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Michelerio A, Greco A, Tomasini D, Tomasini C. Galli-Galli Disease: A Comprehensive Literature Review. Dermatopathology (Basel) 2024; 11:79-100. [PMID: 38390850 PMCID: PMC10885078 DOI: 10.3390/dermatopathology11010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
Galli-Galli disease (GGD) is a rare genodermatosis that exhibits autosomal dominant inheritance with variable penetrance. GGD typically manifests with erythematous macules, papules, and reticulate hyperpigmentation in flexural areas. A distinct atypical variant exists, which features brown macules predominantly on the trunk, lower limbs, and extremities, with a notable absence of the hallmark reticulated hyperpigmentation in flexural areas. This review includes a detailed literature search and examines cases since GGD's first description in 1982. It aims to synthesize the current knowledge on GGD, covering its etiology, clinical presentation, histopathology, diagnosis, and treatment. A significant aspect of this review is the exploration of the genetic, histopathological, and clinical parallels between GGD and Dowling-Degos disease (DDD), which is another rare autosomal dominant genodermatosis, particularly focusing on their shared mutations in the KRT5 and POGLUT1 genes. This supports the hypothesis that GGD and DDD may be different phenotypic expressions of the same pathological condition, although they have traditionally been recognized as separate entities, with suprabasal acantholysis being a distinctive feature of GGD. Lastly, this review discusses the existing treatment approaches, underscoring the absence of established guidelines and the limited effectiveness of various treatments.
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Affiliation(s)
- Andrea Michelerio
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Unit, Ospedale Cardinal Massaia, 14100 Asti, Italy
| | - Antonio Greco
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Dario Tomasini
- Dermatology Unit, ASST Valle Olona, 21052 Busto Arsizio, Italy
| | - Carlo Tomasini
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Trujillo Ramirez L, Morales Cardona CA, Lopez Takegami JCH. Papular acantholytic dyskeratosis of the perianal region in a young woman. An Bras Dermatol 2022; 97:691-692. [PMID: 35863942 PMCID: PMC9453508 DOI: 10.1016/j.abd.2020.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Laura Trujillo Ramirez
- Fundacion Universitaria Sanitas (Unisanitas), Bogotá, Colombia; E.S.E. Hospital Universitario Centro Dermatologico Federico Lleras Acosta, Bogotá, Colombia.
| | - Camilo Andres Morales Cardona
- Fundacion Universitaria Sanitas (Unisanitas), Bogotá, Colombia; E.S.E. Hospital Universitario Centro Dermatologico Federico Lleras Acosta, Bogotá, Colombia
| | - Juan Carlos Hiromi Lopez Takegami
- Fundacion Universitaria Sanitas (Unisanitas), Bogotá, Colombia; E.S.E. Hospital Universitario Centro Dermatologico Federico Lleras Acosta, Bogotá, Colombia
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Farahbakhsh N, Nielson C, Rudnick E, Pothiawala S, Vladimir V. Diagnostic Pearls of Vulvar Epidermolytic Acanthoma: Case Report. Ann Dermatol 2022; 34:221-224. [PMID: 35721331 PMCID: PMC9171174 DOI: 10.5021/ad.2022.34.3.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022] Open
Abstract
Epidermolytic acanthomas (EA) are uncommon benign tumors clinically presenting as single to multiple papules. Histologically, EA display hyperkeratosis, hypergranulosis, acanthosis, and epidermal degeneration—also known as epidermolytic hyperkeratosis (EH). EA may be misdiagnosed as condyloma both clinically and histopathologically when located on the genitalia. Thus, this diagnosis carries a significant psychological burden and must remain in the differential when initially considering genital warts. We utilize the case of a 62-year old female referred to dermatology for a 5-year history of multiple pruritic and hypopigmented vulvar papules—misdiagnosed as genital warts—to highlight the impact of differentiating EA from genital warts. This patient was initially misdiagnosed with common genital warts at her gynecologist’s office and treated unsuccessfully for years. A shave biopsy was performed and histology revealed EH, consistent with EA.
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Affiliation(s)
- Navid Farahbakhsh
- Department of Dermatology, UF Health Dermatology-Springhill, Gainesville, FL, United States
| | - Colton Nielson
- Department of Dermatology, UF Health Dermatology-Springhill, Gainesville, FL, United States
| | - Eric Rudnick
- Department of Dermatology, UF Health Dermatology-Springhill, Gainesville, FL, United States
| | | | - Vincek Vladimir
- Department of Dermatology, UF Health Dermatology-Springhill, Gainesville, FL, United States
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Brihan I, Fekete G, Turda C, Tica O, Venter A, Ianosi S, Neagoe CD, Branisteanu D. Clinicopathological correlation of transient acantholytic dermatosis: A case report. Exp Ther Med 2021; 23:173. [PMID: 35069854 PMCID: PMC8764573 DOI: 10.3892/etm.2021.11096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ilarie Brihan
- Dermatology Department, Dermatology Clinic, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Gyula Fekete
- Dermatology Department, Dermatology Clinic, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology, 540530 Targu Mureș, Romania
| | - Constanta Turda
- Department of Psycho‑Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Ovidiu Tica
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Alina Venter
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Simona Ianosi
- Department of Dermatology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Carmen-Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Daciana Branisteanu
- Department of Dermatology, University of Medicine and Pharmacy ‘Grigore T. Popa’, 700115 Iasi, Romania
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Rogner DF, Lammer J, Zink A, Hamm H. Morbus Darier und Morbus Hailey‐Hailey: Stand 2021. J Dtsch Dermatol Ges 2021; 19:1478-1502. [PMID: 34661362 DOI: 10.1111/ddg.14619_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Danielle Franziska Rogner
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum Rechts der Isar, Technische Universität München
| | - Judith Lammer
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum Rechts der Isar, Technische Universität München
| | - Alexander Zink
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum Rechts der Isar, Technische Universität München
| | - Henning Hamm
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg
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Rogner DF, Lammer J, Zink A, Hamm H. Darier and Hailey-Hailey disease: update 2021. J Dtsch Dermatol Ges 2021; 19:1478-1501. [PMID: 34661345 DOI: 10.1111/ddg.14619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/28/2021] [Indexed: 01/16/2023]
Abstract
The autosomal-dominant genodermatoses Darier disease and Hailey-Hailey disease present special challenges to dermatologists. Despite their similar pathogenesis featuring impaired adhesion of suprabasal keratinocytes as a result of defective ATPases in epidermal calcium channels, the two diseases differ considerably in clinical presentation and therapeutic options. Darier disease is characterized by reddish brown, keratotic papules in seborrheic and intertriginous areas, which may coalesce into extensive lesions. Individuals affected with Hailey-Hailey disease primarily develop intertriginous papulovesicles and small blisters, which often evolve into erythematous plaques with erosions and painful fissures. Quality of life is significantly reduced because of complaints (itch, burning sensation, pain), body malodor and chronicity. Therapeutic options remain limited. Antiseptics and intermittent topical corticosteroids are a cornerstone of therapy, and systemic anti-infective treatment is often required in cases of superinfection. Ablative surgical interventions such as dermabrasion and CO2 laser surgery can lead to long-term remissions in intertriginous Hailey-Hailey disease, while temporary relief may also be achieved by intralesional injections of botulinum toxin. Of the systemic medications available for Darier disease, acitretin, which is approved for this purpose, has the best supporting evidence. The efficacy of immunosuppressants and immune modulators is inconsistent. Low-dose naltrexone produces more satisfactory results in Hailey-Hailey than Darier disease. The present CME article summarizes current knowledge of the two dermatoses, taking recent developments into account.
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Affiliation(s)
- Danielle Franziska Rogner
- Hospital and Clinic for Dermatology and Allergology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Judith Lammer
- Hospital and Clinic for Dermatology and Allergology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Zink
- Hospital and Clinic for Dermatology and Allergology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Henning Hamm
- Department of Dermatology, Venereology and Allergology, University Würzburg, Würzburg, Germany
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Abstract
ABSTRACT Pemphigus vulgaris (PV) is a severe, potentially life-threatening autoimmune blistering disease, which is common in India. Although there is abundant literature on clinical and immunologic features, comprehensive studies on its histopathology are lacking. The aim of this study was to describe the histopathologic and immunofluorescence features as well as discuss various diagnostic pitfalls of PV. Histopathologic and immunofluorescence (DIF/IIF) findings were reviewed for 169 biopsies from 2007 to 2017 (11 years). The 169 samples included 152 skin, 16 oral mucosal, and 1 corneal biopsy. Maximum prevalence was noted in the fifth decade (57%) with a slight male preponderance. Vesicles were seen in 149 cases (88%), the level of which was suprabasal in 91(61%) and both suprabasal and intraepidermal in 50 cases (33.5%). Acantholytic cells were present in 142 cases (95%). Acantholytic keratinocytes showed rounded and polygonal acantholysis. 86 (51%) cases showed evidence of regeneration. Adnexal involvement was seen in 92 cases, commonest in the hair follicles. Unusual histologic findings included: intraepidermal bulla, absence of dermal inflammation, free floating hair shafts, multinucleated epithelial cells, eosinophil predominance; all of which are discussed. DIF was performed in 166 cases, of which 163 were positive (98%), and IgG was the commonest immunoreactant (96%). IIF was performed in 11 cases, of which 9 cases were positive for Dsg3. Although the diagnosis of PV rests on combined clinical, histologic, and IF features, histopathology as the sole means is also a powerful tool. It is important to be aware of the diagnostic pitfalls to optimize its utility.
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Affiliation(s)
- Anisha Manocha
- Department of Pathology, St. John's Medical College, Bangalore, India
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Abstract
Hailey-Hailey disease is a rare blistering dermatosis first described in 1939 by the brothers Howard and Hugh Hailey. Its incidence is estimated at 1/50,000. The inheritance is autosomal dominant with complete penetrance, but a variable expressivity in affected family members. Clinically, Hailey-Hailey disease presents between the third and fourth decade as flaccid vesicles and blisters on erythematous skin, giving rise to erosions, fissures, and vegetations. Maceration and superinfections are frequent. The lesions are typically distributed symmetrically within intertriginous regions such as the retroauricular folds, lateral aspects of the neck, axillae, umbilicus, inguinal, and perianal regions. The disease is characterized by a chronic relapsing course with spontaneous remissions and multiple recurrences. Severe disease can be very frustrating and have a major psychological and social impact. Given the dearth of evidence-based guidelines and large clinical trials, the assessment of the efficacy and safety of treatments is difficult. Treatments include topical and systemic agents, and procedural therapy such as lasers and surgery. This review provides a systematic search of the literature with a focus on classical and emerging treatment options for Hailey-Hailey disease.
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Tintle SJ, Cruse AR, Brodell RT, Duong B. Classic Findings, Mimickers, and Distinguishing Features in Primary Blistering Skin Disease. Arch Pathol Lab Med 2019; 144:136-147. [DOI: 10.5858/arpa.2019-0175-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Blistering diseases comprise a large group of clinically polymorphic and sometimes devastating diseases. During the past few decades, we have developed an elegant understanding of the broad variety of blistering diseases and the specific histopathologic mechanism of each.
Objective.—
To review examples of the classic findings of specific blistering diseases and emphasize the importance of considering unrelated conditions that can mimic the classic finding.
Data Sources.—
This article combines data from expert review, the medical literature, and dermatology and pathology texts.
Conclusions.—
We have chosen several common examples of classic blistering diseases that are mimicked by other cutaneous conditions to highlight the basic findings in blistering conditions and the importance of clinician-to-pathologist communication.
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Affiliation(s)
- Suzanne J. Tintle
- From the Departments of Dermatology (Drs Cruse and Brodell) and Pathology (Drs Tintle, Cruse, and Brodell), and Affiliate Faculty, Dermatopathology Associates (Dr Duong), University of Mississippi Medical Center, Jackson; and the Department of Dermatology, University of Rochester Medical Center, Rochester, New York (Dr Brodell)
| | - Allison R. Cruse
- From the Departments of Dermatology (Drs Cruse and Brodell) and Pathology (Drs Tintle, Cruse, and Brodell), and Affiliate Faculty, Dermatopathology Associates (Dr Duong), University of Mississippi Medical Center, Jackson; and the Department of Dermatology, University of Rochester Medical Center, Rochester, New York (Dr Brodell)
| | - Robert T. Brodell
- From the Departments of Dermatology (Drs Cruse and Brodell) and Pathology (Drs Tintle, Cruse, and Brodell), and Affiliate Faculty, Dermatopathology Associates (Dr Duong), University of Mississippi Medical Center, Jackson; and the Department of Dermatology, University of Rochester Medical Center, Rochester, New York (Dr Brodell)
| | - Buu Duong
- From the Departments of Dermatology (Drs Cruse and Brodell) and Pathology (Drs Tintle, Cruse, and Brodell), and Affiliate Faculty, Dermatopathology Associates (Dr Duong), University of Mississippi Medical Center, Jackson; and the Department of Dermatology, University of Rochester Medical Center, Rochester, New York (Dr Brodell)
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Oliveira A, Arzberger E, Pimentel B, de Sousa VC, Leal-Filipe P. Dermoscopic and reflectance confocal microscopic presentation of Hailey-Hailey disease: A case series. Skin Res Technol 2017; 24:85-92. [PMID: 28782140 DOI: 10.1111/srt.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND/PURPOSE Hailey-Hailey disease is a rare inherited acantholytic skin disorder characterized by heterogeneous clinical presentation. Its differential diagnosis might be wide, including other genodermatoses, inflammatory, and infectious skin diseases. Although histopathology remains as diagnostic gold standard, noninvasive techniques such as dermoscopy and reflectance confocal microscopy may assist clinical examination. Herein, we aim to further characterize the dermoscopic and reflectance confocal microscopic presentation of Hailey-Hailey disease with histologic correlation. METHODS Eight patients with Hailey-Hailey disease were consecutively recruited. All patients were examined using dermoscopy and reflectance confocal microscopy. RESULTS In all cases, dermoscopy enabled the visualization of polymorphous vessels, including glomerular and linear-looped vessels, within a pink-whitish background. Reflectance confocal microscopy revealed wide suprabasilar partial acantholysis and clefting, crusts, dilated papillae with tortuous vessels, and inflammatory cells. Dyskeratosis, uplocated papillae, and adnexal sparing were also observed. CONCLUSION Although definite diagnosis was obtained by histopathology in all cases, dermoscopy and reflectance confocal microscopy allowed the identification of common features (even in cases with dissimilar clinical presentation) that may support an early diagnosis of Hailey-Hailey disease, and its differentiation from other more frequent skin disorders.
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Affiliation(s)
- A Oliveira
- Department of Dermatology, Hospital de Santa Maria, Lisbon, Portugal.,Centro Académico de Medicina, University of Lisbon, Lisbon, Portugal
| | - E Arzberger
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - B Pimentel
- Centro Académico de Medicina, University of Lisbon, Lisbon, Portugal
| | - V C de Sousa
- Department of Dermatology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - P Leal-Filipe
- Department of Dermatology, Hospital de Santa Maria, Lisbon, Portugal.,Centro Académico de Medicina, University of Lisbon, Lisbon, Portugal
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