Cutaneous inflammation as a marker of malignant transformation in a patient with linear unilateral basaloid follicular hamartoma.

Basaloid follicular hamartoma is a rare, benign and superficial malformation of hair follicles, characterized histologically by epithelial proliferation of basaloid cells with radial disposition. It can be mistaken for basal cell carcinoma. Even though these hamartomas are considered benign lesions, malignant transformation has rarely been reported. We report the case of a 45-year-old healthy woman, with linear, unilateral basaloid follicular hamartoma which developed inflamed papules histologically suggestive of basal cell carcinoma. We believe that identification of local inflammation could be a clinical clue to guide us towards a malignant transformation of basaloid follicular hamartoma.

Clinical Pearls: Leprosy Reactions.

Leprosy reactions are acute inflammatory episodes that occur in the setting of Mycobacterium leprae infection. Precipitants of reactions can be pharmacologic and nonpharmacologic. Both type 1 and type 2 reactions typically occur before and during leprosy treatment but may also occur after treatment has been completed. Reactions cause morbidity due to nerve damage, and prompt corticosteroid therapy is warranted to minimize nerve damage due to reactions.

Severe inflammatory and keloidal, allergic reaction due to para-phenylenediamine in temporary tattoos.

Hair coloring with henna has been popular in Turkey for years. In recent years since the tattoos are applied by the street vendors in most of the beach places in Turkey, skin coloring with henna has also increased. Henna can be used alone or in combination with other coloring agents. Henna alone can be safe but due to additives such as para-phenylenediamine (PPD), p-toluenediamine and various essential oils, allergic contact reactions may occur. We report a 22-year-old man who developed severe inflammatory and keloidal, moderately bullous allergic reaction after henna paint-on tattoo. We did a patch test separately with these painting products (henna powder, PPD) and with the European standard series. PPD was strongly positive (+++) on day 2 and remained positive for following days. After treating with topical clobetasol-17 butyrate, resolution was obtained in two weeks. But some keloidal reaction remained.

Early mycosis fungoides vs. inflammatory mimics: how reliable is histology?

BACKGROUND: The histologic diagnosis of early mycosis fungoides (MF) and its distinction from inflammatory dermatoses is challenging, owing to the overlap of several features. AIMS: 1) To assess the efficacy of histologic criteria to diagnose early MF, 2) to study their utility in differentiating inflammatory mimics of MF. METHODS: We retrospectively reviewed slides from 50 cases clinically/histologically suspicious for MF. The diagnoses were established based on response to treatment and follow-up. The slides were analyzed double-blinded by two observers independently. Twenty-eight histologic criteria were assessed and each criterion was graded. Univariate analysis was performed on the results. RESULTS: There were 17 cases of MF and 33 of inflammatory dermatoses. Of the 28 criteria, the following 15 achieved significance on univariate analysis: disproportionate epidermotropism, tagging of lymphocytes along the basal layer, haloed lymphocytes, convoluted lymphocytes, Pautrier's abscesses, larger epidermal lymphocytes, wiry dermal collagen, absence of edema, eccrine infiltration, folliculotropism, follicular mucin, involvement of papillary and reticular dermis, monomorphous infiltrates, and atypia of dermal lymphocytes. The criteria that were 100% specific for MF included convoluted lymphocytes, eccrine infiltration, and follicular mucin. Absence of edema was 100% sensitive and specific in distinguishing MF from its inflammatory mimics. CONCLUSIONS: A combination of histologic patterns and cytology of lymphocytes is reliable in distinguishing MF from inflammatory dermatoses. No single criterion is effective in achieving this. Rather than merely recording the presence or absence of a criterion, grading each of them adds objectivity to the diagnosis.