Progressive Cribriform and Zosteriform Hyperpigmentation: A Case Series and Review of the Literature / 대한피부과학회지

Progressive cribriform and zosteriform hyperpigmentation (PCZH) is a distinctive pigmentary disorder observed along the lines of Blaschko. Clinically, the lesions appear as uniformly tan, cribriform macular hyperpigmentation with a zosteriform distribution, without a history of rash, injury, inflammation, or other associated cutaneous or internal abnormalities. Histopathological specimens show increased melanin pigmentation in the basal cell layer with a complete absence of nevus cells. We report 8 cases of PCZH and review the literature on this peculiar disorder.

A Case of Malignant Melanoma with Zosteriform Skin Metastasis Arising in a Medium-sized Congenital Melanocytic Nevus / 대한피부과학회지

Zosteriform metastasis from malignant melanoma is a rare type of skin metastasis that shows cutaneous lesions including patches, plaques, and nodules along with dermatomes, and thus needs to be distinguished from herpes zoster skin infection. Although some authors have explained the mechanism of zosteriform metastasis, its pathogenesis remains unknown. Herein, we describe an 85-year-old woman with zosteriform metastasis of malignant melanoma arising in a medium-sized congenital melanocytic nevus.

A Case of Zosteriform Cutaneous Metastasis from Lung Cancer / 대한피부과학회지

Cutaneous metastasis is a relatively rare complication of internal malignancy and has been reported in 0.7% to 9% of all malignant cancers. It may be an important clue for undiagnosed malignancies or even the prognosis of primary cancers. Cutaneous metastatic cancers vary in type and are rarely presented with zosteriform distribution. The lung is one of the most common primary sites of zosteriform cutaneous metastasis. We describe a 52-year-old man with a prior history of lung cancer in whom zosteriform cutaneous metastasis developed along the right T4-5 dermatome on his trunk. This case highlights the importance of the differential diagnosis of cutaneous metastasis with zosteriform distribution and the need of skin biopsy in order to confirm the early diagnosis.

A Case of Progressive Cribriform and Zosteriform Hyperpigmentation / 대한피부과학회지

Progressive cribriform and zosteriform hyperpigmentation (PCZH) is a distinctive syndrome first described by Rower et al. in 1978. It characteristically presents as a single area of uniformly tan, cribriform macular pigmentation with zosteriform distribution. Further, it can histologically be characterized by increased melanin pigmentation in the basal cell layer with a complete absence of nevus cells, and a lack of a preceding history of skin rash, injury or inflammation or other associated cutaneous or internal abnormalities. We herein report a case of PCZH that had developed along the right abdomen, right flank area and right back area in a 26-year-old male. The histologic investigation revealed increased melanin pigmentation in the basal layer and a distinct lack of nevus cells.

A Case of Zosteriform Lichen Planus on the Right Scapular Area / 대한피부과학회지

No abstract available.

Zosteriform Atrophoderma of Pasini and Pierini / 대한피부과학회지

Atrophoderma of Pasini and Pierini is characterized by sharply demarcated, slightly depressed blue-brown plaques, arising within the areas of the normal skin. The lesions are usually symmetrically distributed on the trunk, particularly on the back, and to a lesser extent on the extremities. A 14-year-old boy developed well-demarcated depressed plaques in a zosteriform distribution, along the left side of his shoulder, back, and arm, without any symptoms. A biopsy taken from the border between the depressed plaque and the normal-looking skin on the back showed evident dermal atrophy with decreased dermal thickness and thickening of collagen bundles in the depressed plaque, compared to the normal-looking skin, which were consistent with atrophoderma of Pasini and Pierini. Herein, we report an unusual case of zosteriform atrophoderma of Pasini and Pierini.

Linear Hyperpigmentation Along the Blaschko's Line: A Clinicopathologic Study / 대한피부과학회지

BACKGROUND: Many pigmentary disorders can be manifested as linear streaks of hyperpigmentation, along the Blaschko's line. These include progressive cribriform and zosteriform hyperpigmentation (PCZH) and linear and whorled nevoid hyperpigmentation (LWNH). There have been debates on the universally accepted diagnostic criteria differentiating these disease entities. OBJECTIVE: To determine the clinicopathologic characteristics of hyperpigmentation along the line of Blaschko and to examine the acceptability of PCZH or LWNH criteria as a diagnostic tool for differentiating these diseases. METHODS: A retrospective study was conducted on 13 patients who presented with linear hyperpigmentation along the Blaschko's line. The patients' clinicopathologic characteristics were analyzed and matched with the PCZH/LWNH diagnostic criteria. RESULTS: Age of onset widely ranged from birth to 61 years, but predominantly before the age of 4 years. The male-female ratio was 1:1.2. Trunk was the most common site of involvement. Histologic examination commonly showed a basal layer hyperpigmentation in all patients and pigmentary incontinence was observed in 2 patients. Four patients who satisfied all the diagnostic criteria for PCZH also fulfilled the diagnostic criteria for LWNH, except for the timing of onset. An additional 4 patients satisfied all the diagnostic criteria for LWNH and also fulfilled the diagnostic criteria for PCZH, except for the timing of onset. Excluding the age of onset criteria, the other 3 patients fulfilled both diagnostic criteria for PCZH and LWNH. CONCLUSION: These results demonstrate that PCZH and LWNH should not be considered as a different disease entity and that supports the idea that these are part of the same disease spectrum.

Progressive Zosteriform Macular Pigmented Lesion / 대한피부과학회지

A progressive zosteriform macular pigmented lesion (PZMPL) is a chronic pigmentary dermatosis similar to progressive cribriform and zosteriform hyperpigmentation (PCZH), but characteristically accompanied by pruritus as a prodromal symptom and histologic findings, such as pigmentary incontinence. PZMPL was described by Simoes in 1980 and manifests a uniformly tanned macular pigmented lesion in a zosteriform distribution. PZMPL is usually preceded by multiple pruritic macular pigmentation in a part of the dermatome for a period of time. Despite the difficulty in differentiation among other pigmentary disorders with unilateral distribution, such as linear and whorled nevoid hypermelanosis, partial unilateral lentiginosis, and Becker's melanosis, PZMPL can be diagnosed by clinical symptoms and signs, the pattern of lesions, and histologic features. A 6-year-old Korean girl presented with unilaterally located brown macules and patches on the left side of the chest, arm, and back. From childhood, the pigmented macules appeared and coalesced into patches on the left back. The arm and chest lesions extended along the Blaschko's line in a zosteriform distribution. She had no history of previous skin diseases, injuries, or inflammation. The histologic findings revealed increased melanin pigment in the basal layer and focal pigmentary incontinence in the upper dermis. We report a rare case of PZMPL thought to be the same case reported by Simoes.

Multiple Unilateral Zosteriform Connective Tissue Nevi on the Trunk

Connective tissue nevus is not a true tumor, but rather a hamartoma involving various components of connective tissue. It presents as a slow-growing, painless, flesh-colored, or pink nodule or plaque that is evident from childhood. While any region of the body may be affected, there is a predilection for the trunk and extremities. A 20-month-old girl presented with three ipsilateral confluent popular plaques with zosteriform distribution that had formed over the previous 17 months on the left chest and abdomen. The patient remained asymptomatic. Unlike all previously reported cases demonstrating a single lesion, we report a connective tissue nevi in a child who presented with multiple unilateral zosteriform lesions, an unusual pattern of distribution without evidence of tuberous sclerosis complex.

Zosteriform Cutaneous Metastasis from a Gastric Adenocarcinoma / 대한피부과학회지

Skin metastases from internal malignancies are rare and have been reported in 0.7~9% of malignancies, most commonly from carcinomas of the breast, lung, colon, kidney, stomach, and melanoma. The common clinical manifestations of cutaneous metastases are nodular, inflammatory and sclerodermoid metastatic lesions. Other manifestations of skin metastasis include neoplastic alopecia, acute dermatitis like, en cuirasse, carcinoma erysipelatoides, carcinoma telangictatoides, and zosteriform. Zosteriform cutaneous metastases are very rare and may demonstrate vesicobullous, papular, and nodular lesions. In the previous reports, zosteriform metastasis was associated with melanoma, lymphoma, breast cancer, squamous cell carcinoma, colorectal carcinoma, respiratory carcinoma, and urinary tumors. We report the first case of a zosteriform cutaneous metastasis from a gastric adenocarcinoma in the Korean literature.

Zosteriform cutaneous metastases: A case report and brief review of literature.

A 56-year-old woman presented with painful erythematous, papulo-nodular lesions on the left side of the trunk in a dermatomal distribution of two-weeks duration. She had earlier undergone surgery for breast carcinoma and was receiving palliative chemo-radiotherapy, when seen by us. A diagnosis of zosteriform cutaneous metastases was made and biopsy was done from the representative lesion which showed chords and sheets of malignant cells. Majority of these cases in the past have been misdiagnosed as herpes zoster and were treated with antiviral drugs. Metastatic diseases should be considered in the differential diagnosis of zosteriform rash in elderly.

A Case of Zosteriform Piloleiomyoma / 대한피부과학회지

Cutaneous leiomyoma is a rare benign tumor that originates from the smooth muscles derived from arrector pili muscles, the media of dermal blood vessels and the dartos muscle of the scrotum, vulva or nipples. Piloleiomyomas usually occur in the second to third decades of life with an equal incidence in men and women. They can be solitary, but multiple lesions are seen in 80% of these patients. Although multiple leiomyomas are often grouped, unilateral zosteriform pilar leiomyoma is rare. We report here on a rare case of grouped piloleiomyomas that presented as a zosteriform pattern on the right trunk of a 59-year-old woman.

A Case of Zosteriform Kaposi's Sarcoma after Prednisolon Treatment / 대한피부과학회지

Kaposi's sarcoma is a rare lympho-angioproliferative neoplasm with four types of variants: classic, iatrogenic immunosuppressive drug-associated, AIDS-related and Africa-endemic Kaposi's sarcoma. Most immunosuppressive drug- associated Kaposi's sarcomas usually occur after a kidney transplant or after receiving immunosuppressive therapy. A 64-year-old female patient showed numerous purpuric nodules and smaller erythematous plaques on the right lower leg for three months. Previously, the patient was treated with an immunosuppressive drug for rapidly progressive glomerulonephritis for a five-week period. A skin biopsy was performed under the clinical diagnosis of Kaposi's sarcoma. We performed immunohistochemical staining and polymerase chain reaction to detect human herpes virus 8 (HHV-8). We report a case of iatrogenic immunosuppressive drug-associated zosteriform Kaposi's sarcoma that rapidly occurred five weeks after prednisolon therapy in a rapidly progressive glomerulonephritis patient.

A Case of Zosteriform Cutaneous Leiomyomatosis Widely Distributed on the Neck and Chest / 대한피부과학회지

Cutaneous leiomyoma is a benign tumor of smooth-muscle fibers. There are five types of cutaneous leiomyoma; multiple piloleiomyomas; solitary piloleiomyoma; solitary genital leiomyoma; solitary angioleiomyoma; and leiomyoma with additional mesenchymal elements. A 50-year-old woman had a 13-year history of variable sized painful eryhtematous papules and nodules on the left upper chest, shoulder, arm and back. These lesions were distributed in a zosteriform pattern and corresponded with the left fourth cervical and the left second thoracic dermatome. The histopathologic findings revealed typical piloleiomyoma. One case of zosteriform cutaneous leiomyoma has been reported in the Korean literature. However, the lesions of the case corresponded with two close dermatomes and developed widely. Such a case has never been reported in the Korean literature case.

A Case of Progressive Cribriform and Zosteriform Hyperpigmentation Associated with Becker's Nevus and Melanonychia / 대한피부과학회지

Progressive cribriform and zosteriform hyperpigmentation (PCZH) was first described in 1978 by Rower and his colleagues as having the following clinical characteristics: a single area of uniformly-tan, cribriform, macular pigmentation in a zosteriform distribution, an histologically mild increase of melanin pigment in the basal cell layer and complete absence of nevus cells, no preceding history of skin rash, injury or inflammation, onset after birth with gradual extension - age at onset was in the second decade of life, lack of other associated cutaneous or internal abnormalities. We hereby report an atypical case of PCZH in a 16-year-old boy, who presented with multiple, cribriform and zosteriform hyperpigmented lines on his right arm and leg. This is the first ever reported case which has an association with Becker's nevus and melanonychia.

A Case of Zosteriform Kaposi's Sarcoma / 대한피부과학회지

Kaposi's sarcoma is a neoplastic, vascular tumor involving the skin or internal organs. We report a case of a 72-year-old male who presented with multiple, grouped, purpuric papules, hemorrhagic bullae and nodules showing zosteriform distribution on the sole of his right foot. In our case, as in some of the cases from the literature, the patient was initially misdiagnosed clinically as having herpes zoster. Histopathologic findings revealed a diffuse infiltrate of small blood vessels and slit-like spaces extending through most of the dermis. Many of the spindle-shaped cells expressed factor VIII-related antigen, and human herpes virus 8 (HHV-8) DNA was detected by polymerase chain reaction (PCR) in paraffin-embedded tissue.

A Case of Zosteriform Kaposi's Sarcoma / 대한피부과학회지

Kaposi's sarcoma is a neoplastic, vascular tumor involving the skin or internal organs. We report a case of a 72-year-old male who presented with multiple, grouped, purpuric papules, hemorrhagic bullae and nodules showing zosteriform distribution on the sole of his right foot. In our case, as in some of the cases from the literature, the patient was initially misdiagnosed clinically as having herpes zoster. Histopathologic findings revealed a diffuse infiltrate of small blood vessels and slit-like spaces extending through most of the dermis. Many of the spindle-shaped cells expressed factor VIII-related antigen, and human herpes virus 8 (HHV-8) DNA was detected by polymerase chain reaction (PCR) in paraffin-embedded tissue.

A Case of Multiple Eccrine Spiradenoma with Zosteriform Distribution / 대한피부과학회지

Eccrine spiradenoma is a benign tumor which probably originats in the coil of the eccrine sweat gland. It usually presents as a solitary, slowly-growing, sometimes painful, reddish-brown, and intradermal or deeply subcutaneous nodule on the head and trunk. More than 97% of eccrine spiradenoma appear as solitary lesions. Occasionally, it may appear as multiple lesions, however they are rarely arranged in a linear or zosteriform distribution. A search of literature revealed only 17 internationally reported cases of linear or zosteriform eccrine spiradenomas, including 4 Korean cases. We herein present an unusual case of eccrine spiradenoma, showing multiple, large nodules with zosteriform distribution.

A Case of Zosteriform Lichen Planus / 대한피부과학회지

Zosteriform lichen planus is a rare variant of lichen planus, which shows lichenoid papules in a dermatomal arrangement. Unlike the linear lichen planus developing a linear pattern, zosteriform lichen planus forms a broader band that follows the dermatomes. A few cases of zosteriform lichen planus occurring on the site of healed herpes zoster have been reported, and were assumed to represent Wolf's isotopic response. However, even fewer cases have been reported that developed without any previous history of herpes zoster. We present a 32-year-old male patient who showed a hyperpigmented papuloplaques in a zosteriform arrangement along the right upper back, shoulder and arm without a history of herpes zoster.

A Case of Multiple Eccrine Spiradenomas with Zosteriform Distribution / 대한피부과학회지

Eccrine spiradenoma is clinically characterized by a slowly growing, deep-seated nodule occurring most frequently on the ventral surface of the body. It is solitary in 95% of cases. Rarely, multiple lesions may be present and may occur in a linear or zosteriform pattern. Until now only two cases of eccrine spiradenoma in zosteriform pattern have been reported in Korean literatures. A 19-year-old male presented with multiple, gray, macular lesions in a zosteriform distribution along his left subscapular area. These 10-years-old lesions gave him occasional paroxysmal pain. Two years later, the lesions became palpable in the subcutis and were diagnosed as eccrine spiradenoma by an excision biopsy. During the 4 years thereafter, the remaining lesions grew slightly and became symptomatic, which resulted in a second surgical removal. We report a rare case of multiple eccrine spiradenomas with zosteriform distribution with observation of 6 years course.