Dermatomyositis panniculitis: a clinicopathological and immunohistochemical study of 18 cases.

BACKGROUND: Panniculitis occurring in dermatomyositis is uncommon, with only a few cases described in the literature, most of them as case reports. OBJECTIVE: This report describes the clinicopathological and immunohistochemical findings in a series of 18 patients with panniculitis associated with dermatomyositis. METHODS: In each patient, we collected the clinical data of the cutaneous lesions as well as the characteristic clinical and laboratory findings. A series of histopathologic findings was recorded in the biopsy of each patient. A panel of antibodies was used in some cases to investigate the immunophenotype of the infiltrate. Data of treatment and follow-up were also collected. RESULTS: Of the 18 patients, 13 were female and 5 were male, ranging in age from 13 to 74 years (median, 46.4 years). In addition to panniculitis, all patients presented pathognomonic cutaneous findings of DM and reported proximal muscle weakness prior to the diagnosis of panniculitis. Muscle biopsy was performed in 17 patients and MRI in one, all with the diagnosis of inflammatory myopathy. None of the patients presented any associated neoplasia. Panniculitis lesions were located in the upper or lower limbs. Histopathology showed a mostly lobular panniculitis with lymphocytes as the main component of the infiltrate. Most cases showed also numerous plasma cells and lymphocytes surrounding necrotic adipocytes (rimming) were frequently seen. Lymphocytic vasculitis and abundant mucin interstitially deposited between collagen bundles of the dermis were also frequent findings. Late-stage lesions showed hyaline necrosis of the fat lobule and calcification. Immunohistochemistry demonstrated that most lymphocytes of the infiltrate were T-helper lymphocytes, with some B lymphocytes in the lymphoid aggregates and small clusters of CD-123-positive plasmacytoid dendritic cells in the involved fat lobule. CONCLUSION: Panniculitis in dermatomyositis is rare. Histopathologic findings of panniculitis dermatomyositis are identical to those of lupus panniculitis. Therefore, the final diagnosis requires clinic-pathologic correlation.

Concurrent presentation of cutaneous lesions of deep linear morphoea and discoid lupus erythematosus.

Patients with autoimmune disorders are predisposed to develop a second immunologic disease, frequently with systemic involvement. We present a patient who developed lesions of discoid lupus erythematosus (DLE) limited to the face, and, concurrently, a linear morphoea involving her right axilla. No criteria for systemic lupus erythematosus or systemic scleroderma were present in the patient. To our knowledge, no patients with concomitant DLE and linear morphoea, without systemic involvement, have been previously reported in the literature.

Definition of the features of acquired elastotic hemangioma reporting the clinical and histopathological characteristics of 14 patients.

BACKGROUND: During the last few years, new cutaneous vascular proliferations have been described, including a distinctive clinicopathologic variant of hemangioma, denominated acquired elastotic hemangioma. To date, there is only one series of six cases reported in the literature, thus, the clinical and morphological data of this variant are not well established. METHODS: Fourteen cases of acquired elastotic hemangioma were retrieved from the files of the Dermatopathology Unit at Wake Forest University School of Medicine. RESULTS: Acquired elastotic hemangioma affects sun-damaged skin of upper extremities and neck. Clinically, lesions present as slowly growing, painless, solitary, erythematous plaques. Histopathologically, they are characterized by a horizontal proliferation of capillary blood vessels in the upper reticular dermis in a background of solar elastosis. The vessels have plump endothelial cells that protrude into the vascular lumens in a 'hobnail' pattern. Of the 10 cases assessed by immunohistochemistry, 100% (10) expressed CD31 and CD34, 90% (9) expressed D2-40 and 10% (1) expressed SMA. CONCLUSION: Acquired elastotic hemangioma is a distinctive variant of hemangioma which should be differentiated from other cutaneous vascular tumors with a hobnail endothelial pattern, including angiosarcoma. The expression of D2-40 in most cases suggests a lymphatic origin of this acquired vascular proliferation.

[Sensitization to Lyral]. / Sensibilización al Lyral.

INTRODUCTION: Lyral is a fragrance that is present in many cosmetic products. It has turned into an emergent allergen during the last years. In studies carried out in other European countries, the prevalence of sensitization to Lyral has been found to be 1.9-2.7 %, but it is unknown the prevalence in Spain, as well as the need to include it or not in the standard series of the Spanish Group of Contact Dermatitis (GEIDC). METHODS: We have patch-tested to Lyral all patients with suspicion of contact dermatitis of any origin who attended our Service between April and May-2005. RESULTS: From a total of 170 patients included in our study, 2 of them had a sensitization to Lyral (1.2 %). One of these two patients had an axillae contact dermatitis caused by a deodorant containing Lyral. The other patient was a masseur-woman with a contact dermatitis on both hands, with periods of dissemination to upper extremities and trunk, and who used several cosmetics products for private reasons and during her job. CONCLUSION: Although the sample of this study is quite small, we think that the results allow to suspect that Lyral is one of the main allergens, or even the most important, in causing allergic contact dermatitis to fragrances in our environment. Therefore, we believe that we must raise the inclusion of Lyral in the standard series of GEIDC, either as independent allergen, or including it in a new mixture of fragrances.

Sensibilización al Lyral® / Sensitization to Lyral®

Introducción. El Lyral® es una fragancia presente en múltiples productos cosméticos que en los últimos años se ha convertido en un alérgeno emergente. En estudios realizados en otros países europeos se ha encontrado una prevalencia de sensibilización al Lyral® significativa (1,9-2,7 %), pero se desconoce la importancia de este alérgeno entre la población española, así como la necesidad o no de incluirlo en la batería estándar del Grupo Español de Investigación en Dermatología de Contacto (GEIDC). Métodos. Hemos estudiado mediante la prueba epicutánea la sensibilización al Lyral® en los pacientes que fueron parcheados en nuestro Servicio por sospecha de dermatitis de contacto de cualquier origen entre los meses de abril y junio de 2005. Resultados. De un total de 170 pacientes incluidos en este estudio, 2 presentaban una sensibilización al Lyral® (1,2 %). Uno de estos pacientes sufría un eczema de contacto axilar en relación con un desodorante que contenía esta fragancia. El segundo caso de sensibilización al Lyral® se trataba de una esteticista que manejaba diversos productos cosméticos, tanto en su trabajo como en su vida privada, y que presentaba un eczema de contacto en manos con periodos de diseminación a extremidades superiores y tronco. Conclusión. Si bien la muestra de nuestro estudio es pequeña, creemos que los resultados encontrados permiten sospechar que el Lyral® es una de las principales causas, si no la principal, de los eczemas de contacto alérgicos causados por fragancias en nuestro medio. Por ello, pensamos que nos debemos plantear la inclusión de este alérgeno en la batería estándar del GEIDC, bien de forma independiente, bien formando parte de una nueva mezcla de fragancias

Introduction. Lyral® is a fragrance that is present in many cosmetic products. It has turned into an emergent allergen during the last years. In studies carried out in other European countries, the prevalence of sensitization to Lyral® has been found to be 1,9-2,7 %, but it is unknown the prevalence in Spain, as well as the need to include it or not in the standard series of the Spanish Group of Contact Dermatitis (GEIDC). Methods. We have patch-tested to Lyral® all patients with suspicion of contact dermatitis of any origin who attended our Service between April and May-2005. Results. From a total of 170 patients included in our study, 2 of them had a sensitization to Lyral® (1,2 %). One of these two patients had an axillae contact dermatitis caused by a deodorant containing Lyral®. The other patient was a masseur-woman with a contact dermatitis on both hands, with periods of dissemination to upper extremities and trunk, and who used several cosmetics products for private reasons and during her job. Conclusion. Although the sample of this study is quite small, we think that the results allow to suspect that Lyral® is one of the main allergens, or even the most important, in causing allergic contact dermatitis to fragrances in our environment. Therefore, we believe that we must raise the inclusion of Lyral® in the standard series of GEIDC, either as independent allergen, or including it in a new mixture of fragrances