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The sudden appearance of multiple seborrheic keratoses in the two patients could be related to adenocarcinoma of the breast. Despite other isolated reports, this disorder is still controversial as a marker of malignancy.
We report a case of squamous cell carcinoma of the lung associated with the sudden appearance of seborrheic keratosis and acquired ichthyosis. We conclude that the sign of Leser-Trélat is a rare cutaneous manifestation of internal malignant disease.
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BACKGROUND: The increased glucose uptake seen in cancer cells correlates with the expression of human erythrocyte glucose transporter (Glut1) protein in certain human malignancies. OBJECTIVE: Our purpose was to determine Glut1 expression in cutaneous neoplasms. METHODS: A polyclonal anti-Glut1 antibody (MYM) and a standard ABC immunoperoxidase technique were used to determine Glut1 expression in invasive squamous cell carcinomas (SCCs), SCC in situ, basal cell carcinomas (BCCs), melanomas, actinic keratoses (AKs), seborrheic keratoses, common acquired nevi, and scars with regenerative epidermal hyperplasia. RESULTS: All of the cases of SCC in situ, 14 of 15 (93%) of the SCC, and 13 of 15 AKs (87%) showed intense membranous staining for Glut1. Glut1 staining was present in the epidermis of 8 of 15 scars (53%) but was not detected in any BCC, even in areas of focal keratinization and squamous metaplasia. Glut1 reactivity was absent in the melanomas and seborrheic keratoses. CONCLUSION: Glut1 expression in a cutaneous lesion strongly suggests a proliferative lesion of the squamous cell type.
The authors list the really significant paraneoplastic cutaneous syndromes: acanthosis nigricans, paraneoplastic acrokeratosis, acquired ichthyosis (and eventually the "explosive" onset of seborrheic warts) and a special type of desquamative circinate erythema (erythema gyratum repens). The possible paraneoplastic character of other conditions is also discussed: dermatomyositis, necrosing vasculitis, autoimmune bullous conditions and pruritus "sine materia".
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The aim of this open, noncontrolled phase III study was the assessment of the contraceptive efficacy and the evaluation of the safety of long-term use of Belara (30 micrograms ethinyl estradiol plus 2 mg chlormadinone acetate). Furthermore, cycle stability during administration of Belara and the influence of Belara on acne and seborrhea as clinical signs of androgenization were observed. Belara was taken by 1655 women for a total of 22,337 cycles. For the theoretical Pearl index, a value of 0.269 (95% CI [0.109, 0.600]) was calculated. In 1655 of 22,337 cycles (7.4%), no withdrawal bleeding was documented, whereas in 2565 of 22,308 cycles (11.5%), spottings and, in 786 of 22,308 cycles (3.5%), breakthrough bleeding occurred. After the intake of Belara for 12 cycles, acne on the face/neck improved in 64.1% of the women (209 of 326). In 53.4% of the women (175 of 326), acne disappeared completely. Seborrhea improved after 12 cycles in 89 of 131 women (67.9%), of whom 76 women (58.0%) were completely cured. Sixty-two serious adverse events (SAE) occurred in 59 of 1655 women. Accidents and injuries of the musculoskeletal system were the SAE with the highest incidence (0.66%). Two cases of deep venous thrombosis, one pulmonary embolism, and two cases of visual disturbances were observed. Only for the two cases of deep venous thrombosis could a relation to Belara be assumed. Of the adverse events commonly reported for oral contraceptives, headache was observed for the first time under study medication in 37.4%, nausea in 23.1%, breast tenderness in 21.7%, and vaginal discharge in 19.4% of the women. The frequency of adverse events decreased with longer duration of a drug consisting of intake of Belara. In conclusion, Belara can be described as an effective and safe oral contraceptive with marked antiandrogenic properties.
Lesions of seborrheic keratoses studied by transmission electron microscopy showed an unusually large number of Langerhans cells in the epidermis. The role of Langerhans cells in the development of these lesions needs further study.
We describe a case of suspected superficial-type basal cell epithelioma. However, it showed the histologic features of pigmented seborrheic keratosis and, on the basis of the clinical and histologic findings and the developmental course, was presumed to have undergone central regression. Mononuclear cell inflammation was considered to be involved in the regression.
The sign of Leser-Trélat was observed in a patient with multiple seborrheic keratoses and hemangiomata. The increase in these lesions of the skin preceded the development of a poorly differentiated lymphocytic lymphoma, a type of malignancy which has not yet been reported in association with this sign.
A 67-year-old male patient is reported whose clinical manifestations and histological and immunofluorescence features corresponded to seborrheic pemphigoid. This male patient is in contrast with the few cases previously described in the literature, as they were all females. Clinical remission was achieved with azathioprine and low-dose steroid therapy.
Desmosomes exhibit quantitative alterations in neoplastic diseases. We used direct and stereological measurements to quantify these structures in basal cell carcinomas and in seborrheic keratoses, in comparison with the basal stratum of normal epidermis. Tissue fragments were processed for electron microscopy. Random sampling procedure was used to obtain micrographs of cells from each of the three groups. The following parameters were calculated: volume of the 'average' cell (Vcell), relative surface area of plasma membrane occupied by desmosomes (Ss), mean desmosome diameter (delta) and mean desmosome surface area (s), number of desmosomes per unit surface area (Ns), mean surface area of plasma membrane (Spm), total surface area (Sdes) and number of desmosomes on the 'average' cell (Ndes). Cell volume to surface ratio (V/S) and volume density of intercellular space (Vvint) were also determined. The parameters Ns, Sdes, and Ndes decreased both in basal cell carcinomas and in seborrheic keratoses. The lowest values were obtained in basal cell carcinomas. Instead, the parameters delta, Ss and Vvint increased in both lesions.
Demodex folliculorum (D. folliculorum), found in the pilosebaceous unit, is the most common ectoparasite of humans. Various clinical forms such as pustular folliculitis, papulopustular scalp eruptions, perioral dermatitis, and blepharitis have been defined, although in general, the disease has been classified into three main groups as "pityriasis folliculitis", "rosacea-like demodicidosis", and granulomatous rosacea-like "demodicidosis gravis". Our aim was to test for the presence of D. folliculorum in pathogenic numbers in patients who came to our clinic with non-specific symptoms such as facial itching with or without erythema, seborrheic dermatitis-like or perioral dermatitis-like lesions, papulopustular lesions, and an acneiform clinical appearance without telengiectasia or flushing. Twenty-eight (87.5%) female and 4 male (12.5%), patients and 33 age-and-sex matched healthy subjects enrolled in this study. D. folliculorum was sought in the lesion sites using the non-invasive method known as the Standardised Skin Surface Biopsy (SSSB). The discovery of more than five parasites in an area of 1 cm2, was evaluated as pathogenic. For treatment, 5% permethrine cream was applied twice daily for 15 to 30 days. The clinical symptoms of the patients were classified into clinical groups and evaluated as facial itching in 2 (6.3%), nonspecific erythema and itching in 21 (65.6%), erythema and pityriasiform squamous lesions in 3 (9.4%), acneiform in 3 (9.4%), papulopustular lesions in 1 (3.1%), granulomatous rosacea-like in 1 (3.1%), and perioral dermatitis-like symptoms in 1 (3.3%), D. folliculorum density was determined as 5>D/cm2 in all clinical lesions. A significant clinical healing and density of D. folliculorum at <=5 D/cm2 was determined in all but two patients after treatment. We consider that D. folliculorum presentation with different symptoms and signs than classical forms is not rare. For this reason, we suggest that it is useful to test for D. folliculorum in patients with non-classical presentations like facial itching, itching accompanied by non-specific erythema, itching and non-specific pityriasiform squamous lesions, and acneiform lesions.
Using immunohistochemical methods, we investigated the distribution of epithelial membrane antigen (EMA) on the normal eccrine gland, eccrine poroma and hidroacanthoma simplex. Granular membrane-associated reaction of EMA was detected on the outer cells of both the intraepidermal and the upper portion of intradermal eccrine ducts, as well as on the luminal surfaces and intercellular canaliculi of eccrine glands. Clear immunolabeling was also present in the tumor cells of eccrine poroma and hidroacanthoma simplex. Thus, it is suggested that the constituent cells of these tumors originate from the outer cells of the intraepidermal and/or the upper portion of the intradermal eccrine ducts. There was no immunolabeling for EMA on the tumor cells of seborrheic keratosis and basal cell carcinoma. Immunohistochemical staining for EMA is a useful tool for the diagnosis of skin appendage tumors.
The Pityrosporum ovale (PO) is demonstrated in various percentages of the keratotic lesions of the seborrheic areas depending upon the techniques. The accumulation of horny material most probably enhances the multiplication of the yeast and makes its demonstration easier. The PAS technique prevails upon the mycological ones (77 p. 100 versus 50-65 p. 100). PO proliferates only in the keratin layer; there are isolated spores, small clusters or even large stratified colonies. On the other side the prevalence of PO does not differ significantly whatever the ultimate diagnosis of seborrheic keratosis, actinic keratosis, naevocellular nevus or vial wart. Its multiplication within the keratin layer of the lesions does not make any difference as far as the lymphocytic infiltration of the dermis is concerned.
Eosinophilic pustular folliculitis (Ofuji's disease) is a rare skin disease of unknown etiology characterized by infiltrated circinate plaques with sterile follicular pustules in primarily seborrheic areas. Several therapeutic regimens have been reported to control the disease with inconsistent results. We here report on a patient with Ofuji's disease, who was successfully treated with interferon-alpha 2b.
Using the 'ground glass method', the forehead seborrheic index of 72 patients was determined before and during local treatment with promestriene 1% in a o/w base. In hyperseborrheic patients a significant decrease of the seborrheic index was obtained from the 3rd week of treatment and maintained for all its duration, while in normoseborrheics no change was observed under the same conditions. It may be concluded that promestriene reduces the sebum secretion but only in hyperseborrheic patients.