Background: Urticarial dermatitis may represent a useful term for a subset of a reaction pattern designated most commonly as dermal hypersensitivity by pathologists. The term is not commonly used, and requires definit...Background: Urticarial dermatitis may represent a useful term for a subset of a reaction pattern designated most commonly as dermal hypersensitivity by pathologists. The term is not commonly used, and requires definition to determine whether it is clinically relevant. Objectives: To define urticarial dermatitis and distinguish it from other urticarial reaction patterns and to review the frequency with which dermatologists can recognize clinical settings that match the biopsy findings of urticarial dermatitis. Design: Retrospective analysis of clinical and/or histological diagnosis of urticarial dermatitis, applying strict histological criteria in a center using urticarial dermatitis as a diagnostic term in 190 archived reports. Setting: Tertiary referral dermatopathology service reporting for dermatological practices in Sydney, Australia. Main Outcome Measures: The correlation between clinical and histological diagnoses of urticarial dermatitis and alternate diagnoses was analyzed. The frequency of positive immunofluorescence findings for bullous pemphigoid was determined in a subset of patients with urticarial dermatitis in whom this test was ordered to exclude prodromal bullous pemphigoid. Results: Urticarial dermatitis was the histological diagnosis in at least 1 biopsy result in 148 patients, and matched the provisional clinical diagnosis in 49 (33.1% ) patients. Urticarial dermatitis was the only diagnosis provided in 21 patients. The main alternate clinical diagnoses provided were early bullous pemphigoid or dermatitis herpetiformis (47 patients [31.8% ]), dermatitis (39 patients [26.4% ]),drug reaction (35 patients [23.6% ]), urticarial vasculitis (24 patients [16.2% ]), and urticaria (12 patients [8.1% ]). In 91 patients with a clinical diagnosis of urticarial dermatitis, the histological diagnosis in at least 1 biopsy result was matched in 49 patients (53.8% ); other histological diagnoses included dermatitis (21 patients [23.1% ]), papular urticaria (12 patients [13.2% ]), drug reaction (6 patients [6.6% ]), and urticaria (3 patients [3.3% ]). Review of 38 direct immunofluorescent results for prodromal bullous pemphigoid and a biopsy finding of urticarial dermatitis revealed only 3 positive results (7.9% ).Conclusions: Urticarial dermatitis seems to be a useful histological and clinical term for a subset of the dermal hypersensitivityreaction pattern. Although the clinical presentation is not restricted to a specific entity, eczema and drug reactions seem to be the most frequent clinical associations; and in a subset of patients, urticarial dermatitis remains as a recognizable reaction pattern. Urticarial dermatitis without eosinophilic spongiosis is not a reliable indicator for bullous pemphigoid, because the findings of immunofluorescence are often negative.展开更多
Background: Retinoids have the capacity to accelerate the involution ofmultiple keratoacanthomas, including unusual variants such as keratoacanthoma marginatum centrifugum and keratoacanthoma en plaque that may persis...Background: Retinoids have the capacity to accelerate the involution ofmultiple keratoacanthomas, including unusual variants such as keratoacanthoma marginatum centrifugum and keratoacanthoma en plaque that may persist and be associated with progressive growth and provide difficulties in diagnosis and management. Observations: We describe 3 patients who had unusual infiltrated and keratotic plaques affecting the lower legs or nasolabial area that persisted or recurred that may be related to this group of unusual keratoacanthomas. The 3 patients had differing clinical lesions that did not resemble classic keratoacanthomas, but were linked by their biopsy findings of hypertrophic lichen planus-like reaction and pseudoepitheliomatous hyperplasia with a prominent infundibulocystic component that progressed to multiple keratoacanthomas or infundibulocystic squamous cell carcinoma. Polymerase chain reaction analysis of biopsy material from 2 patients failed to detect human papillomavirus. All 3 presentations provided a therapeutic dilemma, but responded rapidly to acitretin treatment at a dosage of 10 to 25 mg daily, which was continued for 15 to 24 months. Conclusions: These cases illustrate an unusual reaction pattern that is hypertrophic lichen planus-like but, instead of evolving to classic lichen planus, progresses to infundibulocystic hyperplasia and the development of multiple keratoacanthomas or infundibulocystic squamous cell carcinomas. Retinoids represent a therapeutic option for this difficult clinical problem and may obviate repeated and extensive surgery.展开更多
Background. A 26-year-old male presented with a 3-year history of lichen am yloidosis. On examination, there was a pigmented papular eruption with a ripple pattern affecting the limbsandtrunkbutsparingtheaxillae,antec...Background. A 26-year-old male presented with a 3-year history of lichen am yloidosis. On examination, there was a pigmented papular eruption with a ripple pattern affecting the limbsandtrunkbutsparingtheaxillae,antecubitalandpopliteal fossae, central chest, neck and face. There was also prominent sparing of the sk in overlying the superficial veins of the limbs. The sparing of the superficial veins of the limbs by lichen amyloidosis raised the possible role of cutaneous t emperature in governing the distribution of amyloid deposits in our patient. Obs ervations. Total body infrared thermography demonstrated consistent sparing of t he amyloid deposits in areas with higher cutaneous temperatures such as the neck and axillae as well as the course of the superficial veins. The cooler areas su ch as the extensor surfaces of the arms and legs corresponded to areas of amyloi d deposition. Narrow band ultraviolet B (NBUVB) phototherapy over a 5-month per iod resulted in a marked improvement of pruritus and clearing of the amyloid dep osits. Conclusions. Our patient clearly demonstrated lichen amyloidosis in a the rmosensitive distribution. This may be a gross manifestation of previous reports of in vitro thermosensitivity of amyloid fibril formation and may have potentia l implications in treatment at least in a subset of patients demonstrating this clinical feature.展开更多
Fungating nodules and infiltrated plaques are usually equated with advanced tumor stage mycosis fungoides. We report an 85- year- old man who presented in this way but multiple skin biopsies revealed that the bulk of ...Fungating nodules and infiltrated plaques are usually equated with advanced tumor stage mycosis fungoides. We report an 85- year- old man who presented in this way but multiple skin biopsies revealed that the bulk of his nodules were due to marked follicular hyperplasia as a result of folliculotropic mycosis fungoides. This clinical presentation may be best described as a pseudotumorous form of mycosis fungoides dominated by follicular epithelial hyperplasia rather than lymphocytic proliferation characteristic of true tumor stage disease. Similar presentations have been described as a verrucous and hyperplastic variant of mycosis fungoides due to the presence of prominent epidermal hyperplasia.展开更多
文摘Background: Urticarial dermatitis may represent a useful term for a subset of a reaction pattern designated most commonly as dermal hypersensitivity by pathologists. The term is not commonly used, and requires definition to determine whether it is clinically relevant. Objectives: To define urticarial dermatitis and distinguish it from other urticarial reaction patterns and to review the frequency with which dermatologists can recognize clinical settings that match the biopsy findings of urticarial dermatitis. Design: Retrospective analysis of clinical and/or histological diagnosis of urticarial dermatitis, applying strict histological criteria in a center using urticarial dermatitis as a diagnostic term in 190 archived reports. Setting: Tertiary referral dermatopathology service reporting for dermatological practices in Sydney, Australia. Main Outcome Measures: The correlation between clinical and histological diagnoses of urticarial dermatitis and alternate diagnoses was analyzed. The frequency of positive immunofluorescence findings for bullous pemphigoid was determined in a subset of patients with urticarial dermatitis in whom this test was ordered to exclude prodromal bullous pemphigoid. Results: Urticarial dermatitis was the histological diagnosis in at least 1 biopsy result in 148 patients, and matched the provisional clinical diagnosis in 49 (33.1% ) patients. Urticarial dermatitis was the only diagnosis provided in 21 patients. The main alternate clinical diagnoses provided were early bullous pemphigoid or dermatitis herpetiformis (47 patients [31.8% ]), dermatitis (39 patients [26.4% ]),drug reaction (35 patients [23.6% ]), urticarial vasculitis (24 patients [16.2% ]), and urticaria (12 patients [8.1% ]). In 91 patients with a clinical diagnosis of urticarial dermatitis, the histological diagnosis in at least 1 biopsy result was matched in 49 patients (53.8% ); other histological diagnoses included dermatitis (21 patients [23.1% ]), papular urticaria (12 patients [13.2% ]), drug reaction (6 patients [6.6% ]), and urticaria (3 patients [3.3% ]). Review of 38 direct immunofluorescent results for prodromal bullous pemphigoid and a biopsy finding of urticarial dermatitis revealed only 3 positive results (7.9% ).Conclusions: Urticarial dermatitis seems to be a useful histological and clinical term for a subset of the dermal hypersensitivityreaction pattern. Although the clinical presentation is not restricted to a specific entity, eczema and drug reactions seem to be the most frequent clinical associations; and in a subset of patients, urticarial dermatitis remains as a recognizable reaction pattern. Urticarial dermatitis without eosinophilic spongiosis is not a reliable indicator for bullous pemphigoid, because the findings of immunofluorescence are often negative.
文摘Background: Retinoids have the capacity to accelerate the involution ofmultiple keratoacanthomas, including unusual variants such as keratoacanthoma marginatum centrifugum and keratoacanthoma en plaque that may persist and be associated with progressive growth and provide difficulties in diagnosis and management. Observations: We describe 3 patients who had unusual infiltrated and keratotic plaques affecting the lower legs or nasolabial area that persisted or recurred that may be related to this group of unusual keratoacanthomas. The 3 patients had differing clinical lesions that did not resemble classic keratoacanthomas, but were linked by their biopsy findings of hypertrophic lichen planus-like reaction and pseudoepitheliomatous hyperplasia with a prominent infundibulocystic component that progressed to multiple keratoacanthomas or infundibulocystic squamous cell carcinoma. Polymerase chain reaction analysis of biopsy material from 2 patients failed to detect human papillomavirus. All 3 presentations provided a therapeutic dilemma, but responded rapidly to acitretin treatment at a dosage of 10 to 25 mg daily, which was continued for 15 to 24 months. Conclusions: These cases illustrate an unusual reaction pattern that is hypertrophic lichen planus-like but, instead of evolving to classic lichen planus, progresses to infundibulocystic hyperplasia and the development of multiple keratoacanthomas or infundibulocystic squamous cell carcinomas. Retinoids represent a therapeutic option for this difficult clinical problem and may obviate repeated and extensive surgery.
文摘Background. A 26-year-old male presented with a 3-year history of lichen am yloidosis. On examination, there was a pigmented papular eruption with a ripple pattern affecting the limbsandtrunkbutsparingtheaxillae,antecubitalandpopliteal fossae, central chest, neck and face. There was also prominent sparing of the sk in overlying the superficial veins of the limbs. The sparing of the superficial veins of the limbs by lichen amyloidosis raised the possible role of cutaneous t emperature in governing the distribution of amyloid deposits in our patient. Obs ervations. Total body infrared thermography demonstrated consistent sparing of t he amyloid deposits in areas with higher cutaneous temperatures such as the neck and axillae as well as the course of the superficial veins. The cooler areas su ch as the extensor surfaces of the arms and legs corresponded to areas of amyloi d deposition. Narrow band ultraviolet B (NBUVB) phototherapy over a 5-month per iod resulted in a marked improvement of pruritus and clearing of the amyloid dep osits. Conclusions. Our patient clearly demonstrated lichen amyloidosis in a the rmosensitive distribution. This may be a gross manifestation of previous reports of in vitro thermosensitivity of amyloid fibril formation and may have potentia l implications in treatment at least in a subset of patients demonstrating this clinical feature.
文摘Fungating nodules and infiltrated plaques are usually equated with advanced tumor stage mycosis fungoides. We report an 85- year- old man who presented in this way but multiple skin biopsies revealed that the bulk of his nodules were due to marked follicular hyperplasia as a result of folliculotropic mycosis fungoides. This clinical presentation may be best described as a pseudotumorous form of mycosis fungoides dominated by follicular epithelial hyperplasia rather than lymphocytic proliferation characteristic of true tumor stage disease. Similar presentations have been described as a verrucous and hyperplastic variant of mycosis fungoides due to the presence of prominent epidermal hyperplasia.
