Erythematous Papules Research Articles

A Descriptive Study of Clinico-histopathological Features of Lichen Planus

Background: Lichen planus is an idiopathic subacute or chronic inflammatory disease of the skin, mucous membranes and nails. We studied the clinicopathological profile of lichen planus in patients came to SMIMER hospital at Surat. Methods: A total of 50 cases of clinically diagnosed lichen planus samples were included. Clinical features like age, sex, type of lichen planus, location were recorded in the case record form. Histological features of lichen planus were studied. Results: Of the total 50 cases studied, Idiopathic Lichen Planus (76%) constituted the commonest type. The other types were Hypertrophic Lichen Planus (12%), followed by Lichen Planus Pigmentosus (8%), Lichen Planopilaris (2%) and Lichen Planus Pemphigoides (2%).21-30 years is the commonest age group affected, Female preponderance in incidence was seen (1.38:1). Lower limb was the commonest site of involvement. Conclusion: In cases with Lichen Planus, majority of the patients presented with violaceous to erythematous plaque, papule, and hyperpigmented plaque over the extremities. The histopathological examination showed hyperkeratosis, irregular acanthosis, saw toothed rete ridges and hypergranulosis, basal cell vacuolization, max joseph space and civatte bodies. Dermoepidermal junction showed band like infiltrate. Dermis showed melanin incontinence, perifollicular and perivascular inflammation. In the present study of 50 cases, 90% (45 cases) showed positive clinicopathological correlation, which emphasizes that histopathological examination, should be done in conjunction with clinical data to arrive at specific and final diagnosis of Lichen Planus lesions. This will help to reduce morbidity in patients with administration of timely and appropriate treatment, based on the histopathological diagnosis.

Dermoscopy of Gottron's papules and other inflammatory dermatoses involving the dorsa of the hands.

Several inflammatory dermatoses, including dermatomyositis (DM), may present as erythematous papules or plaques on the dorsal aspects of the hands over the joints. Limited skin involvement in these entities may pose a diagnostic challenge. (Video)dermoscopy is being utilized more frequently to aid in the differential diagnosis of inflammatory skin conditions. To describe the dermoscopic findings in Gottron's papules and compare them with dermoscopic features of other dermatoses involving the dorsal aspects of the hands. Videodermoscopic images from patients presenting with erythematous papules or plaques on the dorsal surface of the hands were retrospectively analysed for the presence of standardized dermoscopic parameters. Dermoscopic images from patients with DM (n = 12), psoriasis (n = 19), chronic dermatitis (n = 16), mycosis fungoides (n = 7), lichen planus (n = 5) and pityriasis rubra pilaris (n = 3) were included. Gottron's papules were characterized by pleomorphic vessels (dotted vessels accompanied by thick or thin linear vessels with branches or linear curved vessels) in 66.7% of cases, arranged in an unspecified pattern (91.7%), and accompanied by white or pink structureless areas (75.0%). Psoriatic plaques were characterized by dotted vessels arranged in a uniform pattern (94.7%). Vessels arranged in a ring pattern were nearly exclusively observed in psoriasis, while yellow structureless areas and erosions were more frequently present in chronic dermatitis. White lines, corresponding to Wickham striae, were specific for lichen planus. Videodermoscopy might be of value in differentiating Gottron's papules from other dermatoses involving dorsa of the hands.

Erythema elevatum diutinum - Case report of a rare entity

Erythema elevatum diutinum (EED) is a rare entity of chronic cutaneous vasculitis occurring in association with a variety of conditions including autoimmunity, infectious disease, and hematological abnormalities. The exact pathogenesis of EED is unknown. A 59-year old female presented with multiple, itchy, eczematized erythematous papules and plaques over both upper and lower limbs present since 5 months. Histopathological changes were consistent with EED. Patient was started on oral Dapsone 100mg bid along with topical betamethasone diproprionate cream. Within 6 weeks lesions regressed completely leaving post-inflammatory hyperpigmentation. Dapsone was stopped at the end of 3 months. Minor recurrences are managed by topical steroids. EED is a rare form of vasculitis which is difficult to diagnose clinically, histopathology can be diagnostic. Dapsone is the treatment of choice.

Pruritic papules in a longstanding tattoo

A 51-year-old man presented to clinic with extremely pruritic dermal papules within the red-inked areas of a tattoo on his right shoulder placed thirty years previously. He had a history of metastatic renal cell carcinoma treated with 4 cycles of ipilimumab and nivolumab, followed by single-agent nivolumab, which he was receiving on presentation. On examination, the patient had erythematous papules localized within the red-inked areas of the tattoo on his right shoulder (Fig 1), as well as pink dermal papules on his left eyebrow.

Dermatitis herpetiformis Duhring as one of the forms of gluten-associated pathology: a review of the literature and a description of a clinical case

This review presents information on the prevalence, pathogenesis, clinical manifestations, diagnosis and treatment of Duhring’s dermatitis herpetiformis. Although the disease was first clinically described in 1884 by the American dermatologist L.A. Duhring, the study of its pathogenesis and the search for prognostic markers of its occurrence continue. Against the background of a significant expansion of ideas about gluten-dependent diseases and conditions, views on the mechanisms of autoimmune skin damage in dermatitis herpetiformis are detailed. A strong association with hereditary predisposition through the major human leukocyte histocompatibility complex (HLA) DQ2 and DQ8, and a role of epidermal transglutaminase as a major autoantigen in dermatitis herpetiformis are shown. The hypotheses explaining the decline in the incidence of dermatitis herpetiformis in recent decades against the background of increased and more effective serological screening and the resulting earlier diagnosis of celiac disease are commented on. A typical clinical picture of dermatitis herpetiformis, in which erythematous papules, plaques, vesicles are seen, usually clustered on the flexural surfaces of the extremities. Secondary elements are erosions, excoriations and crusts due to rupture of blisters and due to scratching caused by intense itching. A generally favourable prognosis for life and disease is shown with a gluten-free diet and the use of dapsone, glucocorticoids and, if these are ineffective, immunosuppressants. The authors describe a clinical case of the disease in an adolescent girl with a typical clinical history and characteristic rashes on the extensor surfaces of the limbs. The authors show that drug therapy without a gluten-free diet cannot be considered effective, and that the diet for dermatitis herpetiformis, like that for celiac disease, is lifelong. The growing understanding of gluten-associated pathology, which includes dermatitis herpetiformis, in recent decades has led to an intensive search for diagnostic and prognostic markers, as well as the development of ways to correct this group of diseases, including those not related to the lifelong elimination of cereal prolamines.

Wells Syndrome with Sustained Response to Omalizumab

Wells syndrome (eosinophilic cellulitis), a rare dermatosis that arises from a multitude of triggers, may present with pruritic and erythematous plaques, papules, vesicles, or blisters.1 We present a case of Wells syndrome that was successfully treated with omalizumab. A 39-year-old female presented with a three-year history of diffusely located pruritic papules. After a negative lab and infectious workup, a punch biopsy showed dense eosinophilic infiltrate in the dermis as well as “flame figure” formation. Unsuccessful trials of prednisone, cetirizine, hydroxyzine, and dapsone prompted the use of omalizumab, which yielded excellent control of symptoms. Omalizumab’s success in the Wells syndrome disease process may be explained by its anti-inflammatory effects on IgE autoantibodies and receptors.5 Few cases of Wells syndrome treated with omalizumab have been reported. Thus, increased research to thoroughly elucidate omalizumab’s pharmacological mechanism of action in this particular disease process is warranted and would be a valuable contribution to the Wells syndrome literature.

The correlation between the levels of anti-dsDNA IgA antibody and the severity of systemic lupus erythematosus based on cutaneous vasculitis

BackgroundThe purpose of this study was to examine the association between anti double-stranded DNA (anti-dsDNA) IgA levels and the severity of systemic lupus erythematosus (SLE) regarding the presence of cutaneous vasculitis. MethodThe cross-sectional study was conducted at the outpatient installation of Wahidin Sudirohusodo Hospital and Hasanuddin University hospital in Makassar from September 2020 to February 2021. Investigation of anti-ds-DNA IgA levels in SLE patients was performed in two groups: group A (SLE patients with cutaneous vasculitis) and group B (SLE patients without cutaneous vasculitis). The diagnosis of cutaneous vasculitis was based on the presence of efflorescence in the form of erythematous macules and papules, petechiae, urticaria, purpura, nodular lesions and ulcerated lesions. To assess the severity of SLE, the Mexican Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) was employed; the SLE is severe if the value ranges from 11 to 19 and very severe if the value >20. Chi square and Fisher Exact were used in statistical analysis. The results are significant if the p value <0.05. Result54 subjects with SLE patients were identified. The mean age of the subjects in group A was 29.6±7.6 years and in group B 29.9±9.5 years where there were more women in both groups. The most skin manifestations of the entire sample were petechiae with 27.6%. In subjects with positive anti-dsDNA IgA, group A was found to be 100% and significantly higher than in group B at 72.0%. Meanwhile, in subjects with moderate, severe and very severe SLE, the percentages of group A were 37.9%, 48.3% and 13.8%, respectively, which were significantly higher than group B with 20.0%, 44.0%. and 0.0%. Furthermore, in moderate, severe and very severe SLE, the percentage of positive anti-dsDNA IgA (31.9%, 51.1% and 8.5%) was significantly higher than the negative (14.3%, 14.3% and 0.0%). Meanwhile, the mild degree was found to be higher in the negative anti-dsDNA IgA (71.4%) than the positive (8.5%) with p value = 0.002. ConclusionAnti-dsDNA IgA levels are related to the severity of disease in SLE patients based on cutaneous vasculitis. Therefore, anti-dsDNA IgA levels and the presence of cutaneous vasculitis may be useful as the potential predictors of disease severity in SLE patients.

Acquired reactive perforating collagenosis, a rare entity at uncommon site.

Acquired reactive perforating collagenosis (ARPC), rare disorder characterized by transepidermal elimination (TEE) of collagen fibers, is seen in adult diabetics. Genetic predisposition, familial aggregation, trauma, bites and scratching are implicated. Diabetics develop microvascular diseases leading to intense pruritus causing repeated micro trauma leading to necrosis of connective tissue of dermis, causing TEE. Isolated papules, plaques and nodules with central keratotic plugs, are mostly seen on extensor surfaces of limbs but trunk and face may be involved. Histopathology shows extrusion of abnormal collagen fibers through epidermis. Multiple treatment modalities show variable response. A 52 year old diabetic female had multiple, itchy, well defined, erythematous papules and plaques with central adherent crusting on lower back since 1 month. Histopathology showed cup shaped epidermal depression filled with plug of altered collagen, acanthotic epidermis with hyperkeratosis and parakeratosis. Underlying epidermis was thin with fine slits through which vertically oriented basophilic collagen fibers were extruded.

Role of the Skin Prick Test in Urticaria Patients.

BackgroundUrticaria, a vascular reaction of the skin, is marked by the transient appearance of erythematous papules or plaques (wheals) of varying sizes that are blanchable and associated with severe pruritus which lasts from a few hours to days. The etiological factors for urticaria include food, drugs, bacterial foci, pollen, fungi, dust, worms, physical stimuli, stress, anxiety, insect stings, etc. Skin prick tests (SPTs) represent the cheapest and most effective method to diagnose immunoglobulin E-mediated type 1 allergic reactions such as urticaria. A history suggestive of clinical sensitivity supported by a positive test strongly implicates the allergen in the disease process. In this study, we aimed to detect the common allergens and correlate the findings of SPTs with various epidemiological characteristics of urticaria patients.MethodologyA total of 100 patients with urticaria were included in this study. After receiving written and informed consent from patients, SPTs using a battery of 45 allergens were performed.ResultsIn our study, SPT positivity was seen in 88 (88%) patients. The highest sensitization was noted toward Dermatophagoides pteronyssinus (house dust mite) (30%), followed by D. farinae, Cynodon dactylon, and peanuts (each comprising 24%), and Ailanthus excelsa (20%).ConclusionsFinding the causative allergen in urticaria is often a difficult and long-drawn process, both for the physician and the patient. Our study identified an allergen in 88% of patients with urticaria, thereby showing that the SPT is a cost-effective, easy, and reliable tool for diagnosing and guiding treatments in urticaria patients.

Eumisetoma pada Toraks dan Abdomen: Suatu Kasus Jarang

Mycetoma is a chronic granulomatous infectious disease of the skin, subcutis, fascia and bones caused by bacteria (actinomycetoma) or fungi (eumycetoma) in adults aged 20-40 years old, male to female ratio is 3,7:1 respectively. The clinical finding is a painless, solid and cold subcutaneous node. It has been reported a 43-year-old woman with a painless suppurative lump in her chest, stomach, armpits and legs in the past year. The lump were hypertrophic scars, atrophic scars, nodules and erythematous papules with pustules and sinuses, which excretes exudate greenish-yellow. The patient had a history of working in an oil palm farm. Histopathological examination of hematoxylin-eosin showed suppurative granulomatous inflammation consisting of epitheloid histiocytes, solid lymphocytes and neutrophils, and datia cells. PAS (Periodic acid-Schiff) staining showed positive results. The diagnosis of deep mycosis eumycetoma was confirmed based on physical examination and histopathological examination. Eumycetoma is a rare deep fungal disease. Supporting investigations such as direct microscopy, histopathology with biopsy, and culture are needed to establish the diagnosis. The therapies are antifungal drugs and surgery. Death is possible if the infection occurs in the chest or head cavity.Keywords: deep mycosis, eumycetoma, granules, mycetoma, sinuses

Bullous impetigo-like irritant contact dermatitis caused by perfume.

Contact dermatitis usually presents as erythematous macules, papules, and vesicles. Sometimes, unusual clinical presentations of contact dermatitis are reported, including pustular, lymphomatoid, lichenoid, and pigmented variants. We describe the first patient with bullous irritant contact dermatitis caused by perfume, mimicking impetigo lesions. We report this case to raise awareness concerning the possibility of serious cutaneous reactions, such as bullous impetigo-like irritant contact dermatitis due to perfumes which are ubiquitous, especially after direct contact with the solution. Perfume ingredients, such as fragrance, solvents, and preservatives all may cause or contribute to irritant contact dermatitis.

Diffuse plate-like sheets of desquamation

Diffuse plate-like sheets of desquamation

Lichen aureus induced by an insect bite

Lichen aureus is an uncommon variant of pigmented purpura and presents itself with a chronic and benign course. Clinically, lichen aureus cases are asymptomatic and are found in the lower limbs, presenting themselves as erythematous, brownish or golden macules and/or papules. Its diagnosis is based on clinical and histopathological findings. The prognosis of lichen aureus is generally good. A 34-year-old Filipino male presented himself with a single itchy skin lesion on the right leg present for three months. The lesion started as a small, round, reddish to brownish area and then increased in size over time. A history of an insect bite on the same site was reported. An examination revealed a single annular, golden to brownish macule on the right leg. Based on this clinical and histopathological feature, the skin lesion was diagnosed as lichen aureus. The comprehension of the pathogenesis of lichen aureus is essential for knowing its risk factors.

Lichen planus disseminatus partim vesiculosus nakon COVID-19 vakcine

Introduction: Lichen planus is an autoimmune inflammatory disease that can be associated with infections, drugs and vaccines. As concerning the potential triggering effect of vaccine, there is evidence a few cases of new-onset lichen planus that appeared after COVID vaccine, particularly the Pfizer/BioNTech vaccine. Case report: This report is a case of a newonset lichen planus triggered by the Pfizer/BioNTech vaccine administration in a healthy young female. Dermatological examination revealed polygonal, itchy, erythematous papules on trunk, upper and lower limbs, that coalesced into brownish plaques in the ankles, flexural wrist and knee. No mucosal involvement was noted. In view of the clinical picture, the timing of the skin eruption with respect to the vaccine and the histopathologic findings, a vaccine-induced lichen planus triggered by the COVID-19 vaccine has been diagnosed. Conclusion: Lichen planus or lichenoid-like eruption as a cutaneous manifestation following COVID-19 vaccines are rare, and the pathogenesis for its development is still unclear. Clinical trials showed that the leading vaccines upregulate Tcell response (Th1) and incrementing inflammatory cytokines involved in the pathogenesis of autoimmune diseases, such as lichen planus. Although we still do not completely understand its pathogenesis, dermatologists should be aware of the possibility and keep an eye out for worsening or debut of this disease after the COVID-19 vaccine. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.

Histiocitose de células de Langerhans com acometimento exclusivo da pele

A 14-year-old white female patient with allergic rhinitis, reported a 4-week history of pruritic, lichenoid and erythematous papules and plaques involving first cervical region and after throughout the body. The histopathology was indicative of Langerhans cell histiocytosis. Laboratory and imaging tests showed no impairment of other organs. Lesions regressed after oral prednisone for 2 months. Currently, the patient remains asymptomatic without medication. We highlight the rarity of this disease and the importance of its early recognition. It is extremely important to maintain periodic follow-up to evaluate possible recurrences.

A case of segmental form of type 1 mosaic Darier’s disease

Darier's disease is a rare genetic disorder with autosomal dominant inheritance. It is characterized by hyperkeratotic papules in seborrheic areas. Associated abnormalities include nail abnormalities and changes in the mucous membranes. Exacerbation of the disease occurs with exposure to high temperatures, sun, and sweating, resulting in a worsening clinical picture in summer months. The unilateral zosteriform pattern is a rare variant that is clinically manifested by a unilateral outbreak of erythematous keratotic papules without any other associated symptoms. Here we present a 52-year-old male with a zosteriform pattern of Darier's disease. We also discuss the most important clinical and pathohistological characteristics of the disease and various treatment options.

Prevalence and risk factors of diaper dermatitis among newborn babies to two years of age in Al-Baha region, Saudi Arabia

Introduction: Diaper dermatitis is the most common dermatological condition which affects the pediatric age group. A variety of factors contribute to the pathophysiology. Diaper dermatitis presents as an erythematous rash, papules, scaling, and erosions around the thighs, scrotum, suprapubic area, and buttocks, characteristically where skin creases. The primary treatment is to keep the skin around the diaper area as dry as possible by frequent diaper changes together with careful selection of the diaper type. Some creams (barrier creams) and mild topical corticosteroid treatments are also available to protect the infant’s thin skin and to reduce any inflammation. Methods: This was a cross sectional study of 389 parents using structural questionnaires. The study was conducted in the Al-Baha region, Saudi Arabia from January to July 2022. We used bivariate and multivariate logistic regression analyses to analyze our data and test the association between the prevalence of diaper dermatitis and its possible risk factors. Results: The prevalence of diaper dermatitis was 39.33% (153/389). The highest prevalence was among children who were 19-24 months old (65%). When comparing gender groups, females had a higher prevalence (44.4%) compared to males (34.7%) (p=0.005). Preterm babies had a slightly lower prevalence than term babies. Conclusion: Multiple factors are involved in diaper dermatitis which most commonly affect infants and toddlers. The highest prevalence was among children who were 19-24 months old and there was more prevalence among females. Keywords: Diaper dermatitis, Prevalence, Al-Baha, Saudi Arabia

Palisaded neutrophilic granulomatous dermatitis in a patient with HLA-B27–negative axial spondyloarthritis: a case report and literature review

Palisaded neutrophilic granulomatous dermatitis (PNGD) is a rare histopathological pattern belonging to a group of cutaneous granulomatous eruptions that typically manifests with asymptomatic skin-colored, erythematous, or violaceous papules or nodules. PNGD can be triggered by various systemic conditions, including medications and autoimmune and autoinflammatory disorders, as well as malignancies; for example, lymphoproliferative disorders. Therefore, in patients with PNGD an extended diagnostic workup is mandatory as well as follow-up in the case of idiopathic PNGD. To the best of our knowledge, this is the first reported case in the literature of PNGD causally related to a relapse of HLA-B27-negative axial spondyloarthritis.

Ethnic Equity Implications in the Management of Pseudofolliculitis Barbae.

One major issue facing the health care system in the United States is the disparity in health care management of diseases that affect minority patient populations. Pseudofolliculitis barbae (PFB) is very common in Black men. It presents as skin-colored to erythematous, follicular or perifollicular papules and pustules predominantly on the neck and chin. The most definitive treatment for PFB is cessation of close shaving. However, many Black men are forced to comply with "clean-shaven" policies in the workforce. For those who are able to obtain medical waivers, there is significant time and costs associated with this, especially if they must wait to receive this waiver from a dermatologist. If primary care providers are able to identify the disease and spread awareness of its legitimacy, it may be easier for patients to receive the necessary waivers and may encourage employers to reflect on the ethnic equity of this practice. Our professional support can help reduce stigma and lead to improvements in the physical and psychological health of this historically mistreated population.

Three Cases of Disseminated Erythematous Papules with Elevated Serum Thymus and Activation-Regulated Chemokine Levels after COVID-19 Vaccination

Three Cases of Disseminated Erythematous Papules with Elevated Serum Thymus and Activation-Regulated Chemokine Levels after COVID-19 Vaccination