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Dhekariyapak A, Wattanakrai P. Granulomatous Pigmented Purpuric Dermatosis in a Patient with (Inactive) Myasthenia Gravis: A Case Report and Review of the Literature. Case Rep Dermatol 2023; 15:71-84. [PMID: 37383325 PMCID: PMC10293941 DOI: 10.1159/000530034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/20/2023] [Indexed: 06/30/2023] Open
Abstract
Granulomatous pigmented purpuric dermatosis (GPPD) is a rare histologic variant of pigmented purpuric dermatosis (PPD) characterized by dermal histiocyte-rich interstitial infiltration with or without granuloma formation in addition to the other typical features of PPD. GPPD was previously observed more frequently to affect Asians and was reported to be associated with dyslipidemia. However, our literature search of 45 documented GPPD cases revealed an increasing prevalence in Caucasians in addition to dyslipidemia and associated autoimmune diseases. To date, etiopathogenesis of GPPD is unknown but may involve dyslipidemia, genetic and immunological factors such as autoimmune dysregulation or a sarcoidal reaction associated with C. acnes. GPPD is usually persistent and recalcitrant to treatments. We report a case of GPPD in a 57-year-old Thai woman with underlying myasthenia gravis who presented with a pruritic eruption on both lower legs. After treatment with 0.05% clobetasol propionate cream and oral colchicine, the lesion improved with marked flattening and disappeared with residual postinflammatory hyperpigmentation. We provide a literature review of the epidemiology, etiopathogenesis, concomitant comorbidities, clinical symptoms, dermatoscopic features, and treatments of GPPD.
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Affiliation(s)
- Apirada Dhekariyapak
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Penpun Wattanakrai
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Matter AV, Kolm I, Kempf W. Granulomatous pigmented purpuric dermatosis: clinical and histopathologic findings in a series of nine cases. J Cutan Pathol 2022; 49:597-603. [PMID: 35288961 DOI: 10.1111/cup.14224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/18/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
We report the largest series so far of granulomatous pigmented purpuric dermatosis (GPPD), a rare variant of pigmented purpuric dermatoses (PPD). GPPD can cause diagnostic difficulties as it can be mistaken clinically and histopathologically with numerous inflammatory and infectious dermatoses or even cutaneous T-cell lymphoma. We compared the histopathological findings of nine cases of GPPD with a control group consisting of ten randomly selected PPD of other subtypes. GPPD seems to predominantly affect the lower extremities of adult male patients; a clear association with hyperlipidemia or other systemic conditions could not be confirmed. Histopathologically, GPPD is characterized by a dermal histiocyte-rich interstitial infiltrate with or without granuloma formation, thickened capillaries, extravasated erythrocytes and/or hemosiderin deposits. In contrast to other forms of PPD, the inflammatory infiltrate of GPPD can extend to the mid or deep dermis and the admixed lymphocytic infiltrate is mainly composed of CD8+ T-cells. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexandra Valeska Matter
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Isabel Kolm
- Department of Dermatology, University Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, University Zurich, Zurich, Switzerland
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Spigariolo CB, Giacalone S, Nazzaro G. Pigmented Purpuric Dermatoses: A Complete Narrative Review. J Clin Med 2021; 10:jcm10112283. [PMID: 34070260 PMCID: PMC8197337 DOI: 10.3390/jcm10112283] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/10/2023] Open
Abstract
Pigmented purpuric dermatoses (PPD) include several skin diseases characterized by multiple petechial hemorrhage as consequence of capillaritis. PPD generally present with red to purple macules that progressively evolve to golden-brown color as the hemosiderin is reabsorbed. These lesions, often asymptomatic or associated with mild pruritus, usually occur on the lower extremities and may be a diagnostic and therapeutic challenge both for general practitioners and specialists in internal medicine or flebology. Clinical presentations include many subtypes that have been described over the years, although histology is usually superimposable. Prompt recognition and patient reassurance on the benign nature of these diseases is crucial. In this comprehensive review, we focused on pathogenesis and clinical pictures.
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Affiliation(s)
- Cristina B. Spigariolo
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.B.S.); (S.G.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Serena Giacalone
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.B.S.); (S.G.)
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.B.S.); (S.G.)
- Correspondence: ; Tel.: +39-0255035127
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Ollech A, Paller A, Kruse L, Kenner‐Bell B, Chamlin S, Wagner A, Shen L, Yousif R, Balmert L, Mancini A. Pigmented purpuric dermatosis in children: a retrospective cohort with emphasis on treatment and outcomes. J Eur Acad Dermatol Venereol 2020; 34:2402-2408. [DOI: 10.1111/jdv.16397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 02/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- A. Ollech
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
| | - A.S. Paller
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - L. Kruse
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - B. Kenner‐Bell
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - S. Chamlin
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - A. Wagner
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - L. Shen
- Department of Dermatology School of Medicine Boston University Boston MA USA
| | - R. Yousif
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
| | - L.C. Balmert
- Department of Preventive Medicine Division of Biostatistics Northwestern University Feinberg School of Medicine Chicago IL USA
| | - A.J. Mancini
- Division of Dermatology Ann & Robert H. Lurie Children’s Hospital of Chicago Northwestern University Chicago IL USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
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Plachouri KM, Florou V, Georgiou S. Therapeutic strategies for pigmented purpuric dermatoses: a systematic literature review. J DERMATOL TREAT 2018; 30:105-109. [DOI: 10.1080/09546634.2018.1473553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Kerasia-Maria Plachouri
- Department of Dermatology, University of Patras, University General Hospital of Patras, Rio, Greece
| | - Vaia Florou
- Department of Hematology/Oncology, University of Miami Miller School of Medicine/Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Sophia Georgiou
- Department of Dermatology, University of Patras, University General Hospital of Patras, Rio, Greece
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Granulomatous Variant of Pigmented Purpura. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2015.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Hakenoshita H, Yamamoto T. Granulomatous Variant of Pigmented Purpura. ACTAS DERMO-SIFILIOGRAFICAS 2015; 107:91-2. [PMID: 26358500 DOI: 10.1016/j.ad.2015.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/08/2015] [Accepted: 04/11/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- H Hakenoshita
- Department of Dermatology, Shirakawa Kosei General Hospital, and Fukushima Medical University, Fukushima, Japan
| | - T Yamamoto
- Department of Dermatology, Shirakawa Kosei General Hospital, and Fukushima Medical University, Fukushima, Japan.
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Battle LR, Shalin SC, Gao L. Granulomatous pigmented purpuric dermatosis. Clin Exp Dermatol 2014; 40:387-90. [DOI: 10.1111/ced.12549] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 11/30/2022]
Affiliation(s)
- L. R. Battle
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - S. C. Shalin
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - L. Gao
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
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Progressive Petechial and Pigmented Macules and Papules on the Lower Extremities. Am J Dermatopathol 2013. [DOI: 10.1097/dad.0b013e31826e036b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Granulomatous pigmented purpuric dermatosis is a rare entity. Historically, it has been seen in Asians. In this article, we report the case of a white man with this unusual variant. A 65-year-old, white man presented with a 1-year history of asymptomatic purpuric to brown papules on both lower legs and more confluent on dorsum of feet. He had an underlying history of hypertension and hyperlipidemia. Skin biopsy revealed a granulomatous lympho-histocytary inflammatory infiltrate in papillary dermis and superficial reticular dermis with extravasation of red blood cells and siderophages. Periodic acid schiff (PAS), Giemsa and Ziehl-Neelsen stains were negative. A diagnosis of granulomatous pigmented purpuric dermatosis was made. From the 10 cases reported of this granulomatous variant, 6 were associated with hyperlipidemia. We report an additional case with this association.
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MacQuarrie EK, Pasternak S, Torok M, Veerassamy S, Walsh NMG. Persistent pigmented purpuric dermatitis: granulomatous variant. J Cutan Pathol 2011; 38:979-83. [DOI: 10.1111/j.1600-0560.2011.01793.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kaplan J, Burgin S, Sepehr A. Granulomatous pigmented purpura: report of a case and review of the literature. J Cutan Pathol 2011; 38:984-9. [DOI: 10.1111/j.1600-0560.2011.01744.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rosenberg LN, Peppercorn MA. Efficacy and safety of drugs for ulcerative colitis. Expert Opin Drug Saf 2010; 9:573-92. [DOI: 10.1517/14740331003639412] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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