Perplexing papules and plaques

Dermatologic diseases are capable of presenting in a variety of clinical and pathologic guises. We present the clinicopathologic features of an unusual case misinterpreted initially as a dermal hypersensitivity reaction that was later deemed to be the cholesterol emboli syndrome. Salient histologic features of this case were the presence of numerous dermal eosinophils and the diagnostic finding of an intravascular cholesterol embolus. The presence of dermal eosinophilia should prompt a search for cholesterol emboli in the appropriate context.     

Adult‐onset Still disease with peculiar persistent plaques and papules

Adult‐onset Still disease (AOSD) is a systemic inflammatory disorder characterized clinically by high spiking fever, polyarthralgia/arthritis, a salmon‐pink evanescent rash, predominantly neutrophilic leucocytosis, lymphadenopathy, liver dysfunction, and splenomegaly. Recently, a nonclassic, nonevanescent skin rash has been reported. We report a 27‐year‐old woman with AOSD showing persistent pruritic papular lesions. Histologically, dyskeratotic keratinocytes were seen in the upper epidermis. We describe this case in detail and review the previous literature. Nonclassic pruritic eruptions with characteristic dyskeratotic keratinocytes might provide an important clue for the diagnosis of AOSD.     

Pruritic urticarial papules and plaques in pregnancy

PUPPP is a distinct kind of dermatosis that occurs in pregnancy and is characterized by pruritic, mostly urticarial papules. The lesions usually occur during the last trimenon and regress shortly after delivery. In contrast to other types of dermatosis in pregnancy (e.g., herpes gestationis), PUPPP is not associated with a higher incidence of fetal or maternal complications. It is relatively rare and has only occasionally been mentioned in the German literature. The clinical features and courses of eight patients are described, and the differential diagnosis is discussed with regard to other dermatoses of pregnancy.