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Amicrobial pustulosis of the folds (APF) is a rare neutrophilic dermatosis found in association with autoimmune diseases. We present a 49‐year‐old woman with a history of systemic lupus erythematosus and a recurrent pustular eruption in the cutaneous folds. Histologic examination revealed spongiform pustulosis and dermal neutrophilic infiltrate. The Gram and periodic acid–Schiff stains were negative for bacteria and fungi. A diagnosis of amicrobial pustulosis of the folds was given. While there is no standard treatment, our patient's symptoms resolved following an oral prednisone taper and have not recurred since starting colchicine. The presence of pustules and erosive plaques in skin folds in young women with autoimmune conditions should raise suspicion for APF. The combination of localized neutrophilic spongiosis with intraepidermal or subcorneal pustules in conjunction with dermal changes of a neutrophilic dermatosis is a helpful clue to the diagnosis. If the patient does not already have a diagnosis of an underlying autoimmune condition, a presentation of APF should prompt further screening consisting of a relevant review of symptoms and appropriate assessment for autoimmune antibodies, since APF may precede the diagnosis of autoimmune disorders. [ABSTRACT FROM AUTHOR]

Localized argyria with pseudo-ochronosis: A report of two cases highlighting involvement of elastic fibers Pseudo-ochronosis in localized argyria was first reported in 2002,[1] when they described ochre-colored swollen homogenized collagen bundles seen on biopsy of localized argyria in the absence of the typical causes of ochronosis. Keywords: argyria; elastic fibers; localized argyria; pseudo-ochronosis EN argyria elastic fibers localized argyria pseudo-ochronosis 815 818 4 08/16/23 20230901 NES 230901 INTRODUCTION Argyria, either localized or generalized, is a rare dermatologic condition where the deposition of silver within skin or mucous membranes results in grayish-blue pigmentation that can be appreciated clinically. [Extracted from the article]

Reactive infectious mucocutaneous eruption (RIME) is a recently described entity in which there is prominent mucositis, most commonly involving the oral and urogenital mucosa, secondary to a variety of pathogens. There is typically minimal cutaneous involvement in RIME. This contrasts with erythema multiforme (EM) in which characteristic targetoid lesions predominate, usually in isolation (EM minor), but in a subset of cases, with severe mucositis (EM major). While the histopathologic features of RIME have not been as well defined, those of EM are characterized by epidermal apoptosis and interface dermatitis with lymphocytes making up the predominant cell type. We report a unique case of RIME in a 16‐year‐old male with COVID‐19 characterized by significant mucositis involving the oral and genital mucosa, as well as numerous targetoid lesions on the trunk and extremities. Histopathologically, there was an inflammatory infiltrate obscuring and disrupting the epidermal interface, associated with epidermal necrosis, and blister formation. The infiltrate was composed of cells with irregular, non‐segmented and elongate nuclei, with myeloid and histiocytoid cytomorphology. The cells were positive for myeloperoxidase, CD68, and CD163 (subset) suggesting myeloid lineage. RIME is a rarely reported COVID‐19‐related eruption, and targetoid lesions and myeloid interface reactions have not been described with RIME. [ABSTRACT FROM AUTHOR]

VEXAS (Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently described adult-onset inflammatory and hematological disorder.[[1]] It is caused by a somatic mutation in the I UBA1 i gene on the X chromosome, which encodes the major E1 ubiquitin-activating enzyme. Any associated macrocytic anemia, thrombocytopenia, or vascular thrombosis in a male patient above 50 years of age should raise suspicion for VEXAS syndrome. Dermatologists may be the first to encounter VEXAS syndrome patients as almost 90% of patients have been reported to have cutaneous manifestations, with a majority presenting initially due to cutaneous disease.[[3]] In this article, we describe the key clinical manifestations of VEXAS syndrome and offer diagnostic clues that will aid in prompt diagnosis and reduce the associated mortality. [Extracted from the article]

Background: Patients with Sweet syndrome (SS) have acute onset of cutaneous lesions with characteristic histopathology (dense and diffuse neutrophilic infiltrate, dermal edema, leukocytoclasis and no vasculitis) accompanied by systemic symptoms. Sometimes, only skin lesions with classic histopathologic features are seen. Although SS is considered to be a “neutrophilic dermatosis,” lymphocytes are also seen on histological examination. Methods: We evaluated the cellular infiltrate in 9 biopsies from SS lesions with routine staining and immunohistochemistry. Results: Lymphocytes were present in all biopsies in variable amounts, often exceeding the number of intact neutrophils. Prominent fragmentation of neutrophils rendered some biopsies “lymphocyte‐rich” on routine histologic evaluation. Myeloperoxidase was helpful in highlighting the inconspicuous neutrophilic fragments in these cases. Lymphocytes were highlighted with immunohistochemistry, and had a CD3+, CD4+, CD20(−) immunophenotype, with rare CD8+ lymphocytes. Conclusion: Awareness of the lymphocytic component of SS is important to avoid diagnostic errors, especially in subcutaneous lesions of SS, in which the lymphocytic infiltrate predominates in the upper parts of the dermis, while the typical neutrophilic infiltrate may be seen only in the deeper dermis and subcutis. The lymphocytic component may potentially help to differentiate lesions of SS from neutrophilic urticarial dermatosis, which has not been reported to contain a significant lymphocytic population. [ABSTRACT FROM AUTHOR]

Pseudocarcinomatous hyperplasia can occasionally be observed in biopsies of CD30-positive lymphoproliferative disorders. It is important to be cognizant of this association, because epithelial hyperproliferation can overshadow large atypical lymphoid cells, leading to an erroneous diagnosis of squamous cell carcinoma (SCC) or keratoacanthoma. Herein, we present a case of anaplastic large cell lymphoma (ALCL) with pseudocarcinomatous hyperplasia simulating a poorly differentiated carcinoma and review the literature on this subject. Immunohistochemical staining with p63 helped delineate the infiltrating tongues of pseudocarcinomatous hyperplasia from the malignant infiltrate. We present this case to raise awareness of the potential for pseudocarcinomatous hyperplasia to occur in the setting of CD30+ lymphoproliferative disorders. Clinicians and dermatopathologists should consider the possibility of ALCL or lymphomatoid papulosis when examining lesions with features of inflamed SCC, especially if the tumor presents on a site or in a patient that is not typical of SCC. [ABSTRACT FROM AUTHOR]

Annular lichenoid dermatitis (ALDY) is a rare dermatosis that is most often seen in children and young adults and is characterized by annular patches with raised borders, most frequently on the trunk and the groin. A distinct lichenoid tissue reaction involving the base of the rete, resulting in squared-off rete ridges, helps to differentiate this from other lichenoid dermatoses and mycosis fungoides (MF). Herein, we report an additional case of this condition in a 7-year-boy, whose biopsy exhibited the typical quadrangular rete alteration and also contained distinct aggregates of CD8+ lymphocytes, Langerhans cells and colloid bodies within the involved rete. A literature review with emphasis on the clinical and histopathological differential diagnosis reveals additional clinical features of ALDY to potentially help differentiate this entity from annular presentations of mycosis fungoides. [ABSTRACT FROM AUTHOR]

The article presents case study of a 16-year-old girl who was referred to dermatology for assessment of nonhealing cutaneous ulcers on her legs. It mentions low-power histologic examination demonstrated a pandermal mixed infiltrate with necrosis and cutaneous leishmaniasis was diagnosed. It adds insect bites during her vacation to Israel and importance of taking travel history.

Exogenous agents implicated in or suspected of precipitating subacute cutaneous lupus erythematosus (SCLE) and lupus erythematosus (LE) are reviewed. An illustrative case of environmentally induced SCLE is presented. A previously healthy 30-year male homozygous for the tumor necrosis factor-α (TNF-α) 308. A promoter allele developed SCLE after spending several hours removing fertilizer- and pesticide-containing hay from an agricultural barn in the springtime. The cutaneous eruption soon resolved, only to reappear 3 weeks later on the day the patient re-entered the barn. An environmental agent present in the barn, coupled with springtime ultraviolet light, likely triggered the disease in this immunogenetically susceptible individual. [ABSTRACT FROM AUTHOR]

HER2 protein over-expression was investigated in seventeen cases of primary cutaneous and metastatic malignant melanoma using the semi-quantitative Dako Hercep Test[sup TM] immunohistochemical assay. Formalin fixed, paraffin embedded tissue was employed; membrane staining was scored on a scale of 0 to 3+. Control cell lines were stained concurrently in all cases, and performed within prescribed criteria. All cases were negative for HER2 protein over-expression. Fifteen cases had a score of 0, one case showed focal areas of 1+ and another case was 1+ overall, with foci approaching 2+. (A score of 0 or 1+ is negative, 2+ is weak positive and 3+ is strong positive.) Over-expression of HER2 protein is best known in breast cancer. The incidence of HER2 over expression in other malignancies is not known. The value of testing for HER2 over-expression lies in the existence of anti HER2 therapy, namely Herceptin (Trastuzumab) – a monoclonal antibody that targets the HER2 protein, inhibiting tumor cell proliferation. The presence of HER2 protein over-expression in melanoma cells would suggest possible benefit of Herceptin therapy. This study, although limited, suggests that HER2 protein over-expression is, at best, infrequent in melanoma; therefore Herceptin therapy is unlikely to be useful. Since its initial description, it has continued to be a matter of debate whether actinic granuloma (AG) should be considered a specific condition or simply granuloma annulare (GA) with incidental elastophagocytosis because of its location on sun-damaged skin. We conducted a case control study to clarify this issue. Twenty cases diagnosed as AG between 1991 and 2001 were retrieved from our archives. Fourteen met our inclusion criteria: sufficient tissue for elastic and mucin stains; loss of the elastic tissue in or at the side of the granuloma; and elastophagocytosis. Sixteen cases of GA, 8 involving sun-exposed and 8 involving non-sun-exposed body sites, were randomly sel... [ABSTRACT FROM AUTHOR]

The article describes the case of a 22-year-old female patient with a history of painful lesions on the elbows and knees, and who was diagnosed with Sweets syndrome (SS) caused by a high dose estrogen oral contraceptives (OCP). Her condition improved after discontinuation of OCP. It references the study "A Neutrophilic Reaction of Sweets syndrome Type Associated with the Oral Contraceptive," by F. J. Tefany and K. A. Georgouras in the 1991 issued of "Australasian Journal of Dermatology."

Previous reports of a distinctive, fibrous, soft-tissue tumor include eight patients with subcutaneous lesions and six patients with intramuscular lesions. We report a 48-year-old woman with a 2-cm cutaneous and subcutaneous nodule on the left arm with the same histologic features. An excisional biopsy showed a large, well circumscribed tumor replacing the reticular dermis and subcutaneous tissue. The tumor was relatively hypocellular and composed primarily of large, spindled, plump or stellate fibroblasts haphazardly dissecting between thickened Fibrotic collagen bundles. The stroma contained a large amount of mucin which was positive with alcian blue at pH 2.5, and relatively numerous mast cells were present. The fibroblastic-like cells were positive with Vimentin and Factor XIIIA and negative with S-100, desmin, actin and keratin. [ABSTRACT FROM AUTHOR]

Perifollicular fibroma is a cutaneous hamartomatous proliferation of the pilar connective tissue sheath. We describe a patient with multiple perifollicular fibromas and analyze the literature on this topic. Histologically, perifollicular fibroma is characterized by a concentric arrangement of collagen fibers surrounding a generally unaltered hair follicle. Clinically, it is usually multiple and occurs predominantly on the face and upper trunk. This clinical presentation is similar to that observed in patients with the Birt-Hogg-Dubé syndrome where, in addition to perifollicular fibromas, fibrofolliculomas, trichodiscomas, and acrochordans are found. Several reports of multiple peifollicular fibroma prior to the recognition of this syndrome may, in fact, represent cases of the Birt-Hogg-Duké syndrome. [ABSTRACT FROM AUTHOR]

The article offer sinformation on the impact of aluminium chloride (AlCl) on skin and its histiocytic reaction along with the use of positive amorphous material to identify the granules of AlCl in tissue biopsies. Topics discussed include biopsy may lead to hemorrhage if patient has an abnormal coagulation status; Monsel's solution causes pigmented fibrohistiocytic proliferation; and AlCl used to treat axillary hyperhidrosis as well as hemostasis.

The article focuses on the diagnosis and treatment of a woman with Mycobacterium marinum infection. The patient had complications of her right fourth finger wherein pink papules and subcutaneous nodules existed. The patient has improved her condition after undergoing azithromycin, and methotrexate treatment.

Although its cell of origin is still controversial, the blastic NK-cell leukemia/lymphoma clearly represents a distinct type of hematopoietic neoplasm that is particularly clinically aggressive when it occurs in elderly patients as a disseminated, multi-organ disease. Consistently effective treatments have not been developed for this malignancy. The present report describes two elderly patients with widespread blastic NK-cell leukemia/lymphoma involving the skin, bone marrow, peripheral blood, lymph nodes, and viscera. In both cases the malignant cells were CD56+, CD2+, and terminal deoxynucleotidyl transferase (TdT) positive with no detectable T-cell receptor (TCR) gamma chain gene rearrangement. The cells also exhibited a low CD45 expression and strong CD99 (mic-2) expression, as seen in immature lymphoid malignancies. The above findings support the precursor NK-cell, rather than mature NK- or non-NK-cell, origin of the malignant cells. It is noteworthy that the two patients achieved complete responses to treatment with hyper-CVAD (fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone) alternating with high-dose methotrexate/cytarabine, a regimen currently utilized in acute lymphoblastic leukemia and high-grade lymphoma. The complete remission (CR) was sustained for 24 months in one patient who received four cycles (eight courses) of the treatment. It lasted 9 months in the second patient, who received only two cycles (four courses). If similar results are obtained with future patients, a randomized study comparing the hyper-CVAD regimen to other therapeutic strategies may be warranted., (Copyright 2003 Wiley-Liss, Inc.)