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Valiuškytė M, Gonçalves-Castro C, Miroux-Catarino A. Pink Nodule on the Hand of a 12-Year-old Patient. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:823-824. [PMID: 38554753 DOI: 10.1016/j.ad.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- M Valiuškytė
- Department of Skin and Venereal Diseases, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lithuania.
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Valiuškytė M, Gonçalves-Castro C, Miroux-Catarino A. Pink Nodule on the Hand of a 12-Year-old Patient. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T823-T824. [PMID: 38885900 DOI: 10.1016/j.ad.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/24/2024] [Accepted: 02/06/2024] [Indexed: 06/20/2024] Open
Affiliation(s)
- M Valiuškytė
- Department of Skin and Venereal Diseases, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Kaunas, Lituania.
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3
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King HL, Benedetti GB, Keller JJ, DeLoughery TG, Shatzel JJ, Martens KL. Dermatologic manifestations of hematologic disorders. Ann Hematol 2024:10.1007/s00277-024-05761-5. [PMID: 38662204 DOI: 10.1007/s00277-024-05761-5] [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: 02/13/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.
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Affiliation(s)
- Hannah L King
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - Jesse J Keller
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Thomas G DeLoughery
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Joseph J Shatzel
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA
| | - Kylee L Martens
- Division of Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road Mail Code: OC14HO, 97239, Portland, OR, USA.
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4
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Di Bartolomeo L, Li Pomi F, Vaccaro M, Borgia F, Lentini M. Eruptive papules on axillary folds of an adolescent. Pediatr Dermatol 2023; 40:727-729. [PMID: 36754631 DOI: 10.1111/pde.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023]
Affiliation(s)
- Luca Di Bartolomeo
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Federica Li Pomi
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Francesco Borgia
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Maria Lentini
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Italy
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Malana E, Kowalski P, Gallagher M. A Case of Multiple Self-Involuting, Mixed Presentation, Giant Congenital Juvenile Xanthogranuloma. Cureus 2023; 15:e37644. [PMID: 37200655 PMCID: PMC10187945 DOI: 10.7759/cureus.37644] [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] [Accepted: 04/16/2023] [Indexed: 05/20/2023] Open
Abstract
Juvenile xanthogranuloma (JXG) is an uncommon benign skin disorder of infants and young children characterized by dermal proliferation and infiltration of dendrocytes. We present a unique case of giant congenital JXG with a mixed presentation of macules, papules, nodules, and ulcerations in a neonatal male who was observed until the age of 23 months, by which time all lesions had spontaneously self-involuted. Prior to complete resolution, some lesions took the form of pedunculated protrusions. To our knowledge, this is the first of this atypical case to be presented in the literature.
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Affiliation(s)
- Erika Malana
- Pediatric Dermatology, Michigan State University College of Osteopathic Medicine, East Lansing, USA
| | - Paul Kowalski
- Pathology, Michigan Pathology Specialists PC - Spectrum Health, Grand Rapids, USA
| | - Michelle Gallagher
- Pediatric Dermatology, Michigan State University College of Osteopathic Medicine, East Lansing, USA
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Zhu X, Zhang X, Yang K. Diagnostic aid to subepidermal calcified nodule with dermoscopy and reflectance confocal microscopy: a case report. BMC Pediatr 2023; 23:102. [PMID: 36869283 PMCID: PMC9983260 DOI: 10.1186/s12887-023-03913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 02/17/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Subepidermal calcified nodule (SCN) is a type of calcinosis cutis that usually occurs in children. The lesions in the SCN resemble those of other skin diseases, such as pilomatrixoma, molluscum contagiosum, and juvenile xanthogranuloma, leading to a high rate of misdiagnoses. Noninvasive in vivo imaging techniques, represented by dermoscopy and reflectance confocal microscopy (RCM), have dramatically accelerated skin cancer research over the past decade, and their applications have greatly expanded into other skin disorders. However, the features of an SCN in dermoscopy and RCM have yet to be reported previously. Combining these novel approaches with conventional histopathological examinations is a promising method for increasing diagnostic accuracy. CASE PRESENTATION We report on a case of SCN of the eyelid diagnosed with the aid of dermoscopy and RCM. A 14-year-old male patient who presented with a painless yellowish-white papule on his left upper eyelid was previously diagnosed with a common wart. Unfortunately, treatment with recombinant human interferon gel was not effective. To achieve a correct diagnosis, dermoscopy and RCM were performed. The former showed closely grouped multiple yellowish-white clods surrounded by linear vessels, and the latter exhibited hyperrefractile material nests at the dermal-epidermal junction level. The alternative diagnoses were, therefore, excluded because of in vivo characterizations. Subsequent surgical excision, histological examination, and von Kossa staining were performed. Pathology showed hyperkeratosis of the epidermis, a downward-directed basal-layer expansion, and small amorphous basophilic deposits scattered throughout the papillary dermis. The von Kossa staining confirmed calcium deposits in the lesion. An SCN was then diagnosed. During the 6-month follow-up, no relapse was observed. CONCLUSIONS Patients with SCN could benefit from dermoscopy and RCM, which help achieve an accurate diagnosis. Clinicians should consider the possibility of an SCN for an adolescent patient with painless yellowish-white papules.
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Affiliation(s)
- Xiaomei Zhu
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Xiaoyan Zhang
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China
| | - Kun Yang
- Department of Dermatology and Venereology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China.
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7
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Pichler M, Thuile T, Eisendle K. A rare case of agminated juvenile Xanthogranuloma: Clinical and dermatoscopic evolution. J Eur Acad Dermatol Venereol 2023; 37:e418-e420. [PMID: 36178140 DOI: 10.1111/jdv.18618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Pichler
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Hospital Bolzano/Bozen, Bolzano, Italy
| | - Tobias Thuile
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Hospital Bolzano/Bozen, Bolzano, Italy
| | - Klaus Eisendle
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Hospital Bolzano/Bozen, Bolzano, Italy.,Claudiana Research, University Pool of Health-Care Professions Claudiana, Bolzano, Bozen, Italy
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Wegher LSM, Kazmarek LM, Silva ACF, Maciel MG, Sasso BM, Teixeira F, Cintra ML. What is the Role of Different Macrophage Subsets in the Evolution of Juvenile Xanthogranulomas? Appl Immunohistochem Mol Morphol 2022; 30:e54-e58. [PMID: 35435864 DOI: 10.1097/pai.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
Abstract
There are several activated forms of macrophages: 2 main groups are designated M1 and M2. While M1 macrophages have proinflammatory, bactericidal, and phagocytic functions and are the dominant phenotype observed in the early stages of inflammation, M2 macrophages are involved in constructive processes such as tissue repair; they play a role in wound healing and are required for revascularization and re-epithelialization. Juvenile xanthogranuloma (JXG) is the most common non-Langerhans cell histiocytosis. Its pathogenesis is not well understood, but it is not considered a neoplastic entity. JXGs possibly appear as a reaction to a nonspecific injury such as trauma or viral infection, although a genetic predisposition has been suggested in some cases. Tissue damage leads to a histiocytic response. JXGs appear, evolve toward maturation, and then most of them spontaneously regress. Young JXGs are characterized by small macrophages scattered in the dermis, in apposition close to the epidermis. As the lesion matures, the number of foamy macrophages and Touton cells increases and other cell types such as plasma cells, lymphocytes, and polymorphs are observed. Regressing xanthogranulomas will show numerous spindle cells in Significant values are in bold.a storiform distribution, interstitial fibrosis, and few foamy and Touton cells. In this study, we studied the immunophenotypic profile of macrophages found in cutaneous JXGs according to their stage of maturation. We examined the skin biopsies from 25 patients; all were embedded in paraffin and stained with hematoxylin and eosin and for immunohistochemistry. Typically, all JXGs were positive for factor XIIIa and CD4, and were negative for CD1a. The following histiocyte markers were used: CD68, CD204, CD163, MAC387, and HAM56. Images were analyzed by Image J software; data were statistically evaluated by SAS 9.0 software. The cases showed a slight predominance of males and the preference of the JXGs for the axial skin. Lesions occupied the papillary and reticular dermis in 85% of the cases and extended to the subcutaneous fat in the remainder. Compared with mature and regressing JXGs, younger lesions had a higher density of M1 macrophages, stained with MAC387. This antibody labels the histiocytes that have recently arrived in the areas of inflammation. As the lesions matured, there was an overwhelming predominance of M2 macrophages. These cells tended to cluster against the epidermis, except in the 2 cases in phase of regression. This suggests that there is a cross-talk between the epidermis and macrophages and that receptors, cytokines, chemokines, and adhesion molecules may play a role in the development and evolution of JXGs. These results indicate that, for most of their life, JXGs are formed by repairing M2 macrophages and are not just an M1 macrophagic response to a local antigen. The process appears to be influenced by chemical-mediator epidermal-macrophage cross-talking, considering the tendency of these cells to accumulate against the dermoepidermal junction.
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Affiliation(s)
- Lissa S M Wegher
- Departments of Pathology
- Dermatology, School of Medical Sciences, State University of Campinas, Sao Paulo, Brazil
| | | | | | - Marina G Maciel
- Dermatology, School of Medical Sciences, State University of Campinas, Sao Paulo, Brazil
| | - Bruna M Sasso
- Departments of Pathology
- Dermatology, School of Medical Sciences, State University of Campinas, Sao Paulo, Brazil
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Di Brizzi EV, Moscarella E, Scharf C, Argenziano G, Piccolo V. Dermoscopy of juvenile xanthogranuloma: a retrospective descriptive study on 35 paediatric patients. J Eur Acad Dermatol Venereol 2022; 36:e846-e848. [PMID: 35686664 DOI: 10.1111/jdv.18316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Affiliation(s)
- E V Di Brizzi
- Dermatology Unit, University of Campania, Naples, Italy
| | - E Moscarella
- Dermatology Unit, University of Campania, Naples, Italy
| | - C Scharf
- Dermatology Unit, University of Campania, Naples, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania, Naples, Italy
| | - V Piccolo
- Dermatology Unit, University of Campania, Naples, Italy
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Salari B, Dehner LP. Juvenile and adult xanthogranuloma: A 30-year single-center experience and review of the disorder and its relationship to other histiocytoses. Ann Diagn Pathol 2022; 58:151940. [DOI: 10.1016/j.anndiagpath.2022.151940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/01/2022]
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Juvenile Xanthogranuloma: A Comparative Immunohistochemical Study of Factor XIIIa, CD11c, and CD4. Am J Dermatopathol 2022; 44:493-498. [PMID: 35315372 DOI: 10.1097/dad.0000000000002185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
ABSTRACT Juvenile xanthogranuloma is a group C and L non-Langerhans cell histiocytosis, and its cell of origin is still debatable. The expression of CD11c, a more recently described macrophage marker, and CD4 have not been studied comprehensively. This study aimed to expand immunophenotypic profile and hence our understanding of the origin of these lesions. The surgical pathology archive was searched for the cases with the pathologic diagnosis of "xanthogranuloma" from 1995 to 2019. Immunohistochemical (IHC) stains were performed for factor XIIIa, CD11c, and CD4. Morphologically, each lesion was classified into early classic, classic, or transitional subtypes. Seventy-seven cases were included with the median age of 7.8 years (male:female 1.3:1). Uniform positivity was noticed for CD4 (n = 77), CD68 (n = 37), CD163 (n = 5), and vimentin (n = 4) stains. Other stains included CD11c 75/77 (97.4%), factor XIIIa 71/76 (93.4%), S-100 protein 4/23 (17.4%), and CD1a 0/18 (0%). Despite insignificant association between morphologic subtype and main studied IHC stains, factor XIIIa reactivity was highest in transitional lesions and CD11c showed higher reactivity in early classic lesions. CD11c and CD4 are sensitive markers and showed promising results in the diagnosis of juvenile xanthogranuloma compared with factor XIIIa. Despite different reactivity of factor XIIIa and CD11c in various morphologic subtypes, such association was statistically insignificant.
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Wee LWY, Ling HY, Ho VPY, Foong AYW, Koh MJA. Juvenile xanthogranulomas in Asian children. Dermatol Ther 2021; 35:e15224. [PMID: 34820973 DOI: 10.1111/dth.15224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/19/2021] [Indexed: 01/04/2023]
Abstract
Juvenile xanthogranuloma (JXG) is the most common non-Langerhans cell histiocytic disorder. It can rarely be associated with systemic involvement. There is a paucity of literature on JXG in Asian children. We aim to describe the epidemiology, clinical features, systemic associations, histological features and outcome of a cohort of Asian children with JXG, and review the literature on the condition. We retrospectively reviewed the demographic, clinical and histological data of patients less than 16 years of age, diagnosed with JXG at our tertiary pediatric hospital between January 2002 and April 2019. A total of 147 children with JXG were identified, with a slight male preponderance of 53.1%. The median age of the onset was 15.5 months, with 69.4% presenting before 2 years of age. There was no racial predilection. The most frequently involved site was the head and neck region (44.2%). The majority of patients (76.2%) presented with a solitary lesion. Spontaneous resolution was documented in 57.7% of our patients with mean duration to resolution of 18.8 months. The proportion and speed of resolution did not differ in children with single or multiple lesions. No ophthalmologic complications were detected in our study cohort. JXG in children is generally limited to the skin and is rarely associated with systemic involvement, including the eye. Unless clinically indicated, the results from our study does not support routine screening for juvenile myelomonocytic leukemia, eye or systemic complications, even in the setting of multiple cutaneous JXGs.
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Affiliation(s)
- Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Hua Yen Ling
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | | | - Alice Yee Wah Foong
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
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Yellowish nodular changes in infants - juvenile xanthogranuloma and xanthoma. Postepy Dermatol Alergol 2021; 38:159-162. [PMID: 34408584 PMCID: PMC8362781 DOI: 10.5114/ada.2021.104292] [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: 10/10/2018] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
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Schäfer S, Sies K, Haenssle HA, Toberer F. Differenzialdiagnosen nodulärer Hauttumoren im Kindesalter. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bhat YJ, Jha AK. Dermatoscopy of Inflammatory Diseases in Skin of Color. Indian Dermatol Online J 2021; 12:45-57. [PMID: 33768022 PMCID: PMC7982019 DOI: 10.4103/idoj.idoj_613_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/02/2020] [Accepted: 12/20/2020] [Indexed: 11/04/2022] Open
Abstract
Dermatoscopy is a relevant in vivo diagnostic tool for inflammatory diseases of the skin that aids not only in diagnosis, but also in monitoring the response to treatment. The inflammatory diseases show dermoscopic patterns involving the vessels, scales, follicles, background hue, and special clues. This review aims to provide an overview on the use of dermoscopy in inflammatory dermatoses based on the available literature and the deviation from it in the skin of color (SOC) as there is paucity of literature in dermoscopy of inflammatory disorders in SOC. The dermatoscopic patterns in most of the inflammatory diseases in SOC are similar to that of white skin, with pigmentary changes being the prominent dermoscopic findings while vascular patterns and erythema being less evident.
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Affiliation(s)
- Yasmeen J Bhat
- Department of Dermatology, Venereology and Leprosy, Government Medical College, Srinagar, University of Kashmir, Jammu and Kashmir, India
| | - Abhijeet K Jha
- Department of Skin and VD, Patna Medical College, Patna, Bihar, India
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Xu J, Ma L. Dermoscopic Patterns in Juvenile Xanthogranuloma Based on the Histological Classification. Front Med (Lausanne) 2021; 7:618946. [PMID: 33521026 PMCID: PMC7838354 DOI: 10.3389/fmed.2020.618946] [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: 10/19/2020] [Accepted: 12/10/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Several dermoscopic features of juvenile xanthogranuloma (JXG) have been previously described in single cases or small case series and need to be further verified in a large sample. Objective: We aimed to investigate the dermoscopic patterns of JXG in a large case series and the correlations of these with clinical features of different histopathological subtypes of JXG. Methods: Patients who underwent dermoscopic evaluation and had a histopathological diagnosis of JXG were recruited. Histological findings, including stage and Ki67 proliferative index and the dermoscopic features of each lesion were recorded. Results: Forty-one patients with JXG were included. The male to female ratio was 1.28: 1 and the median age of onset was 11 months (range: 0–95 months). Fourteen lesions were histologically categorized in the early stage, 17 in the developed stage, and 10 in the late stage. The “setting sun” pattern was observed in 35 lesions (85.4%) and “clouds” of paler yellow areas in 26 lesions (63.4%). The frequency of the “setting sun” pattern was higher in the early and developed stages (30/31) than in the late stage (5/10) (P = 0.002), while that of “clouds” of paler yellow areas was not significantly different between each stage. Branched linear vessels were detected in the early (11/14) and developed stage (6/17), but not in the late stage. The mean Ki67 index of the lesions with linear vessels was 11.8% (range: 2–40%), which was higher than that of lesions without linear vessels (mean index: 5%, range: 1–30%) (P = 0.005). The pigment network and whitish areas were only detected in 6 and 5 lesions in the late stage, respectively. The whitish areas presented either as streak or stellate shape. The pigment network exhibited either in a centric or a peripheral pattern. Conclusions: The “setting sun” pattern is the characteristic dermoscopic features of JXG in the early and developed stages, while whitish areas and pigment network are the characteristic patterns in the late stage. Linear vessels present as branched patterns and mostly occur in the early stage with a high proliferative index, indicating rapid growth. The whitish areas and pigment network may present in various patterns. Dermoscopy is a useful adjunctive tool in the diagnosis and staging of JXG.
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Affiliation(s)
- Jiaosheng Xu
- Department of Dermatology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lin Ma
- Department of Dermatology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Dermoscopic and reflectance confocal microscopic findings of cutaneous Rosai-Dorfman disease. Chin Med J (Engl) 2020; 134:112-114. [PMID: 33278096 PMCID: PMC7862820 DOI: 10.1097/cm9.0000000000001271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Peruilh-Bagolini L, Silva-Astorga M, Hernández San Martín MJ, Manoli MS, Papageorgiou C, Apalla Z, Lallas A. Dermoscopy of Juvenile Xanthogranuloma. Dermatology 2020; 237:946-951. [PMID: 33075787 DOI: 10.1159/000510265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dermoscopy is useful for the evaluation of juvenile xanthogranuloma (JXG). The classical "setting sun" pattern is characteristic of JXG, but its sensibility appears to be limited. An extensive description of other dermoscopic findings is not available in the literature. OBJECTIVES The aim of this study was to valuate and describe the clinical and dermoscopic characteristics of a series of JXG cases. METHODS This is a retrospective descriptive study, including cases with histopathologic diagnosis of JXG, and the availability of clinical and dermoscopic images, assessed for the presence of dermoscopic features based on the available literature. RESULTS A total of 17 lesions were analyzed. 70.6% showed global symmetry, 35.3% presented the typical "setting sun" pattern. All lesions showed yellow-orange and/or pink-red structureless color. Other dermoscopic features were yellow globules (35.3%), shiny white streaks (23.5%), brown globules (17.6%), pale-brown network (11.8%), negative network (11.8%), erosion/ulceration (11.8%), rosettes (5.9%), and hemorrhage (5.9%). Scales were seen in 64.7% of patients. Vascular structures were observed in all the lesions, mostly in an irregular distribution (76.5%). The observed vessel types were dotted (52.9%), linear (52.9%), branching-arboriform (29.4%), comma-like (23.5%), hairpin-like (17.6%), globular (17.6%), coiled (11.8%), and milky-red globules (5.9%). CONCLUSIONS Symmetry, yellow/orange-pink/red color, yellow globules, shiny white streaks, and irregularly distributed different types of vascular structures are the main dermoscopic features of JXG. This is the largest dermoscopic registry of JXG published to date.
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Affiliation(s)
| | - Mariana Silva-Astorga
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | | | | | | | - Zoe Apalla
- Second Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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A Persistent "Pimple" in a 5-Year-Old Girl. J Pediatr 2020; 224:172-173. [PMID: 32525039 DOI: 10.1016/j.jpeds.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/21/2022]
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Pigem R, Dyer A, Podlipnik S, Carrera C, Puig S, Ferrando J. Dermoscopy of Congenital Langerhans Cell Histiocytosis. Dermatol Pract Concept 2020; 10:e2020063. [PMID: 32642313 DOI: 10.5826/dpc.1003a63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ramon Pigem
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Ariann Dyer
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sebastian Podlipnik
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Cristina Carrera
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Susana Puig
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Juan Ferrando
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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21
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So N, Liu R, Hogeling M. Juvenile xanthogranulomas: Examining single, multiple, and extracutaneous presentations. Pediatr Dermatol 2020; 37:637-644. [PMID: 32468628 DOI: 10.1111/pde.14174] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis characterized by yellowish papules in the skin. JXGs most often occur in infancy or early childhood and are typically solitary and asymptomatic, often regressing after several years. While JXGs predominantly occur on the skin, extracutaneous JXGs also exist. AIMS In this paper, we review the literature on single, multiple, and visceral JXGs and provide recommendations on monitoring and work-up. MATERIALS & METHODS A literature review was conducted with the PubMed database using selective search terms for single, multiple, ocular, and visceral lesions as well as NF1/JMML. RESULTS / DISCUSSION JXG is typically a self-limited disorder if lesions are cutaneous and singular. While rare, JXGs may manifest as multiple and extracutaneous lesions. Further screening and referral to specialists may be warranted in these cases based on age and extent of involvement. CONCLUSION Our review demonstrates common presentations of single, multiple, and extracutaneous lesions in addition to those that occur with NF1 and JMML. We suggest patients be evaluated on a case-by-case basis by a dermatologist and referred to specialists as appropriate.
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Affiliation(s)
- Naomi So
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Regina Liu
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Marcia Hogeling
- Division of Dermatology, UCLA Department of Medicine, Los Angeles, California
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22
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Calderón-Castrat X, Kikushima I, Ballona R. Multiple Acral Papules. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2018.05.038] [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] Open
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23
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Errichetti E, Zalaudek I, Kittler H, Apalla Z, Argenziano G, Bakos R, Blum A, Braun RP, Ioannides D, Lacarrubba F, Lazaridou E, Longo C, Micali G, Moscarella E, Paoli J, Papageorgiou C, Russo T, Scope A, Stinco G, Thomas L, Toncic RJ, Tschandl P, Cabo H, Hallpern A, Hofmann-Wellenhof R, Malvehy J, Marghoob A, Menzies S, Pellacani G, Puig S, Rabinovitz H, Rudnicka L, Vakirlis E, Soyer P, Stolz W, Tanaka M, Lallas A. Standardization of dermoscopic terminology and basic dermoscopic parameters to evaluate in general dermatology (non-neoplastic dermatoses): an expert consensus on behalf of the International Dermoscopy Society. Br J Dermatol 2019; 182:454-467. [PMID: 31077336 DOI: 10.1111/bjd.18125] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Over the last few years, several articles on dermoscopy of non-neoplastic dermatoses have been published, yet there is poor consistency in the terminology among different studies. OBJECTIVES We aimed to standardize the dermoscopic terminology and identify basic parameters to evaluate in non-neoplastic dermatoses through an expert consensus. METHODS The modified Delphi method was followed, with two phases: (i) identification of a list of possible items based on a systematic literature review and (ii) selection of parameters by a panel of experts through a three-step iterative procedure (blinded e-mail interaction in rounds 1 and 3 and a face-to-face meeting in round 2). Initial panellists were recruited via e-mail from all over the world based on their expertise on dermoscopy of non-neoplastic dermatoses. RESULTS Twenty-four international experts took part in all rounds of the consensus and 13 further international participants were also involved in round 2. Five standardized basic parameters were identified: (i) vessels (including morphology and distribution); (ii) scales (including colour and distribution); (iii) follicular findings; (iv) 'other structures' (including colour and morphology); and (v) 'specific clues'. For each of them, possible variables were selected, with a total of 31 different subitems reaching agreement at the end of the consensus (all of the 29 proposed initially plus two more added in the course of the consensus procedure). CONCLUSIONS This expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This tool, if adopted by clinicians and researchers in this field, is likely to enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology. What's already known about this topic? Over the last few years, several papers have been published attempting to describe the dermoscopic features of non-neoplastic dermatoses, yet there is poor consistency in the terminology among different studies. What does this study add? The present expert consensus provides a set of standardized basic dermoscopic parameters to follow when evaluating inflammatory, infiltrative and infectious dermatoses. This consensus should enhance the reproducibility and comparability of existing and future research findings and uniformly expand the universal knowledge on dermoscopy in general dermatology.
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Affiliation(s)
- E Errichetti
- Institute of Dermatology, 'Santa Maria della Misericordia' University Hospital, Udine, Italy
| | - I Zalaudek
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - H Kittler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Z Apalla
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - G Argenziano
- Dermatology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - R Bakos
- Department of Dermatology, Hospital de Clınicas de Porto Alegre, Porto, Alegre, Brazil
| | - A Blum
- Public, Private and Teaching Practice of Dermatology, Konstanz, Germany
| | - R P Braun
- Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
| | - D Ioannides
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - E Lazaridou
- Second Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece
| | - C Longo
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy.,Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Centro Oncologico ad Alta Tecnologia Diagnostica-Dermatologia, Reggio Emilia, Italy
| | - G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - E Moscarella
- Dermatology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - J Paoli
- Department of Dermatology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - C Papageorgiou
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - T Russo
- Dermatology Unit, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - A Scope
- Medical Screening Institute, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - G Stinco
- Institute of Dermatology, 'Santa Maria della Misericordia' University Hospital, Udine, Italy
| | - L Thomas
- Department of Dermatology, Lyon University, Lyon, France
| | - R J Toncic
- Dermoscopy Unit, University of Zagreb, Zagreb, Croatia
| | - P Tschandl
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - H Cabo
- Dermatology Institute of Medical Research, University of Buenos Aires, Buenos Aires, Argentina
| | - A Hallpern
- Memorial Sloan Kettering Cancer Center, Hauppauge, NY, U.S.A
| | | | - J Malvehy
- Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Universitat de Barcelona IDIBAPS, Barcelona, Spain
| | - A Marghoob
- Memorial Sloan Kettering Cancer Center, Hauppauge, NY, U.S.A
| | - S Menzies
- Discipline of Dermatology, Sydney Medical School, The University of Sydney and Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - S Puig
- Melanoma Unit, Dermatology Department, Hospital Clinic Barcelona, Universitat de Barcelona IDIBAPS, Barcelona, Spain
| | - H Rabinovitz
- Skin and Cancer Associates, Plantation, FL, U.S.A
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - E Vakirlis
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - P Soyer
- Dermatology Research Centre, The University of Queensland Diamantina Institute, Woolloongabba, QLD, Australia
| | - W Stolz
- Department of Dermatology and Allergology and Environmental Medicine Clinic Thalkirchen, Hospital Munich, Munich, Germany
| | - M Tanaka
- Department of Dermatology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - A Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
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24
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Lacarrubba F, Verzì AE, Barresi S, Micali G. Multiple xanthogranulomas in an adult patient: clinical, dermoscopic, reflectance confocal microscopy and histopathological features. BMJ Case Rep 2019; 12:12/7/e229772. [PMID: 31266759 DOI: 10.1136/bcr-2019-229772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A case of multiple xanthogranulomas located bilaterally on arms, armpits, legs, trunk, abdomen, scalp, neck and plantar surfaces in a 25-year-old man is reported. The patient was evaluated by polarised light dermoscopy and reflectance confocal microscopy (RCM) that showed peculiar aspects. In particular, dermoscopy showed a homogeneous orange-yellowish hue that is related to the histopathological presence of foamy histiocytes and Touton giant cells; the last typically appeared at RCM as peculiar giant cells surrounded by highly refractive ring due to the cytoplasm rich of lipids. Laboratory investigations, including routine haematological examination, liver and renal function tests, serum lipid and sugar levels were normal. The patient started isotretinoin 20 mg once daily. After 6 months, some lesions flattened, leading to yellowish or hyperpigmented macules, but new lesions raised up.
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25
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Lastrucci I, Gunnella S, Mariotti G, Grandi V. Shiny white streaks in juvenile xanthogranuloma: a worrisome feature in a benign disorder. GIORN ITAL DERMAT V 2019; 153:733-734. [PMID: 30246956 DOI: 10.23736/s0392-0488.17.05653-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Irene Lastrucci
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence Medical School, Florence, Italy -
| | - Susanna Gunnella
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence Medical School, Florence, Italy
| | - Giulia Mariotti
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence Medical School, Florence, Italy
| | - Vieri Grandi
- Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence Medical School, Florence, Italy
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26
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Calderón-Castrat X, Kikushima I, Ballona R. Multiple Acral Papules. ACTAS DERMO-SIFILIOGRAFICAS 2019; 110:855-856. [PMID: 31130243 DOI: 10.1016/j.ad.2018.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/27/2018] [Accepted: 05/01/2018] [Indexed: 10/26/2022] Open
Affiliation(s)
- X Calderón-Castrat
- Servicio de Dermatología Pediátrica, Instituto Nacional de Salud del Niño San Borja, Lima, Perú.
| | - I Kikushima
- Servicio de Dermatología Pediátrica, Instituto Nacional de Salud del Niño Breña, Lima, Perú
| | - R Ballona
- Servicio de Dermatología Pediátrica, Instituto Nacional de Salud del Niño Breña, Lima, Perú
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27
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Behera B, Malathi M, Thappa DM, Gochhait D, Srinivas BH, Toi PC. Dermoscopic features of three cases of Langerhans cell histiocytosis. Indian J Dermatol Venereol Leprol 2018; 84:730-735. [PMID: 30289121 DOI: 10.4103/ijdvl.ijdvl_737_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Biswanath Behera
- Department of Dermatology, Venereology and Leprology, JIPMER, Puducherry, India
| | - Munisamy Malathi
- Department of Dermatology, Venereology and Leprology, JIPMER, Puducherry, India
| | | | | | | | - Pampa Ch Toi
- Department of Pathology, JIPMER, Puducherry, India
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28
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Peter DCV, Thomas AL, Pulimood SA, Thomas M. Setting sun pattern in dermoscopy of a scalp nodule. Australas J Dermatol 2018; 60:71-72. [PMID: 30175842 DOI: 10.1111/ajd.12912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Dincy C V Peter
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, India
| | - Anju Liya Thomas
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, India
| | - Susanne A Pulimood
- Department of Dermatology, Venereology and Leprosy, Christian Medical College, Vellore, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, India
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29
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Hollins LC, Weyant GW, Gibbs MB, Seiverling EV. An eruption of yellow-red papules on the trunk, arms, and legs of an adult. Dermatol Pract Concept 2018; 8:177-179. [PMID: 30116659 PMCID: PMC6092065 DOI: 10.5826/dpc.0803a05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/26/2018] [Indexed: 11/25/2022] Open
Affiliation(s)
- L Claire Hollins
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Grace W Weyant
- Department of Pathology, Lancaster General Health, Lancaster, PA, USA
| | | | - Elizabeth V Seiverling
- Department of Dermatology, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Family and Community Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
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30
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Lacarrubba F, Ardigò M, Di Stefani A, Verzì AE, Micali G. Dermatoscopy and Reflectance Confocal Microscopy Correlations in Nonmelanocytic Disorders. Dermatol Clin 2018; 36:487-501. [PMID: 30201157 DOI: 10.1016/j.det.2018.05.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dermatoscopy and in vivo reflectance confocal microscopy are noninvasive techniques that provide a horizontal approach, with an en face view of the skin structures. Both techniques assist in the clinical diagnosis of a variety of inflammatory and infectious cutaneous disorders. In many cases, they have shown concordance. Their combined use represents, in several instances, a promising option to reach the final diagnosis without the need for invasive procedures.
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Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
| | - Marco Ardigò
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | | | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
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31
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Micali G, Verzì AE, Quattrocchi E, Ng CY, Lacarrubba F. Dermatoscopy of Common Lesions in Pediatric Dermatology. Dermatol Clin 2018; 36:463-472. [PMID: 30201155 DOI: 10.1016/j.det.2018.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The use of dermatoscopy to assist in the diagnosis of a variety of proliferative, pigmentary, inflammatory, infectious, congenital, and genetic cutaneous and skin appendage disorders is constantly increasing, as it is effective, affordable, noninvasive, and quick to perform.
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Affiliation(s)
- Giuseppe Micali
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy.
| | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy
| | - Enrica Quattrocchi
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy
| | - Chau Yee Ng
- Department of Dermatology, College of Medicine, Chang Gung Memorial Hospital, No. 199, Tun-Hwa North Road, Taipei 105, Taiwan
| | - Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via S. Sofia 78, Catania 95123, Italy
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32
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Abstract
Although diagnosis of cutaneous granulomatous disorders (CGDs) is usually suspected based on morphologic findings, localization, and anamnestic data, clinical differentiation from each other and from similar dermatoses may be challenging. Recently, dermatoscopy has been demonstrated to be a useful tool for assisting the recognition of several CGDs. This article provides a current overview of the dermatoscopic features of the main noninfectious and infectious CGDs, including sarcoidosis, necrobiosis lipoidica, granuloma annulare, rheumatoid nodules, and leishmaniasis. Other, less common, CGDs are briefly addressed, including granulomatous rosacea, acne agminata, and leprosy.
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Affiliation(s)
- Enzo Errichetti
- Department of Medical Area, Institute of Dermatology, University of Udine, Udine, Italy.
| | - Giuseppe Stinco
- Department of Medical Area, Institute of Dermatology, University of Udine, Udine, Italy
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33
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Is the setting sun dermoscopic pattern specific to juvenile xanthogranuloma? J Am Acad Dermatol 2018; 78:e49. [PMID: 29332728 DOI: 10.1016/j.jaad.2017.09.079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 11/21/2022]
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34
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Ladha MA, Haber RM. Giant Juvenile Xanthogranuloma: Case Report, Literature Review, and Algorithm for Classification. J Cutan Med Surg 2018; 22:488-494. [DOI: 10.1177/1203475418777734] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Juvenile xanthogranuloma (JXG) is a member of the non-Langerhans cell group of proliferative disorders of mononuclear phagocytes. JXG is a benign tumour of histiocytic cells. Classic JXG is divided into 2 main clinical subtypes: dome-shaped papules (<0.5 cm) and single/multiple nodules (<2.0 cm). A rare variant is referred to as giant; this term encompasses JXG lesions larger than 2.0 cm. In this article, we report a case of a congenital cutaneous giant JXG. In addition, we reviewed and analyzed all cases (n = 51) of giant JXG reported in the English literature. We propose an algorithm for classifying giant JXG based on the following factors: onset of lesions (congenital and acquired), number of lesions (solitary ± satellites and multiple), morphology of cutaneous/mucosal lesions (plaque, nodular, ulcerated-nodular, macular, and other), and extracutaneous manifestations.
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Affiliation(s)
- Malika A. Ladha
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Richard M. Haber
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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35
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Geller S, Pulitzer M, Myskowski PL. Solitary orange papule on the back of a middle-aged man. Dermatol Pract Concept 2018; 8:51-53. [PMID: 29445576 PMCID: PMC5808373 DOI: 10.5826/dpc.0801a11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/03/2017] [Indexed: 11/04/2022] Open
Affiliation(s)
- Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA
| | - Melissa Pulitzer
- Department of Pathology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY, USA
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36
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de Oliveira TE, Tarlé RG, Mesquita LADF. Dermoscopy in the diagnosis of juvenile xanthogranuloma. An Bras Dermatol 2018; 93:138-140. [PMID: 29641718 PMCID: PMC5871383 DOI: 10.1590/abd1806-4841.20186849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/03/2017] [Indexed: 02/03/2023] Open
Abstract
Juvenile xanthogranuloma is the most common form of non-Langerhans cell histiocytosis. It manifests clinically as a red-yellow papule, usually showing spontaneous remission. The diagnosis is based on clinical and histological findings. We report the use of dermoscopy ("setting sun" pattern) as an adjuvant tool in the diagnosis of juvenile xanthogranuloma in a female patient presenting with a 2-month history of a pre-auricular papule.
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Affiliation(s)
| | - Roberto Gomes Tarlé
- Dermatology Department at Hospital Santa Casa
de Curitiba - Curitiba (PR), Brazil
- Discipline of Dermatology at Pontifícia
Universidade Católica do Paraná (PUC-PR) - Curitiba (PR), Brazil
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37
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López-Robles J, Núñez L, Macias-Del-Toro E, Ramírez-Bellver JL, Díaz JL, Requena L. Juvenile xanthogranuloma with angiomatous appearance and a peculiar immunophenotype. Pediatr Dermatol 2018; 35:e55-e56. [PMID: 29165834 DOI: 10.1111/pde.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Juvenile xanthogranuloma is the most common form of non-Langerhans cell histiocytosis in childhood. The clinical differential diagnosis of a solitary juvenile xanthogranuloma includes molluscum contagiosum, Spitz nevus, and melanoma. Lesions larger than 2 cm in diameter may be misdiagnosed as hemangiomas, but this is not typical of smaller juvenile xanthogranuloma. We report a case of solitary juvenile xanthogranuloma in a 10-year-old boy with angiomatous appearance and peculiar immunophenotype.
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Affiliation(s)
- Joaquín López-Robles
- Department of Dermatology, Hospital Universitario Fundacion Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - Lucía Núñez
- Department of Dermatology, Hospital Universitario Fundacion Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - Elena Macias-Del-Toro
- Department of Dermatology, Hospital Universitario Fundacion Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - José Luis Ramírez-Bellver
- Department of Dermatology, Hospital Universitario Fundacion Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - José Luis Díaz
- Department of Dermatology, Hospital Universitario Fundacion Jiménez Diaz, Universidad Autónoma, Madrid, Spain
| | - Luis Requena
- Department of Dermatology, Hospital Universitario Fundacion Jiménez Diaz, Universidad Autónoma, Madrid, Spain
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38
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Vinay K, Sawatkar GU, Saikia UN, Dogra S. Dermatoscopic features of xanthoma disseminatum. Int J Dermatol 2017; 56:1175-1176. [PMID: 28940376 DOI: 10.1111/ijd.13788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/26/2017] [Accepted: 08/28/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Gitesh U Sawatkar
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Uma N Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Ayhan E, Aktaş H. Dermoscopic features and types of orf and milker's nodule. Postepy Dermatol Alergol 2017; 34:357-362. [PMID: 28951712 PMCID: PMC5560185 DOI: 10.5114/ada.2017.69317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 05/01/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Orf and milker's nodule are zoonotic cutaneous diseases generated by parapoxviruses. Contribution of dermoscopy to the diagnosis of these diseases has not been studied in the medical literature as to our knowledge. AIM To investigate whether dermoscopy is a valuable diagnostic tool in orf and milker's nodule diagnosis or not. MATERIAL AND METHODS In this study, macroscopic and dermoscopic features have been evaluated by including 46 lesions of 32 patients who have orf and milker's nodule. RESULTS 56.5% (26) of lesions were orf, while 43.5% (20) of lesions were milker's nodule (MN). Non-vascular dermoscopic structures have been determined as follows: blue-gray area (23.1% of orf, 35% of MN), orange-yellow streaks (19.2% of orf, 19.2% of MN), grayish-whitish streaks (26.9% of orf, 55% of MN), central yellow-white area (26.9% of orf, 35% of MN), crust (46.2% of orf, 40% of MN), erosion-ulceration (69.2% of orf, 55% of MN), yellow-white globule (11.5% of orf, 15% of MN), and yellow-white ring (57.7% of orf, 35% of MN). Limitations: Lack of PCR analysis, based of patient anamnesis types of orf and milker's nodule. CONCLUSIONS No significant dermoscopic differences have been determined between orf and milker's nodule patients' lesions. In our opinion, dermoscopy may be a useful tool to develop diagnosis of these diseases.
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Affiliation(s)
- Erhan Ayhan
- Department of Dermatology, Selahaddin Eyyubi State Hospital, Diyarbakır, Turkey
| | - Hamza Aktaş
- Department of Dermatology, Diyarbakır Ergani State Hospital, Diyarbakır, Turkey
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40
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Satomura H, Ogata D, Arai E, Tsuchida T. Dermoscopic features of ocular and extraocular sebaceous carcinomas. J Dermatol 2017. [PMID: 28631273 DOI: 10.1111/1346-8138.13905] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sebaceous carcinomas are rare but potentially fatal malignant adenocarcinomas with varying degrees of sebaceous differentiation. Several dermoscopic findings of extraocular sebaceous carcinomas have been reported; however, there are no previous reports of ocular sebaceous carcinomas detected using dermoscopy. We present a case of ocular sebaceous carcinomas showing specific findings from dermoscopy, and describe the common dermoscopic characteristics. In our cases and a review of cases in the literature, we noted that polymorphous vessels and yellowish areas were observed in all eight cases. Thus, we consider that dermoscopic findings of polymorphous vessels with yellow backgrounds suggest sebaceous carcinoma.
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Affiliation(s)
- Hanae Satomura
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Dai Ogata
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Eichi Arai
- Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Tetsuya Tsuchida
- Department of Dermatology, Saitama Medical University, Saitama, Japan
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41
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Paolino G, Cota C, Giona F, Donati P, Lora V, Moliterni E, Santopietro M, Calvieri S, Carbone A, Zalaudek I. The different dermoscopic features of the yellow background in Langerhans and non-Langerhans cells histiocytosis. Clin Exp Dermatol 2017; 42:679-682. [PMID: 28543371 DOI: 10.1111/ced.13137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- G Paolino
- Dermatological Clinic, La Sapienza University of Rome, Viale del Policlinico 15, 00186, Rome, Italy
| | - C Cota
- Dermatopathological Laboratory, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - F Giona
- Department of Cellular Biotechologies and Haematology, La Sapienza University of Rome, Viale del Policlinico 15, 00186, Rome, Italy
| | - P Donati
- Dermatopathological Laboratory, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - V Lora
- Clinical Department, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - E Moliterni
- Dermatological Clinic, La Sapienza University of Rome, Viale del Policlinico 15, 00186, Rome, Italy
| | - M Santopietro
- Department of Cellular Biotechologies and Haematology, La Sapienza University of Rome, Viale del Policlinico 15, 00186, Rome, Italy
| | - S Calvieri
- Dermatological Clinic, La Sapienza University of Rome, Viale del Policlinico 15, 00186, Rome, Italy
| | - A Carbone
- Department of Oncologic Dermatology, San Gallicano Dermatologic Institute, IRCCS, Rome, Italy
| | - I Zalaudek
- Dermatology Department, Medical University of Graz, Auenbruggerplatz, Graz, Austria
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42
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Bañuls J, Arribas P, Berbegal L, DeLeón FJ, Francés L, Zaballos P. Yellow and orange in cutaneous lesions: clinical and dermoscopic data. J Eur Acad Dermatol Venereol 2015; 29:2317-25. [PMID: 26369295 DOI: 10.1111/jdv.13249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/21/2015] [Indexed: 11/30/2022]
Abstract
Colour of the lesions is clue for the clinical and dermoscopic diagnosis. Nevertheless, we have detected in the literature an uneven relevance of the colours as a diagnostic criterion. Thus, while red, brown and blue have taken important role in dermoscopic descriptions, other like yellow and orange have been given much less importance. This article reviews those lesions in which the yellow and orange colours have been considered constitutive or essential for diagnosis, and on the other hand it emphasizes the entities in which may appear these colours and are not well reflected in the literature. We believe that organize all this information will help us in a better understanding of these pathologies.
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Affiliation(s)
- J Bañuls
- Dermatology Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain.,Medicina Clínica Department, Miguel Hernández University, Sant Joan D'Alacant, Alicante, Spain
| | - P Arribas
- Dermatology Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain
| | - L Berbegal
- Dermatology Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain
| | - F J DeLeón
- Dermatology Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain
| | - L Francés
- Dermatology Department, University General Hospital of Alicante, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Alicante, Spain
| | - P Zaballos
- Dermatology Department, Sant Pau i Santa Tecla Hospital, Tarragona, Spain.,Medicina I Cirurgia Department, Rovira I Virgili University, Tarragona, Spain
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Pretel M, Irarrazaval I, Lera M, Aguado L, Idoate MA. Dermoscopic "setting sun" pattern of juvenile xanthogranuloma. J Am Acad Dermatol 2015; 72:S73-5. [PMID: 25500052 DOI: 10.1016/j.jaad.2014.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/15/2014] [Accepted: 09/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Maider Pretel
- Department of Dermatology, University Clinic of Navarra, School of Medicine, Pamplona, Spain.
| | - Isabel Irarrazaval
- Department of Dermatology, University Clinic of Navarra, School of Medicine, Pamplona, Spain
| | - Miguel Lera
- Department of Dermatology, University Clinic of Navarra, School of Medicine, Pamplona, Spain
| | - Leyre Aguado
- Department of Dermatology, University Clinic of Navarra, School of Medicine, Pamplona, Spain
| | - Miguel Angel Idoate
- Department of Pathology, University Clinic of Navarra, School of Medicine, Pamplona, Spain
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Ghahramani GK, Swick BL, Ciliberto H. Ulcerated Spitz nevus masquerading as a juvenile xanthogranuloma. Pediatr Dermatol 2015; 32:148-50. [PMID: 25441121 DOI: 10.1111/pde.12448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of ulcerated atypical Spitz nevi that demonstrated a yellow to light orange background under dermoscopy, which can be seen in juvenile xanthogranuloma (JXG) and is referred to as the "setting sun" appearance. This yellow to orange appearance was due to serous crusting and not histiocytic infiltration, which is seen in JXG. This case highlights overlapping dermatoscopic features between the two skin lesions and polymorphous vascular structures, which are unique to atypical Spitz nevi.
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Affiliation(s)
- Grant K Ghahramani
- Department of Dermatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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45
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Unno T, Minagawa A, Koga H, Uhara H, Okuyama R. Alteration of dermoscopic features in a juvenile xanthogranuloma during follow-up of 43 months. Int J Dermatol 2014; 53:e590-1. [DOI: 10.1111/ijd.12530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Toshinori Unno
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Akane Minagawa
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Hiroshi Koga
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Hisashi Uhara
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
| | - Ryuhei Okuyama
- Department of Dermatology; Shinshu University School of Medicine; Matsumoto Japan
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46
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Mervak J, Amadi U, Khandpur R, Ha Lan TT, Hristov A, Do TT, Maier L, Wang F. Case series of volar juvenile xanthogranuloma: clinical observation of a peripheral rim of hyperkeratosis. J Dermatol 2014; 41:933-6. [PMID: 25227151 DOI: 10.1111/1346-8138.12617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 08/05/2014] [Indexed: 11/30/2022]
Abstract
Juvenile xanthogranuloma is a benign histiocytic tumor predominantly occurring in children as yellowish papules on the head and trunk. Presentations on the volar surfaces are rare and may cause diagnostic confusion with pyogenic granuloma, eccrine poroma and digital fibrokeratoma. We report two patients with unusual presentations of solitary juvenile xanthogranuloma on the palm or sole. Both had lesions lacking the classic yellowish color and demonstrating a well-defined, peripheral hyperkeratotic rim. Histopathological evaluation revealed prominent orthokeratosis corresponding to the rim. Additional histological features, including dermal histiocytes and Touton giant cells, were consistent with the diagnosis of juvenile xanthogranuloma. Given the unusual locations and colors of the lesions, we conclude that histopathological evaluation is central to diagnosing volar juvenile xanthogranuloma. We additionally suggest that juvenile xanthogranuloma should be included in the differential diagnoses of volar lesions displaying a peripheral hyperkeratotic rim.
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Affiliation(s)
- Julie Mervak
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, USA
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47
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Nakamura Y, Nakamura A, Muto M. Solitary spindle cell xanthogranuloma mimicking a spitz nevus. Am J Dermatopathol 2014; 35:865-7. [PMID: 24257193 DOI: 10.1097/dad.0b013e3182840d2d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yoshitaka Nakamura
- Department of Dermatology, Yamaguchi University Graduate School of Medicine, Ube, Japan
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48
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Cinotti E, Perrot JL, Labeille B, Douchet C, Thuret G, Cambazard F. Yellow globules in balloon cell naevus. Australas J Dermatol 2012; 54:268-70. [DOI: 10.1111/ajd.12006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/02/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Elisa Cinotti
- Dermatology; Hôpital Nord; Saint Etienne Cedex 2 France
| | | | | | | | - Gilles Thuret
- Ophthalmology Department; Hôpital Nord; Saint Etienne Cedex 2 France
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49
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Tschandl P, Müllauer L, Kittler H. Systemic mastocytosis associated with chronic myelomonocytic leukemia and xanthogranuloma. Dermatol Pract Concept 2012; 2:203a03. [PMID: 23785605 PMCID: PMC3663351 DOI: 10.5826/dpc.0203a03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 03/31/2012] [Indexed: 11/10/2022] Open
Abstract
A patient with a history of non-diagnostic bone marrow biopsies presented with a red to brown maculopapular rash on the back. Biopsies confirmed multiple xanthogranulomas as well as a mastocytosis. A consequently performed bone marrow biopsy verified a systemic mastocytosis and a chronic myelomonocytic leukemia (CMML) type I. Here, we describe for the first time in the literature a patient with three diseases occurring synchronously: CMML, xanthogranulomas and systemic mastocytosis. Two of them at a time are known to be associated and may be indicative of a common progenitor cell.
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Affiliation(s)
- Philipp Tschandl
- Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Austria
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50
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Avilés-Izquierdo J, Parra Blanco V, Alfageme Roldán F. Dermoscopic Features of Cutaneous Rosai-Dorfman Disease. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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