ABSTRACT
Within the literature, there is overlap in the histopathological features described in eosinophilic folliculitis associated with chronic lymphocytic leukemia (CLL), eosinophilic dermatosis of hematologic malignancy, and acneiform follicular mucinosis. These disorders are described with varying degrees of superficial and deep lymphocytic and eosinophilic inflammation demonstrating perivascular, perifollicular, and folliculocentric involvement with or without follicular mucin deposition. Given significant histopathological overlap, these diagnoses may represent a continuum on a spectrum of dermatoses. Here, we present two cases with histopathological elements that reflect components of this clinicopathological spectrum and compare our findings with previously reported cases to compare and contrast reported features. Our first case is a 71-year-old African American man with long-standing CLL who developed a pruritic erythematous papular eruption on the face and chest with biopsy revealing a dense folliculotropic lymphocytic infiltrate with conspicuous eosinophils and follicular mucinosis. Our second case is a 70-year-old Caucasian man recently diagnosed with CLL/small lymphocytic lymphoma who developed an erythematous papular rash on the neck and face with biopsy revealing superficial and deep perivascular and periadnexal lymphocytic inflammation with scattered eosinophils. Characterization of our two cases and comparison with available literature suggest that these disorders may represent a continuum of dermatoses.
Subject(s)
Eosinophilia/pathology , Eosinophils/pathology , Folliculitis/pathology , Hematologic Neoplasms/pathology , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Lymphoma, T-Cell, Cutaneous/pathology , Mucinosis, Follicular/pathology , Skin Diseases, Vesiculobullous/pathology , Skin Diseases/pathology , Acneiform Eruptions/pathology , Administration, Topical , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Biopsy , Diagnosis, Differential , Eosinophilia/drug therapy , Folliculitis/drug therapy , Hematologic Neoplasms/complications , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Lymphoma, T-Cell, Cutaneous/complications , Male , Middle Aged , Mucinosis, Follicular/drug therapy , Prednisone/administration & dosage , Prednisone/therapeutic use , Skin Diseases/drug therapy , Skin Diseases/immunology , Skin Diseases, Vesiculobullous/drug therapy , Treatment OutcomeABSTRACT
A 72-year-old man with history of chronic lymphocytic lymphoma presented with a tender, ulcerated cutaneous eyelid lesion. Excisional biopsy revealed a diagnosis of eosinophilic dermatosis of malignancy. This rare paraneoplastic eruption is associated with hematologic malignancies and characterized histopathologically by lymphocytic infiltration accompanied by numerous eosinophils. To our knowledge, eosinophilic dermatosis of malignancy involving the eyelid has not been previously reported.
Subject(s)
Eosinophilia , Leukemia, Lymphocytic, Chronic, B-Cell , Skin Diseases , Aged , Biopsy , Eosinophilia/diagnosis , Eyelids , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , MaleABSTRACT
Metastatic carcinoma to the skin occurs in only a minority of patients with a visceral or internal malignancy, with breast, lung, and colorectum accounting for the majority of cases. We present the case of a 66-year-old man with a recent violaceous nodule of the left scalp (1.2 × 1.0 × 0.2 cm) that was a metastatic pancreatic adenosquamous carcinoma, representing a seemingly rare event. Two months prior, after complaining of right hip pain, an image revealed a right femoral lesion. A biopsy of that lesion showed moderately differentiated adenocarcinoma. Subsequent imaging showed a mass in the pancreatic tail and also markedly elevated serum tumor markers, CA 19-9 and carcinoembryonic antigen (5325 and 111.5 U/mL, respectively). Before the appearance of the scalp nodule, the patient received radiotherapy and was started on chemotherapy, which was continued after diagnosis and resection of the nodule. Subsequent metastases developed in the liver, lung and additional cutaneous lesions. He died 11 months after initial presentation with right hip pain. As this case shows, cutaneous metastases confer a poor prognosis, often with less than a year survival following their appearance.
Subject(s)
Carcinoma, Adenosquamous/secondary , Head and Neck Neoplasms/secondary , Pancreatic Neoplasms/pathology , Scalp/pathology , Skin Neoplasms/secondary , Aged , Fatal Outcome , Humans , Male , Pancreatic NeoplasmsSubject(s)
Dermatitis, Allergic Contact , Skin Pigmentation , Child , Humans , Patch Tests/methods , Retrospective Studies , Skin , AllergensSubject(s)
Dermatitis, Allergic Contact , Dermatitis, Atopic , Allergens , Child , Dermatitis, Allergic Contact/diagnosis , Humans , Patch Tests , RegistriesABSTRACT
Cutaneous mantle cell lymphoma (MCL) is exceedingly rare, almost always occurring as a dissemination of systemic MCL. To date, only 32 cases have been described. We report a series of 10 cases of MCL in the skin, and provide a comprehensive clinicopathologic review with clinical follow-up. Our cases occurred in older individuals (mean age = 70) and were more frequently in men (90%). Half of them presented in the head and neck region as a mass/nodule, and the remainder in the trunk and extremities as nodules. All patients have stage IV disease. In two of the 10 cases (20%) the cutaneous lesions preceded the diagnosis of disseminated disease. In two of the seven cases with available clinical follow-up information (33%) the skin was immediately involved after the diagnosis of MCL, and in three of the seven the skin was the first site of recurrence (mean interval = 57 months). The mean time to recurrence of the disease was 45.4 months and the overall survival was 66.3 months. Histologically six out of 10 cases (60%) had either pleomorphic or blastoid morphology (four out of 10 and two out of 10, respectively). The mean number of mitoses per 10 high-power fields was 18.44. While nine out of 10 cases expressed cyclin-D1, one case was not positive for cyclin-D1 but did label with SOX-11. Limited cytogenetic data showed trisomy 14 in one case, in addition to the t(11;14) translocation.
Subject(s)
Lymphoma, Mantle-Cell/pathology , Skin Neoplasms/pathology , Aged , Biomarkers, Tumor/analysis , Female , Humans , Immunohistochemistry , Male , Middle Aged , Neoplasm Recurrence, Local/pathologySubject(s)
Betaine/analogs & derivatives , Cosmetics/adverse effects , Dermatitis, Allergic Contact/immunology , Dermatitis, Atopic/immunology , Product Labeling , Betaine/adverse effects , Betaine/immunology , Child , Cosmetics/chemistry , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/rehabilitation , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/rehabilitation , Humans , Patch TestsABSTRACT
Perianal squamous cell carcinoma in situ (SCCIS) is a relatively rare intraepidermal neoplasm that has the potential to progress to invasive squamous cell carcinoma. First-line treatment is surgical excision, though nonsurgical treatment modalities such as 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT) and imiquimod also have been investigated for this neoplasm. Unfortunately, recurrences are known to occur after both surgical and nonsurgical monotherapies. We report a case of perianal SCCIS that was successfully treated with a novel combination of ALA-PDT and imiquimod.
Subject(s)
Aminolevulinic Acid/administration & dosage , Aminoquinolines/administration & dosage , Anal Canal , Carcinoma, Squamous Cell , Neoplasm, Residual , Photochemotherapy/methods , Postoperative Complications , Skin Neoplasms , Anal Canal/pathology , Anal Canal/surgery , Antineoplastic Agents/administration & dosage , Carcinoma, Squamous Cell/pathology , Carcinoma, Squamous Cell/physiopathology , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Dissection/adverse effects , Dissection/methods , Female , Humans , Imiquimod , Middle Aged , Neoplasm, Residual/drug therapy , Neoplasm, Residual/pathology , Photosensitizing Agents/administration & dosage , Postoperative Complications/drug therapy , Postoperative Complications/pathology , Skin Neoplasms/pathology , Skin Neoplasms/physiopathology , Skin Neoplasms/therapy , Treatment OutcomeABSTRACT
Skin cancers are the most common malignancies to affect older adults. The most common skin cancers, basal and squamous cell carcinoma, can usually be cured with surgery. Although less common, melanoma can be deadly when not caught in its earliest stages.
Subject(s)
Carcinoma, Basal Cell , Carcinoma, Squamous Cell , Melanoma , Skin Neoplasms , Humans , Aged , Mohs Surgery , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Skin Neoplasms/pathology , Melanoma/diagnosis , Melanoma/therapy , Melanoma/pathology , Carcinoma, Squamous Cell/therapy , Carcinoma, Squamous Cell/surgery , Carcinoma, Basal Cell/surgeryABSTRACT
With Roche's withdrawl of Accutane from the U.S. market in 2009, isotretinoin has only been available in its generic form. Many clinicians fail to realize that for approval by the U.S. Food and Drug Administration, a generic medication must have a bioequivalence between 80 percent and 125 percent of that of the innovator product. This potential variability in bioavailability between branded and generic medications is important to keep in mind with isotretinoin, given the implications for achieving a sustained remission in acne patients.
Subject(s)
Acne Vulgaris/drug therapy , Drugs, Generic/administration & dosage , Isotretinoin/administration & dosage , Drugs, Generic/standards , Humans , Therapeutic EquivalencyABSTRACT
BACKGROUND: Patch testing is the standard to diagnose allergic contact dermatitis (ACD). OBJECTIVE: This study assessed the value of patch testing for product changes and quality of life in children with ACD. METHODS: In this cross-sectional survey, we used a questionnaire to follow up with families of ACD patients about changes since patch testing and counseling preferences. Eligible participants were 18 years or younger during expanded series or personalized patch tests at the Washington University School of Medicine from 2007 to 2020. RESULTS: Of the 43 enrolled participants, most were positive for multiple allergens (63%) and changed personal products after patch testing (71%). Only 26% of the families consistently read product labels before patch testing, compared with 66% after. Patients saw a mean relative reduction of 49% in severity of rash (8.2-4.2 of 10), 46% in interference with activities (5.7-3.1), and 51% in self-consciousness (7.0-3.4) since patch testing. Families gave favorable feedback for counseling on products to avoid (9.4 of 10 average rating of usefulness), product recommendations (8.5 of 10), and chemical names (7.9 of 10). CONCLUSIONS: Patch testing can lead to meaningful improvements in quality of life for most children with ACD. Counseling related to positive patch test results should include discussion of specific products to use and avoid.
Subject(s)
Dermatitis, Allergic Contact , Quality of Life , Allergens , Child , Cross-Sectional Studies , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/etiology , Follow-Up Studies , Humans , Patch Tests/methods , Surveys and QuestionnairesABSTRACT
BACKGROUND: Angioimmunoblastic T-cell lymphoma (AITL) accounts for 18% of peripheral T-cell lymphomas worldwide. Skin involvement occurs in up to 50% of patients but poses a diagnostic dilemma because of the limited number of reported cases and subsequent lack of established diagnostic criteria. OBJECTIVE: The purpose of this review is to examine common clinical, histologic, and molecular findings in cases of AITL with the hope of improving the diagnostic accuracy of this challenging condition. METHODS: We present a case of AITL and conducted a review of the literature. RESULTS: The common clinical and histologic features in cases of AITL are nonspecific. However, newer immunohistochemical stains and gene rearrangement studies appear very promising at improving diagnostic capabilities. LIMITATIONS: There was a paucity of reported cases of AITL in the literature, and this review is retrospective. CONCLUSION: AITL presents with nonspecific clinical and histologic findings, but immunohistochemical stains and gene rearrangements can help establish the diagnosis.
Subject(s)
Immunoblastic Lymphadenopathy/pathology , Lymphoma, T-Cell, Cutaneous/pathology , Skin Neoplasms/pathology , Aged , Arthralgia/diagnosis , Arthralgia/pathology , Cyclophosphamide/administration & dosage , Deoxycytidine/administration & dosage , Deoxycytidine/analogs & derivatives , Diphtheria Toxin/therapeutic use , Doxorubicin/administration & dosage , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/pathology , Gene Rearrangement, T-Lymphocyte , Humans , Immunoblastic Lymphadenopathy/diagnosis , Immunoblastic Lymphadenopathy/therapy , Immunoblastic Lymphadenopathy/virology , Interleukin-2/therapeutic use , Lymphoma, T-Cell, Cutaneous/diagnosis , Lymphoma, T-Cell, Cutaneous/therapy , Lymphoma, T-Cell, Cutaneous/virology , Male , Methotrexate/administration & dosage , Prednisolone/administration & dosage , Pruritus/diagnosis , Recombinant Fusion Proteins/therapeutic use , Retrospective Studies , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , Skin Neoplasms/virology , Stem Cell Transplantation , Vinblastine/administration & dosage , Vinblastine/analogs & derivatives , Vincristine/administration & dosage , Vinorelbine , GemcitabineABSTRACT
BACKGROUND: Epicutaneous patch testing was developed as a simple and effective method for diagnosing allergic contact dermatitis (ACD). Despite its proven value in ACD diagnoses, there is no defined standard for patch testing in children. OBJECTIVE: The aims of this study were to assess patch test positivity in pediatric patients with and without a history of atopic dermatitis suspected to have ACD, to compare these results with what the Thin-Layer Rapid Use Epicutaneous (T.R.U.E.) Test would have captured, and to evaluate likely exposures. METHODS: Pediatric patients receiving a North American 80 Comprehensive Series patch test or a personalized patch test were analyzed for allergen sensitization 48 to 72 hours after patch removal. These data were analyzed for allergen inclusion in the North American 80 Comprehensive Series patch test compared with the T.R.U.E. Test, as well as compared with patients with and without a history of atopic dermatitis. RESULTS: Of the 29 patients (mean ± SD age = 10.9 ± 5.1 years), 25 children demonstrated at least 1 positive reaction, with a total of 81 reactions overall. 40 (49.4%) of the reactions came from allergens outside of the T.R.U.E. Test, including cocamidopropyl betaine, which was frequent in patients with atopic dermatitis. CONCLUSIONS: Expanded and personalized patch tests provide a more comprehensive allergen inventory than the traditional T.R.U.E. Test. Pediatric patients frequently have reactions to allergens not included in the T.R.U.E. Test, and these allergens are commonly found in household products. Cocamidopropyl betaine was a particularly relevant allergen in our population. Expanded series patch testing and appropriate counseling should be provided to pediatric patients with ACD.
Subject(s)
Allergens/adverse effects , Dermatitis, Allergic Contact/diagnosis , Patch Tests/methods , Adolescent , Child , Child, Preschool , Dermatitis, Allergic Contact/etiology , Dermatitis, Atopic/complications , Female , Humans , Male , Retrospective StudiesABSTRACT
Atopic dermatitis (AD) is a widespread, chronic skin disease associated with aberrant allergic inflammation. Current treatments involve either broad or targeted immunosuppression strategies. However, enhancing the immune system to control disease remains untested. We demonstrate that patients with AD harbor a blood natural killer (NK) cell deficiency that both has diagnostic value and improves with therapy. Multidimensional protein and RNA profiling revealed subset-level changes associated with enhanced NK cell death. Murine NK cell deficiency was associated with enhanced type 2 inflammation in the skin, suggesting that NK cells play a critical immunoregulatory role in this context. On the basis of these findings, we used an NK cell-boosting interleukin-15 (IL-15) superagonist and observed marked improvement in AD-like disease in mice. These findings reveal a previously unrecognized application of IL-15 superagonism, currently in development for cancer immunotherapy, as an immunotherapeutic strategy for AD.
Subject(s)
Dermatitis, Atopic , GATA2 Deficiency , Animals , Dermatitis, Atopic/therapy , Disease Models, Animal , Humans , Immunotherapy , Killer Cells, Natural , MiceABSTRACT
Extramammary Paget's disease (EMPD) is a rare intraepithelial neoplasm with an extremely variable clinical course. The objective of this study was to determine if combination imiquimod and photodynamic therapy could induce remission of EMPD. A 69-year-old man with EMPD was treated with topical imiquimod 5% cream at night for 5 days per week for 1 month, followed by 2 months of 5% imiquimod for three nights a week. For the following 6 months, monthly 5-aminolevulinic acid photodynamic therapy was added. After 6 months, imiquimod was discontinued and the patient continued to be treated with quarterly photodynamic therapy. Treatment resulted in significant improvement in the appearance of the lesion, and pathology revealed no evidence of residual disease. The patient has had no clinical signs of disease for >5 years. We conclude that topical imiquimod 5% cream and photodynamic therapy may aid in the treatment of some patients with EMPD.