Isotopic cutaneous lichen planus possibly related to dental amalgam.
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Dental Amalgam↗
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Results for “FACIAL DERMATOSES”
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Granuloma faciale: a clinicopathological study of 11 cases.
BACKGROUND: Granuloma faciale is an uncommon disease of unknown etiology that is often misdiagnosed clinically and by general pathologists. OBJECTIVE: To describe the clinicopathological features of a series of patients with granuloma faciale. METHODS: Eleven patients diagnosed with granuloma faciale between 1990 and 2002 were included in the study. RESULTS: Granuloma faciale was diagnosed in 11 patients (9 male and 2 female, mean age 53.45 years). All of them presented facial cutaneous lesions and two of them also developed extrafacial lesions. Histologically, in 8 cases the infiltrate was limited to the upper half of the dermis. Two specimens showed fibrinoid necrosis. Concentric fibrosis around small blood vessels was demonstrated in 5 patients. CONCLUSION: The presence of abundant fibrosis in 5 of our patients similar to that observed in erythema elevatum diutinum suggests that granuloma faciale and erythema elevatum diutinum may be produced by similar or the same pathogenic mechanism.
Biopsy↗
Multiple inverted follicular keratoses as a presenting sign of Cowden's syndrome: case report with human papillomavirus studies.
Inverted follicular keratosis is characterized by a squamous epithelial expansion of the infundibular portion of the hair follicle in an exophytic and endophytic pattern. The lesion is often associated with squamous eddies similar to an irritated keratosis and may have a superficial papillomatous architecture. The lesion most often arises as a solitary nodule on the face of middle age to elderly individuals. Inverted follicular keratosis has been described as a distinct entity by some while others believe that it is related to trichilemmomas and/or verruca vulgares. The cutaneous pathology of Cowden's syndrome is characterized by multiple trichilemmomas. We present a woman who fulfills the clinical criteria for Cowden's syndrome and who initially presented with multiple inverted follicular keratoses. Also, in situ hybridization studies performed on the patient's keratoses do not reveal evidence of human papillomavirus infection.
Breast Neoplasms↗
Pimecrolimus 1% cream for cutaneous lupus erythematosus.
Topical treatment of cutaneous lupus erythematosus usually includes potent glucocorticosteroids. However, prolonged use causes adverse side effects including skin atrophy as the foremost concern. In contrast to glucocorticosteroids, the anti-inflammatory and immunosuppressive macrolactam pimecrolimus has no atrophogenic potential. Affected areas of 11 patients with different forms of lupus erythematosus were treated with pimecrolimus 1% cream under semiocclusive conditions twice daily for 3 weeks. Skin involvement before and after therapy was assessed by means of a clinical score. In all patients, significant regression of skin lesions was observed after therapy (P <.001). This was an open and uncontrolled study on a limited number of cases. We suggest that pimecrolimus 1% cream could be an efficacious and safe treatment option for cutaneous lupus erythematosus.
Administration, Cutaneous↗
Measurement of the severity of rosacea.
BACKGROUND: There are no standardized measures for the severity of rosacea. OBJECTIVES: To determine what clinical signs correlate best with global severity of rosacea, and to examine inter-rater reliability. Methods Four clinicians each made 82 assessments of rosacea patients. Each assessment used 60 0-to-10 Likert-like scales for the signs of rosacea. Subjects also assessed the severity of their rosacea. RESULTS: The clinicians' assessment of global severity correlated strongly with erythema, especially on the cheeks. Subjects' assessment of global severity correlated more strongly with papules/pustules. Different methods of assessing severity--estimation of area involved, intensity, or lesion counts--did not produce significantly different results. Inter-rater reliability was low on 11-point (0-10) scales, but improved when scales were collapsed to 5 or 4 points. CONCLUSIONS: Clinicians and patients assess severity of rosacea differently, with clinicians focusing on erythema and patients focusing on papules/pustules. New instruments for assessing severity must address inter-rater reliability.
Adult↗
Plaque-forming demodicidosis.
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Administration, Cutaneous↗
A multicenter, randomized, double-blind trial of tazarotene 0.1% cream in the treatment of photodamage.
BACKGROUND: Previous studies indicate that tazarotene is efficacious in reducing signs of photodamage. Objective We sought to confirm the efficacy and tolerability of tazarotene 0.1% cream in the treatment of facial photodamage. METHODS: A total of 568 patients with at least moderate fine wrinkling or mottled hyperpigmentation applied tazarotene 0.1% cream or vehicle cream to their face once daily for 24 weeks. RESULTS: Tazarotene cream was significantly more effective than vehicle in reducing fine wrinkles, mottled hyperpigmentation, lentigines, irregular depigmentation, apparent pore size, elastosis, tactile roughness, and an overall integrated assessment of photodamage. Significance was achieved as early as week 2 for some parameters and had not plateaued by week 24. The majority of patients reported improvements in their photodamage as early as week 4. Adverse events were predominantly mild or moderate signs or symptoms of skin irritation. CONCLUSION: Once-daily tazarotene 0.1% cream is effective in ameliorating multiple signs of facial photodamage.
Adult↗
Tacrolimus ointment is effective for facial and intertriginous psoriasis.
BACKGROUND: Intertriginous and facial involvement are manifestations of psoriasis that require a different approach than is used for typical plaque psoriasis on other skin areas. Topical corticosteroids are the primary treatment for psoriasis; however, the side effects of corticosteroids are magnified on intertriginous and facial skin. Topical tacrolimus offers the potential for anti-inflammatory effect without the atrophy or other local side effects associated with the use of topical corticosteroids. OBJECTIVE: To determine the efficacy and tolerability of 0.1% tacrolimus ointment for the treatment of facial or intertriginous psoriasis. METHODS: One hundred sixty-seven patients 16 years or older were evaluated in an 8-week, randomized, double-blind, vehicle-controlled, multi-center study. Upon entry into the study, patients were randomized 2:1 to apply the tacrolimus ointment 0.1% or vehicle twice daily to all psoriatic lesions of the face or intertriginous areas for 8 weeks. The physician's global assessment was used to assess improvement from baseline. The inverse psoriasis severity for patients was measured using a 6-point scale from clear to very severe. RESULTS: As early as day 8, more patients ( P = .004) had cleared or achieved excellent improvement in the 0.1% tacrolimus ointment group compared to the vehicle group (24.8% vs 5.8%). At the end of the 8-week treatment period 65.2% of the tacrolimus ointment group and 31.5% of the vehicle were clear or almost clear ( P < .0001) based on a Static Severity Score. Adverse events were similar in the 0.1% tacrolimus ointment and vehicle groups. Conclusion Tacrolimus ointment is an effective treatment for psoriasis of the face or intertriginous areas.
Adolescent↗
Silicone granuloma of the face treated with minocycline.
Siliconoma represents a granulomatous foreign body reaction to silicone, which is often used for soft tissue augmentation. Although considered as biologically inert for a long time, silicone has been implicated in various undesirable local and systemic reactions, sometimes with a latency period of up to several decades. Treatment of siliconomas is difficult and granulomas involving the face are a therapeutic challenge. We present a 43-year-old woman with a severely disfiguring facial silicone granuloma who was successfully treated with minocycline.
Adult↗
Linear lichen planus of the face and neck versus amalgam-induced "isotopic" cutaneous lichen planus.
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Dental Amalgam↗
Persistent erythema and edema of the midthird and upper aspect of the face (morbus morbihan): evidence of hidden immunologic contact urticaria and impaired lymphatic drainage.
BACKGROUND: A persistent erythema and edema of the midthird and upper aspect of the face, which bears some resemblance to Melkersson-Rosenthal syndrome and rosaceous lymphedema, has been characterized as morbus morbihan (MM) by French dermatologists. The disease of yet unknown cause starts with recurrent facial edema of short duration, which ultimately leads to persistent swelling after a period of weeks or months. METHODS: We recruited 6 patients with MM and acquired their history, routine blood tests, and individual UV light tolerability. To check for contact allergies the allergen patch test and the open epicutaneous patch test were performed. To objectify the skin conditions laser Doppler flowmetry and 20-MHz ultrasound were used. Five patients with similar symptoms, but with definitely transient facial erythema and edema caused by proven contact urticaria on cosmetics served as a comparison group. RESULTS: In all patients, routine blood tests and UVA/UVB light tests showed no pathologic results. Observations of 6 patients with MM revealed the common feature of a clinically relevant immunologic contact urticaria caused by various cosmetic ingredients, which could be diagnosed in all of them. Delayed resorption of the acute edema and prolonged inflammation were shown by laser Doppler flowmetry and 20-MHz ultrasound in the affected skin areas in patients with MM after induction of immunologic contact urticaria by a cosmetic ingredient. Strict avoidance of cosmetics yielded a remarkable clinical benefit in the follow-up examinations. CONCLUSIONS: We conclude that recurrent and possibly subclinical inflammation caused by immunologic contact urticaria in conjunction with a locally pre-existing lowered lymphatic drainage plays a crucial role in the evolution of MM.
Adult↗
Granuloma faciale: a clinicopathologic study of 66 patients.
BACKGROUND: Only case reports or studies of small series of patients have focused on granuloma faciale (GF). OBJECTIVE: We sought to describe the clinicopathologic characteristics of GF in a large series of patients. METHODS: We conducted a retrospective analysis of 66 patients and 73 skin specimens. RESULTS: GF mostly presented as reddish plaques or nodules in middle-aged adults. One third of patients had multiple sites involved and 5 patients had extrafacial lesions. A clinical diagnosis of GF was made in only 10 cases; sarcoidosis, lymphoma, lupus, and basal cell carcinoma were the main differential diagnoses. The most frequent histopathologic features were the presence of a grenz zone, neutrophils, and telangiectases. Vascular changes were frequent, although necrotizing vasculitis appeared to be rare. There was often an association of acute and chronic inflammatory patterns, suggesting that GF follows a chronic history with recurrent acute phases, rather than distinct successive acute and chronic stages. LIMITATIONS: In this retrospective study, a reliable analysis of the outcome of patients could not be performed. Results of direct immunofluorescence tests and laboratory investigations were lacking in many cases. CONCLUSION: GF is often clinically misdiagnosed; its morphologic spectrum is broader than usually described and includes a lack of eosinophils, the presence of vascular changes with rare vessel wall necrosis, and associated acute and chronic inflammatory patterns.
Adult↗
Childhood stye and adult rosacea.
BACKGROUND: Little is known about how individuals with a predisposition for rosacea appear in childhood. This retrospective, matched control, longitudinal study examined the relationship between childhood stye and adult rosacea. METHODS: The records of the Rochester Epidemiology Project were examined to identify patients who received care for stye or blepharitis between ages 2 and 17 years, and received care for any cause at age 40 years or older. Patients were matched by group to control subjects (1:2). RESULTS: Patients with stye during childhood (N = 201) had a higher prevalence of adult rosacea than did control subjects (5.5% vs 1.5%, P = .01). Patients who had other childhood eye conditions without stye (N = 504) were not at higher risk. LIMITATIONS: The study population included few minority patients. CONCLUSIONS: The association between childhood stye and adult rosacea appears to be significant and should be examined further. Rosacea prevalence in adults may be lower (2.1%) than previously reported.
Adolescent↗
Self-healing juvenile cutaneous mucinosis: cases highlighting subcutaneous/fascial involvement.
BACKGROUND: Self-healing juvenile cutaneous mucinosis is a rare disease affecting young people characterized by transient cutaneous lesions and sometimes mild inflammatory symptoms. The deep dermal and subcutaneous features of this disorder have not yet been well described. OBJECTIVE: The purpose of our study was to present 3 cases of self-healing juvenile cutaneous mucinosis in which the histopathologic features caused diagnostic confusion between this disorder and proliferative fasciitis. METHODS: The study includes clinical and histologic findings of 3 patients, complemented by a literature review. RESULTS: The histologic descriptions of nodular lesions in self-healing juvenile cutaneous mucinosis reveal features of proliferative fasciitis, including a myxoid stroma and gangliocyte-like giant cells. LIMITATIONS: Self-healing juvenile cutaneous mucinosis is a rare condition and has not been frequently reported in medical literature. Our findings are based on the pathologic features of 3 patients. CONCLUSIONS: Our findings further elucidate the histologic features of self-healing juvenile cutaneous mucinosis and expand the differential diagnosis for entities in which gangliocyte-like giant cells are noted.
Child↗
Neutrophilic eccrine hidradenitis masquerading as facial cellulitis.
Neutrophilic eccrine hidradenitis typically manifests as erythematous plaques on the face, trunk, or extremities. This eruption has been associated with numerous factors, but most commonly is seen with chemotherapy, particularly cytarabine. We report a 73-year-old woman with acute myelogenous leukemia who developed rapidly expansive neutrophilic eccrine hidradenitis mimicking facial cellulitis only after a course of cytarabine was followed by granulocyte-colony stimulating factor. Prompt diagnosis is imperative to prevent prolonged antimicrobial therapy.
Aged↗
Methotrexate-associated lymphoproliferative disorder in a patient with rheumatoid arthritis presenting in the skin.
A 91-year-old woman who had been taking methotrexate for approximately 5 years for rheumatoid arthritis developed papules and nodules on her face that enlarged during 6 months. A series of biopsy specimens demonstrated a lymphoplasmacytic infiltrate with increasingly atypical histopathologic features that resembled diffuse large B-cell lymphoma. Epstein-Barr virus was not identified. Withdrawal of methotrexate resulted in complete resolution of all lesions within 8 weeks. This case illustrates the rare occurrence of methotrexate-associated lymphoproliferative disorder with primary presentation in the skin and documents clinical and histopathologic progression from early changes to fully developed lesions.
Aged, 80 and over↗
Keratoacanthomas associated with sorafenib therapy.
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Aged↗