A case of lichen aureus successfully treated with 595 nm wavelength pulsed-dye laser.

BACKGROUND: Lichen aureus (LA) is a variant of pigmented purpuric dermatosis (PPDs) that typically presents with the acute onset of a solitary, unilateral, purple to rust-yellow colored lichenoid patch or plaque on lower extremities. Treatment remains challenging and is based on anecdotal case reports often with poor results. AIMS: Describe a case of LA successfully treated with 595 nm wavelength pulsed-dye laser (PDL). PATIENT/METHOD: A 46-year-old woman with segmental LA was treated using a 595 nm PDL at a uniform spot size of 10 mm, with pulse durations of 10 milliseconds and fluence of 6 J/cm2. The patient had received previous treatments with no improvement. RESULTS: Clearance was archived after three sessions with PDL. Sessions were performed at intervals of 4 weeks, with no serious adverse events nor recurrence. CONCLUSION: We hypothesize the favorable clinical outcome with PDL is due to the affinity of the wavelength for oxyhemoglobin (allowing uniform vessel penetration and energy delivery to fragile capillaries and intraluminal blood) and to its anti-inflammatory profile. PDL seems to be an alternative for patients with progressive LA that have failed other therapies.

Histopathological Profile In Fatal Yellow Phosphorous Poisoning.

Yellow phosphorous (YP) is the toxic form of elemental phosphorous and the chief constituent of firecrackers and rodenticides. In India, the rodenticide paste is frequently used for the suicidal purpose. This study is an autopsy-based observational study which describes the histopathological features of heart, lungs, liver, and kidney of fatal cases of YP poisoning. The most common autopsy features in the viscera were congestion and petechial hemorrhage. The liver histopathology findings were microvesicular steatosis (68%), hepatic necrosis (62%), macrovesicular steatosis (50%), inflammatory cells (46%), sinusoidal congestion (40%), cholestasis (32%), and toxic hepatitis (18%). Hepatic necrosis ranged from being focal to centrizonal in distribution. Congestion was the most common feature observed in the lungs and the kidney. This is the largest autopsy-based study on YP poisoning till date. The histopathological features of liver were consistent with YP poisoning whereas the findings of heart, lungs, and kidney were nonspecific in nature.

A comparative study with a 755 nm picosecond Alexandrite laser with a diffractive lens array and a 532 nm/1064 nm Nd:YAG with a holographic optic.

BACKGROUND AND OBJECTIVES: This study was performed to better understand the cutaneous effects of using a fractional picosecond laser at 755 nm with a diffractive lens array and a picosecond Nd:YAG laser at 532 mn and 1064 nm with a holographic optic. We characterized the injuries created by these devices on skin clinically and histologically over 24 hours. With this information we modeled the effects of these devices on a cutaneous target. METHODS: Eight patients, representing Fitzpatrick skin types I-VI, were treated on their backs with a picosecond Alexandrite laser with a diffractive lens array, as well as a picosecond Nd:YAG laser at 532 nm and 1064 nm with a holographic optic. Photographs were taken 15 minutes and 24 hours after treatments. Punch biopsies were obtained at 24 hours and examined histologically. RESULTS: Treatment with the picosecond Nd:YAG laser at both 532 nm and 1064 nm with the holographic optic revealed erythema and small scatted areas of petechial hemorrhage areas immediately and in many cases at 24 hours after treatment. The 755 nm picosecond Alexandrite laser with diffractive lens array produced erythema immediately after treatment, which largely dissipated 24 hours later. Histologies revealed intra-epidermal vacuoles with all three wavelengths. Fractional picosecond Nd:YAG laser at 532 nm and 1064 nm with the holographic optic showed focal areas of dermal and intra-epidermal hemorrhage with areas of vascular damage in some patients. CONCLUSIONS: This study demonstrates that both fractional picosecond devices produce vacuoles in the skin, which are most likely due to areas of laser induced optical breakdown (LIOB). In the patients (skin type II-IV) we observed scatter areas of hemorrhage in the skin, due to vascular damage with the 532 nm and 1064 nm, but not with 755 nm wavelengths. Lasers Surg. Med. 50:37-44, 2018. © 2017 Wiley Periodicals, Inc.

Bioenergetics dysfunction, mitochondrial permeability transition pore opening and lipid peroxidation induced by hydrogen sulfide as relevant pathomechanisms underlying the neurological dysfunction characteristic of ethylmalonic encephalopathy.

Hydrogen sulfide (sulfide) accumulates at high levels in brain of patients with ethylmalonic encephalopathy (EE). In the present study, we evaluated whether sulfide could disturb energy and redox homeostasis, and induce mitochondrial permeability transition (mPT) pore opening in rat brain aiming to better clarify the neuropathophysiology of EE. Sulfide decreased the activities of citrate synthase and aconitase in rat cerebral cortex mitochondria, and of creatine kinase (CK) in rat cerebral cortex, striatum and hippocampus supernatants. Glutathione prevented sulfide-induced CK activity decrease in the cerebral cortex. Sulfide also diminished mitochondrial respiration in cerebral cortex homogenates, and dissipated mitochondrial membrane potential (ΔΨm) and induced swelling in the presence of calcium in brain mitochondria. Alterations in ΔΨm and swelling caused by sulfide were prevented by the combination of ADP and cyclosporine A, and by ruthenium red, indicating the involvement of mPT in these effects. Furthermore, sulfide increased the levels of malondialdehyde in cerebral cortex supernatants, which was prevented by resveratrol and attenuated by glutathione, and of thiol groups in a medium devoid of brain samples. Finally, we verified that sulfide did not alter cell viability and DCFH oxidation in cerebral cortex slices, primary cortical astrocyte cultures and SH-SY5Y cells. Our data provide evidence that bioenergetics disturbance and lipid peroxidation along with mPT pore opening are involved in the pathophysiology of brain damage observed in EE.

Pigmented purpuric dermatosis after taking a dietary supplement.

Pigmented purpuric dermatoses (PPDs) are a group of histologically similar skin eruptions characterized by a perivascular lymphocytic infiltrate with extravasated erythrocytes. The etiologies of these conditions are unknown, but triggering factors such as systemic diseases, infections, drugs, and foods have been described. Here, we present a patient who developed pigmented purpura 30 days after initiating a dietary supplement that contained selenium, natural vitamin E, and a parsley concentrate, specifically, Parselenium E. One month after stopping the dietary supplement, the lesions disappeared and no new lesions have developed.

Phototherapy as an effective treatment for Majocchi's disease--case report.

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

Phototherapy as an effective treatment for Majocchi's disease - Case report

Pigmented purpuric dermatoses are chronic and relapsing disorders characterized by a symmetrical rash of petechial and pigmentary macules, mainly confined to the lower limbs. Purpura annularis telangiectodes of Majocchi is a less common variant of Pigmented purpuric dermatoses characterized by punctate telangiectatic macules progressing to annular, hyperpigmented patches with central clearing and infrequent atrophy. A 12 year-old girl presented with asymptomatic round to oval reddish brown macules, present symmetrically over her lower and upper limbs for 3 years. Few lesions were annular in shape. Biopsy from the lesion was compatible with Pigmented purpuric dermatoses. On the basis of clinical and histopathological findings, a diagnosis of Purpura annularis telangiectodes of Majocchi was made. The patient began phototherapy thrice a week and showed excellent response.

Progressive pigmentary purpura.

A 58-year-old man presented for evaluation and treatment of non-tender, non-pruritic, annular patches on the right temple and frontal aspect of the scalp that reddened with exercise. A biopsy specimen showed a purpuric dermatitis with features of lymphocytic vasculitis; a diagnosis of exercise-induced progressive pigmentary purpura was made. Whereas progressive pigmentary purpura is purported to be caused by exercise, other similar appearing entities are associated with exercise, namely exercise-induced vasculitis (EIV). EIV may be considered as an acute microcirculatory deficiency and thermoregulation decompensation that occurs after episodes of exhaustive major muscular activity or after unusual or excessive exercise. The combination of age greater than 50 years, heat, and prolonged exercise are the most potent contributing factors. This is the first report of exercise-induced progressive pigmentary purpura.

Púrpura extensa de largo tiempo de evolución / Long-Standing Widespread Purpura

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Possible green tea-induced thrombotic thrombocytopenic purpura.

PURPOSE: A case of a patient who developed thrombotic thrombocytopenic purpura (TTP) after consuming a weight-loss product containing green tea is reported. SUMMARY: A 38-year-old, 68-kg Caucasian woman arrived at the emergency department with a one-week history of malaise, fatigue, and petechiae of the skin. She had no symptoms of infection and denied illegal drug use. Her medical history included hypothyroidism, for which she was treated with levothyroxine 150 microg daily for the past four years. She reported that she had been using a green tea preparation for the two months before admission to lose body weight. The daily preparation contained 200 mg of green tea extract 5:1, equivalent to 1 g of natural green tea. On clinical examination, the patient appeared acutely ill and was afebrile, with pallor, petechiae, and purpura of the extremities. Laboratory test results at the time of admission revealed that the patient had anemia and marked thrombocytopenia. A peripheral blood smear demonstrated a feature of microangiopathic hemolytic anemia. Immunoglobulin G autoantibodies against ADAM metallopeptidase with thrombospondin type 1 motif, 13 were detected. On hospital day 3, the patient appeared confused and exhibited aphasia that was initially transient but then recurrent. Brain computerized tomography did not exhibit focal pathology. Over the next few days, her neurologic symptoms subsided and her platelet count and hematocrit value gradually increased. Plasmapheresis was performed (12 procedures). Corticosteroid treatment was also initiated. After 20 days of hospitalization, the patient was discharged. CONCLUSION: A 38-year-old woman developed TTP after consuming a weight-loss product containing green tea extract for two months.

Narrowband UVB therapy as an effective treatment for Schamberg's disease.

A 33-year-old man presented with a 3-month history of a widespread pigmented purpuric eruption over his trunk and limbs. The clinical presentation and histology were consistent with a diagnosis of Schamberg's disease. The rash initially cleared following a short course of oral prednisolone at 25 mg daily for 3 weeks, which was weaned over the subsequent 4 weeks. Topical mometasone furoate ointment 0.1% daily was also applied to active areas. The rash recurred when prednisolone was reduced to below 5 mg per day. To prevent a further recurrence with weaning prednisolone, narrowband UVB therapy was commenced three times per week. The patient was continued on UV therapy over the next 5 months. The rash would flare after 2 to 3 weeks without treatment. The frequency of UV therapy was weaned and the patient remained clear on as little as one treatment every 2 weeks. Any further reduction, however, was associated with a recurrence. Narrowband UVB therapy should be considered for difficult or persistent cases of pigmented purpuric eruption.

Unilateral linear capillaritis: two unusual Chinese cases.

Unilateral linear capillaritis (ULC) is a rare special variation of pigmented purpuric dermatosis (PPD), which is characterized clinically by linear or segmental distribution of pigmented purpuric macules located predominantly on the lower extremities and showing a favorable prognosis. In this case report, we describe two unusual cases of ULC, in one male and one female patient, with unilateral lesions involving the upper extremities that loosely follow the dermatome lines. Biopsy results revealed a common histopathology feature to PPD without heavy band-like infiltration in the upper dermis. On review 20 months after the onset, the eruptions of Patient 1 had spontaneously faded from parts of the affected area. Meanwhile, after a period of 18 months post onset, the eruptions of Patient 2 had became less visible after treatment with PUVA for 2 months, leaving a faded pigmentation.

Deaths from accidental steam inhalation during traditional therapy.

Death from accidental steam inhalation is quite a rare occurrence. Two cases of children who died during the inhalation of superheated steam in a closed room are reported. To our knowledge this is the first case report where children died from the injurious effects of steam while inhaling steam. At autopsy, petechial haemorrhages in brain, lungs, heart, and congestion of epiglottis, congestion and oedema of lungs were seen macroscopically. Microscopically, trachea showed swelling and oedema of mucosa and sub mucosa, focal loss of mucosal epithelium and coagulative necrosis with scanty inflammatory reaction, lungs showed congestion, oedema and haemorrhages. It is considered that these findings caused hypoxia and cause of death in these cases was accidental inhalation of superheated steam. It indicates that mucosa of respiratory tract is vulnerable to the effects of vapors of superheated steam. Moreover it would seem that fatal hypoxia occurs within a few minutes from the effects of inhalation of steam in a closed space.

Long-pulsed dye laser treatment for facial telangiectasias and erythema: evaluation of a single purpuric pass versus multiple subpurpuric passes.

BACKGROUND AND OBJECTIVE: Subpurpuric treatments with the pulsed dye laser can be effective for treatment of vascular lesions, although less so than when purpuric fluences are used. Increased efficacy may be achieved by performing multiple passes at the time of treatment. We performed a split-face bilateral paired comparison of multiple low-fluence subpurpuric passes compared with a single high-fluence purpuric pass in the treatment of facial telangiectasias. MATERIALS AND METHODS: Nine patients were included in the study. One cheek was chosen to be treated with four passes of a nonpurpuric fluence, and the contralateral cheek was treated with a single purpuric pass. Reductions in vessel density, diameter, arborization, and background erythema were evaluated 3 weeks after treatment. RESULTS: We found a 43.4% reduction in surface area covered by telangiectasias on the cheek treated with a single purpuric pass compared with 35.9% on the cheek treated with four subpurpuric passes. The purpuric fluences produced greater reduction in vessel diameter and arborization, whereas the subpurpuric protocol was more effective in reducing background erythema. Purpuric fluences were also noted to produce more significant edema and transient hyperpigmentation in one patient. CONCLUSION: The multipass subpurpuric approach to treatment with the pulsed dye laser is both cosmetically acceptable and effective, although purpuric treatments may be required to effectively eliminate larger-caliber, more highly networked vessels.

PUVA therapy in lichen aureus.

Lichen aureus is one of the subtypes of a rare group of diseases, pigmented purpuric dermatoses. The natural course of the disease is slow evolution and slow resolution. Treatment is generally limited. We report a case of lichen aureus that responded dramatically to photochemotherapy (PUVA).

Purpuric phototherapy-induced eruption in transfused neonates: relation to transient porphyrinemia.

OBJECTIVE: Blue light phototherapy is commonly administered to neonates as treatment of indirect hyperbilirubinemia, often in conjunction with blood transfusions to treat hemolytic anemia. We observed a distinctive cutaneous complication of phototherapy in six neonates with hyperbilirubinemia. METHODOLOGY: We studied the clinical and histologic characteristics of the eruption, as well as the porphyrin levels in affected neonates. Five of the patients had erythroblastosis fetalis; the other had profound anemia from twin-twin transfusion. All of the neonates developed purpuric patches at sites of maximal exposure to the phototherapy lights, with dramatic sparing at shielded sites within 24 hours after initiation of the phototherapy. On discontinuation of phototherapy, all eruptions cleared within 1 week. Examination of skin biopsy sections showed purpura without significant inflammation or keratinocyte necrosis. Plasma porphyrins (copro- and proto-) were elevated in the two patients in which they were assessed. CONCLUSIONS: The distribution of the eruption in areas exposed to light and presence of circulating porphyrins suggest that porphyrinemia may underlie the light-induced purpuric eruption. Additional studies will be required to determine definitively the mechanisms of both the purpuric phototherapy-induced eruption and the development of increased blood porphyrin levels in these transfused neonates.

Prolonged bleeding time during ciprofloxacin therapy.

Ciprofloxacin is a broad spectum quinolone antibiotic. Side effects reported include nausea and other gastrointestinal symptoms; skin and musculoskeletal side effects may also occur. No bleeding abnormalities or alteration in coagulation have been documented. We report a case where ciprofloxacin appeared to contribute to an idiosyncratic prolongation of bleeding time although a rechallenge 8 months later did not reproduce the effect. Moreover, subsequent investigation of the influence of ciprofloxacin on bleeding parameters in 10 healthy volunteers demonstrated no alterations in bleeding parameters.

[Changes in the loci minoris resistentiae of the dermis in photosclerosis]. / Altérnation des loci minoris resistentiae du derme dans la photosclérose.

The resistance to traction of the dermo-epidermal junction and of the superficial vascular plexus is altered by oral photochemotherapy. The dermo-epidermal junction is weakened when the resistance of vascular walls increases. These modifications are related to the histological alterations occurring during photosclerosis induced by PUVA.