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Pruritic maculopapular skin lesions in sarcoidosis. An unusual clinical presentation.

Pruritic maculopapular rash occurred in a 23-year-old black man. The lesion remained undiagnosed and required frequent hospital admissions. Twenty years after the onset of symptoms, the skin and lymph node biopsy specimens showed noncaseating granulomas. Sarcoidosis should always be included in the differential diagnosis of pruritic skin lesion.

Adult↗

[Severe initial manifestations of psoriasis in staphylococcal infections].

Psoriasis vulgaris is a chronic disease with certain restrictions of life quality, but rarely life threatening. However, psoriatic erythroderma or pustular psoriasis can be a diagnostic or therapeutic challenge, especially when it arises as the primary manifestation of disease. Here we report on two patients with severe clinical course of pustular psoriasis or psoriatic erythroderma, both possibly induced by Staphylococcus aureus. This microorganism was cultivated from skin scrapings in both patients, in the patient with pustular psoriasis from the blood, and in the patient with erythroderma from the nose. Both patients had anti-staphylolysin antibodies. Both patients showed resolution of their disease only by the action of systemic antibiotics. We suggest that staphylococcal superantigens which activate T-cells might play an important role in severe psoriasis by inducing a systemic Köbner phenomenon and thus a progression of disease.

Adrenal Cortex Hormones↗

[Erythromelanosis follicularis faciei and colli].

BACKGROUND: Erythromelanosis follicularis of the face and neck, originally described in Japan by Kitamura et al. in 1960, is characterized by a clinical set of three: well-demarcated erythema, hyperpigmentation and follicular papules. It affects the face and the neck generally on both sides. Since the original description, it has seldom been reported in the literature. CASE REPORTS: This paper reports two patients with unilateral presentation. DISCUSSION: Having discussed the various differential diagnoses all published cases were listed and analyzed. The prevalence of this disease appears higher than is shown by the limited number of cases reported in the literature. It deserves more recognition. Its nosologic and aetiologic frames still remain to be clarified.

Adult↗

[Mycosis fungoides].

The classical characteristics of Myocsis Fungoides are discussed. 1) The clinical characteristics of the three forms: tumour from the start, erythrodermic and polymorphic forms of Alibert-Buzin. 2) Histological characteristics : dense dermal infiltrates or epidermotropic infiltration, or around a more or less malignant histiocytic reaction, there develops a host reaction, resembling a granuloma. During the course of the disease, one may observe lymphocyte depletion, whilst delayed hypersensitivity tests become negative. The various types of lymphadenopathy are analysed, the possibility of visceral lesions confirmed. However, knowledge of Sezary's syndrome makes his concept of the disease doubtful. A pathological picture similar to Mycosis Fungoides may be observed during Sezary's syndrome, with circulating giant cells. The presence of small Sezary cells, Lutzner-Flandrin variety, is common in the dermal infiltrate, and even more common in the lymph node visceral infiltrates of Mycosis Fungoides. Thus, one is led to the concept according to which the primary phenomenon is probably pathological proliferation of abnormal T lymphocytes (large and small Sezary cells), the histiocytic proliferation would then simply be a secondary reaction. This theory is then discussed.

Adult↗

CD7 expression in reactive and malignant human skin T-lymphocytes.

CD7, a molecule normally expressed on 90% of CD4+ T cells, is often deficient on the malignant T cells of cutaneous T cell lymphoma. Therefore deletion of CD7 is considered a specific marker for the diagnosis of cutaneous T cell lymphomas. Because an expansion of CD4+CD7- cells may also be observed in benign lymphocyte-mediated dermatoses, we present our experience concerning CD7 expression in both cutaneous T cell lymphomas and a broad variety of T cell-mediated inflammatory dermatoses using an immunohistochemical approach on frozen sections from 45 patients. No, or at most scarce, expression of CD7 was detectable in the inflammatory skin conditions investigated as compared to CD3-positive cells. In cutaneous T cell lymphomas, a striking reduction of CD7 reactive cells was found in either reactive or malignant T cell components. Our findings indicate that CD7-negative T cells are more common within both benign and neoplastic T cell infiltrates than was previously demonstrated and suggest that, using a conventional immunoenzymatic technical approach on fresh-frozen sections, CD7 deletion is an unreliable criterion for the immunohistological diagnosis of T cell-mediated skin infiltrates.

Antigens, CD7↗

Caribbean itch.

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Adult↗