Cases reported "Foot Dermatoses"

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1/39. progeria (Hutchinson-Gilford): a case report.

    A new case with the typical features of progeria (Hutchinson-Gilford) occurred in india. Histopathology of the skin showed atrophic epidermis and diffuse fibrosis of dermis with loss of appendages. Roentgenographic findings were characteristic of progeria. The child also had a gangrenous ulcer over the left foot, a finding not highlighted in the literature.
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2/39. Alkaptonuric ochronosis presenting as palmoplantar pigmentation.

    We describe a 37-year-old woman who presented with palmoplantar pigmentation, thickening and pitting of 4 years duration. Bluish pigmented patches were seen over the sclera of her eyes. Her lumbar spine showed typical calcification of the intervertebral discs. Addition of Benedict's reagent to a urine sample of the patient gave rise to greenish brown precipitate and brownish black supernatant. Alkalinization of urine turned it black. A biopsy of the palmar lesion demonstrated irregular breaking up, swelling and homogenization of collagen bundles in the reticular dermis. Yellow-brown (ochre coloured) pigment was seen lying within the collagen bundles and also freely in the deeper dermis confirming our clinical diagnosis of alkaptonuric ochronosis. To the best of our knowledge this is probably the second report of alkaptonuria presenting with palmoplantar pigmentation.
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3/39. Squamous cell carcinoma arising from lesions of porokeratosis palmaris et plantaris disseminata.

    We report a 63-year-old Japanese man with numerous hyperkeratotic papules of porokeratosis palmaris et plantaris disseminata (PPPD) who developed multiple squamous cell carcinomas on the lesional sites of the palms and soles. The hyperkeratotic papules, which showed tightly packed columns of parakeratotic cells in the cornified layer (cornoid lamella), lost granular layer, and dyskeratotic keratinocytes in the epidermis below the cornoid lamella histologically, had been noticed on the palms and soles from the age of 28 and 43, respectively. He has no family history of such hyperkeratotic papules. Treatment with etretinate (10-50 mg/day) was given discontinuously, and the total dose of etretinate amounted to approximately 21 g over 14 years (average: 0.07 mg/kg/day). He noticed erosions on the hyperkeratotic papules on the left sole and palm more than 9 months after cessation of treatment with etretinate. Histological findings showed numerous atypical keratinocytes in the epidermis and upper dermis with mononuclear cell infiltration seen in the upper dermis. The diagnosis of squamous cell carcinoma arising from the lesions of porokeratosis palmaris et plantaris was made. Five erosions with histologically malignant changes were removed 1 cm from the margin of the erosions. These findings suggest that etretinate may have an inhibitory action on malignant changes in PPPD.
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4/39. Volar melanotic macules in a Japanese man with histopathological postinflammatory pigmentation: the volar counterpart of mucosal melanotic macules.

    BACKGROUND: Volar melanotic macules are asymptomatic light-brown or tannish-grey macules usually found on the palms and/or soles of blacks, although they have also been reported on the volar surfaces of whites. Similar lesions have not been reported before in Japanese people. Since the cause is as yet unknown, it remains to be discussed whether they are a distinct entity. methods: In this report, a 52-year-old Japanese man with volar melanotic macules is reported with the clinical and histopathological findings. RESULTS: A 52-year-old Japanese man presented with many light-brown macules on his bilateral soles. He had a 20-year history of tinea pedis. Histopathological examination revealed melanophages and inflammatory infiltrates in the superficial dermis. There was a slight increase in melanin granules around the acrosyringium. Fontana-Masson stain revealed a slight increase in melanin granules in the basal layer including the acrosyringium and superficial dermis. These changes corresponded with postinflammatory pigmentation. CONCLUSIONS: This is the first report of volar melanotic macules in Japanese people. We suggest that volar melanotic macules is not an independent entity but a clinicopathological one that includes postinflammatory pigmentation, and that the condition is the volar counterpart of mucosal melanotic macules.
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5/39. nocardia brasiliensis infection seen on grafted skin of the dorsum of a foot.

    For the past 4 years a 23 y-old female has noticed erythema on the dorsum of the right foot, where skin was grafted due to a traffic accident 20 years ago. She visited the Department of dermatology of Gifu Prefectural Hospital on Oct. 19, 1998; her general health was good. physical examination disclosed a swelling with erythema, papules and pustules on the dorsum of the right foot. The results of routine laboratory investigations were within normal limits except for the white blood cell count (11,300/mm(3)), blood sediment rate (25 mm/hrs), C reactive protein (1.21) and rheumatoid factor (x 16.6). Several yellowish and verrucous or wrinkled colonies were grown on Sabourauds agar culture from the biopsied specimen of the foot. Histopathological features showed epidermal hyperplasia with elongation of rete ridges and granulomatous changes in the dermis; many mononuclear and giant cells were present, and several positive fine filamentous and irregularly branching structures with PAS and Grocott stains were seen in the granulomatous nests. Both clinical and histopathological features led to speculation of nocardia infection, and nocardia brasiliensis was determined. The patient was treated by surgical total resection including the grafted skin. Although a soybean-sized nodule was seen on the border of the skin-graft of the foot three months later, there was no recurrence after the local resection.
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6/39. Cutaneous larva migrans with parts of the larva in the epidermis.

    Creeping eruption is usually caused by hookworms, most commonly ancylostoma braziliensis and ancylostoma caninum. Because lesions of cutaneous larva migrans have a typical clinical appearance, they are rarely biopsied. Specimens usually show spongiotic dermatitis with spongiotic vesicles containing neutrophils and eosinophils and a mixed-cell dermal infiltrate with numerous eosinophils. We report a case with parts of the larva migrans in the epidermis on histologic examination.
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keywords = dermis
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7/39. Acrokeratoelastoidosis.

    Acrokeratoelastoidosis is a genodermatosis characterized by firm papules or plaques on the sides of the hands and feet. Although poorly understood, the lesions may result from an abnormality in the secretion or excretion of elastic material by fibroblasts in the dermis. In this report, we will present a patient with this rare condition and review the clinical and histopathologic features, cause, and differential diagnosis.
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8/39. Isolated plantar collagenoma: a case report.

    Collagenoma is a hamartomatous lesion consisting of proliferation of normal collagen tissue. We describe a 19-year-old girl with a firm, elastic 3 x 2 cm nodule located on her right plantar fossa. Histopathologically, dense, coarse, thick collagen fibers were located in the dermis. In addition, the number of elastic fibers was slightly decreased. Based on these findings, the case was diagnosed as isolated plantar collagenoma.
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9/39. Solitary mastocytoma improved by intralesional injections of steroid.

    Solitary mastocytoma is an uncommon disease characterized by monotonous infiltrations of mast cells that extend from papillary dermis to subcutaneous fat. They usually resolve by adulthood, and there is no satisfactory treatment other than waiting. A two-month-old Korean male infant with deep solitary mastocytoma was treated intralesionally with triamcinolone acetonide. His mastocytoma in medial malleolus was very distressing because it was very sensitive to friction, and he was just reaching the crawling stage. After three injections, his skin lesion flattened with marked decrease of erythema and subjective symptoms. His skin lesion has continued to have a good clinical response for 9 months after the last treatment.
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keywords = dermis
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10/39. Development of psoriatic lesions during acute and convalescent phases of Kawasaki disease.

    A 7-month-old infant developed a discrete pustular rash confined to both soles during the acute phase of Kawasaki disease. Histological examination of a pustular lesion from the sole of a foot showed subcorneal neutrophilic microabscesses, psoriasiform acanthosis with a thin granular layer and mononuclear perivascular infiltrates in the upper dermis, consistent with psoriasis. Following the standard treatment with intravenous gamma globulin, the initial symptoms and signs of Kawasaki disease resolved completely. Eight weeks later, psoriasiform plaques appeared on both cheeks and on the extensor surfaces of the forearms and legs. skin biopsy from one of these lesions revealed psoriasiform epidermal hyperplasia, focal parakeratosis and dilated papillary capillaries. The patient was treated with mild-potency topical steroids that resulted in rapid and complete resolution of the skin lesions. Concurrent association of psoriatic skin lesions and Kawasaki disease might not be incidental and could stem from a common pathogenetic mechanism induced by superantigens.
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