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Background: Macular lymphocytic arteritis is a recently described type of cutaneous vasculitis involving vessels of medium size. Authors consider it as a form of polyarteritis nodosa. Herein we report a case of macular lymphocytic arteritis during the course of which periarteritis nodosa appeared., Patients and Methods: A 50-year-old man, with no history other than chronic venous insufficiency of the lower limbs, presented with an asymptomatic eruption involving all four limbs, mainly the lower limbs, and appearing in episodes. Physical examination revealed brown macules, in some cases outlining the configuration of livedo reticularis. Laboratory findings were normal except for the presence of low levels of anticardiolipin activity at diagnosis, which had subsided three months later. Histological examination of the skin biopsy showed lymphocytic arteritis with some histiocytes and neutrophils, as well as an eosinophilic ring of parietal necrosis. Six months later, the patient developed multineuritis, leading to the diagnosis of polyarteritis nodosa. A diagnosis of cutaneous polyarteritis nodosa could also have been made based on the association of cutaneous livedo and locoregional polyneuritis without systemic involvement., Discussion: The diagnosis of macular lymphocytic arteritis is based upon clinical and histological findings and upon disease progression. This entity seems to belong to the same spectrum as periarteritis nodosa, especially in the cutaneous form. Given the lack of knowledge concerning progression from macular lymphocytic arteritis to nodosa periarteritis, close patient monitoring is called for, as illustrated by our case report., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: Neutrophilic eccrine hidradenitis (NEH) is a form of neutrophilic dermatitis characterized by tender erythematous and painful papules involving the trunk, extremities and face. The generalized form is associated with malignant hemopathies. The palmoplantar form occurs in children without any context of malignancy. Histology shows a neutrophilic infiltrate surrounding and infiltrating the eccrine glands associated with vacuolar degeneration and necrosis of the epithelial secretory portion., Patients and Methods: We report the case of a 4-year-old girl with palmoplantar HEN progressing to the generalized form while in remission from acute lymphoblastic leukemia., Discussion: Progression of HEN from the palmoplantar form to the generalized form has never been published previously in the literature., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Background: Localized myxoedema is a rare dermopathy in patients with Graves' disease. The pretibial area is the most commonly affected region but herein we present a case of myxoedema of the big toe., Patients and Methods: A 44-year-old male with Graves' disease ongoing for seven years presented bilateral ophthalmopathy and myxoedema of the big toes. The myxoedema was treated successfully with intralesional steroids., Discussion: The physiopathology of myxoedema involves fibroblast activation and glycosaminoglycan production. This activation could result from stimulation of TSH receptors at their surface by TSH receptor antibodies (TRAK) or from an inflammatory process. The pretibial topography may be related to the high frequency in this area of microtrauma, with modulation of the cytokine microenvironment., Conclusion: The atypical localization seems to correlate with a Koebner phenomenon. Treatment of Graves' disease is generally insufficient to resolve the cutaneous problems. Topical corticosteroid therapy generally results in rapid improvement of recent lesions., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: Pemphigus vulgaris is a bullous auto-immune disease affecting the skin and mucosa. It is characterised by acantholysis that results in the formation of intraepithelial bullous lesions. Herein we report a case distinguished by its unusual clinical presentation., Patients and Methods: A 45-year-old man, a chronic smoker, consulted for hyperkeratotic lesions of the toes on the right foot present for 5 months. Examination revealed a violet colour of the toes associated with localised yellowish keratoderma on the sole of the foot and impaired toe nails, as well as impairment on the nails of the first, third and fourth fingers on the right hand. In addition, two hyperkeratotic plaques with crusts were noted on the patient's forehead. Histological examination of a biopsy sample taken from the nail bed of the fourth toe on the right foot showed suprabasal acantholysis with a characteristic tombstone appearance. Direct immunofluorescence confirmed the diagnosis of pemphigus. Oral corticosteroid therapy was initiated consisting of prednisone 1.5mg/kg per day. Improvement of the nail lesions and subsidence of the lesions on the patient's forehead occurred after three months of treatment., Discussion: During the course of pemphigus, the nail findings most commonly reported in the literature are paronychia, onychomadesis and onycholysis. However, these signs are generally seen in patients with known pemphigus vulgaris and only rarely indicate bullous disease. The case we report illustrates a special situation in which pemphigus vulgaris was revealed by unusual skin and nail lesions., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Background: Reactive perforating collagenosis (RPC) belongs to the group of perforating dermatoses, which comprises elastosis perforans serpiginosa, RPC, perforating folliculitis and Kyrle's disease. RPC was initially described as a distinctive form of transepithelial elimination of altered collagen related to superficial trauma. Two types are distinguished: a hereditary type (MIM 216700), which is rare and begins during early childhood, and a second type, called acquired RPC, which is more frequent, appears in adults and is associated with other diseases, diabetes mellitus, renal insufficiency, solid tumors, lymphomas and AIDS. We report the case of a young man whose illness began during infancy, militating in favor of a diagnosis of a hereditary form of RPC. The description of similar lesions in the patient's brother confirmed our diagnosis., Patients and Methods: A 26-year-old man, the child of consanguinous parents, presented crusted papular lesions on his hands. The cutaneous lesions, located on the external side of the limbs, had been present since childhood, with flares during winter. Histologic analysis showed a cup-shaped depression in the epidermis containing keratinous material with extruded degenerated collagen towards the cutaneous surface. Treatment with topic retinoids did not result in any real resolution of the disease. The patient reported the presence of similar lesions in his brother, which was consistent with our diagnosis., Discussion: The pathogenesis of hereditary RPC is still unknown, even if superficial trauma is suspected as the cause of RPC. In contrast, in diabetes, acquired RPC pathogenesis has recently been related to advanced glycation end-products of collagen., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Introduction: Palmar or plantar circumscribed hypokeratosis is a remarkable clinicopathologic entity described in 2002. It consists in a well demarcated decrease in thickness of the stratum corneum, that can be clinically mistaken for Bowen's disease or porokeratosis. We present a classical plantar localisation and a more original case on the dorsum of the finger, together with a microscopic and immunohistochemical study., Case Reports: Case 1. A 65-year-old man was seen 15 years after a first consultation for a well demarcated 1.5cm erythematous lesion localised on the border of his left foot. The biopsy, then misinterepreted as keratosis sulcata, was reviewed. It showed a sudden and well demarcated decrease in thickness of the stratum corneum, overlying a slightly acanthotic epidermis, associated with dilated capillaries in the papillary dermis. HPV immunostaining was negative. Case 2. A 75-year-old woman had a well demarcaated erythematous lesion of the dorsum of her right index finger, lasting for months without significant evolution. A first biopsy showed pale and haloed keratinocytes that could be interpreted as koilocytes. She was therefore treated by cryotherapy, 5-fluro-uracile and imiquimod, that proved unsuccessful. A second biopsy showed a sudden and major decrease in thickness of the stratum corneum, overlying an area containing a few pale keratinocytes with perinuclear halo. HPV immunostaing was negative and Ki67 positive cells were slightly decreased in number when compared to lateral normal skin., Discussion: Our first case is typical of plantar hypokeratosis characterised by its long evolution, typical semiology and well demarcated anomaly of the stratum corneum. Our second case is original as it shows that the disease can also affect the dorsum of the fingers. Acral circumscribed hypokeratosis is therefore a better name for this condition. We did not find any arguments in favor of a viral cause or an increased proliferation of keratinocytes. As often described in other cases, the lesion can remain unchanged for decades, which confirm its benign evolution. Topical treatments are generally ineffective. The pathogenesis of this localised hypokeratosis remains mysterious.

Background: Cutaneous reactions may occur in patients receiving terbinafine therapy, mainly rash and urticaria. More exceptionally, development of psoriasis has been described. We describe the development of plantar pustular psoriasis in a patient who took oral terbinafine., Case Report: A 70-year-old man, without previously known history of psoriasis, was treated with terbinafine, 250 mg/day, for onychomycosis. Ten days later, a plantar pustular psoriasis appeared. The psoriasis cleared up after discontinuation of terbinafine and institution of antipsoriatic therapy., Discussion: Terbinafine is an antifungal agent widely use in the treatment of onychomycosis. A skin reaction occurs in 3 p. 100 of patients. Only 24 cases of flare-up of previous psoriasis or psoriasis de novo after terbinafine have been described. The psoriasis generally clears after discontinuation of terbinafine. So, terbinafine is perhaps not the best first line therapy for onychomycosis in patients with psoriasis.

Introduction: Homocysteine is a sulfur amino acid occurring in methionine intermediary metabolism. It was recently shown to be a vascular risk factor even without high serum levels., Case Report: A 29-year-old woman had painful plantar nodules and necrosis of the fifth toe on the right foot with cyanosis of the forefoot. The histology examination of a nodule biopsy gave the diagnosis of subcutaneous thrombophlebitis. Vascular explorations disclosed advanced-stage arteriopathy of the leg. The methionine loading test was abnormal and search for the heterozygous form of cystathionine ss was positive., Discussion: Different diagnoses could be possible for cases associating an inflammatory venous disease and stage IV arteritis. Latent hyperhomocysteinemia was diagnosed in this case on the basis of the methionine loading test and identification of the heterozygous form of cystathionine ss. Patients with latent hyperhomocysteinemia have an increased risk of both thrombosis and arteritis. Our case emphasizes the importance of searching for hyperhomocysteinemia in patients with early arterial and/or venous thromboembolism, either as repeated episodes or occurring in an unusual territory.

Introduction: Several skin diseases can be seen in patients with trisomy 21. We report a case of miliary calcinosis of the extremities., Case Report: A 15-year old adolescent with Down's syndrome presented small papular miliary lesions which had developed over 18 months and tended to discharge a chalk-like substance via the epidermis. Approximately 15 lesions were present on the hands and feet. Histologically, there was a well-delimited calcium deposit in the superficial dermis. There was no alteration in phosphorus/calcium metabolism. Brain CT-scan and cardiac echography did not reveal any calcifications., Discussion: Miliary calcinosis cutis may not be exceptional in Down's syndrome, although only 9 observations have been reported. Preferential localizations include the hands, wrists and feet. Association with syringoma has been noted but would appear to be fortuitous. Transepidermal elimination of the calcium deposits is frequent. Pathogenic hypotheses include precipitation of calcium salts in sudation products and/or increased synthesis by fibroblasts. The association with trisomy 21 appears to be significant since only three cases have been reported in patients with normal karyotypes. This entity should be individualized as perforating milia-like idiopathic calcinosis cutis of the extremities.

Introduction: Regression of osteomalacia after exeresis of a skin tumor is unusual., Case Report: A 62-year-old man had suffered from bone and joint symptoms for several years due to osteomalacia which was confirmed both biologically and histologically. The patient also had a plantar neurinoma. After exeresis of the tumor the biological results returned to normal levels within one week followed by regression of the clinical signs of osteomalacia., Discussion: The neurinoma in this patient was apparently the cause of osteomalacia, since signs of the disease disappeared after exeresis. To date, three cases of neurinoma associated with osteomalacia have been published, including a single case with skin localization. The tumor would secrete a substance which inhibits the synthesis of vitamin D and enhances phosphorus excretion.

Introduction: According to our knowledge, only twenty-three similar cases have been reported in the literature. Possible hypotheses for localised painful red nodules on the feet in children include erythema nodosum, neutrophilic eccrine hidradenitis, traumatic plantar urticaria, vasculitis and cold panniculitis., Case Report: We report a typical case of painful erythematous plantar nodules of the child. A 13-yr-old boy was first seen by a paediatrician for intermittent fever. The fever was associated with red, painful nodules on the soles. He was unable to walk. Routine blood chemistry parameters were within normal limits. Histopathologic examination of lesional skin revealed an image of septal and lobular panniculitis with vasculitis. Direct immunofluorescence study was not contributive. With proper antibiotic therapy, pain resolved within one week while fever and nodules cleared within two weeks., Discussion: Briefly, this observation concerns a child disease occurring as painful erythematous plantar nodules. The lesions are spontaneously resolutive and the children are in good health. Our observation should constitute a supplementary group with the same classical symptoms of nodular plantar painful erythema of the child but moreover accompanied by a septal and lobular panniculitis with vasculitis at the histological examination. Further studies are necessary to verify these hypotheses.

Introduction: Plantar hidradenitis, one of several possible causes of painful papulo-nodular lesions of the foot in children and young adults, was recently described as the presence of characteristic lesions of the eccrine sweat glands., Case Report: A 15-year-old boy consulted for a sudden-onset painful eruption on the sole of the right foot. Physical examination revealed papulo-nodular erythromato-violet infiltrated lesions located on the anterior part of the right planta. Histology examination showed dense neutrophil inflammatory infiltration predominating at the dermo-hypodermic junction around the eccrine sweat glands. The excretory ducts of the sweat glands were infiltrated but the secretory glomerulae were intact. A dense infiltration of venular thrombi without vasculitis was also seen. The lesion regressed with aspirin (8 days) and rest. No recurrence has been recorded after 18 months., Discussion: This clinical and histological presentation led to the diagnosis of plantar hidradenitis, confirming the disease entity. Former cases may have been described as trauma-induced plantar urticaria or plantar erythema nodosum. This diagnosis should be entertained in children or young adults with painful papulo-nodular eruptions of the soles. The histology examination should include the eccrine sweat glands.

Introduction: We report a case of parapsoriasis en gouttes (or pityriasis lichenoides) which presents two peculiarities. First, the patient had lingual ulcerations and second, the eruption appeared during a seroconversion for Parvovirus B19., Observation: A 25 old woman presented a first episode of characteristic parapsoriasis en gouttes associated with purpuric palmoplantar lesions and lingual ulcerations, reaching deep muscular in histology., Discussion: This observation of parapsoriasis en gouttes, peculiar because of lingual ulcerations, is mostly interesting because of its association with a primo-infection to Parvovirus B19. The receptor of the virus is localised on endothelial cells and that could explain purpuric lesions and ulcerations observed.

We report the case of a 60-year old man who, during four years following surgical repair of an inguinal hernia (with transient antithrombotic therapy), suffered from an atypical inflammatory nodule on the dorsum of the left foot with an erythematous plaque on the first intermetatarsal space, together with an inflammatory plaque on the right fifth finger and hairless plaques on both wrists. An ultimate biopsy of the nodule made it possible to discover, unexpectedly, two shadows of cholesterol crystals in a vascular lumen and inside the cytoplasm of a giant multinucleate cell found on a single histological slice and at the deepest part of the fragment. The inflammatory lesions disappeared under a 250 mg/day aspirin treatment. We emphasize the uncommon clinical and pathological pseudo-lymphomatous features of this case and regard our description as original in view of the chronicity of the embolising process.

Pustulosis palmaris et plantaris chronica et recidivans (pustular bacterid of Andrews) is not an exceptional disease. Its characteristic histological structure is to be considered as a major element of the diagnosis. The fully developed pustule is an oval cavity with transverse long axis, entirely situated within a loca-ly hyperplastic epidermis. Its formation goes through several stages. The first one is spongiosis appearing in the epidermis above the top of a dermal papilla. This gives rise to a vesicle filled with fluid and mononuclear leucocytes. In the next stage, the roof consisting of the malpighian layers is disrupted, and the vesicular fluid comes into contact with the horny layer. There is massive invasion of the cavity by polymorphonuclear leucocytes which penetrate into the intercellular spaces of the vesicle wall, where pictures of spongiform pustules are seen. The initial vesicle, and the late, secundary appearance of the spongiform aspects demonstrate that the mechanism of formation of the lesion of pustulosis palmaris et plantaris chronica et recidivans is different from the one of psoriasis pustulosa palmo-plantaris and that, consequently, these are two different diseases.

Acrokerato-elastoidosis described by Costa is characterized by numerous little keratotic points and translucent horny wheals on the dorsal aspect of hands and (or) feets. The ultrastructural study shows lesions of the elastic tissue which is very rarefied with an abnormal structure, but also demonstrates alterations of the fibroblasts that contain dense granules at the periphery of their cytoplasm without elastic extracellular fibers, suggesting a trouble in the secretion or the excretion of the elastic material.

Among 466 children under the age of 12 years who presented with eczema in a 5-year period, 68 p. 100 were atopic. 136 had various atypical signs of atopy. 44 suffered from pityriasis alba of sufficient intensity to justify referral for this reason; 10 had the typical features of seborrhoeic dermatitis of infants. 27 suffered from "forefoot" eczema ("juvenile plantar dermatosis"). The course and characteristics of this condition are discussed and compared with the series recently described in the West of Scotland. Our cases were exactly similar except for an aggravation in the summer months and the fact that our cases responded poorly to topical corticosteroids alone though improved with coal tar. Atopy and contact sensitivity to shoe materials are rare in both groups. We feel that this may be classified as "frictional" dermatitis and agree with our Scottish colleagues that the introduction of nylon socks during the last ten years may be important.