Follicular Accentuation Research Articles

A case of non-scarring alopecia with follicular accentuation at the limbs of a paediatric patient.

A case of non-scarring alopecia with follicular accentuation at the limbs of a paediatric patient.

Dermoscopic features of follicular mycosis fungoides of nonscalp areas: Report of 11 cases and literature review

AbstractBackgroundFolliculotropic mycosis fungoides (FMF) is a rare variant of MF that involves hair follicles and requires a more aggressive treatment regime. Significantly, some patients with classic MF can eventually have some degree of follicular involvement.ObjectivesThe aim of this study was to describe the dermoscopic features of FMF in nonscalp areas to facilitate early diagnosis and posttreatment monitoring.MethodsThe clinical and dermoscopic features in 11 FMF patients were analyzed and compared with the reports in the literature.ResultsObliteration of hair follicles, loss of terminal hairs and hair loss were detected in all patients. Follicular accentuation, follicular dilation and broken hairs were found in almost all patients (90.9%). Other common follicular‐based dermoscopic features (<50%) were follicular plugging, perifollicular orange colour, perifollicular erythema and vessels, hyperpigmented halo around the follicle, follicular hyperkeratosis, comedo‐like lesions and perifollicular scales. The most frequent ‘dominant’ dermoscopic features were follicular accentuation with follicular plugging and dilation of follicular opening.ConclusionsIdentification of specific distinguishing dermoscopic patterns of FMF not only could be helpful in classifying MF patients but also could provide prognostic information regarding the disease course and aid in therapeutic decisions. In MF patients, dilation of follicular opening and spiky follicular keratosis are considered the most specific dermoscopic features of follicular involvement since they are uncommon in other conditions.

Follicular eczema and accentuation: A survey of published data

Follicular eczema and accentuation: A survey of published data

Hist-O-08 - Macular type of primary cutaneous B-cell lymphoma: extension of the clinical and histopathological patterns

Hist-O-08 - Macular type of primary cutaneous B-cell lymphoma: extension of the clinical and histopathological patterns

Folliculotropic mycosis fungoides

Folliculotropic mycosis fungoides (FMF) is a variant of mycosis fungoides (MF) noted in the World Health Organization — European Organization of Research and Treatment of Cancer (WHO/EORTC) update of 2018. FMF is characterized as a subtype with a worse prognosis than classic MF. The situation changed recently when authorities proposed dividing FMF into two prognostically different subtypes: indolent and aggressive. Indolent FMF allows 92% of patients to survive five years, and 72% 10 years. But only 55% and 28% of patients with aggressive FMF can survive respectively five and 10 years. FMF with internal organ involvement on the day of diagnosis shortens lives drastically (23% survive five years, only 2% survive 10 years). There are many clinical subtypes (with plaques with follicular accentuation, alopecia, comedones, erythematous follicular papules, acneiform lesions mimicking rosacea, milia, ‘spikes’, and facial involvement known as leonine face), as well as histopathological variants (with attern with intact hair follicles, folliculotropism with or without mucinosis, basaloid folliculolymphoid hyperplasia with folliculotropism, granulomatous dermatitis associated with folliculotropism, eosinophilic folliculitis, follicular cysts with folliculotropism) of FMF. This all makes diagnosis even more difficult. Combined topical and systemic treatment can be useful, with topical corticosteroids, phototherapy, radiotherapy, bexarotene, interferon, as well as with methotrexate and brentuximab vedotin. If the disease does not respond to these therapies, allogeneic hematopoietic stem cell transplantation (allo-HSCT) should be considered. Chemotherapy (gemcitabine, liposomal doxorubicin, polychemotherapy) is often associated with a merely temporary response, and that is why it should be employed only in non-responsive cases and/or as a bridge to allo-HSCT.

Dermoscopy’s Contribution for the Diagnosis of Folliculotropic Mycosis Fungoides.

Folliculotropic mycosis fungoides (FMF) is one of the three recognized variants of mycosis fungoides. FMF predominates in men over 50 years old. Often it takes a long time for the definitive diagnosis after the onset of skin lesions. Dermoscopy today represents almost an extension of the clinical dermatological examination, with its application being expanded day after day in medical literature. The authors demonstrate the dermoscopic findings recently described in the context of FMF (follicular accentuation / white halo around the follicles), in a case of typical clinical presentation, with a diagnosis confirmed by the clinical-dermatological correlation.

Spontaneous pneumothorax in a patient with skin lesions

Spontaneous pneumothorax in a patient with skin lesions

¿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.

¿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.

Practical strategies for the diagnosis and assessment of atopic dermatitis.

Atopic dermatitis (AD) has a significant, lifelong clinical impact on affected individuals and has profound effects on quality of life both for patients and their families. The diagnosis usually can be reliably established on the basis of the history and physical examination. In patients with skin of color, blanching of the skin may be helpful to detect erythema, lichenification, follicular accentuation, and hypopigmentation (all of which are more common than in lighter-skinned patients). Once the diagnosis of AD is established, an assessment of severity, persistence, and impact on the patient's and family's life is important as a guide to treatment decisions.

Unilesional folliculotropic mycosis fungoides: a unique variant of cutaneous lymphoma

Unilesional folliculotropic mycosis fungoides (UFMF) has been rarely reported. The aim of this study was to describe our experience with UFMF. Data were collected on all patients with clinicopathological UFMF who attended the Department of Dermatology of a tertiary university-affiliated medical centre in 1996-2013 and were followed prospectively. The sample included seven patients (five male, two female) of mean age 38 years at diagnosis; two were aged <18 years. The lesion presented as a solitary patch/plaque with follicular accentuation in five patients, an infiltrated plaque devoid of hair in one and with follicular nodules in one. Four patients had alopecia, and one, secondary anetoderma. The lesion was located on a limb in four patients, the trunk in two, and the face in one. In all cases, the atypical folliculotropic lymphocytes expressed mainly surface CD4(+). Monoclonality was detected in three of the six patients analysed. Treatment consisted of localized electron beam in five patients, all of whom had a complete response (CR), and excision in one patient. The remaining patient, a 9-year-old boy, was treated with topical psoralen and UVA with CR. The duration of follow-up was 0.5-10 years (mean 4). There were no recurrences in six patients and local recurrence in one. UFMF presents at a young age, usually with early disease clinical morphology. The treatment goal should be cure. Our experience indicates an excellent prognosis of early UFMF with no multifocal/internal spread.

Clinical response to ustekinumab in familial pityriasis rubra pilaris caused by a novel mutation inCARD14

Funding sources: none. Conflicts of interest: none declared. Dear Editor, Pityriasis rubra pilaris (PRP) manifests with erythematous scaly plaques, typically involving the scalp, trunk and limbs, associated with a yellowish diffuse palmoplantar keratoderma (PPK).1 Familial PRP is a very rare entity, which is inherited as an autosomal dominant trait.1 Recently, gain‐of‐function mutations in CARD14, which encodes the caspase recruitment domain family member 14, were identified as the cause of familial PRP and found to be associated with increased expression of CARD14 in the epidermis of affected patients.2 CARD14 is a known activator of the noncanonical nuclear factor‐kappa B (NF‐κB) pathway, leading to the activation of the inflammatory response.3 Herein, we describe the beneficial effect of ustekinumab in a case of familial PRP caused by a novel mutation in CARD14 that was refractory to multiple other therapeutic approaches. A 57‐year‐old man was referred for investigation of near‐erythroderma. The patient had experienced erythematous scaly plaques over most parts of the body since childhood. His father, a younger sister and his daughter were similarly affected (Fig. 1a). Physical examination revealed a diffuse and symmetric rash, involving the trunk and limbs, consisting of large scaly plaques and distinct islands of sparing. PPK and follicular accentuation were also noted (Fig. 1b,c). The patient was obese. Initially, psoriasis was diagnosed, but the clinical findings were, upon reconsideration during subsequent visits, deemed more consistent with PRP. Histopathology was not conclusive, showing epithelial hyperplasia with alternating para‐ and orthohyperkeratosis, and a mild lymphohistiocytic perivascular infiltrate (not shown).

Granuloma faciale with extrafacial involvement and response to tacrolimus

Granuloma faciale (GF) is a chronic condition characterized by red-brown plaques with follicular accentuation present usually on the face. We present a case of 35-year-old female with 5 year history of plaques over cheek and extra facial sites consistent with GF and its response to topical tacrolimus. This case supports previous reports of successful treatment of GF with topical tacrolimus.

A Novel Visual Clue for the Diagnosis of Hypertrophic Lichen Planus

D ERMATOLOGY HAS AN ILLUSTRIOUS HISTORY of formulating visual clues to facilitate diagnosis of oft-confused conditions. From the opulent (“crown-of-jewels”) to the mundane (“apple jelly”), dermatologists haveconsistentlydrawninspirationfromthephysicalworld when classifying disease. We intend to add to this literature by submitting a novel visual clue to aid in the diagnosis of hypertrophic lichen planus. Given a causal linkage with the hepatitis C virus and recentcasereportsofmalignant transformation,hypertrophic lichen planus requires astute and careful consideration. The condition is marked by firm, elevated, hyperkeratotic, red-brown to purple-gray plaques with chalky-white scale and follicular accentuation that imparts a geologic appearance to affected skin (Figure1). Lesions thus bear a striking resemblance to the extrusive (or rapidly cooled) variants of igneous rock (Figure 2), characterized by a fine-grained (or aphanitic) texture with the occasional vesicular (pocked)surfaceandvariablecolors fromdarkpink to gray-black. The igneous rock sign has been a useful adjunct in several cases (Figure3) tohelpdifferentiatehypertrophic lichen planus from other members of the papulosquamous differential, and we hope that it becomes a valued visual clue in the armamentarium against dermatologic disease.

Smooth-Muscle Hamartoma

The specific diagnosis of a hamartoma may create diagnostic difficulties, both grossly and histologically. We observed an infant who was noted at birth to have a hyperpigmented plaque with follicular accentuation and a slight increase in the amount of hair on the anterior abdominal wall. The clinical differential diagnosis included mastocytoma, epidermal nevus, congenital pigmented nevus, and congenital Becker's nevus. The most striking feature of the biopsy specimen was the presence of large numbers of smooth-muscle fibers permeating the dermis, a finding most consistent with a diagnosis of Becker's nevus, although Becker's nevus has not previously been known to be present at birth. <h3>Report of a Case</h3> At birth, a 3 × 4-cm, yellow-brown, slightly hairy, barely palpable plaque (Fig 1) was noted on the anterior abdominal wall of an otherwise normal, full-term, 2.1-kg female infant. When the plaque was stroked, a slight accentuation, with rapid, brief elevation of the

Detailed examination of polychlorinated dibenzofurans in PCB preparations and Kanemi Yusho oil

Polychlorinated dibenzofurans(PCDFs) are known to be highly toxic substances. (HOFMANN 1958) Through chick embryo bioassays, Vos et al. (1970) identified two kind of PCDFs as toxic components in PCBs. Subsequent investigations have revealed that several PCDFs are present in a number of PCB preparations. (BOWES et al. 1973, ROACH and POMERANTZ 1974, NAGAYAMA et al. 1976) However, only limited informations are available on the isomer components of this toxic material. PCDFs were recently reported to be present in Yusho oil which gave rise to a large scale of human intoxication. (NAGAYAMA et al. 1976) "Yusho", namely oil disease, is a peculiar skin didease characterized by clinical manifestations as follicular accentuation, acneform eruption, pigmentation of the skin and nail and hypersecretion of Meibonian gland. The cause has been considered to be PCB poisoning (Kuratsune et al. 1972) but it was recently suggested that the toxic role of PCDFs was not negligible in the causation of Yusho. Hence, detailed characterization of PCDF components seemed to be necessary in Yusho oil. The present paper will describe detailed analytical result of PCDF components as to the numbers and compositions in Yusho oil and sixteen PCB preparations.

Yusho, a Poisoning Caused by Rice Oil Contaminated with Polychlorinated Biphenyls

SPORADIC outbreaks of a peculiar skin disease were reported in Fukuoka-Ken (Fukuoka Prefeeture), Japan, in early October 1968. It was charaeterized by sueh symptoms as follicular accentuation, acneform eruption, pigmentation of the skin and nails, and hypersecretion of the Meibomian gland. Staff members of the department of dermatology of the Faculty of Medicine, Kyushu University, Fukuoka, who examined some of the early patients suspected they had chloraene. A possible causal relationship between the disease and ingestion of a certain brand of rice oil was also suspected in view of the distinet familial aggregation of the patients and their common use of the oil (1). This relationship was subsequently proved, and the disease was called Yusho, or rice oil disease. To elarify the cause of the epidemic, a study group headed by Prof. S. Katsuki of the Kyushu University Faculty of Medicine was organized by the staff of that university, the School of Medicine of Kurume University, and local health departments. An epidemiologic study subgroup was set up within the study group on October 19, 1968, which was directed by Kuratsune and also included the other three authors. This subgroup immnediately designed and carried out a series of extensive surveys in close cooperation with the department of hygiene of our faculty of medicine and the departments of public health of the Prefecture of Fukuoka and of the cities of Kitakyushu, Fukuoka, and Ohmuta. The epidemic spread not only over FukuokaKen but also over 20 other prefectures in the western part of Japan. It produced 1,001 patients -502 males and 499 females-according to the latest tabulation by the section of food hygiene, Ministry of Welfare. Although our study of the epidemic was confined to Fukuoka-Ken, and the epidemic proved to be caused by accidentally contaminated oil, we believe that publication of our results will help prevent similar food poisonings. These incidents can occur anywhere in the world if sufficient care is not exercised.