Multiple linear eccrine spiradenomas with eyelid involvement

Eccrine spiradenoma is an uncommon tumour of the sweat gland and usually occurs as a solitary small painful nodule. Very rarely, it may present as multiple tumours arranged in a linear/zosteriform fashion. We present the case of a 23-year-old female who had multiple spiradenomas arranged linearly from the midline of forehead to the left corner of the mouth and a few lesions also on the margin of the left eyelid. The lesions were probably along the Blaschko's lines. Tumours were excised surgically in stages. Literature search revealed only 13 reported cases of linear/zosteriform/naevoid multiple spiradenomas and only four cases of solitary spiradenoma of the eyelid. The review of reported cases suggests that arrangement of tumours in a linear/zosteriform pattern is an important diagnostic clue for multiple (naevoid) spiradenomas.     

Unusual clinical variants of cutaneous leishmaniasis in Pakistan

Cutaneous leishmaniasis is endemic in the Baluchistan province of Pakistan and poses a great risk to non-immune visitors to the area. The wide spectrum of clinical variants of this common disease is at times a diagnostic challenge. A total of 1709 patients with cutaneous leishmaniasis were recorded over a 1-year period. In 37 (2%) patients the lesions were very unusual, and therefore worth reporting. These included acute paronychial, chancriform, annular, palmoplantar, zosteriform and erysipeloid forms. The zosteriform and erysipeloid forms have rarely been reported previously, but to the best of our knowledge, acute paronychial, chancriform, annular and palmoplantar lesions are being reported for the first time. The morphologically unusual lesions may be attributed to an altered host response or involvement of an atypical strain of parasite in these lesions.     

Cutaneous zosteriform squamous cell carcinoma metastasis arising in an immunocompetent patient

Cutaneous metastases from internal malignancies or primary skin cancers are uncommon, and a zosteriform pattern is very rare. Histologically, these cutaneous metastases usually appear as malignant epithelial cells located throughout the dermis or subcutaneous fat and without connection to the overlying epidermis. The presence of melanocytes in such lesions is atypical. Moreover, although zosteriform cutaneous metastases of cutaneous squamous cell carcinoma have previously been described in immunosuppressed patients, they have not been reported in immunocompetent patients. We report an unusual case of a woman with cutaneous hyperchromic zosteriform metastases, clinically mimicking a metastatic melanoma but appearing histologically as epidermotropic and pigmented metastases of a cutaneous squamous cell carcinoma.     

Multiple Segmental Eccrine Spiradenoma with a Zosteriform Pattern: A Case Report and Literature Review

Eccrine spiradenoma usually occurs as solitary tender nodules. However, it rarely occurs as multifocal localized tumors or has zosteriform distribution. We report the case of a 32-year-old woman with a 20-year history of itchy lesions on the left side of the back and forearm with a zosteriform distribution. Before disease onset, almost no patients have inducing factors, but our patient received an injection beforehand; however, whether this was coincidental or causative remains unknown. The lesions became very itchy after perspiration or eating spicy food, which has never been reported. A literature search revealed 22 cases of multiple segmental eccrine spiradenoma; we summarized the clinical characteristic in order to aid diagnosis and treatment selection.     

Blaschkoid eccrine spiradenomas

We report a case of multiple eccrine spiradenomas that arose in adulthood along a patient's arm and continued to the midline of the patient's chest across multiple dermatomes. This is one of a handful of such cases, which have been reported as linear, nevoid, or zosteriform eccrine spiradenomas. We believe this distribution is best described as Blaschkoid rather than zosteriform or linear because these lesions follow the lines of Blaschko rather than those of a single dermatome.     

Zosteriform lichen planus

A 95-year-old woman presented with a 4-month history of a pruritic eruption involving her trunk, medial thighs, and lesions limited to the C5 dermatome of the left upper extremity. Punch biopsy supported a clinical diagnosis of zosteriform lichen planus. Linear lichen planus refers to lichen planus with a unilateral linear distribution. This variant may present as an example of the Wolf isotopic response, or more rarely, a de novo eruption on previously-normal skin. In very rare instances linear lichen planus presents in a segmental fashion corresponding to a dermatome and is termed zosteriform lichen planus.     

Zosteriform Kaposi's sarcoma

We report the case of a 92-year-old man with lesions of classic Kaposi's sarcoma occurring in a zosteriform pattern. The mechanisms of dermatomal distribution are speculated and cutaneous lesions presenting in a zosteriform pattern are reviewed.     

Lichen planus in the lines of Blaschko

We describe three adolescents with eruptive linear lesions of the back, abdomen, and extremities distributed along the lines of Blaschko. Clinically one of these lesions resembled an epidermal nevus in its morphology and distribution. A biopsy specimen demonstrated the typical histology of lichen planus (LP). There have been fewer than 20 reported cases of childhood linear LP. Our patients demonstrate that linear LP sometimes may closely resemble an epidermal nevus and may auger the onset of more generalized LP or more involvement along the lines of Blaschko, that is, "Blaschkoian" disease. Previous studies have referred to this variant as zosteriform. Our cases are the fourth, fifth, and sixth cases of childhood LP reported to occur along the lines of Blaschko. Based on the clinical findings in our patients and a review of the English-language literature, we believe that linear LP is usually distributed along the lines of Blaschko and should be renamed lichen planus, Blaschko subtype.     

Cutaneous ectopic schistosomiasis: diagnostic challenge

Cutaneous schistosomiasis is a rare clinical manifestation of schistosomiasis, an infectious and parasitic disease, caused in Brazil by the trematode Schistosoma mansoni. The lesions are due to the deposition of eggs or, rarely, adult worms, usually involving the genital and groin areas. Extra-genital lesions occur mainly on the torso as papules of zosteriform appearance. The case of a patient with ectopic cutaneous schistosomiasis is reported in this article, due to the rarity of its occurrence and its difficult clinical diagnosis.     

Relapsing linear acantholytic dermatosis in a four-year-old boy

Linear acantholytic dermatoses are a spectrum of cutaneous disorders that form a subset of linear dermatoses with distinct clinical features and histopathologically show acantholysis. The lesions may be zosteriform or follow the lines of Blaschko. This report describes a four-year-old boy who, on a follow up of two years, exhibited a relapsing acantholytic dermatosis along the lines of Blaschko. Histopathology of a representative lesion revealed epidermal acantholysis with multiple acantholytic keratinocytes with in the prickle cell layer and an absence of corp ronds and grains, consistent with features of Hailey-Hailey disease. This, to our knowledge, is the third case of relapsing linear acantholytic dermatosis reported.     

Presence of varicella zoster virus in zosteriform leukaemia cutis

Leukaemia cutis is a relatively rare manifestation in chronic lymphocytic leukaemia, characterized by a diverse morphology of skin lesions. We report two patients who developed zosteriform skin symptoms; however, the histological analysis revealed leukaemia infiltration as the cause of their symptoms. Contrary to previous reports, varicella zoster virus DNA was detectable in the lesions. These findings suggest that varicella zoster virus plays an active role in the development of zosteriform leukaemia cutis.     

Bilateral zosteriform extragenital lichen sclerosus et atrophicus: A new clinical presentation

We report a 13‐year‐old female child with sequentially occurring lesions of extragenital zosteriform lichen sclerosus et atrophicus (LSA). The skin lesions first appeared at the right waist when she was 8 years and gradually extended inferiorly and medially along the dermatome of the right L1–2. Subsequently, another skin lesion occurred along the dermatome of the left L5–S1 from the left buttock to left dorsum of the foot in the following 5 years. Microscopic findings obtained from the right inguinal sclerotic plaque revealed typical features of LSA. We report the first case of bilateral zosteriform LSA and remind clinicians of including lichen sclerosus in the differential diagnoses of cutaneous zosteriform lesions.     

Zosteriform cutaneous leiomyoma-Type Ⅱ: An uncommon presentation

Cutaneous leiomyomas are rare, benign smooth muscle tumors, characterized by painful nodules in most of the cases. They can occur in multiple disseminated, segmental or zosteriform and solitary forms. Segmental or zosteriform leiomyoma can occur either alone(Type Ⅰ), or with scattered nonsegmental lesions elsewhere(Type Ⅱ); the latter variety occurring rarely. Here we present a case of Type Ⅱ zosteriform leiomyoma in a middle aged individual.     

ACQUIRED LINEAR NAEVUS SHOWING HISTOLOGICAL FEATURES OF KERATOSIS FOLLICULARIS

SUMMARY.— The case is reported of a linear and zosteriform warty naevus of 3 years' duration in a woman aged 30.
Biopsy showed the histological features of keratosis follicularis.
The relationship between circumscribed dyskeratotic lesions and Darier's disease is discussed.     

Bilateral Multisegmental Zosteriform Leiomyoma Cutis: A Rare Entity

Cutaneous leiomyomas are benign tumors derived from the smooth muscles of the skin. They are firm, skin-colored to brownish, frequently painful papules and nodules presenting either as a solitary tumor or multiple clustered lesions. Uncommon patterns of multiple leiomyoma cutis include linear, zosteriform, or dermatomal-like arrangement of lesions. We saw a 32-year-old man who presented with clusters of skin colored to reddish brown, occasionally painful papules and nodules distributed segmentally over C6 to T8 dermatomes on left side and T11 to L1 dermatomes on right side. Histopathology confirmed the diagnosis of cutaneous leiomyoma. The case is reported here for the occurrence of this benign cutaneous neoplasm in an extremely rare bilateral multisegmental distribution.     

ZOSTERIFORM INFLAMMATORY METASTATIC CARCINOMA

A 57-year-old man presented with chest wall lesions and swelling of his left arm. The rapid onset of vesicular lesions in a dermatomal distribution resulted in an initial diagnosis of herpes zoster. Cutaneous biopsy revealed adenocarcinoma and further evaluation revealed a primary source of pulmonary adenocarcinoma. Lymphatic spread of tumor cells is the most likely source of the zosteriform skin lesions, but other possibilities are discussed.     

Wolf's isotopic response: a case of zosteriform lichen planus

Lichen planus is a lichenoid disorder characterized by shiny, flat papules. In addition to the classical appearance, there are several variants. Zonal or zosteriform lesions have been described. A 25-year-old male with a complaint of increasing numbers of erythematous swellings on his left groin for twenty days was admitted to our out-patient clinic. He had a history of herpes zoster in the same localization which had been treated with topical acyclovir two weeks prior to his admission. Dermatological examination revealed multiple, shiny, erythematous, umblicated papules localized to the left inguinal region in a linear pattern. A biopsy was taken from the lesions. According to the clinical and pathological findings the diagnosis was zosteriform lichen planus. Zosteriform lichen planus is a rare variant of lichen planus; its differentiation from zona zoster and other linear dermatoses is difficult. We presented our case because of its rarity as a variant of lichen planus and its appearance in the area of healed herpes zoster as an isotopic response.     

Zosteriform connective tissue nevus: a case report

Because of its distinctive clinical features and histopathological characteristics, zosteriform connective tissue nevus is considered a separate entity from other connective tissue nevi. Only two cases have previously been reported in the worldwide dermatological literature. Here we report a zosteriform connective tissue nevus in a 3-year-old boy with similar clinical presentation.     

Isotopic response, Köbner phenomenon and Renbök phenomenon following herpes zoster

Linear skin diseases may follow Blaschko’s lines, Langer’s relaxed skin tension lines or head zones (dermatomes), thus indicating an embryogenic, hematogenic or neuronal aspect in their pathogenesis. Köbner phenomenon describes the eruption of an inflammatory skin disease following mechanical alteration of the skin. Renbök phenomenon describes an area of non‐involvement in an otherwise generalized skin disease. Wolf’s isotopic response may be understood as a special subtype of Köbner phenomenon, in which one skin disease triggers a second one. Pathogenically unrelated skin diseases may follow a zosteriform distribution, if they are linked to a preceding herpes zoster by Köbner phenomenon, Renbök phenomenon or an isotopic response. We report three instructive patients diagnosed with Wegener’s granulomatosis, cutaneous graft‐versus‐host disease and lichen planus, whose skin manifestations were following or sparing a zosteriform distribution pattern. Köbner phenomenon, Renbök phenomenon or Wolf’s isotopic response may link pathogenically unrelated skin diseases to a zosteriform pattern, which may present diagnostic difficulties even for dermatologists.     

Dermatologic manifestations among human immunodeficiency virus patients in south India

BACKGROUND: Human immunodeficiency virus (HIV) may be associated with a large number of dermatologic manifestations, which may at times constitute the presenting symptoms. These skin lesions are well delineated in the Western literature, but there is a paucity of information from the southern part of the Indian subcontinent. Objective We evaluated 833 persons with HIV to determine the types of dermatologic lesions present. RESULTS: The various lesions observed were oral candidiasis (45.0%), multidermatomal herpes zoster (11.2%), dermatophytosis of the skin (8.0%), herpes genitalis (7.7%), papular pruritic dermatitis (7.7%), staphylococcal infection of the skin (2.9%), oral hairy leukoplakia (2.3%), molluscum contagiosum (1.3%), genital warts (1.2%), and scabies (0.5%). Alopecia, intractable itching, dry skin, Addisonian pigmentation, and Kaposi's sarcoma were also noted. A correlation between the dermatologic manifestations and CD4 cell counts was found. CONCLUSION: Although the pattern of cutaneous lesions was comparable with that from the West, there is a strikingly lower incidence of Kaposi's sarcoma.