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Borg Grech S, Vella Baldacchino A, Corso R, Pisani D, Boffa MJ. Superficial Granulomatous Pyoderma Successfully Treated with Intravenous Immunoglobulin. Eur J Case Rep Intern Med 2021; 8:002656. [PMID: 34671571 DOI: 10.12890/2021_002656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/05/2021] [Indexed: 11/05/2022] Open
Abstract
Superficial granulomatous pyoderma is a relatively rare variant of pyoderma gangrenosum, characterized by superficial ulceration with a vegetative margin and a clean granulating base. Ulcers in superficial granulomatous pyoderma are typically located on the trunk and may follow minor trauma. It may be misdiagnosed as classic pyoderma gangrenosum, despite having distinct characteristics. Here we report a case of superficial granulomatous pyoderma successfully treated with intravenous immunoglobulin (IVIg). LEARNING POINTS Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum.Histopathological and clinical characteristics of superficial granulomatous pyoderma are distinct from those of classic pyoderma gangrenosum.Superficial granulomatous pyoderma is often slow-growing and is only rarely linked to underlying systemic disease.IVIg may be an effective treatment option for superficial granulomatous pyoderma.
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Affiliation(s)
| | | | - Roberto Corso
- Department of Dermatology, Mater Dei Hospital, Malta
| | - David Pisani
- Department of Histopathology, Mater Dei Hospital, Malta
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2
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Boontaveeyuwat E, Rerknimitr P, Asawanonda P, NoppaKun N. Progressive annular verrucous erosive plaques on the face. Clin Exp Dermatol 2018; 44:784-786. [PMID: 30447015 DOI: 10.1111/ced.13835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- E Boontaveeyuwat
- Dermatology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Rerknimitr
- Dermatology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Asawanonda
- Dermatology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - N NoppaKun
- Dermatology Department, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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3
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Tull TJ, Calonje E, Wain EM. Widespread vegetating ulcers. Clin Exp Dermatol 2018; 44:553-555. [PMID: 30259553 DOI: 10.1111/ced.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- T J Tull
- St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - E Calonje
- St John's Institute of Dermatology, Guy's Hospital, London, UK
| | - E M Wain
- St John's Institute of Dermatology, Guy's Hospital, London, UK
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Li JJ, Beresford R, Fyfe J, Henderson C. Clinical and histopathological features of cutaneous nontuberculous mycobacterial infection: a review of 13 cases. J Cutan Pathol 2017; 44:433-443. [PMID: 28098393 DOI: 10.1111/cup.12903] [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: 11/22/2016] [Revised: 01/09/2017] [Accepted: 01/11/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The incidence of cutaneous nontuberculous mycobacterial (NTM) infection has increased in recent decades because of widespread use of immunosuppressive therapy and better detection methods. The histopathology of cutaneous NTM infection is not pathognomic and the organisms are slow and difficult to culture, making diagnosis challenging. METHODS We reviewed the clinical and histopathological features of 13 cases of cutaneous NTM infection, and performed panmycobacterial polymerase chain reaction (PCR) on the paraffin blocks. RESULTS The immunocompetent patients presented with localized lesions on the extremities, whereas the immunocompromised patients presented with disseminated cutaneous lesions. The histopathology in immunocompetent patients was characterized by pseudoepitheliomatous epidermal hyperplasia, intraepithelial abscesses, transepidermal elimination and dermal granulomatous inflammation accompanied by necrosis and suppuration. The immunocompromised patients showed suppurative inflammation with little granuloma formation and numerous acid-fast bacilli. Paraffin block PCR was positive in 4 of 13 cases (31%), whereas culture was positive in 11 of 13 cases (85%). CONCLUSION The aforementioned histological features should help in diagnosing cutaneous NTM infection when combined with clinical and microbiological correlation. In our study, we did not find paraffin block PCR to be superior to conventional culture in detecting cutaneous NTM infection.
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Affiliation(s)
- Jing Jing Li
- Department of Anatomical Pathology, Liverpool Hospital, Liverpool, Australia
| | - Rohan Beresford
- Department of Microbiology and Infectious diseases, Liverpool Hospital, Liverpool, Australia
| | - Janet Fyfe
- Mycobacterium Reference Laboratory Victorian Infectious Diseases Reference Laboratory, North Melbourne, Australia
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D'Epiro S, Salvi M, Mattozzi C, Giancristoforo S, Faina V, Macaluso L, Luci C, Grieco T, Calvieri S, Richetta AG. Facial superficial granulomatous pyoderma. Int Wound J 2013; 12:737-8. [PMID: 24283375 DOI: 10.1111/iwj.12195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 11/04/2013] [Indexed: 02/02/2023] Open
Affiliation(s)
- Sara D'Epiro
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Monica Salvi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Carlo Mattozzi
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Simona Giancristoforo
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Valentina Faina
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Laura Macaluso
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Cecilia Luci
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Teresa Grieco
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Stefano Calvieri
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
| | - Antonio G Richetta
- Clinica Dermatologica, "Sapienza" University of Rome, Policlinico UmbertoI, Rome, Italy
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Kratzsch D, Ziemer M, Milkova L, Wagner JA, Simon JC, Kendler M. Facial pyoderma gangrenosum in senescence. Case Rep Dermatol 2013; 5:295-300. [PMID: 24403893 PMCID: PMC3884177 DOI: 10.1159/000356100] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Clinically, pyoderma gangrenosum (PG) is characterized by a rapidly progressive, painful cutaneous ulcer with an irregular, violaceous and undermined border. PG occurs most frequently on the lower extremities and the trunk of middle-aged individuals. The face is only very rarely affected. We present an 89- and a 90-year-old patient, who developed a facial ulcer consistent with PG.
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Affiliation(s)
- Dorothea Kratzsch
- Department of Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany
| | - Mirjana Ziemer
- Department of Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany
| | - Linda Milkova
- Department of Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany
| | - Justinus A Wagner
- Department of Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany
| | - Jan C Simon
- Department of Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany
| | - Michael Kendler
- Department of Dermatology, Venerology and Allergology, Leipzig University Hospital, Leipzig, Germany
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Tollefson MM, Cook-Norris RH, Theos A, Davis DMR. Superficial granulomatous pyoderma: a case in an 11-year-old girl and review of the literature. Pediatr Dermatol 2010; 27:496-9. [PMID: 21182640 DOI: 10.1111/j.1525-1470.2010.01271.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Superficial granulomatous pyoderma is a rare entity thought to be a variant of pyoderma gangrenosum and is often mistaken for classic pyoderma gangrenosum. Superficial granulomatous pyoderma has mainly been described in adults. We describe a case of Superficial granulomatous pyoderma in an 11-year-old girl and present a review of the literature. Superficial granulomatous pyoderma maintains clinical and histopathologic characteristics distinct from classic pyoderma gangrenosum and has a more favorable prognosis. It is often responsive to conservative treatment.
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Affiliation(s)
- Megha M Tollefson
- Division of Clinical Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Covadonga Martínez-González M, del Pozo J, Martínez W, Verea M, Carro E, Fonseca E. Pioderma granulomatoso superficial, resolución completa con tratamiento tópico. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0213-9251(08)70965-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Salavert M, Franck F, Amarger S, Mansard S, Souteyrand P, D'Incan M. Dermatose pustuleuse érosive des jambes : rôle de la carence en zinc ? Ann Dermatol Venereol 2006; 133:975-8. [PMID: 17185927 DOI: 10.1016/s0151-9638(06)71081-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Erosive pustular dermatosis of the legs is a rare and recently described condition seen in elderly subjects. It is characterised by symmetric erosions of the legs resulting from a confluence of sterile pustules, usually following minor trauma. Treatment with dermal corticosteroids is rapidly effective but is not codified and relapse is common. CASE-REPORTS Three patients aged respectively 74, 84 and 92 years presented ulcers of the legs and ankles associated with peripheral pustules following minor injury. These pustules were sterile and exhibited a spongiform appearance on histological examination. None of these patients had a prior history of psoriasis. However, all presented zinc deficiency. Treatment with dermal corticosteroids combined with oral zinc gluconate resulted in complete resolution in two of the patients after several days of therapy and proved effective during relapse in the third patient. DISCUSSION Erosive pustular dermatosis of the legs is a benign dermatosis that is probably under-reported that should be included in the category of inflammatory neutrophilic dermatoses. The cases we present suggest a triggering or enhancing role of zinc deficiency.
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Affiliation(s)
- M Salavert
- Service de Dermatologie, CHU Clermont-Ferrand
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García VS, Trelles AS. Superficial granulomatous pyoderma: successful treatment with minocycline. J Eur Acad Dermatol Venereol 2006; 20:1134-5. [PMID: 16987273 DOI: 10.1111/j.1468-3083.2006.01625.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bassi E, Matthews S, Cerio R. Superficial granulomatous pyoderma associated with chronic osteomyelitis. Br J Dermatol 2005; 153:684-6. [PMID: 16120175 DOI: 10.1111/j.1365-2133.2005.06822.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Affiliation(s)
- Sinead M Langan
- Regional Center of Dermatology, Mater Misericordiae Hospital, Dublin, Ireland
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Abstract
INTRODUCTION Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum, which is often diagnosed at a late stage because of misleading clinical-histopathological features. We report a new case of this rare disease. CASE REPORT A 67 year-old man presented with inflammatory lesions that had become ulcerated over the past 4 months despite prolonged antibiotic therapy. The histopathological aspect was initially suggestive of palisading granuloma annulare and subsequently a necrotizing granuloma compatible with a mycobacteriosis. The various supplementary examinations eliminated the possibility of an infectious or systemic disease. The lesions became painful and ulcerated. A second biopsy showed a neutrophilic dermatosis with dermal necrosis and a granuloma leading to the diagnosis of superficial granulomatous pyoderma. The lesions healed after 3 months of systemic corticosteroids at the dose of 1 mg/kg/day. DISCUSSION The clinical features of superficial granulomatous pyoderma are similar to those of classical pyoderma gangrenosum. However, its histological profile is more superficial and is associated with dermal granulomas. The latter are unusual in neutrophilic dermatosis and would suggest an infectious disease. This explains the frequent diagnostic errors, with inappropriate anti-infectious treatments and notably unnecessary surgical exeresis.
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Affiliation(s)
- M Mitcov Milea
- Clinique Dermatologique, Hôpitaux Universitaires, 1 place de l'Hôpital, 67091 Strasbourg, France
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Kaneko T, Tamai K, Yamazaki T, Harada K, Nakano H, Hanada K. Superficial granulomatous pyoderma: a case report of two Japanese patients and clinical comparison with foreign patients. J Dermatol 2003; 30:472-6. [PMID: 12810995 DOI: 10.1111/j.1346-8138.2003.tb00418.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2003] [Accepted: 03/18/2003] [Indexed: 11/30/2022]
Abstract
Superficial granulomatous pyoderma (SGP) is an unusual variant type of pyoderma gangrenosum characterized by a benign course and specific histological features; it is quite a rare cutaneous disorder in Japan. We reported two Japanese cases of SGP and compared the clinical features of 13 Japanese cases with those of 42 foreign cases. Case 1 was a 53-year-old female who presented with three indolent and ulcerative plaques with elevated edges on the back and the posterior portion of the left thigh. Case 2 was a 74-year-old female who presented with crusted and vegetative erythematous plaques on the left shoulder and left upper arm. Histological examinations revealed a characteristic three-layer granuloma in each case. Laboratory and physical examinations found no abnormalities. Topical corticosteroid, oral administration of minocycline, and/or additional supplementation with corticosteroid were effective. In comparison with foreign cases, Japanese cases show a possible differentiation in the ratio of sex and distribution of the ulcer. Females have a high incidence and the extremities are frequently involved area in Japanese cases. Up to now, 11 cases of SGP have been reported in Japan. To our best knowledge, our patients are the first Japanese cases described in the English literature.
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Affiliation(s)
- Takahide Kaneko
- Department of Dermatology, Hirosaki University School of Medicine, Hirosaki 036-8562, Japan
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16
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Dobson CM, Parslew RA, Evans S. Superficial granulomatous pyoderma treated with intravenous immunoglobulin. J Am Acad Dermatol 2003; 48:456-60. [PMID: 12637931 DOI: 10.1067/mjd.2003.172] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Superficial granulomatous pyoderma is a rare variant of pyoderma gangrenosum. The superficial ulceration and vegetative margins are clinically distinctive; the suppurative and granulomatous histology is characteristic, though not pathognomonic. The condition is said to be relatively benign and more responsive to treatment than classic pyoderma gangrenosum, though published evidence of this is not always convincing. We present a case of superficial granulomatous pyoderma that was unusually aggressive, but that underwent dramatic and lasting resolution after intravenous immunoglobulin therapy.
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Dawn G, Loney M, Zamiri M, Shaffrali F, Urcelay M, Patel M, Howatson SR, Douglas WS. Erosive pustular dermatosis of the leg associated with compression bandaging and fungal infection. Br J Dermatol 2003; 148:489-92. [PMID: 12653740 DOI: 10.1046/j.1365-2133.2003.05094.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Erosive pustular dermatosis of the leg (EPDL) has been described in association with venous insufficiency and atrophy of the skin of the lower leg. Like erosive pustular dermatosis of the scalp, this disease has also been reported to be a non-infective condition. OBJECTIVES To investigate the clinicopathological features and, where possible, the aetiology of clinical EPDL. METHODS We identified a group of patients undergoing continuous compression bandaging for venous dermatitis of the legs and/or predominantly venous leg ulceration with clinical features described in patients with EPDL. They were investigated by skin biopsy, patch testing and microbiological tests for the presence of bacteria and fungi. RESULTS Twenty-four of 400 (6%) patients were noted to have pustules on the leg(s). There was laboratory evidence of fungal infection in 13 of 24 patients (54%), with complete and sustained resolution of pustules after antifungal treatment. Pustulation in the other 11 patients (46%) was unresponsive to antibiotics for confirmed bacterial infection; some improvement was seen with potent topical corticosteroids but full clearance was achieved only after a switch from continuous four-layer compression bandaging to the use of intermittent long stretch compression. CONCLUSIONS EPDL is a fairly common clinical picture seen in patients undergoing continuous compression bandaging. It may be produced by opportunistic, particularly fungal, infection. In almost half an infective aetiology cannot be demonstrated and a pyoderma gangrenosum-like process may be implicated.
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Affiliation(s)
- G Dawn
- Departments of Dermatology and Pathology, Monklands Hospital, Airdrie, Lanarkshire ML6 0JS, UK
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Thami GP, Kaur S, Punia RS, Kanwart AJ. Superficial granulomatous pyoderma: an idiopathic granulomatous cutaneous ulceration. J Eur Acad Dermatol Venereol 2002; 16:159-61. [PMID: 12046823 DOI: 10.1046/j.1468-3083.2002.00425.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A 70-year-old male with a superficial granulomatous ulcer is reported. Histopathological findings were the same as those described for superficial granulomatous pyoderma, a recognized variant of classic pyoderma gangrenosum. The differences between pyoderma gangrenosum and its variant superficial granulomatous pyoderma are highlighted.
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Affiliation(s)
- G P Thami
- Department of Dermatology and Venereology, Government Medical College and Hospital, Chandigarh, India.
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Usuki K, Hamada H, Terasaki Y, Hiwatashi S, Hisadome H, Setoyama M, Kanzaki T, Mera S. Sarcoidosis associated with psoriasis vulgaris. J Dermatol 2001; 28:86-90. [PMID: 11320712 DOI: 10.1111/j.1346-8138.2001.tb00095.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a 70-year-old patient with sarcoidosis associated with psoriasis vulgaris. He had a nodule on the medial lower lid of his right eye. Oral corticosteroid for the sarcoid lesions and oral PUVA for psoriasis were employed. The cutaneous lesion disappeared within two months after starting the therapy. No relapse of sarcoidosis has been seen for eight years. The association of sarcoidosis with psoriasis has been previously reported; however, it is still unclear whether this association coincidental or meaningful.
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Affiliation(s)
- K Usuki
- Usuki Clinic, Juttyo 912-1, Ibusuki City, Kagoshima 890-0412, Japan
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Affiliation(s)
- V J Swale
- Centre for Cutaneous Research, Barts and the London NHS Trust, London E1 2AT, UK
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Park HJ, Kim YC, Cinn YW, Yoon TY. Granulomatous pyoderma gangrenosum: two unusual cases showing necrotizing granulomatous inflammation. Clin Exp Dermatol 2000; 25:617-20. [PMID: 11167975 DOI: 10.1046/j.1365-2230.2000.00721.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present two cases of pyoderma gangrenosum (PG) with unusual histopathological findings. The main histopathological feature of PG is usually massive neutrophilic infiltration; the neutrophil is thus the cytologic hallmark of PG. The occurrence of vasculitis is controversial. In our patients, in contrast, biopsy specimens revealed extensive granulomatous inflammation with massive tissue necrosis throughout the entire dermis and subcutaneous tissue and vascular involvement simulating many other granulomatous diseases. However, there was no evidence of systemic disease. Our cases may therefore represent a histopathologically distinct subset of PG.
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Affiliation(s)
- H J Park
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea.
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de La Blanchardière A, Bachmeyer C, Toutous L, Franck N, Salmon D, Leibowitch M, Sicard D. [Cutaneous ulcerations in sarcoidosis]. Rev Med Interne 1995; 16:927-9. [PMID: 8570957 DOI: 10.1016/0248-8663(96)80815-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report the case of a 23 year-old Caribbean woman with sarcoidosis who developed specific skin ulcerations. Ulcerative lesions in sarcoidosis are distinctly unusual, generally multiple, painless, with preponderant location on the lower limbs. The diagnosis is difficult. The pathogenesis is discussed. The most successful therapy is hydrochloroquine with corticosteroids.
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MURAYAMA N, ENDO M, ASAJIMA H, MATSUOKA Y, SAITO R, IWAHIRA Y. A Case of Superficial Granulomatous Pyoderma Associated with Anaphylactoid Purpura. ACTA ACUST UNITED AC 1995. [DOI: 10.2336/nishinihonhifu.57.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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