Actinic reticuloid: action spectra and UVA protection factor sunscreens

This study compares the action spectra on two new patients with actinic reticuloid (AR), with one previously reported patient. All three patients had exquisite photosensitivity in the UVB range being up to 27 times more sensitive than controls. Sensitivity also increased into the UVA Range, all up to 335 nm and, one into the visible. Their photosensitivity made evaluation of the Sun Protection Factor (SPF) of selected, more recent, high-numbered sunscreens easier to compare, because of the shorter time of the minimal erythema dose when tested with a solar simulator. A sunscreen containing butyl methoxydibenzoylmethane (Parsol 1789) with an overall SPF of 16 was not as effective at protecting the actinic reticuloid patients as a higher SPF numbered sunscreen containing a benzophenone (SPF of 40). The Parsol 1789 gave a protection value of 5 in the UVA Range, compared to one of 3 given by the sunscreen containing benzophenone. The SPFs of seven of these commerically available high-numbered sunscreens were compared with controls.     

Actinic granuloma. A clinical, histopathologic, and immunocytochemical study

Two cases of actinic granuloma are described with emphasis on distinctive clinical and histopathologic features, including immunoperoxidase staining for lysozyme and immunophenotyping of mononuclear leukocytes. Actinic granuloma presents in chronically sun-damaged skin as normally colored to erythematous papules that coalesce to form centrifugally enlarging annular patterns. By light microscopy, a granulomatous infiltrate of giant cells and histiocytes is seen to be intimately related to the presence of elastotic fibers in the upper dermis. Selective localization of lysozyme in the giant cells of the granuloma is apparent by a tertiary antibody immunoperoxidase technique. Determination of mononuclear leukocyte subsets with monoclonal antibodies reveals a predominance of helper T cells in the lymphocytic infiltrate associated with the granuloma. It is postulated that actinic granuloma represents a cell-mediated immune response to weakly antigenic determinants on actinically altered elastotic fibers.     

Actinic reticuloid. Response to combination treatment with azathioprine, hydroxychloroquine, and prednisone

We treated an intractable case of actinic reticuloid with azathioprine, hydroxychloroquine, prednisone, and solar protection with E-Z film and obtained a clinically worthwhile effect. The patient was initially sensitive to less than 2 mjoules/cm2 ultraviolet B (UVB) and less than 1 joule/cm UVA, which caused erythematous and infiltrated scaly plaques that persisted for more than 6 weeks after testing. The case is also instructive in the difficulty presented in differentiating it from mycosis fungoides, and for the presence of Sézary-type cells in skin, blood, and lymph nodes.     

A flow cytometric study of actinic reticuloid

Potential progression of actinic reticuloid to malignant lymphoma was studied by DNA flow cytometry of affected formalin-fixed skin from six patients with histological and photobiological evidence of actinic reticuloid. DNA aneuploidy was absent in all patients providing no evidence that actinic reticuloid is a premalignant condition.     

Asymmetric periflexural exanthem of childhood: a clinical, pathologic, and epidemiologic prospective study.

OBJECTIVE: To assess the clinical, pathologic, and epidemiologic features of asymmetric periflexural exanthem of childhood (APEC), a clinically distinctive eruption, especially its link with pityriasis rosea and pattern of transmission. DESIGN: A prospective case series, including an analysis of epidemiologic triggering factors and mode of transmission. Pathologic study, including immunohistochemistry of the inflammatory infiltrate. SETTING: A mixed, community-based referral center. PATIENTS: A total of 37 girls and 30 boys with typical APEC referred from April 1994 to December 1996 were included in the study; 82% came from the greater Bordeaux area in France. INTERVENTION: None. MAIN OUTCOME MEASURE: Possible interhuman transmission of APEC. REUSLTS: No triggering factor was identified; no interhuman transmission occurred; and no demonstrable link with pityriasis rosea was apparent. Several new clinical variants were recognized or confirmed (high fever, facial and peripheral involvement, prolonged course). Distinctive perisudoral interface CD8+ infiltrate was suggestive of diagnosis. CONCLUSIONS: Interhuman transmission was doubtful, but inoculation disorder was still possible. Histopathologic findings seem more specific than previously thought.     

Actinic keratoses: review of clinical,dermoscopic, and therapeutic aspects

Actinic keratoses are dysplastic proliferations of keratinocytes with potential for malignant transformation. Clinically, actinic keratoses present as macules, papules, or hyperkeratotic plaques with an erythematous background that occur on photoexposed areas. At initial stages, they may be better identified by palpation rather than by visual inspection. They may also be pigmented and show variable degrees of infiltration; when multiple they then constitute the so-called field cancerization. Their prevalence ranges from 11% to 60% in Caucasian individuals above 40 years. Ultraviolet radiation is the main factor involved in pathogenesis, but individual factors also play a role in the predisposing to lesions appearance. Diagnosis of lesions is based on clinical and dermoscopic examination, but in some situations histopathological analysis may be necessary. The risk of transformation into squamous cell carcinoma is the major concern regarding actinic keratoses. Therapeutic modalities for actinic keratoses include topical medications, and ablative and surgical methods; the best treatment option should always be individualized according to the patient.     

A morphologic, pathologic, and virologic study of anogenital warts in men.

BACKGROUND AND DESIGN--Infection with human papillomavirus (HPV) in the anogenital region is associated with benign papillomas (condyloma acuminatum), subtle verrucous changes, subclinical infection, and malignant lesions. Although both men and women are affected, much of the investigation has been directed toward women in the study of cervical and vulvar carcinoma. The current investigation focuses on HPV infection in men. This study was undertaken to correlate the clinical spectrum of disease in our population of male patients with histopathologic features, immunoperoxidase staining for viral capsid antigen, and viral typing. Genital lesions from 26 patients were examined and tested prospectively over a 1-year period. RESULTS--The 26 lesions examined demonstrated variable morphologic features with regard to location, size, surface characteristics, and color. Histopathologic features were consistent with the diagnosis of venereal warts, but not necessarily diagnostic. Three of five standard histopathologic criteria were present in only 71% of the specimens. Despite the morphologic variability and the indeterminant histopathologic findings, 20 of 23 lesions positive for the genital tract HPV types tested contained HPV types 6 and/or 11. CONCLUSIONS--We conclude that the morphologic appearance of anogenital warts does not necessarily correlate with HPV type. Histopathologic study is helpful in excluding other diagnoses but may be indeterminant in the diagnosis of venereal warts. All men with anogenital warts should be counseled, treated, and undergo follow-up regardless of HPV type.     

Actinic keratosis: a clinical and epidemiological revision

Actinic keratoses are benign intraepithelial skin neoplasms constituted by atypical proliferation of keratinocytes that may evolve to squamous cell carcinoma. They develop in photoexposed skin areas; they are induced mainly by ultraviolet radiation and are considered cutaneous markers of chronic exposure to sunlight. They develop mainly in adults and older, fair skinned individuals, and are the fourth most common cause of dermatologic consultation in Brazil. Damage to the apoptosis pathway in photoexposed epithelium favors cellular proliferation and the permanence of the lesions. In this revision, the authors assemble the main epidemiological data regarding this disease and suggest that strategies to identify risky phenotypes, early diagnosis, adequate treatment, clinical follow-up, stimulus to skin self examination, photoeducation and photoprotection should be promoted with the aim of avoiding the progression to malignancy and also the prevention and the diagnose of concomitant neoplasms also induced by ultraviolet radiation.     

The spectrum of spitzoid tumours: A clinical study

This study explores the relationship between different types of spitzoid tumours, spindle cell naevus of Reed and spitzoid melanomas. Clinical and histopathological data were retrospectively reviewed from our hospital database in Cambridge from January 2006 to July 2009. Clinical images, where available, were recorded. Search headings from our pathology database included ‘spitzoid tumours’, ‘Spitz naevi’, ‘atypical spitzoid tumours’, spitzoid tumours of uncertain malignant potential (‘STUMP’), ‘spindle cell naevus of Reed’ and ‘spitzoid melanomas’. The total number of spitzoid tumours was 118 comprising Spitz naevi (72), atypical spitzoid tumours (30), spitzoid melanomas (eight), and other naevi with spitzoid features (eight). In total, 60% of Spitz naevi were diagnosed clinically and 50% reported a history of change with spitzoid melanoma, compared with 32% with Spitz naevi. In all, 60% of Spitz naevi and atypical spitzoid tumours were pigmented in contrast with spitzoid melanomas (83%). Variegated pigmentation was found in 20% of Spitz naevi and atypical spitzoid tumours, however, no spitzoid melanomas had mixed pigmentation. There were 30 atypical spitzoid tumours (9 M : 21 F); 16 occurred on the lower limbs, peaking in the 20–30‐years age group. There were eight patients with spitzoid melanomas with a 7:1 F : M ratio, 50% of which were diagnosed clinically. Of the 34 spindle cell naevus of Reed (10 M : 24 F), 31 were misdiagnosed, most commonly as melanoma. Reed naevi peaked in the 30–40 year age group and on the upper limbs and lower limbs in the 20–30‐years age group. In summary, age and sex appeared helpful in distinguishing benign from malignant spitzoid tumours, however history was less discriminatory. Spitzoid melanomas, most of which were pigmented occurred more commonly in females. Atypical spitzoid tumours were more common in females and pathologists favoured malignancy in this group beyond 20 years of age.     

Actinic granuloma. An ultrastructural study of two cases

Ultrastructural findings in 2 eases of actinic granuloma are presented. The changes observed at the periphery of the lesion and in the elastic fibers, with early stage of damage, were similar to those described in actinic elastosis. Later, an histiocytic reaction which was apparently directed against damaged elastic fillers was observed. The ultrastructure confirms the light-microscopic findings, but does not clarify the etiology of the lesion or its relation to granuloma annulare     

Eccrine spiradenoma: clinical and pathologic study of 49 tumors

A clinical and pathologic study of 49 eccrine spiradenomas occurring in 46 patients is presented. The study showed that pain and/or tenderness are not such characteristic clinical features of this tumor as has previously been suggested; either or both were present in only 23% of the 35 patients with well-documented clinical histories. Some pathologic features, not previously documented in this tumor, were seen and included: cylindromatous foci, aggregates of stromal clear cells, clear cells lining ducts and ulceration of the overlying epidermis. Two tumors had undergone malignant transformation, but there were no recurrences in the 35 patients with adequate follow-up.     

Papular xanthoma. A clinical, histologic, and ultrastructural study

Electron microscopic examination in a case of papular xanthoma revealed the presence of myelinlike laminated bodies in the cytoplasm of the foam cells. To our knowledge, similar bodies have been described in large numbers in only two cases of congenital self-healing histiocytosis and one case of generalized eruptive histiocytoma. The presence of laminated bodies may be a morphologic characteristic of papular xanthoma. However, this possibility should be confirmed by identification of the same inclusions in other cases of this disease.     

Scarring alopecia: clinical and pathologic study of 54 African-American women

Background  Cicatricial or scarring alopecia results in the destruction of hair follicles and is a significant cosmetic concern in African-American women.
Objective  To correlate the clinical examination and histologic findings in African-American women with scarring alopecia with a history of hairstyling practices.
Methods  We reviewed retrospectively the medical records and scalp biopsy specimens of 54 women with scarring alopecia. Patients were selected from two dermatologic practices in the Detroit Metropolitan area.
Results  Alopecia commonly presents in patients who use a variety of traumatic haircare techniques, including chemical and physical straighteners, traction, braiding, hair extensions, hair gluing, and chemical curls. Histologic findings are centered around the follicular infundibulum with a lymphocytic infiltrate and perifollicular fibrosis.
Conclusion  Traumatic hairstyling techniques are common in African-American women, and all result in a similar picture of a peri-infundibular lymphocytic infiltrate and fibrosis, leading to alopecia.     

Argyria. A clinical, chemical analytic and micromorphologic study

A 62-year-old male patient developed generalized argyria following the intake of silver-proteinacetyltannate (Targesin; approx. 60 g in 10 years) as treatment for gastric discomfort. On histological and ultrastructural examination of the skin, silver particles were found not only in the usual locations but also in the Schwann cell, the mast cell, and in smooth muscle cells. This corresponded to chemical analysis, proving the presence of this metal in the skin. In the blood, a level of 0.26 +/- 0.04 ppm silver was found. By means of an equation, attempts were made to demonstrate the reaction process involved in the formation of Ag2S as subjected to the photochemical effect of sunlight.