Alzheimer's disease identified in a patient with bullous pemphigoid by dementia screening scales

To the Editor:A 73-year-old man presented with erythemas on his trunk and limbs with significant itching,which he had experienced for 11 months[Figure 1A and 1B].Histological examination of his skin biopsy revealed sub-epidermal blister formation with eosinophilic and lymphocytic infiltration in the dermis.Direct immunoflu-orescence revealed the presence of a linear deposition along the basement membrane zone(BMZ).Indirect immuno fluorescence revealed that the patienfs serum was positive(titer≥1:320)for anti-BMZ antibodies.Anti-BP180 antibody was 102 U/mL.Based on these findings,a diagnosis of bullous pemphigoid(BP)was established.

Clinical Profile and Significance of Mucocutaneous Lesions of Primary Sjogren＇s Syndrome： A Large Cross-sectional Study with 874 Patients

Background： Mucocutaneous lesions are common features of primary Sjogren＇s syndrome （pSS）, but only a few studies have focused on them. To demonstrate the profile ofmucocutaneous lesions ofpSS and further explore their potential clinical significance, we perfermed a cross-sectional study on 874 patients. Methods： Demographic data, clinical manifestations, and laboratory results of 874 pSS patients were collected. Patients were divided into two groups according to the presence of mucocutaneous lesions. Differences in primary symptoms and systemic impairments between the two groups were analyzed. Results of laboratory tests were also compared alter excluding those who had taken corticosteroid from both groups. One-year follow-up was done, and occurrences of various new complications were compared. Results： Among the 874 pSS patients, 181 patients had mucocutaneous lesions, accounting for 20.7%. Multiple mucocutaneous manifestations were displayed, and the top four most common types of lesions were purpuric eruptions （39.8%）, urticaria （23.8%）, Raynaud＇s phenomenon （14.9%）, and angular stomatitis （9.9%）. Incidences of pulmonary interstitial fibrosis, pulmonary bullae, leukopenia, and anemia were significantly higher among patients with mucocutaneous lesions （P 〈 0.05）. Increase in lgG and decrease in C4 among patients with mucocutaneous lesions displayed statistical significance after excluding patients from both groups who had taken corticosteroid （P 〈 0.05）. Alter one-year follow-up, patients with mucocutaneous lesions presented a slightly higher incidence of new complications compared to those without. Conclusions： Mucocutaneous manifestations ofpSS patients were common and diverse. Patients with mucocutaneous manifestations had more systemic damages, higher level of IgG, and lower level of serum C4, suggesting a higher activity of the primary disease.

Hailey-Hailey disease with lichenoid lesions around the anus

To the Editor: Hailey-Hailey disease (HHD), first discovered by the brothers Howard and Hugh Hailey,[1]is a genodermatosis at intertriginous sites. Mutation of ATP2C1 on chromosome 3q21-2 coding a calciumdependent ATPase gives rise to calcium dysfunction within keratinocytes, resulting in acantholysis due to a signal transduction disorder.[2] It has been suggested that this gene mutation combined with irritation such as frequent friction, cold, and ultraviolet exposure leads to the development of HHD.[3]

Clinical and pathologic features and therapeutic management of eosinophilic fascitis

To the Editor:Eosinophilic fasciitis(EF)is a rare scleroderma-like syndrome of diffuse fascitis and eosino-philia with unknown etiology,and occurs almost equally in both sexes.At onset,the mean age of patients is 40 to 50 years.Pinal-Fernandez et al[1] and Jinnin and Yamamoto[2]proposed criteria for EF diagnosis,including sclerotic lesions,cutancous induration,and typical fascial thicken-ing with inflammatory infiltration.

Eosinophilic Pustular Folliculitis Associated with Cutaneous Angiosarcoma

To the Editor： A 64-year-old Chinese man had a 12-month history ofnonmetastatic primary scalp angiosarcoma [Figure 1a] that had been confirmed by skin biopsy [Figure I el. Immunohistochemical examination showed CD31-, CD34-, and D2-40-positive tumor cells [Figure lf-lh]. Extensive local excision and placement of a free skin graft was performed in December 2016.

Pityriasis Lichenoides et Varioliformis Acuta and Psoriasis Vulgaris： Mere Coincidence or a Rare Association？

To the Editor： A 23-year-old otherwise healthy male presented with diffuse, erythematous, nonpruritic papules on the trunk and extremities, which gradually developed over 1 month [Figure 1a and 1b]. The patient was afebrile and had no other systemic symptoms. His personal and family histories were unremarkable. He denied any drug intake or episode of infection before the onset. Head, hands, feet, and mucosa were spared. No lymphadenopathies were detected. Histopathological examination revealed full-thickness epidermal necrosis, parakeratosis, vacuolization of the basal layer, and superficial perivascular infiltration of lymphocytes and histiocytes in the dermis. Exocytosis was prominent, and intraepidermal red blood cells could be seen [Figure 1c]. A diagnosis ofpityriasis licbenoides et varioliformis acuta （PLEVA） was established. He was prescribed with oral prednisolone （30mg/d） for 2 weeks, and complete remission was obtained. A follow-up visit at 3 years later showed no evidence of recurrence of PLEVA.