ABSTRACT
Syringomas are benign neoplasms derived from eccrine sweat glands. Eruptive syringomas are a subtype of syringomas and are typically located on the chest, neck, and abdomen during puberty or childhood. Herein, we present a 20-year-old African American female with an atypical case of eruptive syringomas, characterized by an unusual distribution on her chest, abdomen, and anterior and posterior bilateral extremities. This case underscores the importance of recognizing diverse presentations of skin conditions in patients with skin of color and adds to the limited reports of eruptive syringoma in these populations. We present and emphasize this atypical manifestation of eruptive syringomas in an individual with darker skin to promote awareness and improve diagnosis and patient outcomes.J Drugs Dermatol. 2024;23(7):564-566. doi:10.36849/JDD.8103.
Subject(s)
Skin Pigmentation , Sweat Gland Neoplasms , Syringoma , Humans , Syringoma/pathology , Syringoma/diagnosis , Female , Sweat Gland Neoplasms/diagnosis , Sweat Gland Neoplasms/pathology , Young Adult , Black or African AmericanABSTRACT
We report a case of a 42-year-old immunocompromised (human immunodeficiency virus [HIV], CD4 count 86 cells/µL) Black male who presented with fever, oropharyngeal candidiasis, and phimosis, followed by eruption of umbilicated papulovesicles most concentrated on the face. The patient was diagnosed with Mpox (MPXV, formerly monkeypox), herpes simplex virus 1 (HSV1), varicella-zoster virus (VZV), and late latent syphilis. Tzanck smear of a Mpox lesion proved a useful and rapidly obtained pertinent negative test, lacking the typical changes of HSV/VZV (multinucleation, margination, and molding). A biopsy specimen showed viral changes consistent with both Mpox (ballooning degeneration and multinucleated keratinocytes) and herpesvirus (multinucleated epithelial giant cell within a zone of follicular necrosis). Lesion PCR was positive for HSV1 and MPXV, and negative for HSV2 and VZV. Immunohistochemistry was positive for VZV and orthopoxvirus. Empiric treatment for HSV/VZV in patients with suspected or confirmed Mpox should be considered for patients with HIV or other immunocompromised patients. It is important to recognize that MPXV, HSV, and VZV may all be present and difficult to distinguish clinically. More than one test modality (PCR, H&E, immunohistochemistry, and Tzanck) and multiple lesion samples may be required to thoroughly evaluate widespread papulovesicular eruptions, especially in immunocompromised patients.
Subject(s)
Coinfection , Exanthema , HIV Infections , Herpes Simplex , Herpes Zoster , Herpesvirus 1, Human , Mpox (monkeypox) , Humans , Male , Adult , Herpes Zoster/diagnosis , Herpes Zoster/pathology , Herpes Simplex/diagnosis , Monkeypox virus , Coinfection/diagnosis , Herpesvirus 3, Human , HIV Infections/complications , HIV Infections/diagnosisABSTRACT
This case detailing a poroma in Fitzpatrick Type V skin presents gross, dermatoscopic, and histopathologic images that have not been adequately represented in the literature. Diagnosing poroma can be challenging and misdiagnoses can have tragic consequences. The scarcity of published poroma images in darker skin types can further complicate this problem. Mineroff J, Jagdeo J, Heilman E, et al. Poroma in a patient with Fitzpatrick type V skin. J Drugs Dermatol. 2023;22(7):690-691. doi:10.36849/JDD.7371.
Subject(s)
Poroma , Sweat Gland Neoplasms , Humans , Poroma/diagnosis , Skin , Skin Pigmentation , Sweat Gland Neoplasms/diagnosisABSTRACT
Endocrine mucin-producing sweat gland carcinoma (EMPSGC) is thought to be a precursor to mucinous carcinoma, both of which are rare. In this case report, the authors present a 55-year-old woman with concurrent EMPSGC and mucinous carcinoma manifesting with 2 distinct lesions on her left upper and lower eyelid and 1 lesion on her right lower eyelid. Biopsy and immunohistochemical staining supported primary cutaneous origin of the tumors. Systemic metastatic workup was initiated and thus far negative. The patient underwent staged slow Mohs micrographic surgery to remove one tumor at a time, with delayed reconstruction. This is the first reported case of EMPSGC and mucinous carcinoma presenting as distinct lesions both bilaterally and synchronously.
Subject(s)
Adenocarcinoma, Clear Cell , Adenocarcinoma, Mucinous , Eyelid Neoplasms , Neuroendocrine Tumors , Sweat Gland Neoplasms , Adenocarcinoma, Mucinous/surgery , Eyelid Neoplasms/pathology , Eyelids/pathology , Female , Humans , Middle Aged , Mucins , Sweat Gland Neoplasms/pathology , Sweat Glands/pathologyABSTRACT
Scleromyxedema (SMX) is an inflammatory condition of unknown etiology strongly associated with monoclonal gammopathy. Classical histopathology of SMX is characterized with the triad of diffuse mucin deposits, increased amount of collagen, and presence of stellate fibroblasts. Herein, we report an unusual histopathological variant of SMX in a 41-year-old female with lesions of the nose histopathologically mimicking cellular angiofibromas. The dome-shaped papules were characterized by increased collagen bundles and fascicles of spindle cells. Widened vessels were seen at the periphery of the proliferation. Cells expressed CD68. Factor XIIIa was expressed only by dendritic cells. The mucin was highlighted with colloidal iron. In sum, we draw attention to this unusual variant of SMX, which should be suspected in a setting of multiple "angiofibromas/fibrous papules" on the face with presence of mucin.
Subject(s)
Scleromyxedema/diagnosis , Scleromyxedema/pathology , Adult , Angiofibroma/diagnosis , Angiofibroma/pathology , Diagnosis, Differential , Female , Humans , ParaproteinemiasABSTRACT
Genital herpes simplex virus (HSV) infection in a human immunodeficiency virus (HIV) patient can present as a vegetative nodule. Clinical differential diagnoses of the nodule include condyloma latum, condyloma acuminatum, viral or fungal infection, and cutaneous neoplasms. Histological examination of herpetic nodules has been reported to show thick pseudoepitheliomatous hyperplasia with dense dermal lymphoplasmacytic infiltrate and multifocal multinucleated cells with herpetic viral cytopathic changes. We report two patients with HIV presenting with vegetative tumor-like HSV nodules with distinctive histopathologic pattern of inflammation that has not been described in the literature before. All samples displayed slightly acanthotic epidermis with focal ulceration, dense dermal sclerosis, scattered plasma cells, and a brisk lymphoeosinophilic infiltrate found dissecting between dense collagen bundles. This pattern of inflammation is an important clue that can guide the pathologist to look for focal herpetic viral changes in the epidermis, as patients with HIV possibly tend to amount a predominantly eosinophilic immune response in inflammatory skin conditions.
Subject(s)
Eosinophilia , HIV Infections , HIV-1/metabolism , Herpes Genitalis , Herpesvirus 2, Human/metabolism , Skin , Adult , Eosinophilia/metabolism , Eosinophilia/pathology , HIV Infections/metabolism , HIV Infections/pathology , Herpes Genitalis/metabolism , Herpes Genitalis/pathology , Humans , Male , Middle Aged , Skin/metabolism , Skin/pathologyABSTRACT
Infective dermatitis (ID) associated with Human T-cell leukemia virus type-1 (HTLV-1) is a rare form of severe superinfected eczema seen mostly in the Caribbean islands and Latin America. Although rapid response to antibiotic treatment is observed, patients should be monitored for development of complications associated with this retroviral infection, including T-cell leukemia/lymphoma (ATLL) and HTLV-1 associated myelopathy/tropical spastic paraparesis (HAM/TSP). Infective dermatitis is rarely seen in the United States and therefore may be under-recognized by physicians unfamiliar with this condition. Herein, we present an additional case report of an ID associated with HTLV-1 in an 11-year-old girl from Trinidad.
Subject(s)
HTLV-I Infections/complications , Skin Diseases, Infectious/diagnosis , Anti-Bacterial Agents/therapeutic use , Female , Glucocorticoids/therapeutic use , Human T-lymphotropic virus 1/immunology , Humans , Skin/pathology , Skin Diseases, Infectious/drug therapy , Skin Diseases, Infectious/virology , Trinidad and TobagoABSTRACT
Folliculocystic and collagen hamartoma (FCCH) of tuberous sclerosis is a rare entity described in 2012 by Torrelo et al. with only 8 cases described, predominantly in males. It presents since birth or early infancy and in the majority of cases is associated with tuberous sclerosis. The hamartoma presents as an exophytic plaque and has distinctive histopathological features including hair follicles, intact or ruptured epidermal cysts, and an increased number of collagen fibers extending to the subcutaneous tissue. Herein we present an additional case of this rare entity in an 18-year-old female who met clinical criteria for tuberous sclerosis. The patient had an exophytic mass in the left temporal area for many years and wanted surgical excision due to its cosmetic appearance. Histopathology of the surgical specimen showed a hamartomatous lesion with multiple large intact epidermal cysts, hairs and increased thickened collagen. The patient has followed up for 1 year after the excision, with no recurrence. Additionally, we provide a literature review of known cases of FCCH as well as its clinical and histopathological differential diagnosis.
Subject(s)
Hamartoma/etiology , Hamartoma/pathology , Scalp Dermatoses/etiology , Scalp Dermatoses/pathology , Tuberous Sclerosis/complications , Adolescent , Female , HumansABSTRACT
Langerhans cell histiocytosis is a rare group of disorders that results from the abnormal proliferation and accumulation of dendritic-derived cells in various organs of the body, such as the skin and bones. Hypopigmented macules are a rare cutaneous presentation of Langerhans cell histiocytosis that may pose a diagnostic dilemma when no other findings of Langerhans cell histiocytosis are present at the time of examination. We present 2 cases of the hypopigmented variant of Langerhans cell histiocytosis, including a case with histopathologic features of regression, and a review of the literature. These cases highlight the importance of including Langerhans cell histiocytosis in the differential diagnosis of an infant with hypopigmented macules and papules.
Subject(s)
Histiocytosis, Langerhans-Cell/diagnosis , Skin Diseases/diagnosis , Diagnosis, Differential , Female , Glucocorticoids/therapeutic use , Humans , Hypopigmentation/etiology , Infant , Male , Skin/pathology , Skin Diseases/pathologyABSTRACT
A 15-month-old boy presented with 1-4 cm, pink edematous plaques with overlying round erosions and hemorrhagic bullae in the setting of a gastrointestinal illness and was ultimately diagnosed with bullous-type Sweet syndrome. Despite appropriate treatment with oral steroids, the patient's cutaneous lesions healed with secondary anetoderma. This case should prompt practitioners to be aware of bullous-type Sweet syndrome and the possibility of lesions healing with postinflammatory scarring.
Subject(s)
Anetoderma/etiology , Sweet Syndrome/diagnosis , Anetoderma/pathology , Glucocorticoids/therapeutic use , Humans , Infant , Male , Prednisolone/therapeutic use , Skin/pathology , Sweet Syndrome/complications , Sweet Syndrome/drug therapy , Wound HealingABSTRACT
BACKGROUND: Striae distensae (SD) are aesthetically troublesome to patients and therapeutically challenging. OBJECTIVE: Herein, the authors comprehensively review the literature pertaining to the history, pathogenesis, clinical presentation, clinical rating scales, and laboratory, imaging, and histologic features of SD. METHODS AND MATERIALS: A review of PubMed, MEDLINE, Scopus, Embase, and Google scholar was conducted, including literature published from 1773 to August 6, 2016. RESULTS: The authors identified 68 articles that met inclusion and exclusion criteria. CONCLUSION: There are few randomized controlled trials evaluating the long-term efficacy and safety of various topical and energy-based devices. Based on clinical and anecdotal experience, both nonablative and ablative fractionated lasers have shown modest SD improvement compared with other treatment modalities (including Excimer laser, CuBr laser, pulsed dye laser, and 1,064-nm Nd:YAG laser). In the authors' experience, 1,540-nm nonablative fractionated laser is a worthy first-line modality for the treatment of SD. Future researchers may consider greater focus on enhanced study design, including larger, long-term split-body, or split-SD head-to-head randomized comparative trials with objective outcome measures and end points, such as biopsy and molecular studies demonstrating increased collagen and elastic fibers that correlate to clinical improvement.
Subject(s)
Esthetics , Laser Therapy , Striae Distensae/prevention & control , Striae Distensae/therapy , Humans , Striae Distensae/etiology , Striae Distensae/pathologyABSTRACT
Pigmentation of the nail plate, or melanonychia, is typically a benign condition caused by melanocyte activation. Although rare, melanonychia may be the initial presentation of melanoma, thus all cases require an in-depth examination. Evaluation in pediatric patients can prove especially difficult as benign cases have a higher prevalence of atypia compared to adults. Lack of specific treatment guidelines in the pediatric population can make diagnosis and treatment challenging. We report a pediatric patient with melanonychia with atypical features that required significant evaluations and collaboration to ultimately reach a treatment plan.
Subject(s)
Hyperpigmentation/pathology , Nail Diseases/pathology , Child , Humans , Hyperpigmentation/surgery , Male , Nail Diseases/surgeryABSTRACT
Hidradenoma papilliferum is a benign cutaneous adnexal neoplasm, commonly occurring in the vulva and perianal region of adult women. It has characteristic histopathological features composed of anastomosing and branching tubules, lined by columnar cells, and a basal layer of myoepithelial cells. A 39-year-old woman was evaluated for 2 asymptomatic labial masses. The histopathological examination revealed a Bartholin's cyst and a hidradenoma papilliferum. The latter contains a distinct area of oncocytic/oxyphilic metaplasia. Immunohistochemical stains revealed positive staining for gross cystic disease fluid protein (GCDFP)-15 and androgen receptor. GATA-3, a protein expressed in sweat glands, highlights a similar positive staining pattern with weaker staining in areas of oncocytic metaplasia. P63 highlighted the myoepithelial differentiation. In situ hybridization for Human Papilloma Virus 6, 11, 16, and 18 was negative. P53 was negative and Ki-67 was low, confirming its benign nature. Oncocytes are enlarged epithelial cells with voluminous eosinophilic granular cytoplasm resulting from staining of nonribosomal cytoplasmic components. Few reports documented it in hidradenoma papilliferum. Our case demonstrated a florid distinct appearance of this metaplasia. The immunoprofiles of this oncocytic metaplasia such as p53 negativity and positivity for androgen receptor and GCDFP-15 demonstrates similarity to apocrine metaplasia in the breast. The authors' case demonstrates the benign nature of oncocytic metaplasia and supports the common origin of oncocytic cells and columnar cells in hidradenoma papilliferum.
Subject(s)
Acrospiroma/pathology , Oxyphil Cells/pathology , Sweat Gland Neoplasms/pathology , Adult , Biomarkers, Tumor/analysis , Female , Humans , Immunohistochemistry , MetaplasiaSubject(s)
Arthritis/etiology , Chest Pain/etiology , Dermatomyositis/etiology , Skin/pathology , Still's Disease, Adult-Onset/complications , Arthritis/diagnosis , Arthritis/drug therapy , Biopsy , Chest Pain/diagnosis , Chest Pain/drug therapy , Dermatomyositis/drug therapy , Dermatomyositis/pathology , Dexamethasone/therapeutic use , Glucocorticoids/therapeutic use , Humans , Immunosuppressive Agents/therapeutic use , Male , Methotrexate/therapeutic use , Middle Aged , Skin/drug effects , Still's Disease, Adult-Onset/diagnosis , Still's Disease, Adult-Onset/drug therapy , Treatment OutcomeABSTRACT
AGEP is a rare skin reaction that causes the formation of numerous aseptic pustules on an erythematous base. In most cases, it presents after exposure to drugs, more often antibiotics. Fever and leukocytosis are common. The history, clinical appearance, and histology of the pustules confirm the diagnosis of AGEP. Pustular psoriasis, SJM, and EM must be ruled out. The lesions heal spontaneously within 2 weeks after discontinuation of the offending agent, an occurrence that further supports the diagnosis. Immediate withdrawal of the causative agent and supportive therapy is the mainstay of treatment for AGEP.