Dermatological manifestations associated with COVID-19 and COVID-19 vaccination: results from the Lebanese COVID registry.

BACKGROUND: A number of cutaneous manifestations and adverse cutaneous reactions have been associated with COVID-19 infection and vaccine. OBJECTIVES: A Lebanese national registry was established to characterize the dermatologic manifestations and adverse cutaneous reactions associated with COVID-19 infection and vaccination in a sample of the Lebanese population. METHODS: An observational cross-sectional study was conducted via a web-based clinical form distributed to physicians wishing to report their cases from May 2021 till May 2022. RESULTS: In total, 142 patients were entered in the registry, of which 133 were adults and nine were pediatric patients. The main dermatological manifestations reported with COVID-19 infection in the adult group were urticaria (32.9%), telogen effluvium (21.4%), morbilliform (10%), and papulosquamous (8.6%) eruptions. Urticaria was the most common adverse cutaneous reaction to the vaccine (33%). Interestingly, herpes zoster was triggered in 12 patients post vaccination in our series with this finding more frequently seen in patients above the age of 41 (P = 0.013). In the pediatric group, the most reported dermatological findings associated with COVID-19 infection were malar erythema (25%) and telogen effluvium (25%). One 16-year-old patient developed lichen planus after one dose of a COVID-19 vaccine. No deaths were reported in both age groups. CONCLUSION: This Lebanese registry adds more robust evidence that clinical manifestations of the COVID-19 virus and vaccine are diverse. More studies are necessary to establish the pathophysiology of these dermatological findings in the context of COVID-19 infection and vaccination.

Non-syndromic hypotrichosis: A report of two novel variants in the LSS gene.

To date, more than 15 genes have been linked to syndromic and non-syndromic hypotrichosis, among which the LSS gene encoding lanosterol synthase was recently linked to autosomal recessive isolated hypotrichosis. Here we report the case of a 6-year-old girl born to non-consanguineous Iraqi parents and presenting with sparse lanugo hair since birth on the scalp, eyelashes, and eyebrows. Whole exome sequencing followed by Sanger sequencing allowed the detection of two novel compound heterozygous variants in LSS (p.Ile323Thr and p.Gly600Val). Reporting and investigating further cases with LSS variants might help establishing a better genotype-phenotype correlation.

Vulvar hidradenoma papilliferum (HP) is located on the sites of mammary-like anogenital glands (MLAGs): Analysis of the photographs of 52 tumors.

BACKGROUND: Hidradenoma papilliferum (HP) is a benign tumor that primarily affects the anogenital area of adult women. Previously considered apocrine tumors, anogenital HP tumors are now interpreted as adenomas of mammary-like anogenital glands based on their histologic features. OBJECTIVE: This clinical study was undertaken to determine whether vulvar HP is located on mammary-like anogenital gland sites and to describe its morphologic features. METHODS: The clinical photographs of 52 histologically confirmed vulvar HP provided by 7 vulva specialists were analyzed. RESULTS: In all, 90.4% of the HP were located on the interlabial sulcus, adjacent zone, or the perineum. These tumors were polymorphous in terms of number (1 or multiple), size (<1-4.5 cm), color (pink, red, blue), surface (ulcerated or not), and architecture (unilobular or multilobular). LIMITATIONS: Eight histologic reports could not be reviewed by the authors but the contributors confirmed that the photographs sent were only those of histologically confirmed HPs. CONCLUSIONS: Vulvar HP is mainly located on mammary-like anogenital gland sites, thereby providing further evidence to their histogenesis. Although a nonulcerated or ulcerated tumor of the interlabial sulcus should evoke a HP diagnosis, the latter must be confirmed histologically.

Fibroblast-activation protein: valuable marker of cutaneous epithelial malignancy.

Fibroblast-activation protein (FAP) is a key protein that is characteristically expressed by carcinoma-associated fibroblasts (CAFs). It has been shown to be expressed in CAFs of 90 % of internal epithelial cancers as well as cutaneous epithelial malignancies. We have recently shown that this marker is useful in differentiating between morpheaform/infiltrative BCC from desmoplastic trichoepithelioma (TE). Given this, we sought to assess FAP expression in both benign and malignant cutaneous epithelial entities. Immunohistochemical FAP staining was performed on BCC (n = 26), SCC (n = 26), porocarcinoma (n = 10), metastatic adenocarcinoma (n = 12), keratoacanthoma (KA) (n = 16), TE (n = 14), pseudoepitheliomatous hyperplasia (n = 15), poroma (n = 15), syringoma (n = 10), and chondroid syringoma (n = 6). Control group consisted of scars (n = 10). FAP expression was observed in all scars and all malignant entities, but not in any of the benign cases. Interestingly, ten KA cases exhibited positivity, whereas six were negative. In summary, FAP is a reliable marker of cutaneous epithelial malignancy.

Elastophagocytosis: underlying mechanisms and associated cutaneous entities.

Elastophagocytosis is the phagocytosis of elastic fibers that can microscopically be seen in the cytoplasm of histiocytes, multinucleated giant cells, or both. Generally believed to be a characteristic feature of certain granulomatous disorders such as annular elastolytic giant cell granuloma or elastolytic disorders such as mid-dermal elastolysis, this feature has also been described in other cutaneous inflammatory conditions, cutaneous malignancies, infectious entities, and secondary to certain medications. The list of diseases that can exhibit this peculiar finding on histopathology is long. In this review we attempt to shed light on the available literature concerning the pathogenesis of this phenomenon and the plethora of skin conditions that exhibit elastophagocytosis.

Cutaneous metastasis: clinicopathological study of 72 patients from a tertiary care center in Lebanon.

BACKGROUND: Cutaneous metastasis is the result of malignant cell spread from primary malignancy to the skin. This is not uncommon, and rates reported in the literature are as high as 10.4%. To the best of our knowledge, there are no studies assessing the epidemiologic, clinical, and histopathological features of cutaneous metastasis in our region. OBJECTIVE: To assess the clinical and histopathological findings of all patients diagnosed with cutaneous metastasis at the American University of Beirut - Medical Center (AUB-MC) and to compare our findings with those published in the literature. METHODS: Retrospective clinical and histopathologic evaluation of all cases diagnosed as cutaneous metastasis at AUB-MC between 1992 and 2010. RESULTS: A total of 72 patients (50 females and 22 males) were identified. The mean age at diagnosis was 55.2 years. The most common primary cancer was breast cancer in women and laryngeal cancer in men. The most common clinical presentation was a single nodule in 27% of cases followed by multiple nodules in 23%. Cutaneous metastasis lesions were asymptomatic in the majority. The chest was the most commonly affected site. On microscopy, the majority of metastatic cases were adenocarcinomas (74%). CONCLUSION: This is, to our knowledge, the first study characterizing the epidemiological, clinical, and histopathological features of cutaneous metastasis in the Lebanese population. The clinical and histopathological features observed were in concordance with the published literature, with minor differences.

Topical immunomodulation with diphenylcyclopropenone for alopecia areata: the Lebanese experience.

Topical immunotherapy with diphenylcyclopropenone (DPCP) is a treatment that can be used in patients with alopecia areata (AA) with more than 50% involvement of the scalp. The aim of this study is to assess the response of our patients with AA treated with topical immunotherapy with DPCP at the American University of Beirut-Medical Center (AUB-MC) and to characterize the favorable prognostic factors that predict response to treatment. This is a retrospective study of all patients diagnosed with AA at AUB-MC and treated with topical immunotherapy with DPCP over a period of 10 years. A total of 34 cases were included for analysis (19 males and 15 females). The majority of patients had limited AA (58.8%) with a mean of 39% of scalp involvement. The remaining patients had alopecia universalis (29.4%) and alopecia totalis (11.8%). The percentage of patients that responded to DPCP therapy in our series was 79.4% (n = 27). Ten patients achieved a maximal grade of 3 following treatment, six patients only achieved a grade of 1, and six patients achieved a grade of 2. Only five of the patients who responded to therapy achieved a grade of 4. Of the patients who responded, 10 relapsed (29.4%), and the mean time to relapse was 74.6 weeks from the initiation of treatment. No specific favorable prognostic factors were identified to predict response to treatment; however, a negative family history of atopy was found to be protective against relapse (P = 0.020). The most common side effect of therapy was itching (85.3%), followed by contact dermatitis (58.8%), blistering (17.6%), and cervical lymphadenopathy (17.6%). Limitations of this study were the retrospective nature of the study and the limited number of patients. This is, to the best of our knowledge, the first study on topical immunotherapy with DPCP in patients with extensive AA from a Middle Eastern population. This modality of treatment is effective in inducing a response in patients with extensive AA, although the response is partial in the majority of the cases. Benefits should be weighed against the high side-effect profile of therapy before initiation of treatment.

Mucocutaneous pseudoepitheliomatous hyperplasia: a review.

Pseudoepitheliomatous hyperplasia, also called pseudocarcinomatous hyperplasia because of its resemblance to well-differentiated squamous cell carcinoma, is a reactive epithelial proliferation that is characterized by prominent irregular hyperplasia of the epithelium with tongue-like epithelial projections into the dermis. This reactive pattern may involve cutaneous or mucosal surfaces and has been described in association with a wide variety of stimuli including infectious, neoplastic, inflammatory, and traumatic among others. In this review, we will discuss the pathophysiology of pseudoepitheliomatous hyperplasia, the histopathological findings that are helpful in its differentiation from squamous cell carcinoma, and the spectrum of conditions that may show this unique feature on microscopic examination.

Livedoid vasculopathy associated with sickle cell trait: significant improvement on aspirin treatment.

Livedoid vasculopathy (LV) is a chronic, recurrent, painful cutaneous disease manifesting as longstanding distal lower extremity ulcers that scar leaving stellate atrophic lesions known as 'atrophie blanche'. A significant number of cases have been associated with thrombophilic abnormalities. In this study, we describe, to the best of our knowledge, the first report of LV only associated with sickle cell trait with significant improvement on aspirin.