1
|
Starace M, Iorizzo M, Trüeb RM, Piccolo V, Argenziano G, Camacho FM, Gallyamova Y, Rudnicka L, Umbert I, Lyakhovitsky A, Vañó-Galván S, Goren A, Alessandrini A, Bruni F, Piraccini BM. Erosive pustular dermatosis of the scalp: a multicentre study. J Eur Acad Dermatol Venereol 2020; 34:1348-1354. [PMID: 31954062 DOI: 10.1111/jdv.16211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia. OBJECTIVES AND METHODS We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease. RESULTS Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus. CONCLUSION The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high-potency steroids or tacrolimus, which should be considered as first-line treatment.
Collapse
Affiliation(s)
- M Starace
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
| | - M Iorizzo
- Private Dermatology Practice - Lugano & Bellinzona, Bellinzona, Switzerland
| | - R M Trüeb
- Center for Dermatology and Hair Disease Professor Trüeb, Zürich-Wallisellen, Switzerland
| | - V Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - G Argenziano
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - F M Camacho
- Department of Dermatology, University of Seville, Seville, Spain.,Doctor Honoris Causa from University of Cadiz, Cadiz, Spain
| | - Y Gallyamova
- State Budget Educational Institution of Additional Professional Education "Russian Medical Academy of Postgraduate Education Studies" of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - L Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - I Umbert
- Instituto de Dermatologia Ignacio Umbert (Private Research Institute), Barcelona, Spain
| | - A Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Ramat Gan, Israel
| | - S Vañó-Galván
- Department of Dermatology - Trichology Unit, Ramon y Cajal Hospital, Madrid, Spain
| | - A Goren
- Department of Dermatology, University of Rome G. Marconi, Rome, Italy
| | - A Alessandrini
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
| | - F Bruni
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
| | - B M Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine - Division of Dermatology, University of Bologna, Bologna, Italy
| |
Collapse
|
3
|
Abstract
A patient with necrobiotic xanthogranuloma (NXG) and paraproteinaemia, who was followed-up for several years, and treated with low-dose chlorambucil, died as a result of a respiratory illness. The significant findings at autopsy were a xanthogranuloma of the spleen and giant cell myocarditis. The myocardial lesions were composed of macrophages, giant cells and lymphocytes. This finding is important because four of five known autopsied patients with NXG have had giant cell myocardial disease, and an effort at antemortem diagnosis should be made.
Collapse
Affiliation(s)
- I Umbert
- Mayo Clinic, Scottsdale, AZ 85259, USA
| | | |
Collapse
|
4
|
Umbert I, Winkelmann RK, Wegener L. Comparison of the pathology of fascia in eosinophilic myalgia syndrome patients and idiopathic eosinophilic fasciitis. Dermatology 1993; 186:18-22. [PMID: 8435512 DOI: 10.1159/000247297] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The L-tryptophan eosinophilic myalgia syndrome (EMS) clinically has some similarities with idiopathic eosinophilic fasciitis (EF). In order to study the pathology of both syndromes, we analyzed 21 biopsies of patients with EMS and 8 with idiopathic EF. In both diseases there is dermal and fascial mucin and dermal edema, but this was more common in EMS. EMS is also characterized by dilated lymphatics, dermal and septal sclerosis and macrophage-rich inflammation. Neural inflammation was seen in 4 of the cases with EMS and in none with idiopathic EF. In both syndromes, there are many histopathological similarities. The differences may be due to sampling and to sample size. The nerve lesions of EMS may result from the nature of lymphocyte-macrophage inflammation, or the effect of the eosinophil neurotoxin and may not be a primary event.
Collapse
Affiliation(s)
- I Umbert
- Department of Dermatopathology and Laboratory Medicine, Mayo Clinic, Scottsdale, Ariz
| | | | | |
Collapse
|
5
|
López-Gil F, Roura M, Umbert I, Umbert P. Malignant proliferative angioendotheliomatosis or angiotropic lymphoma associated with a soft-tissue lymphoma. J Am Acad Dermatol 1992; 26:101-4. [PMID: 1732314 DOI: 10.1016/0190-9622(92)70015-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report a 63-year-old man with violaceous nummular patches on the trunk. Histopathologic studies were consistent with a diagnosis of malignant angioendotheliomatosis or angiotropic lymphoma. Immunohistochemical study of skin was positive for UCHL-1 antigen and leukocyte common antigen and negative for L-26, Ulex europaeus lectin I, vimentin, cytokeratin, and epithelial membrane antigen. Ultrastructural study ruled out an endothelial origin of the neoplastic cells. These data confirmed the diagnosis of malignant proliferative angioendotheliomatosis. Five years before, a soft tissue lymphoma had been excised. This is an unusual case of malignant angioendotheliomatosis for the following two reasons: (1) a previous association with a soft tissue lymphoma and (2) the rarely described T immunophenotype of neoplastic lymphoid cells.
Collapse
Affiliation(s)
- F López-Gil
- Dermatology Department, Hospital Sagrado Corazón-Q.S.A., Barcelona, Spain
| | | | | | | |
Collapse
|
7
|
Abstract
We reviewed 15 cases of reticulohistiocytoma cutis (RHC). Three cases were of solitary lesions. Four cases were associated with a destructive arthritis but no other systemic features. One additional patient had a destructive arthritis and lesions of reticulohistiocytoma in synovium, larynx, and mucosa. Three patients had associated xanthelasma. Two cases were associated with internal malignancy (metastatic malignant melanoma, adenocarcinoma of the bowel). Two cases were sequentially associated with systemic vasculitis (Wegener's granulomatosis, periarteritis nodosa). This occurrence of systemic vasculitis in RHC patients is unique. RHC may have variable cutaneous and systemic manifestations and associations with malignancy and immunoinflammatory diseases, including vasculitis.
Collapse
Affiliation(s)
- G F Oliver
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
| | | | | | | |
Collapse
|
8
|
Britton FC, Gawkrodger DJ, McVittie E, Umbert I, Hunter JA. UVB reduces the cutaneous cellular infiltrate of atopic eczema: a preliminary study. Photodermatol 1988; 5:232-4. [PMID: 2975779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- F C Britton
- Department of Dermatology, University of Edinburgh, United Kingdom
| | | | | | | | | |
Collapse
|