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Histopathological and Immunohistochemical Characteristics of Measles Exanthema: A Study of a Series of 13 Adult Cases and Review of the Literature. Am J Dermatopathol 2020; 41:914-923. [PMID: 31021834 DOI: 10.1097/dad.0000000000001431] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Despite available vaccination, measles is one of the leading causes of death among young children in developing countries. In clinical practice, the spectrum of differential diagnoses of morbilliform exanthemas associated with fever is wide, and it can be hard to differentiate from other infectious eruptions, especially in adults or in atypical courses in immunocompromised patients. The goal of our study was to identify characteristic histomorphological and immunohistochemical patterns of measles exanthema through the study of 13 skin biopsy specimens obtained from 13 patients with this disease and a review of cases in the literature. Histopathological features of measles exanthema are quite distinctive and characterized by a combination of multinucleated keratinocytes, and individual and clustered necrotic keratinocytes in the epidermis with pronounced folliculosebaceous as well as acrosyringeal involvement. Immunohistochemical staining of skin biopsies with anti-measles virus (MeV) nucleoprotein and anti-MeV phosphoprotein can be of great value in confirming the diagnosis of measles. Both methods can serve as quick additional diagnostic tools for prompt implementation of quarantine measures and for providing medical assistance, even in patients in whom the clinician did not consider measles as a differential diagnosis of the rash due to the rarity of the disease in a putatively vaccinated community.
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Thanguturi S, Tabareau-Delalande F, Kerdraon R, Michenet P, Wakosa A, Finon A. [Bullous dermatitis with multinucleated keratinocytes in dermatitis artefacta: A case report]. Ann Pathol 2020; 40:324-328. [PMID: 32001033 DOI: 10.1016/j.annpat.2019.12.004] [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: 03/10/2019] [Revised: 10/30/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
We report the case of a 13-year-old young lady with a one year reccuring bullous dermatitis history for which the diagnostic hypothesis of dermatitis arterfacta was made. This hypothesis was made by the pathologist, without it being suggested by the dermatologist, after observing singular histological lesions coresponding to a cutaneous blister associated with epidermic necrosis with multinucleated keratinocytes. When dermatitis artefacta is suspected, a biopsy is usually conducted to rule out differential diagnosis such as auto-immmune dermatitis when there is a blister. Confession from patients is rarely obtained. Therefore, having positive histogical clues for dermatitis artefacta would be of a great use to help making the diagnosis in difficult cases.
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Affiliation(s)
- Soumanth Thanguturi
- Service d'anatomie et de cytopathologie pathologiques, hôpital de la Source, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France
| | - Flore Tabareau-Delalande
- Service d'anatomie et de cytopathologie pathologiques, hôpital de la Source, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France.
| | - Rémy Kerdraon
- Service d'anatomie et de cytopathologie pathologiques, hôpital de la Source, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France
| | - Patrick Michenet
- Service d'anatomie et de cytopathologie pathologiques, hôpital de la Source, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France
| | - Adeline Wakosa
- Service de dermatologie, hôpital de la Source, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France
| | - Antoine Finon
- Service de dermatologie, hôpital de la Source, CHR d'Orléans, 14, avenue de l'Hôpital, CS 86709, 45067 Orléans cedex 2, France
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Mahon C, Webber L, Bisson N, Droop E, Angus J, Shaw L, Wlodek C. Aerosolised deodorant-induced bullous dermatitis artefacta: A clinicopathological correlation. Australas J Dermatol 2019; 60:331-333. [PMID: 31158918 DOI: 10.1111/ajd.13083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Caroline Mahon
- Department of Paediatric Dermatology, Starship Child Health, Auckland, New Zealand.,Department of Paediatrics and Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lucy Webber
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nicholas Bisson
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Elizabeth Droop
- Department of Pathology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Janet Angus
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lindsay Shaw
- Department of Paediatric Dermatology, Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christina Wlodek
- Department of Dermatology, Waikato Hospital, Hamilton, New Zealand
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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Abstract
Dermatitis artefacta, also known as factitial dermatitis, is a condition whereby self-induced skin damage is the means used to satisfy a conscious or unconscious desire to assume the sick role. It is particularly common in women and in those with an underlying psychiatric diagnosis or external stress. The diagnosis is one of exclusion, and it is often difficult to confirm, with patients rarely admitting their role in the creation of their lesions. Treatment can be challenging, and management should adopt a multidisciplinary team approach composed of dermatologists and mental health professionals. We present a literature review of dermatitis artefacta, highlighted by a case report of a patient with bilateral ulcerations to the legs, which after thorough investigation represented dermatitis artefacta.
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Affiliation(s)
- Michael Joseph Lavery
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
| | - Carolyn Stull
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Iain McCaw
- Assertive Outreach Team, Leeds and York Partnership NHS Foundation Trust, Asket Croft, Leeds, UK
| | - Rachel B Anolik
- Department of Dermatology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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Tittelbach J, Peckruhn M, Elsner P. Dermatopathologische Hinweise auf Artefakte. J Dtsch Dermatol Ges 2018; 16:560-566. [DOI: 10.1111/ddg.13504_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/08/2017] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Peter Elsner
- Klinik für HautkrankheitenUniversitätsklinikum Jena
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Tittelbach J, Peckruhn M, Elsner P. Histopathological patterns in dermatitis artefacta. J Dtsch Dermatol Ges 2018; 16:559-564. [DOI: 10.1111/ddg.13504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/08/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Jörg Tittelbach
- Department of DermatologyJena University Hospital Jena Germany
| | | | - Peter Elsner
- Department of DermatologyJena University Hospital Jena Germany
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Factitious Dermatitis Due to Thermal Burn With Histologic Features Simulating Fixed Drug Eruption. Am J Dermatopathol 2017; 39:622-624. [PMID: 28614838 DOI: 10.1097/dad.0000000000000840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Factitious dermatitis (FD) (dermatitis artefacta) is rare and often difficult to diagnose because of conflicting history and nonspecific clinical and histologic findings. It can present with varied clinical features including geometric ulcers, erosions, and less commonly bullae secondary to external trauma from chemicals, electric burns, heat, and suction. Herein, we describe a case of bullous FD due to thermal burn with histologic features demonstrating overlap with fixed drug eruption. Histopathology demonstrated a subepidermal blister with epidermal necrosis along with pigment incontinence and dermal eosinophils and neutrophils. Although these features, and the clinician's impression, were suggestive of fixed drug eruption, several morphologic findings allowed accurate diagnosis of FD: sharp demarcation of necrotic keratinocytes from adjacent uninvolved epidermis, elongated keratinocytes reminiscent of thermal or electrical artifact, and multinucleated keratinocytes. Although FD is often considered a diagnosis of exclusion, these clues may help dermatopathologists distinguish this entity from inflammatory dermatoses.
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