Benign Skin Diseases Research Articles

Nevoid hyperkeratosis of the nipple and areola

Nevoid hyperkeratosis of the nipple and areola is an extremely rare and benign skin disease of unknown etiology, predominantly seen in childbearing aging women, especially in the second and third decades of life. The disease is characterized by gradually growing verrucous thickening and brown pigmentation of the nipple. Here, we present a case of nevoid hyperkeratosis of the nipple and areola in a 42-year-old female patient. Although nevoid hyperkeratosis of the nipple and areola has a benign character, it is a problem for patients due to deformity and for clinicians because of its similarity to paget disease. There is no consensus on treatment; Topical agents such as keratolytics, steroids, retinoids or calcipotriol, and ablative methods such as cryotherapy, carbon dioxide laser, radiofrequency, or shaving excision are treatment options.

Radyofrekans ablasyonla tedavi edilen vulvar lenfanjioma sirkumskriptum: Olgu sunumu

Lymphangioma circumscriptum (LC) is a rare benign skin disease involving hamartomatous lymphatic malformation of the deep dermal and subcutaneous lymphatic ducts. Upon occuring in uncommon areas such as axilla, shoulder, groin, and vulva, it is a therapeutic challenge for the dermatologist. Various methods such as surgical excision, lasers, and sclerotherapy have been used in the past to treat this unsightly skin condition. In this article we report the efficacy of a radiofrequency ablation in a female patient with vulvar LC. The treatment efficiency of radiofrequency was satisfactory in our patient without recurrence during the 6-month follow-up period. Based on previous studies, radiofrequency technique is a safe and cost-effective treatment for LC management, as in our case.

Evaluation of the molecular marker TOX protein in diagnosis of early stages of mycosis fungoides.

Background: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma (CTCL). Differentiation of MF especially early stages (eMF) from its benign mimickers is important to ensure proper management. TOX is a critical regulator of early T-cell development in the thymus that is considered as a useful marker for MF diagnosis and prognosis. Objective: The aim of the current study is to evaluate the ability of molecular marker TOX protein in diagnosis of eMF, and its ability to differentiate eMF from similar benign inflammatory skin diseases (BIDs). Materials and Methods: This is a case control study, and was carried out on 60 subjects; 20 patients as eMF, 20 patients as (BIDs) and 20 normal skin specimens as control cases. The diagnosis was established after clinicopathological correlation. Immunohistochemistry (IHC) was done for MF, BIDs and normal skin cases for TOX and CD4 IHC stains. Results: TOX expression showed a significant positive expression in MF cases compared to BIDs and control groups, with 100% sensitivity and 95% specificity. The pattern of TOX IHC stain in MF was diffuse, while in BIDs was focal. There was positive correlation between TOX and CD4 staining in MF cases. Conclusion: TOX might be considered a diagnostic marker for eMF that can differentiate eMF from BIDs mimickers.

The Treatment of Infantile Cafe Au Lait Spot Using Dr. Hoon Hur’s Golden Parameter Therapy with a High Fluence 1064nm Q-Switched Nd: Yag Laser

Background: Infantile Café-Au-Lait Spot (CALS) is a benign hyperpigmentary skin disorder that ranges in color from light brown to dark brown. Using traditional laser therapies including 532nm potassium titanyl phosphate(KTP) laser, 694nm ruby laser and 755nm alexandrite laser for infantile CALS treatment may provoke harmful side effects such as purpurae, crusts,Post-Inflammatory Hyperpigmentation (PIH), mottled hypopigmentation and scarring. Unfortunately, there is no clear standard for the laser treatment of infantile CALS because an infant is too young to receive laser treatment. Objectives: This study was performed to investigate the efficacy and safety of Dr. Hoon Hur’s Golden Parameter Therapy (GPT) with a high fluence 1064nm Q-switched Nd:YAG laser laser (QSNL) for infantile CALS treatment. Methods: Nineteen Korean patients with infantile CALS were enrolled in this study and treated with a 1064nm QSNL on a weekly basis for 20-50 treatment sessions of Dr. Hoon Hur’s GPT. The parameters were a spot size of 7 mm, a fluence of 2.2 J/cm2 and a pulse rate of 10Hz with one pass by a sliding-stacking technique over the infantile CALS. Results: After the final treatment, all of the 19 patients with infantile CALS were achieved the complete removal of pigmented lesions without any side effects such as purpurae, crusts, PIH, mottled hypopigmentation or scarring. No recurrences were observed in any of the patients after a follow- up of 6-14 months. Conclusion: We suggest that Dr. Hoon Hur’s GPT with a high fluence 1064nm QSNL is a safe and effective treatment for infantile CALS without causing side effects and recurrences. Keywords: Infantile Cafe au Lait Spot; 1064nm Nd:YAG laser; Dr. Hoon Hur’s GPT

Granulome annulaire généralisé : étude anatomoclinique

Granuloma annulare (GA) is a benign granulomatous skin disorder that is generalized (GGA) in 15% of cases. Although many case reports describe a relationship between GGA and systemic diseases, few large series have been published, and their association is debated. We present herein a series of GGA in order to describe their clinical and histological features. We included all biopsy-proven cases of GA presenting at the dermatopathology laboratory of Strasbourg where generalized (i.e. over 10lesions). Clinical features were obtained from patients' medical files. We included 35GGA, with a sex ratio of 0.5. The mean age was 54years. Lesions were annular or non-annular in equal measure and were symptomatic in 25% of cases. Most patients (77%) had an associated disease, already known in 60% of cases, including dyslipidemia (27%), diabetes mellitus (20%), immunosuppressive drugs (17%), atopy (17%), auto-immune disease (17%), hematological disease (14%), and cancer (9%). Histological analysis revealed the predominant pattern to be interstitial (54%) rather than palisading (20%), having no correlation with clinical type. Eosinophils were frequent (46%) in GA but were not correlated with systemic disease or drug taking. Among the 40% of patients treated, 50% had a successful outcome on topical corticosteroids, doxycycline, antimalarial drugs or phototherapy. GGA differs from localized GA, which is mostly associated with an already known systemic disease, whether metabolic, infectious or neoplastic, uncorrelated with clinical or histological features, and screening is necessary.

Infantile granular parakeratosis: Case report and review of the literature

Granular parakeratosis (GP) is a benign skin disease that has been reported in adults and children. Lesions usually affect the axillae, groin, and submammary region. The primary lesions present as brown keratotic papules and can form plaques. The etiologies implicated in the development of GP include the use of topical cream and the use of deodorants, local irritation and in children, it was linked to repetitive washing of the affected area and the use of zinc oxide cream. This is a case report of GP in a 14-month-old boy noted after washing the groin area with soap and using zinc oxide cream. The lesions have improved after the discontinuation of the use of zinc oxide cream and soap in washing the affected area.

¿Reconoce esta clave diagnóstica? Parte 2

Se trata de una enfermedad cutánea inflamatoria, benigna e infrecuente que corresponde a una vasculitis leucocitoclástica de vasos pequeños. Típicamente compromete el rostro, de etiología desconocida, aunque se ha planteado daño actínico, entre otras posibles causas. Se manifiesta como pápulas, placas o nódulos de color marrón rojizo a violáceo, bien definidas, infiltradas, de superficie brillante, que muestran acentuación folicular y telangiectasias. Esta entidad tiene un curso indolente y benigno, los pacientes suelen buscar tratamiento por estética y por su curso crónico. No existen guías de manejo ni buena calidad de evidencia con respecto al tratamiento, por lo que la estrategia de manejo debe individualizarse.

Dermatologist‐level classification of malignant lip diseases using a deep convolutional neural network

Deep convolutional neural networks (DCNNs) can classify skin diseases at a level equivalent to a dermatologist, but their performance in specific areas requires further research. To evaluate the performance of a trained DCNN-based algorithm in classifying benign and malignant lip diseases. A training set of 1629 images (743 malignant, 886 benign) was used with Inception-Resnet-V2. Performance was evaluated using another set of 344 images and 281 images from other hospitals. Classifications by 44 participants (six board-certified dermatologists, 12 dermatology residents, nine medical doctors not specialized in dermatology and 17 medical students) were used for comparison. The outcomes based on the area under curve, sensitivity and specificity were 0·827 [95% confidence interval (CI) 0·782-0·873], 0·755 (95% CI 0·673-0·827) and 0·803 (95% CI 0·752-0·855), respectively, for the set of 344 images; and 0·774 (95% CI 0·699-0·849), 0·702 (95% CI 0·579-0·808) and 0·759 (95% CI 0·701-0·813), respectively, for the set of 281 images. The DCNN was equivalent to the dermatologists and superior to the nondermatologists in classifying malignancy. After referencing the DCNN result, the mean ± SD Youden index increased significantly for nondermatologists, from 0·201 ± 0·156 to 0·322 ± 0·141 (P < 0·001). DCNNs can classify lip diseases at a level similar to dermatologists. This will help unskilled physicians discriminate between benign and malignant lip diseases. What's already known about this topic? Deep convolutional neural networks (DCNNs) can classify malignant and benign skin diseases at a level equivalent to dermatologists. The lips are a unique feature in terms of histology and morphology. Previous studies of DCNNs have not investigated tumours on specific locations. What does this study add? This study shows that DCNNs can distinguish rare malignant and benign lip disorders at the same rate as dermatologists. DCNNs can help nondermatologists to distinguish malignant lip diseases. What are the clinical implications of this work? DCNNs can distinguish malignant and benign skin diseases even at specific locations such as the lips, as well as board-certified dermatologists. Malignant lip diseases are rare and difficult for less trained doctors to differentiate them from benign lesions. This study shows that in dermatology, DCNN can help improve decision-making processes for rare skin diseases in specific areas of the body.

Generalized granuloma annulare: a report of 2 cases and literature review

Granuloma annulare (GA) is an idiopathic benign skin disease, characterized by annular dermal plaques or papules. Much is still unknown concerning its aetiology, association, and pathogenesis.We report two patients with generalized GA (GGA), with different age of presentation, co-morbidities, and disease morphology. Herein, we report two patients with GGA with different clinical features, disease morphologies, and histology patterns. We also illustrate the treatment used in our patients and the outcome. GA is a self-limiting disease and can regress spontaneously. GGA tends to be more persistent and usually requires treatment for symptomatic or cosmetic reasons. Expert consensus on treatments recommends topical corticosteroid, psoralen and ultraviolet A (PUVA), and antimalarial drugs.

Clinical efficacy of paiteling in the treatment of condyloma acuminatum infected with different subtypes of HPV.

Condyloma acuminatum (CA) is a type of mucosal benign hyperplasia skin disease that is caused by human papillomavirus (HPV) infection, which mainly occurs in the genitalia and anus. The aim of the present study was to explore the clinical efficacy underlying the traditional Chinese medicine paiteling in the treatment of CA via the detection of HPV. One hundred CA patients were enrolled in the current study and were externally treated with paiteling for 5 weeks. HPV subtypes were examined both before the treatment and at 6 months after the treatment. After the external paiteling therapy, 92 cases were cured, and the apparent efficiency was 92.0% (92/100), while 8 cases exhibited recurrence. Before the external paiteling therapy, the numbers of cases of low-risk, high-risk, and mixed types of HPV were 40, 35, and 25, respectively. At 6 months after treatment, the numbers of negative cases of low-risk, high-risk, and mixed types of HPV were 38, 32, and 20, respectively. The results demonstrated that external paiteling treatment has a good curative effect on the treatment of CA.

Erythema chronicum migrans like- T cell lymphoma: First description in the medical literature. Successful management with methotrexate and methylprednisolone aceponate!

The group of cutaneous T-cell lymphomas (CTCL) or the so-called Mycosis fungoides (MF) is also referred to as a “great imitator" and in some cases may be misinterpreted as benign inflammatory skin disorders. Difficulties could arise both clinically and histopathologically, especially in the early stages of the disease. For this reason, it is recommended that the diagnosis of MF to follow a three-stage pattern of behavior and be performed on the basis of clinic, histopathology and immunohistochemistry.

A Novel Radiotherapy Approach for Keloids with Intrabeam.

Background Keloids are hard nodules or plaques formed by excessive proliferation of connective tissue. Radiotherapy, widely used in various benign and malignant skin diseases, is an effective treatment for keloids. This work evaluates Intrabeam photon radiotherapy in the management of keloids. Methods Fourteen patients who have undergone Intrabeam radiotherapy for a total of 15 sites of keloids were followed up. Twelve cases were first onset and the other two had recurrent diseases. Thirteen patients underwent surgical resection of keloids before radiotherapy. One relapsing patient received only 2 rounds of radiation therapy as she could not be reoperated. Radiotherapy was divided into 2 sessions on days 0 and 3 after surgery. The dose was 4 or 5 Gy each time for 3 min 14 s to 12 min 1 s. In addition, we compared our data to the recurrence of keloids in fourteen patients who had previously been exposed to electron beam using conventional accelerators. Results We analyzed the treatment for adverse reactions and recurrence. In the Intrabeam group, one patient developed superficial skin ulcers a month after treatment. No one experienced wound rupture, bleeding, infection, skin contractures, or obvious hyperpigmentation. None of the fourteen cases showed any recurrence so far after on median 22.5 months of follow-up. Five patients in the electron beam group relapsed 3 to 10 months after treatment. Conclusion Here, Intrabeam photon radiotherapy was shown to be an effective treatment for keloid scars and it is therefore recommended for management of this disease.

Extraction of features from cross correlation in space and frequency domains for classification of skin lesions

This paper proposes a systematic approach for the feature extraction and subsequent classification of benign and malignant skin diseases of both the melanocytic and epidermal lesion categories from dermoscopic images. For this purpose, melanoma and nevus are considered as representatives of the melanocytic skin lesion category, whereas basal cell carcinoma (BCC) and seborrheic keratoses (SKs) are included under the epidermal lesion category. The present work explicates the extraction of spatial and the spectral features from conspicuous regions of skin lesions on the basis of similar visual impacts with the appropriate kernel patches, using the Cross-correlation technique. Depending on the dermoscopic features, the kernel patches have been chosen from a set of dermoscopic images comprising all the skin disease categories selected for this work. A multi-label ensemble multiclass skin lesion classification strategy has been introduced for the segregation of malignant and benign melanocytic and epidermal skin lesions, along with their subclass classification. It has been possible to identify both malignant and benign lesions of melanoma, nevus, BCC and SK disease classes, with sensitivities of 98.76%, 99.01%, 98.87% and 99.41% respectively.

The histopathological pattern of benign and non-neoplastic skin diseases at King Fahad Hospital, Madinah, Saudi Arabia.

Objectives:To characterize and compare the histopathological pattern of benign skin diseases in patients from Madinah region of Saudi Arabia.Methods:This retrospective study was conducted at the Department of Pathology, King Fahad Hospital, Madinah, Saudi Arabia, and contained cases of benign skin diseases for 11 years (from January 2006 to December 2017). The findings were tabulated in Microsoft Excel sheet and classified based on histopathological diagnosis.Results:Of 1,125 skin tissues reviewed, 579 (51.5%) specimens were from male patients and 546 (48.5%) specimens were from females giving a male: female ratio of 1.1:1. The ages ranged from 1 to 101 years with a mean age of 36.9±9.8 years. Most of the skin diseases (n=639; 57%) were seen in the age group 20-49 years. The most common skin diseases observed were disorders of skin appendages (29.6%) followed by benign tumors (18.3%), disorders of pigmentations (11.9%), papulosquamous lesions (11.4%), and dermatitis/eczema (10%). In the group of skin appendages disorders, epidermal inclusion cyst was the most common disease entity representing 20.4% of cases, followed by trichilemmal cyst accounting for 9.2% of the total cases. Mean ages of the patients were 35±8.5 years and 36.7±9.7 years respectively.Conclusion:A variety of benign skin lesions were seen in the present study in a wide age distribution range. The most common skin diseases observed in this study were skin appendage disorders, benign skin and adnexal tumors, pigmentation disorders, and papulosquamous lesions.

¿Reconoce esta clave diagnóstica? Parte 2

El pilomatrixoma proliferante es una entidad poco frecuente, considerándose una variante benigna pero localmente agresiva de los pilomatrixomas. La mayoría de los casos se presentan entre los 60-80 años, como nódulos cutáneos solitarios, localizados principalmente en cabeza y cuello, con un tamaño que oscila entre 1.5 - 5.5 cm. El tratamiento consiste en la resección quirúrgica completa con márgenes quirúrgicos adecuados, con posibilidad de recidiva local de hasta un 14% si no se consigue este margen.

Assessment of Vitamin D Status Among Cases with Pityriasis Alba

Background: Pityriasis alba, is a common benign skin disease occurring predominantly among children, often on their face. Clinically, the spots of pityriasis alba are off-white in color, round with poorly defined margins that bear scanty fine scales on it. No specific cause of pityriasis alba has been identified . In this disease, the number of melanocytes declines and melanosomes reduce within melanocytes. Vitamin D exerts its effect via the vitamin D receptor on melanocytes, if intracellular Ca2+ level decreases, this leads to high levels of reduced thioredoxin this, in turn, inhibit tyrosinase activity with the inhibition of melanin synthesis. In addition, the apoptotic activity of melanocytes reduces by the active form of vitamin D. Aim: The study aimed to assess the status of vitamin D for patients with pityriasis alba. Materials and Methods: 44 patient diagnosed with pityriasis alba were enrolled and the second group of 44 controls was involved in our study. Serum levels of circulating 25 (OH) D were measured. Results: None of the cases had sufficient serum level; the level ranged between 8.1-27.3 ng/ml. The patients had lower circulating vitamin D levels than controls. Conclusion: Our findings in the present study are significant, but further studies with large samples are needed to correlate the extent and severity of pityriasis alba with vitamin D deficiency.

Current Immunotherapy Approaches for Malignant Melanoma

Melanoma is one of the skin cancers caused by various causes. Since the patients often do not feel pain that melanoma is mistaken for benign skin diseases. However, melanoma has the risk of multiplying rapidly and spreading easily through metastasis. It is important to treat it through chemo- or radiotherapy after surgical resection. Immunotherapy is a relatively new cancer treatment, which has shown longer survival rates than conventional cancer treatments in some cases. Cytokines or immune checkpoint blockers are the common immunotherapy strategies for melanoma. However, there are still melanoma patients who have not been benefited by immunotherapies. To overcome the limitations of current immunotherapy approaches, studies are underway to find new immunomodulators and various combinational immunotherapies. In this review, the existing treatments for melanoma are introduced and efforts to find optimal immunotherapy conditions for melanoma treatment have been summarized. Attempts to study the immunotherapy of melanoma with biochip technologies that simulate the body's microenvironment have also been summarized.

Mycosis fungoides: A great imitator

Mycosis fungoides (MF), the most common cutaneous T-cell lymphoma, typically presents in its early stage as inflammatory erythematous patches or plaques, with epidermotropism as the histopathologic hallmark of the disease. Over the past 30 years, numerous atypical types of MF, which deviate from the classic Alibert-Bazin presentation of the disease, have been described. These variants can simulate a wide variety of benign inflammatory skin disorders either clinically, both clinically and histopathologically, or mainly histopathologically. We have summarized the many faces of the disease, which set MF as a “great imitator,” with special focus on the differential diagnosis and its benign mimickers.

The role of biologics in the treatment of chronic granuloma annulare.

Granuloma annulare (GA), a benign inflammatory skin disease, is considered a Th1-type delayed hypersensitivity reaction. Localized GA is likely to resolve spontaneously, whereas disseminated GA (DGA) may persist for decades and can be resistant to treatment. Biologics including TNF-α inhibitors have been proposed and utilized as salvage therapy for GA and other related diseases, interstitial granulomatous dermatitis (IGD), and actinic granuloma (AG). A systematic review was conducted using the combination of search terms "granuloma annulare," "interstitial granulomatous dermatitis," or "actinic granuloma" and either "biologics," "etanercept," "adalimumab," "infliximab," "ustekinumab," "ixekizumab," "secukinumab," "guselkumab," "golimumab," "brodalumab," "tildrakizumab," or "certolizumab" from the years 1970-2017. Review of the literature revealed that 79.3% of the patients with GA, IGD, or AG who had been treated with demonstrated TNF-α inhibitor therapy a clinical response. TNF-α inhibitor therapy has been used to treat chronic GA, IGD, and AG that involved extensive body surface areas. However, the literature is limited to case series lacking control groups. Randomized, controlled trials are required to establish evidence-based treatment of GA and related cutaneous, granulomatous conditions.

Erythrosis interfollicularis colli and cutis rhomboidalis nuchae: two sides of a coin

Chronic exposure to sunlight accelerates extrinsic aging due to changes in the extracellular matrix. Cutis rhomboidalis nuchae and erythrosis interfollicularis colli are two benign skin disorders related to extrinsic aging. The study investigated possible co-occurrence in 50 male patients that developed skin cancer due to professional outdoor work, and demonstrated cutis rhomboidalis nuchae clinically and by dermoscopy. The study observed 11 cases of co-existent erythrosis interfollicularis colli characterized by perifollicular white halos in dermoscopy. These patients had Fitzpatrick skin type II or III but not type I. The severity of erythrosis interfollicularis colli was diminished in the area of cutis rhomboidalis nuchae. Basal cell carcinomas were seen in only one patient on the borders of cutis rhomboidalis nuchae, whereas erythrosis interfollicularis colli did not prevent development of basal cell carcinomas. Actinic keratoses were seen in nine of 11 patients with erythrosis interfollicularis colli, but not with cutis rhomboidalis skin. This study argues for a local protective effect of cutis rhomboidalis nuchae against other ultraviolet light-induced cutaneous pathologies.