Background: Only case reports or studies of small series of patients have focused on granuloma faciale (GF). Objective: We sought to describe the clinicopathologic characteristics ofGF in a large series of patients. M...Background: Only case reports or studies of small series of patients have focused on granuloma faciale (GF). Objective: We sought to describe the clinicopathologic characteristics ofGF in a large series of patients. Methods: We conducted a retrospective analysis of 66 patients and 73 skin specimens. Results: GF mostly presented as reddish plaques or nodules in middle-aged adults. One third of patients had multiple sites involved and 5 patients had extrafacial lesions. A clinical diagnosis of GF was made in only 10 cases; sarcoidosis, lymphoma, lupus, and basal cell carcinoma were the main differential diagnoses. The most frequent histopathologic features were the presence of a grenz zone, neutrophils, and telangiectases. Vascular changes were frequent, although necrotizing vasculitis appeared to be rare. There was often an association of acute and chronic inflammatory patterns, suggesting that GF follows a chronic history with reccurrent acute phases, rather than distinct successive acute and chronic stages. Limitations: In this retrospective study, a reliable analysis of the outcome of patients could not be performed. Results of direct immunofluorescence tests and laboratory investigations were lacking in many cases. Conclusion: GF is often clinically misdiagnosed; its morphologic spectrum is broader than usually described and includes a lack of eosinophils, the presence of vascular changeswith rare vessel wall necrosis, and associated acute and chronic inflammatory patterns.展开更多
Objective: To determine if a therapeutic regimen of twice weekly applications of mechlorethamine hydrochloride and betamethasone dipropionate cream is effective in the treatment of early- stage mycosis fungoides while...Objective: To determine if a therapeutic regimen of twice weekly applications of mechlorethamine hydrochloride and betamethasone dipropionate cream is effective in the treatment of early- stage mycosis fungoides while increasing cutaneous tolerance. Design: Prospective nonrandomized study conducted from November 1999 to November 2002. Setting: Eleven university or hospital dermatology departments in France. Patients: Sixty- four consecutive patients with newly diagnosed early- stage mycosis fungoides (stage IA, n=33; stage IB, n=26; stage IIA, n=5). Interventions: Patients were treated with twice- weekly applications of a 0.02% aqueous solution of mechlorethamine followed by an application of betamethasone cream during a 6- month period. Main OutcomeMeasures: The primary end point was the rate of complete response during the treatment. Secondary end points were mean delay to achieve complete response, rate of severe cutaneous reactions of intolerance, and rate of relapse after achieving complete response. Results: Thirty- seven patients (58% ) had a complete response after a mean± SD treatment duration of 3.6± 2.5 months: 20 (61% ) of 33 patients with stage IA disease, 15 (58% ) of 26 patients with stage IB disease, and 2 (40% ) of 5 patients with stage IIA disease. Eighteen patients (28% ) developed severe cutaneous reactions of intolerance that necessitated treatment discontinuation. Relapse was observed in 17 patients (46% )- after a mean± SD time of 7.7± 6.5 months. Conclusions: A regimen of twice- weekly applications of mechlorethamine and betamethasone cream is an effective treatment for early- stage mycosis fungoides. The decreased frequency of applications provides an advantage to the patient by being easy to use with limited adverse effects.展开更多
文摘Background: Only case reports or studies of small series of patients have focused on granuloma faciale (GF). Objective: We sought to describe the clinicopathologic characteristics ofGF in a large series of patients. Methods: We conducted a retrospective analysis of 66 patients and 73 skin specimens. Results: GF mostly presented as reddish plaques or nodules in middle-aged adults. One third of patients had multiple sites involved and 5 patients had extrafacial lesions. A clinical diagnosis of GF was made in only 10 cases; sarcoidosis, lymphoma, lupus, and basal cell carcinoma were the main differential diagnoses. The most frequent histopathologic features were the presence of a grenz zone, neutrophils, and telangiectases. Vascular changes were frequent, although necrotizing vasculitis appeared to be rare. There was often an association of acute and chronic inflammatory patterns, suggesting that GF follows a chronic history with reccurrent acute phases, rather than distinct successive acute and chronic stages. Limitations: In this retrospective study, a reliable analysis of the outcome of patients could not be performed. Results of direct immunofluorescence tests and laboratory investigations were lacking in many cases. Conclusion: GF is often clinically misdiagnosed; its morphologic spectrum is broader than usually described and includes a lack of eosinophils, the presence of vascular changeswith rare vessel wall necrosis, and associated acute and chronic inflammatory patterns.
文摘Objective: To determine if a therapeutic regimen of twice weekly applications of mechlorethamine hydrochloride and betamethasone dipropionate cream is effective in the treatment of early- stage mycosis fungoides while increasing cutaneous tolerance. Design: Prospective nonrandomized study conducted from November 1999 to November 2002. Setting: Eleven university or hospital dermatology departments in France. Patients: Sixty- four consecutive patients with newly diagnosed early- stage mycosis fungoides (stage IA, n=33; stage IB, n=26; stage IIA, n=5). Interventions: Patients were treated with twice- weekly applications of a 0.02% aqueous solution of mechlorethamine followed by an application of betamethasone cream during a 6- month period. Main OutcomeMeasures: The primary end point was the rate of complete response during the treatment. Secondary end points were mean delay to achieve complete response, rate of severe cutaneous reactions of intolerance, and rate of relapse after achieving complete response. Results: Thirty- seven patients (58% ) had a complete response after a mean± SD treatment duration of 3.6± 2.5 months: 20 (61% ) of 33 patients with stage IA disease, 15 (58% ) of 26 patients with stage IB disease, and 2 (40% ) of 5 patients with stage IIA disease. Eighteen patients (28% ) developed severe cutaneous reactions of intolerance that necessitated treatment discontinuation. Relapse was observed in 17 patients (46% )- after a mean± SD time of 7.7± 6.5 months. Conclusions: A regimen of twice- weekly applications of mechlorethamine and betamethasone cream is an effective treatment for early- stage mycosis fungoides. The decreased frequency of applications provides an advantage to the patient by being easy to use with limited adverse effects.
