RESUMEN

BACKGROUND: Acne vulgaris is a common condition that occurs in all skin types. Postinflammatory hyperpigmentation (PIH) is often associated with acne in patients of darker skin types, making it a common complaint in dermatology offices. Despite this, there is limited understanding of and effective treatment options for PIH. OBJECTIVES: The study objective was to validate an in vivo model for PIH and to compare the clinical, histological and spectroscopic characteristics of artificially induced PIH and acne-induced PIH. METHODS: A nonblinded, nonrandomized pilot study was performed. Thirty subjects served as their own control in which four sites treated with 35% trichloroacetic acid (TCA) solution and four truncal acne pustules were followed for 8 weeks and were evaluated clinically and histologically, and by colorimetry and spectroscopy. RESULTS: The initial phases of inflammation between TCA- and acne-induced PIH differ. However, clinical evaluations were similar on and after day 14. Acne- and TCA-induced lesions were clinically, histologically and spectroscopically indistinguishable at day 28. CONCLUSIONS: Clinical, spectroscopic and histological similarities of acne-induced and TCA-induced PIH at day 28 suggest that TCA-induced PIH can be a reproducible model for the study of acne-induced PIH.

Asunto(s)

RESUMEN

BACKGROUND: Polymorphous light eruption (PMLE) is the most common chronic idiopathic photodermatosis usually manifesting as a papular eruption along with several other morphological variants including a pinpoint papular variant. METHODS AND MATERIALS: Between June 1998 and August 2003, 10 PMLE patients presented to the Department of Dermatology at Henry Ford Hospital with complaints of a pruritic pinpoint papular eruption associated with sun exposure. In six patients skin biopsies were performed along with a detailed history and complete skin examination. We correlated the histology with the clinical course of disease corresponding to acute and subacute disease presentation. We also performed immunohistochemistry on three cases to study the immunophenotype in PMLE. RESULTS: The clinical, histologic and immunostain findings are summarized. Acute: Clinically pinpoint papules and vesicles, some with erythematous base, were seen. Histology showed focal vesicle formation, spongiosis, oedema, red blood cells extravasation, and superficial and deep perivascular and interstitial lymphocytic infiltrate with occasional eosinophils. Subacute: Clinically pinpoint papules with or without erythema were seen. Histology of the pinpoint lesion showed a nodular collection of lymphocytes and histiocytes with claw-like extension of epidermal rete ridges at the lateral boundaries of the lesion. Overlying epidermal atrophy with adjacent spongiosis, exocytosis, oedema and a superficial perivascular lymphocytic infiltrate and parakeratosis was also observed. The histologic differential diagnosis included lichen nitidus. Immunohistochemical stains revealed the following results: CD8, CD68 positive, CD4 variable (strongly positive to negative) and S-100 negative. CONCLUSION: (i) Pinpoint papular variant of PMLE is a distinct entity, which shows characteristic histology corresponding to the clinical course of the disease (acute and subacute). (ii) The histologic and immunophenotypic differential diagnosis of this variant during the subacute phase includes lichen nitidus.

Asunto(s)

Asunto(s)

RESUMEN

A 63-year-old woman was evaluated in 1995 for a nodule on the left parietal scalp. Biopsy revealed pilomatrixoma. The lesion was treated by curettage. The patient returned to the clinic in March of 1998 with a 2-month history of a rapidly growing nodule at the surgical site. Histology showed changes consistent with pilomatrix carcinoma. We will discuss the malignant transformation of a common hair matrix tumor and review the literature.

Asunto(s)

RESUMEN

Hamartomas with eccrine differentiation are quite rare. There are 5 accepted classifications: eccrine nevus, eccrine-centered nevus, eccrine angiomatous hamartoma, eccrine syringofibroadenoma, and porokeratotic eccrine ostial and dermal duct nevus. The latter, PEODDN, typically presents as congenital keratotic papules and plaques located on the distal extremities. We report a classic case of PEODDN that was localized to the left hand since early childhood. The literature on this rare benign tumor is also reviewed.

Asunto(s)

RESUMEN

OBJECTIVE: To determine the efficacy of the 585-nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in the treatment of hypertrophic scars in lighter- and darker-skinned patients. DESIGN: Prospective, single-blind, randomized, internally controlled, comparison investigation. SETTING: Large academic dermatology department. PATIENTS: Twenty patients with hypertrophic scars (19 completed the laser treatments and 18 completed the silicone gel sheeting treatments). MAIN OUTCOME MEASURES: Clinical measurements included hypertrophic scar blood flow, elasticity, and volume. Patients' subjective complaints of pruritus, pain, and burning were also monitored. Histological assessment of fibrosis, number of telangiectasias, and number of mast cells was performed. Statistically significant improvements in clinical measurements and patients' subjective complaints determined treatment success. RESULTS: Mean scar duration was 32 months (range, 4 months to 20 years). There was an overall reduction in blood flow, volume, and pruritus over time (P = .001, .02, and .005, respectively). However, no differences were detected among treatment and control groups. There was no reduction in pain or burning (0-40 weeks), elasticity (8-40 weeks), or fibrosis (0-40 weeks, n = 5 biopsies) in the treated or control sections of the scars. Unlike in a previous study, the number of mast cells in the scars was similar to the number of mast cells in healthy skin. CONCLUSION: Clinical results demonstrate that the improvements in scar sections treated with silicone gel sheeting and pulsed-dye laser were no different than in control sections.

Asunto(s)

RESUMEN

BACKGROUND: Calciphylaxis is a rare and life-threatening condition occurring in patients with end-stage renal disease on dialysis. The diagnosis is frequently delayed or missed and therapy is often unsuccessful. OBJECTIVE: The clinical and pathological components of calciphylaxis are emphasized in a patient that may facilitate early diagnosis and initiation of therapy. RESULTS: Early recognition of the clinical signs and symptoms of calciphylaxis is crucial. The tissue diagnosis requires large elliptical biopsies because histological findings are segmental and often missed. CONCLUSION: Early diagnosis and intervention in calciphylaxis is critical. Parathyroidectomy should be considered in all cases.

Asunto(s)

RESUMEN

Telomeres are the end regions of linear chromosomes, and in normal somatic cells the lengths of telomeres shorten with successive cell divisions. Telomerase, a ribonucleoprotein enzyme, maintains the length of telomeres in immortal and germline cells. Although present in human fetal tissues, shortly after birth telomerase activity is not detectable except in germline cells, hematopoietic cells, and most human primary tumors. In the present study we show telomerase activity to be present in 73 of 77 basal cell carcinomas, 15 of 18 nonmetastatic cutaneous squamous cell carcinomas, and 6 of 7 cutaneous melanomas, contrasting with extremely low levels detected in sun-protected skin. Sun-damaged skin, psoriatic lesional skin, and skin from lesions of poison ivy dermatitis, however, have increased levels of telomerase activity compared to sun-protected skin, although less than that detected in tumor tissue. Because telomerase activity can be found in inflammatory lesions of the skin, this indicates that telomerase activity does not always correlate with the malignant phenotype. In addition, we show that telomerase activity is localized to the epidermis of newborn foreskin, which suggests that telomerase is expressed constitutively by cells in the epidermis. Finding higher levels of telomerase activity in sun-exposed skin compared to nonexposed skin suggests that environmental factors may modulate telomerase activity.

Asunto(s)

RESUMEN

Metastatic umbilical carcinoma has been referred to by generations of physicians as Sister Joseph's nodule. Though not common, this characteristic lesion is important to recognize and properly evaluate. We present a case of an eighty-two-year-old woman with a Sister Joseph's nodule due to an unknown primary carcinoma, and we review the diagnostic and prognostic features of umbilical metastases.

Asunto(s)

Asunto(s)