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Kalb RE, Helm TN, Sperry H, Thakral C, Abraham JL, Kanal E. Gadolinium-induced nephrogenic systemic fibrosis in a patient with an acute and transient kidney injury. Br J Dermatol 2007; 158:607-10. [PMID: 18076707 DOI: 10.1111/j.1365-2133.2007.08369.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) describes a characteristic fibrosing disorder which typically presents with indurated plaques on the trunk and extremities of patients with advanced renal disease. We present a case of biopsy-confirmed NSF in a patient with severe acute kidney injury with no prior history of renal disease. A 64-year-old man with an acute and severe decrease in glomerular filtration rate underwent magnetic resonance imaging studies with gadolinium contrast (Omniscan) and subsequently developed NSF. His renal disease had normalized at the time his skin disease developed. Skin biopsies revealed findings of NSF and scanning electron microscopy with energy-dispersive X-ray spectroscopy confirmed insoluble gadolinium within lesional tissue.
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Affiliation(s)
- R E Kalb
- Department of Dermatology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Williamsville, NY 14221, USA.
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2
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Helm TN. Photo quiz. Disseminated superficial actinic porokeratosis. Cutis 2001; 67:286, 296-8. [PMID: 11324388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, 8625 Sheridan Dr, Williamsville, NY 14221, USA
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3
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Kling CW, Helm TN, Narins RB. Photo quiz. Intradermal tophaceous gout. Cutis 2001; 67:196, 205-6. [PMID: 11270291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Affiliation(s)
- C W Kling
- Department of Dermatology, Buffalo Medical Group, 6255 Sheridan Dr, Suite 208, Williamsville, NY 14221, USA
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4
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Helm TN, Bisker E, Bergfeld WF. Lipodystrophy. Cutis 2001; 67:163-4. [PMID: 11236228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Congenital lipodystrophy is an uncommon autosomal recessive disorder that occurs mainly in females and is characterized by loss of subcutaneous fat, insulin-dependent diabetes mellitus, and masculinization due to defective metabolism of fat. Acquired lipodystrophy is now most commonly encountered in patients infected with HIV who take protease inhibitors. We present an illustrative case of lipodystrophy and review the presenting signs allowing for an accurate clinical diagnosis.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, 6255 Sheridan Dr, Bldg B, Suite 208, Williamsville, NY 14221, USA
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5
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Foley E, Helm TN. Air bag injury and the dermatologist. Cutis 2000; 66:251-2. [PMID: 11109145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Most new car models have driver-side air bags and many also have passenger-side and side-impact air bags. Air bags are known to be dangerous to small children and may cause death, fractures, and cerebral spinal injury. However, the cutaneous manifestations of air bag injury are less well known. Additional potential air bag injuries include retinal damage and high-frequency hearing loss. The following case report illustrates significant burns from a low-impact air bag injury and reviews the pertinent literature.
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Affiliation(s)
- E Foley
- Department of Dermatology, State University of New York at Buffalo, USA
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6
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Helm TN, Lee J, Helm KF. Spiny keratoderma. Cutis 2000; 66:191-2. [PMID: 11006853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Spiny keratoderma is a descriptive term used to encompass a variety of unusual, disparate keratodermas. Spiny keratoderma has been associated with lipid abnormalities and has been limited to the palms and soles in some individuals. We describe an acquired case of spiny keratoderma in which an adult woman developed filiform lesions predominating on the trunk and proximal extremities. Treatment with topical emollients and keratolytic agents was unsuccessful, but topical tazarotene led to long periods of resolution. She has had no other associated abnormalities. The clinical features and differential diagnosis of spiny keratoderma are reviewed.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, Williamsville, NY 14221, USA
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7
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Helm TN. Photo quiz: urticaria pigmentosa. Cutis 2000; 66:172, 177-8. [PMID: 11006849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, Williamsville, NY 14221, USA
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8
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Paolini TS, Helm TN. Photo quiz. Xanthoma disseminatum. Cutis 2000; 65:351, 377-8, 384. [PMID: 10879300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Helm TN. Photo quiz. What is your diagnosis? Cutis 2000; 65:281, 329-30. [PMID: 10826086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, Williamsville, NY 14221, USA
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10
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Helm TN, Wirth PB, Helm KF. Inexpensive digital photography in clinical dermatology and dermatologic surgery. Cutis 2000; 65:103-6. [PMID: 10696563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Digital photography can be used to follow clinical improvement in a variety of dermatoses, document pre and postoperative results, and document histologic findings from skin biopsies. Images may be printed as part of text documents and can be filed in conventional medical charts. Images can be transmitted via electronic mail rapidly and to any location. We have found digital photography to be relatively inexpensive and a powerful tool to enhance dermatologic practice.
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Affiliation(s)
- T N Helm
- Hershey Medical Center, Pennsylvania, USA
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Camisa C, Taylor JS, Bernat JR, Helm TN. Contact hypersensitivity to mercury in amalgam restorations may mimic oral lichen planus. Cutis 1999; 63:189-92. [PMID: 10190076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Oral lichenoid lesions caused by hypersensitivity to mercury in amalgam fillings may mimic oral lichen planus on clinical and histologic examination. A positive patch test reaction to more than one mercurial allergen increases confidence in the diagnosis and justifies the removal and replacement of all amalgam fillings with those made of other materials. A complete remission may be expected about 3 months after the last amalgam filling is removed.
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Affiliation(s)
- C Camisa
- Section of Clinical Dermatology, Cleveland Clinic Foundation, Ohio, USA
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Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, Williamsville, New York 14221, USA
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Helm TN, Kalb RE, Helm KF. Granular cell dermatofibroma. A benign tumor that can simulate malignancy. Dermatol Surg 1997; 23:976-8. [PMID: 9357510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report on an unusual dermatofibroma with granular cells. The dermatofibroma contained mitotic figures raising a differential diagnosis that included malignant granular cell tumor. Granular cell dermatofibroma is an uncommon variant, but one that clinicians and surgeons should become aware of to ensure accurate diagnosis.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, New York, USA
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Helm TN, Wirth PB, Helm KF. Congenital fascial dystrophy: the stiff skin syndrome. Cutis 1997; 60:153-4. [PMID: 9314621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Congenital fascial dystrophy is an uncommon disorder that may mimic scleroderma. The skin is bound down and feels "wood hard" on palpation of the trunk and extremities. Sclerodactyly, telangiectases, and nail fold changes are not present. Unlike scleroderma, the onset is at birth. Flexion contractures result and other associated abnormalities may include developmental delay and mild hirsutism. We report a typical case to illustrate the clinical and pathologic findings of patients with this disorder.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, New York, USA
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Mashek HA, Pham CT, Helm TN, Klaus M. Rheumatoid neutrophilic dermatitis. Arch Dermatol 1997; 133:757-60. [PMID: 9197831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rheumatoid neutrophilic dermatitis (RND) is a recently recognized, rare cutaneous manifestation of rheumatoid arthritis. It occurs in patients with severe rheumatoid arthritis and is typically asymptomatic. Rheumatoid neutrophilic dermatitis was originally described by Ackerman in 1978. Since that time, 8 patients with this disease have been described in the literature. OBSERVATIONS We report 2 cases of RND. Findings of skin biopsy specimens from both patients revealed characteristic signs of dermal leukocytosis and leukocytoclasia without vasculitis. The pathogenesis of the neutrophilic infiltrate is unclear. Processes that may play a role in the pathogenesis of RND include immune complex activations, cell adhesion and migration, and cytokine release. CONCLUSIONS Rheumatoid neutrophilic dermatitis falls into the spectrum of neutrophilic vascular reactions described by Jorizzo and Daniels. Although early reports suggest that prominent leukocytoclasia is not a feature of RND, our findings confirm the observations of Lowe et al that leukocytoclasia can be seen in RND and may be striking. It is important for dermatologists to be aware of this rare manifestation of rheumatoid arthritis.
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Affiliation(s)
- H A Mashek
- Department of Dermatology, State University of New York at Buffalo, USA
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Helm TN, Danziger J, Helm KF. Bilateral plantar amyloidosis: a unique presentation of localized cutaneous amyloidosis. Cutis 1997; 59:142-4. [PMID: 9071554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Nodular amyloidosis is uncommon and is due to a local production of amyloid by aberrant plasma cells. Localized bosselated plantar amyloidosis has been reported before but we present the first case to our knowledge of bilateral plantar amyloidosis. The clinical presentation as well as therapeutic options for this uncommon entity are reviewed.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, New York, USA
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Helm TN, Spigel GT, Helm KF. Erythema ab igne caused by a car heater. Cutis 1997; 59:81-2. [PMID: 9040977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Erythema ab igne is a reticulated erythematous hyperpigmented eruption that occurs after chronic exposure to heat. In the past, the shins were the most common area of involvement, but with the widespread availability of central climate control in most buildings the incidence has decreased dramatically. New causes of erythema ab igne have been noted that have been caused by such heat sources as therapeutic chairs with built-in heaters. We present a case in which prolonged and close contact of the legs to a car heater led to erythema ab igne. Practitioners must be aware of the changing causes of erythema ab igne so that an appropriate history can be obtained.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Buffalo Medical Group, Williamsville, New York 14221, USA
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Affiliation(s)
- A G Bridges
- Department of Dermatology, University of Cincinnati, OH, USA
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Ruxin TA, Steck WD, Helm TN, Bergfeld WF, Bolwell BJ. Pseudallescheria boydii in an immunocompromised host. Successful treatment with debridement and itraconazole. Arch Dermatol 1996; 132:382-4. [PMID: 8629840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- T A Ruxin
- Cleveland Clinic Foundation, OH, USA
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Kuivaniemi H, Tromp G, Bergfeld WF, Kay M, Helm TN. Ehlers-Danlos syndrome type IV: a single base substitution of the last nucleotide of exon 34 in COL3A1 leads to exon skipping. J Invest Dermatol 1995; 105:352-6. [PMID: 7665911 DOI: 10.1111/1523-1747.ep12320704] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The Ehlers-Danlos syndrome has been classified into nine phenotypic presentations. Type IV is a variant of particular importance because people affected with this genodermatosis are at great risk of spontaneous hemorrhage from vascular rupture or bowel perforation. Recent molecular advances have identified mutations in the gene for type III procollagen as responsible for Ehlers-Danlos syndrome type IV. We report a case of a 14-year-old male with a typical presentation of the type IV variant who was found to have markedly dilated fibroblast cisternae and varying collagen fibril diameter on ultrastructural study. A novel genetic defect was noted by polymerase chain reaction and DNA sequencing of genetic material isolated from skin fibroblast cultures. Analysis of the gene for type III procollagen revealed a single base mutation in the last nucleotide of exon 34. The mutation led to abnormal RNA splicing and skipping of exon 34 on the mRNA level.
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Affiliation(s)
- H Kuivaniemi
- Department of Biochemistry and Molecular Biology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Affiliation(s)
- J Clark
- Cleveland Clinic Foundation, Ohio
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22
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Affiliation(s)
- J Morgan
- Cleveland (Ohio) Clinic Foundation, USA
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Affiliation(s)
- T N Helm
- State University of New York at Buffalo
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24
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Kuhn CA, Helm TN, Bergfeld WF, Glanz S, Steck WD. Acneiform papules on the neck. Elastosis perforans serpiginosa (EPS). Arch Dermatol 1995; 131:341, 344. [PMID: 7887667 DOI: 10.1001/archderm.131.3.341b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- C A Kuhn
- Cleveland (Ohio) Clinic Foundation
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Abstract
BACKGROUND The proliferation of non-Langerhans cell histiocytes is a poorly understood process of unknown cause. Variation in the clinical features and/or histopathology of histiocytic proliferation has led to subclassification of the general category of non-Langerhans cell histiocytes. Although the current classification may provide some useful generalizations in regard to the anticipated clinical course, wide variability in presentation and outcome make this classification less than optimal when dealing with individual patients. The objectives of the study were to present four cases of generalized non-Langerhans cell histiocytosis. MATERIALS AND METHODS Medical records and slides of four patients diagnosed with non-Langerhans cell histiocytosis at the Cleveland Clinic are reviewed. RESULTS The patients exhibit features of more than one subtype of non-Langerhans cell histiocytosis. CONCLUSION The overlap among the clinical and histologic features of the generalized cutaneous non-Langerhans cell histiocytic disorders suggests that they represent one disease entity with a wide spectrum of presentations rather than many distinct disorders.
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Affiliation(s)
- E A Mullans
- Department of Internal Medicine of Baylor University, College of Medicine, Houston, Texas, USA
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Marsico R, Narurkar V, Helm TN. Stump the experts. Eccrine acrospiroma. J Dermatol Surg Oncol 1994; 20:787, 845. [PMID: 7798408 DOI: 10.1111/j.1524-4725.1994.tb03705.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- R Marsico
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195
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Lawlor KB, Helm TN, Narurkar V, Vidimos A. Stump the experts. Multiple glomus tumors. J Dermatol Surg Oncol 1994; 20:572, 629-30. [PMID: 8089355 DOI: 10.1111/j.1524-4725.1994.tb00148.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- K B Lawlor
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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King T, Helm TN, Valenzuela R, Bergfeld WF. Diffuse intraepidermal deposition of immunoreactants on direct immunofluorescence: a clue to the early diagnosis of epidermal necrolysis. Int J Dermatol 1994; 33:634-6. [PMID: 8002159 DOI: 10.1111/j.1365-4362.1994.tb02922.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Toxic epidermal necrolysis is a distinctive disorder that is readily identified clinically and histologically in advanced cases. Early on, however, toxic epidermal necrolysis may be difficult to identify. Some consider fixed drug eruption a limited form of toxic epidermal necrolysis. METHODS Direct immunofluorescence was performed on biopsy material of erythematous skin lesions. RESULTS Diffuse deposition of immunoreactants in the midmalpighian layer was noted. This finding has not been encountered in other disorders studied in our immunopathology laboratory. CONCLUSIONS Diffuse immunoreactant deposition in the mid-epidermis should suggest a diagnosis of epidermal necrolysis either from toxic epidermal necrolysis or fixed drug eruption. Additional cases will need to be assessed to document the usefulness of this pattern for prospective diagnosis.
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Affiliation(s)
- T King
- Department of Dermatopathology, Cleveland Clinic Foundation, Ohio 44195
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Affiliation(s)
- K F Helm
- Department of Medicine/Dermatology, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Affiliation(s)
- T A Ruxin
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195-5032
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Abstract
BACKGROUND Individual case reports have suggested an occasional association of lichen planus with internal malignancy. OBJECTIVE Our purpose was to describe five patients with a neoplastic disease in whom lichen planus developed. METHODS Serologic and immunopathologic studies were conducted. RESULTS No evidence of autoantibody production characteristic of paraneoplastic pemphigus was found, and antibodies reactive with basal cell keratinocytes were not detected. CONCLUSION Lichen planus may be rarely induced by neoplasia. A cell-mediated immune reaction possibly causes this phenomenon.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195-5032
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Abstract
BACKGROUND Regressing atypical histiocytosis is a recently described disease characterized by recurrent nodules or ulcers. The cutaneous lesions appear abruptly and then regress only to return in a manner reminiscent of lymphomatoid papulosis. Immunophenotypic analysis has revealed that most cases are a form of anaplastic large-cell Ki-1-positive (CD30+) lymphoma. OBJECTIVE We describe two patients with Ki-1-positive anaplastic large-cell lymphoma that had clinical and pathologic features of regressing atypical histiocytosis and mimicked benign dermatoses (pyoderma gangrenosum and morphea), causing a delay in confirming the true diagnosis. A third case that was readily recognized as a lymphoma is also presented. METHODS The clinical and histopathologic findings were recorded. In addition, T-cell receptor gene rearrangement and immunophenotyping were determined in the index case. RESULTS The index patient and second patient were diagnosed as having Ki-1-positive anaplastic large-cell lymphoma by immunophenotyping and underwent cyclophosphamide, doxorubicin, prednisone, and vincristine (CHOP) chemotherapy with complete remission. The patient detected by chart review died of her disease without receiving antineoplastic therapy; disseminated lymphoma was diagnosed at autopsy. Studies on paraffin-embedded tissue were consistent with Ki-1-positive anaplastic large-cell lymphoma. CONCLUSION Regressing atypical histiocytosis may clinically resemble some benign dermatoses. Recent evaluation of these cases has shown that many represent a form of Ki-1-positive anaplastic large-cell lymphoma. Multiple skin biopsy specimens with immunophenotyping and gene rearrangement studies are required to arrive at the diagnosis.
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Affiliation(s)
- C Camisa
- Department of Dermatology, Cleveland Clinic Foundation
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33
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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Abstract
A 65-year-old man presented with a history of a giant blue plaque of the parietal scalp since childhood. Biopsy revealed a cellular blue nevus. The blue nevus was observed for 10 years and thought to be unchanged until a new adjacent lesion was noted. Biopsy of the new lesion revealed metastatic malignant melanoma. A wide excision was performed of the original lesion which revealed malignant melanoma arising in a blue nevus. Areas within the blue nevus were consistent with a pilar neurocristic hamartoma, whereas other areas were consistent with a common blue nevus. Subsequent satellite metastases developed, with early metastases resembling blue nevi except for the absence of a stromal component and the presence of hyperchromatic nuclei. Later metastases were typical of metastatic melanoma. This case illustrates the uncommon evolution of malignant melanoma from a blue nevus. The histological features and relationship between melanoma, blue nevus, and pilar neurocristic hamartoma are reviewed.
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Affiliation(s)
- A L Pathy
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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Abstract
BACKGROUND AND OBJECTIVE We identified several patients with a histologic diagnosis of pretibial myxedema in whom thyroid disease was not found. The purpose of this study was to investigate if histologic characteristics can distinguish between pretibial mucinosis secondary to Graves' disease and that unassociated with thyroid disease. METHODS Biopsy specimens interpreted as compatible with pretibial myxedema were reviewed; these included 12 cases of pretibial mucinosis with documented Graves' disease, and six cases of pretibial mucinosis without evidence of Graves' disease. Ten specimens interpreted as compatible with stasis dermatitis were also evaluated for histologic characteristics, including the possible presence of mucin. RESULTS Features that distinguish between pretibial mucinosis associated with Graves' disease and pretibial mucinosis without Graves' disease included preservation of a zone of normal-appearing collagen in the superficial papillary dermis (12/12 with Graves' disease, 0/6 without), mucin deposition in the reticular dermis (12/12 with Graves' disease, 0/6 without), lack of mucin deposition in the superficial papillary dermis (11/12 with Graves' disease, 1/6 without), angioplasia (2/12 with Graves' disease, 6/6 without), and the presence of hemosiderin (2/12 with Graves' disease, 6/6 without). Mucin deposition in the papillary dermis was found in six of 10 specimens interpreted as stasis dermatitis. CONCLUSIONS There are patients with pretibial mucinosis in whom there is no thyroid disease. Specimens from patients without Graves' disease have features of stasis dermatitis in addition to mucinosis. We conclude that pretibial mucinosis may result from stasis or Graves' disease and that histologic differences allow for accurate differentiation.
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Affiliation(s)
- S C Somach
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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36
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Helm TN, Calabrese LH, Longworth DL, Barna B, Liu AY, Bergfeld WF. Vascular nodules and plaques resembling chronic mucocutaneous candidiasis in a patient with a low interleukin 2 level. J Am Acad Dermatol 1993; 29:473-7. [PMID: 8349866 DOI: 10.1016/0190-9622(93)70214-e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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]
Abstract
A 21-year-old woman had a lifelong history of widespread friable vascular nodules and plaques. Her condition had previously been diagnosed as chronic mucocutaneous candidiasis because of her clinical appearance. Routine studies of immune function were performed in addition to a comparison of cytokine secretion in mononuclear leukocytes of our patient and normal controls. Interleukin 2 secretion by phytohemagglutinin-stimulated mononuclear leukocytes was deficient when compared with six healthy donors (< 300 pg/ml vs 2108 +/- 336 pg/ml). Interleukin 2 deficiency may be a causative factor in cases of unusual vascular proliferation. Treatment with methotrexate, which increases interleukin 2 activity and inhibits neovascularization in vitro, was helpful in our patient.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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Kuhn CA, Helm TN, Bergfeld WF, McMahon JT. Acquired uncombable hair. Arch Dermatol 1993; 129:1061-1062. [PMID: 8352616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Pierson JC, Helm TN, Taylor JS, Elston DM, Tuthill RJ. Neutrophilic eccrine hidradenitis heralding the onset of acute myelogenous leukemia. Arch Dermatol 1993; 129:791-2. [PMID: 8507092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Liu AY, Valenzuela R, Helm TN, Camisa C, Melton AL, Bergfeld WF. Indirect immunofluorescence on rat bladder transitional epithelium: a test with high specificity for paraneoplastic pemphigus. J Am Acad Dermatol 1993; 28:696-9. [PMID: 7684408 DOI: 10.1016/0190-9622(93)70095-b] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.5] [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: 01/26/2023]
Abstract
BACKGROUND Paraneoplastic pemphigus is a blistering disease with specific serum immunoprecipitation findings. Although immunoprecipitation studies allow accurate diagnosis, they are time-consuming, expensive, and not readily available. In contrast, indirect immunofluorescence (IIF) testing of serum on transitional rat bladder epithelium is a simple and inexpensive method available to any immunopathology laboratory. OBJECTIVE Our purpose was to determine the specificity of positive IIF on rat bladder epithelium for paraneoplastic pemphigus. METHODS The IIF findings in four index cases of paraneoplastic pemphigus were compared with the findings in 47 patients with a variety of malignant neoplasms and no associated blistering disease as well as 49 patients with vesiculobullous or lichenoid disease but no neoplasia. RESULTS IIF was negative in all patients with neoplasia and no blistering disease and negative in all but one of the patients with vesiculobullous or lichenoid disease without neoplasia (98.9% specificity). CONCLUSION IIF on transitional rat bladder epithelium appears to be a highly specific test for paraneoplastic pemphigus. Because of its simplicity and inexpensiveness, we suggest that IIF be performed on transitional epithelium in any suspected case of paraneoplastic pemphigus.
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Affiliation(s)
- A Y Liu
- Department of Allergy, Cleveland Clinic Foundation, OH 44195
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Abstract
Annular erythema of infancy is an uncommon, nonpruritic, figurate erythema that begins in the first year of life. Biopsy specimens reveal a perivascular and interstitial lymphocytic infiltrate with numerous eosinophils. The cause of the disorder is unknown, but a hypersensitivity response to unrecognized antigens is suspected. The disorder is self-limited, but may last for many months. In our patient the eruption continued 19 months after its onset.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195-5032
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195
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Trott MS, Helm TN. Pathologic quiz case 1. Cicatricial pemphigoid. Arch Otolaryngol Head Neck Surg 1993; 119:246-248. [PMID: 8427692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Helm TN, Camisa C, Valenzuela R, Allen CM. Paraneoplastic pemphigus. A distinct autoimmune vesiculobullous disorder associated with neoplasia. Oral Surg Oral Med Oral Pathol 1993; 75:209-13. [PMID: 8426720 DOI: 10.1016/0030-4220(93)90095-l] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A vesiculobullous disease termed paraneoplastic pemphigus with distinct autoantibodies was newly described in 1990. All reported cases have occurred in patients with a history of neoplasia, including lymphoma, chronic lymphocytic leukemia, poorly differentiated sarcoma, and benign thymoma. As in pemphigus vulgaris, intraepithelial clefts with acantholysis are noted histopathologically, and intercellular binding of immunoreactants is seen with direct immunofluorescence studies of mucous membrane and skin biopsies. However, immunoreactants may also be found along the basement membrane zone in paraneoplastic pemphigus. Indirect immunofluorescence using rat bladder epithelium as substrate shows an intercellular pattern that appears to be highly specific for paraneoplastic pemphigus. We report a patient with non-Hodgkins lymphoma of 8 years duration who developed severe erosive stomatitis and lichenoid dermatitis after receiving chemotherapy for a relapse of lymphoma. Her case illustrates the typical features of the disorder described as paraneoplastic pemphigus. Neoplasia-associated pemphigus may be a more precise term for this disorder because the course of the blistering eruption does not always parallel the course of the underlying cancer. The clinical features, histopathologic findings, and immunofluorescence findings of this unique syndrome are reviewed.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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Helm TN, Liu AY, Kasick J. Symptomatic zinc deficiency in a one-year-old child precipitated by changing from formula to cow's milk. Cutis 1992; 50:411-2. [PMID: 1486790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The case of a one-year-old girl with symptomatic zinc deficiency is presented. She had been misdiagnosed as having impetigo and/or candidiasis and had been treated with topical antifungal agents and both oral and topical antibiotic agents without success during the four months before she presented. Zinc replacement led to rapid improvement. Her nutritional history suggests that weaning from formula to cow's milk precipitated her eruption. The clinical findings, differential diagnosis, and treatment of zinc deficiency are reviewed.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195
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Camisa C, Helm TN, Liu YC, Valenzuela R, Allen C, Bona S, Larrimer N, Korman NJ. Paraneoplastic pemphigus: a report of three cases including one long-term survivor. J Am Acad Dermatol 1992; 27:547-53. [PMID: 1401305 DOI: 10.1016/0190-9622(92)70220-a] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.1] [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: 12/26/2022]
Abstract
BACKGROUND Paraneoplastic pemphigus is a newly described autoimmune disease characterized by painful mucosal ulcerations and polymorphous skin lesions in association with an underlying neoplasm. All reported patients with an associated malignant neoplasm have had a poor prognosis. OBJECTIVE We present three new cases of paraneoplastic pemphigus associated with a malignant neoplasm and further characterize this disease. METHODS We used clinical criteria, histologic and immunopathologic examinations, and immunophenotyping to characterize this disease. In addition, we performed immunoprecipitation studies with extracts of radiolabeled human keratinocytes to characterize the antigens to which patient serum binds. RESULTS All three patients had clinical, histologic, and immunopathologic findings that were strongly suggestive of paraneoplastic pemphigus. Their sera immunoprecipitated a complex of four polypeptides from human keratinocyte extracts with molecular weights of 250, 230, 210, and 190 kd, confirming the diagnosis of paraneoplastic pemphigus. The 250, 230, and 210 kd antigens comigrated with desmoplakin I, the 230 kd bullous pemphigoid antigen, and desmoplakin II, respectively. Lymphocyte immunophenotyping revealed large populations of monoclonal CD19+, CD5+ B cells in two cases. Although two of the patients died, one patient is alive and well 2 years after the diagnosis of paraneoplastic pemphigus. CONCLUSION We report three cases of paraneoplastic pemphigus. One patient is alive and well 2 years after diagnosis, which suggests that a subgroup of patients may have a more benign course.
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Affiliation(s)
- C Camisa
- Department of Dermatology, Cleveland Clinic Foundation, OH 44195-5032
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Helm TN, Tomecki KJ. Stump the experts. J Dermatol Surg Oncol 1992; 18:776, 838. [PMID: 1512309 DOI: 10.1111/j.1524-4725.1992.tb03034.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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Helm TN, Bergfeld WF, Elston D. Angiotropic lymphoma: malignant angioendotheliomatosis. Cutis 1992; 50:204-6. [PMID: 1526176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Malignant angioendotheliomatosis is an angiotropic lymphoma that may present with clinical findings suggestive of thrombophlebitis or vasculitis. Examination of a biopsy specimen with special stains for leukocyte common antigen establishes the diagnosis. Although malignant angioendotheliomatosis is usually fatal, early treatment with chemotherapeutic agents is helpful. We review the characteristics and treatment of this uncommon disorder and present an illustrative case.
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio
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Affiliation(s)
- T N Helm
- Department of Dermatology, Cleveland Clinic Foundation, Ohio 44195-0338
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