Distinguishing histopathologic features of acantholytic dermatoses and the pattern of acantholytic hypergranulosis.

BACKGROUND: Acantholysis can be seen in multiple skin diseases. Adnexal acantholysis has been regarded as a feature distinguishing pemphigus vulgaris (PV) from acantholytic conditions. METHODS: A retrospective review of the histopathologic features of diseases with acantholysis including PV, pemphigus foliaceus (PF), Hailey-Hailey disease (HHD), Darier disease (DD), Grover disease, and pityriasis rubra pilaris (PRP) was performed. RESULTS: Biopsies of PV (n = 49), HHD (n = 27), DD (n = 25), Grover disease (n = 65), and PRP (n = 33) showed suprabasilar acantholysis. Acantholysis was limited to the lower epidermis in PV and PRP, and involved all epidermal layers in HHD, DD, and Grover disease. Acantholysis in PF (n = 38) mainly involved the upper epidermis. Follicular acantholysis occurred more frequently in PV and PF (P < 0.0001). Eccrine acantholysis was found in PV (42%), HHD (18%), PF (13%), and DD (4%). Grover disease, DD, and HHD had greater dyskeratosis (P < 0.0001). Neutrophils were more common in PV, PF, and HHD, while eosinophils were more common in Grover disease and DD. A pattern termed acantholytic hypergranulosis occurred predominantly in PF. CONCLUSION: Adnexal acantholysis does not reliably distinguish PV from PF. The level of acantholysis, degree of dyskeratosis, and acantholytic hypergranulosis are distinguishing features between the two types of pemphigus and other acantholytic disorders.

A profound case of linear epidermal nevus in a patient with epidermal nevus syndrome.

BACKGROUND: Epidermal nevus syndrome is a multi-system disease with a wide spectrum of clinical presentation. Numerous specialists may be required to address its extra cutaneous manifestations. MAIN OBSERVATIONS: We report a severe case of epidermal nevus syndrome involving the oral cavity, pharynx, and central nervous system in addition to disfiguring skin lesions. CONCLUSIONS: Dermatologists are in a unique position to first render the diagnosis of epidermal nevus syndrome for young patients and ensure appropriate follow-up.

A case report and discussion of cetuximab-induced folliculitis.

Use of human epidermal growth factor receptor inhibitors by oncologists has led to the occurrence of an acne-like eruption that is technically a folliculitis. Misidentification of the rash often leads to unfruitful treatment attempts as its morphologic features do not correlate well with its histologic findings. We describe a case history, diagnosis, and management of a man undergoing treatment with cetuximab for colorectal carcinoma who experienced the characteristic follicular eruption. Our patient responded well to daily moisturizers and 1% clindamycin gel and experienced near complete resolution of the rash. The evolving research and understanding of this unique entity are also discussed.

How misconceptions among elderly patients regarding survival outcomes of inpatient cardiopulmonary resuscitation affect do-not-resuscitate orders.

CONTEXT: On hospital admission, many elderly patients make the decision to enact a do-not-resuscitate (DNR) order. However, few studies have evaluated the beliefs of elderly patients regarding the likelihood of surviving cardiopulmonary resuscitation (CPR) if it should become necessary during their hospitalization. OBJECTIVES: To quantify elderly patients' beliefs about their chances of survival to discharge following CPR; to ascertain the sources of information that may lead to these beliefs; and to determine how these beliefs affect decisions regarding DNR orders. METHODS: An oral standardized survey was administered to 100 patients aged 70 years or older. Patients were randomly selected from the emergency department, internal medicine clinic, and general medical wards at one urban medical center. RESULTS: Most respondents (81%) believed that their chance of surviving inpatient CPR and leaving the hospital was 50% or better, and 23% of those respondents believed that their chance was 90% or better. Forty-four percent of patients reported having a standing DNR order. Most patients reported obtaining healthcare information from television, physicians, or both. CONCLUSION: Elderly patients often hold erroneous beliefs regarding the outcomes of inpatient CPR. A significant number of our participants had standing DNR orders despite demonstrating extremely optimistic beliefs about CPR. Educating patients and their families about these poor outcomes would allow them to make more informed decisions regarding end-of-life issues.