Fruit and food eponyms in dermatology.

Dermatology world is brimming with myriad of interesting clinical conditions, signs and syndromes. It is infinite, which has systemic clinical connotations too. Complicated pronunciations of diagnosis have always placed residents in an intricate state. Each one is trying his best to make this cumbersome subject comparatively more acceptable and convenient. The present paper is an attempt to further simplify the subject by correlating difficult conditions with commonly used and seen things such as fruit and food. A total of 45 dermatological conditions were found to be based on fruit and food eponyms. For example, strawberries can remind us of strawberry gums of Wegener's granulomatosis and strawberry nevus.

What was known?

Various dermatological conditions, signs and syndromes are known, based on commonly used things such as fruits and foods. Information is available on various misnomers, pseudo, triads and name signs in dermatology. Till date, no compiled data is available describing various dermatology conditions under the heading of fruit and food eponyms in dermatology.[6]

Introduction

Dermatologists are blessed with the special advantage of visualizing the lesions with naked eyes. Thank god! Skin being visible to the naked eye and approachable to elicit easily reproducible bed side tests, which can help to make a diagnosis more comfortably and effectively.

However, it is not as simple as it appears to be. The ever increasing number of fascinating conditions juxtaposed against the limited space of our brain persistently prompts us to adopt ways to make things easy to remember. A system of correlating things helps to remember difficult conditions that eventually become part of our memory box. To compile these eponyms a thorough search of standard dermatology textbooks such as Fitzpatrick's Dermatology in General Medicine 7th ed., Rook's Textbook of Dermatology 8th ed., IADVL Textbook of Dermatology 3rd ed., Lever's Histopathology 10th ed., Textbook of Pediatric Dermatology, 3rd ed., Sexually Transmitted Diseases 4th ed. and electronic search data basis such as MD consult, PubMed, etc., was performed.

We here list the complied data of conditions based on fruit and food eponyms in dermatology. However, no explanations for the pathophysiology and other details have been discussed as these are beyond the scope of this manuscript.

Apple jelly nodules: Granulomas of lupus vulgaris on diascopy appear as yellow brown macules.[1] May be appreciated in granulomatous lesion of leishmaniasis and sarcoidosis.

Bean bag cells: Cytophagic histiocytes of cytophagic histiocytic panniculitis packed with white blood cells, red cells, nuclear fragments and platelets, thus giving a characteristic “bean-bag” appearance on histopathological examination.[2]

Bean’ syndrome: Also known as blue rubber-bleb nevus syndrome. Blue/purple, soft, dome shaped, nipple like “rubber blebs,” compressible nodules with a rubbery feel are seen.[3]

Black berry stomatitis: Paracoccidioidomycosis, which affects, especially the mucous membranes of the mouth and is accompanied by marked adenopathy and granulomatous lesions that bleed easily giving an appearance of “black berry.”[4]

Blueberry muffin baby: Neonatal purpura of congenital rubella syndrome.[5]

Blueberry muffin lesions: Seen in congenital cytomegalovirus infection as a result of primary infection during first and second trimesters of pregnancy. Infant presents with purple or red papules or nodules lasting for 4-6 weeks; as a result of erythropoietic tissue in the dermis derived from undifferentiated dermal mesenchyme.[6]

Breakfast, lunch and dinner sign: Clustered linear flea bite reactions[5] [Figure 1].

Figure 1

Breakfast, lunch and dinner sign of papular urticaria

Café-au-lait macules: Sharply defined, light brown patches that vary in size from 0.5 cm to 50 cm; majority of them are <10 cm. They are present in a variety of genodermatoses like neurofibromatoses[7] and syndromes like LEOPARD syndrome.

Cayenne pepper spots: Irregular plaques of orange or brown pigmentation due to hemosiderin appearing with in and at the edges of old lesions. Seen in progressive pigmented purpuric dermatosis.[8]

Champagne bottle leg: Progressive subcutaneous fibrosis following chronic lipodermatosclerosis gives the leg an inverted bottle leg shape.[9]

Cherry angiomas: The most common vascular analomies, characterized by ruby red slightly elevated round papules[1] [Figure 2].

Figure 2

Cherry angioma

Corn flake sign: Keratotic papules (2-3 mm) with discrete irregular polygonal margins. Seen in Kyrle's and Flegel's disease.[10]

Curry-Hall syndrome: Dental abnormalities associated with short limbs, polydactyly and nail dysplasia.[11]

Curry Jones syndrome: Asymmetrical facial appearance, craniosynostosis, pre-axial polysyndactyly, agenesis of the corpus callosum and unusal skin with streaky areas of atrophy.[7]

Doughnut sign: Central depression surrounded by an elevated rim of skin is noted on the extended proximal interphalangeal joint.[12] Seen in scleromyxedema.

Fried egg: Central elevation in atypical nevi may have an appearance of sunny side up fried egg.[5]

Garlic clove fibroma: Also known as acquired periungual fibrokeratoma or acquired digital fibrokeratoma. Benign asymptomatic fibromas with a hyperkeratotic tip and narrow base arising in the eperiunguium, especially at the proximal matrix[13] [Figure 3].

Figure 3

Garlic clove fibroma

GEMSS syndrome: It is an autosomal dominant condition with features of Glaucoma, lens ectopia, microspherophakia, joint stiffness and stocky short “pseudoathletic build.”[14]

Grain itch/Barley itch/straw itch/Mattress itch/Prairie itch/cotton weed dermatitis: Itch caused by mite chiefly affecting the harvesters of wheat, hay, barley, oats and cereals or farm hands and packers who have contact with straw. Characterized by an urticarial papule with a vesicle.[1]

Honey comb atrophy: Another name for vermiculate atrophoderma.[14] It is a characteristic reticulate or “honeycomb” atrophy that develop as a late reaction to inflammation around horny follicular plugs on the cheeks [Figure 4].

Figure 4

Honey comb atrophy

Mango dermatitis: Dermatitis in persons exposed to Toxicodendron species.[1]

Milian citrine skin: Leathery photoaged skin with a yellow hue.[1]

Mulberry like erosions: Granulomatous ulcers in mucous membranes in patients with Paracoccidioidomycosis.[15]

Mulberry molars: Affected first molar has occlusive flat surface with only poorly enameled rudiments of the usual cusps. A syphilitic stigmata.[16]

Mushroom deformity: Changes appreciated on radiological examination in patients of psoriatic arthritis; osteolysis producing whittling of the terminal phalanges and to a lesser extent metacarpals and metatarsal.[17]

Oil acne: Acneiform eruption in the areas of skin that are in contact with oils and crude tars.[18]

Oil granuloma: A granulomatous reaction to the injection of a relatively bulky oil fluid into the tissues.[2]

Oil spot: It is seen in patients with psoriasis. Nail bed separation proximal to free margin in an oval area 2-6 mm broad, with a yellowish-brown hue.[17]

Onion skin cysts: Histopathological picture seen after injection of bulky oils. Large oil droplets became encysted with fibrosis.[2]

Peau d’ orange: Dermal edema manifests as Peau d’ orange appearance due to expansion of interfollicular dermis. It is seen in various conditions such as rosacea, pretibial myxedema and carcinoma en cuirasse.[19]

Port wine stain: Macular telangiectasia, which is present at birth and remains throughout the life.[3] Synonymous for nevus flammeus [Figure 5].

Figure 5

Port wine stain

Red Strawberry tongue: Prominent papillae and erythema of tongue in scarlet fever.[5]

Salt and pepper fundus: Syphilitic stigmata due to scarred choroiditis and optic atrophy.[16]

Sandwich sign: Histopathological sign of dermatophytosis; hyphae “sandwiched” between upper normal and lower compact orthokeratotic/parakeratotic stratum corneum.[20]

Sausage finger: Association of asymmetric oligoarticular arthritis of psoriasis associated with tenosynovitis results in sausage finger.[18]

Spaghetti and meat balls: Potassium hydroxide preparation performed on the scale of pityriasis versicolor will reveal short hyphae and spores.[5]

Strawberry gums: Hypertrophic gingivitis in patients of Wegener's granulomatosis.[1]

Strawberry hemangioma/strawberry nevus: Another name for infantile hemangioma[1] [Figure 6].

Figure 6

Strawberry nevus

Sweet syndrome: Acute febrile neutrophilic dermatoses characterized by fever, peripheral neutrophilic leukocytosis, acute onset of painful erythematous papules, plaques or nodules and histological features of neutrophilic infiltration without any evidence of primary vasculitis.[21]

Swiss cheese effect: Classical “Parafinoma” histopathologically shows multiple, small, cystic areas (swiss cheese like) with little inflammation but prominent fibrosis.[2]

Toasted skin syndrome: Another name for Erythema Ab Igne.[1]

Tomato catsup fundus: Choroidal angiomas are seen as redness of the fundus. May be seen in association with facial port wine stain and Sturge-Weber syndrome.[22]

Wafer like scales: Thin adherent mica-like scale attached at the center of a lichenoid firm reddish brown papule and free at the periphery, e.g., pityriasis lichenoides chronica.[23]

Watermelon stomach: Gastric antral vascular ectasia of Progressive systemic sclerosis giving striped appearance on endoscopy.[14]

White strawberry tongue: White coated tongue of scarlet fever.[5]

Conclusion

To learn by rote is the best thing one can adopt; that is possible only when one correlates these complex facts with simple things like food, etc. For example, we can start our morning with corn flake sign reminding us of Kyrle's and Flegel's disease while enjoying mango we can remember mango dermatitis caused by Toxicodendron. The system of correlating things will eventually help us to permanently ingrain in our minds these difficult signs and syndromes. This comprehensive compilation will help residents to learn things in a better and faster way.

What is new?

The present paper is a compilation of various dermatological conditions based on fruit and food eponyms. To the best of our knowledge no comprehensive review like this is available in the existing literature.