Plasma Cell-Predominant Lichen Planopilaris.

ABSTRACT: Lichen planopilaris (LPP) is a scarring alopecia that is characterized by a lichenoid interface infiltrate with follicular extension. We present a case of LPP composed predominantly of plasma cells in a 52-year-old man. The patient was originally diagnosed with scalp psoriasis 30 years before presentation. Punch biopsies performed at an outside institution 2 years before presentation revealed lymphocyte-predominant LPP. After referral to the senior author's institution due to inadequate response to therapy, biopsies demonstrated a robust, superficial, and deep lichenoid interface dermatitis composed predominantly of plasma cells. Immunohistochemical and special staining for CD138, MUM-1, kappa and lambda light chains, immunoglobulin G4, CD3, CD20, PAX5, CD5, CD7, CD4, CD8, CD43, CD123, Gram, Grocott's methenamine silver stain, treponemal antibody, colloidal iron, and Movat showed a scarring alopecia and were not supportive of a hematolymphoid, infectious, or autoimmune etiology. B-cell clonality studies were below the threshold needed for definitive diagnosis of a clonal process. Doxycycline and hydroxychloroquine were subsequently added to the patient's treatment regimen, leading to an improvement of symptoms. We present this case to bring awareness to this unusual feature and discuss its differential diagnosis.

Urticarial Vasculitis Associated With Levothyroxine.

Urticarial vasculitis (UV) is a protean disorder that can be triggered by a myriad of causes although it is often idiopathic. Treatment is often successful with corticosteroids and/or immunosuppressive drugs. However, when a cause is found, specific treatment of the underlying problem or removal of an offending agent will resolve the symptoms. This report describes a patient with UV triggered by thyroid replacement, necessitated by Hashimoto's thyroiditis, which can itself cause UV. In this unusual presentation, rather than thyroiditis, thyroid replacement was the trigger for the vasculitis.

Marginal corneal infiltrates as an ocular manifestation of acute generalized exanthematous pustulosis.

Purpose: To report a case of keratoconjunctivitis with marginal corneal infiltrates in a patient with acute generalized exanthematous pustulosis (AGEP) secondary to trimethoprim-sulfamethoxazole. Observations: A 63-year-old female presented with a diffuse pustular skin rash and bilateral keratoconjunctivitis with marginal corneal infiltrates. Skin biopsy led to the diagnosis of AGEP secondary to trimethoprim-sulfamethoxazole use. Treatment of the ocular findings with topical corticosteroids and lubrication led to near-full resolution after two weeks. Conclusions and Importance: To the best of our knowledge, this is the first reported association between AGEP and keratoconjunctivitis with marginal corneal infiltrates. A hypersensitivity reaction to a foreign antigen is implicated in the pathogenesis of both AGEP and sterile marginal infiltrates, and we suggest that the patient's underlying hypersensitivity process associated with AGEP accounted for the ocular findings.

Chemical scalp burns secondary to the hair highlighting process: clinical and histopathologic features.

Hair highlighting procedures are very common throughout the world. While rarely reported, potential adverse events to such procedures include allergic and irritant contact dermatitis, thermal burns, and chemical burns. Herein, we report two cases of female adolescents who underwent a hair highlighting procedure at local salons and sustained a chemical burn to the scalp. The burn etiology, clinical and histologic features, the expected sequelae, and a review of the literature are described.