hypoor hyper-pigmentation after treatment. There are two forms of UNT, the rarer congenital form and the more common acquired form.2 Telangiectasia develops during puberty in most of the acquired cases, as in our patient. Several reports point out the systemic association of acquired UNT, such as hyperestrogenemia and chronic liver disease.2 In out patient, there was no evidence of high serum level of estrogen or hepatic disease. Both long-pulsed 1064-nm Nd:YAG laser and pulsed dye laser have been shown to be effective in treating vascular lesions.3,4 Major et al3 reported good response with the former for facial and leg telangiectasias. However, it does not seem to be a good treatment modality for UNT for the current case. One possible explanation is that while the 1064-nm Nd:YAG laser beam tends to penetrate to deeper dermis, due to its long wavelength and lesser absorption Figure 1 Clinical picture before treatment.

An otherwise healthy 61-year-old female presented with a skin tumor on the left flank, which had been present since her early adulthood. The tumor gradually enlarged during the first 2–3 years and then stabilized in size. There were no symptoms from the tumor. On examination, a red to violaceous, shiny, polypoid, fusiform nodule with firm consis tency, measuring approximately 3.0 cm × 2.0 cm, was noted on her left flank (Figure 1). There were also many skin tumors on her face and scalp, most of which were dome-shaped, smooth surfaced, violaceous, firm nodules measuring several millimeters in diameter. These tumors were 1-cm dermal nodules that caused pain; others were rounded, skin-colored, firm papules with a size of approximately 5 mm in diameter around her nose. An excisional biopsy specimen was obtained from the tumor at the flank. Histopathologic examination revealed a tumor occupying the reticular dermis, which was composed of aggregations of neoplastic cells arranged in a jigsaw puzzle pattern. The aggregations consisted of neoplastic cells with two different appearances: (1) peripheral cells aligned in a palisade with small, dark staining columnar nuclei surrounded by a scant cytoplasm, and (2) cells with nuclei that were larger and paler, and that had a more abundant pale cytoplasm. Each aggregation was surrounded by a rim of homogenous eosinophilic basement membrane-like material. Globules of the same material were also present within the aggregations themselves (Figure 2). The patient then underwent several sessions of surgical removal for other tumors on the face and scalp, and pathology exams showed cylindroma, spiradenoma, trichoepithelioma, or combinations of them (Figure 3A: cylindroma + trichoepithelioma; Figure 3B: cylindroma + spiradenoma). She reported that two of her younger brothers and sisters also had similar skin tumors, but they were not as numerous as hers.