Linear Focal Elastosis Following Striae Distensae: Further Evidence of Keloidal Repair Process in the Pathogenesis of Linear Focal Elastosis

Linear focal elastosis (LFE) is a rare dermal elastosis characterized by hypertrophic yellowish linear plaques and increased abnormal elastic tissues in the lumbosacral area. Although the pathogenesis of this disorder remains unknown, it may be associated with keloidal repair process (KRP) of elastic tissues in striae distensae (SD), because there have been some reported cases of LFE accompanied by SD. We herein report a 14-year-old boy with LFE following SD in the lumbar region. Our case supports the hypothesis of KRP in the pathogenesis of LFE. Immunohistochemical study for transforming growth factor-beta (TGF-beta) was negative. Therefore, we assume that the pathogenesis of KRP in LFE is different from that of keloid development, which is the TGF-beta signaling pathway.

Unilateral Nevoid Acanthosis Nigricans with a Submammary Location

Unilateral nevoid acanthosis nigricans (AN) is an exceedingly rare form of AN, which is a benign disorder of keratinization. The lesions of unilateral nevoid AN are distributed unilaterally while the histopathologic findings are similar to the common form of AN, and this is characterized by hyperkeratosis, papillomatosis and moderate acanthosis. A 19-year-old female presented with asymptomatic brownish pigmented plaques on the medial side of the left submammary area. Based on her clinical and histopathologic findings, a diagnosis of unilateral nevoid AN was made. She was treated with topical tretinoin and her skin lesions were almost cleared 9 months after her first visit to our clinic. Various previous reports have described the localization of this disorder, but there has been no previous case report with the clinical manifestations on the unilateral submammary area. Therefore, we herein report the first case of unilateral nevoid AN with an unusual submammary location.

Black Hairy Tongue Associated with Erlotinib Treatment in a Patient with Advanced Lung Cancer

Erlotinib is a tyrosine kinase inhibitor that acts on the epidermal growth factor receptor (EGFR). There have been many reports of the mucocutaneous side effects related to several EGFR inhibitors (EGFRIs). However, no case of black hairy tongue (BHT) associated with EGFRI has been reported. Herein, we report the first case of erlotinib-induced BHT in a 61-year-old man with advanced lung cancer. Considering recent use of EGFRIs worldwide, dermatologists should recognize the possible occurrence of BHT associated with EGFRIs such as erlotinib.

A Clinical and Histopathological Study of 27 Cases of Prurigo Pigmentosa / 대한피부과학회지

BACKGROUND: Prurigo pigmentosa is a rare recurrent inflammatory disease of the skin, and this is characterized by an abrupt onset of erythematous papules that usually resolve with leaving reticular hyperpigmentation. Although its incidence has increased in Korea as well as in the international community, there are few comprehensive studies on this malady in the Korean dermatologic literature. OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathological features of prurigo pigmentosa. METHODS: We reviewed all the medical records, photographs and histopathological slides of 27 patients who had been diagnosed with prurigo pigmentosa at 3 hospitals between 1998 and 2009. Additionally, we also reviewed the clinical findings of the 37 cases that have been reported in the Korean dermatologic literature. RESULTS: The ratio of males to females was 1:2.4 and the mean age of onset was 24.6+/-8.2 years old. Twenty six patients (96.3%) complained of pruritus that was usually moderate to severe and the most commonly involved site was the back (63.0%). Although all 27 patients presented with erythematous papules, the skin lesions were accompanied with reticulated hyperpigmentation in 17 patients (63.0%) at the time of diagnosis. Fourteen patients were treated with minocycline alone or in combination therapy, and two pregnant women were treated with topical steroid alone. The major microscopic features of the lesions of prurigo pigmentosa were mild to moderate acanthosis and spongiosis in the epidermis, extravasation of erythrocytes and a mild to moderate perivascular lymphohistiocytic infiltrate in the dermis. A neutrophilic infiltrate tended to be observed in the relatively early lesions rather than in the fully developed lesions. CONCLUSION: Clinicopathologic correlation and thorough long-term follow-up are necessary to establish a diagnosis of prurigo pigmentosa because a pathologic examination does not show pathognomonic features. Our data suggest that neutrophils may play a role in the pathogenesis of prurigo pigmentosa, based upon finding them in the early lesion and the efficacy of the agents that inhibit neutrophil function, such as dapsone or minocycline.

Actinic Granuloma Showing the Histopathologic Findings of Suppurative Granuloma / 대한피부과학회지

Actinic granuloma is a rare chronic granulomatous dermatosis that is characterized by the elastophagocytosis by multinucleated giant cells. This malady presents in middle-aged individuals and it manifests as asymptomatic papules or annular plaques in the sun-exposed area. There are four main histopathologic patterns of actinic granuloma, including the giant cell, necrobiotic, histiocytic and sarcoidal variants. However, there are no previously reported cases of actinic granuloma associated with the histopathologic findings of suppurative granuloma. We herein report on an unusual case of actinic granuloma that showed the histopathologic findings of suppurative granuloma in a 58-year-old female.

Two Cases of Hand-Foot Syndrome Induced by Sunitinib / 대한피부과학회지

Sunitinib (SU11248) is a novel orally administered small molecule that inhibits multiple receptor tyrosine kinases so that can block tumor growth and angiogenesis. It was approved on 2006, for the treatment of advanced renal cell carcinoma and gastrointestinal stromal tumor. Various cutaneous adverse reactions induced by sunitinib have been reported, including hand-foot syndrome. We report two cases of hand-foot syndrome induced by sunitinib for treatment of advanced renal cell carcinoma.

A Case of Benign Cephalic Histiocytosis / 대한피부과학회지

Benign cephalic histiocytosis is a rare non-Langerhans histiocytosis, which typically presents as a benign self-healing eruption of papules on the head and neck of infants and young children. We report the case of a 13-month-old boy who presented with many reticulated erythematous papules and macules on the face. The histologic examination showed relatively well-circimscribed band-like interstitial and perivascular infiltration of histiocytes, with vesicular nuclei and ample cytoplasms in the upper dermis. Immunohistochemically, the histiocytes were positive for CD68 while lacking expression of CD1a. Approximately 1 year after the first visit, the facial papules became flattened and hyperpigmented.

A Case of Palisaded Neutrophilic and Granulomatous Dermatitis on the Buttock / 대한피부과학회지

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon condition that has been reported under several different names in association with various disorders such as rheumatoid arthritis and systemic lupus erythematosus. We report a 60-year-old man with rheumatoid arthritis who presented with two, erythematous, asymptomatic nodules on the buttock. The histologic examination showed that degenerated collagen, neutrophilic dust, neutrophils, fibrin, and mucin were present in the centers of the palisades of histiocytes throughout the dermis. After initiation of intralesional steroid injections, the lesions improved. The lesions recurred 2 months later, but, as before, improved after treatment with intralesional steroid injections.