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Wollina U, Schönlebe J, Heinig B, Tchernev G, França K, Lotti T. Segmental Erythema Multiforme-Like Drug Eruption by Aromatase Inhibitor Anastrozole - First Case Report and another Example of an Immunocompromised District. Open Access Maced J Med Sci 2018; 6:79-81. [PMID: 29483990 PMCID: PMC5816324 DOI: 10.3889/oamjms.2018.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/07/2017] [Accepted: 09/29/2017] [Indexed: 12/22/2022] Open
Abstract
Anastrozole is a non-selective aromatase inhibitor for adjuvant breast cancer therapy in postmenopausal women. Cutaneous adverse events have been reported. We observed a 64-year-old female patient with a medical history of locally advanced breast cancer of her right breast that was treated with radiotherapy and adjuvant drug therapy with anastrozole. She developed a segmental bullous eruption limited to the cancer-affected breast. Cessation of the aromatase inhibitor and systemic therapy with prednisolone cleared the lesions completely. This is the first report of a segmental erythema multiforme like drug eruption by anastrozole and another example of the concept of the immunocompromised district of skin.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Friedrichstrasse 41, 01067 Dresden, Germany
| | - Jacqueline Schönlebe
- Städtisches Klinikum Dresden - Institute of Pathology "Georg Schmorl", Dresden, Germany
| | - Birgit Heinig
- Städtisches Klinikum Dresden - Center of Physical and Rehabilitative Medicine, Dresden, Germany
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, Sofia, Bulgaria.,Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Katlein França
- Department of Dermatology and Cutaneous Surgery, Department of Psychiatry & Behavioral Sciences; Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, FL, USA
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Wollina U, Nowak A, Tchernev G, Lotti T. Chronic Scalp Ulcer 35 Years after Skull Trepanation Surgery and Radiotherapy for Oligodendroglioma: A Further Example of Immunocompromised Cutaneous Districts. Open Access Maced J Med Sci 2018; 6:55-57. [PMID: 29483982 PMCID: PMC5816315 DOI: 10.3889/oamjms.2018.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/17/2017] [Accepted: 08/19/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Chronic ulcers of the scalp have a variety of underlying pathologies. In case of cancer patients, a second malignancy must be excluded. CASE REPORT: A 78-year-old female patient presented to our department with a large soft tissue defect on the frontotemporal left side. The lesion was about 3 cm in diameter with exposed bone and inflammatory soft tissue on the edges of the defect. About 35 years ago, she had undergone a combined neurosurgery with skull trepanation and radiotherapy for an oligodendroglioma. Three years ago, sandwich transplantation with the dermal template and meshed skin graft failed. Now she re-presented with inflammatory ulcer borders. A complex defect repair was performed after exclusion of a second malignancy. CONCLUSION: Chronic scalp ulcers may be the result immunocompromised cutaneous districts and need a complex reconstruction.
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Affiliation(s)
- Uwe Wollina
- Städtisches Klinikum Dresden, Dresden, Sachsen, Germany; Academic Teaching Hospital Dresden-Friedrichstadt, Germany
| | - Andreas Nowak
- Department of Anesthesiology & Intensive Care Medicine, Emergency Medicine & Pain Management, Dresden, Germany
| | - Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria.,Onkoderma - Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
| | - Torello Lotti
- Università Degli Studi "G. Marconi", Rome, Italy, Facoltà di Medicina e Chirurgia - Chair of Dermatology, University of Rome, Rome, Italy
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53
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Wu MY, Lin CY, Kuo TT, Chen CH. Unilateral granulomatous rosacea – The immunocompromised district as a possible cause. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2017.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Happle R, Kluger N. Koebner's sheep in Wolf's clothing: does the isotopic response exist as a distinct phenomenon? J Eur Acad Dermatol Venereol 2017; 32:542-543. [PMID: 29080318 DOI: 10.1111/jdv.14664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Until 1995, a case of psoriasis developing within the dermatome of a healed herpes zoster was taken as a Koebner phenomenon. In this year, however, the term 'isotopic response' was introduced by Wolf et al. to describe 'the occurrence of a new skin disorder at the site of another, unrelated and already healed skin disease', thus appearing 'on apparently unaffected and healthy skin'. Initially, the term was mainly related to herpes zoster, but today the name 'Wolf's isotopic response' is used to include a plethora of other triggering factors such as healed cutaneous leishmaniasis, tinea or varicella. For obvious reasons, such triggering factors cannot be taken as examples of 'unaffected and healthy skin'. Notably, the authors themselves have categorized the dermatome of a healed herpes zoster as a 'vulnerable area'. In a recent commentary, Wolf et al. have expanded the definition of healed skin diseases triggering an 'isotopic response'. They now included 'scars, pigment changes, color changes or various other minimal changes by the first disease'. Hence, there is no clear-cut criterion to distinguish the isotopic response from a Koebner reaction. Wolf et al. even argue that, if the triggered disorder precedes the appearance of generalized skin lesions, then it is not a Koebner reaction but 'Wolf's isotopic response'. In our view, such definition is unacceptable. All reactions of this kind represent examples of a Koebner phenomenon. Accordingly, the 'isotopic response' should today be taken as a historical error.
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Affiliation(s)
- R Happle
- Department of Dermatology, Medical Center, University of Freiburg, Freiburg, Germany
| | - N Kluger
- Departments of Dermatology, Allergology and Venereology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
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De Vita V, Ruocco E. Hidradenitis suppurativa after radiotherapy for uterine adenocarcinoma: A typical example of an isoradiotopic response. JAAD Case Rep 2017; 3:570-571. [PMID: 29159253 PMCID: PMC5684502 DOI: 10.1016/j.jdcr.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Valerio De Vita
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - Eleonora Ruocco
- Dermatology Unit, University of Campania L. Vanvitelli, Naples, Italy
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Ramirez-Fort MK, Zeng J, Feily A, Ramirez-Pacheco LA, Jenrette JM, Mayhew DL, Syed T, Cooper SL, Linden C, Graybill WS, French LE, Lange CS. Radiotherapy-induced reactivation of neurotrophic human herpes viruses: Overview and management. J Clin Virol 2017; 98:18-27. [PMID: 29197712 DOI: 10.1016/j.jcv.2017.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/20/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Infection by Human Herpes Viruses (HHV) types 1-3, are prevalent throughout the world. It is known that radiotherapy can reactivate HHVs, but it is unclear how and to what extent reactivations can interact with or affect radiotherapeutic efficacy, patient outcomes and mortality risk. Herein, we aim to summarize what is known about Herpes Simplex Virus (HSV)-1,2 and Varicella Zoster Virus (VZV) pathophysiology as it relates to tumor biology, radiotherapy, chemo-radiotherapy, diagnosis and management so as to optimize cancer treatment in the setting of active HHV infection. Our secondary aim is to emphasize the need for further research to elucidate the potential adverse effects of active HHV infection in irradiated tumor tissue and to design optimal management strategies to incorporate into cancer management guidelines. MATERIALS AND METHODS The literature regarding herpetic infection, herpetic reactivation, and recurrence occurring during radiotherapy and that regarding treatment guidelines for herpetic infections are reviewed. We aim to provide the oncologist with a reference for the infectious dangers of herpetic reactivation in patients under their care and well established methods for prevention, diagnosis, and treatment of such infections. Pain management is also considered. CONCLUSIONS In the radiotherapeutic setting, serologic assays for HSV-1 and HSV-2 are feasible and can alert the clinician to patients at risk for viral reactivation. RT-PCR is specific in identifying the exact viral culprit and is the preferred diagnostic method to measure interventional efficacy. It can also differentiate between herpetic infection and radionecrosis. The MicroTrak® HSV1/HSV2/VZV staining kit has high sensitivity and specificity in acute lesions, is also the most rapid means to confirm diagnosis. Herpetic reactivation and recurrences during radiotherapy can cause interruptions, cessations, or prolongations of the radiotherapeutic course, thus decreasing the biologically effective dose, to sub-therapeutic levels. Active HHV infection within the treatment volume results in increased tumor radio-resistance and potentially sub-therapeutic care if left untreated. Visceral reactivations may result in fatality and therefore, a high index of suspicion is important to identify these active infections. The fact that such infections may be mistaken for acute and/or late radiation effects, leading to less than optimal treatment decisions, makes knowledge of this problem even more relevant. To minimize the risk of these sequelae, prompt anti-viral therapy is recommended, lasting the course of radiotherapy.
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Affiliation(s)
- Marigdalia K Ramirez-Fort
- Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States; Urological Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Jianying Zeng
- Pathology, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Amir Feily
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Joseph M Jenrette
- Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - David L Mayhew
- Radiation Oncology, Tufts Medical Center, Boston, MA, United States; Medicine, Dana Farber Cancer Institute, Boston, MA, United States
| | - Talal Syed
- Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - S Lewis Cooper
- Radiation Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Craig Linden
- Radiology, State University of New York Downstate Medical Center, Brooklyn, NY, United States
| | - Witney S Graybill
- Gynecology Oncology, Medical University of South Carolina, Charleston, SC, United States
| | - Lars E French
- Dermatology, Zurich University Hospital, Zurich, Switzerland
| | - Christopher S Lange
- Radiation Oncology, State University of New York Downstate Medical Center, Brooklyn, NY, United States.
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Haber R, Bachelez H. Radiation-induced inflammatory dermatosis: Another facet of the immunocompromised cutaneous district. JAAD Case Rep 2017; 3:572-573. [PMID: 29159254 PMCID: PMC5684424 DOI: 10.1016/j.jdcr.2017.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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58
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Chen SX, Cohen PR. Edema Bullae Mimicking Disseminated Herpes Zoster. Cureus 2017; 9:e1780. [PMID: 29255659 PMCID: PMC5732012 DOI: 10.7759/cureus.1780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Edema bullae typically forms at the site of skin swelling during acute states of volume overload, most commonly during renal or cardiac failure. Herpes zoster is a reactivation of latent varicella zoster virus that typically presents as painful vesicles in a dermatomal distribution. In immunocompromised individuals, disseminated herpes zoster skin manifestations may occur with several lesions in multiple dermatomes or widespread individual lesions or both, even visceral organs can be involved. Additionally, many conditions are known to mimic the lesions and distribution of herpes zoster. A 53-year-old immunosuppressed male with a history of renal transplant presented with dermatomal and non-dermatomal, disseminated herpes zoster that was confirmed by polymerase chain reaction testing. After one week of intravenous antiviral therapy during which his virus infection-associated lesions were resolved, new blisters developed near the insertion site of a peripheral venous line located on a previously uninvolved yet swollen upper extremity. The varicella zoster virus disease was initially suspected, but lab studies and skin biopsy of a blister excluded progressive or persistent viral infection and established a diagnosis of acute edema bullae. The blisters resolved following removal of the peripheral catheter. Acute edema bullae should be added to the list of mimickers of disseminated varicella zoster virus infection.
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Affiliation(s)
- Stella X Chen
- School of Medicine, University of California, San Diego
| | - Philip R Cohen
- Department of Dermatology, University of California, San Diego
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59
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De Vita V, Ruocco E. The concept of immunocompromised district might explain the carcinogenic progression in hidradenitis suppurativa. Acta Oncol 2017; 56:1330-1331. [PMID: 28509651 DOI: 10.1080/0284186x.2017.1324214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Valerio De Vita
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Eleonora Ruocco
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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60
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Wollina U, Langner D, Hansel G, Koch A, Tchernev G. Scalping Surgery - Dermatologic Indications beyond Curative Primary Skin Cancer Surgery. Open Access Maced J Med Sci 2017; 5:414-419. [PMID: 28785321 PMCID: PMC5535646 DOI: 10.3889/oamjms.2017.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 04/22/2017] [Accepted: 04/23/2017] [Indexed: 12/16/2022] Open
Abstract
Skin tumours are among the most frequent tumour types of mankind. In the case of large tumours, field cancerization, or satellitosis scalping surgery is a possible option. The procedure can also be used in a palliative setting with tumour debulking. Less common indications are multiple benign tumours of the scalp and chronic inflammatory scalp dermatoses not responding to medical treatment. We present a case series and discuss surgical modalities beyond curative surgery of primary skin cancer.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany
| | - Dana Langner
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany
| | - Gesina Hansel
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany
| | - André Koch
- Department of Dermatology and Allergology, Academic Teaching Hospital Dresden-Friedrichstadt, Friedrichstrasse 41, 01067, Dresden, Germany
| | - Georgi Tchernev
- Department of Dermatology, Venereology and Dermatologic Surgery, Medical Institute of Ministry of Interior, and Onkoderma Policlinic for Dermatology and Dermatologic Surgery, Sofia, Bulgaria
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61
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DeMartinis NC, Brown MM, Hinds BR, Cohen PR. Leukemia Cutis Associated with Secondary Plasma Cell Leukemia. Cureus 2017; 9:e1235. [PMID: 28620566 PMCID: PMC5467771 DOI: 10.7759/cureus.1235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Plasma cell leukemia is an uncommon, aggressive variant of leukemia that may occur de novo or in association with multiple myeloma. Leukemia cutis is the cutaneous manifestation of leukemia, and indicates an infiltration of the skin by malignant leukocytes or their precursors. Plasma cell leukemia cutis is a rare clinical presentation of leukemia. We present a man who developed plasma cell leukemia cutis in association with multiple myeloma. Cutaneous nodules developed on his arms and legs 50 days following an autologous stem cell transplant. Histopathologic examination showed CD138-positive nodular aggregates of atypical plasma cells with kappa light chain restriction, similar to the phenotype of his myeloma. In spite of systemic treatment of his underlying disease, he died 25 days after the presentation of leukemia cutis. Pub-Med was searched for the following terms: cutaneous plasmacytomas, leukemia cutis, plasma cell leukemia nodules, plasma cell leukemia cutis, and secondary cutaneous plasmacytoma. Papers were reviewed and appropriate references evaluated. Leukemia cutis in plasma cell leukemia patients is an infrequent occurrence. New skin lesions in patients with plasma cell leukemia should be biopsied for pathology and for tissue cultures to evaluate for cancer or infection, respectively. The diagnosis plasma cell leukemia cutis is associated with a very poor prognosis.
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Affiliation(s)
| | - Megan M Brown
- Department of Dermatology, University of California, San Diego
| | - Brian R Hinds
- Department of Dermatology, University of California, San Diego
| | - Philip R Cohen
- Department of Dermatology, University of California, San Diego
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62
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Castrillón MA, Murrell DF. Lupus profundus limited to a site of trauma: Case report and review of the literature. Int J Womens Dermatol 2017; 3:117-120. [PMID: 28560307 PMCID: PMC5440450 DOI: 10.1016/j.ijwd.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 01/01/2023] Open
Abstract
Lupus erythematosus profundus (LEP) is a rare form of chronic cutaneous lupus erythematosus. We report on a case of a 56-year-old Caucasian woman who presented with a single, persistent, painful rash on the left hip and lateral aspect of the left upper thigh, which had been present for 2.5 years. The patient had a history of previous injury to this area before the rash started. Clinical findings showed an inflamed, hyperpigmented, and indurated plaque with a linear skin invagination and no associated systemic symptoms. A skin biopsy test result confirmed the diagnosis of LEP and the clinical and laboratory examinations ruled out systemic lupus erythematosus. After 2 months of treatment with methotrexate 20 mg weekly and 1 month of prednisolone 7.5 mg daily, the skin rash improved considerably. We also present a brief review of the epidemiology, etiology, clinical features, histopathology, laboratory findings, differential diagnosis, and treatment of LEP.
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Affiliation(s)
- María Adriana Castrillón
- St. George Hospital, Sydney, Australia.,Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Dédée F Murrell
- St. George Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
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64
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Fabbrocini G, Ruocco E, De Vita V, Monfrecola G. Squamous cell carcinoma arising in long-standing hidradenitis suppurativa: An overlooked facet of the immunocompromised district. Clin Dermatol 2016; 35:225-227. [PMID: 28274364 DOI: 10.1016/j.clindermatol.2016.10.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The list of comorbidities and complications associated with hidradenitis suppurativa is extensive. Among the complications of hidradenitis suppurativa, squamous cell carcinoma is considered the most severe. After a meticulous literature research starting from the 1950s, we were able to identify over 90 cases of patients with hidradenitis suppurativa developing squamous cell carcinoma. Most squamous cell carcinomas appear on the perineal or buttock areas. We believe that the development of squamous cell carcinoma in longstanding hidradenitis suppurativa is a typical condition of an immunocompromised district. The "immunocompromised cutaneous district" is a novel concept that applies to an area of diseased or injured skin where local immune control has been altered, thereby permitting the development of a dysimmune reaction, infection, or tumor confined to the diseased or injured site.
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Affiliation(s)
- Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Valerio De Vita
- Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
| | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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Abstract
Basal cell carcinoma (BCC) typically occurs in sun-exposed sites. Only 16 individuals with umbilical BCC have been described in the literature, and the characteristics of patients with umbilical BCC are summarized. PubMed was used to search the following terms: abdomen, basal cell carcinoma, basal cell nevus syndrome, and umbilicus. Papers with these terms and references cited within these papers were reviewed. BCC of the umbilicus has been reported in five men and 11 women; one man had two tumors. Two patients had basal cell nevus syndrome (BCNS). Other risk factors for BCC were absent. The tumor most commonly demonstrated nodular histology (64%, 9/14); superficial and fibroepithelioma of Pinkus variants were noted in three and two patients, respectively. The tumor was pigmented in eight individuals. Treatment was conventional surgical excision (87%, 13/15) or Mohs micrographic surgery (13%, 2/15); either adjuvant laser ablation or radiotherapy was performed in two patients. The prognosis after treatment was excellent with no recurrence or metastasis (100%, 16/16). In conclusion, BCC of the umbilicus is rare. It usually presents as a tumor with a non-aggressive histologic subtype in an individual with no risk factors for this malignancy. There has been no recurrence or metastasis following excision of the cancer.
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Affiliation(s)
| | - Philip R Cohen
- Department of Dermatology, University of California, San Diego
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66
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Chu CH, Cheng YP, Kao HL, Liang CW, Chan JY, Yu Y. Lymphedema-associated neutrophilic dermatosis: Two cases of localized Sweet syndrome on the lymphedematous lower limbs. J Dermatol 2016; 43:1062-6. [PMID: 27099208 DOI: 10.1111/1346-8138.13379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Abstract
Neutrophilic dermatosis on the site of lymphedema is a rare condition and considered as a localized and less severe variant of Sweet syndrome. Only 13 cases of this variant have been reported after mastectomy for breast cancer in the English-language published work. However, this condition has never been described on the lower limbs or from other causes of lymphedema. Herein, we report two cases of localized Sweet syndrome on the lymphedematous lower limbs: one occurred after radical hysterectomy, bilateral pelvic lymph node dissection and radiotherapy for cervical cancer; the other developed after radiotherapy for malignant melanoma on the right groin. Based on clinical and histological features, we suggest the name "lymphedema-associated neutrophilic dermatosis" for this underrecognized disease entity.
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Affiliation(s)
- Chien-Ho Chu
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Yu-Ping Cheng
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Hua-Lin Kao
- Department of Pathology and Laboratory Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Cher-Wei Liang
- Department and Graduate Institute of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jung-Yi Chan
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Yu Yu
- Department of Dermatology, Sijhih Cathay General Hospital, Taipei, Taiwan
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Hsu CH, Rokni GR, Aghazadeh N, Brinster N, Li Y, Muehlenbachs A, Goldsmith CS, Zhao H, Petersen B, McCollum AM, Reynolds MG. Unique Presentation of Orf Virus Infection in a Thermal-Burn Patient After Receiving an Autologous Skin Graft. J Infect Dis 2016; 214:1171-4. [PMID: 27456708 DOI: 10.1093/infdis/jiw307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/14/2016] [Indexed: 12/23/2022] Open
Abstract
We describe a burn patient who developed skin lesions on her skin-graft harvest and skin-graft recipient (burn) sites. Orf virus infection was confirmed by a combination of diagnostic assays, including molecular tests, immunohistochemical analysis, pathologic analysis, and electron microscopy. DNA sequence analysis grouped this orf virus isolate among isolates from India. Although no definitive source of infection was determined from this case, this is the first reported case of orf virus infection in a skin graft harvest. Skin graft recipients with exposures to animals may be at risk for this viral infection.
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Affiliation(s)
- Christopher H Hsu
- Poxvirus and Rabies Branch Epidemic Intelligence Service, Atlanta, Georgia
| | | | - Nessa Aghazadeh
- Razi Dermatology Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Brinster
- Department of Dermatology, New York University Medical Center, New York
| | - Yu Li
- Poxvirus and Rabies Branch
| | - Atis Muehlenbachs
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention
| | - Cynthia S Goldsmith
- Infectious Diseases Pathology Branch, Centers for Disease Control and Prevention
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Primary and Disseminated Cutaneous Coccidioidomycosis: Clinical Aspects and Diagnosis. CURRENT FUNGAL INFECTION REPORTS 2016. [DOI: 10.1007/s12281-016-0263-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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69
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Radiotherapy for oral cancer decreases the cutaneous expression of host defence peptides. J Craniomaxillofac Surg 2016; 44:882-9. [PMID: 27193476 DOI: 10.1016/j.jcms.2016.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 03/03/2016] [Accepted: 04/12/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Bacterial resistance against antibiotics has become an increasing challenge in the treatment of cutaneous infections. Consequences can be severe, especially in infected wounds following previous local radiotherapy. Certain endogenous peptide antibiotics, the host defence peptides (HDPs), exhibit broad-spectrum antimicrobial activity and promote wound healing. Their use as supplements to conventional antibiotics is a current topic of discussion; however, knowledge of their quantities in healthy and compromised tissue is a prerequisite for such discussion. To date, no data concerning HDP quantities in irradiated skin are available. METHODS Expression profiles of the genes encoding HDPs, namely human beta-defensin-1 (DEFB1, hBD-1), beta-defensin-2 (DEFB4A, hBD-2), beta-defensin-3 (DEFB103, hBD-3) and S100A7, were assessed in samples of non-irradiated and irradiated neck. RESULTS A reduction in the expression of all of the examined genes was observed in irradiated skin when compared with non-irradiated skin (statistically significant in the case of S100A7, P = 0.013). Immunohistochemistry revealed differences in HDP distribution with respect to the epithelial layers. CONCLUSION The study demonstrates a significant reduction in HDP gene expression in neck skin as a result of radiotherapy. These findings might represent a starting point for novel treatments of cutaneous infections in irradiated patients, such as topical supplementation of synthetic HDP.
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Cohen PR. Injection Site Lichenoid Dermatitis Following Pneumococcal Vaccination: Report and Review of Cutaneous Conditions Occurring at Vaccination Sites. Dermatol Ther (Heidelb) 2016; 6:287-98. [PMID: 26988991 PMCID: PMC4906099 DOI: 10.1007/s13555-016-0105-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Cutaneous dermatoses and malignancies have occurred at the sites of vaccines. Purpose To describe a man who developed a lichenoid dermatitis at the pneumococcal vaccine injection site and to review cutaneous dermatoses and malignancies occurring at vaccination sites. Methods PubMed was used to search the following terms, separately and in combination: adverse, condition, cutaneous, dermatosis, dermatitis, injection, PCV13, pneumococcal, pneumonia, prevnar, reaction, skin, site, vaccination, and vaccine. All papers were reviewed, and relevant manuscripts, along with their reference citations, were evaluated. Results Several vaccines—including bacillus Calmette-Guerin, hepatitis B, influenza, leishmaniasis, meningitis, pneumococcal, smallpox, tetanus (alone and in combination with diphtheria, pertussis, polio, Haemophilus influenza type B or plague and yellow fever), and varicella-zoster—have been associated with post-vaccination site reactions. A 70-year-old male developed a lichenoid dermatitis that occurred at the pneumococcal vaccine injection site within 2 weeks after PCV13 vaccination; the erythematous nodule resolved spontaneously within 9 weeks following immunization. Conclusions Dermatoses at the injection sites of vaccines can be granulomatous, immunity-related conditions, infections, lichenoid, neutrophilic, or pseudolymphomatous. Basal cell carcinoma and squamous cell carcinoma are the most common vaccination site-associated malignancies; however, melanoma and sarcomas (dermatofibrosarcoma protuberans, fibrosarcoma, and malignant fibrous histiocytoma) are also smallpox vaccine-related site neoplasms. A cutaneous immunocompromised district that is created by vaccine-induced local immunologic changes is hypothesized to be the pathogenesis of vaccination site reactions.
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Affiliation(s)
- Philip R Cohen
- Department of Dermatology, University of California San Diego, San Diego, CA, USA.
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Schulman JM, Pauli ML, Neuhaus IM, Sanchez Rodriguez R, Taravati K, Shin US, McCalmont TH, Rosenblum MD. The distribution of cutaneous metastases correlates with local immunologic milieu. J Am Acad Dermatol 2016; 74:470-6. [PMID: 26778012 DOI: 10.1016/j.jaad.2015.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/20/2015] [Accepted: 10/21/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metastases to the skin are found with increased frequency at certain sites, such as the scalp, but the biological factors that influence this distribution are not understood. OBJECTIVE We aimed to compare the proportional frequency of metastases at various cutaneous locations with the immunologic microenvironments at those sites. METHODS We retrospectively identified all biopsy specimens of cutaneous metastases diagnosed at our institution from 1991 to 2014 (n = 1984) and mapped their anatomic distribution while controlling for regional surface area. Using a separate, mapped cohort of normal-appearing skin samples (n = 140), we measured the density of regulatory T cells, CD4(+) effector T cells, and CD8(+) T cells by flow cytometry. RESULTS Per unit surface area, cutaneous metastases arise most commonly on the head and neck, followed by the trunk, upper extremities, and lower extremities, respectively. Sites with more frequent metastases tend to contain a greater density of regulatory T cells and a lower proportion of CD8(+) T cells (P < .05). LIMITATIONS Immunologic factors were only assessed in control tissue and were not measured from patients with metastatic disease in this correlative single-center study. CONCLUSION The distribution of cutaneous metastases follows the distribution of regulatory and effector T cells in skin. Further studies are required to prove a mechanistic association between local immunologic factors and the development of cutaneous metastases.
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Affiliation(s)
- Joshua M Schulman
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Mariela L Pauli
- Department of Dermatology, University of California, San Francisco, California
| | - Isaac M Neuhaus
- Department of Dermatology, University of California, San Francisco, California
| | | | - Keyon Taravati
- Department of Dermatology, University of California, San Francisco, California
| | - Uk Sok Shin
- Department of Dermatology, University of California, San Francisco, California
| | - Timothy H McCalmont
- Department of Dermatology, University of California, San Francisco, California; Department of Pathology, University of California, San Francisco, California
| | - Michael D Rosenblum
- Department of Dermatology, University of California, San Francisco, California.
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Piccolo V, Russo T. Facial flat warts at a completely healed site of trauma are not an example of Wolf's isotopic response. Int J Dermatol 2015; 55:e305-6. [DOI: 10.1111/ijd.13076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/06/2011] [Accepted: 07/14/2011] [Indexed: 11/28/2022]
Affiliation(s)
- Vincenzo Piccolo
- Department of Dermatology and Venereology; Second University of Naples; Naples Italy
| | - Teresa Russo
- Department of Dermatology and Venereology; Second University of Naples; Naples Italy
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Lund AW, Medler TR, Leachman SA, Coussens LM. Lymphatic Vessels, Inflammation, and Immunity in Skin Cancer. Cancer Discov 2015; 6:22-35. [PMID: 26552413 DOI: 10.1158/2159-8290.cd-15-0023] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/19/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED Skin is a highly ordered immune organ that coordinates rapid responses to external insult while maintaining self-tolerance. In healthy tissue, lymphatic vessels drain fluid and coordinate local immune responses; however, environmental factors induce lymphatic vessel dysfunction, leading to lymph stasis and perturbed regional immunity. These same environmental factors drive the formation of local malignancies, which are also influenced by local inflammation. Herein, we discuss clinical and experimental evidence supporting the tenet that lymphatic vessels participate in regulation of cutaneous inflammation and immunity, and are important contributors to malignancy and potential biomarkers and targets for immunotherapy. SIGNIFICANCE The tumor microenvironment and tumor-associated inflammation are now appreciated not only for their role in cancer progression but also for their response to therapy. The lymphatic vasculature is a less-appreciated component of this microenvironment that coordinates local inflammation and immunity and thereby critically shapes local responses. A mechanistic understanding of the complexities of lymphatic vessel function in the unique context of skin provides a model to understand how regional immune dysfunction drives cutaneous malignancies, and as such lymphatic vessels represent a biomarker of cutaneous immunity that may provide insight into cancer prognosis and effective therapy.
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Affiliation(s)
- Amanda W Lund
- Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon. Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, Oregon. Department of Dermatology, Oregon Health and Science University, Portland, Oregon. Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon.
| | - Terry R Medler
- Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon
| | - Sancy A Leachman
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon. Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
| | - Lisa M Coussens
- Department of Cell, Developmental and Cancer Biology, Oregon Health and Science University, Portland, Oregon. Knight Cancer Institute, Oregon Health and Science University, Portland, Oregon
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Piccolo V, Russo T. Varicella Within a Prior Immunization Reaction Site is Not a Wolf's Isotopic Response. Pediatr Dermatol 2015; 32:878. [PMID: 26584700 DOI: 10.1111/pde.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Caccavale S, Kannangara AP, Ruocco E. Categorization of and comments on isomorphic and isotopic skin reactions. Clin Dermatol 2015; 35:105-110. [PMID: 27938807 DOI: 10.1016/j.clindermatol.2015.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Locus minoris resistentiae (lmr) can be defined as a site of the body that offers lesser resistance than the rest of the body to the onset of disease. The well-known Köbner phenomenon is itself a clear example of lmr in dermatology. The new term locus maioris resistentiae (LMR), a site of the body that offers greater resistance than the rest of the body to the onset of disease, defines the opposite condition. Renbök phenomenon (reverse Köbner's isomorphic response) typically represents an example of LMR.
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Affiliation(s)
- Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy.
| | | | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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Cohen PR. Zosteriform impetigo: Wolf's isotopic response in a cutaneous immunocompromised district. Dermatol Pract Concept 2015; 5:35-9. [PMID: 26336623 PMCID: PMC4536881 DOI: 10.5826/dpc.0503a09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/05/2015] [Indexed: 11/15/2022] Open
Abstract
Background: Impetigo can result from Staphylococcus aureus (S. aureus). Wolf’s isotopic response is the occurrence of a new cutaneous disorder at the site of a previously healed disease. A cutaneous immunocompromised district is an area of skin that is more vulnerable than the rest of the individual’s body. Purpose: To describe a man with impetigo localized to a unilateral dermatome and review the clinical features of other patients with zosteriform Staphylococcus aureus cutaneous infection. Methods: PubMed was used to search the following terms, separately and in combination: cutaneous, dermatome, dermatomal, district, herpes, immunocompromised, impetigo, infection, isotopic, response, skin, staphylococcal, Staphylococcus aureus, Wolf, zoster, zosteriform. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated. Results: Crusted, eroded and intact, erythematous papules and nodules acutely presented localized to the mandibular branch of the left trigeminal nerve on the face of a 66-year-old man; he did not recall a prior episode of varicella-zoster virus infection in that area. A bacterial culture isolated methicillin-susceptible S. aureus. Viral cultures and direct fluorescent absorption studies were negative for herpes simplex and herpes zoster virus. All of the lesions resolved after oral treatment with cefdinir. Impetigo and/or furunculosis in a zosteriform distribution have also been described in 3 additional patients. The bacterial culture showed either methicillin-susceptible or methicillin-resistant S. aureus; the skin infection resolved after treatment with oral antibiotics; however one man experienced 2 recurrences in the same area. Conclusions: Zosteriform cutaneous staphylococcal impetigo may be an example of Wolf’s isotopic response in a cutaneous immunocompromised district
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Affiliation(s)
- Philip R Cohen
- Department of Dermatology, University of California San Diego, CA, USA
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Yazdani Abyaneh MA, Raghu P, Kircher K, Kutzner H, Alison K, Carlson JA. Circumscribed cicatricial alopecia due to localized sarcoidal granulomas and single-organ granulomatous arteritis: a case report and systematic review of sarcoidal vasculitis. J Cutan Pathol 2015; 42:746-56. [DOI: 10.1111/cup.12530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/21/2014] [Accepted: 01/09/2015] [Indexed: 01/14/2023]
Affiliation(s)
| | - Preethi Raghu
- Divisions of Dermatology and Dermatopathology; Albany Medical College; Albany NY USA
| | | | - Heinz Kutzner
- Dermatopathologie; Dermatopathologie Friedrichshafen; Friedrichshafen Germany
| | | | - John Andrew Carlson
- Divisions of Dermatology and Dermatopathology; Albany Medical College; Albany NY USA
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Piccolo V, Russo T, Ruocco E, Baroni A. Selective localization or sparing of skin disorders in neurologically injured areas: an underestimated connubium. Indian J Dermatol 2014; 59:612-3. [PMID: 25484398 PMCID: PMC4248505 DOI: 10.4103/0019-5154.143540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Vincenzo Piccolo
- Department of Dermatology, Second University of Naples, Naples, Italy. E-mail:
| | - Teresa Russo
- Department of Dermatology, Second University of Naples, Naples, Italy. E-mail:
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy. E-mail:
| | - Adone Baroni
- Department of Dermatology, Second University of Naples, Naples, Italy. E-mail:
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Ruocco V. The immunocompromised district: How the pieces of the puzzle gradually fell into place. Clin Dermatol 2014; 32:549-52. [PMID: 25160094 DOI: 10.1016/j.clindermatol.2014.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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