Idiopathic eruptive macular pigmentation or acanthosis nigricans?

A 21-year-old male presented with numerous asymptomatic dark brown to brown black pigmented macules and barely raised plaques on the face, trunk and extremities, developing over a period of 2 year. The surface of most lesions had a velvety raised surface similar in appearance to acanthosis nigricans and a biopsy from one of the lesions showed pigmented papillomatosis. This case fulfils all the criteria for idiopathic eruptive macular pigmentation (IEMP) with papillomatosis, and the clinical appearance of acanthosis nigricans in most lesions suggests that IEMP is a form of eruptive acanthosis nigricans.

Vulvar vestibular papillomatosis.

Vulvar vestibular papillomatosis is considered an anatomical variant of the vulva. Recognition of this condition enables one to distinguish it from warts and therefore avoid unnecessary therapy. A 29-year-old lady presented to this clinic with a history of 'small growths' in her vulva since two years. Examination identified skin colored translucent papules; some of them appeared digitate and were seen on the vestibule and inner aspect of both labia minora. They were soft to feel and non-tender. Few lesions looked like elongated pearly penile papules. A provisional diagnosis of vestibular papillomatosis was made and a biopsy was done. It showed finger-like protrusions of loosely arranged subdermal tissue with blood vessels and which were covered by normal mucosal epithelium. No koilocytes were seen and the diagnosis of vestibular papillomatosis was confirmed. We believe that this is the first case report of vulvar vestibular papillomatosis in Indian dermatologic literature.

Idiopathic eruptive macular pigmentation with papillomatosis: Report of nine cases.

Nine patients, seven males and two females aged 6-14 years, presented with extensive, asymptomatic, brown-black macules and mildly elevated, pigmented lesions of a few months' duration. The sites affected were the face, trunk and proximal extremities. The skin lesions were discrete and individual lesions were less than 2 cm in size. The clinical diagnoses rendered by the referring physicians were lichen planus pigmentosus, urticaria pigmentosa, erythema dyschromicum perstans and postinflammatory hyperpigmentation. Histology in all nine cases showed papillomatosis of the dermis with prominent pigmentation of the basal layer (pigmented papillomatosis) without any significant dermal inflammation. Two cases had spores of Pityrosporum ovale in the thickened horny layer, one of which also had, in addition, bacterial colonies in the stratum corneum. The pigmentation resolved on its own over several months. This presentation is similar to the previously described idiopathic eruptive macular pigmentation with the additional histological finding of papillomatosis that is being described for the first time and may be nosologically related to acanthosis nigricans and confluent and reticulate papillomatosis.

Florid cutaneous papillomatosis with adenocarcinoma of stomach in a 35 year old male.

Various paraneoplastic dermatoses may be seen in association with underlying visceral, especially gastrointestinal, malignancy. Florid cutaneous papillomatosis describes the sudden appearance of multiple acuminate keratotic papules that morphologically resemble viral warts. It may be seen in association with acanthosis nigricans and/or the sign of Leser Triotalat. We report a 35-year-old male with extensive seborrhoeic keratoses and florid cutaneous papillomatosis. Unusually marked verrucous changes caused disfigurement of the hands and feet. The patient also reported dyspepsia, abdominal distention and weight loss 6 months prior to the development of cutaneous lesions. Gastroscopy revealed a large growth in the stomach. Histopathology of the tumor showed features of adenocarcinoma.