Answers
CASE 1
A plantar fibroma is a benign nodule of unknown etiology affecting the arch of the foot. Most cases are nontraumatic and originate in the deep fascia of the foot abutting the muscle. Lesions are firm and may be painful upon application of pressure. Most instances are solitary; multiple lesions may be hereditary and with variable penetrance. Initial management of symptomatic fibromas consists of off-loading with shoe padding or custom inserts, along with NSAID therapy to reduce inflammation. Intralesional steroid injections may also be beneficial in the initial stages. Due to the high incidence of recurrence, surgery is usually reserved for refractory cases.
CASE 2
Dermatitis herpetiformis (DH) is an autoimmune disorder linked to the ingestion of gluten and is associated with gluten-sensitive enteropathy (celiac disease). The condition is associated with human leukocyte antigens DQ2 and DQ8, the highest prevalence of which is seen in men of Northern European descent. Patients with DH develop intensely pruritic papules and vesicles of the extensor surfaces, scalp, and buttocks after ingesting gluten. Biopsy of these lesions reveals IgA deposits. A strict gluten-free diet is the cornerstone of therapy, though adherence often proves difficult for many patients. Dapsone provides rapid relief of pruritus and skin lesions.