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Salah EM, Bedair NI, El-Rahim SKA, El-Khalawany MA. Efficacy and safety of excimer light (308 nm) in the treatment of pityriasis lichenoides chronica. PHOTODERMATOLOGY, PHOTOIMMUNOLOGY & PHOTOMEDICINE 2024; 40:e12964. [PMID: 38616405 DOI: 10.1111/phpp.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/14/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Pityriasis lichenoides chronica is the chronic end of the spectrum of pityriasis lichenoides which have several forms of papulosuamous conditions. Several treatments obtained complete clearance of the condition including phototherapy and specifically narrow band ultraviolet B. The Excimer light 308 is a monochromatic light that acts within the ultraviolet B wavelength and used as a targeted phototherapy in several skin conditions. METHODS Thirty-four patients with histopathologically diagnosed pityriasis lichenoides chronica underwent treatment with biweekly sessions of excimer light 308 nm. Treatment continued until complete clearance was obtained or to a maximum of 48 sessions (24 weeks). RESULTS Thirty-one patients obtained complete clearance with no recurrence till the end of the study period, two patients had partial response and only one patient showed poor response to treatment. CONCLUSION Excimer light can be a safe and effective treatment of pityriasis lichinoides chronica in different ages and genders.
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Affiliation(s)
- Eman Mohamed Salah
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Nermeen Ibrahim Bedair
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
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Chen C, Fahmy LM, Schreidah CM, Magro CM, Geskin LJ. Febrile Ulceronecrotic Mucha-Habermann Disease Associated With Hemophagocytic Lymphohistiocytosis: A Case Report and Review of the Literature. Am J Dermatopathol 2024; 46:238-242. [PMID: 38457671 DOI: 10.1097/dad.0000000000002619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
ABSTRACT Mucha-Habermann disease (MHD) is an inflammatory skin disease characterized by polymorphous eruptions of erythematous, necrotic macules that have been reported for similarities to cutaneous T-cell lymphoma. Febrile ulceronecrotic MHD (FUMHD) represents a severe variant of MHD, marked by ulcers, hemorrhagic bullae, and systemic symptoms. Herein, we report a case of a severely atypical lymphomatoid expression of FUMHD associated with hemophagocytic lymphohistiocytosis (HLH). A previously healthy 21-year-old woman was admitted to the hospital with a rapidly progressive necrotic papular rash. Physical examination revealed right orbital swelling, bilateral hemorrhagic auricular bullae, and multiple ulcerative purpuric papulonodules on the trunk, face, and extremities. Biopsy indicated a dermal and subcutaneous infiltrate of atypical CD8 + lymphocytes with loss of CD5 and reduction in CD7 expression, along with features of lymphomatoid vasculitis. A diagnosis of a severely atypical lymphomatoid expression of FUMHD was made. The patient also met 7 of 9 HLH-2004 criteria, leading to a diagnosis of HLH. Positron emission tomography/computed tomography, flow cytometry, and rheumatologic workup were unremarkable. Treatment with an eight-week course of etoposide and dexamethasone for HLH led to rapid clinical improvement. Over time, her skin lesions regressed and eventually scabbed over to leave hyperpigmented scars, confirming the diagnosis of MHD. She has remained stable, off therapy for 4 years. Although potentially fatal, FUMHD often exhibits favorable outcomes and may resolve without recurrence, as in our patient. FUMHD should be considered in the differential diagnosis for patients presenting with cutaneous CD8 + necrotizing angiocentric lymphoproliferative disease complicated by HLH.
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Affiliation(s)
- Caroline Chen
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lauren M Fahmy
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Celine M Schreidah
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Cynthia M Magro
- Department of Pathology, Weill Cornell Medical Center, New York, NY; and
| | - Larisa J Geskin
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY
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Singh G, Arora S, Das P, Gupta A. A fatal case of febrile ulceronecrotic mucha–Habermann disease in a 10-year-old boy. Indian Dermatol Online J 2022; 13:535-538. [PMID: 36262572 PMCID: PMC9574138 DOI: 10.4103/idoj.idoj_472_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/25/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
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Raghavan SS, Wang JY, Gru AA, Marqueling AL, Teng JMC, Brown RA, Novoa RA, Kim Y, Zehnder J, Zhang BM, Rieger KE. Next-generation sequencing confirms T-cell clonality in a subset of pediatric pityriasis lichenoides. J Cutan Pathol 2021; 49:252-260. [PMID: 34614220 DOI: 10.1111/cup.14143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/10/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pityriasis lichenoides (PL) is a papulosquamous disease that affects both adults and children. Previous studies have shown a subset of this entity to have clonal T-cell populations via PCR-based assays. In this study, we sought to implement next-generation sequencing (NGS) as a more sensitive and specific test to examine for T-cell clonality within the pediatric population. METHODS We identified 18 biopsy specimens from 12 pediatric patients with clinical and histopathologic findings compatible with PL. Patient demographics, clinical features, management, and histopathologic findings were reviewed. All specimens were analyzed for clonality with NGS of T-cell receptor beta (TRB) and gamma (TRG) genes. RESULTS Of the 12 patients, 9 (75%) had complete resolution of lesions at the time of data collection (mean follow-up 31 months). The remaining three patients significantly improved with methotrexate (with or without acitretin). Interestingly, 7 of 12 patients (58%) and 9 of 17 biopsy specimens (53%) showed evidence of T-cell clonality. Two patients showed matching TRB clones from different anatomic sites. CONCLUSIONS T-cell clonality is a common finding in PL, probably representing a "reactive clonality" rather than a true lymphoproliferative disorder. Clonality alone cannot be used as a means to distinguish PL from lymphomatoid papulosis or cutaneous lymphoma.
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Affiliation(s)
- Shyam S Raghavan
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Jennifer Y Wang
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Alejandro A Gru
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Ann L Marqueling
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Joyce M C Teng
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - Ryanne A Brown
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Roberto A Novoa
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Youn Kim
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA
| | - James Zehnder
- Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Bing Melody Zhang
- Department of Pathology, Stanford University Medical Center, Stanford, California, USA
| | - Kerri E Rieger
- Department of Dermatology, Stanford University Medical Center, Stanford, California, USA.,Department of Pathology, Stanford University Medical Center, Stanford, California, USA
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Rossetti E, Guitter M, Peruzzo L, Cervini A, Centeno M, Sánchez la Rosa C, Galluzo L, Pennella C, Felice M. Primary cutaneous T-cell lymphoma not otherwise specified (NOS) with expression of cytotoxic molecules: Case report in a pediatric patient. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2021. [DOI: 10.1016/j.phoj.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Wang B, Li J, Xie H, Chen M, Li B, Shi W. Striking case of Febrile ulceronecrotic Mucha‐Habermann disease responding to lymphoplasmapheresis and methotrexate. J Dermatol 2020; 47:e430-e431. [DOI: 10.1111/1346-8138.15598] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ben Wang
- Department of Dermatology Xiangya Hospital Central South University ChangshaChina
- National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University ChangshaChina
| | - Jia Li
- Department of Dermatology Xiangya Hospital Central South University ChangshaChina
| | - Hong‐fu Xie
- Department of Dermatology Xiangya Hospital Central South University ChangshaChina
- National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University ChangshaChina
| | - Mingliang Chen
- Department of Dermatology Xiangya Hospital Central South University ChangshaChina
- National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University ChangshaChina
| | - Bijuan Li
- Department of Transfusion Xiangya Hospital Central South University Changsha China
| | - Wei Shi
- Department of Dermatology Xiangya Hospital Central South University ChangshaChina
- National Clinical Research Center for Geriatric Disorders Xiangya Hospital Central South University ChangshaChina
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Kilgallon K, Urs J, Fernandez Faith E. Visual Diagnosis: Severe Ulceronecrotic Eruption with Systemic Symptoms. Pediatr Rev 2018; 39:e54-e56. [PMID: 30385591 DOI: 10.1542/pir.2017-0039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Kevin Kilgallon
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Jagadisharaje Urs
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Esteban Fernandez Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
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Rojanapanthu P, Srisuttiyakorn C. A young man with necrotic skin lesions. Clin Exp Dermatol 2018; 44:102-105. [PMID: 29947104 DOI: 10.1111/ced.13658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- P Rojanapanthu
- Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - C Srisuttiyakorn
- Division of Dermatology, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
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Xing C, Shen H, Xu J, Liu Z, Zhu J, Xu A. A Fatal Case of Febrile Ulceronecrotic Mucha-Habermann Disease which Presenting as Toxic Epidermal Necrolysis. Indian J Dermatol 2017; 62:675. [PMID: 29263553 PMCID: PMC5724328 DOI: 10.4103/ijd.ijd_631_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a severe form of pityriasis lichenoides et varioliformis acuta, is an inflammatory dermatosis of unknown etiology manifested by ulcerative and necrotic lesions accompanied by systemic manifestations. The mortality rate of FUMHD is about 15%. It is reported here a case of FUMHD presenting as toxic epidermal necrolysis that resulted in multiple organ failure and death.
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Affiliation(s)
- Chenjing Xing
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Hong Shen
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Junzhu Xu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Zehu Liu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Jun Zhu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
| | - Aie Xu
- Department of Dermatology, Hangzhou Institute of Dermatology and Venereology, The Third People's Hospital of Hangzhou, Hangzhou, China
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Orenstein LAV, Coughlin CC, Flynn AT, Pillai V, Boos MD, Wertheim GB, Treat JR, Teachey DT. Severe Mucha-Habermann-Like Ulceronecrotic Skin Disease in T-Cell Acute Lymphoblastic Leukemia Responsive to Basiliximab and Stem Cell Transplant. Pediatr Dermatol 2017; 34:e265-e270. [PMID: 28884915 DOI: 10.1111/pde.13235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A 5-year-old girl with T-cell acute lymphoblastic leukemia (T-ALL) developed a progressive eruption of crusted papules and ulcerative plaques involving 80% of her body surface area with histopathology consistent with febrile ulceronecrotic Mucha-Habermann disease (FUMHD), although multiple specimens also contained clonal leukemic cells. Her skin disease was refractory to many classic treatments for FUMHD, including methotrexate, and became so severe that concern about superinfection prevented intensification of chemotherapy for her malignancy. The addition of basiliximab promoted gradual improvement of the skin, allowing for chemotherapy intensification and subsequent bone marrow transplantation, after which the eruption resolved completely. This report describes a severe case of FUMHD-like eruption associated with clonal leukemic cells that improved with basiliximab, suggesting anti-CD25 therapy as a novel treatment for ulceronecrotic skin disease in the setting of high interleukin-2 levels.
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Affiliation(s)
- Lauren A V Orenstein
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carrie C Coughlin
- Division of Dermatology, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Andrea T Flynn
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vinodh Pillai
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Gerald B Wertheim
- Department of Pathology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - James R Treat
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David T Teachey
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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12
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13
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Muñoz Gómez MDM, Novella Navarro M, Salvatierra Ossorio J. Seronegative arthritis secondary to Mucha-Habermann disease. Med Clin (Barc) 2016; 147:564. [PMID: 27345853 DOI: 10.1016/j.medcli.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/19/2016] [Accepted: 05/05/2016] [Indexed: 11/18/2022]
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Alratrout J, Alshammasi F, Ansari N. Febrile ulceronecrotic Mucha-Habermann disease in an 8-year-old boy responding to methotrexate. Int J Dermatol 2016; 55:1205-1209. [DOI: 10.1111/ijd.13323] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 01/16/2016] [Accepted: 02/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Jehad Alratrout
- Department of Dermatology; Qatif Central Hospital; Kingdom of Saudi Arabia
| | - Fatima Alshammasi
- Department of Dermatology; Qatif Central Hospital; Kingdom of Saudi Arabia
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15
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Nofal A, Alakad R, Assaf M, Nofal E. A fatal case of febrile ulceronecrotic Mucha-Habermann disease in a child. JAAD Case Rep 2016; 2:181-5. [PMID: 27222883 PMCID: PMC4864117 DOI: 10.1016/j.jdcr.2016.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rania Alakad
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Magda Assaf
- Department of Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Eman Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Dupin A, Bosset D, Atger L, Chevallier B, Saiag P, Benoist G. Maladie de Mucha-Habermann fébrile et ulcéronécrotique. Arch Pediatr 2016; 23:82-5. [DOI: 10.1016/j.arcped.2015.09.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/23/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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17
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Nofal A, Assaf M, Alakad R, Amer H, Nofal E, Yosef A. Febrile ulceronecrotic Mucha-Habermann disease: proposed diagnostic criteria and therapeutic evaluation. Int J Dermatol 2015; 55:729-38. [DOI: 10.1111/ijd.13195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/13/2015] [Accepted: 08/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmad Nofal
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Magda Assaf
- Department of Pathology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Rania Alakad
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Hala Amer
- Al-Haud Al-Marsoud Dermatology Hospital; Cairo Egypt
| | - Eman Nofal
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Ayman Yosef
- Department of Dermatology; Faculty of Medicine; Zagazig University; Zagazig Egypt
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Lejuste FX, Michaux C, Lehners C, Calteux N. Febrile ulceronecrotic Mucha-Habermann disease. BMJ Case Rep 2013; 2013:bcr2013009739. [PMID: 24127370 PMCID: PMC3822268 DOI: 10.1136/bcr-2013-009739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The Mucha-Habermann disease is an inflammatory disease of the skin and is a variant of pityriasis lichenoides et varioliformis acuta. We describe the case of a 64-years-old woman who was admitted for erysipelas of the face. Despite treatment, evolution was marked by the appearance of a necrotising ulcerative area in the centre of the erysipelas associated with local oedema and headache. A skin biopsy revealed a pityriasis lichenoides et varioliformis acuta. Corticosteroids led to a rapid stabilisation of lesions, and after 6 months the patient shows only a small area of frontal hypopigmentation. The aetiology remains uncertain. There is no established standard treatment. We would like to draw attention of the medical and surgical specialists to this rare disease. The diagnosis should be considered in a necrotic lesion associated with rapid expansion of systemic and peripheral cutaneous signs. Diagnosis must be considered to avoid unnecessary debridement and extensive scars.
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Affiliation(s)
- F-X Lejuste
- Service de Chirurgie Plastique Reconstructrice et Esthétique, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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Parfenova MA, Belousova IE, Samtsov AV. Ulceronecrotic Mucha Habermann’s disease: case study. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The rare dermatosis febrile ulceronecrotic Mucha Gabermann’s disease is described. Etiology, pathogenesis, clinical and pathomorphological criteria of diagnosis, treatment of the disease are discussed. Based on the literature review describes the historical and current data classification of the disease and patient management tactics.
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Gomes Bica BER, Reis Monteiro de Barros MDGC, Junior CS. Doença de Mucha-Habermann. REVISTA BRASILEIRA DE REUMATOLOGIA 2013; 53:314-7. [DOI: 10.1590/s0482-50042013000300011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/18/2013] [Indexed: 11/22/2022] Open
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Kaufman WS, McNamara EK, Curtis AR, Kosari P, Jorizzo JL, Krowchuk DP. Febrile ulceronecrotic Mucha-Habermann disease (pityriasis lichenoides et varioliformis acuta fulminans) presenting as Stevens-Johnson syndrome. Pediatr Dermatol 2012; 29:135-40. [PMID: 22084981 DOI: 10.1111/j.1525-1470.2011.01608.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present two pediatric patients with pityriasis lichenoides et varioliformis acuta fulminans whose admitting diagnosis was Stevens Johnson Syndrome. The patients were successfully treated with methotrexate and prednisone. These cases highlight the importance of early recognition and treatment of this disease to prevent further morbidity and a potentially fatal prognosis.
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Affiliation(s)
- William S Kaufman
- Department of Dermatology, Wake Forest Baptist Health, Winston-Salem, NC 27104, USA
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Meziane L, Caudron A, Dhaille F, Jourdan M, Dadban A, Lok C, Chaby G. Febrile Ulceronecrotic Mucha-Habermann Disease: Treatment with Infliximab and Intravenous Immunoglobulins and Review of the Literature. Dermatology 2012; 225:344-8. [PMID: 23391565 DOI: 10.1159/000346245] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Affiliation(s)
- L Meziane
- Department of Dermatology, Amiens University Medical Centre, South Hospital, and University Picardie Jules Verne, Amiens, France.
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Perrin BS, Yan AC, Treat JR. Febrile ulceronecrotic Mucha-Habermann disease in a 34-month-old boy: a case report and review of the literature. Pediatr Dermatol 2012; 29:53-8. [PMID: 21906156 DOI: 10.1111/j.1525-1470.2011.01531.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) in a 34-month-old boy. Our patient had a history of biopsy-proven pityriasis lichenoides et varioliformis acuta (PLEVA) since age 2. At 34 months, his skin lesions rapidly progressed to ulceration and necrosis in the setting of high fever. Skin biopsy revealed an intense lichenoid infiltrate with parakeratosis at the edges of areas of epidermal necrosis consistent with FUMHD, which is the severe variant of PLEVA. Despite initial treatment with prednisolone, his disease progressed to involve more than 50% of his body surface area. In addition to corticosteroids, he was treated with intravenous immunoglobulin, dapsone, and acyclovir, without complete resolution of disease. Methotrexate successfully cleared his skin disease and systemic symptoms. This patient highlights the exceptional response of FUMHD to methotrexate. Based on our review of the literature, this also represents the youngest reported case of FUMHD.
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Affiliation(s)
- Bridget S Perrin
- School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Lymphomatoid Papulosis Followed by Pityriasis Lichenoides: A Common Pathogenesis? Am J Dermatopathol 2011; 33:835-40. [DOI: 10.1097/dad.0b013e3181f4d8c3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Fernandes NF, Rozdeba PJ, Schwartz RA, Kihiczak G, Lambert WC. Pityriasis lichenoides et varioliformis acuta: a disease spectrum. Int J Dermatol 2010; 49:257-61. [DOI: 10.1111/j.1365-4632.2008.03915.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Febrile ulceronecrotic Mucha–Habermann disease associated with herpes simplex virus type 2. J Am Acad Dermatol 2009; 60:149-52. [PMID: 19103367 DOI: 10.1016/j.jaad.2008.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 07/13/2008] [Accepted: 07/21/2008] [Indexed: 11/22/2022]
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Abstract
Parapsoriasis is a peculiar reaction pattern of the skin that appears to have a spectrum with small plaque parapsoriasis at one end and large plaque at the other. The spectrum between is bridged by pityriasis lichenoides, pityriasis lichenoides chronica, pityriasis lichenoides et varioliformis acuta, and lymphomatoid papulosis. The highlights of the clinical pattern of these diseases has been succinctly elucidated here to facilitate their recognition in day-to-day dermatologic practice. Their possible etiopathogenesis has been brought to focus in the light of changing concepts reported in the literature. Further, possible future implications demand a meticulous follow-up because, in a few cases, true neoplasms may ultimately develop. Treatment modalities are briefly discussed.
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Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, New Delhi, India.
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Kukova G, Gerber PA, Neumann NJ, Bruch-Gerharz D, Homey B. [Febrile ulceronecrotic Mucha-Habermann syndrome]. Hautarzt 2007; 58:835-6. [PMID: 17846729 DOI: 10.1007/s00105-007-1399-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- G Kukova
- Hautklinik der Heinrich-Heine-Universität, Moorenstrasse 5, 40225, Düsseldorf, Germany
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29
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Abstract
Pityriasis lichenoides (PL) is an uncommon, acquired spectrum of skin conditions that poses various challenges to patients as well as clinicians. It is a difficult and debatable disorder to diagnose, categorize, and treat. Besides these inherent obstacles, PL merits awareness because of its potential to progress to cutaneous lymphoma or an ulceronecrotic presentation, both of which carry a significant risk of mortality. The scope of PL presentations is delineated along a continuum of multiple variants including pityriasis lichenoides et varioliformis acuta (PLEVA), pityriasis lichenoides chronica (PLC), and febrile ulceronecrotic Mucha-Habermann disease (FUMHD). Classification of these presentations as separate subsets is debatable in view of their overlapping clinical, histopathologic, and etiologic features. PLEVA generally presents as an acute-to-subacute skin eruption of multiple, small, red papules that develops into polymorphic lesions and vacillates with periods of varying remissions as well as possible sequelae of hyper/hypopigmentation and varicella-like scars. PLC has a more gradual manifestation of very small red-to-brown flat maculopapules with mica-like scale; it also follows a relapsing course but with long periods of remission. FUMHD is an acute and severe generalized eruption of purpuric and ulceronecrotic plaques with associated systemic involvement and a mortality rate of up to 25%; hence, it should be approached as a dermatologic emergency.Histopathological evaluation of PL usually reveals dermal, wedge-shaped, lymphocytic infiltrate, epidermal spongiosis, parakeratosis, and variable necrosis of keratinocytes. PLC demonstrates more subtle histology whereas, at the other end of the spectrum, febrile ulceronecrotic FUMHD exhibits the most exaggerated histological features. The pathogenic mechanism behind PL is unclear although infectious or drug-related hypersensitivity reactions versus premycotic lymphoproliferative disorder are the mainstay theories. The foremost therapies for PLEVA and PLC are phototherapy, systemic antibacterials, and topical corticosteroids. Aggressive treatment with immunosuppressant and/or immunomodulating agents as well as intensive supportive care are recommended for FUMHD. We first describe a representative case of a 14-year-old boy with PLC who was successfully treated with narrow-band UVB. We then review the pathophysiology, classification, and treatment of PL.
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Affiliation(s)
- Amor Khachemoune
- Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
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30
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Bowers S, Warshaw EM. Pityriasis lichenoides and its subtypes. J Am Acad Dermatol 2006; 55:557-72; quiz 573-6. [PMID: 17010734 DOI: 10.1016/j.jaad.2005.07.058] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 07/05/2005] [Accepted: 07/23/2005] [Indexed: 11/18/2022]
Abstract
Pityriasis lichenoides represents a unique group of inflammatory skin disorders that include pityriasis lichenoides et varioliformis acuta (PLEVA), febrile ulceronecrotic Mucha-Habermann disease (a subtype of PLEVA), and pityriasis lichenoides chronica. The history, epidemiology, clinical features, pathophysiology, and treatment of this group of conditions are reviewed in this manuscript.
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31
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Helmbold P, Gaisbauer G, Fiedler E, Stücker M, Wolter M, Marsch WC. Self-limited variant of febrile ulceronecrotic Mucha-Habermann disease with polyclonal T-cell receptor rearrangement. J Am Acad Dermatol 2006; 54:1113-5. [PMID: 16713489 DOI: 10.1016/j.jaad.2006.02.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 02/08/2006] [Accepted: 02/19/2006] [Indexed: 10/24/2022]
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