Elastolytic giant cell granuloma: clinic-pathologic review of twenty cases.

BACKGROUND: O'Brien described four histopathological patterns of actinic granuloma (AG). Since then, only single cases and a few series have been reported in the literature, most corresponding to cases of the giant cell type. METHODS: We reviewed all the cases diagnosed as AG or elastolytic giant cell granuloma (EGCG) in our department from 1988 until 2010. The biopsies were classified into the four patterns previously described. RESULTS: Giant cell pattern was found to be the most frequent (70% of the cases). In four cases, the biopsies showed more than one histopathologic pattern. All the lesions were located on sun-exposed areas or were related to chronic heat exposure. Diabetes mellitus was associated in 40 % of the cases. CONCLUSIONS: The giant cell pattern of EGCG is the most frequent. Some cases may share histopathologic features of more than one variant and thus, we consider they may be categorized as mixed patterns. Diabetes mellitus is the most common associated disease and should always be ruled out.

Cutaneous collagenous vasculopathy: description of two new cases in elderly women and review of the literature.

Cutaneous collagenous vasculopathy (CCV) is an idiopathic microangiopathy with characteristic histological findings. It was described in 2000, and 9 cases have since been described. Two women of 83 and 74 years consulted for long-standing telangiectasias. In case 1, they affected the limbs and trunk and in case 2 were located on the legs. Biopsies of these lesions showed dilated vascular structures whose walls were thickened due to deposition of eosinophilic hyaline material. The affected vessels were located in the superficial dermis in case 1, and in case 2 the reticular dermis was also affected. CCV is a microangiopathy of unknown etiology. Clinically it is indistinguishable from generalized essential telangiectasia and differs in its histology. CCV may be underdiagnosed, and some nonbiopsied cases of generalized essential telangiectasia may really be CCV. We contribute 2 new cases of this entity to help establish its clinical and epidemiological characteristics and make its etiology better known.

Granuloma annulare photoinduced by paroxetine.

Granuloma annulare (GA) is a benign granulomatous skin disease with several clinical manifestations and characteristic histological findings. GA located in photoexposed areas is a rare finding and its association to a drug-induced systemic photosensitivity is even less common. To the best of our knowledge, only one case of systemic drug photosensitivity manifesting as a GA has been reported. We describe a patient with systemic photosensitivity to paroxetine with clinical and histological manifestations of GA, which was confirmed by the photobiological study. The phototest revealed a reduction of the minimal erythematous dose for UVB while taking the paroxetine and its normalization after its withdrawal, which was accompanied by the clinical resolution of the skin eruption. The manifestation of systemic drug photosensitivity as a GA like in our case is exceptional.

Systemic photosensitivity due to Goji berries.

Systemic photosensitivity due to the intake of plants or herbal compounds is a rare phenomenon. Goji berries are widely used as a well-being and anti-aging remedy. In spite of this, only a few adverse reactions and no cases of photosensitivity have been reported to date. A 53-year-old male consulted due to a pruriginous eruption located on sun-exposed areas of 2 weeks of duration. He had been taking Goji berries and infusions of cat's claw herb for 5 and 3 months, respectively. Minimal erythema dose for UVB (MED-UVB) was diminished when the patient was taking these products, and became normal when they were withdrawn. Photoprovocation tests with Goji berries and cat's claw were performed. MED-UVB decreased after the intake of Goji berries, and was normal with cat's claw. We report the first case of systemic photosensitivity due to Goji berries.

Erythema multiforme photoinduced by paroxetine and herpes simplex virus.

Erythema multiforme (EM) is a self-limited skin disease, characterized by the abrupt onset of symmetric red papules that may evolve into target lesions often precipitated by an infection. Photosensitive erythema multiforme (PEM) is a rare disorder characterized by the distribution of the lesions on sun-exposed areas. It has been described at the sites of sunburn, following episodes of polymorphic light eruption or herpes labialis and in association with drugs. To our knowledge, PEM photoinduced by selective serotonin reuptake inhibitors has not been reported. We describe a patient who had two consecutive episodes of PEM related to two different triggers: paroxetine and HSV infection. In the first episode, systemic photosensitivity was confirmed with the photobiological study. UVB-MED was decreased when the patient was taking paroxetine and did not change after its substitution for duloxetine. However, it became normal after the withdrawal of both drugs, suggesting a cross-reactivity reaction. The UVB photopatch test with paroxetine was positive. The second episode occurred after a herpes labialis relapse. At that time, UVB-MED was normal.

Systemic photosensitivity due to a contraceptive patch.

Hormonal contraceptives are a known but rarely reported cause of photosensitivity. A 35-year-old female developed several episodes of a prurigionous papulovesicular eruption located on sun-exposed areas that resolved without scarring in days. She had been using a transdermal contraceptive (EVRA: norelgestromin and ethinyloestradiol) for 3 years, and once it was stopped, the patient became asymptomatic. She had another episode after the use of oral contraceptives (YAZ: ethinyloestradiol and drospirenone). The biopsy of the lesions showed a spongiotic dermatitis. Minimal erythema dose was diminished when the patient was using EVRA and YAZ and became normal when they were withdrawn. Phototesting with UVA, photopatch testing and blood porphyrins were normal. Antinuclear antibodies were 1/80 initially and were 1/320 6 months later. Anti-deoxyribonucleic acid antibodies, extractable nuclear antigens, anti Ro and Anti La were negative and no systemic symptoms had developed. When all hormonal contraceptives were stopped, the patient became asymptomatic. We report a case of systemic photosensitivity induced by the contraceptive patch. To the best of our knowledge, no other cases induced by transdermal contraceptives have been reported previously.