The Koebner phenomenon in eruptive xanthoma.

A 49-year-old woman with Type V hyperlipidemia had yellow papules smaller than 3 mm in diameter with red haloes on her elbows, shoulder, buttocks, and hands. Two linear lesions composed of papules arising at the sites of skin previously injured by a cat scratch were observed. Histopathological examination of these papules revealed the presence of many foam cells in the dermis which stained positively with oil red O stain. A survey of the literature found only 5 cases of the Koebner phenomenon in xanthoma.     

Unilateral colloid milium: a rare presentation

We report a case of a 31-year-old man with asymptomatic papules on one side of his face that had been present for 31 months. On physical examination, he had clusters of 1 to 4 mm skin colored translucent and dome-shaped, papules forming a plaque with a size of 4 x 3 cm on his left mandibular angle. Histopathology revealed atrophy of the epidermis with extensive deposition of pale eosinophilic homogenous deposits containing artifactual fissures that were PAS positive, diastase resistant, and Congo red negative. The final diagnosis was unilateral colloid milium.     

Truncal lesions do not exclude a diagnosis of Gianotti-Crosti syndrome

A boy aged 2 years and 10 months had a pruritic eruption and low-grade fever for 1 week. Examination revealed discrete erythematous papules and papulovesicles on his buttocks and extensor surfaces of four limbs. Several papules were also present on his back. No lymphadenopathy and no hepatosplenomegaly were noted. Investigations failed to identify a single viral aetiology. Topical calamine lotion and a sedating oral antihistamine to be taken at night were prescribed. The truncal lesions subsided in 3 weeks. Complete remission of all lesions was seen after 6 weeks. Although most patients with Gianotti-Crosti syndrome only have the typical acrally distributed eruption, additional truncal lesions, if few in number, do not exclude the diagnosis.     

Papular acne scars. A common cutaneous finding

One hundred thirty-three patients were examined for the presence of a cutaneous eruption consisting of small, asymptomatic, hypopigmented, follicular papules on the upper part of the trunk. The papules were present in 57% of patients who had a history of acne vulgaris and in 9% of patients who denied ever having had acne. Biopsy specimens from five patients revealed circumscribed, perifollicular or parafollicular lesions in which both elastic and collagen fibers were attenuated in comparison with those in normal adjacent dermis. These changes are consistent with scar. We conclude that the papules are a scarring process secondary to acne vulgaris and propose calling the lesions papular acne scars. They appear closely related to or identical with changes previously termed perifollicular elastolysis, postacne anetoderma-like scars, and papular elastorrhexis.     

Granular parakeratosis presenting with facial keratotic papules

A 27-year-old female presented with pruritic keratotic papules over the left side of the face since one month. The lesions developed a few days after working in a hot humid environment and were preceded by severe uncontrollable pruritus for which she had repeatedly wiped the area with handkerchiefs and towels. A biopsy from one of the keratotic papules revealed granular parakeratosis with a markedly thick stratum corneum that had parakeratosis and also housed keratohyaline granules. Similar changes were seen in keratotic plugs of dilated follicular infundibula.     

发疹性毳毛囊肿1例

患者女,40岁。前胸部出现丘疹2年,无自觉症状。皮损为直径2～4mm的丘疹,呈肤色。皮损组织病理示:真皮内见囊肿样结构,囊壁为复层鳞状上皮,囊内见多个毳毛横断面或斜断面。诊断:发疹性毳毛囊肿。     

Acral syringomas presenting as a photosensitive papular eruption

A 43-year-old woman presented with a recurrent and remitting eruption of reddish-brown papules in the sun-exposed areas of the arms and forearms that had been present for 2 years. Results of a histopathologic examination revealed syringoma. To the best of our knowledge, this is the first case report of syringomas confined to sun-exposed areas with a recurrent and remitting course over time. We also review the literature on acral syringomas.     

Multiple trichoepitheliomas in a mother and daughter

A 38-year-old mother and her 8-year-old daughter presented with multiple facial papules. In both cases, the papules had started to develop at about the age of 4-5 years. Biopsy of one of the mother's papules revealed a trichoepithelioma. With time the lesions had become less obvious in the mother, so she and her daughter elected to have no treatment. Both mother and daughter were otherwise well. However, there have been rare reports of multiple trichoepitheliomas being associated with systemic conditions. Multiple trichoepitheliomas are inherited in an autosomal dominant manner and have been mapped to chromosome 9p21.     

Inflammatory Linear Verrucose Epidermal Nevus Coexisting with Lichen Amyloidosus

The clinical and histopathological findings in a case of inflammatory linear verrucose epidermal nevus coexisting with lichen amyloidosus are presented. A 33-year-old woman had had linear verrucose lesions which were histopathologically compatible with ILVEN, and with which no amyloid deposits were associated, on her left lower leg for 30 years. She had noticed keratotic papules around the verrucose lesions on the left leg for the last 3 years. Histopathology of these papules revealed amyloid deposits in the upper dermis under the hyperkeratotic and acanthotic epidermis. Topical application of DMSO liniment with dexamethasone successfully treated the ILVEN. This remission of both lesions and itching also alleviated the keratotic papules on the left leg.     

A case of infectious eccrine hidradenitis

We report a case of "infectious" neutrophilic eccrine hidradenitis who developed papules on the upper arm and trunk. Histological findings revealed vacuolar degeneration and necrosis of epithelial cells in the eccrine sweat ducts and neutrophils that had migrated through ductal epithelium to the lumen. A microabscess was also seen in the eccrine sweat gland coil. Our patient had received no chemotherapy such as cytarabine. Gram-positive cocci were present in the lesional eccrine duct indicating an infective origin of the disease. Human beta defensin-2, one of epithelial antimicrobial peptides, was present in the lesional epidermis and eccrine duct.     

Case of Cowden syndrome associated with eccrine angiomatous hamartoma

Cowden syndrome, also known as multiple hamartoma syndrome is a rare autosomal dominant disorder characterized by multiple hamartomatous tumors of ectodermal, mesodermal and endodermal origin. A 47-year-old woman had a skin-colored plaque on the left foot. She had total abdominal hysterectomy due to uterine leiomyoma at the age of 35, and had modified radical mastectomy due to right breast cancer at 38. Thyroid adenoma was diagnosed at age 46. Physical examinations revealed macrocephaly, multiple papules of the buccal mucosa, skin tags of the neck and multiple keratotic papules of both hands. Multiple gastrointestinal polyps were detected on gastrofiberoscopy and colonoscopy. Histological examination of the skin lesion on the left foot showed an increased numbers of eccrine sweat glands and blood vessels, which are characteristic histological findings of eccrine angiomatous hamartoma (EAH), a rare benign tumor. We present a case of Cowden syndrome with an associated EAH, which has not been described in the English literatures.     

Multiple piloleiomyomas associated with solitary angioleiomyoma.

A 58 year-old male had reddish scattered papules strictly confined to the right side of his upper back and neck, right shoulder, and right upper arm. Additionally, he also noticed a subcutaneous nodule on his left thigh. Histopathological examinations revealed that the papules on the back, nape of the neck, shoulder, and arm were multiple piloleiomyomas, as shown by the proliferation of bundles of smooth muscles in the dermis. The subcutaneous nodule of the thigh was angioleiomyoma with a well-circumscribed lesion composed of smooth muscles and blood vessels. Ipsilaterality and segmentality of the distribution of the papules of piloleiomyomas and probable family history that his mother had similar papules with a similar distribution suggest the nevoid character of our case. Piloleiomyomas are often reported to be associated with leiomyoma of the uterus or other organs. This is the first reported case of multiple piloleiomyomas with solitary angioleiomyoma in the literature.     

Discrete papular mucinosis on the back

A rare case of papular mucinosis on the back of a 78-year old man is described. The patient developed approximately 20 discrete papules on the upper back. His serum glucose concentration was borderline elevated, but no other systemic symptoms or signs were apparent. A biopsy revealed mucin deposits only in the upper reticular dermis. The papules were distinctly different from lichen myxedematosus in clinical and histochemical appearance. The present case may represent very early-stage lichen myxedematosus complicated by borderline diabetes mellitus.     

会阴部单纯性获得性淋巴管瘤1例

患者女,56岁,外阴部丘疹、水疱10余年。体检:外阴部可见密集片状分布的粟粒大正常皮色丘疹和水疱。行皮损部分切除术,切除物组织病理示:表皮肥厚,真皮见囊性扩张淋巴管,有含淋巴细胞的腔隙。诊断:单纯性淋巴管瘤。     

Langerhans-cell histiocytosis in an adult patient with multiple myeloma

A 44-year-old man who had suffered for 6 years from multiple myeloma developed multiple papules on the face and chest. Histological examination of these papules revealed the infiltration of predominantly histiocytic cells into the dermis and into parts of the epidermis. These cells were seen on electron-microscopic study to have Langerhans granules in the cytoplasm, which led to a diagnosis of Langerhans-cell histiocytosis concomitant with multiple myeloma. Possible explanations for this unusual association are discussed.     

The hyperkeratotic variant of disseminated superficial actinic porokeratosis (DSAP)

A 78-year-old South Korean man was referred to us from the Medical Intensive Care Unit (MICU) for an opinion. He was comatose and was on ventilatory care due to aspiration pneumonia. Multiple tiny papules had developed 10 years previously and since then the number and size had been increasing gradually. He had been diabetic for the past 4 years, and had Parkinson's disease diagnosed 1 year previously. Laboratory examinations revealed an elevated level of white blood cells (WBCs) (25,000/microL) and decreased hemoglobin (8.8 g/dL). Other laboratory results were negative or within normal limits. Skin examination showed multiple, discrete, crust-like, brownish papules over the erythematous base on the face, upper extremities, and lower extremities. With the clinical impressions of irritated verruca vulgaris, seborrheic keratosis, or cutaneous fungal infection, a skin biopsy was taken from a papule on the left shin, and histopathologic examination revealed several pronounced hyperkeratotic and parakeratotic columns, and characteristic cornoid lamellae in the stratum corneum. Beneath the cornoid lamellae, the granular layer was decreased. A number of round or oval, dyskeratotic, homogenized eosinophilic cells with pyknotic nuclei were scattered in the prickle cell layer below the cornoid lamellae. A mild lymphohistiocytic infiltrate was observed in the papillary dermis and around the blood vessels in the upper dermis. Also, actinic degeneration was present in the upper dermis.     

Primary cutaneous amyloidosis of the auricular concha: case report and review of published work

A 70-year-old Japanese female developed tiny papules on her bilateral ears 2 years previously. A histological study of a biopsy specimen revealed that amorphous materials were present in the widened dermal papillae. Because these materials were positive for both Congo red and Dylon, we diagnosed the lesion as primary cutaneous amyloidosis of the auricular concha. Immunohistochemically, the amyloid substance stained positively with 34betaE12 (cytokeratin 1/5/10/14), suggesting that it had an epidermal origin. Seven reported cases of this unique disorder were also reviewed.     

面部发疹性毳毛囊肿

报告1例面部发疹性毳毛囊肿。患者女,35岁。面部起丘疹10余年,无自觉症状。皮损为直径2～4mm的丘疹,呈肤色或浅黄白色,泛发于面部。组织病理检查示:真皮内见囊肿样结构,囊壁为复层鳞状上皮,囊内可见板层状角质物及数个毳毛横断面或斜断面。     

Painful Piezogenic Pedal Papules on a Child with Ehlers-Danlos Syndrome

A 5-year-old girl with Ehlers-Danlos syndrome developed painful piezogenic pedal papules. She had suffered from pain in her heels for the previous two years and had undergone extensive orthopedic examinations that revealed no abnormalities. On admission, she had typical signs associated with piezogenic pedal papules (PPP), with pain induced by standing and disappearance of the lesions and the pain on relief of pressure. These papules were due to herniation of subcutaneous fat into the dermis, possibly because of structural defects of the connective tissue. To the best of our knowledge, this is the first reported case of painful PPP occurring in childhood. We suggest that the herniation of subcutaneous fat in our patient was most probably due to the connective tissue defect that occurs in the Ehlers-Danlos syndrome.     

MALIGNANT ATROPHIC PAPULOSIS (DEGOS'' SYNDROME)

A 29-year-old Japanese man with malignant atrophic papulosis had a 1-year history of scattered, asymptomatic, whitish or skin-colored papules, as well as erythematous papules with central atrophy showing a porcelain-like appearance on the trunk and extremities. Histologic examination revealed lymphocyte-mediated necrotizing vasculitis with considerable deposition of mucin in the dermis. The wedge-shaped necrosis of the dermis was not detected. Based on a review of the literature we think that this case represents the histologic features of the early skin lesions of malignant atrophic papulosis.