Atypical plaque psoriasis: a clinicopathological study of 20 cases.

BACKGROUND: Plaque psoriasis is relatively straightforward to identify. When diagnostic concerns arise in atypical cases, a biopsy is needed. It is widely accepted that the Munro microabscess and the spongiform pustule of Kogoj are diagnostic pathological features. However, the diagnostic dilemma is likely to arise in cases without these specific pathological changes and typical clinical features. This study aimed to investigate clinical and pathological clues in distinguishing atypical plaque psoriasis from its mimics. METHODS: We evaluated the clinicopathological features of 20 cases of atypical plaque psoriasis and 40 cases of psoriasis mimics as controls including pityriasis rosea (n = 10), pityriasis lichenoides chronica (n = 8), and subacute dermatitis (n = 22). RESULTS: A retrospective analysis of the clinicopathological characteristics of patients with atypical plaque psoriasis and controls was performed. Pathologically, there were significant differences between the two groups in the types of parakeratosis (P = 0.046), epidermal capture of extravasated erythrocytes (P = 0.011), focal basal liquefied degeneration (P = 0.017), types of inflammatory cells (P = 0.000), and depth of inflammation (P = 0.000). Clinically, we found the presence of scales and crusts was significantly different between the two groups. CONCLUSION: This study offers insight into the clinicopathological features of atypical plaque psoriasis. These differential diagnostic features, compared with its mimics, are proposed to assist the clinician in the diagnosis and treatment of atypical plaque psoriasis.

Axillary Granular Parakeratosis.

We describe a case of an 85-year-old Caucasian female who presented to the dermatology clinic with pruritic, scaly hyperpigmented papules and plaques with surrounding erythema in the left axilla. Based on the history and physical examination, there was concern for possible varicella zoster infection, and the patient was started on valacyclovir 1000 mg three times daily for seven days. A shave biopsy was taken from the left axilla to confirm a diagnosis. Microscopic examination revealed compact hyperparakeratosis with keratohyalin granules throughout the parakeratotic stratum corneum as well as admixed eosinophils within the stratum corneum. The epidermis was acanthotic with irregular hyperplasia of the rete ridges. These microscopic findings supported a diagnosis of axillary granular parakeratosis, a benign skin condition caused by a defect in epidermal differentiation. Granular parakeratosis is seemingly rare but is felt to be an underreported condition. It is important for clinicians to be aware of the disease in order to correctly identify the lesions and reassure patients of its benign nature and provide appropriate treatment recommendations.

Caso de paraqueratosis pustulosa: entidad poco frecuente y síntoma de enfermedad inflamatoria del aparato ungueal en pacientes pediátricos / Case of pustular parakeratosis: a rare entity common and symptom of inflammatory disease of the nail apparatus in pediatric patients

La paraqueratosis pustulosa es una entidad poco descrita en la literatura y se define como un proceso inflamatorio cutáneo, ungueal y periungueal en el área distal de un dedo habitualmente pulgar o índice, frecuentemente en la infancia. Su evolución suele ser benigna y la respuesta a emolientes tópicos es favorable. A continuación, se presenta un caso de esta enfermedad con el objetivo de resaltar su consideración en patologías ungueales pediátricas.

Pustular parakeratosis is an entity scantly described in literature. It has been described as a skin, nail, and periungual inflammatory process in the distal area of a finger, usually the thumb or index finger, frequently in childhood. Its evolution is usually benign and management is favorable with topical emollients. A clinical case is presented, to raise awareness of this entity in pediatric nail pathologies.

Lichen planus-like keratosis: clinicopathological evaluation of 1366 cases.

BACKGROUND: Lichen planus-like keratosis (LPLK) is a frequent skin lesion usually biopsied to rule out basal cell carcinoma (BCC). Because of overlapping histopathological characteristics, LPLK is frequently muddled with lichen planus (LP), lichenoid actinic keratosis (LAK), and lupus erythematosus (LE). OBJECTIVE: To investigate the clinical and histopathological characteristics of LPLK. METHODS: A clinicopathologic review was performed of all LPLK cases (1366) signed in one calendar year in a busy academic practice. RESULTS: LPLK occurs mostly as a single lesion (97%) with the chest (41.4%) being the most common site. It is almost equally present in women and men (51.5%-48.5%). The most common clinical concern (65%) is basal cell carcinoma. Parakeratosis, red blood extravasation, and presence of dermal eosinophils and plasma cells, usually not seen in lichen planus, are helpful signs to suggest LPLK but are seen only in a minority of cases. CONCLUSION: Clinicopathologic correlation is necessary to diagnose lichen planus-like keratosis, as the most consistent feature is a clinical history of a lesion/neoplastic process rather than an inflammatory process. There are histopathologic features that can help distinguish lichen planus-like keratosis from lichen planus; however, these features are nonspecific and lacking in almost half of the cases.

The significance of parakeratosis alone in cervicovaginal cytology of turkish women.

BACKGROUND: We aimed to analyze the significance of parakeratosis on an otherwise negative Papanicalaou (Pap) smear, in the absence of any characteristic human papilloma virus (HPV) findings. METHODS: A total of 22,076 Papanicalaou smears that were diagnosed as negative for intraepithelial lesions or malignancy between 2013 and 2015 were included in this study. Samples were separated into two groups, according to the presence of parakeratosis. We investigated the association between parakeratosis in the cytology results and a high-risk HPV status and high-grade squamous intraepithelial lesion (HSIL) in the colposcopic biopsy specimens. RESULTS: A positive HPV result was more frequently identified in cases with parakeratosis than in cases without parakeratosis (P < 0.001). A histological diagnosis of HSIL was more frequently observed in HPV-positive cases with a diagnosis of parakeratosis on cytology than in cases without parakeratosis (P = 0.8). CONCLUSION: Our results demonstrate that a finding of parakeratosis on an otherwise negative Pap smear supports a follow-up HPV DNA test. Also we should consider whether the presence of parakeratosis should be included in standard cytology reports. Additionally parakeratosis trended toward increased frequency of HSIL in follow-up biopsy specimens. But it did not reach statistical significance. That is why larger studies are necessary to evaluate the association of parakeratosis and HSIL in colposcopic biopsy specimens. Diagn. Cytopathol. 2017;45:297-302. © 2016 Wiley Periodicals, Inc.

Paraqueratosis granular: revisión de la literatura a propósito de un caso / Granular parakeratosis: review of the literature apropos of a case

La paraqueratosis granular es un desorden de la queratinización adquirido, secundario a un error en la diferenciación epidérmica. Se presenta en forma de pápulas y placas pruriginosas, eritematosas o de color marrón oscuro, que afectan áreas intertriginosas. Su patogénesis es desconocida, pero algunos casos han sido relacionados con ciertos factores, tales como irritantes físicos o agentes químicos. Entre los hallazgos histopatológicos se incluyen un estrato córneo engrosado, paraqueratosis compacta con retención de gránulos de queratohialina, mientras que el estrato granuloso está preservado. Presentamos un caso de paraqueratosis granular axilar en una mujer y se revisan las principales características clínicas, histológicas y terapéuticas de esta inusual entidad.

Granular parakeratosis is a rare acquired keratinization disorder suspected as a consequence of an error in epidermal differentiation. Clinically it appears as dark or erythematous pruritic papules and plaques, that usually involve intertriginous areas. The pathogenesis of this entity is unknown, but some cases have been related to different factors, such as physical irritation or chemical agents. Histopathologic features include a thickened stratum corneum, compact parakeratosis with retention of keratohyalin granules whereas the stratum granulosum is preserved. We report a case of axillary granular parakeratosis in an adult female and a revision of the clinical, therapeutic and histological features of this unusual entity

[Spiny hyperkeratosis of the palms and soles]. / Spiny Hyperkeratosis palmaris et plantaris.

Spiny hyperkeratosis of the palms and soles is a rare dermatosis presenting as multiple tiny keratotic plugs on the palms and soles. There are two different forms of spiny keratoderma of the palms and soles - the hereditary form and the acquired form. The latter is usually associated with internal malignancies or systemic disease. Since spiny hyperkeratosis of the palms and soles has been under-reported and under-diagnosed, it is important for dermatologists not to forget this disease in daily practice. We report this rare disease for the first time in the German literature.

Esophageal parakeratosis mimicking endoscopic appearance of superficial esophageal neoplastic lesion such as dysplasia.

The endoscopic findings of esophageal parakeratosis have not been well defined and its clinical significance including malignant potential is unclear. Here, we report a case of esophageal parakeratosis presenting as a discrete flat elevated lesion and mimicking the endoscopic appearance of superficial esophageal neoplastic lesion such as dysplasia or cancer. A 72-year-old woman was referred to our hospital for an esophageal lesion detected by upper endoscopy during a medical check-up. Upper endoscopy revealed a 5-cm sized whitish flat elevated lesion involving the mucosa of the middle esophagus. The surface of this lesion showed mild nodularity and the margin was discrete. When spraying with lugol solution, the lesion was not stained. On microscopic examination, esophageal parakeratosis was noted on the luminal surface with a hyaline eosinophilic cytoplasm and small elongate nuclei oriented parallel to the surface. Although pathological examination of initial biopsy specimens revealed no evidence of neoplasia or infection, we carried out follow-up upper endoscopies 1 month and 1 year later because of endoscopic findings mimicking dysplasia or cancer. Endoscopic and histopathological findings from the first and the second follow-up upper endoscopies were same as those of the first examination and the final diagnosis of esophageal parakeratosis was made. Given the present case, esophageal parakeratosis needs to be considered as a differential diagnosis when a flat elevated lesion is found in the esophagus and biopsy specimens reveal no evidence of dysplasia or cancer.

Ichthyosiform sarcoidosis: A case report and review of the literature.

Sarcoidosis is a potentially life-threatening, multisystem, granulomatous disease that can present with cutaneous manifestations in patients. A rare cutaneous manifestation of this disease may resemble acquired ichthyosis. We report a 45-year-old woman with a several year history of dyspnea on exertion and panuveitis who presented to a county hospital with acquired lower extremity ichthyosis and a biopsy consistent with both acquired ichthyosis and noncaseating, granulomatous sarcoidosis. To our knowledge, this entity has been described in only 22 previous independent cases, with the present case being 1 of only 5 cases to rapidly progress to full systemic involvement. Furthermore, it is important to recognize the manifestations of sarcoidosis in the skin, because these may be the presenting signs of systemic illness.

Paraqueratosis granular: descripción de un caso y revisión de la literatura / Granular parakeratosis, report of a case and review of the literatura

La paraqueratosis granular es una dermatosis de probable etiología reaccional descripta en la última década. Se presenta como pápulas hiperqueratósicas y eritematosas que confluyen formando placas de aspecto reticulado. Predomina en mujeres de entre 50 y 60 años, en zona de pliegues, particularmente axilares. Comunicamos un caso de paraqueratosis granular axilar, el primero dentro de la literatura médica argentina, y revisamos la bibliografía sobre el tema.

Granular parakeratosis is a cutaneous eruption probably due to a re-active mechanism described during the past decade. It has hyper-keratotic erythematous papules that coalesce into reticular plaques.Women are mostly affected, in their 5th to 6th decade, with a prefer-ence for axillary folds. This is the first report of a patient a with axillarygranular parakeratosis in Argentina, and review the medical literature on this condition.

Granular parakeratosis: response to calcipotriene and brief review of current therapeutic options.

A 34-year-old Hispanic woman presented with an 18-month history of an intermittent, asymptomatic eruption that began on her left axilla after using a depilatory cream containing corn starch and thioglycolate (Figure 1A). The eruption then spread to her right axilla and lower abdomen (Figure 1B). She reported worsening with deodorant use, but had been using the same deodorant for many years and had continued using it twice a day. Treatment with topical corticosteroids had not helped. The patient coincidentally had been started on isotretinoin 5 months previously for acne, but it had no effect on her axillary or abdominal lesions. Physical examination revealed multiple dark brown and black papules with a "stuck-on" appearance in both axillae and on the lower right abdomen. A biopsy of the left axilla revealed a thickened parakeratotic stratum corneum with retention of keratohyalin granules within the parakeratoric cells, which is considered diagnostic of granular parakeratosis (Figure 2). The patient was prescribed calcipotriene cream twice daily. After 2 weeks, she had complete resolution of the axillary lesions, but the abdominal lesions persisted. She has since had mild recurrences while using calcipotriene.