Loss of Aβ-nerve endings associated with the Merkel cell-neurite complex in the lesional oral mucosa epithelium of lichen planus and hyperkeratosis

The Merkel cell-neurite complex initiates the perception of touch and mediates Ap slowly adapting type I responses. Lichen planus is a chronic inflammatory autoimmune disease with T-cell-mediated inflammation, whereas hyperkeratosis is characterized with or without epithelial dysplasia in the oral mucosa. To determine the effects of lichen planus and hyperkeratosis on the Merkel cell-neurite complex, healthy oral mucosal epithelium and lesional oral mucosal epithelium of lichen planus and hyperkeratosis patients were stained by immunohistochemistry （the avidin-biotin-peroxidase complex and double immunofluorescence methods）using pan cytokeratin, cytokeratin 20 （K20, a Merkel cell marker）, and neurofilament 200 （NF200, a myelinated Aβ- and Aδ-nerve fibre marker） antibodies. N F200-immunoreactive （ir） nerve fibres in healthy tissues and in the lesional oral mucosa epithelium of lichen planus and hyperkeratosis were counted and statistically analysed. In the healthy oral mucosa, K20-positive Merkel cells with and without close association to the intraepithelial NF200-ir nerve fibres were detected. In the lesional oral mucosa of lichen planus and hyperkeratosis patients, extremely rare NF200-ir nerve fibres were detected only in the lamina propria. Compared with healthy tissues, lichen planus and hyperkeratosis tissues had significantly decreased numbers of NF200-ir nerve fibres in the oral mucosal epithelium. Lichen planus and hyperkeratosis were associated with the absence of Aβ-nerve endings in the oral mucosal epithelium. Thus, we conclude that mechanosensation mediated by the Merkel cell-neurite complex in the oral mucosal epithelium is impaired in lichen planus and hvperkeratosis.

Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis:A case report

BACKGROUND Staphylococcus aureus bacteraemia(SAB)is among the leading causes of bacteraemia and infectious endocarditis.The frequency of infectious endocarditis(IE)among SAB patients ranges from 5%to 10%-12%.In adults,the characteristics of epidermolytic hyperkeratosis(EHK)include hyperkeratosis,erosions,and blisters.Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cellmediated immunity.CASE SUMMARY We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases.After genetic tests,the skin disease was diagnosed as EHK.CONCLUSION A breached skin barrier secondary to EHK,coupled with inadequate sanitation,likely provided the opportunity for bacterial seeding,leading to IE and deepseated abscess or organ abscess.EHK may be associated with skin infection and multiple risk factors for extracutaneous infections.Patients with EHK should be treated early to minimize their consequences.If patients with EHK present with prolonged fever of unknown origin,IE and organ abscesses should be ruled out,including metastatic spreads.

Giant nipples and areola caused by hyperkeratosis:successful treatment by surgery

Introduction Hyperkeratosis of nipples and areola (HNA) is a benign skin disease with unknown etiology, and is sporadic and clinically rare. It was first described by Tauber in 1923, and characterized by verrucous hyper-keratosis and dark brown pigmentation of nipples and/or areola(1)Currently, the classification proposed by Levy-Franckel in 1938 is widely used[2], which divides HNA into three types accoding to its clinical mani-festations:TypeⅠis characterized by the extension of epidermis nevus, involving only unilateral nipple and/or areola. TypeⅡis mostly bilateral, involving nipples and areolae, and usually accompanied by other skin diseases, for example ichthyosis, acanthosis nigricans, Darier's disease, chronic eczema, allergic dermatitis, and skin T cell lymphoma. TypeⅢ is congenital or nevus-shaped, and mostly occurrs among 20 to 30 years old females, with involvement of bilateral nipples and/or areolae. Herein, we reported a female patient with hyper-keratosis of bilateral giant nipples and areolae, who was successfully treated by surgery in the Hospital for Dermatology.

Black hairy tongue syndrome

Black hairy tongue(BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient's re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Complications of BHT(burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Prognosis is excellent with treatment of underlying medical conditions. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment.

Verrucous carcinoma of the esophagus: A case report and literature review

Verrucous carcinoma of the esophagus is a variant of a squamous cell cancer. Our case is a 78-year-old male patient comes in with the dysphagia and weight loss, and on endoscopy(EGD) he is found to have an irregular intraluminal mass at the distal esophagus. With the deep EGD assisted biopsy, diagnosis of the verrucous carcinoma is made. Due to multiple co morbidities and possible infiltration to the pericardium, patient is taken for the esophageal stent placement and is being referred for the chemo-radiation treatment. The diagnosis can be very difficult to make with the superficial biopsies due to very non specific histological changes and requires very high clinical suspicion and deep mucosal biopsies are required for accurate diagnosis of the tumor. Chronic and local disease process is the main risk factor for the development of the verrucous carcinoma of the esophagus. Surgery is the treatment of the choice for the early stage tumor and advanced cases are treated with the palliation and possibly chemoradiation. The prognosis is usually guarded and needs long term follow up.

Epidermolytic acanthoma:A case report

BACKGROUND Epidermolytic acanthoma(EA)is a rare benign skin lesion,usually found in the genital area of men and women,with epidermolytic hyperkeratosis as its distinguishing histologic characteristic.It is commonly misdiagnosed as condyloma accuminatum,verruca,and seborrheic keratosis.Since this lesion is benign,treatment is not necessary.However,it is often misdiagnosed,and patients are likely to undergo incorrect counseling and unnecessary treatment,causing undue burden to the patient.This study seeks to increase awareness of this rare condition to prevent future misdiagnoses.CASE SUMMARY A 55-year-old man living with human immunodeficiency virus presented for anal cancer screening.His physical examination revealed a flesh colored papule at the anal margin.The initial differential diagnosis included molluscum contagiosum,anal condyloma,and basal cell carcinoma.The lesion was excised to obtain a definitive diagnosis and was discovered to be EA.CONCLUSION EA is often misdiagnosed due to its similarity to other dermatologic conditions.Careful examination and pathologic evaluation should be obtained to ensure proper diagnosis.

Papillon-Lefèvre Syndrome: A Case Report

Introduction:Papillon-Lefèvre syndrome(PLS)is an autosomal recessive disorder characterized by a diffuse palmoplantar hyperkeratosis and early periodontal destruction.Only a few PLS cases are reported by dermatological clinicians due to its rarity.Case presentation:The patient had also experienced recurrent episodes of swollen gums with premature loss of teeth.He is treated with multidisciplinary approaches.On follow-up,he continued to have recurrent gingival inflammation.Discussion:The etiopathogenesis of PLS is obscure and its management presents a special challenge,which call for in-depth studies that will reveal the complex interactions of genetic,immunologic,and microbiological factors involved in pathogenesis of PLS.Conclusion:PLS is a very rare genodermatosis with characterized palmoplantar hyperkeratosis.Dermatological clinicians should be aware of this rare clinical entity to promote its early diagnosis.