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Foster KW, Robinson SK, Tung-Hahn E, Gibbons G, Cruse CW, Mudaliar K, Tung R, Kim W. Multifocal Langerhans Cell Histiocytosis: A Unique Presentation of Eosinophilic Granuloma with Intracranial Extension, Massive Lymphadenopathy, and Epstein-Barr Viral Infection in an Adolescent Female. Case Rep Dermatol 2021; 13:28-35. [PMID: 33613231 PMCID: PMC7879306 DOI: 10.1159/000511488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/08/2020] [Indexed: 11/29/2022] Open
Abstract
We report the case of an otherwise healthy 17-year-old female who presented for surgical removal of an enlarging “atypical cyst” on her scalp. During subtotal excision, only friable serosanguinous translucent ribbons of tissue were found. A histopathologic diagnosis of Langerhans cell histiocytosis (LCH) was rendered and imaging studies revealed extradural invasion of the tumor. Within weeks, the patient also developed progressive lymphadenopathy with grossly elevated levels of Epstein-Barr virus viral capsid antigen antibody levels. This report aims to highlight a unique presentation of LCH with discussion of workup, management, and avoidance of potential surgical complications.
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Affiliation(s)
- Kent Wade Foster
- Department of Biology, Brigham Young University, Provo, Utah, USA
| | - Shamika Kayo Robinson
- Division of Dermatology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Eleanor Tung-Hahn
- Department of Public Health, The University of South Florida, Tampa, Florida, USA
| | | | - Carl Wayne Cruse
- Cutaneous Oncology Program, Moffitt Cancer Center, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Kumaran Mudaliar
- Department of Pathology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Rebecca Tung
- Florida Dermatology and Skin Cancer Centers, Winter Haven, Florida, USA
| | - Wendy Kim
- Division of Dermatology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
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Pincelli TP, Heckman MG, Cochuyt JJ, Sluzevich JC. Valchlor ® in the Treatment of Lichen Planopilaris and Frontal Fibrosing Alopecia: A Single Arm, Open-label, Exploratory Study. Int J Trichology 2020; 12:220-226. [PMID: 33531744 PMCID: PMC7832166 DOI: 10.4103/ijt.ijt_16_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Lichen Planopilaris (LPP) is a lymphocyte-mediated scarring alopecia that frequently is treatment resistance to both topical and systemic therapies. Aims and Objectives: The object of this pilot study was to assess the effectiveness of topical mechlorethamine 0.016% gel (Valchlor®) in decreasing disease activity in LPP and the related clinical variant frontal fibrosing alopecia (FAA). Methods: Twelve patients with biopsy-proven LPP/FAA who failed prior topical or systemic therapy with active disease were included. Participants applied mechlorethamine 0.016% gel to involved areas daily for 24 weeks. Outcome measures included LPP Activity Index (LPPAI) score, Physician Global Assessment (PGA) score, Dermatology Quality of Life Index (DQLI) score, and phototrichograms assessing follicular counts before and after six months of therapy. Results: LPP Activity Index (LPPAI) before and after treatment was significantly different (5.0 before treatment, 2.0 after treatment; p value=0.006). Mean follicular density and follicular units were unchanged during the treatment period. Conclusion: Treatment with mechlorethamine 0.016% gel for 24 weeks resulted in statistically significant improvement of LLP/FFA with no change in phototrichogram parameters. Treatment duration was limited by high rate of contact dermatitis. Further investigation to optimize dosing frequency and to assess the role of combination topical therapy is needed.
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Affiliation(s)
- Thais P Pincelli
- Department of Dermatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael G Heckman
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
| | - Jordan J Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, Florida, USA
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Fronek LF, Grubbs H, Dorton DW, Miller R. Isolated Cutaneous Langerhans Cell Histiocytosis Presenting in an Adult Male. Cureus 2020; 12:e9861. [PMID: 32963902 PMCID: PMC7500710 DOI: 10.7759/cureus.9861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Langerhans cell histiocytosis (LCH) is an infrequent clonal proliferative disorder of myeloid dendritic cells. It has a wide variety of cutaneous manifestations and retains the possibility of systemic implications. Because LCH is predominantly a disease of childhood, there are well-established clinical definitions, as well as guidelines regarding workup and treatment, in the context of pediatric disease. Here we present a case of isolated cutaneous LCH in an adult male, followed by a discussion of our diagnostic plan and treatment course. The patient exhibited a small, excoriated, yellow papule on his inferior forehead during a skin examination. The specimen underwent tangential shave biopsy; histopathologic evaluation with appropriate immunohistochemical staining confirmed a diagnosis of cutaneous LCH. After thorough investigation via serologic and imaging diagnostics, we confirmed isolated cutaneous disease. The patient underwent wide local excision (WLE) with no evidence of recurrence. It is crucial to appropriately screen all patients diagnosed with cutaneous LCH for internal organ involvement. The authors aim to highlight the need for further investigations to ultimately dictate standardized management and treatment for isolated cutaneous LCH in the adult population.
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Affiliation(s)
- Lisa F Fronek
- Dermatology, Hospital Corporation of America / University of South Florida Morsani College of Medicine: Largo Medical Center Program, Largo, USA
| | - Hailey Grubbs
- Dermatology, Broward Health Medical Center, Fort Lauderdale, USA
| | - David W Dorton
- Dermatology, Hospital Corporation of America / University of South Florida Morsani College of Medicine: Largo Medical Center Program, Largo, USA
| | - Richard Miller
- Dermatology, Hospital Corporation of America / University of South Florida Morsani College of Medicine: Largo Medical Center Program, Largo, USA
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Diethelm-Varela B, Ai Y, Liang D, Xue F. Nitrogen Mustards as Anticancer Chemotherapies: Historic Perspective, Current Developments and Future Trends. Curr Top Med Chem 2019; 19:691-712. [PMID: 30931858 DOI: 10.2174/1568026619666190401100519] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/11/2019] [Accepted: 02/25/2019] [Indexed: 12/30/2022]
Abstract
Nitrogen mustards, a family of DNA alkylating agents, marked the start of cancer pharmacotherapy. While traditionally characterized by their dose-limiting toxic effects, nitrogen mustards have been the subject of intense research efforts, which have led to safer and more effective agents. Even though the alkylating prodrug mustards were first developed decades ago, active research on ways to improve their selectivity and cytotoxic efficacy is a currently active topic of research. This review addresses the historical development of the nitrogen mustards, outlining their mechanism of action, and discussing the improvements on their therapeutic profile made through rational structure modifications. A special emphasis is made on discussing the nitrogen mustard prodrug category, with Cyclophosphamide (CPA) serving as the main highlight. Selected insights on the latest developments on nitrogen mustards are then provided, limiting such information to agents that preserve the original nitrogen mustard mechanism as their primary mode of action. Additionally, future trends that might follow in the quest to optimize these invaluable chemotherapeutic medications are succinctly suggested.
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Affiliation(s)
- Benjamin Diethelm-Varela
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, United States
| | - Yong Ai
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, United States
| | - Dongdong Liang
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, United States
| | - Fengtian Xue
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, Maryland 21201, United States
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Blattner CM, Snider K, Boudreaux L, Bohlke A. A case of adult onset folliculocentric Langerhans cell histiocytosis. J Cutan Pathol 2018; 45:469-472. [PMID: 29924409 DOI: 10.1111/cup.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Karla Snider
- Western University/Silver Falls Dermatology - Dermatology, Corvallis, OR
| | - Lauren Boudreaux
- Western University/Silver Falls Dermatology - Dermatology, Corvallis, OR
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Topical Imiquimod for the Treatment of Relapsed Cutaneous Langerhans Cell Histiocytosis after Chemotherapy in an Elderly Patient. Case Rep Dermatol Med 2018. [PMID: 29535877 PMCID: PMC5817217 DOI: 10.1155/2018/1680871] [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] [Indexed: 11/26/2022] Open
Abstract
Diagnosis and treatment of Langerhans cell histiocytosis (LCH) in elderly patients are often difficult. We report here a 61-year-old female suffering from a refractory axillary ulcer for nearly a year, whose biopsy revealed LCH. It was also noted that the patient had other cutaneous papulovesicular eruptions of LCH as well as central diabetes insipidus. The patient was first successfully treated with multiagent chemotherapy (cytosine arabinoside/vinblastine/prednisolone). DDAVP also well controlled diabetes insipidus; however, the axillary ulcer and cutaneous LCH relapsed. Thereafter, we found topical imiquimod to be effective in the treatment of relapsed cutaneous LCH lesions.
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Luder C, Nordmann T, Ramelyte E, Mühleisen B, Kerl K, Guenova E, Dummer R. Histiocytosis - cutaneous manifestations of hematopoietic neoplasm and non-neoplastic histiocytic proliferations. J Eur Acad Dermatol Venereol 2018; 32:926-934. [DOI: 10.1111/jdv.14794] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 12/11/2017] [Indexed: 01/18/2023]
Affiliation(s)
- C.M. Luder
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - T.M. Nordmann
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - E. Ramelyte
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - B. Mühleisen
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - K. Kerl
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - E. Guenova
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - R. Dummer
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
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Harmon CM, Brown N. Langerhans Cell Histiocytosis: A Clinicopathologic Review and Molecular Pathogenetic Update. Arch Pathol Lab Med 2016; 139:1211-4. [PMID: 26414464 DOI: 10.5858/arpa.2015-0199-ra] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Langerhans cell histiocytosis (LCH) comprises a wide spectrum of clinical disorders that have in common a proliferation of Langerhans-type cells with characteristic morphologic, immunophenotypic, and ultrastructural features. In part because of the diverse clinical manifestations of LCH, there has long been controversy over whether LCH is best considered a reactive process or a neoplasm. Herein, we discuss the clinical and pathologic features of LCH, including recent advances in the understanding of the molecular pathogenesis of this disease that support its categorization as a neoplasm. We also review the implications that these recently described molecular characteristics may have on risk stratification and treatment of LCH.
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Affiliation(s)
| | - Noah Brown
- From the Department of Pathology, University of Michigan Hospital and Health Systems, Ann Arbor
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Simko SJ, Garmezy B, Abhyankar H, Lupo PJ, Chakraborty R, Lim KPH, Shih A, Hicks MJ, Wright TS, Levy ML, McClain KL, Allen CE. Differentiating skin-limited and multisystem Langerhans cell histiocytosis. J Pediatr 2014; 165:990-6. [PMID: 25441388 PMCID: PMC4254414 DOI: 10.1016/j.jpeds.2014.07.063] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/17/2014] [Accepted: 07/28/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify features associated with multisystem involvement and therapeutic failure in patients with skin Langerhans cell histiocytosis (LCH). STUDY DESIGN We reviewed medical records of 71 consecutive patients with LCH with skin involvement evaluated at Texas Children's Hospital and analyzed clinical features, laboratory results, and the presence of circulating cells with the BRAF-V600E mutation with respect to initial staging and clinical outcomes. RESULTS Skin disease in patients older than 18 months of age at diagnosis was associated with the presence of multisystem disease (OR, 9.65; 95% CI, 1.17-79.4). Forty percent of patients referred for presumed skin-limited LCH had underlying multisystem involvement, one-half of these with risk-organ involvement. Patients with skin-limited LCH had a 3-year progression-free survival of 89% after initial therapy, and none developed multisystem disease. Patients with skin/multisystem involvement had a 3-year progression-free survival of 44% with vinblastine/prednisone therapy, and risk-organ involvement did not correlate with failure to achieve nonactive disease. Circulating cells with BRAF-V600E were detected at higher frequency in patients with multisystem involvement (8 of 11 skin/multisystem vs 1 of 13 skin-limited; P = .002). CONCLUSION Skin-limited LCH necessitates infrequent therapeutic intervention and has a lower risk of progression relative to skin plus multisystem LCH. The less-aggressive clinical course and lack of circulating cells with the BRAF-V600E mutation in skin-limited LCH suggest a different mechanism of disease origin compared with multisystem or risk-organ disease.
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Affiliation(s)
- Stephen J. Simko
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Benjamin Garmezy
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Harshal Abhyankar
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - Philip J. Lupo
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | | | | | - Albert Shih
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
| | - M. John Hicks
- Department of Pathology, Baylor College of Medicine, Houston, TX
| | | | - Moise L. Levy
- Pediatric Dermatology, Baylor College of Medicine, Houston, TX,Pediatric Dermatology, Dell Children’s Medical Center, Austin, TX,Dermatology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Carl E. Allen
- Texas Children’s Cancer Center, Baylor College of Medicine, Houston, TX
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Kruse L, Chamlin SL. A 6-month-old boy with persistent pruritic eruption. Langerhans cell histiocytosis. Pediatr Ann 2014; 43:e9-e12. [PMID: 24549087 DOI: 10.3928/00904481-20131223-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A previously healthy 6-month-old boy presented to the pediatric dermatology clinic for evaluation of a persistent, pruritic eruption. This eruption involved the scalp, extremities, and inguinal creases and was intensely pruritic. The patient had been previously treated with multiple topical corticosteroids and antifungals, all with minimal improvement. He born at full term and was otherwise well and thriving. Review of systems was negative. Examination revealed erythematous to yellow scaly, greasy plaques, some with underlying purpuric papules in the frontal, temporal, and vertex of the scalp, post-auricular regions, and the conchae of both ears. There were also scattered papules and purpura noted in the inguinal creases, and hyperkeratotic yellow papules on the extensor extremities. He had no abnormal lymphadenopathy or hepatosplenomegaly. The remainder of his examination was normal. A diagnostic skin biopsy was performed.
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Abstract
PURPOSE OF REVIEW Diaper dermatitis is the most common cutaneous diagnosis in infants. In this review, common causes of diaper dermatitis and similarly presenting conditions will be covered, as well as updates on treatments of common diaper dermatitides. RECENT FINDINGS There have been recent advancements in the treatment of diaper dermatitis. In addition, there are many newly recognized causes of diaper dermatitis that clinicians should be aware of. SUMMARY Irritant dermatitis is the most common cause of diaper dermatitis. However, there are multiple other common causes of diaper dermatitis and it is thus imperative that the clinician be aware of cutaneous mimickers of irritant diaper dermatitis as well as their treatments.
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