Nevus comedonicus of glans with unusual morphology due to manipulation.

Nevus comedonicus, an uncommon skin condition, was originally termed "comedo nevus" by Kofmann in 1895. It is characterized by the clusters of pits-containing black keratinous plugs resembling blackheads. Conventionally, nevus comedonicus manifests at birth (in 50% of cases) or during the first decade of life. The commonly affected areas include the head, neck, chest, upper, and lower limbs, with patterns ranging from unilateral, bilateral, linear, interrupted, segmental, to blaschkoid. While genital nevus comedonicus is rare, some cases have been reported. In this report, we present a case of nevus comedonicus on the glans, underscoring the importance of considering nonsexually transmitted disease-related causes for genital lesions.

Follmann balanitis in secondary syphilis.

Syphilitic balanitis is an uncommon rather underreported manifestation of primary syphilis initially described by Eugene Follmann and subsequently named after him. It is characterized by balanitis with or without a primary chancre and inguinal lymphadenopathy. Given its rarity, Follmann balanitis may be misdiagnosed with other causes of balanitis. Therefore, a strong clinical suspicion and awareness are crucial, particularly in the current resurgence of syphilis. With this background, we hereby report a case of Follmann balanitis in secondary syphilis, diagnosed based on clinical features, positive syphilis serology, and response to benzathine penicillin treatment.

A Retrospective Study of the Histopathological Spectrum of Erythema Nodosum Leprosum.

Background: There are no recent studies with a focus on the histopathology of erythema nodosum leprosum (ENL). Objectives: To describe the histopathological spectrum of ENL. Materials and Methods: Digital records from the pathology department were searched, and 125 slides were included. The histopathologic findings were recorded using a pre-designed proforma. Results: Several patterns were noted with the most common being a superficial and deep, perivascular and peri-appendageal, well-circumscribed dermal infiltrate that was seen in 70 (56.0%) biopsies. Other dermal patterns included a similar but loose infiltrate in 19 (15.2%) biopsies, diffuse dermal involvement in 9 (7.2%), top-heavy in 9 (7.2%), and bottom-heavy infiltrates in 12 (9.6%). Subcutaneous tissue was included in 107 biopsies. Extension of dermal infiltrates to the subcutis was noted in 71 (66.4%) biopsies and predominant involvement of the subcutis was noted in 6 (4.8%) biopsies, with lobular involvement in 60 (56.1%), septal involvement in 3 (2.8%), and septo-lobular involvement in 14 (13.1%). In 30 (28.0%) biopsies, the subcutaneous fat was uninvolved. The infiltrates contained neutrophils and foamy histiocytes in variable proportions, along with lymphocytes and plasma cells. Eosinophils were noted occasionally. Medium and/or small vessel vasculitis was noted in 11 (8.8%) biopsies. Fite-Faraco staining was available for 112 biopsies and revealed mainly fragmented and granular acid-fast bacilli (AFB) in 29 (25%) biopsies. Limitations: Our study had a retrospective design; we could not compare the lesional age and clinical characteristics of patients with the histological features. Conclusion: ENL is characterized by dermal infiltrates composed of foamy histiocytes and neutrophils in varying proportions arrayed in different dermal patterns. Extension of dermal infiltrates into the subcutis was frequent but absent in some. Predominant or exclusive involvement of the subcutis was rare. Vasculitis was noted in a small minority, while AFB were demonstrated in about a quarter of cases.