Pitiriasis liquenoide varioliforme aguda posterior al inicio de eritropoyetina / Acute varioliform lichenoid pityriasis following the initiation of erythropoietin

Resumen La pitiriasis liquenoide varioliforme aguda (PLEVA) pertenece a un grupo de enfermedades categorizadas como pitiriasis liquenoides, junto con la enfermedad febril úlcero-necrótica de Mucha-Habermann y la pitiriasis liquenoide crónica (PLC). Se caracteriza por la aparición aguda de múltiples pápulas eritemato-violáceas con posterior necrosis, discromía residual y cicatrices varioliformes. Dentro de las teorías patogénicas propuestas se encuentra el posible papel de agentes infecciosos, trastornos linfoproliferativos, complejos inmunes e incluso, asociación a medicamentos. Se presenta un casode una mujer adulta con un cuadro típico de PLEVA con confirmación histopatológica, cuyas lesiones aparecieron posteriormente al inicio de eritropoyetina.

Abstract Pityriasis lichenoides et varioliformes acuta (PLEVA) is part of a group of diseases clustered as pityriasis lichenoides, next to febrile ulceronecrotic Mucha-Habermann disease and pityriasis lichenoides chronica. It's characterized by a sudden onset of multiple erythematous and violaceous papules which develop necrosis, leaving residual dyschromia and varioliform scars. It's been hypothesized the possible role of infectious agents, lymphoproliferative diseases, immune complexes and drugs. We present the case of a woman with a typical PLEVA with histopathological confirmation, whose lesions appeared after therapy with erythropoietin.

Histopathological Features and Clinical Variants of Biopsy Confirmed Psoriasis Cases in a Tertiary Care Setting in Kerala.

Psoriasis is a chronic, immune mediated, relapsing, papulosquamous disease having a high prevalence. Since it affects other organ systems such as musculoskeletal system, gastrointestinal system and the eye, it can lead to considerable disability. Although only rarely life threatening, it has high morbidity due to its chronicity and absence of cure. MethodsThis study was conducted over a period of 2 years in the Department of Pathology, Medical College, Thiruvananthapuram. A total of 217 skin biopsy specimens in which a clinical diagnosis / differential diagnosis of psoriasis was made, was studied during this period. Results108 cases out of 217 which were histopathologically diagnosed as psoriasis were studied in detail. Male predominance was noted in the study population. The mean duration of disease in this study was 6.69 yrs. Fifty percentage of the patients had associated comorbidities with hypertension outnumbering others. Among male patients, 26 (32.5 %) had the habit of smoking. The most common presentation was as erythematous scaly plaques, with pruritus being the second most common presentation. Histopathology proved to be conclusive of psoriasis in all cases. Hyperkeratosis was seen in all cases which was the most consistent histopathological feature. Confluent parakeratosis which is one of the characteristic features of psoriasis was seen in 62 (57.4 %) cases with the rest being focal. Other epidermal features studied were papillomatosis, hypogranulosis, suprapapillary thinning, and basal mitotic figures. Spongiosis was seen in 83 (76.9 %), exocytosis of neutrophils in 66 (61.1 %) and Munro’s micro abscess in 42 (38 %) cases. Dilated blood vessel was the most common dermal change observed, seen in 105 (97 %). Lymphocytes were the most frequent upper dermal inflammatory infiltrate observed. Oedema was seen in 5 (4.6 %) of cases. ConclusionsPsoriasiform lesions pose diagnostic dilemma to the treating clinician. To provide a clear-cut diagnosis, histopathological evaluation is essential. It is also important to differentiate between the different variants of psoriasis in the context of treatment. It has an important role in the follow up of psoriatic patients.

Clinicopathological Correlate of Papulosquamous Skin Disorder in a Tertiary Health Care

Papulosquamous skin disorder is one of the frequently seen skin dermatoses; but due to clinical and morphological overlap, it is sometimes difficult to make a straight forward clinical diagnosis without histological confirmation. This study seeks to examine the level of correlation between clinical diagnosis and histological confirmation.Medical records of subjects diagnosed at the Dermatology clinic with papulosquamous skin disorder between January 2017and December 2019 were retrieved. Their bio data, clinical description of their lesions, clinical diagnosis and histopathological report were noted and analyzed with SPSS version 23of the 88 patients with clinical diagnosis of a papulosquamous skin disease, 62 had record of skin biopsy result; these were included in the data analysis. The mean age was 39.1± 13.8 years (age ranged from 3-64 years). Ratio of male to female was 1.7:1 Thirty-four 34 (54.8%) were clinically diagnosed as lichen planus, 25 (40.3%) as psoriasis, 1(1.6%) each as parapsoriasis, lichen nitidus and lichen simplex chronicus. Histopathological diagnosis was the same in 26 cases of lichen planus, 19 of psoriasis and for the above mentioned disorders.Common histological findings for lichen planus were acanthosis 88.5%, hyperkeratosis (30.8%), parakeratosis (3.8%), papillomatosis (61.5%), hypergranulosis (3.8%) and band-like lymphocytic infiltrate (57.7%). While acanthosis (68.4%), Elongated rete ridges (84.2%); band-like lymphocytic infiltrate (78.9%) and dermal dilated blood vessels (5.3%) were seen in psoriasis. In conclusion: We observed 77.4% accuracy in diagnosis of papulosquamous skin disorder

Analysis of clinical and pathological diagnoses of 29 987 skin biopsy samples in Peking Union Medical College Hospital / 中华皮肤科杂志

Objective To analyze the disease constitution,accuracy of clinical and pathological diagnoses of skin biopsy samples in Peking Union Medical College Hospital.Methods A total of 29987 patients subjected to skin biopsy were collected from Department of Dermatology,Peking Union Medical College Hospital from June 2010 to November 2018,and clinical and histopathological diagnoses of these skin biopsy samples were analyzed retrospectively.Results According to the results of histopathological diagnosis,confirmed diagnoses of these patients could be classified into 33 categories and 242 kinds.Common disease categories included epidermal tumors (2931 cases,9.77％),connective tissue diseases (2809 cases,9.37％),melanocytic tumors (2078 cases,6.93％),erythematous scaly pustular dermatoses (1376 cases,4.59％),lichenoid dermatoses (1291cases,4.31％),allergic or eczematous skin diseases (1282 cases,4.28％)and infectious skin diseases (1156 cases,3.86％).Common skin diseases included scleroderma (1887 cases,6.29％),pigmented nevus (1755 cases,5.85％),seborrheic keratosis (1136 cases,3.79％),eczema (1089 cases,3.63％),psoriasis (881 cases,2.94％),lichen planus (867 cases,2.89％),lupus erythematosus (638 cases,2.13％),pemphigus (549 cases,1.83％),and basal cell carcinoma (501 cases,1.67％).Poor consistency was observed between clinical diagnosis and histopathological diagnosis of lichen planus,bullous pemphigoid,granuloma annulare and hypereosinophilic dermatitis.Conclusions Common disease categories of the skin biopsy samples in Peking Union Medical College Hospital were epidermal tumors,connective tissue diseases,melanocytic tumors,erythematous scaly pustular dermatoses,lichenoid dermatoses,and allergic or eczematous skin diseases.Poor consistency was observed between clinical and pathological diagnosis in some skin diseases,and understanding of these diseases should be improved.

Therapeutic effect of Tripterygium wilfordii polyglycosides combined with doxycycline on palmoplantar pustulosis / 中国基层医药

Objective To study the efficacy of Tripterygium wilfordii polyglycosides combined with doxycycline in the treatment of palmoplantar pustulosis.Methods From June 2014 to November 2017,144 patients with palmoplantar pustulosis treated in the Second People's Hospital of Changzhi were selected and divided into three groups according to different treatment methods,with 48 cases in each group.The doxycycline group was treated with doxycycline.The Tripterygium wilfordii polyglycosides group was treated with Tripterygium wilfordii polyglycosides.The combination group was treated with Tripterygium wilfordii polyglycosides combined with doxycycline.The symptom score decline index (SSRI),clinical effect and changes of T lymphocyte subsets in peripheral blood were compared among three groups.Results The SSRI improvement rates of pustule,erythema,scab and pruritus in the combination group were 95.83％ (46/48),93.75％ (45/48),97.92％ (47/48),97.92％ (47/48),respectively,which were higher than those in the doxycycline group [72.92％ (35/48),70.83％ (34/48),75.00％ (36/48),77.08％ (37/48)] and the Tripterygium wilfordii polyglycosides group [83.33 ％ (40/48),81.25 ％ (39/48),85.42％ (41/48),89.58 ％ (43/48)],the differences were statistically significant (x2 =9.417,8.542,10.568,6.306,all P ＜ 0.05).The total effective rate of the combination group was 95.83％ (46/48),which was higher than that of the doxycycline group [66.67 ％ (33/48)] and the Tripterygium wilfordii polyglycoside group [81.25 ％ (39/48)] (x2 =5.285,P ＜0.05;x2 =1.771,P =0.076).There were statistically significant differences in CD4+,CD4+,CD4+/CD4+ among the three groups (F =3.854,4.856,5.019,P =0.017,0.024,0.030).Conclusion Tripterygium wilfordii polyglycoside combined with doxycycline can improve the clinical symptoms and T lymphocyte immune function in patients with palmoplantar pustulosis.

An Epidemiological Study Of 104 Cases Of Papulosquamous Disorders In South India

BACKGROUND: Papulosquamous disorder is heterogeneous group of diseases characterised by scaly papules and plaques. AIM OFTHE STUDY:To observe the recent trends in age and sex distribution ,co-morbidities and associated nail changes in a sample of patients with Papulosquamous disorders. MATERIALS AND METHODS:In a Tertiary care centre in Tamilnadu , 104 patients with Papulosquamous disorders were selected over a period of one year and studied clinically with special attention to nail changes. RESULTS: The male: female ratio was 1.2:1. Age group commonly affected was 31-45 years. Psoriasis was most common followed by Lichen planus and Pityriasis rubra pilaris. Pityriasis Lichenoides chronica and parapsoriasis were least common. 61.5% of the total patients had nail changes with nail pitting being the most common change. The common co-morbidities observed were diabetes mellitus, hypertension and atopy. . CONCLUSION: More detailed studies are required for effective management of this subset of skin disorders.

A Case Series of Esophageal Lichen Planus: An Underdiagnosed Cause of Dysphagia

Lichen planus (LP) is a chronic mucocutaneous inflammatory condition that typically affects middle-aged adults. Esophageal involvement in LP is rare and underrecognized, often leading to delayed diagnosis and treatment of LP. Herein, we describe three cases of esophageal LP (ELP) in clinically symptomatic patients with endoscopic lesions in the upper to mid-esophagus. This case series suggests that ELP is be more common than was previously thought and emphasizes that clinicians should have a high index of suspicion for this diagnosis, particularly when evaluating proximal esophageal lesions in patients presenting with dysphagia. The series also highlights the successful treatment of our patients with budesonide-honey slurry.

Are patients with lichen planus really prone to urolithiasis? Lichen planus and urolithiasis

ABSTRACT Purpose to investigate whether patients with lichen planus (LP) are really prone to urolithiasis or not. Patients and Methods We performed a prospective analysis of 40 patients diagnosed with lichen planus (LP) (group I), and 40 volunteers did not have LP before (group II). Participants were all checked for urolithiasis by radiological investigations. Blood samples were analyzed for biochemistry parameters including calcium and uric acid. 24-h urine samples were analyzed to investigate oxalate, citrate calcium, uric acid, magnesium, sodium and creatinine. Results Men/women ratio and mean age were similar between group I and II (p>0.05). A presence or history of urolithiasis was detected in 8 (20%) and 2 (%5) patients in group I and II, respectively (p<0.05). Hypocitraturia was the most common anomaly with 35% (n:14) in group I. The rate of hypocitraturia in group II was 12.5% (n:5) and the difference was statistically significantly different (p=0.036). In group I, hyperuricosuria and hyperoxaluria followed with rates of 27.5% (n:11) and 25% (n:10), respectively. The rate of hyperuricosuria and hyperoxaluria were both 5% (n:2) in group II and the differences were significant (p<0.05). Hyperuricemia was another important finding in the patients with LP. It was detected in 13 (32.5%) patients in group I and in 1 (2.5%) participant in group II (p=0.001). Conclusion According to our results, metabolic disorders of urolithiasis were highly detected in the patients with LP. However, similar to the etiology of LP, the exact reasons for these metabolic abnormalities in LP remain a mystery.

Reflectance confocal microscopy features of several common diseases manifesting as papules in children / 中华皮肤科杂志

Objective To evaluate the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of several common diseases manifesting as papules in children, including lichen nitidus, verruca planae, lichen striatus, milium, molluscum contagiosum and lichen pilaris. Methods A total of 579 children clinically characterized by papules were recruited into this study. RCM was used to observe lesions and perilesional normal skin. The RCM features of 6 diseases manifesting as papules were analyzed and compared. Results Based on RCM images, 236 patients were diagnosed with lichen nitidus, 70 with verruca planae, 123 with lichen striatus, 40 with milium, 53 with molluscum contagiosum and 57 with lichen pilaris. All the 6 diseases had typical RCM features. Concretely speaking, RCM images of lichen nitidus lesions showed infiltration of dense inflammatory cells and melanophages in enlarged dermal papillae. In RCM images of verruca planae lesions, cells in the granular and spinous layers were arranged in concentric circles, giving a rose cluster?like appearance. RCM images of lichen striatus lesions revealed focal swelling of stratum spinosum, absent or local liquifaction degeneration of basal cells, and clustering of a moderate number of inflammatory cells in the superficial dermis. In RCM images of milium lesions, well?circumscribed round or oval structures containing highly but nonuniformly refractive materials could be seen in the dermis. RCM images of molluscum contagiosum lesions showed intact cystoid structures containing highly refractive molluscum bodies. Lowly to moderately refractive cutin ? like materials were observed along with the dilation of hair follicle infundibula in RCM images of lichen pilaris lesions. In RCM images, the 6 diseases were distinguished mainly based on structural features(patterns and refractivity)of skin lesions shown by continuous vertical scanning. Conclusion RCM is of great value to the diagnosis of diseases manifesting as papules in children.

Pityriasis Versicolor (Tinea Versicolor) Due to Malassezia Furfur: A Case Report

A 22-year-old boy presented with 6 months history of asymptomatic hyperpigmented patches on the upper arms and trunk. Skin scrapings from the patches were subjected to 10% KOH wet mount which showed short, stout, blunt, curved hyphae and clusters of round yeast cells. Culture was put up on Sabouraud dextrose agar with olive oil overlay (SDA-0). Malassezia furfur was isolated from the culture. A diagnosis of Pityriasis versicolor was made which is an emerging fungal infection.

Hiperqueratose lenticular persistente / Hyperkeratosis lenticularis perstans

Doença de Flegel ou hiperqueratose lenticular persistente é uma doença rara, caracterizada por pequenas pápulas hiperceratóticas, assintomáticas, localizadas preferencialmente nos membros inferiores. Histologicamente, há hiperortoceratose, atrofia epidérmica e infiltrado inflamatório em banda. Os tratamentos, em geral, são ineficazes. Relatamos um caso em que as lesões biopsiadas não recidivaram após dois anos de seguimento.

Flegel's disease, also known as hyperkeratosis lenticularis perstans, is a rare skin disease characterized by small reddish-brown asymptomatic hyperkeratotic papules usually located on the lower extremities. The histopathological features are hyperorthokeratosis, epidermal atrophy and band-like inflammatory infiltrate in the superficial dermis. Treatment is generally ineffective. We report a case of hyperkeratosis lenticularis perstans that improved following excisional biopsy of the lesions.

Líquen estriado no adulto / Lichen striatus on adult

Líquen estriado é uma erupção inflamatória incomum, de etiologia desconhecida. Raramente acomete adultos, e é caracterizada pelo surgimento abrupto de pápulas coalescentes, em arranjo linear, usualmente em extremidades. A histopatologia mostra reação liquenóide envolvendo folículos e glândulas. Ocasionalmente há sobreposição com líquen plano linear e "blaschkitis", seus principais diagnósticos diferenciais. Relata-se um caso de mulher adulta com pápulas eritematovioláceas em região cervical e hemiface direitas, cuja correlação clínico-histopatológica permitiu o diagnóstico de líquen estriado. Os achados atípicos e a dificuldade diagnóstica são discutidos.

Lichen Striatus is an uncommon inflammatory skin eruption of unknown etiology. It rarely affects adults, and it is characterized by abrupt onset of coalescent papules, in a linear disposition, usually on the extremities. Histopathology shows lichenoid reaction involving follicles and glands. Occasionally, there is overlap with linear lichen planus and "blaschkitis", the main differential diagnoses. It is reported here the case of an adult woman with erythematous violaceous papules on the right side of the neck and face, diagnosed with lichen striatus by clinical and histopathological correlation. The atypical findings and the diagnostic difficulty are discussed.

A Case of Subacute Cutaneous Lupus Erythematosus That Simultaneously Presented with Papulosquamous and Annular Lesions / 대한피부과학회지

Subacute cutaneous lupus erythematosus (SCLE) includes the papulosquamous and annular-polycyclic variants that present with psoriasiform lesions and annular/polycyclic erythema, respectively. Most patients predominantly have either one or the other subtype, but it is rare that patients have a combination of both lesions. A 13-year-old boy had both erythematous, well-defined, annular-shaped patches and erythematous, ill-defined, hyperkeratotic scaly patches that were scattered on the entire body. Although his clinical manifestations seemed typical for SCLE, his laboratory findings were all negative for LE-specific autoantibodies, including ANA, anti-Ro/SS-A antibody, anti-La/SS-B antibody, anti-dsDNA antibody, etc. The characteristic histopathological features for lupus erythematosus and the granular deposition of IgG and C3 along the dermo-epidermal junction, as detected by direct immunofluorescence testing of lesional skin biopsy specimens, could lead us to the diagnosis of SCLE. We herein report on a case of SCLE that simultaneously presented with both papulosquamous and annular-shaped lesions.