Pyogenic granuloma: who are you?
Explore the source record for details and available documents.
Biopsy, Needle↗
Biomedical subjects
E Grosshans
Publications and source records attributed to E Grosshans.
A histologic and immunohistochemical study of chilblains.
BACKGROUND: The histopathologic diagnosis of chilblains is controversial and the histologic changes are often considered nonspecific, mainly because they are poorly documented. Although a dermal inflammation in chilblains has been noticed, the infiltrate has not yet been characterized. OBJECTIVE: Our purpose was to analyze microscopic and immunohistochemical findings in a large series of chilblains and to compare the results with those of lupus erythematosus (LE). METHODS: We included 36 cases of clinically typical chilblains of the hands, of which 17 were thoroughly investigated to rule out cryopathy or LE. Ten biopsy specimens of hand lesions from patients with proven LE were included as controls. All slides were analyzed by conventional microscopy and by immunohistochemistry with anti-CD3, anti-CD20, and anti-CD68 antibodies. RESULTS: The most characteristic finding in chilblains (47% of cases) was the association of edema and reticular dermis infiltrate that showed a perieccrine reinforcement. Such a combination of changes was not observed in LE. Epidermal changes in chilblains consisted mainly in necrotic keratinocytes in 52% of cases. The comparison of 17 idiopathic chilblains with LE showed significant differences in spongiosis (58% vs 0% respectively), vacuolation of basal layer (6% vs 60%), edema of the dermis (70% vs 20%), and deep perieccrine inflammation (76% vs 0%). Immunohistochemistry showed that the infiltrate was composed of a majority of T cells associated with macrophages and a few B lymphocytes. The same pattern was observed in both chilblains and LE. CONCLUSION: Our results show that a predominantly T-cell papillary and deep infiltrate with a perieccrine reinforcement, associated with dermal edema and necrotic keratinocytes, are the hallmarks of chilblains of the hands. These changes can help differentiate idiopathic perniosis from LE; immunohistochemistry is of no use in differentiation.
Adolescent↗
Molluscum contagiosum: histologic patterns and associated lesions. A study of 578 cases.
Molluscum contagiosum (MC) is rarely associated with other skin diseases, especially cutaneous neoplasms. Such associations are exceptional and of unknown frequency. The aim of this study was to record the histologic variants and frequency of associated lesions in a large series of consecutive MC cases. We reviewed 578 MC cases from the Laboratory of Dermatopathology of the University Hospitals of Strasbourg, France (1959-1999). The locations of MC were as follows: head and neck (34.7%), trunk (27.1%), lower limbs (20.7%), upper limbs (8.7%), and genitalia (3.8%). Molluscum contagiosum occurred more often in female patients (56.7%). The age range of patients included in this study was 0 to 19 years (34.9%), 20 to 39 years (31.1%), 40 to 59 years (22.8%), and over 60 years (6.5%). Histologic variants of MC were noted in 46 cases (31 pseudocystic, 8 giant, and 7 pedunculated). An underlying abscess was present in 65 cases. Of the 578 cases, 22 were associated with other lesions (3.8%). There were 9 cases of epidermal cysts, 4 of nevocellular nevi, 3 of metaplastic ossifications, 2 of true epidermal nevi, 2 of sebaceous hyperplasias, 2 of soft fibromas, and 1 of Kaposi sarcoma. Except in immunocompromised patients, such associations are likely to be coincidental. The clinical diagnosis was correct in 42.3% of the cases. Clinical accuracy varied according to the age, localization, and histologic pattern of MC. Pseudocystic MC, giant MC, and MC associated with other lesions were responsible for frequent clinical misdiagnosis.
Adolescent↗
The Schnitzler syndrome. Four new cases and review of the literature.
The Schnitzler syndrome is characterized by a chronic urticarial eruption with a monoclonal IgM gammopathy. The other signs of the syndrome include intermittent elevated fever, joint and/or bone pain with radiologic evidence of osteosclerosis, palpable lymph nodes, enlarged liver and/or spleen, elevated erythrocyte sedimentation rate, and leukocytosis. The mean delay to diagnosis is more than 5 years, and this syndrome is of concern to internists and many medical specialists. Patients with this syndrome are often initially considered to have lymphoma or adult-onset Still disease, which are the main differential diagnoses. However, hypocomplementic urticarial vasculitis, systemic lupus erythematosus, cryoglobulinemia, acquired C1 inhibitor deficiency, hyper IgD syndrome, chronic infantile neurologic cutaneous and articular (CINCA) syndrome, and Muckle-Wells syndrome should also be excluded, because diagnosis relies on a combination of clinical and biologic signs and there is no specific marker of the disease. The disease pursues a chronic course, and no remissions have yet been reported. Disabling skin rash, fever, and musculoskeletal involvement are the most frequent complications. Severe anemia of chronic disease is another serious complication. The most harmful complication, however, is evolution to an authentic lymphoplasmacytic malignancy, which occurs in at least 15% of patients. This hematologic transformation can occur more than 20 years after the first signs of the disease, thus patients deserve long-term follow-up. Treatment is symptomatic and unsatisfactory. The skin rash is unresponsive to treatment, and nonsteroidal antiinflammatory drugs, antihistamines, dapsone, colchicine, and psoralens and ultraviolet A (PUVA) therapy give inconstant results. Fever, arthralgia, and bone pain often respond to nonsteroidal antiinflammatory drugs. In some patients, these symptoms and/or the presence of severe inflammatory anemia require steroids and/or immunosuppressive treatment, which ameliorate inflammatory symptoms but do not change the course of the skin rash.
Adult↗
Multiple anemic macules or Bier's spots?
Explore the source record for details and available documents.
Diagnosis, Differential↗
[What is Verneuil's disease?].
Explore the source record for details and available documents.
Anti-Bacterial Agents↗
[Erysipelas. Clinicopathological classification and terminology].
Erysipelas and necrotizing fasciitis are the words used to qualify 2 well-defined aspects of acute microbial dermohypodermal infection. According to the literature a third word, "cellulitis" is used to describe a large variety of inflammatory conditions of soft tissues, either infectious or not. The authors who advocate using this word consider either that an infectious cellulitis is a clinical variant differing from erysipelas or fasciitis, or that it describes the whole spectrum of acute microbial infections of soft tissues, including these 2 entities. This term, whatever its meaning, has no anatomical or histopathological validation. It should be definitively deleted and replaced by "dermohypodermal infection".
Erysipelas↗
[Eosinophilic arteritis of the scalp].
BACKGROUND: The occurrence of recurrent peripheral arterial thromboses together with a blood eosinophilia generally suggests an occlusive vascular disease or a systemic vasculitis. CASE REPORT: In a 31-year-old woman with a 15-year history of severe smoking and a blood eosinophilia from 1,200 to 2,500/mm(3), we observed recurrent attacks of pruritus and urticaria and recurrent lesions of eosinophilic thromboangiitis of hypodermal medium-sized elastic arteries of the scalp. In spite of the persistent eosinophilia, the evolution was spontaneously regressive and no other clinical or biological sign occurred within a follow-up time of 3 years. DISCUSSION: In Buerger's disease (thromboangiitis obliterans) and in most systemic vasculitis, especially in Churg-Strauss syndrome, the first lesions may be inflammatory thromboses of the extra-cranial scalp arteries. The diagnosis of an eosinophilic arteritis of the scalp may only be considered if the examination of the other peripheral vessels is normal and if the course of the disease is benign, without any treatment, in spite of a persistent blood eosinophilia. This clinico-pathological presentation should be considered as a distinct entity.
Adult↗
The rediscovery of previously described dermatoses.
Explore the source record for details and available documents.
Dermatology↗
[Survival after cutaneous metastasis: a study of 200 cases].
BACKGROUND: Cutaneous metastatic disease is uncommon and the outcome after cutaneous metastasis has rarely been thoroughly studied. The objective of this work was to study the survival after diagnosis of cutaneous metastasis in a large series of patients and to evaluate survival according to the type of cancer. PATIENTS AND METHODS: This retrospective study was conducted out in the Laboratoire d'Histo-pathologie Cutanée of Strasbourg. Between 1950 to 1996, 228 patients with cutaneous metastasis were diagnosed on the basis of typical histopathology, confirmed by two dermatopathologists. We excluded lymphoma or leukaemia with secondary skin involvement. Medical and demographic data were collected from hospital data, and the "Registre du Cancer du Bas-Rhin". The type of neoplasm, the time of diagnosis of primary cancer and the time of death (or survival at 12/31/1996) was established in 200 patients, 99 men and 101 women with a mean age 62.4 +/- 13 years. We found 64 cases of breast carcinoma, 36 cases of lung carcinoma, 31 cases of melanoma and 69 cases of other cancers. Long term actuarial survival after cutaneous metastasis was calculated using by the Kaplan-Meier method. RESULTS: The median survival after cutaneous metastasis was 6.5 months (mean 22.8 +/- 43.8 months). The mortality rate was 13 p. 100 at 1 month, 48 p. 100 at 6 months and 64.5 p. 100 at 12 months. Median survival was calculated according to the primary neoplasm: breast carcinoma: 13.8 months, melanoma: 13.5 months, lung carcinoma: 2.9 months (36 cases). The outcome of patients with cutaneous metastasis of lung carcinoma was worse than those with melanoma (p < 10(-4)) and breast cancer (p < 10(-4)). Survival after cutaneous metastasis of other cancers could not be compared because of the small size of the subgroups: median survival after cutaneous metastasis of non cutaneous squamous cell carcinoma of the head and neck: 8.8 months (5 cases), cutaneous squamous cell carcinoma: 6.5 months (12 cases), carcinoma of oesophagus: 4.7 months (2 cases), colo-rectal cancer: 4.4 months (9 cases), pancreatic cancer: 3.3 months (2 cases), stomach cancer: 1.2 months (7 cases) and liver and gall bladder carcinoma: < 1 month (3 cases). Survival beyond 10 years was observed in 9 patients: 3 melanoma, 2 breast cancers, 2 prostatic carcinomas, 1 larynx carcinoma and 1 cutaneous squamous cell carcinoma. CONCLUSION: This is the first study in which the survival after the occurrence of skin metastasis was systematically analysed in a large series of patients. It shows that half of patients with cutaneous metastasis die within the first 6 months after the diagnosis. Those cases due to lung carcinoma have the poorest prognosis.
Actuarial Analysis↗
[Basal cell carcinoma of a light exposed area in a dark skinned African woman].
Explore the source record for details and available documents.
Biopsy↗
[Does subcutaneous cellular tissue exist?].
BACKGROUND: The definition of the "subcutaneous cellular tissue" is still debated. METHODS: In order to establish the localisation and composition of this tissue, or, merely its existence, we interviewed French dermatologists and conducted a bibliographic study on the historical definitions of the so-called "subcutaneous cellular tissue". A questionnaire was sent to French professors of dermatology to assess their definition of the "subcutaneous cellular tissue". They were also asked to make a simple cartoon showing the anatomy of the skin and "subcutaneous cellular tissue". RESULTS: We obtained 37 answers which could be classified in three main categories: 1) "subcutaneous cellular tissue" and hypodermis are synonymous, 2) "subcutaneous cellular tissue" is an autonomous tissue which separates the hypodermis from the tissues below and 3) "subcutaneous cellular tissue" designates all structures located below the hypodermis. In an historic perspective, the "cellular system" was a macroscopic concept described in the eighteenth century as whitish fibrils delimitating "cells". It was renamed loose connective tissue in the twentieth century and thus "cellular" became obsolete. The definition of skin, and of "subcutaneous cellular tissue" in particular, has greatly changed over time. In the eighteenth century, only epidermis and dermis were considered as belonging to the skin, although some included the tela subcutanea. In the twentieth century, the "subcutaneous cellular tissue" is considered either as a part of the hypodermis, or as the hypodermis itself or as a tissue located between the hypodermis and the fascia. DISCUSSION: The difficulty in defining "subcutaneous cellular tissue" is the result of a French semantic problem. The "cellular tissue" became loose connective tissue. For French dermatologists, the skin is composed of epidermis, dermis and hypodermis and the hypodermis can therefore not be subcutaneous. In order to check whether an autonomous tissue could be evidenced under the skin, we conducted an histologic study, which is presented in a second article.
Connective Tissue↗
[Cellular subcutaneous tissue. Anatomic observations].
INTRODUCTION: We showed in a companion paper that the definition of the French "subcutaneous cellular tissue" considerably varied from the 18th to the end of the 20th centuries and has not yet reached a consensus. To address the anatomic reality of this "subcutaneous cellular tissue", we investigated the anatomic structures underlying the fat tissue in normal human skin. METHODS: Sixty specimens were excised from the surface to the deep structures (bone, muscle, cartilage) on different body sites of 3 cadavers from the Institut d'Anatomie Normale de Strasbourg. Samples were paraffin-embedded, stained and analysed with a binocular microscope taking x 1 photographs. Specimens were also excised and fixed after subcutaneous injection of Indian ink, after mechanic tissue splitting and after performing artificial skin folds. RESULTS: The aspects of the deep parts of the skin greatly varied according to their anatomic localisation. Below the adipose tissue, we often found a lamellar fibrous layer which extended from the interlobular septa and contained horizontally distributed fat cells. No specific tissue below the hypodermis was observed. Artificial skin folds concerned either exclusively the dermis, when they were superficial or included the hypodermis, but no specific structure was apparent in the center of the fold. India ink diffused to the adipose tissue, mainly along the septa, but did not localise in a specific subcutaneous compartment. DISCUSSION: This study shows that the histologic aspects of the deep part of the skin depend mainly on the anatomic localisation. Skin is composed of epidermis, dermis and hypodermis and thus the hypodermis can not be considered as being "subcutaneous". A difficult to individualise, fibrous lamellar structure in continuity with the interlobular septa is often found under the fat lobules. This structure is a cleavage line, as is always the case with loose connective tissues, but belongs to the hypodermis (i.e. fat tissue). No specific tissue nor any virtual space was observed below the skin. Thus, the commonly used term "subcutaneous cellular tissue" is inappropriate.
Adipose Tissue↗
[Drug-induced urticaria].
According to different estimations, the systemic or topical administration of drugs is the 2nd or 3rd identified cause of urticarias. Urticaria may be the leading symptom of drug-induced immuno-allergic reactions such as anaphylaxis or serum sickness. More often, it is the manifestation of non-immune reactions by drug-induced direct release of histamine, activation of complement or enzymatic impairment of the metabolism of arachidonic acid derivatives. Skin tests may be helpful for the demonstration of the responsibility of drugs in the immuno-allergic reactions. Whatever the mechanism may be, one should dissuade from provocation reintroduction of the suspected drug without an extreme wariness.
Anaphylaxis↗
Allergic contact dermatitis caused by skin painting (pseudotattooing) with black henna, a mixture of henna and p-phenylenediamine and its derivatives.
BACKGROUND: Skin painting (pseudotattooing) with henna is traditionally performed mainly in Muslim or Hindu persons. Recently, transient artists have begun using black henna mixtures to temporarily paint the skin. Emergence of allergic contact dermatitis after application indicates the presence of a skin sensitizer in such preparations and poses future risks. OBSERVATIONS: Four patients developed allergic contact dermatitis after skin painting with black henna performed in France, Egypt, and the United States. The delay of symptoms suggested previous sensitization in 1 patient and active sensitization in 3 patients. Of 3 patients who underwent patch testing, the results were positive for p-phenylenediamine in 3 patients and for p-toluylenediamine in 1 patient. These sensitizers are found in hair dye preparations. CONCLUSIONS: The mixtures used by the artists possibly contained natural henna, a rare and weak skin sensitizer, and likely contained chemical coloring agents, diaminobenzenes, such as p-phenylenediamine and/or diaminotoluenes. The long duration of skin contact, the high concentrations of sensitizing materials, and the lack of a neutralizing agent dramatically increase the risk of skin sensitization, which is why such substances are prohibited for direct skin application. Because of the worldwide vogue of skin painting, future cases of sensitization to p-phenylenediamine and diaminobenzenes or diaminotoluenes are expected.
Adult↗
Genetic mosaicism in an acquired inflammatory dermatosis following the lines of Blaschko.
Explore the source record for details and available documents.
Adult↗
Tumors arising in nevus sebaceus: A study of 596 cases.
BACKGROUND: Prophylactic surgical excision of nevus sebaceus (NS) during childhood is often recommended because various neoplasms can occur on NS. The proportion of malignant tumors occurring on NS is highly variable among the published series, and there are controversies on the nature of these neoplasms because many of the previously described basal cell carcinomas could actually be trichoblastomas, which are benign follicular tumors. OBJECTIVE: We retrospectively analyzed all cases of NS of our collection, excised during the period from 1932 through 1998, and recorded all associated epithelial and nonepithelial changes. We especially differentiated basal cell carcinomas from trichoblastomas by silhouette analysis and examination of the stroma. These findings were analyzed according to gender, age, and localization. METHODS: Microscopic analysis of NS by two examiners was performed independently of clinical data. RESULTS: A total of 596 cases were included from 290 females and 306 males, mean age 25.4 years (range, 1 month to 87 years); 232 were excised in children younger than 16 years. NSs were located on the scalp in 49.8% of cases. Basal cell carcinomas were found in 5 cases (0.8%, mean age 39.3 years) and benign tumors in 81 cases (13.6%, mean age 46.3 years). Syringocystadenoma papilliferum (n = 30, 15 males, 15 females) and trichoblastoma (n = 28, 7 males, 21 females) were the most frequent benign tumors. NS with associated tumors were located on the scalp in 79% of cases. Only 4 benign tumors (1.7%) and 2 warts were observed in patients younger than 16 years. Various types of epithelial hyperplasia were noted that could not be considered neoplasms, as well as epidermal and apocrine cysts. CONCLUSION: The rate of malignant tumors arising on NS was very low and we did not observe such cases in children, who had associated benign tumors in only 1.7% of cases. Benign neoplasms were common and most of them occurred on the scalp; this was not a bias resulting from a longer duration before surgery. Trichoblastoma and not basal cell carcinoma was the most frequent follicular tumor associated with NS and showed a striking female predominance. Most trichoblastomas had previously been misdiagnosed but could actually be easily recognized by typical histologic features. Because most tumors occurred in adults older than 40 years, our study suggests that prophylactic surgery in young children is of uncertain benefit. Clinical follow-up is probably sufficient, and even those cases with clinical changes often proved to be benign tumors or warts.
Adolescent↗