Malignant transformation of a spiradenoma with blaschkoïd pattern.

Eccrine spiradenoma is a benign and rare adnexal tumor originating from cutaneous eccrine sweat glands. It usually presents as a solitary lesion. It can have different presentations, including a blaschkoid arrangement which is rare. Malignant transformation is possible and usually occurs after a long period of latency in multifocal types.

[Ecthyma gangrenosum]. / Ecthyma gangrenosum.

Ecthyma gangrenosum (EG) is a severe potentially lethal cutaneous infection that progresses sequentially from maculopapular rash to haemorrhagic bulla and then to necrotic ulceration with surrounding erythema. It usually occurs in immunocompromised patients (aplasia secondary to chemotherapy, HIV infection, neutropenia or functional deficit of neutrophils, agammaglobulinemia). It rarely affects healthy people. Differential diagnosis includes leishmaniasis, pyoderma gangrenosum, eschars and papulonecrotic tuberculides. Blood cultures and/or local sample allow the isolation of P. aeruginosa, which is the causative germ. Treatment is based on suitable parenteral antibiotic therapy according to results of susceptibility tests (third-generation cephalosporins, fluoroquinolones). We here report the case of a 2-year old child with no particular past medical history presenting with multiple necrotic ulcers on the back with erythematous border evolving in a febrile context. Blood culture was negative. Laboratory tests showed sedimentation rate 30 mm, CRP 80mg/l. Bacteriological sampling of pus revealed pseudomonas aeruginosa. The diagnosis of ecthyma gangrenosum was made. The patient underwent parenteral third-generation cephalosporins. Complete patient recovery with healing occurred after 4 weeks.

[Self-induced dermatosis on the shoulder]. / Une dermatose auto provoquée de l'épaule.

Self-induced dermatoses are more and more frequent in adolescent substance abusers with adaptation problems. We here report a case of self-induced bullous lesions on the shoulder in an adolescent with major depression and suicidal ideations. The study involved a 22-year old man, who was a chronic smoker, an occasional user of cannabis and alchool with no particular past medical history, with divorced parents, in conflict with his father. He presented with bullous eruption on the left shoulder made of bubbles, post-bullous skin erosions and scabs on a healthy skin. The monomorphic appearance of lesions, their accessibility (on the left shoulder in a right-handed patient), patient's history and his psychiatric problems have immediately suggested the investigation of self-induced dermatosis or factitious disorder. The patient admitted that he had taken psychotropic drugs and that the self-induced lesions had been caused by cigarette burns. This first psichologic evaluation also showed that the patient had suicidal ideations and a self-and hetero-aggressive behavior. The patient was treated with emollients and healing creams and referred to the Department of Psychiatry for complementary therapies.

[A pink nodule on the face]. / Un nodule rose du visage.

We report the case of a 32-year old female patient, with no notable medical history, requiring dermatology consultation for evaluation of a nodule on her right cheek which had evolved over the past 10 years. Clinical examination showed a reddish dermal-based nodule with a smooth surface. The lesion measured 1cm in diameter and was located at the level of the right cheek (A). There was no adenopathy and the remainder of the clinical examination was normal. The patient underwent skin biopsy which showed tumor proliferation composed of fusiform cells with poorly limited eosinophilic cytoplasm and lightly atypical elongated nuclei without mitosis and with mononuclear inflammatory cell infiltrate at the level of the dermis. The epidermis was thinner. Anti-CD68 antibody was positive, while anti-CD34 antibody, PS100 and anti-AML were negative. The diagnosis of benign cellular histiocytofibroma was retained. The patient underwent total resection with a healthy resection margin of 5mm. The patient had a median 2-year follow-up with no recurrences identified. Benign histiocytofibroma mainly occurs in middle-aged women. It more often appears as an erythematous nodular, bluish, brownish or achromique dermal-based little painful but sometimes embarrassing lesion characterized by firm consistency and commonly located at the level of the lower limbs. Racial histiocytofibroma is rarely reported in the literature. Differential diagnosis includes Darier-Ferrand dermatofibrosarcoma, leiomyoma, Kaposi nodule and solitary fibrous tumor of the skin. Histologically, benign cellular histiocytofibroma is composed of pure intradermal disordered proliferation of fusiform cells arranged in bundles or in eddies and circumscribed by lymphocytic inflammatory reaction with presence of foamy histiocytes. The lesion is often highly vascularized with possibile hemorrhagic foci and especially, with angiogenesis images. In a minority of cases, especially in the case of huge histiocytofibromas, the epidermis is thinner and may even ulcerate. The immunohistochemistry shows the expression of CD68 and F XIIIa + positive cells while a lack of CD34, PS100 and Anti-AML expression. It is characterized by a chronic, benign evolution with possible spontaneous regression. The treatment is based on surgical resection.

[Desquamative erythrodermia]. / Erythrodermie desquamative.

Paraneoplastic dermatoses are a spectrum of cutaneous manifestations which may precede, coincide with or follow the diagnosis of cancer. Our study aims to remind clinicians that desquamative erythrodermia is a form of paraneoplastic dermatosis which may occur during hematologic malignancies. Hence the importance of a complete assessment to identify a neoplastic process in the presence of these clinical signs and especially when they are suspect.