1/8. Basosquamous carcinoma after ultraviolet therapy with artificial sunlight.We report a 63-year-old Japanese man with basosquamous carcinoma developing after ultraviolet therapy with artificial sunlight. Because he had had an eczematous lesion on the right leg five years previously, he had received ultraviolet therapy with artificial sunlight from a mercury-quartz lamp for a total of 30 sessions over a 3-year period. physical examination revealed an irregular erythematous plaque measuring 5 x 6 cm, with slight eruptions and erosions, on the right leg. A brownish plaque, measuring 9 x 12 cm, surrounded the erythematous plaque. Histopathologically, in the nests of atypical cells in the dermis, nuclear palisading was present at the edge of each tumor cluster. Adjacent clusters exhibited transitions to squamous cells and contained horn pearls. Most of the cells of the epidermis and adnexa were atypical, but cells of the normal adnexal epithelium extended over the atypical cells of the epidermis in an umbrella-like fashion in other lesions. We believe that, in the present case, artificial sunlight therapy caused solar keratosis and that this developed into basosquamous carcinoma. To our knowledge, skin cancer developing after ultraviolet therapy with artificial sunlight without PUVA has not previously been reported in the English literature.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
2/8. Estrogen dermatitis that appeared twice in each menstrual period.A 23-year-old woman presented with millet-sized red papules that were scattered over her chest and abdomen. She stated that since the age of 20, she had recurrently suffered from pruritic eruptions that coincided with ovulation and the time prior to menstruation, and that they persisted for a few days before vanishing spontaneously leaving some pigmentation. A skin biopsy specimen revealed spongiotic bullae in the epidermis and marked infiltration of lymphocytes accompanied by some histiocytes and eosinophils in the upper dermis. An intradermal test for conjugated estrogen showed an urticarial reaction that faded in about four hours. Although the test did not strictly meet the criterion (erythema to remain for more than 24 hours for papulovesicular eruptions), it was concluded that the timing of the episodes along with the result of the test suggested that a diagnosis of estrogen dermatitis was highly probable. There have been several reports of this condition since it was first reported as a distinct entity in 1995; but whatever the reasons, the flares were observed only before menstruation in these cases, despite the fact that the serum estrogen levels showed a double-peaked pattern during each menstrual period. This is considered to be a rare case of estrogen dermatitis that flared twice in each menstrual period. Limited improvement was noted in the symptoms even without treatment.- - - - - - - - - - ranking = 0.66666666666667keywords = dermis (Clic here for more details about this article) |
3/8. A typical case of sezary syndrome mimicking an eczema.An 87-year-old woman was admitted with buccal pain that had started a few weeks before. She had been treated with topical steroids and antihistamines for an undetermined skin disease characterised by generalized erythroderma associated with pruritis for years. Her total white cell count was 13,290/mm3 with 19 % Sezary cells among the lymphocytes. skin biopsy showed an infiltrate of inflammatory cells forming a dense band below the epidermis characterised by the presence of atypical lymphoid cells with large convoluted nuclei, and significant epidermotropism. immunophenotyping studies in peripheral blood identified a large increase in CD4 cells; CD7- T cells. Clonal T- cell receptor gamma gene rearrangement was detected on skin biopsy and bone marrow and on the skin biopsy with the PCR method. This case illustrates the misleading skin presentation of the sezary syndrome in the elderly.- - - - - - - - - - ranking = 0.33333333333333keywords = dermis (Clic here for more details about this article) |
4/8. Cutaneous lymphohistiocytic infiltrates in patients with hypogammaglobulinemia.Six patients (5 to 15 years of age) with hypogammaglobulinemia had scattered papular lesions in association with widespread dermatitis. These disfiguring lesions were a portal of entry for secondary infections and led to social withdrawal. biopsy specimens from the papules demonstrated dense lymphohistiocytic infiltrate limited to the dermis. Infectious causes (bacterial, fungal, and viral) were excluded. The skin lesions failed to respond to conventional treatment, including topical corticosteroids. Replacement therapy with monthly infusions of high doses of immune serum globulin resulted in gradual improvement and ultimate clearing of the lesions. This unusual skin abnormality, which is unresponsive to traditional treatment, may provide the earliest clue to the presence of hypogammaglobulinemia.- - - - - - - - - - ranking = 0.33333333333333keywords = dermis (Clic here for more details about this article) |
5/8. immunophenotyping of the eczematous flare-up reaction in a nickel-sensitive subject.An eczematous flare-up reaction, occurring at a previously involved site, which followed oral challenge with 5.6 mg of nickel in a 29-year-old nickel-sensitive woman, was biopsied and studied by immunohistochemistry. The cellular infiltrate in the dermis and epidermis at 8 days was predominantly of Leu 3a phenotype (helper/inducer T lymphocytes), with smaller numbers of Leu-2a-reactive (suppressor/cytotoxic) T lymphocytes. Many infiltrating cells were DR-positive. No increase in epidermal Leu-6-positive langerhans cells was seen but Leu-6-reactive cells were noted in the dermal infiltrate. keratinocytes showed some expression of class II antigen (mainly DR). In comparison with the 48-hour allergic patch test reaction, the eczematous flare-up site showed no increase in epidermal Langerhans cell numbers nor infiltration with macrophages, but the responses were similar since both showed a superficial T cell reaction in the skin.- - - - - - - - - - ranking = 0.66666666666667keywords = dermis (Clic here for more details about this article) |
6/8. PEEPO: papular eruption with elimination of papillary oedema.Multiple biopsies from a patient with a pruritic papular eruption of endogenous origin demonstrated a sequence of histopathological changes which varied markedly with the age of the lesion. Early lesions showed marked papillary oedema but no evidence of epidermal involvement. The next phase was characterized by the appearance of focal spongiosis and intra-epidermal vesiculation without involvement of the stratum corneum. Late lesions were characterized by residual spongiosis in the epidermis and groups of pyknotic nuclei in a parakeratotic stratum corneum. It would seem that this sequence of events is due to the elimination of papillary oedema through the epidermis. The fact that this process produces changes indistinguishable from those seen in eczema may indicate the eczema itself is a condition characterized by sub-epidermal oedema in which the epidermis is involved only as a secondary event. The title TEEPO (trans-epidermal elimination of papillary oedema) is suggested as a suitable acronym for this phenomenon. The term PEEPO (papular eruption with elimination of papillary oedema) is proposed for the eruption seen in this patient.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
7/8. Nonbullous pemphigoid: prodrome of bullous pemphigoid or a distinct pemphigoid variant?We describe two patients with pruritic, mainly urticarial or eczematous lesions associated with peripheral blood eosinophilia. No vesicles or blisters developed in either patient throughout the course of the disease (29 and 38 months, respectively). To characterize the clinicopathologic features of these patients we performed histopathologic studies, direct and indirect immunofluorescence, immunoelectron microscopy (patient 2), and immunoprecipitation of both patients' serum. Histopathologic examination revealed a moderate eosinophilic infiltrate partly arranged along the basement membrane zone and focally invading the epidermis. Linear deposits of immunoglobulin and C3 along the dermoepidermal junction were localized within the lamina lucida and over the hemidesmosomal plaques. immunoprecipitation revealed the presence of circulating autoantibodies against the 230 kd bullous pemphigoid antigen. These findings suggest that our patients had a distinct, nonbullous variant of the pemphigoid spectrum.- - - - - - - - - - ranking = 0.33333333333333keywords = dermis (Clic here for more details about this article) |
8/8. Papuloerythroderma of Ofuji: a report of 2 cases including the first European case associated with visceral carcinoma.Papuloerythroderma (PE) is a rare type of erythroderma of the elderly which results from the coalescence of sheets of papules that spare skin folds, with peripheral eosinophilia in most cases. skin biopsy shows a nonspecific eczematous pattern with a mature T cell lymphocytic and eosinophilic infiltrate with langerhans cells in the dermis. We report 2 cases of PE. The 1st case, in which no underlying malignancy could be found, responded partially to oral etretinate, topical steroid creams and tar derivates. The 2nd case did not respond to high-dose oral steroids and was associated with adenocarcinoma of the colon, with a fatal outcome. PE has been associated with lymphoma and carcinoma. We report the first European case of PE associated with visceral carcinoma and review the cases reported in the western literature.- - - - - - - - - - ranking = 0.33333333333333keywords = dermis (Clic here for more details about this article) |