Liquen plano, variante pápulo-escamosa o clásica: afectación vulvar y extragenital / A lichen planus subtype papulo-squamous or classic: Vulvar and extragenital presence

Resumen: ANTECEDENTES: El liquen plano de vulva se manifiesta como una lesión erosiva, papuloeritematosa o hipertrófica aislada o con afectación extragenital concomitante. CASO CLÍNICO: Paciente de 41 años, sin antecedentes médicos de interés, que acudió a consulta por la aparición de lesiones cutáneas pruriginosas de dos meses de evolución. A la exploración se objetivaron múltiples pápulas eritematoescamosas, violáceas, hiperqueratósicas, concomitantes con fenómeno de Koebner y tendencia a la agrupación, ubicadas en la cara anterior de los antebrazos y las muñecas, el dorso del pie y el tronco; en los pliegues inguinales, región vulvar y perianal, y de forma asintomática en el surco interlabial izquierdo, una pápula no pruriginosa de 3 mm, de tonalidad violácea con reticulado blanquecino en la superficie (estrías de Wickham), y otras dos pápulas de 11 y 3 mm. Se estableció el diagnóstico de liquen plano pápulo-escamoso vulvar, variante hipertrófica cutánea. Puesto que la enfermedad aparece de forma espontánea, se decidió el tratamiento expectante y para el prurito se indicaron antihistamínicos por vía oral. Seis semanas después desaparecieron las lesiones cutáneas (sin cambios cicatriciales). CONCLUSIONES: En pacientes con procesos dermatológicos complejos se requiere la correcta anamnesis y exploración ginecológica, sobre todo cuando hay afectación de las mucosas, para evitar el infradiagnóstico. La biopsia de las lesiones es útil en caso de duda, sobre todo en las lesiones vulvares aisladas de tipo hipertrófico.

Abstract: BACKGROUND: Vulvar lichen planus is a subtype of dermatological pathology that is presented as erosive, papulo-erythematous, or hypertrophic lesions on the vulva. This lesion could appear in isolation or with concomitant extragenital involvement. CASE REPORT: A 41-year-old patient with no previous history of interest, who attended due to the onset of itchy skin lesions of two months of evolution. At medical examination, multiple erythematous squamous, violaceous, hyperkeratotic papules were observed, with Koebner phenomenon and a tendency to cluster at the forearms and wrists, dorsum of the feet and trunk. The same lesions were seen in inguinal folds, vulvar and perianal region. We also notice an asymptomatic non-itchy 3 mm papule with violet edge in left labia majora (it had a whitish reticulate on the surface called Wickham's striae) and other erosive papules 11 mm and 3 mm respectively, with violet edge. No vaginal or other mucosal lesions were seen. Diagnosis of vulvar papule-squamous lichen planus was established which coexists with a cutaneous hypertrophic form. Given the self-limited nature of this pathology, a wait-and-see approach and symptomatic treatment of pruritus with oral antihistamines was adopted. Six weeks later, disappearance of the cutaneous lesion without cicatricial areas was observed. CONCLUSIONS: It is essential to carry out an anamnesis and gynecological examination in dermatological preocedures, especially when mucosas are involvement to avoid under-diagnosis. The biopsy of the lesions will be useful when there are doubts in the diagnosis, and it is essential in isolated hypertrophic vulvar lesions.

Evaluation of Some common clinical factors in extensive vitiligo- a case control study

Introduction: Vitiligo is a common depigmenting disorder with profound stigma. Prevalence of vitiligo is 0.5% to 1%. Information about association of progressive vitiligo are well known. Prognostic factors of vitiligo also enlisted. However, little information is available on the risk factors for developing extensive vitiligo. Aims and Objectives: Aims of the study was to identify – factors which are associated with extensive vitiligo (involving more than 5% of the body surface area). The following risk factors were evaluated, Onset before 20 years of age, Duration of disease greater than 2 years, Presence of Koebner’s phenomenon, Family history of vitiligo, Presence of leucotrichia and Mucosal involvement. Materials and Methods: A case control study were designed. Patients with Vitiligo > 5% body surface area involvement were classified as cases and <5% body surface area were labeled as controls. The frequency of evaluating associated clinical factors among the cases and controls were used to evaluate the extensive vitiligo’s association with risk factors (disease risk associated exposure). Results: Two hundred and eleven patients were evaluated. The mean age at onset was 19.07+13.51 (+SD) years. Acrofacial vitiligo was the commonest type of vitiligo. Duration of disease more than 2 years, presence of Koebner’s Phenomenon, Family history, Symmetry of lesions, milky white colour of lesion, presence of Leucotrichia, mucosal involvement and Acrofacial type vitiligo had statistically significant (p<.05) association with extensive vitiligo. Ratio of the odds of the outcomes in two groups was noted significant with Duration of disease more than 2 years, Koebner,s Phenomenon, Mucosal involvement and Leucotrichia. Conclusion: This case-control study has demonstrated a weak association between extensive vitiligo and duration of disease greater than 2 years. It has also indicated that koebner’s phenomenon, mucosal involvement and leucotrichia are additional risk factors.

Multivariate Analysis of Factors Associated with the Koebner Phenomenon in Vitiligo: An Observational Study of 381 Patients

BACKGROUND: The Koebner phenomenon (KP) is a common entity observed in dermatological disorders. The reported incidence of KP in vitiligo varies widely. Although the KP is frequently observed in patients with viltiligo, the associated factors with KP has not been established yet. OBJECTIVE: The aim is to estimate the prevalence of KP in vitiligo patients and to investigate the associated factors with KP among vitiligo characteristics. METHODS: A cross-sectional observational study was conducted using 381 vitiligo patients. Demographic and clinical information was obtained via the completion of Vitiligo European Task Force (VETF) questionnaires. Patients with positive history of KP were extracted from this vitiligo database. Multivariate analysis was performed to assess associations with KP. RESULTS: The median age of cases was 24 years (range, 0.6~76). In total, 237 of the patients were male (62.2%). Vitiligo vulgaris was the most common type observed (152/381, 39.9%). Seventy-two percent (274/381) patients did not exhibit KP, whereas 28.1% (107/381) of patients exhibited this condition. Multivariable analysis showed the following to be independent factors with KP in patients with vitiligo: the progressive disease (odds ratio [OR], 1.82; 95% confidence interval [95% CI], 1.17~2.92; p=0.041), disease duration longer than 5 years (OR, 1.92; 95% CI, 1.22~2.11; p=0.003), and body surface area more than 2% (OR, 2.20; 95% CI, 1.26~3.24; p<0.001). CONCLUSION: Our results suggest that KP may be used to evaluate disease activity and investigate different associations between the clinical profile and course of vitiligo. Further studies are needed to predict the relationship between KP and responsiveness to therapy.

Relationship between the severity of isomorphic response at the donor site and the therapeutic effect of cultured melanocyte transplantation in patients with vitiligo / 中华皮肤科杂志

Objective To investigate the value of the severity of isomorphic response at the donor site in evaluation of the therapeutic effect of cultured melanocyte transplantation.Methods A total of 172 vitiligo patients,who received cultured melanocyte transplantation or non-cultured epidermal suspension transplantation at the Department of Dermatology of Hangzhou Third Hospital from May 2008 to August 2016 and developed isomorphic response at the donor site,were enrolled into this study.According to the area of isomorphic response,these patients were divided into 2 groups:incomplete isomorphic response group whose area of isomorphic response was less than the suction area,and complete isomorphic response group whose area of isomorphic response was equal to the suction area.The correlation between therapeutic effects of melanocyte transplantation and isomorphic response was analyzed.Results Of the 172 patients,83 had incomplete isomorphic response,and 89 had complete isomorphic response at the donor site.In the incomplete isomorphic response group,21 (25.3％) patients were cured,and 17 (20.5％) were markedly improved,while 4 (4.5％) patients were cured,and 11 (12.4％) were improved in the complete isomorphic response group.Additionally,the response rate was significantly higher in the incomplete isomorphic response group than in the complete isomorphic response group (45.8％ vs.16.9％,x2 =31.581,P ＜ 0.001).Furthermore,the duration of stable phase was also significantly longer in the incomplete isomorphic response group than in the complete isomorphic response group (18.5 ± 15.3 months vs.10.2 ± 7.3 months,t =4.581,P ＜ 0.001).Correlation analysis showed that the duration of stable phase,which was classified into 5 grades including 6-11 months,12-23 months,24-35 months,36-47 months and ≥ 48 months,was negatively correlated with the severity (incomplete or complete) of isomorphic response (rs =-0.322,P ＜ 0.001),but positively correlated with repigmentation rates of the skin lesions (rs =0.675,P ＜ 0.001).Conclusion The length of duration of stable phase is an important factor affecting the therapeutic effect of melanocyte transplantation in vitiligo patients with isomorphic response at the donor site,and the severity of isomorphic response can indicate the length of duration of stable phase and predict the therapeutic effect of melanocyte transplantation.

Relationship between the severity of isomorphic response at the donor site and the therapeutic effect of cultured melanocyte transplantation in patients with vitiligo / 中华皮肤科杂志

Objective To investigate the value of the severity of isomorphic response at the donor site in evaluation of the therapeutic effect of cultured melanocyte transplantation.Methods A total of 172 vitiligo patients,who received cultured melanocyte transplantation or non-cultured epidermal suspension transplantation at the Department of Dermatology of Hangzhou Third Hospital from May 2008 to August 2016 and developed isomorphic response at the donor site,were enrolled into this study.According to the area of isomorphic response,these patients were divided into 2 groups:incomplete isomorphic response group whose area of isomorphic response was less than the suction area,and complete isomorphic response group whose area of isomorphic response was equal to the suction area.The correlation between therapeutic effects of melanocyte transplantation and isomorphic response was analyzed.Results Of the 172 patients,83 had incomplete isomorphic response,and 89 had complete isomorphic response at the donor site.In the incomplete isomorphic response group,21 (25.3％) patients were cured,and 17 (20.5％) were markedly improved,while 4 (4.5％) patients were cured,and 11 (12.4％) were improved in the complete isomorphic response group.Additionally,the response rate was significantly higher in the incomplete isomorphic response group than in the complete isomorphic response group (45.8％ vs.16.9％,x2 =31.581,P ＜ 0.001).Furthermore,the duration of stable phase was also significantly longer in the incomplete isomorphic response group than in the complete isomorphic response group (18.5 ± 15.3 months vs.10.2 ± 7.3 months,t =4.581,P ＜ 0.001).Correlation analysis showed that the duration of stable phase,which was classified into 5 grades including 6-11 months,12-23 months,24-35 months,36-47 months and ≥ 48 months,was negatively correlated with the severity (incomplete or complete) of isomorphic response (rs =-0.322,P ＜ 0.001),but positively correlated with repigmentation rates of the skin lesions (rs =0.675,P ＜ 0.001).Conclusion The length of duration of stable phase is an important factor affecting the therapeutic effect of melanocyte transplantation in vitiligo patients with isomorphic response at the donor site,and the severity of isomorphic response can indicate the length of duration of stable phase and predict the therapeutic effect of melanocyte transplantation.

Reticulohistiocitosis multicéntrica de inicio súbito por quemadura solar / Multicentric reticulohistiocytosis, sudden onset after sunburn

Las reticulohistiocitosis son un grupo de enfermedades muy poco frecuentes que se caracterizan por la acumulación de histiocitos en piel y articulaciones principalmente. Se suelen asociar a condiciones y patologías muy variadas, predominantemente neoplasias. Presentamos un caso de inicio súbito luego de quemadura solar (AU)

Reticulohisticytosis is a group of diseases characterized by the accumulation of cells of histiocytic lineage primarily in the skin and joints. They have been associated with many conditions and diseases, mainly malignant neoplasms. A case of multicentric reticulohitiocytosis of sudden onset after sunburn is reported (AU)

Koebner Phenomenon Related to Cupping Therapy in a Patient with Psoriasis / 대한피부과학회지

No abstract available.

Koebner Phenomenon Related to Cupping Therapy in a Patient with Psoriasis / 대한피부과학회지

No abstract available.

The diagostic dilemma of oral psoriasis: a review

Psoriasis is chronic immunologically mediated inflammatory skin disorder affecting 1–3% of Swedish population. It is associated with impairments quality of life even in mild cases, while in severe cases it excess mortality .Oral manifestations of psoriasis are rare and has various clinical presentations which are often difficult to diagnose. Oral psoriasis is a rare entity that might be confused with other oral mucous membrane dermatoses; hence, it should be considered under differential diagnosis of oral mucous membrane disorders and confirmed histo-pathologically. The occurrences of cutaneous lesions along with oral lesions that are diagnosed histo-pathologically give definite diagnosis for oral psoriasis.

Sarcoidosis detected due to tattoo swellings in an Indian female.

A female patient presented with asymptomatic swellings in old blue-black tattoo marks of her forearms. On careful skin examination, few raised erythematous, circular plaques were also found on the non-tattooed skin on her back, about which she was unaware. The diagnosis of cutaneous and systemic sarcoidosis was confi rmed after classical histopathological fi ndings from skin lesions from her non tattooed back and from papulonodular tattooed lesions, ruling out other causes of granulomas and supported by a negative Mantoux test, raised serum angiotensin converting enzyme level, high resolution computed tomography thorax, etc. She responded well to oral steroid therapy. The importance of a careful skin examination, easy access provided by skin lesions in suspected cases of cutaneous/systemic sarcoidosis, the value of sudden tattoo changes in the diagnosis here and the possible contribution of tattoos toward the causation of cutaneous and/or systemic sarcoidosis are highlighted.

The Koebner Phenomenon in Erythema Multiforme after Getting Acupuncture and Cupping Glass Therapy / 대한피부과학회지

Since its first description in 1887 as the appearance of psoriatic lesions in the uninvolved skin of psoriatic patients as a consequence of trauma, the Koebner phenomenon has been described in numerous diseases. Several types of injury can trigger the Koebner phenomenon, such as physical injury, surgical wound, irritation, sunburn, or radiation therapy. In this report, we describe a 43-year-old woman who developed erythema multiforme which was accompanied by the Koebner phenomenon after getting acupuncture and cupping glass therapy. The purpose of the report is to broaden our awareness of the spectrum of injury that can trigger the Koebner phenomenon.

A Case of Lichen Nitidus with the Koebner Phenomenon Mimicking Lichen Striatus / 대한피부과학회지

Lichen nitidus is an uncommon, asymptomatic cutaneous shiny papular eruption and it can rarely show Koebner's phenomenon, which may clinically resemble lichen striatus. It is known that for such cases, the clinicopathological correlation is the most important factor for making the diagnosis and immunohistochemical staining for CD4, CD8 and CD68 can be helpful to differentiate these two diseases. We experienced a case of Koebner phenomenon, which clinically mimicked lichen striatus, in a patient suffering with lichen nitidus.

A Case of Eruptive Xanthoma Associated withType IV Hyperlipoproteinemia and Koebner Phenomenon / 대한피부과학회지

Type IV hyperlipoproteinemia is characterized by increased blood levels of the triglyceride form of the fat that makes up very low-density lipoproteins (VLDL). Eruptive xanthomas have been frequently observed in type I and V hyperlipoproteinemias but rarely observed in patients with type IV hyperlipoproteinemia. The Koebner phenomenon is the development of the isomorphic skin lesions in persons with certain skin diseases after an injury has occurred on skin of normal appearance. Although this response can develop in psoriasis, lichen planus, verruca etc., it has seldom been associated with eruptive xanthoma. We report a case of eruptive xanthoma with type IV hyperlipoproteinemia and Koebner phenomenon in a 28-year-old Korean male.

Recurrent Koebner Phenomenon in Psoriasis after Skin Grafts / 대한피부과학회지

The Koebner phenomenon, described by Koebner in 1876, represents the appearance of isomorphic skin lesions on the unaffected skin of patients suffering from certain skin diseases. The mechanism of the Koebner phenomenon is not yet clear, but cytokines such as basic fibroblast growth factor may be involved. Several types of injury can trigger the Koebner phenomenon, such as irritation, physical injury, surgical wound, and sunburn or radiation therapy. We report a case of recurrent Koebner phenomenon in psoriasis in a 27-year-old man, which developed after several skin grafts.

A Case of Psoriasis Developed by Koebner Phenomenon after Radiation Therapy / 대한피부과학회지

The Koebner phenomenon is the development of the isomorphic skin lesions in persons with certain skin diseases after an injury occurred on normal-appearing skin. This response can be developed in psoriasis, pityriasis rubra pilaris, verruca etc. Several types of injury can produce the Koebner phenomenon such as irritation, physical injury, surgical wound, and sunburn or radiation therapy. We report a case of psoriasis developed by Koebner phenomenon after radiation therapy and this is the first report in Korea.

Koebner phenomenon developed on skin grafts and flaps but not on graft donor site in a psoriasis patient / 대한피부과학회지

The Koebner phenomenon describes the appearance of new isomorphic lesions on otherwise normal-looking skin in response to trauma. A 42-year-old male presented erythematous macules and patches with silvery scales on left leg, right knee, and surgical wounds including skin grafts, flaps, and donor sites for flaps, but not on the donor site for split thickness skin graft. He had received surgical treatment for electrical burns on both arms 4 months before the skin lesions developed. The mechanisms of the phenomenon is not clear yet. We present evidence that local factors may be important in the development of the Koebner phenomenon.

A Case of Necrobiosis Lipoidica Diabeticorum with Koebner Phenomenon / 대한피부과학회지

The isomorphic response of Koebner is a well-known phenomenon commonly associated with psoriasis, but it has been also described in conjuction with a host of other disorders. However it has seldom been associated with necrobiosis lipoidica diabeticorum, a rare skin manifestation of diabetes mellicuts. In this report, we describe a 59-year-old woman who developed necrobiosis lipoidica diabeticorum on the left shin where a mosquito had bitten her 2 months ago. Four months ago, she was diagnosed as necrobiosis lipoidica diabeticorum on the right forearm and shin by biopsy and the lesions were improved with corticosteroids intralesional injection. The lesions were asymptomatic and had grown slowly. Histopathological findings showed a large palisading granulomas composed of histiocytes, epithelioid cells and areas of necrobiosis of collagen with multinucleated giant cells. Van Gieson stain showed decreased and fragmented elastic fibers and there were no deposits of mucin in the necrobiotic areas. The lesions were improved with triamcinolone acetonide intralesional injection and there was no recurrence during 4 months.

An Unusual Case of Sweet's Syndrome Associated with Myelodysplastic Syndrome / 대한혈액학회지

Sweet's syndrome, initially described in 1964 as acute febrile neutrophilic dermatosis by Sweet, is characterized by five cardinal feature: fever; neutrophilia; abrupt appearance of erythematous, painful, cutaneous plaque, primarily located on the upper extremities, head and neck; a dermal infiltrate of mature neutrophils; and a rapid response to steroid therapy. More than 500 cases of Sweet's syndrome have been documented since original description of Sweet, of which, approximately, 15~20 percent of published cases occurred in patient with hematologic malignancy. The authors describe an unusual case of Sweet's syndrome in a man, who affected with myelodysplastic syndrome (RAEB). A 56-year-old male patient admitted to Yonsei University, Medical Center because of sustained fever and cellulitis of right lower leg. With anemia and thrombocytopenia, the bone marrow study revealed myelodysplastic syndrome (RAEB). On 4th hospital day, with the development of pneumonia, he was treated with mechanical ventilation and broad spectrum of antibiotics. Although the treatment of pneumonia was successful, erythematous nodules, showing Koebner phenomenon and strong positive pathergy reaction, was appeared on the whole body (21st hospital day). Skin biopsy was taken. Under the diagnosis of Sweet's syndrome associated with myelodysplastic syndrome (RAEB), oral prednisolone 60mg/day was prescribed. The cuteneous lesions were regressed, but the brownish pigmentation was remained, till the patient discharged.