ABSTRACT
Background@#Psoriasis and seborrheic dermatitis are difficult to distinguish if the lesion is localized to the scalp. @*Objective@#To validify the use of langerin and CD1a as markers of Langerhans cells to distinguish scalp psoriasis from seborrheic dermatitis. @*Methods@#We retrospectively evaluated 25 seborrheic dermatitis cases and 17 psoriasis cases diagnosed at a tertiary medical center in Korea from 2010 to 2019. The histopathological features and expression of CD1a and langerin were analyzed by dermato-pathologists. @*Results@#Hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound were observed more frequently in the psoriasis group than in the seborrheic dermatitis group (p=0.016, p=0.027, and p=0.021, respectively). Other features examined did not show statistically significant differences. Dermal expression of langerin occurred more frequently in the psoriasis group than in the seborrheic dermatitis group (76.5% vs. 36.0%, p=0.010). Additionally, stronger CD1a dermal expression was observed in the psoriasis group than in the seborrheic dermatitis group (p=0.049), although the difference in overall dermal CD1a expression regardless of strength was not significant. In contrast, the epidermal expressions of CD1a and langerin did not show significant differences. Similarly, the follicular expressions of CD1a and langerin did not demonstrate significant differences. @*Conclusion@#In this retrospective study, histopathological findings that favored psoriasis over seborrheic dermatitis included hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound. The use of Langerhans cells, CD1a, and langerin as markers could help distinguish scalp psoriasis from seborrheic dermatitis.
ABSTRACT
Background@#Psoriasis and seborrheic dermatitis are difficult to distinguish if the lesion is localized to the scalp. @*Objective@#To validify the use of langerin and CD1a as markers of Langerhans cells to distinguish scalp psoriasis from seborrheic dermatitis. @*Methods@#We retrospectively evaluated 25 seborrheic dermatitis cases and 17 psoriasis cases diagnosed at a tertiary medical center in Korea from 2010 to 2019. The histopathological features and expression of CD1a and langerin were analyzed by dermato-pathologists. @*Results@#Hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound were observed more frequently in the psoriasis group than in the seborrheic dermatitis group (p=0.016, p=0.027, and p=0.021, respectively). Other features examined did not show statistically significant differences. Dermal expression of langerin occurred more frequently in the psoriasis group than in the seborrheic dermatitis group (76.5% vs. 36.0%, p=0.010). Additionally, stronger CD1a dermal expression was observed in the psoriasis group than in the seborrheic dermatitis group (p=0.049), although the difference in overall dermal CD1a expression regardless of strength was not significant. In contrast, the epidermal expressions of CD1a and langerin did not show significant differences. Similarly, the follicular expressions of CD1a and langerin did not demonstrate significant differences. @*Conclusion@#In this retrospective study, histopathological findings that favored psoriasis over seborrheic dermatitis included hyperkeratosis, parakeratosis, and the presence of neutrophils in the parakeratotic mound. The use of Langerhans cells, CD1a, and langerin as markers could help distinguish scalp psoriasis from seborrheic dermatitis.
ABSTRACT
Friction melanosis (FM) is an acquired pigmented disease that is caused by recurrent mechanical stress. There is no previous report explaining the presence of tiny brown-colored particles confined to the corneal layer. We describe a case of a rare form of FM of the finger that showed a relatively transient clinical course. A 17-year-old Korean female presented with a 5-month history of an asymptomatic localized hyperpigmented patch on the tip of the right index finger. The dermoscopic examination revealed homogenous globular pattern, which favored pigmentation over hemorrhage. Histopathologically, hyperkeratosis and acanthosis with lymphohistiocytic infiltration of the superficial dermis were noted on hematoxylin and eosin staining; however, there was neither a definite increase in melanophages in the upper dermis nor melanocytic proliferation in the basal layer. Per high-power field, multiple brown-colored tiny particles were scattered in the corneal layer. The particles were not dyed by Fontana-Masson stain, iron stain, and S-100. We questioned the patient about the presence of irritation and found that she had bought new shoes at the time of the onset. She was habituated to placing her fingers in her shoes while wearing them because they were slightly tight. The lesion disappeared spontaneously a week after the cause of friction was eliminated.Altogether, we encountered a rare form of FM that occurred in a rare location with a transient clinical course. Further cases on pigmentation restricted to finger tips might reveal the origin of the particles.
ABSTRACT
Benign cephalic histiocytosis is a rare subtype of non-Langerhans cell histiocytosis of unknown etiology. It usually occurs in infants and children and resolves spontaneously. A 14-month-old infant presented with multiple papules on his face, trunk, as well as upper and lower extremities. Histopathological examination of a biopsy specimen showed diffuse proliferation of histiocytes in the dermis with scattered lymphocytes and eosinophils. Immunohistochemical evaluation showed cells that were immunonegative for S-100 and CD1a but strongly immunopositive for CD68.Benign cephalic histiocytosis usually affects the head and neck areas and rarely spreads to other sites. Some reports in the available literature have described an association between juvenile xanthogranuloma and neurofibromatosis type 1; however, the association, if any, between benign cephalic histiocytosis and neurofibromatosis type 1 is unclear. We report a rare case of benign cephalic histiocytosis in a patient with a family history of neurofibromatosis type 1.
ABSTRACT
A 31-year-old Korean man presented with a 6-month history of a painful nodule on his neck. Excisional biopsy was performed for diagnosis and treatment. Histopathological evaluation of the resected specimen revealed well-demarcated vascular proliferation with adipose tissue in the dermis, and the patient was diagnosed with cutaneous angioleiomyoma with fat modulation. To our knowledge, angioleiomyomas most commonly occur on the extremities, and the head and neck are rarely involved. Few cases of cutaneous angioleiomyomas of the neck have been reported in the literature. We report a rare case of cutaneous angioleiomyoma of the neck.
ABSTRACT
Wolf’s isotopic response refers to the occurrence of a novel skin disease at the site of a preceding treated or untreated skin disease. Although the most common preceding skin disease was found to be herpes zoster (HZ), HZ-related dermatological phenomena are not well known in the literature. We report a case of HZ granulomatous dermatitis in a 77-year-old female with a previous history of hypertension, diabetes mellitus, chronic kidney disease, and HZ. She presented with a 3-month history of a pruritic skin lesion on her right thigh. The location of the lesion was consistent with a previous HZ site. Histopathological examination revealed lympho-histiocytic infiltration in the superficial dermis, forming a granulomatous structure. Based on clinical and histopathological findings, we made a diagnosis of granulomatous dermatitis at a previous HZ site. We assumed that the lesion arose from an isotopic response of Wolf. The patient was treated with topical steroids for 3 months and showed clearance of the lesion and symptom. We suggest that treatment should be based on the individual disease, which in our case was topical steroid.
ABSTRACT
Fungal melanonychia is typically associated with onychomycosis and is known to be a relatively uncommon nail disorder. The known pathogens causing fungal melanonychia include both dematiaceous and non-dematiaceous fungi. Here we describe the case of a 60-year-old man with a 1-year history of nail discoloration in both index fingers. The possibility of subungual neoplasm was excluded by histological examination. Subsequent mycological examination revealed the presence of Cladosporium species in the lesion. The patient was successfully treated with oral itraconazole.
ABSTRACT
Patients presenting with green nail syndrome often show coinfection with fungus. A delay in the accurate diagnosis of coinfection may warrant longer treatment duration. Four patients with green nail syndrome coinfected with fungus were reviewed retrospectively. Fungal culture, cultivating Candida parapsilosis and Candida albicans, was performed in two patients' samples. The mean time of the initiation of treatment for onychomycosis after the first visit was 5.75 weeks. If green nail syndrome is suspected, screening for fungal coinfections and precise management are necessary.
ABSTRACT
A 19-year-old woman presented with an asymptomatic cutaneous discoloration on her nape. Dermatological examination revealed localized dark brown to dark pigmented velvety macules and patches. She denied a past medical history, except for a 7-kg weight gain over a 6-months period. Histopathologically, the specimen showed hyperkeratosis, epidermal hyperplasia, mild acanthosis, and papillomatosis. In addition, keratin material and fungal spore were noted between the papilloma ridges. Periodic acid-Schiff special stain showed a positive result for the fungal spore in the horny layer. She was treated with a daily oral dose of terbinafine and topical flutrimazole. After 12 weeks of treatment, she is currently under observation without pigmentation and adverse effect. We considered the initial diagnosis as acanthosis nigricans because of weight gain, similar clinical features, and histological findings. However, the final diagnosis was hyperkeratotic head and neck Malassezia dermatosis considering the presence of yeast and the dramatic improvement after antifungal treatment. To the best of our knowledge, hyperkeratotic head and neck Malassezia dermatosis is not well characterized in the literature. It is an unusual variant of pityriasis versicolor. The skin lesion appears brown to dark, scaly, and hyperkeratotic macules and patches located on the face and neck. Here, we reported an unusual case of hyperkeratotic head and neck Malassezia dermatosis.