1/10. Pyodermatitis-pyostomatitis vegetans: report of a case and review of the literature.Pyodermatitis-pyostomatitis vegetans is a benign, rare disorder characterized by a pustular eruption in the oral mucosa and vegetating plaques involving the groin and axillary folds. Its association with inflammatory bowel disease is well established. We report the case of a 49-year-old-white man with ulcerative colitis who manifested a vegetating, annular plaque in the left inguinal region of 2 months' duration. Oral examination disclosed an erythematous mucosa with multiple painful pustules involving the labial and gingival mucosa. Histopathologic study demonstrated epidermal hyperplasia and an inflammatory infiltrate composed mostly of neutrophils and eosinophils, grouped into microabscesses within the epidermis and with a bandlike configuration in the upper dermis. Results of direct and indirect immunofluorescence studies were negative. We discuss the differential diagnosis between pyodermatitis-pyostomatitis vegetans and pemphigus vegetans.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
2/10. A case of chronic perianal pyoderma treated with the recycled skin graft method.We present here a case of chronic perianal pyoderma (CPP), who was treated with a novel skin graft. The patient was a 28-year-old male who had suffered from painful abscesses and nodules on his buttocks for over 10 years. Although the abscesses and nodules were initially restricted to one buttock, they gradually spread over both buttocks. He visited our hospital in July of 2000. He was clinically diagnosed as CPP and treated with oral doses of antibiotics. When admitted to our hospital in September of 2000, an anal fistula was also found. The operations for CPP and anal fistula were simultaneously performed. After the anal fistula treatment, the lesions of CPP were totally resected. In this procedure, we removed the epidermis and upper dermis from the excised CPP lesions and grafted them on the defects of the excised lesion. There has been no recurrence of the CPP. This operation procedure, which we call the "recycled skin graft method" is less invasive, because a donor site for the skin graft is unnecessary. We considered it to be as one of the effective treatments for CPP.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
3/10. Chronic superficial pyoderma of the face: an unusual male case of rosacea fulminans.A 62-year-old Japanese male developed acneiform papules on the face in November of 2002. The eruptions progressed to exudative erythema with central necrosis, and then to thick-crusted superficial abscesses in a short period. The shallow ulcers exposed by removal of the crusts and abscesses immediately re-epithelized without leaving scars. The histology of the eruption was a dense infiltration of neutrophils associated with granulomatous changes in the upper to middle dermis. histology of the tiny white particles in the abscess showed an irregularly proliferated mass of keratinocytes including accumulated neutrophils. The skin lesions resisted intravenous injection of antibiotics but responded to systemic administration of a corticosteroid agent. colchicine did not work well, but the additional administration of etretinate was effective. The patient is currently receiving combined therapy with prednisolone and etretinate, but eruptions are still episodically observed. We diagnosed this case as an unusual male case of rosacea fulminans.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
4/10. Cutaneous manifestations of neutrophilic disease. A study of seven cases.Seven patients with a complex form of neutrophilic dermatosis are reported. Clinically, they had variable associations of four types of lesions: blisters/pustules, plaques, nodules and ulcerations. Histologically, a neutrophilic infiltrate was observed at variable levels in the epidermis, dermis and subcutis. Systemic manifestations were present in all cases (general symptoms, joint, renal, ocular and lung involvements). Three patients had an associated disease (myelodysplasia, metastatic carcinoma, IgG gammopathy). steroids were the most efficient treatment. These observations, as well as a review of the literature, support the opinion that the neutrophilic dermatosis represents a continuous spectrum encompassing four well-defined entities: subcorneal pustular dermatosis, Sweet's syndrome, erythema elevatum diutinum and pyoderma gangrenosum. We propose that the different patterns of the neutrophilic dermatosis are the most obvious manifestations of a potentially multisystemic neutrophilic disease and allow its recognition.- - - - - - - - - - ranking = 1keywords = dermis (Clic here for more details about this article) |
5/10. A case of pyoderma vegetans associated with acne conglobata.A 41-year-old man visited our clinic because of vegetating plaques resembling pemphigus vegetans on his sacral and perianal areas. He had also suffered from acne conglobata since adolescence. A biopsy specimen taken from the perianal area showed marked acanthosis, exocytosis, and inflammatory infiltrates in the dermis, but no acantholysis. Direct and indirect immunofluorescent tests were negative for anti-intercellular antibodies. Bacterial cultures from the lesions showed many different types of organisms. We diagnosed the case as pyoderma vegetans and discussed the relationship between pyoderma vegetans and other pyoderma.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
6/10. Squamous syringometaplasia in lobular panniculitis and pyoderma gangrenosum.Squamous metaplasia of eccrine sweat glands has been most frequently described in chronic cutaneous ulcerations with associated epidermal hyperplasia. We found examples of the process in skin biopsy specimens from five patients: three had associated lobular panniculitis and two had lesions of pyoderma gangrenosum. The metaplasia was located in the mid-to-deep reticular dermis in all five patients and extended into the superficial subcutis in one. Immunohistochemical stains for CEA and S-100 protein were used to accentuate the relationship of the metaplastic islands with eccrine ducts. It is postulated that necrosis of a portion of the eccrine duct is the stimulus for this process.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
7/10. A case of malignant pyoderma with neurological manifestations.A case of malignant pyoderma with a fatal course is presented. A 62-year-old Chinese man was admitted with a 8-month history of progressive ulcerative nodular skin lesions starting on the right antecubital fossa and spreading to the chest, face, arms and legs. The lesions failed to respond to many antibiotics. Examination revealed multiple large crusted foul-smelling ulcers with erythematous raised vegetative edges and tender erythematous nodules. Investigations showed an anaemia of chronic disease and an erythrocyte sedimentation rate of 135mm/1st hour. histology showed multiple circumscribed microabscesses in the upper dermis. The skin lesions responded well to systemic corticosteroid therapy. Three months after admission, he developed multiple cranial nerve palsies, and severe progressive peripheral neuropathy. Radiographic studies revealed cavitating lesion in the right upper lobe consistent with a diagnosis of carcinoma of the lung. Five months after admission, patient was intubated for stridor but he succumbed to aspiration pneumonia. Malignant pyoderma should be considered if an ulcer fails to respond to antibiotics, and possible neurological complications should be thought of.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
8/10. pyoderma gangrenosum involving the eyelid.A 62-year-old man was seen with an ulcer of the left upper eyelid of two weeks' duration. Over the previous 40 years, similar ulcers had intermittently developed elsewhere on his skin and spontaneously resolved over several months leaving atrophic scars. A biopsy specimen of the eyelid lesion showed epidermal ulceration with acute inflammation and liquefactive necrosis of the underlying dermis. Microorganisms and vasculitis were not present. On the basis of the clinical history and a compatible biopsy specimen, the diagnosis of pyoderma gangrenosum was made. This is an uncommon, idiopathic, ulcerating skin disease that may also have ocular manifestations. Eyelid ulcers have not previously been reported, to our knowledge. The diagnosis is established by clinical history and exclusion of other causes of ulceration.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
9/10. Malignant pyoderma. Report of a case associated with a disorder of the immune system.A 41-year-old man developed multiple suppurative ulcers and subcutaneous inflammatory nodules and abscesses on the face, the trunk and the extremities. Repeated bacterial and fungus cultures gave nonspecific and inconstant results. light-microscopic studies showed diffuse inflammatory reaction in the dermis with abscess formation and tissue destruction. There was no evidence of blood vessel inflammatory changes. The course of the disease was characterized by marked chronicity and partial response to systemic steroid and antibiotic therapy. Treatment with clofazimine resulted in a marked improvement of the lesions. Laboratory test results suggest that a deficiency of cell-mediated immunity, associated with increased concentrations of immunoglobulins, may have been the pathogenic event in this case.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
10/10. Pyodermite vegetante of Hallopeau. Immunofluorescence studies performed in an early disease stage.A 50-year-old woman with autoimmune thyroiditis had an eruption resembling pyodermite vegetante as described initially by Hallopeau. Direct immunofluorescence microscopy studies indicated deposition of IgG and C3 in the intercellular area of the epidermis. Circulating IgG antibodies to the intercellular areas of stratified epithelial tissue were demonstrable on indirect immunofluorescence microscopy. Treatment with prednisone and azathioprine resulted in the disappearance of vetetating lesions and in healing, with postinflammatory hyperpigmentation. Immunofluorescence microscopy studies, in an early stage of the disease, are of great value in the diagnosis of pyodermite vegetante of Hallopeau. Our findings support the view that pyodermite vegetante of Hallopeau belongs immunologically to the pemphigus group.- - - - - - - - - - ranking = 0.5keywords = dermis (Clic here for more details about this article) |
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