Idiopathic atrophoderma of Pasini and Pierini: A case study of collagen and elastin texture by multiphoton microscopy.

BACKGROUND: The diagnosis of idiopathic atrophoderma of Pasini and Pierini (IAPP) relies on typical clinical features, particularly distinctive pigmented ovular/round depressed plaques. Histologic examination often reveals no obvious changes, but patterns of collagen distribution, using multiphoton imaging and second harmonic generation can help track hidden details of tissue organization contributing to atrophy. OBJECTIVE: To identify histologic features that distinguish IAPP from unaffected skin. METHODS: Eleven patients were included for conventional analyses. Masson trichrome- and Unna-Tanzer orcein-stained sections were evaluated using automated morphometry. Hematoxylin-eosin-stained sections were analyzed by multiphoton imaging using 2-photon excited fluorescence and second harmonic generation. RESULTS: No abnormalities were found under light microscopy or by automated quantification. Multiphoton imaging revealed no difference in optical density of either collagen or elastic fibers in lesioned and unaffected skin; however, horizontal collagen fiber organization in lesion specimens increased toward the lower dermis, whereas elastic fibers featured greater disorganization within the upper dermis. LIMITATIONS: The low number of patients evaluated. CONCLUSION: The atrophic appearance of IAPP lesions reflects changes in organization, but not in collagen and elastic tissue content. Minute organizational differences that are imperceptible to the experienced pathologist and undetectable by automated analyses were revealed by multiphoton analyses, particularly second harmonic generation, in association with texture analyses.

Lichen planus and lichenoid drug-induced eruption: a histological and immunohistochemical study.

INTRODUCTION: Lichenoid drug eruption (LDE) shares similar features with lichen planus (LP), that could reflect the same pathogenesis. In LP, an autoimmune attack is accepted and cytotoxic T-lymphocytes (CD8+) predominate, especially in late lesions. Apoptosis of keratinocytes may be mediated by CD8+ T and NK cells in two distinct ways: by the release of cytotoxic molecules such as perforin and granzyme B or by the Fas/FasL system. The immunological mechanisms involved in LDE are not yet fully established. OBJECTIVES: Investigate immunohistological features in LP and LDE to add clues to better understand their pathogenesis. MATERIAL AND METHODS: Twenty-two patients fulfilled all clinical, laboratory, histopathological, and follow-up features of lichen planus (n = 16) and lichenoid drug eruption (n = 6). Classic histological features favoring LP or LDE were evaluated by two observers. HAM56, MAC387, UCHL-1, OPD4, CD8, Granzyme B, Perforin, and ICAM-1 antibodies were used to decorate the immune infiltrate. Results were analyzed through Pearson correlation, Student's t-test, and linear discriminant analysis. RESULTS: A higher number of necrotic keratinocytes as well as plasma cells and eosinophils within inflammatory cells were associated with LDE diagnosis. Only in LDE, a correlation was found between the number of T and CD8+ cells and between the number of granzyme B+ cells and apoptotic keratinocytes. CONCLUSION: Our findings suggest a more important role of CD8+ granzyme B-containing cells in LDE group, being its synthesis associated with more intense apoptosis. So, LP and LDE may have a somewhat distinct pathogenesis.

Perforin and granzyme B expression in oral and cutaneous lichen planus - a comparative study.

BACKGROUND: Although cutaneous and oral lichen planus (LP) share similar histopathological features, oral LP often follows a recalcitrant course while LP skin lesions tend to be self-limiting. Apoptosis, mediated by cytotoxic T-cells in LP, may be triggered by the release of molecules such as perforin and granzyme B. As variation in clinical behavior can reflect differences in LP immune expression, we studied the role of those cytotoxic molecules in oral and cutaneous LP. METHODS: We analyzed 16 cases of cutaneous LP and 29 of oral LP. The sections were studied on hematoxylin and eosin, CD4, CD8, perforin and granzyme B staining. RESULTS: The mean number of immunostained cells expressing each cytotoxic molecule was significantly higher in oral LP than in cutaneous LP. A higher number of single necrotic keratinocytes (apoptotic bodies) was found in oral LP lesions when compared to cutaneous LP. Only in oral LP lesions, a higher number of CD4-positive cells was found in active lesions when compared to regressive lesions. CONCLUSIONS: Our results confirm increased expression of granzyme B and perforin in oral LP lesions as compared to cutaneous LP. The increased expression suggests a relationship with the clinical behavior of the disease.

Reactions to the different pigments in tattoos: a report of two cases.

Tattoos are defined as the intentional or accidental deposit of pigment into the skin. These pigments have been associated with various dermatoses such as allergic contact dermatitis, lichenoid dermatitis, photoinduced reactions, and granulomatous, sarcoid and pseudolymphomatous reactions. The objective of this report was to describe the various types of reactions to pigments and the importance of recognizing them clinically. Two cases are reported: one of lichenoid dermatitis resulting from a reaction to the red pigment of a tattoo and the other of a pseudolymphoma resulting from a reaction to red and lilac pigments and a photo-induced reaction to a yellow pigment. Removal generally requires multiple forms of treatment, most of which fail to remove the colors completely.

Reações aos diferentes pigmentos de tatuagens: relato de dois casos / Reactions to the different pigments in tattoos: a report of two cases

A tatuagem é definida como deposição de pigmento intencional ou acidental na pele. Os pigmentos têm sido associados a diversas dermatoses, como a dermatite de contato alérgica, a dermatite liquenoide e as reações fotoinduzidas, granulomatosas, sarcoídeas e pseudolinfomatosas. Enfocam-se os diversos tipos de reações aos pigmentos e a importância de reconhecê-los clinicamente. São relatados dois casos: um de dermatite liquenoide sobre o pigmento vermelho e outro de pseudolinfoma sobre os pigmentos vermelho e lilás e de reação fotoinduzida sobre o amarelo. A remoção geralmente requer múltiplos tratamentos, e a maioria não retira as cores completamente.

Tattoos are defined as the intentional or accidental deposit of pigment into the skin. These pigments have been associated with various dermatoses such as allergic contact dermatitis, lichenoid dermatitis, photoinduced reactions, and granulomatous, sarcoid and pseudolymphomatous reactions. The objective of this report was to describe the various types of reactions to pigments and the importance of recognizing them clinically. Two cases are reported: one of lichenoid dermatitis resulting from a reaction to the red pigment of a tattoo and the other of a pseudolymphoma resulting from a reaction to red and lilac pigments and a photo-induced reaction to a yellow pigment. Removal generally requires multiple forms of treatment, most of which fail to remove the colors completely.

Acne and diet: truth or myth?

Numerous studies were published over the last 50 years to investigate whether diet is associated with the etiology of acne. Although older studies well known by dermatologists that refute the association between acne and diet exist, their scientific foundation is weak. New articles have recently brought to light evidence contrary to previous findings. Therefore, we would like to investigate whether diet, directly or indirectly, influences one or more of the four fundamental etiopathogenic pillars of acne: (1) hyperproliferation of basal keratinocytes, (2) increase of sebaceous production, (3) colonization by Propionibacterium acnes, and (4) inflammation.

Paget's disease: the importance of the specialist.

A twenty-six-year-old woman with a two-year history of an erythematous, scaly lesion on the left nipple was being followed up by her gynecologist and treated using a topical corticoid for chronic eczema albeit with no improvement. She was referred to this department where a diagnosis of Paget's disease of the breast associated with a ductal carcinoma in situ was made. Paget's disease is uncommon prior to the fourth decade of life and the great majority of cases are associated with breast carcinomas. Differential diagnosis must be made between this condition and nipple eczema. As shown in the present case report, late diagnosis results in poor prognosis and higher morbidity since mutilating procedures then become necessary.

Acne e dieta: verdade ou mito?: [revisão] / Acne and diet: truth or myth?: [review]

Nos últimos 50 anos, foram publicados inúmeros estudos com a finalidade de comprovar se a dieta está relacionada à etiologia da acne. Embora existam estudos antigos, que são bem difundidos entre os dermatologistas e negam a associação entre acne e dieta, seu delineamento científico é pobre. Recentemente, novos artigos demonstraram evidências contrárias às publicações anteriores. Sendo assim, os autores realizaram esta revisão bibliográfica com o intuito de averiguar se a dieta influencia direta ou indiretamente um ou mais dos quatro pilares etiopatogênicos fundamentais da acne: (1) hiperproliferação dos queratinócitos basais, (2) aumento da produção sebácea, (3) colonização pelo Propionibacterium acnes e (4) inflamação.

Numerous studies were published over the last 50 years to investigate whether diet is associated with the etiology of acne. Although older studies well known by dermatologists that refute the association between acne and diet exist, their scientific foundation is weak. New articles have recently brought to light evidence contrary to previous findings. Therefore, we would like to investigate whether diet, directly or indirectly, influences one or more of the four fundamental etiopathogenic pillars of acne: (1) hyperproliferation of basal keratinocytes, (2) increase of sebaceous production, (3) colonization by Propionibacterium acnes, and (4) inflammation.

Doença de Paget: a importância do especialista / Paget's disease: the importance of the specialist

Mulher, 26 anos, com história de lesão eritêmato-escamosa no mamilo esquerdo, há dois anos. Era acompanhada pelo seu ginecologista como eczema crônico em uso de corticoide tópico, sem melhora. Encaminhada ao nosso serviço, realizou-se o diagnóstico de doença de Paget mamária associada ao carcinoma intraductal. Antes da quarta década de vida, a doença de Paget é rara, e, na grande maioria dos casos, está associada ao carcinoma mamário. Essa enfermidade constitui diagnóstico diferencial obrigatório do eczema do mamilo. O diagnóstico tardio, como no caso relatado, implica em pior prognóstico e aumento da morbidade, já que terapêutica mutilante é necessária.

A twenty-six-year-old woman with a two-year history of an erythematous, scaly lesion on the left nipple was being followed up by her gynecologist and treated using a topical corticoid for chronic eczema albeit with no improvement. She was referred to this department where a diagnosis of Paget's disease of the breast associated with a ductal carcinoma in situ was made. Paget's disease is uncommon prior to the fourth decade of life and the great majority of cases are associated with breast carcinomas. Differential diagnosis must be made between this condition and nipple eczema. As shown in the present case report, late diagnosis results in poor prognosis and higher morbidity since mutilating procedures then become necessary.

Nevo de reed: lesão melanocítica benigna com feições malígnas / Nevus of reed: benign melanocytic lesion with malignant features

Este estudo apresenta achados microscópicos do nevo pigmentado de células fusiformes, designado como nevo de Reed, os quais resultaram de exames microscópicos realizados em múltiplos cortes de lesão de pele. Apresenta ainda a revisão de literatura pertinente. Os achados clínicos e microscópicos são consistentes com os dados da literatura descritos, originariamente, por Reed e colaboradores. O nevo de Reed é uma lesão melanocítica benigna, que, no entanto, pode ser equivocadamente identificada como um melanoma malígno. As lesões melanocíticas que podem ser confundidas com melanoma malígno devem ser avaliadas cuidadosamente, a fim de obter-se um diagnóstico acurado, e seguir-se a conduta pertinente.

This paper presents the findings of microscopic studies of the PigmentedSpindle-cell Nevus, called Nevus of Reed, carried on multiple sections of skin lesion. It presents, as well, a review of the related literature. The clinical andmicroscopic findings coincide with those originally described by Reed andcolleagues. The Nevus of Reed is a benign melanocytic lesion, which, however,can be easily misdiagnosed as a malignant melanoma. Therefore, in case of suchlesions, all efforts should be made to render an accurate diagnosis, and thus, toprovide the adequate therapy.