Miliaria crystallina.

Miliaria crystallina (MC) is an uncommon form of a sweat retention syndrome that chiefly affects neonates. It is more common in hot and humid conditions, such as in tropical regions. It commonly presents as clusters of dewdrop-like vesicles on a nonerythematous base that heals with furfuraceous scaling. A clinical diagnosis is often sufficient. The differential diagnosis is wide and varying. One of the hallmarks of MC is its self-limiting nature. The purpose of this review is to increase awareness of this condition among physicians and dermatologists.

Miliaria crystallina induced by idarubicin and all-trans-retinoic acid: Two case reports.

Miliaria crystallina is a benign, self-limiting disorder of the eccrine sweat glands characterized by the obstruction of the sweat ducts, which leads to secondary sweat retention into stratum corneum. We present two patients with MC during treatment with idarubicin and all-trans-retinoic acid (ATRA) for acute promyelocytic leukaemia (APL). Anthracyclines can be excreted through sweat and induce MC through exfoliation. The use of idarubicin in combination with ATRA would favour the process of producing a peeling effect. Reports of MC associated with idarubicin and ATRA are scarce. Recognizing this benign entity and its triggers will help to differentiate it from other skin reactions, improving the management of patients by avoiding unnecessary studies and treatments.

Miliaria crystallina secondary to herbal remedies-induced toxic epidermal necrolysis: A case report.

Miliaria crystallina is a skin disorder that often erupts in the process of febrile diseases or under hot and humid climatic conditions. Toxic epidermal necrolysis (TEN) is a rare, acute, and life-threatening mucocutaneous disease with a mortality rate of 25-35%. There has been no inevitable connection between the two diseases among previously reported cases, but we observed a case of secondary miliaria crystallina a woman with herbal remedies-induced TEN during the therapeutic process.

Milia En Plaque as a Distinct Follicular Hamartoma With Cystic Trichoepitheliomatous Features.

Milia en plaque (MEP) is an uncommon disorder characterized by an erythematous plaque containing numerous milia. The pathogenesis of MEP is not clear. The authors report a man with an erythematous plaque on the right retroauricular area, containing numerous white-yellow cysts varying in size. Histological examination showed that multiple cystic structures at various levels of the dermis that were lined by stratified squamous epithelium and contained keratinous material-these findings were consistent with the diagnosis of multiple milia. In addition to epidermal cysts, however, the lesion consisted of a branched proliferation of pale-staining keratinocytes lined with basal keratinocytes budding from the overlying epidermis. Moreover, some cysts were formed within the branched epithelial proliferation, had thicker cyst walls than the ordinary milium, or had irregular or branched projections toward the surrounding dermis. From these findings, the authors conclude that MEP is a distinct follicular hamartoma with cystic trichoepitheliomatous features.

Histopathological and immunohistochemical features of nodular podoconiosis.

BACKGROUND: Podoconiosis is a familial geochemical dermatosis which is common in Ethiopia but relatively unknown in Europe/United States. It is related to exposure of bare feet to volcanic soil and presents with extensive bilateral lymphedema of legs and feet. Histopathological and immunohistochemical features of it have not been described yet. OBJECTIVES: The objectives of this study are to characterize podoconiosis histopathologically and immunohistochemically and to increase awareness of the disease. METHODS: Ten specimens of fully developed podoconiosis were examined with hematoxylin/eosin, periodic acid-Schiff, Gram, elastica-van Gieson stainings, with immunohistochemistry (CD3,CD20,CD31,CD68,CD138, tryptase, podoplanin, collagen IV), and with polymerase chain reaction (PCR) for human papillomavirus (HPV)-specific DNA. RESULTS: All specimens showed verrucous acanthosis and papillomatosis. Eccrine ducts demonstrated hyperplasia, syringofibroadenomatous changes and miliaria. Dermal collagen bundles were thickened, and elastic fibers were dramatically reduced. A moderate lymphoplasmacytic infiltrate was joined by mast cells and scattered macrophages; neutrophils and eosinophils were sparse. Blood vessels were increased, dilated, and often sclerotic while lymphatics were reduced and largely not dilated. HPV-PCR was negative in all specimens. CONCLUSIONS: Podoconiosis demonstrates distinctive changes of chronic lymphedema with extensive sclerosis, loss of elastic fibers, verrucous acanthosis (not HPV induced) and reactive changes of eccrine structures. Mast cells, macrophages and altered blood vessels may be involved in the pathogenesis.

Rare benign tumours of the nipple.

BACKGROUND: Benign lesions of the breast in total are much more frequent than malignant ones. However, there are no epidemiologic data on the prevalence of benign or malignant tumours of the nipple, and the bibliography on benign nipple tumours in general is limited. AIMS: To present some rare cases of benign nipple tumours and review the literature. MATERIALS AND METHODS: Four cases of rare benign nipple tumours: neurofibromas, wart, leiomyoma and milium are presented. The literature search on benign nipple tumours was performed using MEDLINE, Pubmed, and Cochrane databases with limits: English language, human species and available abstract. The keyword used was 'benign nipple tumours'. RESULTS: The initial search retrieved 337 articles. The papers were reviewed and the articles that referred to benign lesions that appeared at the nipple specifically were identified. Different entities that were described included: neurofibroma, leiomyoma, milium, florid papillomatosis, syringomatous adenoma, nevoid hyperkeratosis, fibroma, pseudolymphoma and haemangioma. DISCUSSION: Differential diagnosis of benign tumours of the nipple can be demanding for the physicians. Many of the symptoms and signs like pruritus, serosanguinous discharge, lichenification, erosion and nodular enlargement are produced by either malignant or benign nipple lesions. Radiology can be unclear in the diagnosis of nipple abnormalities. CONCLUSION: Histological examination of the lesion can be the only definite answer in these cases.

Eruptive milia and comedones during treatment with dovitinib.

Dovitinib (TKI258) is a multi-targeted receptor tyrosine kinase inhibitor currently under clinical trials for a wide variety of cancers. Well-known side effects include nausea, vomiting, diarrhea, and fatigue. To date, there have only been only two reported cases with skin manifestations as a side effect. We report a case of eruptive facial milia and comedones in the setting of dovitinib treatment for metastatic gastrointestinal cancer. This case is unique as the clinical presentation was more rapid in onset and showed an absence of inflammatory lesions. Although the pathogenesis for skin manifestations is presently unknown, we present this case to increase awareness of potentially under-reported cutaneous side effects.

Linear milia en plaque on the forearm.

A 64-year-old man presented with asymptomatic eruption on his right forearm and the dorsum of the hand present for 2 weeks. There was no history of trauma, prolonged sun exposure, or application of or contact with any substance prior to the development of lesions. He was a known hypertensive and diabetic and was taking treatment for these conditions. The rest of his history was noncontributory. On examination, multiple grouped tiny white papules were found on both normal skin and on the erythematous plaque. These papules were of almost uniform size (2-4 mm) and were notable for absence of umbilication. The erythematous plaque was roughly 15 cm in length and was extending along the ulnar border of forearm and dorsum of hand in a linear pattern (Figure 1). The surface temperature of the plaque appeared similar to the surrounding area, and the surface was studded with multiple tiny white papules. There were no lesions suggestive of chronic actinic damage in the surrounding area. The papules revealed solid whitish material on expression with a needle. The rest of the mucocutaneous examination was noncontributory. Based on clinical presentation, a diagnosis of linear milia en plaque was made.

Granulomatous variant of giant centrifugal miliaria profunda.

Two infants presented with multiple asymptomatic papules and geographic and annular plaques over the extensor aspect of the upper and lower extremities and trunk. Skin biopsy of both lesions showed plugged and hyperplastic dilated acrosryingia and deep dermal ducts, along with granulomatous inflammatory reaction. These lesions showed self-healing with complete resolution. A previous report described similar clinical and histopathologic features and labeled it giant centrifugal miliaria profunda. Because of the large granulomatous plaques and deep infiltrate, we propose that it was a granulomatous variant of giant centrifugal miliaria profunda. We report these cases for their rarity and self-healing nature.

Widespread miliaria crystallina in a newborn with hypernatremic dehydration.

Miliaria, which is extravasation of sweat into the epidermis and dermis due to sweat duct obstruction, is a commonly seen dermatologic disorder in newborns. We present a case of extensive, widespread miliaria crystallina that developed in a newborn during treatment of severe hypernatremic dehydration. A possible mechanism could be the destruction of sweat ducts with excretion of sweat with high levels of sodium.

Acral milia-like idiopathic calcinosis cutis in a child with down syndrome: report of a case, review of the literature, and description of dermoscopic findings.

Milia-like idiopathic calcinosis cutis (MICC) is a rare dermopathy, usually occurring in children with Down syndrome. We report a case of an 8-year-old girl with Down syndrome who presented with histologically verified MICC, briefly review the literature on MICC, discuss the differential diagnosis, and describe the use of dermoscopy in the evaluation of lesions, which we believe has never been published previously with this entity.

Multiple eruptive milia.

Multiple eruptive milia (MEM) is a rare skin condition characterized by sudden onset of multiple milia occurring mainly on the head, neck, and trunk. Milia are small, benign, 1- to 4-mm, white keratinous cysts. The lesions generally are asymptomatic and may arise spontaneously or secondary to a number of processes. Multiple eruptive milia are cosmetically troublesome and difficult to treat. We report the case of a 40-year-old man with an abrupt onset of MEM on the face.

Paraviral cutaneous manifestations associated to SARS-CoV-2 Omicron variant.

BACKGROUND: The spreading of the SARS-CoV-2 Omicron variant is probably due to its increased transmissibility and ability to escape from neutralising antibodies. Cutaneous manifestations have been reported after infection with the Omicron strain, consisting mainly of generalised urticarial eruption and prickly heat rash, also known as miliaria, that can persist for several days. Here the impact of Omicron SARS-CoV-2 on skin was investigated. METHODS: The case series of 10 patients with SARS-CoV-2 Omicron variant-related cutaneous manifestations were described; moreover, skin derived cells were challenged in vitro with SARS-CoV-2 Omicron variant. RESULTS: The main clinical cutaneous features observed were urticarial lesions lasting more than 24 h, mainly involving the trunk and sometimes extending to the extremities, and miliaria presenting with clusters of small sweat-filled vesicles, sometimes surrounded by slight erythema. HaCaT keratinocytes, BJ fibroblast cell lines and outer root sheath (ORS) keratinocytes were not susceptible to SARS-CoV-2 Omicron variant infection; they also did not present any evident cytopathic effect or modification of cells viability. CONCLUSION: Our findings suggests that, despite the high number of nucleotide mutations in the spike protein of SARS-CoV-2 Omicron variant, responsible to the higher transmissibility of this virus, and the increased reports of cutaneous manifestation in COVID-19 affected patients, the virus is not able to directly infect and damage the keratinocytes and fibroblasts, thus suggesting an indirect virus-induced activation of the immune system as the major pathogenetic driver.