Recurrent erythema nodosum associated with Echinacea herbal therapy.

We report a case of recurrent erythema nodosum that is temporally and perhaps causally associated with use of echinacea herbal therapy. The genus Echinacea is traditionally used as an immunostimulant in the prophylaxis and treatment of upper respiratory tract infections. In vitro and in vivo studies of echinacea administration in animal and human-derived models suggest a definite stimulatory effect on the cellular immune system, although the clinical impact of echinacea is still unknown. The public's increasing use of alternative and complementary therapies necessitates that dermatologists be familiar with the cutaneous adverse effects of these agents.

Bullous pilomatricoma: a report of clinical and pathologic findings and review of dermal bullous disorders.

BACKGROUND: Pilomatricoma is a common benign adnexal tumor differentiating toward elements of the hair matrix and shaft. It typically presents as a solitary, deep, dermal nodule. We describe a case of a pilomatricoma with the unusual feature of a thick-walled dermal bulla overlying the tumor. OBJECTIVE: We describe a case of bullous pilomatricoma and discuss the potential etiology of the bullous feature of the lesion. METHODS: This article includes a case report and a literature review. CONCLUSIONS: Bullous pilomatricoma has rarely been described. A common pathological feature in this type of pilomatricoma is the presence of dilated lymphatics. Bullous morphea associated with dermal lymphatic dilation has also been described. In both bullous pilomatricoma and morphea, it is possible that individual pathological features of the lesion lead to obstruction and congestion of the dermal lymphatics thereby inducing enough dilation and edema to form a dermal bulla.

Pseudolipomatosis cutis: superficial dermal vacuoles resembling fatty infiltration of the skin.

Empty spaces within the dermis of paraffin-embedded sections of skin have been attributed to fatty infiltration and postulated to originate from topical steroid administration or sebaceous gland rupture. We examined skin biopsy specimens exhibiting dermal vacuolation to determine whether this phenomenon was associated with specific skin diseases and to attempt to illuminate its etiology. Routine hematoxylin-eosin-stained sections from 26 formalin-fixed, paraffin-embedded biopsy specimens were examined. Histochemical stains for mucin and immunohistochemical staining for S100 protein and vascular markers were performed. Dermal vacuolation was characterized by empty spaces, 15-120 microm in diameter, in the superficial dermis, associated with either fibrosis/sclerosis or a lymphocytic infiltrate. There was no relationship to clinical findings, topical steroid treatment, or histologic diagnosis. There was no evidence of true adipocyte differentiation, and vascular markers were negative. Transmission electron microscopy showed nonmembrane-bound irregular spaces in the dermis. Dermal vacuoles likely represent an artifact of tissue fixation or processing and are unrelated to the underlying pathologic process. We propose the name pseudolipomatosis cutis, analogous to insufflation-induced colonic vacuolation, to distinguish this phenomenon from true dermal fatty infiltration and to emphasize its incidental, likely artifactual nature.

Cutaneous manifestations of chronic granulomatous disease. A report of four cases and review of the literature.

BACKGROUND: Chronic granulomatous disease represents a group of genetic disorders in which impaired intracellular microbial killing by phagocytes leads to recurrent bacterial and fungal infections and granuloma formation. Cutaneous disease occurs in 60% to 70% of cases. The characteristic histologic finding of pigmented lipid macrophages in visceral granulomas has not been described previously in the skin. OBJECTIVE: Our purpose was to review our experience of skin disorders in chronic granulomatous disease. METHODS: We studied the clinical and histologic findings in four patients with chronic granulomatous disease and unusual skin lesions. We reviewed the skin disorders seen in five additional patients with chronic granulomatous disease referred to the pediatric dermatology clinic. The literature was reviewed for previously reported cutaneous manifestations of chronic granulomatous disease. RESULTS: A teenage boy with chronic granulomatous colitis had nonulcerating cutaneous granulomas from which no organisms were isolated. Histologic examination of both skin and bowel revealed the characteristic golden-yellow granular pigment in macrophages. A second boy had cutaneous aspergillosis involving the left foot; histologic examination revealed macrophages containing yellow-brown pigment at the periphery of the granulomatous inflammation. Two children had vesicular skin lesions. These lesions were recurrent in one boy for several years. In the second child they were associated with fatal intracranial and pulmonary infection. Histologic examination in both cases revealed a subcorneal polymorphonuclear infiltrate and perivascular macrophages containing yellow-brown pigment. Cultures were either negative or revealed organisms that are normally nonpathogenic skin commensals, such as coagulase-negative staphylococci. CONCLUSION: The cutaneous manifestations of chronic granulomatous disease encompass a variety of infections and inflammatory lesions. Diagnostic and therapeutic problems may arise because of difficulty in isolating a causative organism. The characteristic pigmented macrophages of visceral granulomas can also be found in skin lesions.

Mitotic granuloma annulare: a clinicopathologic study of 20 cases.

The finding of mitotic figures in granuloma annulare (GA) has not been emphasized in the literature. We describe 20 cases of a cellular, mitotically active variant of GA; we defined this group as cases having > or = 1 mitosis per 10 hpf. Clinically, the lesions could not be distinguished from typical, localized GA: there were 9 males and 11 females with a mean patient age of 49 +/- 15 years (mean +/- SD), compared to 45 +/- 20 years in a randomly selected control group of 60 patients with GA, and no unusual sites of predilection were noted. Histologically, a classic, palisading granuloma pattern predominated (18/20 cases). Lesions were located in the mid-dermis and tended to be more cellular than typical GA. The histiocytes comprising the lesion often had enlarged nuclei and prominent nucleoli. The number of mitoses per 10 hpf was 3.0 +/- 1.5 (range 1.0-7.2), control group 0.3 +/- 0.5; occasional atypical mitotic figures were observed. The proliferative nature of these lesions was confirmed using MIB-1 staining; the percentage of MIB-1 positive cells ranged from 5%-29% (mean 15 +/- 6%). Mitotic GA must be distinguished histologically from neoplastic processes, in particular epithelioid sarcoma. We conclude that histiocytes in clinically typical GA can exhibit an increased mitotic rate. Recognition of this variant is important in order to avoid overdiagnosis of a malignant condition.

Transient erythroporphyria of infancy.

We describe a neonate with hemolytic disease of the newborn in whom a photosensitivity eruption developed during phototherapy for treatment of hyperbilirubinemia. Free erythrocyte protoporphyrin and zinc protoporphyrin levels were markedly elevated during the neonatal period. Porphyrin levels were normal at 19 weeks of age. The infant had residual skin atrophy and showed clinical and radiologic evidence of kernicterus. The pathogenesis of transient porphyrinemia associated with hemolytic disease of the newborn is unclear.

Sinonasal malignant melanoma--a clinicopathologic analysis of 18 cases.

Sinonasal melanoma is a rare malignancy. We present the clinicopathologic review of 18 cases seen at the British Columbia Cancer Agency between 1976 and 1992: 13 men and five women, mean age 66 years (range 32-88). Patients presented with nasal obstruction and bleeding (n = 8), obstruction alone (n = 4), bleeding alone (n = 5) or pain (n = 1). Those with bleeding presented with a shorter duration of symptoms than those with obstruction alone. All patients with obstruction alone died of their disease, while all patients with bleeding alone are alive or have died of an unrelated cause; four out of eight patients with both obstruction and bleeding are alive. There was no significant relationship between treatment modality and outcome. Histologic subtypes included epithelioid (n = 10), spindle-cell (n = 4), small-cell (n = 3) and pleomorphic (n = 1). Eight out of 11 cases from whom samples of paraffin-embedded tissue were available showed more prominent staining for HMB-45 than for S-100. In two cases, only rare (< 0.1%) cells stained for S-100. Cell type, mitotic rate and P53 expression were unrelated to disease outcome. Six out of seven patients with < or = 10% of cells showing intense staining for PCNA were alive or had died of an unrelated cause, while three out of four with > 10% staining died of their disease.(ABSTRACT TRUNCATED AT 250 WORDS)