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1.
JAAD Int ; 15: 38-43, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38371672

RESUMO

Background: Mast cells (MCs) have recently been implicated in lymphocytic scarring alopecias, which may share a common pathogenesis. MCs in central centrifugal cicatricial alopecia (CCCA) have not been studied. Objective: We looked for the presence of MCs in CCCA using 2 different stains to see if their numbers correlated with the number of hair follicles, the degree of inflammation and perifollicular fibrosis, disease duration and severity, and patient symptoms. Methods: We performed a retrospective review of biopsies of patients diagnosed with CCCA, tabulated MC counts and correlated them with histopathologic and clinical findings. Results: MC counts were significantly greater using immunoperoxidase staining with CD117 than Giemsa stain, and more were present when the isthmus level was included with the infundibulum. MC counts with CD117 immunostain significantly correlated with the degree of inflammation. MC counts with both stains were significantly associated with the degree of fibrosis independently and after controlling for other factors. Limitations: The study was limited by insufficient tissue remaining in a small number of the transversely cut blocks. Conclusion: Our findings may have therapeutic implications for CCCA and other types of lymphocytic scarring alopecia.

2.
Am J Dermatopathol ; 46(1): 50-53, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-38086086

RESUMO

ABSTRACT: A case of 67-year-old male patient with superficial papular neuroma (SPN) on the occiput is reported. This is the second report of SPN and the first with clinical images. Histologically, in the superficial dermis and periadnexa, the specimen exhibits a nodule of bland spindle cells with an S-shaped and spindle nucleus, surrounded by eosinophilic collagen fibers and scattered mast cells, which forms focally peripheral nerve-like structures. Lichen simplex chronicus-like changes are observed. Immunostaining result revealed that the tumor cells are positive for S-100, neurofilament, collagen IV, and CD34 but negative for Melan A, epithelial membrane antigen, and glial fibrillary acidic protein. Histological differential diagnosis includes prurigo nodularis, neurotized nevus, benign peripheral nerve sheath tumor, such as neurofibroma or schwannoma, a type of neuroma, such as traumatic neuroma, mucosal neuroma, and palisaded encapsulated neuroma, or a type of neural hamartoma. A careful histological investigation will enable dermatopathologists to make a diagnosis of SPN.


Assuntos
Neoplasias de Bainha Neural , Neurilemoma , Neurofibroma , Neuroma , Masculino , Humanos , Idoso , Neuroma/patologia , Neoplasias de Bainha Neural/patologia , Neurilemoma/patologia , Neurofibroma/patologia , Proteínas S100 , Colágeno
3.
J Am Acad Dermatol ; 89(2S): S1-S2, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37591559

RESUMO

Hair loss is devastating to the patient, but the diagnosis and treatment of alopecia are also difficult for primary care providers and even dermatologists. Given recent advances in the field, there has never been a more pressing time to reevaluate and improve upon the significant clinical skills needed to accurately diagnose and treat our patients with hair loss. This CME activity on alopecia is designed to (1) educate dermatologists in a simple, succinct fashion on the identification of, and the distinction between, the diverse types of hair loss and (2) discuss how to manage them.


Assuntos
Alopecia , Competência Clínica , Humanos , Alopecia/diagnóstico , Alopecia/etiologia , Alopecia/terapia
5.
J Cutan Pathol ; 49(11): 988-992, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36222212

RESUMO

BACKGROUND: Sebaceous gland (SG) atrophy is well-documented in scalp lesions of psoriasis and has been considered as an important clue to psoriatic alopecia. However, its specificity for psoriasis has been questioned over the years. We hypothesize that SG atrophy is not specific for psoriasis and looked for its presence in biopsies of seborrheic dermatitis of the scalp. METHODS: We conducted a retrospective study of biopsy specimens of clinically suspected and histopathologically proven seborrheic dermatitis of the scalp for changes in SGs between January 1, 2014 and August 6, 2021. RESULTS: SGs lobules were smaller and narrower in five of the six cases of seborrheic dermatitis, and SG atrophy was present in four out of six cases. CONCLUSIONS: SG atrophy is observed in seborrheic dermatitis and is not specific for psoriasis or psoriatic alopecia.


Assuntos
Dermatite Seborreica , Psoríase , Alopecia/patologia , Atrofia/patologia , Dermatite Seborreica/patologia , Humanos , Projetos Piloto , Psoríase/patologia , Estudos Retrospectivos , Couro Cabeludo/patologia , Glândulas Sebáceas/patologia
6.
Skin Appendage Disord ; 8(5): 431-434, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36161076

RESUMO

Introduction: Alopecia areata (AA) is a type of nonscarring alopecia that has autoimmune etiology, in which the hair follicle, usually an immune-privileged site, becomes the target of attack. Alopecia totalis (AT) is a subset of AA in which patients completely lose hair on the scalp. Initial hair regrowth is often fine and without pigment. We present a case of AT in which pigmented hair grew only overlying superficial veins, a finding which has not been previously reported. Case Presentation: An adult female with brown hair presented with AA that progressed to AT despite the use of triamcinolone ointment and topical 2% tofacitinib ointment. She was treated with nightly augmented betamethasone dipropionate 0.05% ointment under occlusion. Two months later, she noticed diffuse regrowth of thin hair on her scalp, most of which was depigmented. However, linear bands of darkly pigmented hairs were noted overlying superficial scalp veins. Discussion/Conclusion: Loss of pigmentation and subsequent repigmentation of the hair shaft in regrowing AA is not entirely understood. Initial hair regrowth in AA tends to be fine and depigmented, although the hair will usually regain normal texture and color. Pigmentation following a vein suggests that local temperature may play a role, possibly augmented by corticosteroid induced reduced expression of inflammatory cytokines and endothelial release of the vasoconstrictor hormone endothelin, which stimulates melanogenesis.

8.
Am J Dermatopathol ; 44(2): e23-e25, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-35076434

RESUMO

ABSTRACT: Three hundred thousand new cases of Lyme disease are diagnosed annually in the United States. The earliest manifestation of the disease, erythema migrans, occurs earlier than serologic conversion, and skin biopsies can be very helpful in suggesting the diagnosis. Histopathologic findings vary depending on where in the lesion the specimen is taken, but typically consist of a superficial and deep perivascular and interstitial lymphocytic infiltrate with eosinophils centrally and with histiocytes and plasma cells at the periphery. Rare cases with interstitial histiocytes and rare-to-sparse plasma cells exist. We present a 67-year-old man whose skin biopsy, taken on day 2 of his eruption, demonstrated a subtle perivascular and interstitial infiltrate of histiocytes without plasma cells. Dermatopathologists need to be aware of this pattern and consider the diagnosis of erythema migrans, despite negative initial serologic testing.


Assuntos
Eritema Migrans Crônico/patologia , Plasmócitos/patologia , Idoso , Borrelia burgdorferi/isolamento & purificação , Eritema Migrans Crônico/diagnóstico , Humanos , Masculino
9.
J Cutan Pathol ; 49(5): 482-486, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34913185

RESUMO

Superficial temporal artery pseudoaneurysm is a rare complication of arterial injury developing on the forehead following blunt trauma. There is little written on this entity in the dermatopathology literature. We describe two cases of superficial temporal artery pseudoaneurysm in two men aged 53 and 25 years, one of whom had a recent history of head trauma. This report reviews the classic histopathologic findings of STA pseudoaneurysm and highlights ways to distinguish it from other entities in the differential diagnosis.


Assuntos
Falso Aneurisma , Artérias Temporais , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/patologia , Diagnóstico Diferencial , Testa , Humanos , Masculino , Pessoa de Meia-Idade , Artérias Temporais/lesões , Artérias Temporais/patologia
10.
Clin Dermatol ; 39(5): 809-818, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34785008

RESUMO

Healthy hair results from a combination of good generalized health and mindful health care practices. Many nutritional deficiencies lead to poor hair health and include changes to hair structure, texture, and viability. Although the mechanisms by which individual nutrients contribute to hair growth and maintenance have yet to be fully resolved, there are a variety of risk factors that predispose an individual to a nutritional deficiency; age, malnutrition, malabsorption, and medication use are among the most common. A thorough history should be taken in a patient with a hair disturbance to identify risk factors for a nutritional deficiency, which will then guide directed laboratory testing and treatment.


Assuntos
Desnutrição , Estado Nutricional , Cabelo , Humanos , Desnutrição/complicações
11.
J Clin Aesthet Dermatol ; 14(1): 38-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33584967

RESUMO

BACKGROUND: Aging is an unavoidable biological process with many influencing factors, accounting for a multitude of visible manifestations on the hair as well as the skin. As the population ages while becoming more diverse, it is increasingly important to better understand the hair aging process. METHODS: A literature search was performed to review what is known about changes in hair structure over time, focusing on the differences in hair aging according to ethnic background. RESULTS: Sixty-nine publications were selected and information regarding hair structure, aging characteristics, and responses to extrinsic damage together with differences between races and ethnicities was collected. Hair-graying onset varies with race, with the average age for Caucasians being mid-thirties, that for Asians being late thirties, and that for Africans being mid-forties. Caucasians and Asians typically experience damage to the distal hair shaft, while African-Americans see damage occurring closer to the hair root. Postmenopausal changes include decreased anagen hairs in the frontal scalp, lower growth rates, and smaller hair diameters. CONCLUSION: There is a paucity of literature examining the characteristics of hair aging across all races. The unique characteristics of hair aging in different ethnicities provides information that will aid in a culturally sensitive approach and recommendations.

12.
Am J Dermatopathol ; 42(8): 571-577, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32701691

RESUMO

BACKGROUND: Exogenous ochronosis (EO) is a deposition disease associated with application of hydroquinone-containing preparations. Characteristic ochronotic bodies (OBs) arise from endogenous connective tissues, most often reported as collagen. We highlight a significant role for elastic fibers as a precursor tissue. OBJECTIVE: To evaluate elastic tissue pathology in EO, specifically as it relates a precursor role in ochronotic body formation. METHODS: In this retrospective observational study, a literature review using PubMed/MEDLINE database was conducted to ascertain the most commonly ascribed precursor connective tissue. Eleven histopathologic cases of EO were identified. Patient demographics and clinical characteristics were recorded. Slides were reviewed for the presence and grade of solar elastosis (SE), the relationship of OBs to elastotic material, the presence of elastotic fibers transitioning to OBs, and positivity of bodies with Verhoeff-van Gieson elastic tissue stain. RESULTS: Elastic fibers are uncommonly reported as the major precursor tissue of OBs. SE was uniformly present in our cases, and the majority demonstrated heavy/high-grade elastosis. Elastotic fibers transitioning to OBs were observed in all cases, and the bodies demonstrated Verhoeff-van Gieson positivity. LIMITATIONS: Small sample size. CONCLUSIONS: Ochronotic body formation is associated with SE, and bodies appear to arise from damaged elastic fibers.


Assuntos
Tecido Elástico/patologia , Ocronose/patologia , Humanos , Hidroquinonas/efeitos adversos , Ocronose/induzido quimicamente , Estudos Retrospectivos
16.
Melanoma Res ; 28(1): 71-75, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29227334

RESUMO

There is a significant need for the development of diagnostic tools that can precisely distinguish Spitz nevi and spitzoid melanomas. Here, we report the development of a PCR-based quantitative diagnostic assay for spitzoid melanocytic lesions utilizing the expression ratio of neuropilin-2 and melan-A genes in primary tumor specimens. We find that the expression ratio of neuropilin-2/melan-A is significantly increased in spitzoid melanomas compared with Spitz nevi. The diagnostic potential of this quantitative assay was validated in two independent sets of patient samples as demonstrated in a receiver operating characteristic curve analysis showing an area under the curve value of 91.8%. Furthermore, the assay was found to quantitatively distinguish the clinical nature of atypical spitzoid melanocytic lesions that were diagnostically undetermined using histopathologic criteria alone. Our data indicate that this quantitative assay may be used as a tool in determining the diagnostic classification of histologically challenging spitzoid tumors.


Assuntos
Biomarcadores Tumorais/genética , Testes Diagnósticos de Rotina/métodos , Melanócitos/patologia , Melanoma/diagnóstico , Neuropilina-2/genética , Nevo de Células Epitelioides e Fusiformes/diagnóstico , Biomarcadores Tumorais/análise , Diagnóstico Diferencial , Humanos , Melanócitos/metabolismo , Melanoma/genética , Nevo de Células Epitelioides e Fusiformes/genética
17.
Dermatol Ther ; 31(1)2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28976625

RESUMO

Disseminated superficial actinic porokeratosis (DSAP) is the most common variant of porokeratosis with a potential for malignant transformation. Its association with malignant melanoma, however, is exceedingly rare. Treatment of DSAP is often ineffective. We report a unique case of amelanotic melanoma arising within a lesion of DSAP. The melanoma was managed surgically, and her DSAP were treated successfully with a novel approach utilizing 5-fluorouracil chemowraps.


Assuntos
Antimetabólitos Antineoplásicos/administração & dosagem , Transformação Celular Neoplásica , Fluoruracila/administração & dosagem , Melanoma Amelanótico/cirurgia , Poroceratose/tratamento farmacológico , Lesões Pré-Cancerosas/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Administração Cutânea , Idoso , Bandagens , Biópsia , Transformação Celular Neoplásica/patologia , Feminino , Humanos , Melanoma Amelanótico/patologia , Poroceratose/diagnóstico , Lesões Pré-Cancerosas/diagnóstico , Neoplasias Cutâneas/patologia , Resultado do Tratamento
18.
J Cutan Pathol ; 44(11): 969-973, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28796338

RESUMO

Epidermodysplasia verruciformis (EV) is a genodermatosis characterized by overgrowth of flat warts, pityriasis versicolor-like lesions and an increased propensity for developing cutaneous squamous cell carcinomas due to abnormal susceptibility to infection with beta-human papilloma viruses. Adnexal tumors are not typically associated with EV. Here we report a spectrum of hybrid adnexal tumors with divergent eccrine and folliculosebaceous differentiation, and cytologic features ranging from benign to frankly atypical, in a patient with inherited EV.


Assuntos
Epidermodisplasia Verruciforme/complicações , Neoplasias de Anexos e de Apêndices Cutâneos/patologia , Neoplasias de Anexos e de Apêndices Cutâneos/virologia , Carcinoma de Células Escamosas/virologia , Humanos , Masculino , Neoplasias Primárias Múltiplas/virologia , Neoplasias Cutâneas/virologia , Adulto Jovem
19.
J Cutan Pathol ; 44(10): 898-902, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28628256

RESUMO

Luteinized thecomas with sclerosing peritonitis (LTSP) is a rare disease characterized by ovarian luteinized thecomas and associated fibrosing peritonitis. Cutaneous involvement has never been reported. We report a case of classical LTSP with skin involvement, outlining the clinical and histopathologic features of this novel presentation of a rare syndrome.


Assuntos
Neoplasias Ovarianas , Peritonite , Neoplasias Cutâneas , Tumor da Célula Tecal , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/metabolismo , Neoplasias Ovarianas/patologia , Peritonite/metabolismo , Peritonite/patologia , Neoplasias Cutâneas/metabolismo , Neoplasias Cutâneas/patologia , Síndrome , Tumor da Célula Tecal/metabolismo , Tumor da Célula Tecal/patologia
20.
J Am Acad Dermatol ; 77(2): 349-355, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28624120

RESUMO

BACKGROUND: Chronic cutaneous lupus erythematosus (CCLE) often affects the scalp resulting in scarring alopecia. While histopathologic findings of CCLE have been well described, there is little written on the morphologic changes to the hair follicles in this condition. OBJECTIVE: We aim to determine the histopathologic findings of hair follicles in CCLE of the scalp. METHODS: We conducted a retrospective study of 33 transversely sectioned skin biopsy specimens of CCLE of the scalp at the Skin Pathology Laboratory at Boston University between April 2005 and March 2015. RESULTS: New findings include basaloid follicular epithelium lacking hair follicles at deep levels, follicular miniaturization, increased catagen/telogen hair follicles, and pigment casts. Two histopathologic patterns could be discerned, an alopecia areatalike pattern and a lichen planopilarislike pattern. LIMITATIONS: Generalizability of a single-center experience may be limited. CONCLUSION: Follicular findings in CCLE of the scalp are reported. We hypothesize that the basaloid aggregates are remnants of hair follicles that are no longer actively cycling.


Assuntos
Folículo Piloso/patologia , Lúpus Eritematoso Discoide/patologia , Dermatoses do Couro Cabeludo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Técnicas de Preparação Histocitológica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
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