Can granuloma annulare evolve into cutaneous sarcoidosis?

We report the unique case of a 50-year-old African American female with pulmonary sarcoidosis who presented with a new ichthyosiform eruption symmetrically located on the anterior shins and surrounded by red, translucent, intradermal papules. A skin biopsy of a new red papule showed features consistent with granuloma annulare (GA) with positive mucin staining, and an older hyperpigmented papule showed classic dermal noncaseating granulomas consistent with sarcoidosis. Recent reports have clearly demonstrated GA occurring in association with sarcoidosis, but this is the first report that suggests that a GA lesion may develop into a sarcoidal granuloma. We propose that GA may act as a precursor lesion to the more mature sarcoidal granuloma. This case further underscores the importance of careful clinicopathologic correlation.     

Is it,or isn't it? Poison ivy look-a-likes

Poison ivy causes more allergic contact dermatitis (ACD) than any other cause. Although physicians rightfully focus on the treatment of the dermatitis, prevention will be aided by recognition of the foreboding plant. Likewise, many other plants can masquerade as poison ivy and cause one to needlessly curtail his or her activities because of fear of a bad reaction. The most common poison ivy pretenders in the United States are discussed, and distinguishing plant characteristics are highlighted.     

Papular elastolytic giant cell granuloma: a clinical variant of annular elastolytic giant cell granuloma or generalized granuloma annulare?

A 71-year-old man with asymptomatic red papules on the trunk and upper arms was reported as a case of papular elastolytic giant cell granuloma. A skin biopsy specimen from a papule on the back showed similar findings to those of annular elastolytic giant cell granuloma. However, centrifugal annular lesions were not clinically observed. He was successfully treated with tranilast and topical steroids.     

Where does the antigen of cutaneous sarcoidosis come from?

Background: The antigen pathway of cutaneous sarcoidosis remains obscure. We have investigated topographic involvement of inflammatory cells and lymphatic vessels. Methods: Eleven cutaneous biopsies from eight patients were studied, along with controls from other granulomatous disorders and various skin lesions. Markers for lymphocytes, dendritic cells (DCs), and lymphatic vessel endothelial cells were detected using immunohistochemistry. Results: S100⁺ and CD1a⁺ immature DCs (Langerhans cells) occurred more frequently within the epidermis, whereas S100⁺, fascin⁺, or CD83⁺ maturing DCs occurred more frequently beneath the epithelium in cutaneous sarcoidosis cases than in controls (e.g. CD83, cutaneous sarcoidosis vs. other granulomatous disorders: r = 0.557, p = 0.011). Fascin⁺ and CD83⁺ mature DCs were often closely attached to CD3⁺ T‐lymphocytes around dermal granulomas. D2‐40⁺ lymphatic vessels were often found surrounding dermal granulomas, especially those located in the deeper dermis, in contrast to fascin⁺ blood vessels. Conclusions: Antigen‐capturing by immature DCs seems to take place initially in the epidermis, followed by maturation of DCs. These mature DCs may present the processed antigen to T‐lymphocytes that cause dermal granulomas either in the interstitium of the upper dermis, or in or around lymphatic vessels of the lower dermis. Environmental antigen could be verified by skin test. Kurata A, Terado Y, Izumi M, Fujioka Y, and Franke FE. Where does the antigen of cutaneous sarcoidosis come from?     

Systemic sarcoidosis and cutaneous lymphoma: is the association fortuitous?

The association of systemic sarcoidosis and malignant lymphoma is known as the 'sarcoidosis-lymphoma syndrome'. Cutaneous involvement is rare in this syndrome. We report a 52-year-old woman who was diagnosed as having tumour-stage mycosis fungoides. Complete remission was achieved by combination therapy consisting of isotretinoin, interferon (IFN) alpha, electron beam irradiation, photochemotherapy and topical corticosteroids. Three years later, the patient developed systemic sarcoidosis characterized by yellowish papules on the abdominal wall and the eyelids that histologically revealed non-caseating granulomas, multiple fine-nodular interstitial pulmonary infiltrates on chest X-ray, hilar lymphadenopathy, decreased vital capacity and increased lymphocyte count in bronchoalveloar lavage fluid. As opposed to most of the reported cases, in our patient the manifestation of cutaneous lymphoma preceded the diagnosis of systemic sarcoidosis. We review the cases reported in the literature and discuss a possible causal and temporal relationship as well as the role of IFN alpha in the development of sarcoidosis.     

Is pyogenic granuloma associated with Bartonella infection?

Lobular capillary hemangioma and bacillary angiomatosis due to Bartonella infection share several clinical and histopathologic characteristics. We sought to determine whether lobular capillary hemangioma is caused by the same agent as bacillary angiomatosis. Forty-five pathology specimens with a histologic diagnosis of lobular capillary hemangioma obtained from patients with the same clinical diagnosis were tested by immunohistochemistry and polymerase chain reaction for the presence of DNA elements of Bartonella spp. None of the 45 lobular capillary hemangioma specimens tested positive for Bartonella spp. We conclude that lobular capillary hemangioma is not associated with Bartonella spp infection. Further research is required to determine the etiologic agent.