Subject(s)
Botulinum Toxins, Type A , Dermatology , Hyperhidrosis , Neuromuscular Agents , Axilla , Botulinum Toxins, Type A/therapeutic use , Humans , Hyperhidrosis/drug therapy , Injections, Intradermal , Neuromuscular Agents/therapeutic use , Patient Satisfaction , Prospective Studies , Quality of Life , Treatment Outcome , United KingdomABSTRACT
BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering dermatosis associated with a number of neurological conditions, including idiopathic Parkinson's disease (IPD). Only 1 case of BP in a patient with multiple system atrophy (MSA) has been reported. CASES: We report 3 cases of men with probable MSA who developed bullous pemphigoid at a latency of 4-6 years from MSA symptom onset. CONCLUSIONS: Skin α-synuclein deposition in neurodegenerative conditions such as IPD and MSA may be a potential substrate for the exposure of BP-related antigens. Alternatively, central neurodegeneration may expose antigens as a substrate for cross-reactivity and BP pathogenesis. Our report suggests an association between BP and MSA, in addition to the previously documented association with IPD.
ABSTRACT
BACKGROUND: We present a distinctive type of acquired vascular proliferation, for which we propose the name of poikilodermatous plaque-like hemangioma. OBJECTIVE: The aim of this study was to summarize the clinical and histopathologic features in a case series of poikilodermatous plaque-like hemangioma. METHODS: Sixteen cases were identified from the routine clinical and referral practices of the authors. Clinical characteristics, including demographic details and clinical morphology, were collated. The salient histopathologic features, including immunohistochemical staining results, were summarized. RESULTS: The lesions were usually solitary erythematous-to-violaceous poikilodermatous plaques on the lower extremities and pelvic girdle, with an indolent clinical course. Mean age of affected patients was 72 (range 58-80) years, and there was a male predominance. Histology comprised a distinctive band-like proliferation of vascular channels suggestive of postcapillary venules within the superficial dermis with a background of fibrosis, edema, and loss of elastic fibers. Despite the clinical atrophic appearance, acanthosis was a frequent finding. LIMITATIONS: Retrospective study. CONCLUSION: Poikilodermatous plaque-like hemangioma is a distinctive and previously undescribed vascular proliferation defined by a constellation of consistent and reproducible clinical and histologic features.
