Lifelong widespread warts associated with human papillomavirus type 70/85: a new diagnostic entity?

We present a patient with HPV 70/85-positive widespread cutaneous warts characterized by clinical and histological features atypical for classic generalized verrucosis or epidermodysplasia verruciformis. The cutaneous HPV infection is characterized by verrucous papules or plaques variable in size, number, and distribution depending on the genotype of HPV involved and the immune status of the patient. Human papillomaviruses comprise five genera (alpha, beta, gamma, mu, and nu papillomavirus) with different life-cycle characteristics, epithelial tropisms, and disease associations. Epidermodysplasia verruciformis (EV) is a rare, lifelong, autosomal recessive skin disease characterized by persistent cutaneous human papillomavirus infection not necessarily associated with immune system defects. The disease results from an unusual genetic susceptibility to infections with various types of HPVs (especially ß-HPV), some of which cause malignant transformation. Conversely, generalized verrucosis has been more typically associated with generalized warts, which are associated with immunocompromised conditions.

Candida Albicans Dural Granuloma: Case Report.

Candida albicans dissemination to the central nervous system (CNS) may occur in immunocompromised patients even without prior cranial surgery. In such cases, intracerebral lesions are most frequent, meningeal or cerebrospinal fluid involvement being rare. We, here, describe a case of Candida albicans granuloma developing exclusively inside the width of the dura mater, successfully treated by surgical excision followed by antimycotic therapy. A 75-year-old man, previously affected by urinary sepsis from Candida albicans, was admitted to the emergency department of our hospital because of the acute appearance of sensory obtundation, blurred speech, and right hemiparesis. Emergency computed tomography (CT) scan and magnetic resonance imaging (MRI) with and without contrast enhancement disclosed a huge, left fronto-parietal mass, causing severe brain compression. At surgery, the lesion appeared to develop exclusively inside the dural envelope, and was completely removed. At pathology, a totally intradural Candida albicans granuloma was observed and appropriate antimycotic treatment was started. After an uneventful postoperative course the patient was sent to rehabilitation. Five months later he was admitted again because of a bone flap infection, leading to bone removal and further cranioplasty, with full neurological recovery. At 2 years follow-up, no neuroradiological or clinical evidence of residual/relapsing intracranial infection was found. Isolated intradural granuloma from Candida albicans has never been described before. Even though surgical excision may lead to complete resolution of mass effect in these patients, prolonged observation should be maintained, to disclose further, potentially lethal, complications.

Elastosis perforans serpiginosa: a case successfully treated with intralesional steroids and topical allium cepa-allantoin-pentaglycan gel.

Elastosis perforans serpiginosa is a rare skin disease in which abnormal elastic fibers, other connective tissue elements, and cellular debris are expelled from the papillary dermis through the epidermis. Three clinical variants of EPS can be detected: idiopathic, reactive, and drug-induced. Clinically it consists of small horny or umbilicated papules arranged in a linear, arciform, circular, or serpiginous pattern. It usually occurs in young adults and shows a predilection for the head and neck. The lesions are generally asymptomatic or slightly itching. Several treatments have been reported with poor long-term success; these include intralesional and topical corticosteroids, tazarotene, imiquimod, and cryotherapy. We report a case of 40-year-old black woman affected by elastosis perforans serpiginosa that was referred to our department and treated with intralesional injections of triamcinolone acetonide and topical application of allium cepa-allantoin-pentaglycan gel.

Cytophagic histiocytic panniculitis, hemophagocytic lymphohistiocytosis and undetermined autoimmune disorder: reconciling the puzzle.

Cytophagic histiocytic panniculitis is a rare disease, associated with either nonmalignant conditions or subcutaneous panniculitis-like T-cell lymphoma, and often also associated with hemophagocytic lymphohistiocytosis (HLH). We report the case of a 11-year-old boy with a history of secondary HLH who, after a local trauma, developed a painful, indurated plaque over the right thigh associated with relapsing HLH. Histopathologic findings from skin biopsy specimens revealed significant lobular panniculitis with benign histiocytes showing hemophagocytosis. High-dose intravenous methylprednisolone and cyclosporine A treatment was highly effective. A genetic study after a new, relapsing episode of HLH revealed an heterozygous missense mutation on STX 11 gene inherited from the mother.

The successful off-label use of photodynamic therapy for classic porokeratosis of Mibelli: case report.

Porokeratosis of Mibelli is an uncommon chronic disorder of epidermal keratinization that should be treated because it can undergo malignant change into epithelial tumors on the lesions. At the moment, it represents a therapeutic challenge for dermatologists because of the lack of standardized guidelines about the treatment. Herein, we report a case of classic porokeratosis of Mibelli treated with photodynamic therapy successfully.

Lichen striatus in adults and pimecrolimus: open, off-label clinical study.

BACKGROUND: Lichen striatus is a well-known, acquired, self-healing, linear inflammatory dermatosis. Lichen striatus occurring in adults tends to be more extensive and itchy than in children, sometimes requiring symptomatic treatment. The therapeutic approach usually adopted is topical steroids, even though prolonged use may lead to several side-effects, particularly cutaneous atrophy. OBJECTIVE: To report the results of an open, off-label study on the use of pimecrolimus 1% in the treatment of diffuse, nonresponsive forms of lichen striatus. METHODS: Three adult patients suffering from relapsing or disseminated and itchy lichen striatus received topical application of pimecrolimus 1% cream (Elidel, Novartis Pharma, Basle, Switzerland) twice daily for 6 weeks, or until complete disappearance of the cutaneous lesions. RESULTS: All patients experienced rapid healing of the dermatosis, without any recurrence for at least 14 months. CONCLUSION: Our preliminary results show that pimecrolimus may represent a useful therapeutic alternative for lichen striatus, although further studies on a larger number of cases are needed to confirm its safety and efficacy in the treatment of this condition.

Indications for excision of nevi and melanoma diagnosed in a pediatric surgical unit.

BACKGROUND/PURPOSE: Childhood melanoma is rare but increasing in incidence. Its management relies on early diagnosis. The purpose of this study is to discuss surgical indications of nevi and diagnosis of melanoma in a pediatric surgical unit. METHODS: Data relative to the patients who underwent removal of nevi in our pediatric surgical unit from 1999 to 2005 were reviewed to identify indications, histology, and melanoma occurrence. RESULTS: The most frequent indication was atypical nevus. Compound nevus was the most common finding, followed by congenital and Spitz nevi. Melanoma was diagnosed in 3 excised nevi, and in 1 case it occurred as a metastatic disease. CONCLUSIONS: Our data showed a pattern of indications for surgery similar to that described in the literature, with a high detection rate of melanoma, nonetheless showing that some rare conditions may delay diagnosis.

A case of follicular mycosis fungoides with follicular mucinosis: a rare association.

Follicular mycosis fungoides (FMF) is a rare cutaneous T cell lymphoma characterized by an atypical lymphoid infiltrate spreading within and around hair follicles without epidermotropism or follicular mucin deposits. Its occasional presentation with minimal epidermal involvement and/or follicular mucinosis suggests the need for uniform histologic criteria. We describe a new case of FMF associated with follicular mucinosis and discuss its morphologic spectrum of presentation.