Dermatomyositis: Histopathologic findings of parakeratosis and dermal edema revisited.

The cutaneous manifestations of dermatomyositis range from classical in the case of heliotrope rash and Gottron papules to less common papulosquamous and edematous/vesiculobullous lesions; histopathologic descriptions are dominated by interface dermatitis. We present a case of dermatomyositis with a combination of common and rare skin findings, both clinically and histologically. Increased awareness of papulosquamous and edematous lesions of dermatomyositis can help direct patient care. Although uncommon, confluent parakeratosis and dermal edema can be manifestations of dermatomyositis.

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.

[Spontaneous remission of Kikuchi-Fujimoto disease (lymphadenopathy) with focal skin parakeratosis]. / Samoistna remisja choroby (limfadenopatii) Kikuchi-Fujimoto z ogniskowa parakeratoza skórna.

Kikuchi-Fujimoto disease is subacute, necrotizing lymphadenopathy affecting mainly young women, and manifested by cervical lymphadenopathy. It is often observed, and described in Asia, but in other world regions sporadically too. Etiology is unknown, but it has been postulated that this condition is induced by infectious factor. We described a case of 20-year-old Caucasian woman with diagnosis of Kikuchi-Fujimoto lymphadenopathy. First symptoms as a cervical lymph nodes enlargement 2 cm in diameter was associated with elevated body temperature, without associated symptoms of infection appeared about one year ago (data from history). Lymphadenopathy and general symptoms receded after empiric therapy with amoxicilin. Relapse of cervical lymphadenopathy alongshore sternocleidomastoid muscles bilateral to about 2 cm in diameter with pseudo-flu symptoms like fever and joints and muscles pains. Focal hiperpigmentation of abdomen, arms and legs skin appeared. In histopathology of collected lymph node histiocytic necrotizing lymphadenopathy without neutrophils infiltration Kikuchi type was diagnosed. In peripheral blood morphology transitional leucopenia 2.58 x 10(9)/l with granulocytopenia 0.64 x 10(9)/l was noted. Anemia and thrombocytopenia did not be observed. In serology active CMV, EBV or toxoplasmosis were excluded. In immunology presence of eleveted levels of anti-Jo, anti-nuclear and anticardiolipin antibodies was excluded too. Serum protein electrophoresis and additional biochemical parameters was normal. In chest X-ray and abdomen ultrasonography abnormalities was not found. In skin and muscles biopsy specimens focal parakeratosis was found. Despite no empiric antiinfectious therapy after 3-4 weeks remission of general symptoms and lymphadenopathy was noted.

The cutaneous manifestations of atypical complete DiGeorge syndrome: a histopathologic and immunohistochemical study.

DiGeorge syndrome is a congenital anomaly with a constellation of findings that includes thymic hypoplasia. Only a small subset of patients with DiGeorge syndrome has complete athymia, classified as complete DiGeorge anomaly; one third of these patients show an eczematous dermatitis, oligoclonal T-cells and lymphadenopathy, known as atypical complete DiGeorge anomaly. Six biopsies from six patients with the distinctive clinical phenotype of atypical complete DiGeorge anomaly were studied. Every biopsy showed exocytosis (100%), parakeratosis, often confluent and spongiosis (100%). Neutrophilic abscesses (50%), dyskeratosis (67%) and satellite cell necrosis (50%) were seen. Perieccrine and perivascular inflammation were seen in half of the cases. Eosinophils were identified (83%); most commonly in both the epidermis and dermis. All of lymphocytes were CD3 positive. Most (83%) of cases contained T-cell intracellular antigen 1 (TIA-1) positive cells. Special testing of the selected patients using spectratyping identified oligoclonal T-cell populations. The presence of dyskeratotic keratinocytes, satellite cell necrosis and parakeratotic scale with neutrophils characterizes the cutaneous rash seen in this subset of complete DiGeorge syndrome patients. Such skin lesions from patients with DiGeorge anomaly should alert the pathologist to the potential diagnosis of atypical complete DiGeorge anomaly. The pathophysiologic role of the oligoclonal T-cells in this entity requires additional study.

Impact of global genome repair versus transcription-coupled repair on ultraviolet carcinogenesis in hairless mice.

The nucleotide excision repair (NER) system is comprised of two subpathways, i.e., transcription-coupled repair (TCR) and global genome repair (GGR). To establish the relative importance of TCR and GGR for UV effects on the skin, we have used hairless knockout mouse strain lacking either TCR (CSB -/-) or GGR (XPC -/-). In single exposure experiments, we found that CSB -/- mice have a 7-16 times higher susceptibility to sunburn than XPC -/- mice and than heterozygous (+/-) and wild-type (+/+) controls. Exposure to 80 J/m2 UV radiation (i.e., suberythemogenic in CSB -/-) on 10 consecutive days gives rise to epidermal hyperplasia in CSB -/- and XPC -/-, whereas repair-proficient controls do not show epidermal hyperplasia from these exposures. In addition, CSB -/- mice develop marked parakeratosis, whereas XPC -/- mice and controls do not. Under continued exposure to this daily dose, squamous cell carcinomas appear in CSB -/-, XPC -/-, and in the control groups, whereas only in the CSB -/- animals is a fairly high number of benign papillomas also found. The median latency time of squamous cell carcinomas (diameters > or = 1 mm) is 84 days for the XPC -/- mice, 115 days for the CSB -/- mice, and 234-238 days for the heterozygous and wild-type control groups. These results indicate that GGR is more important than TCR in protection against UV-induced carcinomas of the skin but not against other UV effects such as sunburn, epidermal thickening, scaling of the stratum corneum, and development of papillomas. These results also indicate that GGR capacity may serve as a better predictor for skin cancer susceptibility than sensitivity to sunburn. The relative cancer susceptibilities of GGR- and TCR-deficient skin could well depend on the balance between an increased mutation rate and the presence (in CSB -/-) or lack (in XPC -/-) of a compensatory apoptotic response.

Sulcus vocalis: A new clinical paradigm based on a re-evaluation of histology.

OBJECTIVES/HYPOTHESIS: Sulcus vocalis is an epithelial invagination adherent to deep tissues of the vocal fold. Traditionally, dysphonia is believed to result from attenuation or absence of lamina propria and consequent alteration of mucosal dynamics. This conception does not account for several clinical features of the lesion, most notably inflammation. The goal of this study is to elucidate the clinical nature of sulcus by re-examination of its histopathology. STUDY DESIGN: Retrospective review. METHODS: Clinical features, including stroboscopic examination, and hematoxylin and eosin sections of 19 lesions in 15 patients who underwent surgery were reviewed. RESULTS: Epithelial change was found uniformly in all specimens, consisting of parakeratosis (78.9%), epithelial thickening (77.8%), dyskeratosis (63.2%), basement membrane thickening (47%), epithelial inflammation (52.6%), and retention of keratin debris (36.8%). In contrast, submucosal findings were less prevalent. Seven patients (36.8%) had essentially normal subepithelial tissues. Submucosal inflammation was present in seven (36.8%), and other submucosal changes in four of 17 (23.5%). Clinical characteristics demonstrated general improvement after surgical intervention in most cases. CONCLUSIONS: Sulcus vocalis appears to have an important component of epithelial pathology, with especially high prevalence of parakeratosis, dyskeratosis, and epithelial thickening. Clinical changes may result from prominent perilesional inflammation related to epithelial changes instead of or in addition to any alteration of the lamina propria. Surgical treatment, when necessary, should refocus on removal of pathologic epithelium as a source of inflammation independent of reconstructive considerations. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:1397-1403, 2016.

Occurrence of patchy parakeratosis in normal-appearing skin in patients with active atopic dermatitis and in patients with healed atopic dermatitis: a cause of impaired barrier function of the atopic skin.

It remains unclear whether an impaired barrier function often seen in areas of normal-appearing skin in patients with active atopic dermatitis (AD) is primary event in nature or secondary to subclinical eczematous change. We then attempted to evaluate the barrier function of normal-appearing skin in both active and healed AD patients, and as well as see whether a subclinical eczematous change exists or not in the normal-appearing skin using a non-invasive method. Transepidermal water loss (TEWL) measurement and exfoliative cytology method for corneal layer were applied in 153 AD patients who have active skin lesions and 29 individuals with completely healed AD for at least 5 years and 40 normal individuals. The TEWL of normal-appearing skin in severe, moderate and mild AD cases was 10.5+/-2.9, 8.3+/-2.4 and 7.3+/-2.1 g/m2 per h, respectively. The TEWL values in severe and moderate cases were significantly higher than the normal controls (6.2+/-1.6 g/m2 per h). However, the TEWL was not deranged in patients with completely healed AD. An exfoliative cytology examination of corneal layer disclosed that patchy parakeratosis appeared in normal-appearing skin in severe, moderate and mild AD cases at a rate of 42, 29 and 19%, respectively. However, no patchy parakeratosis was recognized in patients with completely healed AD. The occurrence of patchy parakeratosis in normal-appearing skin in patients with active AD suggests that an impaired barrier function often seen in normal-appearing skin in AD patients is secondary to subclinical eczematous change in the area.

Oesophagogastric parakeratosis in the growing pig: effects of the physical form of barley-based diets and added fibre.

In four experiments a total of 288 individually fed pigs were given barley-based diets for about 100 days from about 20 kg liveweight. Fine grinding of barley increased the number and severity of oesophagogastric lesions. Pelleting a diet based on coarsely ground barley had a similar effect. Coarser grinding of the barley and substituting small proportions of oat husk, but not of bran, gave lower incidences and severities of lesions. The performance responses of the pigs differed and give a framework for deciding on the balance to be struck between optimal performance and the risk of lesion development.

Rate of development of oesophagogastric parakeratosis in the growing pig: some effects of finely ground barley diets, genotype and previous husbandry.

The rate of development of parakeratotic lesions in the gastric pars oesophagea was investigated in three experiments using 360 pigs, initially aged 10 to 11 weeks and weighing about 30 kg, of differing genotype and with some differences in previous rearing method, given a diet based on finely ground barley which was known to predispose to lesion formation. Lesions were found in some pigs at 10 to 11 weeks old but the incidence and severity increased progressively indicating development as quickly as one month after first giving the finely ground diet. There were indications that different genotypes and different diets given previously in rearing may have influenced the results obtained. The possible influence of other environmental factors is discussed.

Lichen nitidus of the palms.

A case is presented of lichen nitidus that evolved into an acquired palmar keratoderma in a fifty year old woman; this is a rare manifestation of the disease. Lichen nitidus must be considered in the differential diagnosis of keratoderma palmaris.

Methods for exposure of laboratory animals to ultraviolet radiation.

Two different sources of ultraviolet B (UVB) radiation, an electronically controlled UVB exposure unit, containing FS40 tubes, and a hand-held Kromayer lamp, were evaluated for actual irradiance in W/m2 and spectra (physical dosimetry and biological dosimetry (skin effects in rodents)). The technical studies of the FS40 sources demonstrated that the flux intensity of the lamps could be changed electronically, without affecting the spectrum. Thus it was possible to standardize UVB exposure electronically. The biologically effective doses of these sources were analysed in RIV-Tox Wistar rats and BALB/c mice. After low doses of UVB radiation, histopathological changes such as acanthosis, hyperkeratosis and dermal inflammation were observed in the skin without the presence of major side effects such as erythema and oedema. After higher doses of UVB radiation erythema and oedema were clearly visible. Quantitative studies showed that the minimal erythema dose, as a biological parameter, correlated well to the emission in J/m2. In addition, biological parameters such as acanthosis and inflammation in the skin correlated well to the actual exposure in J/m2 and were sensitive biomarkers for UVB-induced skin toxicity. Thus, in addition to minimal erythemal doses, acanthosis and inflammation may also be applied as biologically relevant doses for studies of the biological effects of UVB radiation.

[Exogenous zinc deficiency syndrome]. / Das exogen bedingte Zinkmangelsyndrom.

Two cases of acquired zinc deficiency after excessive bowel resection and total pancreatectomy and after total parenteral nutrition are reported. Skin lesions include diffuse hair loss and a psoriasis like dermatitis localized mainly at acral areas and around body orifices, which disappeared rapidly after oral supplementation of zinc sulfate. Clinical symptoms, etiological factors, differential diagnosis and therapy are discussed.

Citrus pulp for cattle.

Citrus pulp is classified as an energy concentrate by-product feed. Citrus by-products fed to beef cattle include citrus molasses, citrus meal, wet citrus pulp, dried citrus pulp, and pelleted citrus pulp; however, in current production systems, pulp (wet, dry, and pelleted) is the only by-product commonly used. Citrus pulp production in the United States is limited to specific subtropical regions, of which south central Florida remains the largest with additional production in California and Texas.

[Distress of the airway due to vertebral ankylosing hyperostosis or Forestier-Rotes' disease]. / Compromiso de la vía aérea en la hiperostosis anquilosante vertebral o enfermedad de Forestier-Rotes.

The AA. present one case in which the air-way was severely compromised because of the causative vertebral ankylosing hyperostosis, the so-called Forestier-Rotés's malady. Only 7 of resembling cases are recorded in the consulted literature. Survey of the related bibliography and comments about pathogenic criteria and diagnostic and therapeutic questions as well.

Two episodes of axillary granular parakeratosis triggered by different causes: case report.

Granular parakeratosis is an acquired disorder of keratinization characterized by keratotic papules and plaques located in the intertriginous areas. Its etiology is unknown. Some cases have been related to the application of deodorants and antiperspirants, local irritation or increased sweating; in other cases no precipitant factors have been found. We report a case of axillary granular parakeratosis in an adult male in whom the lesions appeared twice under different circumstances: the first time the lesions appeared after local irritation produced by an antiperspirant and/or the use of a paste containing zinc oxide; two years later, an identical eruption reappeared in both axillae, while using his habitual deodorant and without a preceding irritation of the zone; only excessive sweating was mentioned this time after a weight gain of 20 kg. On both occasions, the lesions disappeared completely a few days after using topical calcipotriol. A constitutional factor may predispose the development of granular parakeratosis, which must be considered a reaction pattern that can be induced by multiple different causes.

History of zinc in agriculture.

Zinc was established as essential for green plants in 1926 and for mammals in 1934. However, >20 y would pass before the first descriptions of zinc deficiencies in farm animals appeared. In 1955, it was reported that zinc supplementation would cure parakeratosis in swine. In 1958, it was reported that zinc deficiency induced poor growth, leg abnormalities, poor feathering, and parakeratosis in chicks. In the 1960s, zinc supplementation was found to alleviate parakeratosis in grazing cattle and sheep. Within 35 y, it was established that nearly one half of the soils in the world may be zinc deficient, causing decreased plant zinc content and production that can be prevented by zinc fertilization. In many of these areas, zinc deficiency is prevented in grazing livestock by zinc fertilization of pastures or by providing salt licks. For livestock under more defined conditions, such as poultry, swine, and dairy and finishing cattle, feeds are easily supplemented with zinc salts to prevent deficiency. Today, the causes and consequences of zinc deficiency and methods and effects of overcoming the deficiency are well established for agriculture. The history of zinc in agriculture is an outstanding demonstration of the translation of research into practical application.