Benign Dermatoses Research Articles

Single-cell sequencing delineates T-cell clonality and pathogenesis of the parapsoriasis disease group

BackgroundMycosis fungoides (MF), the most common cutaneous T-cell lymphoma, is often underdiagnosed in early stages due to similarities with benign dermatoses such as atopic dermatitis (AD). Furthermore, the delineation from so-called “parapsoriasis en plaque,” a disease that can appear either in a small- or large-plaque form, is still controversial. ObjectiveTo characterize the parapsoriasis disease spectrum. MethodsWe performed single-cell RNA sequencing of skin biopsies from patients within the parapsoriasis-to-early-stage MF spectrum, stratified for small and large plaques, and compared them to AD, psoriasis and healthy control skin. Results6 out of 8 large-plaque lesions harbored either an expanded alpha/beta or gamma/delta T-cell clone with downregulation of CD7 expression, consistent with a diagnosis of early-stage MF. By contrast, 6 out of 7 small-plaque lesions were polyclonal in nature thereby lacking a lymphomatous phenotype, and also revealed a less inflammatory microenvironment than early-stage MF or AD. Of note, polyclonal small- and large-plaque lesions characteristically harbored a population of NPY+ innate lymphoid cells and displayed a stromal signature of complement upregulation and antimicrobial hyperresponsiveness in fibroblasts and sweat gland cells, respectively. These conditions were clearly distinct from AD or psoriasis, which uniquely harbored CD3+CRTH2+ IL13-expressing “Th2A” cells or strong type 17 inflammation, respectively. ConclusionThese data position polyclonal small- and large-plaque dermatitis lesions as a separate disease entity, that characteristically harbors a so far undescribed ILC population. We thus propose the new term “polyclonal parapsoriasis en plaque” to this kind of lesions, as they can be clearly differentiated from early and advanced-stage MF, psoriasis and AD on several cellular and molecular levels.

H02 Superficial X-rays and grenz rays for benign dermatoses: from saviour to pariah over the course of the 20th century – the story of the remarkable rise and slow decline of an entire therapeutic modality and its potential for revival

H02 Superficial X-rays and grenz rays for benign dermatoses: from saviour to pariah over the course of the 20th century – the story of the remarkable rise and slow decline of an entire therapeutic modality and its potential for revival

Lichen Striatus: An Updated Review.

Lichen striatus is a benign dermatosis that affects mainly children. This condition mimics many other dermatoses. The purpose of this article is to familiarize pediatricians with the clinical manifestations of lichen striatus to avoid misdiagnosis, unnecessary investigations, unnecessary referrals, and mismanagement of lichen striatus. A search was conducted in June 2023 in PubMed Clinical Queries using the key term "Lichen striatus". The search strategy included all observational studies, clinical trials, and reviews published within the past ten years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of this article. Lichen striatus is a benign self-limited T-cell mediated dermatosis characterized by a linear inflammatory papular eruption seen primarily in children. The onset is usually sudden with minimal or absent symptomatology. The eruption in typical lichen striatus consists of discrete, skin- colored, pink, erythematous, or violaceous, flat-topped, slightly elevated, smooth or scaly papules that coalesce to form a dull red, potentially scaly, interrupted or continuous band over days to weeks. Although any part of the body may be involved, the extremities are the sites of predilection. Typically, the rash is solitary, unilateral, and follows Blaschko lines. In dark-skinned individuals, the skin lesions may be hypopigmented at onset. Nails may be affected alone or, more commonly, along with the skin lesions of lichen striatus. The differential diagnoses of lichen striatus are many and the salient features of other conditions are highlighted in the text. Lichen striatus is a self-limited condition that often resolves within one year without residual scarring but may have transient post-inflammatory hypopigmentation or hyperpigmentation. As such, treatment may not be necessary. For patients who desire treatment for cosmesis or for the symptomatic treatment of pruritus, a low- to mid-potency topical corticosteroid or a topical immunomodulator can be used. A fading cream can be used for post-inflammatory hyperpigmentation.

The mycosis fungoides cutaneous microenvironment shapes dysfunctional cell trafficking, antitumor immunity, matrix interactions, and angiogenesis.

Malignant T lymphocyte proliferation in mycosis fungoides (MF) is largely restricted to the skin, implying that malignant cells are dependent on their specific cutaneous tumor microenvironment (TME), including interactions with non-malignant immune and stromal cells, cytokines, and other immunomodulatory factors. To explore these interactions, we performed a comprehensive transcriptome analysis of the TME in advanced-stage MF skin tumors by single-cell RNA sequencing. Our analysis identified cell-type compositions, cellular functions, and cell-to-cell interactions in the MF TME that were distinct from those from healthy skin and benign dermatoses. While patterns of gene expression were common among patient samples, high transcriptional diversity was also observed in immune and stromal cells, with dynamic interactions and crosstalk between these cells and malignant T lymphocytes. This heterogeneity mapped to processes such as cell trafficking, matrix interactions, angiogenesis, immune functions, and metabolism that affect cancer cell growth, migration, and invasion, as well as antitumor immunity. By comprehensively characterizing the transcriptomes of immune and stromal cells within the cutaneous microenvironment of individual MF tumors, we have identified patterns of dysfunction common to all tumors that represent a resource for identifying candidates with therapeutic potential as well as patient-specific heterogeneity that has important implications for personalized disease management.

Cutaneous manifestations induced by check point inhibitors in 120 melanoma patients-The European MelSkinTox study.

Checkpoint inhibitors provide an effective approach for the melanoma treatment. They prolong lymphocyte effects, which explains the cytotoxicity underlying immune-related adverse events (IrAEs). Cutaneous IrAEs affect nearly 40% of PD-1i and 50% of CTLA4i-treated patients. Severe cutaneous irAE do not often occur but could be life-threatening and may persist despite treatment discontinuation. We aimed to investigate cutaneous IrAEs in a cohort of patients treated with ICI across Europe in an effort to characterize the reactions in a real-world, phase IV, post-marketing study using a follow-up questionnaire. Data since November 2016 until March 2021 were obtained from the Melskintox database, a European multicentric biobank dedicated to the follow-up of melanoma and cutaneous adverse events, supported by EADO. The dermatoses reported were pooled into four categories: inflammatory dermatosis, bullous diseases, drug-related eruptions and pigmentary diseases. Inflammatory benign dermatoses (n = 63) represented the most common group of reactions (52.5%), followed by drug-related eruptions (n = 24, 20%), pigmentary diseases (n = 23, 19.2%) and bullous diseases (n = 10, 8.3%). Grade II (n = 41, 34.2%) are represented by bullous pemphigoid, eczema, hypodermitis, lichenoid eruption, maculopapular rash, pruritus, psoriasis-like rash, urticarial eruption and vitiligo. Grade III (n = 18, 15.0%) are represented by bullous pemphigoid, lichenoid eruption and rashes. Grade IV (n = 2, 1.7%) is only represented by bullous disease. Most cutaneous IrAEs led to immunotherapy continuation (n = 95, 88.0%). CR is associated with more severe the cutaneous irAEs. We report an average time-to-onset of 208 days and some late-onset events. Our study has characterized the clinical spectrum of cutaneous irAEs, their timing and severity and their relationship with tumour response. Grade I-II cutaneous IrAE are easily managed allowing ongoing anticancer treatment. Severe late-onset cutaneous irAE are not uncommon. A dermatological follow-up helps mitigate the risk of life-threatening adverse events. These findings highlight the importance of oncodermatological involvement in management of patients with melanoma receiving immunotherapy.

Cover Image

The cover image is based on the Original Article Interface change in early mycosis fungoides: A potential mimicker of benign dermatoses by Matthew Tsang and Jennifer M. McNiff https://doi.org/10.1111/cup.14369.image

Chronicles of A.I. Pospelov Moscow Dermatovenerology and Cosmetology Society (MSDC was founded on October 4, 1891) Bulletin of the MSDC № 1146

On February 15, 2022, the 1146th meeting of the Moscow Society of Dermatovenereologists and Cosmetologists named after A.I. Pospelov took place.
 The meeting was held in a remote format. There were 120 participants in total. Accepted as a member of MSDC 1 person.
 Three clinical clinical observations are presented. The first of them is a case of giant-cell variant of annular granuloma with extensive skin lesions. Annular granuloma is a benign dermatosis of unclear etiology, prone to spontaneous resolution; it occurs as a reaction to ultraviolet radiation against the background of lymphoproliferative or autoimmune diseases, sarcoidosis, chronic lung diseases, prostate cancer. In the presented case, the clinical diagnosis was confirmed by histological examination.
 The second presentation was devoted to livedoid vasculopathy with a tendency to thrombotic complications. This is a relatively rare disease that is excluded from the group of vasculitis due to one distinctive feature ― a pronounced tendency to thrombosis in the absence of indications of the primary nature of inflammation. In therapy, in addition to medications, the appointment of vitamins is mandatory.
 The third observation concerned Merkels carcinoma, one of the relatively rare but extremely aggressive most malignant forms of skin cancer. With epithelial and neuroendocrine differentiation, which is superior to melanoma in terms of aggressiveness of the course and tendency to metastasis. Due to the rare occurrence of the tumor, diagnostic errors are frequent. Diagnosis requires histological and immunohistochemical examination. Any inflamed atheroma or synovial cyst that recurs after surgical treatment should be alarming.
 Scientific reports were heard on the biological therapy of psoriasis, a chronic systemic immunoassociated disease of a multifactorial nature with a hereditary predisposition characterized by the formation of inflammatory papules and plaques, often with joint damage (arthropathy), accelerated proliferation of epidermocytes and a violation of their differentiation, an imbalance between pro-inflammatory and anti-inflammatory cytokines and chemokines. And the second scientific report contained information about modern approaches to the treatment of acantholytic pemphigus.

110 Non-invasive molecular analysis for CTCL detection and differentiation from other skin conditions with adhesive smart sticker skin sample collection

Cutaneous T cell lymphoma (CTCL) is a complex and heterogenous disease with a range of pathogenic, diagnostic, prognostic and therapeutic courses. Broadly, CTCL is characterized by cutaneous infiltrates of aberrant monocolonal T-lymphocytes. Clinically and histopathologically, CTCL often mimics psoriasis, eczema and other benign dermatoses. Diagnosis of CTCL is often delayed by 4-6 years from the time lesions initially appear, and typically requires multiple skin biopsies and blood tests. In this study, we employed non-invasive adhesive patches to collect samples from lesional skin of CTCL (n=12) and psoriasis (n=10) patients as well as non-lesional skin from healthy (n=12) volunteers.

Milia en Plaque of the Earlobe.

Introduction: Milia en plaque is an uncommon benign dermatosis. Case presentation:We present a case of a 43-year-old Caucasian man with a five-month history of asymptomatic symmetric lesions on the earlobes that has been previously treated by self-medication with potent topical steroids, emollients, cosmetic procedures, herbal medication and punch-procedure. Based on clinical examination, a diagnosis of milia on earlobes was established and treated with topical steroids. Discussion and conclusion:Milia en plaque of the earlobes has yet not been reported. Treatment is not different from other localizations.

Carcinoma Cuniculatum with Bone Invasion Mimicking a Viral Wart

Carcinoma cuniculatum is a rare variant of low-grade and well-differentiated squamous cell carcinoma. It is a locally invasive tumor, although it has low metastatic potential. It was originally described in the plantar region but may exceptionally appear in other locations. It predominates in middle-aged men and presents clinically as an exophytic, solitary, painful tumor, with insidious growth. Histologically, this tumor simulates a variety of benign dermatoses and may require several biopsies for the correct diagnosis. It is often misdiagnosed as a viral wart, due to the clinical similarity and the indolent course. The treatment of choice is surgical excision due to the high risk of recurrence and locally aggressive behavior. Amputation can be performed in cases of deep tissue invasion. We present a case of carcinoma cuniculatum in which the late diagnosis favored the invasion of the underlying bone, resulting in amputation of the affected finger.

Optimization of the molecular genetics for the diagnosis of early mycosis fungoides

BACKGROUND: Mycosis fungoides (MF) is the most common disease among the cutaneous T-cell lymphomas (8590%). The accuracy of the diagnosis of MF, which is confirmed only by clinical, histological and immunohistochemical signs, is 5075%. AIMS: To investigate genetic marker STAT4 for early diagnosis of mycosis fungoides. MATERIALS AND METHODS: A study involving 42 patients with MF and chronic benign dermatoses (CBD) was performed. The analysis of gene expression STAT4 was carried out by TaqMan Real time-PCR. The objects of the study were lesional skin samples of patients. A group with MF consisted of 29 patients, a group with CBD consisted of 13 patients, a control group included 10 healthy volunteers. RESULTS: The study revealed that the level of STAT4 gene expression showed a significant (9 times) increase in the expression of gene STAT4 in patients with MF (168.2) compared with patients with CBD (18.5; p 0.001) and 561 times with healthy volunteers (0.3; p 0.001). CONCLUSION: For early diagnosis of MF the level of expression STAT4 is of great importance. Inclusion of STAT4 in the list of diagnostic algorithm increases the accuracy of differential diagnosis of MF and CBD from 59.1 to 92.2%.

Hydroxychloroquine for generalized granuloma annulare: 35% response rate in a retrospective case series of 26 patients

Hydroxychloroquine for generalized granuloma annulare: 35% response rate in a retrospective case series of 26 patients

Lesiones premalignas del pene

The dermatological conditions that affect the penis are diverse, and may be typical of this area or be part of systemic diseases. The anamnesis and inspection are often sufficient for diagnosis, but other times, it is difficult to distinguish between benign dermatoses and premalignant lesions. The delay in consulting, due to fear, shame or the doctor's own ignorance, can cause the lesions to progress to malignancy and require aggressive treatments that can alter the quality of life and physical and mental health of the patient. We must suspect premalignancy or malignancy any lesion of the penis that is not modified with specific or empirical treatment and refer for biopsy. HPV infections are the origin of 50% of premalignant lesions. After treatment and due to possible relapses and progression to infiltrating carcinomas, a strict follow-up plan is necessary.

Análise da qualidade de vida de pacientes portadores de dermatoses benignas em um hospital de ensino de Minas Gerais

Objetivo: Analisar a qualidade de vida (QV) de pacientes portadores de dermatoses benignas em ambulatório de dermatologia de hospital de ensino do Sul de Minas Gerais. Métodos: Estudo quantitativo, transversal, do tipo pesquisa de campo e de perfil populacional e formas de promoção de saúde, no qual se fez a análise da QV de pacientes portadores de dermatoses benignas (psoríase, vitiligo, melasma, acne, dermatite e rosácea), de fevereiro a julho de 2017. Foram aplicados o Questionário Genérico de Qualidade de Vida - SF36 e o Dermatology Life Quality Index (DLQI-BRA), traduzidos e validados para a língua portuguesa. Resultados: Foram entrevistados 68 pacientes, dos quais 47 eram do sexo feminino (mín. 13; máx. 75 anos). No SF36, os domínios Limitação por Aspectos Emocionais (escore médio, EM, de 57,3) e Vitalidade (EM 58) foram os de pior resultado. No DLQI-BRA, o EM foi de 6,97, sendo Sintomas e Sentimentos (EM 2,69) e Atividades Diárias (EM 1,79) os de maior prejuízo para o doente. Não foram observadas correlações relevantes entre os diferentes domínios de cada questionário. Conclusão: Este estudo identificou piores escores nos Aspectos Emocionais e na Vitalidade do paciente no que diz respeito à QV de forma geral. Em relação à situação dermatológica foi pontuado escore geral de moderado efeito na QV dos pacientes. Os sintomas, sentimentos e as atividades diárias foram os fatores que causam maior prejuízo para o doente.

Sequential Use of Topical Imiquimod and Photodynamic Therapy in Extramammary Paget’s Disease: Disease and Treatment Update and Review of the Literature

Extramammary Paget’s disease (EMPD) represents an intraepithelial carcinoma whose diagnosis is often delayed as it can be easily misdiagnosed as a benign inflammatory dermatosis. Surgery is considered to be the standard treatment, but all surgical modalities are associated with high local recurrence rates. We give concern of this disease through the description of a case of primary EMPD in an 83-year-old lady treated with an alternative modality of treatment: the sequential use of topical imiquimod and photodynamic therapy. Topical treatments can be an alternative, and when used in combination, it allows increasing tolerance and, therefore, treatment compliance and satisfactory outcomes.

Geriatric dermatosis; The concerns of aging skin.

Objectives: To study the cutaneous manifestations in elderly and their association with gender. Study Design: Cross Sectional study. Setting: Sir Syed Hospital Karachi. Period: Jan 2016 to Jan 2018. Material & Methods: Total 217 geriatric cases (>60 years; both genders) were included from outdoor dermatology clinic. The previous pregnancy, lactation, severe systemic disease and drug induced skin changes were excluded. The association of skin manifestation with gender was analyzed by Chi-square test with significant p<0.05. Results: Among 217 cases, there were 126(58%) females and 91(42%) males. Mean age was 69.3+4.99 years. Wrinkling was seen in 92%, skin laxity in 54.8%, xerosis (43%), dryness (65%), sagging (46%), pigmentation (37%), eczema (25%), sparse hair (21%), skin atrophy (19%), tinea (13%) and LSC (10%). While herpes zoster, psoriasis, onychomycosis, tinea corporis ,asteotic eczema in 7%. Folliculitis 6%, scabies and bullous pemphigoid seen in 5%, while lichen planus, actinic elastosis, BCC, Prurigo nodularis in 3%. Cellulitis, pediculosis, Seborrheic Dermatitis and contact dermatitis were seen in 2% followed by 1% cases of warts, candidiasis, photodermatosis and SCC seen in our study. Folliculitis (6%) was the most frequent bacterial infection followed by impetigo (0.9%). Herpes zoster (6.5%) was frequent among viral infections followed by warts (0.9%) and HSV-1 (0.9%). Tinea (13.4%) was most frequent fungal infection followed by onychomycosis (7%) and candidiasis (0.9%). Scabies was most common parasitic infection (4.6%) followed by pediculosis (2.3%). Eczema seen in 24.8%. The benign dermatosis, Actinic elastosis was frequent (3.2%), stucco keratosis 4(1.8%), Keratoacanthoma (0.9%). Amongst malignancies, BCC was common (3.2%), followed by SCC (1.4%). 5% Bullous Pemphigoid cases were found. The psychocutaneous disorder included LSC (10%), prurigo nodularis (2.8%) and neurotic excoriation (0.9%). Wrinkling, sagging, dryness of skin, actinic keratosis, actinic elastosis was found to be associated with female gender, however cellulitis, squamous cell carcinoma and asteatotic eczema with male gender. Conclusion: Geriatric population is facing multiple dermatological concerns. Contributory factors being the natural aging process, exposure to UV radiation, pathogens, dryness, humidity, temperature and chemical irritants. Female geriatrics are prone to wrinkling, sagging, dryness of skin and male geriatrics to basal cell carcinoma. There is need to address the skin problems in elderly for better quality of life in geriatrics.

Challenges in early diagnosis of primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma: a case series of four patients

Primary cutaneous aggressive epidermotropic CD8+ cytotoxic T-cell lymphoma (AECTCL) is a rare and aggressive lymphoma characterised by ulcerated lesions and a poor prognosis. To present a case series of four previously misdiagnosed AECTCL patients and discuss the importance of early diagnosis. All patients in this study were identified from the database of the Dermatology Department of the Medical School of Bezmialem Vakif University, based on clinical and histopathological diagnosis of AECTCL between 2010 and 2018. AECTCL cases may mimic many benign dermatoses and accurate diagnosis may be delayed. Because of its poor prognosis, early diagnosis of AECTCL may be helpful in improving the likelihood of patient survival, but further study is needed to address the challenges in diagnosing this rare and aggressive lymphoma.

CIRCULATING SEZARY CELLS IN SUBACUTE SPONGIOTIC DERMATITIS

Sezary syndrome comprises a triad of fiery red erythroderma, generalized lymphadenopathy, and circulating atypical cells with cerebriform nuclei (Sezary cells) exceeding an absolute value of 1000/cumm or exceeding 10% of circulating cells. Sezary cell is not pathognomonic of Sezary syndrome and can be seen in many benign dermatoses such as chronic eczema, psoriasis, lupus erythematosus, parapsoriasis, atopic dermatitis, and vasculitis. We report circulating Sezary cells in a patient of subacute spongiotic dermatitis, one of the rare causes for Sezary cells in peripheral blood.

Benign dermatoses of the male genital areas: A review of the literature.

The male genitalia are a common site of dermatoses. Patients with penile diseases often delay or avoid medical care due to anxiety and embarrassment. In this narrative review, we describe some of the main benign dermatoses localized to male genital, focusing on their epidemiology, clinical and dermoscopic features, as well as available therapies.

Acral Lentiginous Melanoma on the Palm: Unusual Site with a Fatal Outcome

Introduction: Melanoma is more common in the western countries than among darker pigmented individuals, but acral lentiginous is the most frequently encountered subtype among Indians. Case Presentation: An Indian male presented with a progressively increasing blackish ulcerated nodule on left palm overlying a heterogeneously hyperpigmented macule present since 6 months. A diagnosis of acral lentiginous melanoma was made and a wide local excision with left axillary dissection was done. The patient missed the initial sessions of chemotherapy and succumbed three months later due to metastatic complications. Conclusions: Melanoma may present with varied morphologies which may resemble benign dermatoses at initial presentation causing a delay in diagnosis. Occurrence of acral lentiginous melanoma on the palm is unusual and may go unnoticed due to its innocuous appearance. The survival rates drop drastically as the tumor metastasizes. Thus, a high index of suspicion is warranted to make a timely diagnosis in an attempt to improve patient outcome.