Acute localized exanthematous pustulosis (ALEP) is typically a benign drug reaction that occurs shortly after drug intake. We report a five-year-old male who developed a localized, zosteriform pustular rash on his back 10 days after treatment with oseltamivir and ceftriaxone for an upper respiratory tract infection. The lesions, which appeared three days prior to presentation, were mildly itchy and resolved completely without scarring within two days of treatment with topical betamethasone valerate and fusidic acid. No bacterial growth was detected in the pustular culture. This case highlights the rare occurrence of ALEP in a pediatric patient and suggests variations from the EuroSCAR diagnostic criteria, which usually indicate a 72-hour onset post-drug intake, noting instead a 7-14 day onset in atypical cases.To best of our knowledge, This is the first report of ALEP presenting with a zosteriform distribution.

Eccrine porocarcinoma (EPC) is a rare skin adnexal malignancy with a high potential for metastases. The most common metastatic sites are the lymph nodes and lungs. CCutaneous metastasis is extremely rare, particularly the zosteriform variant, with fewer than 5 cases reported in the literature. Here, we report a unique case of EPC in a 71-year-old male, clinically presenting with multiple clusters of ulcerated nodules distributing as a zosteriform pattern throughout his upper left limb, along with draining lymphatic metastases and lymphedema.

Lichen planus pigmentosus (LPP) is a rare chronic variant of lichen planus. LPP distribution tends to be symmetrical and is frequently seen on the face, neck, and trunk. Atypical clinical patterns of LPP, including segmental, zosteriform, and linear, were reported in the literature. Herein, we report a rare presentation of LPP in a 16- year-old female with a unilateral linear pattern along the Blascko lines.

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A case of phakomatosis pigmentovascularis (PPV) type III a with a zosteriform distribution of nevus spilus as the main manifestation was reported. A 41-year-old man was born with a zosteriform distribution of pigmented rash on the left half-body, namely upper limb, shoulder and back. Physical examination revealed light brown pigments in a giant zosteriform distribution on the extensor side of the left upper limb and the left shoulder and back, with scattered brown spots and patches of variant sizes on the surface, which are consistent with the appearance of nevus spilus (NS). A relatively small area of dark red patch occurred on the left anterior shoulder, which showed telangiectasia and fading after pressing. It was consistent with the performance of a port-wine stain (PWS). Dermoscopy showed a clearer appearance and localized fusion of blood vessels and pigmented patch. He has no systemic involvement. The patient was diagnosed with phakomatosis pigmentovascularis type Ⅲa. NS and PWS can be treated with lasers if required.

Cutaneous metastasis is a rare occurrence and often is confused with infectious etiology most commonly herpes zoster rash. We present a case 49 year old male with history of metastatic colon cancer with persistent dermatomal vesicular rash that thought to be due to herpes zoster. A skin biopsy eventually revealed malignant cells.

Cutaneous metastasis in a zosteriform pattern is a very rare entity being reported only in 63 patients worldwide. Cutaneous metastases usually presents late in the course of the disease or sometimes after the treatment of the primary when it indicates recurrence of a treated malignancy. We report a case of zosteriform cutaneous metastases masquerading as lymphangioma without prior presentation of the primary malignancy.

BACKGROUND: Impetigo can result from Staphylococcus aureus (S. aureus). Wolf\'s isotopic response is the occurrence of a new cutaneous disorder at the site of a previously healed disease. A cutaneous immunocompromised district is an area of skin that is more vulnerable than the rest of the individual\'s body.
OBJECTIVE: To describe a man with impetigo localized to a unilateral dermatome and review the clinical features of other patients with zosteriform Staphylococcus aureus cutaneous infection.
METHODS: PubMed was used to search the following terms, separately and in combination: cutaneous, dermatome, dermatomal, district, herpes, immunocompromised, impetigo, infection, isotopic, response, skin, staphylococcal, Staphylococcus aureus, Wolf, zoster, zosteriform. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated.
RESULTS: Crusted, eroded and intact, erythematous papules and nodules acutely presented localized to the mandibular branch of the left trigeminal nerve on the face of a 66-year-old man; he did not recall a prior episode of varicella-zoster virus infection in that area. A bacterial culture isolated methicillin-susceptible S. aureus. Viral cultures and direct fluorescent absorption studies were negative for herpes simplex and herpes zoster virus. All of the lesions resolved after oral treatment with cefdinir. Impetigo and/or furunculosis in a zosteriform distribution have also been described in 3 additional patients. The bacterial culture showed either methicillin-susceptible or methicillin-resistant S. aureus; the skin infection resolved after treatment with oral antibiotics; however one man experienced 2 recurrences in the same area.
CONCLUSIONS: Zosteriform cutaneous staphylococcal impetigo may be an example of Wolf\'s isotopic response in a cutaneous immunocompromised district.

Cutaneous leiomyomas are benign tumors derived from the smooth muscles of the skin. They are firm, skin-colored to brownish, frequently painful papules and nodules presenting either as a solitary tumor or multiple clustered lesions. Uncommon patterns of multiple leiomyoma cutis include linear, zosteriform, or dermatomal-like arrangement of lesions. We saw a 32-year-old man who presented with clusters of skin colored to reddish brown, occasionally painful papules and nodules distributed segmentally over C6 to T8 dermatomes on left side and T11 to L1 dermatomes on right side. Histopathology confirmed the diagnosis of cutaneous leiomyoma. The case is reported here for the occurrence of this benign cutaneous neoplasm in an extremely rare bilateral multisegmental distribution.

Cutaneous metastases of internal malignancies occur infrequently and the zosteriform spread of the skin lesions represents a rare entity. We report here a case of cutaneous metastases from a colon carcinoma clinically mimicked Herpes varicella-zoster. The literature is also reviewed.