Follicular Eruption Research Articles

BI30 An extensive follicular eruption in a transplant recipient

BI30 An extensive follicular eruption in a transplant recipient

Posthatch developmental changes in the ovary with emphasis on follicular development and atresia in the native chicken (Uttara fowl) of Uttarakhand, India.

This experiment was designed to investigate the postnatal development of the ovary in the Uttara fowl chicken and was conducted on 54 apparently healthy female birds divided into different age groups, namely Day 1 and Weeks 1, 4, 8, 12, 16, 20, 24, 28 with six birds each. During postnatal development, the left ovary gradually increased in size and complexity. The segmentation of the ovary started by 4 weeks, follicular eruption by 8 weeks, small liquor follicles (1-5 mm) appeared by 16 weeks, pre-hierarchical follicles by 20 weeks and hierarchical follicles by 24 weeks of age. The cortex was distinctly differentiated from the medulla in the early stage of ovarian development. However, the division between cortex and medulla was gradually obscured with age (transitional stage) and distinction was completely lost in the mature ovary. The different stages of follicular development in the chicken ovary were classified as primordial, primary, growing at Stage I, II and III stromal follicles besides pre-hierarchical and hierarchical surface follicles. The primordial and primary follicles showed cytoplasmic sudanophilic substances, especially in the Balbiani's yolk body, indicating the presence of lipids (Sudan Black B) with no activity for neutral polysaccharides (periodic acid Schiff method). It was observed that apoptotic changes may affect any stage of developing follicle resulting in arrested growth and atrophy. An early form of follicular atresia was the fate of the growth-arrested primordial and primary follicles, whereas the glandular form of atresia was commonly observed in growing follicles arrested at Stages I and II. The scanning electron micrographs unveiled the follicles as hollow oval structures with a follicular lumen lined by the perivitelline membrane (glycoprotein membrane) having lacunae giving a honeycomb-like appearance.

Hookworm – Related cutaneous larva migrans: Case report

Hookworm-related cutaneous larva migrans is caused by the intradermal migration of soil-dwelling filariform larvae of dog and cat hookworms, most commonly Ancylostoma, usually develop itchy skin lesions, usually consisting of migrating superficial serpiginous traces, or sometimes stationary follicular eruptions. The plantar topography or on the regions of the body in contact with the sand of the beaches of the Antilles, West Africa and East Asia, the presence of fine and not very mobile serpiginous furrows and eczematization with vesiculobullous eruption, are characteristic. There are misleading profuse forms such as pseudo-folliculitis. We present a Moroccan patient who developed the disease after their return from and who responded well to treatment with albendazole.

Pembrolizumab-induced follicular eruption and response to isotretinoin.

Background: Pembrolizumab is a monoclonal antibody targeting PD-1. Folliculitis secondary to pembrolizumab has rarely been reported in the treatment of malignant melanoma. Case: A 49-year-old with a history of mild lower limb folliculitis developed metastatic malignant melanoma, and immunotherapy with pembrolizumab was initiated. Following 19 doses of pembrolizumab, a folliculocentric pustular eruption developed on the lower legs. Biopsy was consistent with folliculitis. Treatment with topical corticosteroids, high-dose prednisolone, lymecycline, clarithromycin, trimethoprim and clindamycin was unsuccessful. Pembrolizumab was stopped after 22 cycles, but the folliculitis persisted. Oral isotretinoin was required for disease control. Discussion: Drug-induced follicular eruptions have rarely been described with anti PD-1 therapy. Isotretinoin may be required to achieve remission.

SÍNDROME DE GRAHAM-LITTLE-PICCARDI-LASSUEUR

Síndrome de Graham-Little-Piccardi-Lassueur (SGLPL) é uma dermatose rara, de etiologia desconhecida, que acomete principalmente mulheres entre 30 a 60 anos de idade. Caracteriza-se pela tríade de alopecia cicatricial multifocal do couro cabeludo, erupção folicular liquenoide e hipotricose das regiões axilar e pubiana. O exame anatomopatológico revela diminuição do numero dos folículos pilosos, infiltrado perifolicular e fibrose. A terapêutica é um desafio, com recidivas frequentes após tratamentos locais e sistêmicos. Relatamos um caso típico desta síndrome rara, em um paciente sexo masculino de 46 anos.

Striking Follicular Eruption to Pegylated Liposomal Doxorubicin

The adverse effects of pegylated liposomal doxorubicin are primarily cutaneous. The majority of these cutaneous side effects manifest as palmar-plantar erythrodysesthesia, whereas few reports of other cutaneous reactions exist in the literature. The authors report a case of an exuberant follicular eruption in a patient treated with pegylated liposomal doxorubicin. This case also highlights the potential mechanism underlying this unusual histological and clinical reaction.

Lithium-Induced Fixed Drug Eruption in a Case of Bipolar Mania

To the Editor: Lithium is one of the commonly used drugs for the treatment of bipolar affective disorders. Its use is associated with various side effects, dermatologic side effects being one of them. Dermatologic side effects can be one of the reasons for poor compliance and are reported in 3%–45% of the population receiving lithium. Mohandas and Rajmohan1 found acneiform eruptions, psoriasis, maculopapular eruptions, and follicular eruptions to be most commonly reported. However, fixed drug eruption due to the use of lithium carbonate has not been reported. We report one such case in a patient with bipolar mania. Case report. Mr A, a 16-year-old male diagnosed with bipolar affective disorder as the second episode of mania with psychotic symptoms according to ICD-10 criteria, reported for follow-up. A maintenance dose of tablet lithium carbonate 900 mg/d was effective until the past year. At this visit, he reported blisters over the dorsal aspects of the hands and foot, with lesions extending to the mouth and genitalia. After 2–3 days, the blisters had subsided and were now seen to have been replaced by a hypopigmented patch surrounded by hyperpigmented border over the same areas (Figure 1). The lesions were associated with itching and disappeared after a few days of treatment with povidone-iodine (Betadine) application and multivitamin capsules. Figure 1. Fixed Drug Eruption Over the Wrist Mr A attributed the lesions to the antidiarrheal medication taken during one of those instances and continued taking lithium carbonate in the same dose. His serum lithium level was within the therapeutic range at this visit. However, the lesions recurred in a similar manner a month later on 2 successive occasions. On consultation, lithium carbonate therapy was stopped because lithium carbonate was considered the possible precipitant. A rechallenge was done in a low dose, after which the lesions appeared again, thereby confirming lithium to be the likely cause. The Naranjo Adverse Drug Reaction Probability Scale2 was applied with a score of 6, suggesting that lithium carbonate was the probable cause of the side effect. Mr A was subsequently started on tablet sodium valproate (1,000 mg/d) and olanzapine (10 mg/d). He was maintaining well for 4 months after the change in medications but was lost to follow-up. The exact cause for the cutaneous side effects associated with lithium is not known, but the role of stress and psychological factors has been proposed. Kansal et al3 state that the decrease in cyclic adenosine monophosphate and inositol that results from lithium treatment has also been considered as a possible cause. The low intracellular levels of calcium, the lack of differentiation of keratinocytes, and enhanced phagocytic activity of leukocytes have been suggested as the possible mechanisms of action. Reduction in the dosage apart from specific intervention for the lesions has been suggested as a possible treatment strategy.

Indications, Protocols, and Outcomes of Drug Desensitizations for Chemotherapy and Monoclonal Antibodies in Adults and Children

Advances in the understanding of various malignancies and chronic inflammatory diseases has led to the development of better treatment options for prolonging patient survival and minimizing morbidity. The recognition of "first-line" chemotherapy and monoclonal agents for these conditions has given more urgency to the need to re-administer these drugs in cases of drug hypersensitivity reactions. Therefore, in these cases, not only is desensitization considered when there is no alternative therapy available but also when alternative treatments are considered therapeutically inferior and/or more toxic. In this article, we describe the steps involved in the evaluation of these patients, factors to consider before making a decision to desensitize, the implementation of desensitization protocols, and the outcomes of such procedures.

Erlotinib-induced Adverse Skin Reactions

Erlotinib is low molecular-weight quinazolin derivatives which selectively inhibit the epidermal growth factor receptor (EGF-R) tyrosine kinase activity of the intracellular domain, block autophosphorylation and the subsequent signaling cascades. EGF-R is expressed on basal keratinocytes, sebocytes, the outer root sheath of hairs, and endothelial cells in the skin, and plays important roles in the regulation of differentiation, proliferation, apoptosis, attachment and migration of keratinocytes, inflammation, and wound healing. Therefore, inhibition of EGF-R causes a number of cutaneous adverse reactions. Among them, severe skin lesions are very stressful, and impair quality of life of patients. Moreover, they even bring disadvantages such as drug withdrawal or interruption. Several review papers describe representative or common skin lesions which appear either during the first a few weeks or at later phases. Common skin manifestations include papular and pustular follicular eruptions (acneiform eruption), xerosis, paronychia, pruritus, and abnormalities of hairs; however, other than those eruptions, several unusual lesions are also induced. Early intervention of dermatologists and management of skin lesions are quite important, because discontinuance of the drug is unfavorable for patients with clinical benefits for cancers. In this brief review, various cutaneous manifestations seen in Japanese patients treated with erlotinib (Tarceva) are shown, and current management of representative severe conditions is also described.

A case report of Graham-Little–Piccardi–Lassueur syndrome

Graham-Little–Piccardi–Lassueur syndrome is a rare entity which consists of scarring patchy alopecia of the scalp, noncicatricial axillary and pubic hair loss, and lichenoid follicular eruption. Although these three problems can arise simultaneously but usually scalp is the first to be involved with persistent itching and hair loss. Associated cutaneous or mucosal lichen planus is also one of the regular features. Thinning and destruction of nails is also present. The axillary and pubic alopecia is regularly described as noncicatricial, because there is no clinical atrophy. This syndrome has been reported among females of postmenopausal age. Here, we report a male patient of 46 years suffering from this syndrome.

Graham-Little Piccardi Lassueur Syndrome: case report

A 33-year-old woman presented with a 3-year history of progressive alopecia of the scalp. Past treatment with hydroxicloroquine did not show improvement. Physical examination revealed multiple areas of alopecia with atrophic aspect of the scalp, and axillary and pubic hypotrichosis. Dermoscopy showed hyperkeratosis and accentuation of follicular ostia. Anatomopathological examination revealed decrease in the number of hair follicles, upper perifollicular infiltrate and areas with fibrosis. The Piccardi-Lassueur-Graham-Little syndrome is a rare disorder, characterized by the triad of multifocal scarring alopecia of the scalp, keratotic follicular eruption and hypotrichosis of axillary and pubic regions. Management is a challenge and many medications tried have controversial results. We report a case of this rare syndrome which improved with corticoids.

Follicular pityriasis rosea. A case report and a new classification of clinical variants of the disease.

Atypical forms of pityriasis rosea are often noticed in Indian children. We describe a 9-year-old male child with predominant follicular eruptions on trunk consistent with a clinical diagnosis of pityriasis rosea. Follicular pityriasis rosea is an extremely rare presentation of the disease. We propose a new classification of clinical variants of pityriasis rosea.

Peripheral nerve and skin damage associated with working in a STCP factory: Report of four cases

Sodium 3,5,6-trichloropyridin-2-ol (STCP) is a widely used intermediate for the production of chlorpyrifos. However, its effect on the health of workers in STCP factories has become increasingly problematic. This article reports four workers who worked in a STCP factory developed peripheral neuropathy in the lower extremities and chloracne-like skin lesions on the whole body. Patches of follicular skin eruptions (mainly blackheads, accompanied by follicular orifice cornification occasionally accompanied by milia-like skin eruptions) were found on the head and face, around the auricle, chest and back, abdomen and scrotum. In one patient, the activity of serum cholinesterase was decreased and recovered slowly, but there were no muscarinic, nicotinic, or central nervous system symptoms. The concentrations of urine STCP detected in four patients were 0.266, 0.066, 0.044, and 0.033 μg/mL.

Malassezia Folliculitis versus Truncal Acne Vulgaris (Clinical and Histopathological Study)

Background: Malassezia folliculitis is an infection of the hair follicle, which commonly affects young adult, and is often misdiagnosed as truncal acne. Objectives: To shed light on different clinical, histopathological, and microbiological aspects of Malassezia folliculitis and to be compared with truncal acne. Patients and Methods: This is a descriptive comparative cross sectional, out patient based study, which was conducted at the Department of Dermatology, Basrah Teaching Hospital from October 2008 to October 2009. Total number of 113 patients with papular and/or pustular follicular skin lesions on the trunk were enrolled in this study. They were divided according to the clinical features, Wood’s light examination, direct microscopic examination, PAS stained skin biopsy and the response to a trial of antifungal drugs into two groups: group 1: patient with Malassezia folliculitis and group 2: patient with truncal acne vulgaris. Results: Group 1: They were 53(46.9%) out of a total 113, 33(62.3%) males and 20(37.7%) females, their ages ranged from 19 - 40 years. Group 2 consisted of 60(53.1%) patients, 25(41.6%) males and 35(58.4%) females, whose ages ranged from 14 - 29 years. The ages were earlier in the acne group in comparison with MF group (p Malassezia folliculitis was more common among males than females, while in truncal acne, females predominated males. The center of the back was the predominant site among MF group affecting (90.6%) of patients with sparing the face, in contrast to truncal acne where the periphery of the back was involved in (91.7%) and the face in (75%) (p 0.0001). Wood’s light examination, skin scrapping and PAS stained skin biopsies were also positive in all patients with MF in contrast to acne group where all these tests were negative. All MF patients showed marked response to a two weeks trial of antifungal while the reverse is true for the acne patients, whereas the antibiotic was the second most common leading aggravating factor in 20 (37.7%) of cases with MF, which was significantly different from acne group (p 0.0001). Conclusion: Malassezia folliculitis should be considered in young adults with an itchy papulopustulr follicular eruptions affecting the trunk that should be differentiated from truncal acne by their characteristic clinical, histopathological features and its remarkable response to antifungal therapy.

Graham-Little-Piccardi-Lassueur syndrome

Graham-Little-Piccardi-Lassueur syndrome (GLPLS) traditionally describes patients with a triad of a multifocal cicatricial alopecia of the scalp, noncicatricial alopecia of the axillae and groin, and a lichenoid follicular eruption. The entity has caused much controversy with respect to both etiology and clinical definition. We present a patient with lichen planopilaris, lichen planus pigmentosus, and nonscarring alopecia of the genitals, who is reminiscent of GLPLS. Recent work shows evidence for autoimmunity in GLPLS. Further elucidation of underlying mechanisms can improve categorization and treatment options in this rare and controversial syndrome.

Disseminated follicular eruption during therapy with the MEK inhibitor AZD6244

To the Editor: MEK (small-molecule mitogen-activated protein kinase [MAPK]/extracellular signal-regulated kinase [ERK]) is a key component of the RAS/RAF/MEK/ERK signaling pathway that regulates cell proliferation and survival; constitutive activation of this pathway is implicated in many solid tumors.1 The benzimidazole AZD6244 (ARRY-142886) is an orally available, highly selective MEK inhibitor that is being evaluated in early clinical trials.2,3 We report the cutaneous side effects of AZD6244 in a patient with metastatic papillary thyroid cancer.

Spiny Follicular Hyperkeratosis Eruption: A New Cutaneous Adverse Effect of Sorafenib

Spiny Follicular Hyperkeratosis Eruption: A New Cutaneous Adverse Effect of Sorafenib

Cetuximab‐induced cutaneous toxicity

Epidermal growth factor receptor inhibitors are recently utilized by oncologists in advanced cases of certain malignancies. However, these agents are associated with numerous cutaneous adverse reactions. To systematically review the cutaneous toxicity of cetuximab-treated patients. An analysis of a series of 24 patients (20 men and 4 women) treated with cetuximab (12 patients with head and neck cancer and 12 patients with colorectal cancer) was performed with respect to relevant clinical characteristics. A total of 22 patients (91.7%) developed pustular or maculopapular follicular eruption, often referred to as acneiform rash. One patient (4.2%) developed paronychia in the course of cetuximab therapy. All patients with head and neck cancer had a combination treatment with radiotherapy and experienced radiation dermatitis accompanied by skin xerosis. Anaphylactic reaction was observed in three patients (12.5%). The most frequent cutaneous side effect reported in this series was acneiform eruption. The authors observed that all women with acneiform rash had only limited facial involvement, whereas all but one man experienced more widespread lesions of the face, the back and the chest. We found no association between the extent and severity of cutaneous eruptions (grade 1 vs. grade 2) and patients' response to therapy.

Follicular Graft-Versus-Host Disease: A Rare Manifestation of Chronic Cutaneous Graft-Versus-Host Disease

Chronic cutaneous graft-versus-host disease (GVHD) is generally classified into 2 major clinical categories, lichenoid and esclerodermoid. A follicular eruption as major clinical manifestation of GVHD is very rare. We report a patient who underwent an allogeneic stem-cell transplantation and developed an extensive erythematous-to-violaceous lichenoid papular eruption, predominantly follicular, on day +120. After 4 years of follow-up, the patient is doing well.

Follicular Eruption on Arms and Legs—Quiz Case

A 17-year-old boy with congenital absence of the intrahepatic bile ducts owing to Alagille syndrome presented with a pruritic eruption of 3 months’ duration. He also reported a new problem, seeing “dark spots” at night. His medical therapy included bile acid–binding resins and supplementation of fat-soluble vitamins. His chronic jaundice was unchanged. Physical examination revealed jaundice and numerous 2to 8-mm follicular, keratotic erythematous papules on the distal extensor surfaces of his arms and legs (Figure 1). His vitamin A level was 11 μg/dL (reference level, 26-72 μg/dL), and his carotene level was less than 2 μg/dL (reference level, 9-190 μg/dL). (To convert vitamin A and -carotene to micromoles per liter, multiply by 0.0349 and 0.01863, respectively.) Treatment resolved his lesions and vision changes. A punch biopsy specimen was obtained from the forearm for histopathologic evaluation (Figure 2 and Figure 3). What is your diagnosis?