Asymptomatic Macules Research Articles

Multiple Asymptomatic Violaceous Macules on the Thigh—Diagnosis

Multiple Asymptomatic Violaceous Macules on the Thigh—Diagnosis

Multiple Asymptomatic Violaceous Macules on the Thigh—Quiz Case

Multiple Asymptomatic Violaceous Macules on the Thigh—Quiz Case

ARTERITE MACULAR – A NOVA VASCULITE CUTÂNEA DOS VASOS DE MÉDIO CALIBRE

Introdução: A arterite macular (AM) é a designação para um novo tipo de vasculite cutânea dos vasos de médio calibre, caracterizada clinicamente por máculas eritemato-violáceas ou acastanhadas, reticuladas e assintomá- ticas. A histopatologia revela uma arterite linfocitária. Relato de caso: Homem de 35 anos, caucasiano, sem hábitos tabágicos ou antecedentes pessoais relevantes, observado por erupção cutânea com dois meses de evolução, localizado no tronco e membros. Negava outras queixas e o exame fisíco geral foi normal. Ao exame físico dermatológico observavam-se múltiplas máculas eritemato-violáceas, assintomáticas e de configuração linear e reticulada. Colocou-se como principal hipótese de diagnóstico periarterite nodosa cutânea (PNC). A avaliação imagiológica e analítica não revelaram doença sistémica subjacente. O exame histológico demonstrou um vaso de médio calibre na junção entre a derme profunda e o tecido adiposo subcutâneo envolvido por infiltrado inflamatório predominantemente linfocitário e depósito de fibrina no lúmen, compatível com AM. Conclusão: A AM é uma vasculite cutânea pouco relatada na lite- ratura, cujo diagnóstico é essencialmente histológico. Clinicamente, a PNC constitui o principal diagnóstico diferencial.PALAVRAS-CHAVE – Arterite; Doenças da Pele.

Hyperpigmented Asymptomatic Macule in a Fingertip With Suspicious Dermoscopic Pattern —Quiz Case

A previously healthy 51-year-old man presented with asymptomatic brown-pigmented lesions on his first left-hand fingertip. The lesions had appeared 3 months ago and gradually spread. He had no history of tobacco smoking, wearing rings, chemotherapy, or work involving friction or in wet places. On physical examination we found an ill-defined, golden to light brown patch over the left thumb finger-tip (Figure 1). Dermoscopy revealed a parallel ridge pattern (Figure 2). A skin biopsy specimen was obtained and stained with hematoxylin-eosin (Figure 3). What is your diagnosis?

メルケル細胞癌の1例

自然消退傾向を示したメルケル細胞癌の1例を報告した。症例68歳女。2003年12月頃, 右頬部に米粒大の自覚症状を欠く常色調の小結節が出現。2004年3月当科初診。初診時, 光沢を有し, 紅色調でドーム状に隆起する小指頭大結節が認められた。生検組織では表皮直下から脂肪織にかけて, 繊細な核網を有し円形の核を持つ異型細胞の増殖が認められた。異型細胞はS100蛋白, Synaptophysin, Chromogranin A, Keratin陽性, 電顕検査にて細胞質に有芯顆粒が認められ, Merkel細胞癌と診断した。生検から1ヵ月後の拡大切除時には, 臨床的に生検時の癩痕を認めるのみであった。組織HE染色像でも真皮内にリンパ球の密な浸潤を認めその中に変性した腫瘍細胞塊が散見された。生検時には組織学的に腫瘍は残存しており, 腫瘍細胞が自然消退したものと考えられた。

Ashy Dermatosis With Significant Perivascular and Subepidermal Fibrosis

To the Editor: Erythema dyschromicum perstans or ashy dermatosis is a chronic hyperpigmentary disease of unknown etiology.1 It presents as ash-colored usually asymptomatic macules located in trunk and proximal extremities. Histopathological findings demonstrate lichenoid dermatitis with vacuolization of basal cells, colloid bodies, and a moderate infiltrate of lymphocytes in the papillary dermis admixed with melanophages.2-4 An 80-year-old man presented to our department with a 4-month history of asymptomatic, progressively increasing in number, blue-gray oval macules over his trunk and proximal extremities, which ranged in size from 3 to 4 cm (Fig. 1). No history of photosensitivity or preceding erythema was found. Darier's sign was negative. Dermoscopy showed small grayish spots of pigment in a diffuse distribution and arranged in a fine linear pattern in some areas, together with whitish areas mimicking regression or scarring (Fig. 2).FIGURE 1: Generalized blue grayish macules scattered over the back.FIGURE 2: Dermoscopy shows dots of grayish pigment and whitish areas.Histologically, the epidermis was slightly hyperplastic with basal cell hyperpigmentation. Numerous melanophages were present around superficial blood vessels, with virtually absent lymphocytic infiltration. Besides, significant perivascular and subepidermal fibrosis was also noted. Masson-Fontana staining confirmed the melanin nature of the pigment present within macrophages (Fig. 3).FIGURE 3: Top: low-power magnification showing a slightly hyperplastic epidermis, numerous perivascular melanophages, and striking fibrosis surrounding vessels and in the papillary dermis (hematoxylin and eosin, ×100). Bottom: abundant melanin in the cytoplasm of basal keratinocytes and in dermal melanophages (Masson-Fontana, ×200).Erythema dyschromicum perstans, also referred to as ashy dermatosis, is a benign disease of unknown origin that occurs more frequently in the Latin American population. Clinically, it is characterized by ash-colored, oval or round, asymptomatic macules that may disappear within several months. These lesions especially involve the trunk and proximal extremities and extend peripherally, usually sparing palms, soles, scalp, nails, and mucous membranes. The histopathologic findings from the active border may show a vacuolar degeneration of the basal cell layer, occasional colloidal bodies, pigment incontinence, phagocytic cells, congestive and dilated vessels, and a perivascular inflammatory lymphohistiocytic infiltrate.1-4 Fibrosis has not been reported as a histological feature for the diagnosis of ashy dermatosis. It is necessary to exclude fixed drug eruptions, lichen planus pigmentosus, postinflammatory hyperpigmentation, idiopathic eruptive macular pigmentation, and dermatosis that present with diffuse hyperpigmentation such as Addison disease or hemochromatosis.5,6 Several treatments such as topical steroids or systemic corticosteroids, antibiotics, ultraviolet light therapy, dapsone, or clofazimine have been tried with an inconsistent efficacy.3 This case is interesting because of the correlation between the dermoscopic and pathologic findings. The pigment showed by dermoscopy arranged in spots and in a fine linear pattern corresponds to the melanophagia appreciated histologically. Otherwise, the white areas similar to regression or scarring appreciated dermoscopically would correspond histologically with the significant fibrosis present in the papillary dermis and surrounding vessels. To our knowledge, there are no previous reports that emphasize this correlation that otherwise could be helpful for the diagnosis of this disease. As a conclusion, dermoscopy could add helpful clues for the diagnosis of ashy dermatosis. José M. Martín, MD Verónica López, MD Esperanza Jordá, MD, PhD Department of Dermatology Hospital Clínico Universitario Valencia, Spain Carlos Monteagudo, MD, PhD Department of Pathology Hospital Clínico Universitario Valencia, Spain Funding sources: None. Conflict of interest: None.

Pigmentatio maculosa eruptiva idiopathica: a case report and review of the literature

Pigmentatio maculosa eruptiva idiopathica is a rare pediatric disease characterized by asymptomatic, brownish macules involving the neck and trunk with no preceding inflammatory process or history of drug exposure. A 9-year-old girl presented with brown-gray, nonconfluent, asymptomatic macules on the trunk, neck, and limbs, ranging from 5 to 30 mm in diameter. The macules appeared suddenly with no lesions preceding their occurrence. Histopathologic examination showed basal cell layer hyperpigmentation, and abundant melanophages with a mild perivascular lymphohistiocytic infiltrate in the papillary dermis. The lesions disappeared spontaneously 1.5 years later with no therapy. No relapse occurred. Pigmentatio maculosa eruptiva idiopathica must be differentiated from other skin disorders with hyperpigmentation in pediatric practice in order to avoid unnecessary treatment, as spontaneous resolution is expected. Following a literature review, we underline the importance of spontaneous regression as an additional clinical feature for this disease.

Pseudoangiomatosis eruptiva: 7 casos clínicos

Introduction Eruptive pseudoangiomatosis consists in the acute development of small vascular lesions in the face and extremities that resolve in several weeks without scarring. Lesions are described as 3-4 mm asymptomatic macules and papules with peripheral whitish halo that blanch upon pressure. Initially it was considered a disease limited to children but it has also been described in adults. It overlaps with the entity known in Japan as «erythema punctatum Higuchi», possibly caused by an insect named Culex pipiens pallens. Methods We report a serie of 7 patients that consulted for lesions compatible with eruptive pseudoangiomatosis. We performed a detailed clinical history and histological, microbiological and serological studies. Follow-up time was up to 4 years. Results Eighty-five percent of patients were women and the mean age was 62 years. All cases appeared in spring/summer and 71 % relapsed. Lesions predominated in the face and extremities and the outbreak lasted 2-4 weeks. The anamnesis did not disclose any specific etiologic agent in any of the cases. Complete laboratory tests including serologies and cultures were negative or within normal limits. Histological study revealed vascular dilatation in all cases with endothelial cell protrusion and a peripheral lymphohistiocytic infiltrate. Conclusions Currently, the etiology of this entity is not well established although it probably represents a reactive disorder to different etiologic processes.

Eruptive Pseudoangiomatosis: Study of 7 Cases

IIntroduction Eruptive pseudoangiomatosis consists in the acute development of small vascular lesions in the face and extremities that resolve in several weeks without scarring. Lesions are described as 3-4 mm asymptomatic macules and papules with peripheral whitish halo that blanch upon pressure. Initially it was considered a disease limited to children but it has also been described in adults. It overlaps with the entity known in Japan as «erythema punctatum Higuchi», possibly caused by an insect named Culex pipiens pallens. Methods We report a serie of 7 patients that consulted for lesions compatible with eruptive pseudoangiomatosis. We performed a detailed clinical history and histological, microbiological and serological studies. Follow-up time was up to 4 years. Results Eighty-five percent of patients were women and the mean age was 62 years. All cases appeared in spring/summer and 71% relapsed. Lesions predominated in the face and extremities and the outbreak lasted 2-4 weeks. The anamnesis did not disclose any specific etiologic agent in any of the cases. Complete laboratory tests including serologies and cultures were negative or within normal limits. Histological study revealed vascular dilatation in all cases with endothelial cell protrusion and a peripheral lymphohistiocytic infiltrate. Conclusions Currently, the etiology of this entity is not well established although it probably represents a reactive disorder to different etiologic processes.

A case of tinea nigra palmaris in Okinawa, Japan

We report a case of tinea nigra on the left palm of a 13-year-old girl. She had noticed a pigmented, asymptomatic macule on the left palm approximately 4-5 years prior to her first visit to our hospital. The color of the lesion tended to change before and after a bath; it became lighter after a bath and darkened some time later. Physical examination revealed that the macule was 4 cm x 5 cm in size, dark brown in color and irregularly shaped. Direct potassium hydroxide (KOH) microscopic examination from skin scrapings revealed branched brown hyphae with light brown septa. A fungal culture on Sabouraud's agar media produced wet, medium brown, yeast-like colonies, the surface of which later became black and shiny. A slide culture disclosed light brown, elliptic or peanut-shaped conidia comprised of one to two ampullaceous cells. Scanning electron microscopic examination of the conidia showed both annellation conidia with lunate bud scars and sympodial conidiogenesis. Using extracted DNA from separately cultured fungi, we performed polymerase chain reaction with the primers specific to Hortaea werneckii. The results showed positive bands. We performed direct sequencing with the DNA segments from the positive bands. The causative fungus in our case was determined to be type C of H. werneckii on the grounds of the base sequences obtained. The final diagnosis of the present case was made as tinea nigra by H. werneckii. We also report a brief survey of all the cases of tinea nigra reported in Japan to date.

Acquired perforating disorder

A 53-year-old man presented with asymptomatic, hyperkeratotic papules and hyperpigmented macules of the face and upper extremities. Treatment was initiated with topical tretinoin and intralesional glucocorticoids. Acquired perforating disorder is a disorder of keratinization that is associated with diabetes mellitus and uremia. Classic presentation involves hyperkeratotic papules with a central core, which occur most frequently on the lower extremities. Treatment includes topical tretinoin, glucocorticoids, keratolytics, systemic retinoids and glucocorticoids, and ultraviolet B phototherapy.

Leukomelanodermic leprosy

A 39‐year‐old woman presented with a 6‐year history of asymptomatic macules on her back. The patient had no other complaints, and she did not report any case of infectious disease in her family. Examination revealed hyperpigmented macules, presenting irregular edges but with a sharp demarcation, on the midline of the back from the cervical to the lumbar region. Within these hyperpigmented areas, islands of normal appearing skin were observed. There were also some hypopigmented macules on the lateral and posterior aspects of the trunk (Fig. 1). The patient presented thickening of the left ulnar nerve and sensory loss to temperature on the lateral aspect of the left arm.Hyperpigmented macules, presenting irregular but sharply demarcated edges, on the midline of the back. Islands of normal appearing skin are observed in these hyperpigmented areas. Hypopigmented macules on the lateral and posterior aspects of the trunkimageBiopsy specimens were obtained from the hyper‐ and hypopigmented areas. In the hyperpigmented macule, the biopsy revealed focal areas of hypomelanosis in the epidermis and the presence of melanophages in the superficial dermis, but no acid‐fast bacilli were found (Fig. 2a). The Masson–Fontana stain showed an evident pigmentary incontinence (Fig. 2b). The biopsy obtained from the hypopigmented lesion also revealed focal areas of hypomelanosis, but in the superficial dermis an infiltrate of foamy macrophages was observed, as typically found in lepromatous leprosy (Fig. 3a); acid‐fast bacilli were found by Fite–Faraco stain. The focal hypomelanosis was confirmed by Masson–Fontana stain (Fig. 3b). Mitsuda's reaction in this patient was negative and slit‐skin smears (cutaneous lesion, earlobes, elbows, and knees) were negative for acid‐fast bacilli.Biopsy of hyperpigmented macule. (a) Focal areas of hypomelanosis and presence of melanophages in the superficial dermis (hematoxylin and eosin stain, ×100). (b) Evident pigmentary incontinence in the superficial dermis (Masson–Fontana stain, ×100)imageBiopsy of hypopigmented macule. (a) Focal areas of hypomelanosis in the epidermis and dermal infiltrate of foamy macrophages (hematoxylin and eosin stain, ×100). (b) Focal areas of hypomelanosis (Masson–Fontana stain, ×100)imageThe patient was treated with multidrug therapy for multibacillary leprosy: rifampin, 600 mg once monthly (supervised), clofazimine, 300 mg once monthly (supervised), dapsone, 100 mg daily, and clofazimine, 50 mg daily, all given for 2 years. After 7 months of treatment, the hypopigmented lesions diminished and the hyperpigmented lesions improved after 2 years of treatment and the sensory loss to temperature was restored.

FAMILIAL SCHAMBERG'S DISEASE.

Schamberg's disease, an uncommon disorder of the skin, is manifested by asymptomatic brown macules and petechiae distributed primarily on the lower extremities. 1-3 Since the disease is of a benign nature, it is important to distinguish it from the more serious disorders which produce bleeding in the skin. Except for a positive tourniquet test in about half the patients, 3 no hematologic abnormalities have been described. The histopathologic picture is characterized by inflammation of the capillaries in the upper dermis, diapedesis of red cells, and the deposition of hemosiderin. Although the changes in the skin may last for months, the prognosis for complete recovery is excellent. The etiology remains obscure, but there have been reports suggesting that irritation from chemicals in clothing may play a role in some patients. 4 The purpose of this paper is to describe a previously unreported finding in this disorder, its occurrence in two members