1/12. Eosinophilic pustular folliculitis starting initially only with palmoplantar pustular lesions. Report of a case and review of the literature.We report a 23-year-old Japanese male with eosinophilic pustular folliculitis (EPF) that had started with palmoplantar rash. Only when follicular pustules appeared on the bilateral cheek 31 months later, we revised our initial diagnosis of pustulosis palmaris et plantaris (PPP) to EPF, and all the skin eruptions cleared mostly with indomethacin. A review of the Japanese literature for the past 20 years disclosed that in 207 cases of EPF so far reported, palmoplantar pustular lesion was noted in 38 (18%). Among them, in 16 cases (8%) the skin lesions started first from the palmoplantar region with the average period of 26 months until the appearance of other eruptions of EPF. None of them was diagnosed as EPF when skin lesions were localized only to the palmoplantar region. When we find pustules on the palmoplantar region, we should suspect the possibility of early lesions of EPF as well as PPP. Histopathologic demonstration of multilocular pustules located in the upper epidermis containing numerous eosinophils in the palmoplantar pustular lesions, together with the dramatic therapeutic response to indomethacin greatly favor the diagnosis of EPF.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
2/12. Neonatal eosinophilic pustulosis.A pre-term, 7-week-old male infant presented with a recurrent pustular eruption involving his face and scalp with associated peripheral blood eosinophilia. skin biopsy revealed spongiosis with numerous dermal and epidermal eosinophils without predominant follicular involvement. Immunohistology showed deposition of eosinophil granule major basic protein and eosinophil derived neurotoxin in the dermis and epidermis. He responded to conservative management. We discuss the differential diagnosis of neonatal eosinophilic pustular eruptions and suggest the term 'neonatal eosinophilic pustulosis' to best describe our case.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
3/12. Successful treatment of recalcitrant necrotizing eosinophilic folliculitis using indomethacin and cephalexin.A 56-year-old man presented with a 4-month history of a painful and pruritic eruption consisting of crusted plaques and blisters on his face, scalp and chest. The patient suffered from headaches and malaise but was afebrile. Two skin biopsies revealed an epidermis which was eroded and covered by locules of serum and neutrophils. In the underlying dermis, there was a marked mixed inflammatory reaction including lymphocytes, neutrophils and numerous eosinophils. There was exocytosis of eosinophils into several follicles with areas of follicular mucinosis. A diagnosis of necrotizing eosinophilic folliculitis was made based upon the clinical and histopathological findings. The diagnosis was supported by the rapid response to a combination of indomethacin and cephalexin. The patient has taken continuous indomethacin (with rabeprazole and misoprostol cover) and cephalexin for 2 years. If treatment is withdrawn he experiences a flare of his disease within 2 weeks. This case highlights the potentially chronic nature of this disease.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
4/12. Cutaneous larva migrans.Cutaneous larva migrans, or creeping eruption, is an infection caused by certain nematode larvae and, occasionally, fly maggots. After penetrating human skin, the larvae remain in the epidermis and wander aimlessly. The burrows may be intensely pruritic. Systemic reactions may include profound eosinophilia. Oral or topical thiabendazole is effective therapy.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
5/12. Ofuji's disease: high circulating titers of IgG and IgM directed to basal cell cytoplasm.A patient with Ofuji's eosinophilic pustulosis and peculiar immunofluorescence findings is described. High titers of circulating IgG and IgM have been found directed to the cytoplasm of the basal cells of epidermis and the outer sheath of hair follicles. Such antibodies appear to be related to the course of the disease.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
6/12. Eosinophilic pustular folliculitis.Eosinophilic pustular folliculitis was first described by Ofuji et al in 1970. It is characterized by pruritic circinate plaques that are studded with follicular papules and pustules. Lesions are located chiefly on the face, trunk, and arms. Biopsies of lesions demonstrate an infiltrate of eosinophils and neutrophils within hair follicles, dermis, and epidermis. Peripheral leukocytosis and eosinophilia are common.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
7/12. Histiocytoid hemangioma with features of angiolymphoid hyperplasia and Kaposi's sarcoma. A study by light microscopy, electron microscopy, and immunologic techniques.We examined by light and electron microscopy 99 vascular lesions removed on 17 occasions over a 2-year period from a 55-year-old black man. The lesions all showed histologic features of a vascular neoplasm composed of enlarged "histiocytoid" endothelial cells and overlapping features of angiolymphoid hyperplasia with eosinophilia and Kaposi's sarcoma. An apparently unique feature was early loss of melanin from the overlying epidermis and a mononuclear inflammatory-cell infiltrate. The patient also had an abnormal immunologic state very similar to that seen in homosexuals with Kaposi's sarcoma.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
8/12. Eosinophilic pustulosis with pemphigus-like antibody.A 75-year-old male with eosinophilic pustulosis Ofuji complicated by superinfection with pseudomonas aeruginosa and proteus mirabilis is described. This is the first case of eosinophilic pustulosis with an antiepidermal antibody. This antibody was directed against the intercellular substance of the lower epidermis and it was detected by direct immunofluorescence in the patient's normal and lesional skin. As revealed by indirect immunofluorescence the patient's serum reacted with intercellular substance of human lower epidermis but not with guinea pig esophagus. Possibly the detected autoantibody is not characteristic for eosinophilic pustulosis Ofuji but rather an accompanying feature of this case similar to the antiepidermal antibodies found in patients with drug reactions and burns.- - - - - - - - - - ranking = 2keywords = epidermis (Clic here for more details about this article) |
9/12. Childhood pemphigus initially seen as eosinophilic spongiosis.The condition of a 3-year-old boy with an intermittent, generalized, bullous eruption was initially diagnosed as (and treated as) bullous impetigo. After a relapse, two skin biopsies were performed. Each biopsy specimen showed the changes of eosinophilic spongiosis. A third biopsy specimen was also examined by direct immunofluorescence microscopy. The specimen showed deposition of IgG in the intercellular region of the epidermis. The patient's serum contained intercellular antibodies in a dilution of 1:160, confirming the diagnosis of pemphigus. A biopsy should be performed in the case of a child with a persistent or recurring bullous eruption; immunofluorescence microscopy of the biopsy is essential.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
10/12. Papuloerythroderma and cutaneous T cell lymphoma.An 83-year-old man had the typical cutaneous features of papuloerythroderma of Ofuji. There were reduced numbers of lymphocytes and platelets in his peripheral blood but the eosinophil count was normal. skin biopsy showed a nondiagnostic infiltrate of T lymphocytes in the dermis. Treatment with topical steroids and UVB phototherapy was ineffective. Twelve months after presentation, a further skin biopsy revealed atypical lymphoid cells invading the epidermis and the skin adnexae. A diagnosis of malignant lymphoma was made; no evidence of extracutaneous spread was found. photochemotherapy produced rapid resolution of the skin eruption and clearance of the cutaneous infiltrate. Papuloerythroderma may be a manifestation of a cutaneous lymphoma.- - - - - - - - - - ranking = 1keywords = epidermis (Clic here for more details about this article) |
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