Vasculitis in a case of rupioid syphilis in HIV.

Secondary syphilis can present with a diffuse, nonpruritic, contagious skin rash. The most common presentation of the rash consists of reddish-brown macules and papules seen on the palms and soles, often with papules and plaques on the torso and proximal extremities. However, the presentation may also include warty or raised mucous membrane lesions or patchy alopecia. In this case, we present a patient with rupioid syphilis, an atypical cutaneous manifestation of malignant secondary syphilis. Further, this case illustrates atypical biopsy findings in patients with rupioid syphilis. The variety of cutaneous and histologic presentations in secondary syphilis can make it challenging to identify the cause of the rash.

Cutaneous signet-ring cell squamous cell carcinoma.

Cutaneous signet-ring cell squamous cell carcinoma (SRCSCC) is a rare variant, most commonly occurring in the head and neck. We report a case of a 66-year-old transgender woman with an ulcerated growing facial mass measuring 5.6 × 4.0 × 2.0 cm. Histological analysis showed features consistent with SRCSCC. Immunohistochemical analysis showed positive staining for high-molecular-weight cytokeratin, estrogen receptor (1-2+ in 10%), E-cadherin (mostly positive with partial loss), and p40 and negative staining for Ber EP-4, cytokeratin 7, low-molecular-weight cytokeratin, mucicarmine, Alcian blue PAS, HER2, and MUC4. The tumor had invaded the perineurium, lymphovascular spaces, and subcutaneum. Additionally, microsatellite instability testing was negative. This case adds to the limited knowledge of this poorly characterized entity.

Disseminated cutaneous histoplasmosis in newly diagnosed HIV.

We present a woman with a widespread severe papulopustular eruption, fever, and fatigue of 5 weeks' duration. HIV infection was diagnosed, with an absolute CD4(+) count of 3 cells/µL. The eruption was consistent with disseminated cutaneous histoplasmosis. The clinical manifestations and management of cutaneous histoplasmosis are reviewed.

Oral melanocytic nevi: a clinicopathologic study of 100 cases.

OBJECTIVE: The purpose of this study was to evaluate the clinical and histopathologic features of oral melanocytic nevi (OMN). STUDY DESIGN: One hundred cases of OMN were retrieved from the files of two oral pathology services, and the data were analyzed with regard to histologic type and clinical features. RESULTS: Intramucosal nevus was the most common type (61%), followed by common blue nevus (23%), compound nevus (7%), and junctional nevus (3%). Combined nevus and cellular blue nevus were rare (2% each). The hard palate was the most commonly affected site (33%), followed by the buccal mucosa (18%), vermilion border of the lip (18%), and gingiva (15%). An interesting case of intramucosal nevus with lipomatosus-like changes and neurotization and two cases of oral dysplastic nevus are also reported. CONCLUSIONS: Intramucosal and common blue nevi are the most common types of OMN. Dysplastic nevus, which is recognized as a marker for melanoma in the skin, can rarely involve the oral cavity. Accordingly, dentists, especially oral and maxillofacial pathologists, should become familiar with the clinical and histopathologic features of this entity.

Angiolymphoid hyperplasia with eosinophilia.

A patient with multiple erythematous nodules on her posterior scalp presented to our dermatology clinic. Biopsy confirmed the diagnosis of angiolymphoid hyperplasia with eosinophilia. The etiology of this disorder is unclear. Several cases have been treated in the past with complete surgical excision, although the recurrence rate remains relatively high.

Widespread dermal ulcerations and bullae.

Bullous pemphigoid is an autoimmune disease of the skin characterized by large, tense bullae resulting in significant morbidity in affected individuals. The diagnosis of bullous pemphigoid may present challenges due to clinical similarities with various other bullous eruptions. Frequently, epidemiological features can provide clues to the diagnosis of bullous pemphigoid, with histologic analysis commonly required for definitive diagnosis. This case study illustrates the typical clinical and histologic findings seen in bullous pemphigoid patients and briefly discusses the differential diagnosis. An in-depth understanding of the intricate pathophysiology is essential in order to educate patients. After diagnosis and appropriate workup, an array of treatment approaches, including topical and systemic corticosteroids, immunosuppressive agents, antibiotics, chemotherapeutic agents, and even monoclonal antibodies, may be utilized individually or in combination to achieve an optimal therapeutic response.

Dermal scatter reduction in human skin: a method using controlled application of glycerol.

BACKGROUND AND OBJECTIVE: Previous studies in a hairless Guinea pig model showed that transdermal application of glycerol effected a temporary reduction in dermal scatter of light. This study focuses on the application of this protocol on human patients. STUDY DESIGN/MATERIALS AND METHODS: After stratum corneal removal, glycerol was applied to human subjects using a low pressure transdermal application device. Optical coherence tomography imaging showed increased intensity of radiation reaching deeper regions in the skin and photographs showed enhanced visualization of dermal structures. RESULTS/CONCLUSION: Topically applied glycerol increased light penetration of in vivo corneal-stripped skin. This minimally invasive approach to temporary dermal scatter reduction has the potential to improve the efficacy of light-based diagnostic or therapeutic devices.

Cutaneous Infection with Mycobacterium abscessus in a child.

Nontuberculous mycobacteria can cause cutaneous infections in both children and adults. Localized nontuberculous mycobacterial infections of the skin have been reported in children following injections or surgical procedures. We report a child who developed a cutaneous nontuberculous mycobacterial infection after exposure of a skin wound to pond water. Cutaneous infection with the rapidly growing mycobacteria Mycobacterium abscessus was demonstrated by clinical and histologic evaluation on the lower leg of an otherwise healthy 12-year-old Caucasian boy. We describe this as an instance of an unusual acquisition of cutaneous M. abscessus infection in a child.

Morphological changes in blood vessels produced by hyperosmotic agents and measured by optical coherence tomography.

Optical tissue clearing by hyperosmotic chemical agents significantly increases light depth penetration in skin and may improve light-based therapeutics such as laser treatment of cutaneous vascular lesions. A feasibility study was conducted to evaluate the potential role of optical clearing by glycerol in laser treatment of cutaneous vessels. Optical imaging was performed to investigate the morphological effects of glycerol on blood vessels of skin. Blood vessels were imaged using Doppler optical coherence tomography in in vivo hamster skin treated with glycerol. Images were obtained from the subdermal side to assess morphological changes in the blood vessels caused by glycerol and from the epidermal side to assess enhanced Doppler imaging of blood vessels. Application of glycerol to the subdermis resulted in venule stasis and for prolonged treatment times, arteriole stasis. In cases where flow remained in arterioles, an improved Doppler signal was detected from blood vessels when imaging transepidermally compared with the native condition. Intensity images indicated changes in blood optical properties and improved contrast of skin cross sections after glycerol application. The observed optical and morphological effects were reversed upon hydration of the skin with phosphate-buffered saline. The combination of increased depth of light penetration and the temporary slowing or cessation of flow in blood vessels could mean improved laser treatment of vessels.