Auriculotemporal (Frey) syndrome in late childhood: an unusual variant presenting as gustatory flushing mimicking food allergy

Auriculotemporal or Frey syndrome is characterized mainly by recurrent episodes of facial gustatory flushing and/or sweating, limited to the cutaneous distribution of the auriculotemporal nerve. Although relatively common in adults following injury to the auriculotemporal nerve or parotid disease, the condition has rarely been reported in children. Moreover, in childhood, auriculotemporal syndrome has been described mainly in infancy and early childhood as a sequel of perinatal birth trauma resulting from assisted forceps delivery. We report a 13-year-old girl with a 2-month history of recurrent, painless, preauricular gustatory flushing without sweating, initially suspected to be a food allergy. Detailed inquiry revealed a history of a bicycle accident with mandibular condyle fracture 7 years prior to the onset of symptoms. Our patient demonstrates an unusual presentation of auriculotemporal syndrome in late childhood as gustatory flushing mimicking food allergy. Awareness of this variant is essential for prompt recognition, thus avoiding unnecessary laboratory tests, especially as this condition usually resolves spontaneously.     

Erythroderma with lichenoid granulomatous features induced by erythropoietin

The increasing use of new drugs in cancer therapy, especially growth factors, hormones, and chemotherapies resulted in several reports of unusual skin eruptions. We studied a patient with erythroderma who had received erythropoietin because of myeloma with tumor anemia. The histological features were characterized by a lichenoid, focally granulomatous infiltrate with predominance of histiocytes. It is important for dermatopathologists to recognize this interesting pattern induced by erythropoietin.     

HLA-DR-antigen bearing keratinocytes in various dermatologic disorders

In normal human epidermis HLA-DR-antigen is only present on Langerhans' cells and the acrosyringeal epithelium. We investigated the distribution of HLA-DR-antigen in 78 specimens of various skin diseases by an immunoperoxidase method using a monoclonal anti-HLA-DR antibody. HLA-DR-antigen bearing keratinocytes were not only found in lichen planus and mycosis fungoides, as it has been referred previously, but were also observed in some cases of cutaneous B-cell lymphoma, pseudolymphoma, lupus erythematosus, parapsoriasis en plaque, bullous pemphigoid, drug reaction, contact dermatitis, actinic keratosis and verrucous carcinoma. Direct contact of lymphoid cells with keratinocytes was not necessary for Ia-antigen expression.     

Expression of cytoskeletal components in melanocytic skin lesions. An immunohistochemical study

The cytoskeleton is considered to be important for maintaining cell shape and facilitating cell movement. In the present study, the expression of cytoskeletal components is examined in benign and malignant melanocytic skin tumors. Paraffin sections of 75 cases (25 each of nevocellular nevus, primary malignant melanoma, and cutaneous metastases of malignant melanoma) were stained with antibodies to tubulin, myosin, actin, and vimentin using a three-step immunoperoxidase method. The staining results were assessed independently for tumor cells and stroma cells in comparison to inbuilt reference structures. Vimentin is found in all melanocytic lesions in the tumor as well as in the stroma cells. In malignant lesions, the tumor cell staining intensity varies between neighboring regions; particularly in malignant melanoma the staining is pronounced in the tumor periphery (chi 2 test: p less than 0.05). Actin is only weakly positive in nevus cells and primary melanoma tumor cells, but strongly expressed in metastatic tumor cells (p less than 0.001). Nevus fibroblasts are only weakly positive, whereas the stroma fibroblasts in the malignant lesions are strongly positive (p less than 0.001). The same is true for myosin and tubulin expression in dermal fibroblasts (p less than 0.001), whereas the tumor cells are equally (weakly) positive in all melanocytic lesions. Our study shows that there are significant differences in the immunohistochemical expression of cytoskeletal components in various melanocytic tumors. There is an elevated expression of vimentin and actin in the tumor cells, particularly of metastatic lesions. However, the most pronounced differences are found in the dermal fibroblasts.(ABSTRACT TRUNCATED AT 250 WORDS)     

HLA-DR-positive keratinocytes are associated with suppressor lymphocyte epidermotropism. A biomathematical study

The expression of HLA-DR antigen on keratinocytes has recently been described as a frequent finding in various dermatologic disorders without restriction to a particular entity or a peculiar histologic reaction pattern, except for the association with a mononuclear dermal infiltrate. To determine the relationship of HLA-DR+ keratinocytes and T lymphocyte epidermotropism in human disease in vivo, 82 skin specimens were investigated by immunohistologic and stereologic methods and by two- and three-dimensional linear regression analysis. In randomly selected cases of various dermatoses, HLA-DR+ keratinocytes were associated with T lymphocyte epidermotropism. Furthermore, HLA-DR+ keratinocytes correlated particularly with the proportion of epidermotropic suppressor/cytotoxic cells. Our findings demonstrate that HLA-DR+ keratinocytes are associated with a particular pattern of epidermotropism, which may suggest an interaction of keratinocytes and T suppressor/cytotoxic cells in vivo.