Tumorlike eosinophilic granuloma of the skin.

In 1952, Kuske reported on a patient with a peculiar tumor on the dorsum of the right hand; histological analysis revealed a dense dermal infiltrate with numerous eosinophils. Not aware of any similar case report in the literature, he coined the descriptive term "tumor-like eosinophilic granuloma of the skin." In 1995, a 55-year-old white man with cancer of the prostate presented with a 4-month history of two reddish-brown, solid skin tumors on his left forearm and on the right side of his abdomen, respectively. Histologic examination revealed a dense, superficial and deep, tumorlike dermal inflammatory infiltrate consisting mainly of eosinophils as well as neutrophils and in part epithelioid, in part foamy histiocytes. Flame figures were absent. Immunohistochemical analysis was negative for S-100 protein, whereas sporadic cells in the infiltrate were CD1a positive and many mononuclear-histiocytic cells reacted with MAC 387. Stains as well as cultures for bacteria, mycobacteria, and fungi were negative. The descriptive diagnosis of tumorlike eosinophilic granuloma of the skin was made. Seven weeks after prostatectomy, both tumors resolved spontaneously and so far has not recurred. In our opinion, this is the second report of Kuske's tumorlike eosinophilic granuloma of the skin. Perhaps tumorlike eosinophilic granuloma of the skin, eosinophilic ulcer of the mucosa, and transient eosinophilic nodulomatosis should be considered a mucocutaneous reaction pattern as is seen in cats. In humans, hypersensitivity reactions or atopy could emerge as an etiological link.

T cell involvement in persulfate triggered occupational contact dermatitis and asthma.

BACKGROUND: Ammonium and potassium persulfates may induce a variety of cutaneous and respiratory diseases. The precise underlying mechanisms, however, are unclear. OBJECTIVE: To describe a hairdresser, who developed contact dermatitis, rhinoconjuntivitis, and bronchial asthma of delayed onset after occupational exposure to hair bleaches containing persulfate salts and to provide evidence for a common T-cell mediated mechanism responsible for the clinical manifestations. METHODS: We performed skin testing, routine histologic and immunohistochemical examination of the skin reaction after prick testing, lymphocyte proliferation analysis, nasal challenge test, and pulmonary function testing. RESULTS: The causative role of bleaching powder and ammonium persulfate was demonstrated by case history, skin tests, and a nasal challenge test. Patch tests produced a delayed cutaneous reaction to ammonium persulfate confirming contact sensitization. Prick tests with bleaching powder and ammonium persulfate were negative at 15 minutes but revealed a late skin reaction with a papule at the prick sites after 24 hours. Histologic examination of this late reaction demonstrated a perivascular infiltration comprising predominantly T lymphocytes. Further, a significant proliferation of T cells to bleaching powder was reproducibly found by a lymphocyte proliferation analysis. Nasal challenge test with bleaching powder showed a significant reduction of air flow after 24 hours. CONCLUSION: Our findings suggest that immunologic mechanism with direct involvement of T cells may not only play an important role in the pathogenesis of the cutaneous but also in the respiratory and rhinoconjunctival reactions.

[Erythema elevatum diutinum. A rare dermatosis with a broad spectrum of associated illnesses]. / Erythema elevatum diutinum. Eine seltene Dermatose mit einem breiten Spektrum assoziierter Erkrankungen.

Erythema elevatum diutinum (EED) is a rare disease presenting with persistent red to yellow-brown papules or plaques which are mainly localized symmetrically on the extensor aspects of the hands and fingers, the elbows and the knees. The histology shows a leucocytoclastic vasculitis in early lesions and fibrosis of the dermis later on. Dapsone is the treatment of choice. Today, EED is usually assigned to the neutrophilic dermatoses in which an association with hematological disturbances is well documented. We report on a patient with EED and glioma WHO grade IV, a coincidence unreported hitherto. Additionally, we review the literature on diseases associated with EED.

Malignant atrophic papulosis.

We describe a 34-year-old woman presenting with a 1-year history of asymptomatic, atrophic papules disseminated mainly on the trunk. The clinical features were characteristic of malignant atrophic papulosis, and the histopathologic features were confirmatory. The etiology of this rare condition, described for the first time in 1941, remains unknown. Also the pathogenesis is still controversial. A vascular disorder has been postulated by most authors, primary inflammatory or thrombotic vascular changes as well as primary endothelial proliferation being often mentioned in the literature. In the present case, the biopsy specimen of a recent efflorescence showed these three alterations all together, making it impossible to identify conclusively the primary event. Thrombosis, being already noticed in such early lesions, is likely to be of pathogenic importance. Rheological therapy as described in the literature may therefore be the most appropriate. In the present case, the lesions came spontaneously to a standstill without drug therapy.

Kaposi's sarcoma as manifestation of immunosuppression in organ transplant recipients.

We report 2 patients, negative for human immunodeficiency virus (HIV) antibodies, who developed generalized Kaposi's sarcoma (KS), one 5 months after renal transplantation while receiving cyclosporin A and prednisone, and the other 24 months after heart transplantation while receiving cyclosporin A, azathioprine and prednisone. Reduction of the immunosuppressive therapy combined with chemotherapy and radiotherapy in both cases led to a remission of KS without development of transplant rejection.

[Angioma serpiginosum, a skin change along Blaschko lines?]. / Angioma serpiginosum, eine Hautveränderung entlang den Blaschko-Linien?

We present a 34-year-old woman with angioma serpiginosum on the medial aspect of the left thigh, extending to the groin and the lower abdomen, and on the volar aspect of the left forearm. In addition to the late onset, the distribution along the lines of Blaschko was a remarkable feature of this case. We therefore reexamined our recent cases of angioma serpiginosum. In 6 of 7 cases, the distribution indeed corresponded to the lines of Blaschko. Thus, we suggest adding angioma serpiginosum to the list of skin lesions that may follow the lines of Blaschko.

Livedo racemosa: a report of five cases.

We present 5 patients in whom the diagnosis of livedo racemosa gave rise to clinical and laboratory investigations revealing arterial disease of different etiologies. This presentation emphasizes the importance of not missing the clinical diagnosis of livedo racemosa.

Pigmentation following long-term bismuth therapy for pneumatosis cystoides intestinalis.

In the recent literature, only a few reports deal with generalized pigmentation caused by bismuth treatment. We report a patient developing generalized pigmentation of the skin and mucous membranes without further signs of chronic bismuth poisoning following long-term administration of bismuth for pneumatosis cystoides intestinalis. Bismuth deposits were documented in a skin biopsy.

Chronic cutaneous infection caused by Mycobacterium gordonae.

We report on a patient with a chronic nodular cutaneous infection histologically presenting with tuberculoid granulomas and growing Mycobacterium gordonae in culture from a biopsy. The lesions were treated surgically. M. gordonae is a potentially pathogenic environmental mycobacterium only rarely causing skin infections.

[Eccrine angiomatous nevus]. / Ekkrin-angiomatöser Nävus.

A case of eccrine angiomatous nevus in a 46-year-old woman is described. The histological examination revealed convolutions of eccrine sweat glands with no major structural abnormalities, and a closely related angiomatous component. Two components of this tumour are of special interest: the bone formation and a medium-sized artery with pathologic wall structure.

[Sneddon syndrome]. / Sneddon-Syndrom.

A 44-year-old female with Sneddon's syndrome, i.e. generalized racemose livedo and recurrent cerebrovascular disease, is presented. Significant levels of IgG anticardiolipin antibodies were found in her serum.

PIP: The entity of generalized livedo racemose and cerebrovascular bleeding disorders was introduced in 1965 by I. B. Sneddon describing 5 cases. it is not clear what role oral contraceptives and smoking play in the etiology of this syndrome. The case of a 44-year old multipara is described who had taken pills up to 1980 and smoked 5-10 cigarettes a day. In 1980 just before age 35 she suffered an apoplectic insult with hemisyndrome on the left side that she recovered from. An acute hypoglossal, and trigeminal paresis appeared on the left side. Computer tomogram showed a hypodense field in the area of both hemispheres of the brain. An audible mesosystolic click led to the diagnosis of suspecting cerebral embolism with mitral valve prolapse. Therapy was started with thrombocyte aggregation inhibitors. Although the prolapse could not be showed by echocardiography, the frontal mitral valve was slightly thickened. Another hospitalization in 1985 owing to a recurring attack of vertigo revealed higher blood pressure. She received betablocker treatment. In 1987 sudden weakness in the left arm and speech disorders ensued, and skin color alterations were manifest characteristic of generalized racemose livedo. Skin necrosis appeared on both toes. Sneddon syndrome was diagnosed, and full anticoagulation therapy was started with cumarin. The sensomotoric and speech symptoms receded only slightly. In 1988 a light cerebral insult occurred with the deterioration of the speech disorder. Laboratory finding showed immunoglobulin G (IgG) anticardiolipin antibodies (ACA) with 255 U/ml (normal range 0-10 U/ml), and normal IgM anticardiolipin antibodies with 8 U.ml (range of 0-10 U.ml). ACA has been detected in patients with lupus erythematosus and racemose livedo indicating the possible association of Sneddon syndrome with systemic lupus erythematosus.

[Extensive acrodermatitis chronica atrophicans involving the face]. / Ausgedehnte Acrodermatitis chronica atrophicans mit Gesichtsbefall.

We report on an 81-year-old woman suffering from extensive acrodermatitis chronica atrophicans with facial involvement. This unusual manifestation may be related to an immunodeficiency state in the course of multiple malignancies. The cutaneous lesions cleared significantly during an aminopenicillin therapy administered orally over 4 weeks.

[Roentgen ray-induced pemphigus vulgaris]. / Röntgenstrahleninduzierter Pemphigus vulgaris.

The pemphigus vulgaris lesions first developed in a 70-year-old man as a reaction to superficial X-ray treatment of solar keratoses on the forehead.

Metastatic eccrine sweat gland carcinoma: case report.

Eccrine sweat gland carcinoma is a rare malignancy of skin adnexa with potential aggressive growth and metastatic spread. We report here a case of eccrine carcinoma arising on a finger with widespread pulmonary metastasis. A brief synopsis of the pathological and clinical aspects of eccrine sweat gland carcinoma is presented and currently available therapeutic modalities are discussed.

[Removal of tattoos with the Nd:YAG laser]. / Entfernung von Tätowierungen mit dem Nd:YAG-Laser.

Irradiation of 20 tattoos using the Q-switched Nd:YAG laser (energy density 3-5 J/cm2, asymmetrical pulse shape with 50% energy output in 18 ns, spot size 3 mm in diameter) gave the impression that black ink tattoos can be completely removed without scarring. Some patients needed several treatments. The results continued to improve even some months after the irradiation. In preliminary experiments on excised tattooed and untattooed skin the non-Q-switched Nd:YAG laser had distinct burning effects. It was therefore not tested in patients. The results of chemical, physical, and histological examinations are discussed with special reference to toxic side-effects that might be induced by laser irradiation.

[Green lacewing larvae (Chrysopidae) as accidental ectoparasites of the human]. / Florfliegenlarven (Chrysopidae) als akzidentelle Ektoparasiten des Menschen.

The larvae of green lacewings (Chrysopidae) may occasionally attack man as temporary ectoparasites, causing papular reactions similar to those produced by gnat bites.

[Acquired cutis laxa (elastolysis generalisata)]. / Erworbene Cutis laxa (Elastolysis generalisata).

Following glomerulonephritis with subsequent anasarca and repeated penicillin treatments, generalized cutis laxa developed in a forty-year-old patient. Progressive signs of pulmonary emphysema appeared in the same period. Additionally, a monoclonal gammopathy was detected during extensive examination.

[Localized form of psoriasis of the erythema annulare centrifugum type with pustulation]. / Lokalisierte Form der Psoriasis vom Typ des Erythema anulare centrifugum mit Pustulation.

We report two cases of localized psoriasis of the erythema anulare centrifugum-type with pustulation. Problems of nosological classification and histological differentiation are discussed.