Eosinophilic granuloma. Presence of OKT6-positive cells and good response to intralesional steroid.

A patient with eosinophilic granuloma, with extensive oral mucous membrane involvement, was treated with intralesional triamcinolone acetonide injections. Although radiation therapy had failed, this treatment resulted in remission. The biopsy specimen from the patient's lesion contained a predominance of OKT6-positive cells, which were shown by electron microscopic analysis to be mostly indeterminate cells and a small percentage of Langerhans' cells, with characteristic L-cell granules; there was also 5% eosinophils. Many L-cell granules were being produced between cell membranes of the same as well as neighboring L cells. It was thought that in this condition, as in other proliferative conditions of L cells, cell membranes are extremely adhesive and that such adhesion areas of L cells form L-cell granules. This occurs in a similar fashion as the adhesive areas of epithelial cells form desmosomes.

Spiny keratoderma: a common under-reported dermatosis.

Spiny keratoderma is a dermatosis consisting of multiple projections located on the palms and soles, with a distinct histology characteristic of a parakeratotic column above a hypogranular epidermis. We report six cases discovered within a year and review the present literature on spiny keratoderma. The average age of the patients was 57 years. Fifty-seven percent of the patients were male and forty-three percent were female. The duration of lesions ranged from 4 months to 40 years. Symptoms were variable, however, lesions were often unnoticed by the patient. The location of the lesions involved the palms and soles or the palms alone. Past medical history was significant for hypertension and hyperlipidemia treated with HMG-CoA reductase inhibitors. Lesions often occurred in patients involved in manual labor. Spiny keratoderma is a relatively common under-reported dermatosis found most often in older patients with history of manual labor and is possibly related to treatment with HMG-CoA reductase inhibitors.