Painful Papules Research Articles

Equine coital exanthema – Eradicated or underdiagnosed disease?

SummaryEquine coital exanthema (ECE) is a contagious, sexually transmitted disease affecting horses. It manifests itself as painful papules, vesicles, pustules and ulcers on the external genitalia in both mares and stallions. While widespread, the disease is generally not classified as reportable in most countries and is not considered a significant threat to the equine industry. ECE is endemic in horse breeding populations internationally. The absence of comprehensive epidemiological data can give a false sense of security, which increases the risk of local transmission. Lack of surveillance programmes or routine control in risk group (reproductive stallions and mares) leads to unawareness and lack of proper biosecurity measures. An outbreak in breeding facilities may result in significant economic consequences. Although ECE has not been officially confirmed in Poland, equine practitioners have noted isolated clinical cases resembling the disease in farm horses in the last decades. This study aims to confirm the presence of ECE in Poland. Clinical diagnosis has been made based on characteristic lesions. Positive diagnosis was confirmed in two out of four outbreaks by real‐time PCR on genital swabs. The presence of the disease has been confirmed in different regions in Poland in farm horses bred as meat animals. Confirming EHV‐3 infection in the Polish equine population through laboratory examinations marks a significant milestone. It is now crucial to raise awareness among owners, breeders and equine practitioners about the current epidemiological status of the disease.

Acquired lymphangioma circumscriptum of the vulva in a middle aged woman with chronic hidradenitis suppurativa – A case report

Lymphangioma circumscriptum (LC) is a distention of lymphatic channels present in skin and subcutaneous tissues. LC is either primary (usually present at birth or develops in early childhood) or secondary due to diminished lymphatic outflow. It is commonly prone to develop in oral cavity, tongue, proximal regions of arms and legs, groin, axilla, and trunk. Primary vulvar involvement is unusual. Vulvar LC is a rare untoward outcome of hidradenitis suppurativa (HS), which causes significant physical and emotional discomfort. We report a case of acquired LC of vulva as a sequlae of HS in a 42 years old female who presented with painful papules, edema and thickening of the vulva with history of foul-smelling discharging sinuses. The patient was managed surgically by wide excision and reconstructive surgery by Plastic surgery unit.

GLANDULAR CHEILITIS: CASE REPORT

Glandular cheilitis is a rare chronic inflammatory disease affecting the minor salivary glands, predominantly in the lower lip. An 18-year-old Black woman presented with macrocheilia with a soft consistency in the lips. There were yellowish crusts in the vermilion border that, when removed, revealed multiple punctate red, painful papules in lip mucosa. After ruling out associated systemic disease and infections, an incisional biopsy was performed in the lower lip. Histopathologic findings consisted of enlarged salivary ducts with accumulation of material suggestive of mucus, intense inflammatory mononuclear infiltrate, and areas of ductal metaplasia and acinar degeneration in the minor salivary glands. A final diagnosis of glandular cheilitis was made. Topical clobetasol propionate was prescribed 3 times per day and progressive improvement was observed over 30 days. The patient did not present recurrence in 6 months of follow-up.

Dorsal hand eruption in a man with ulcerative colitis

A 24-year-old man with ulcerative colitis well controlled on infliximab for 3 years presented to dermatology clinic with a recurrent eruption on the dorsal hands. The patient reported a similar rash 1 month prior that resolved spontaneously. The present eruption started as a single red, painful papule that progressed into several lesions. The patient was afebrile and well appearing. Examination showed multiple nonblanching dark red papulovesicles coalescing into plaques on the bilateral dorsal hands (Fig 1).

Folliculitis decalvans: a case report of satisfactory recovery after implementing isotretinoin therapy

Introduction: Folliculitis decalvans is a rare skin disease characterized by the presence of painful papules and pustules with an underlying neutrophilic infiltrate, usually on the scalp. Its treatment is lengthy and challenging, and recurrence is relatively common. Although its etiology is unknown, several theories explaining its development have been proposed, including colonization by Staphylococcus aureus. Case description: This is the case of a 26-year-old male healthcare worker who visited the outpatient service after experiencing a 4-year history of painful pustules on the scalp; initially these lesions were located in the occipital region, but then also started to appear in the temporal and parietal regions. After being treated for bacterial folliculitis and having several recurrences, a skin biopsy was performed, which allowed diagnosing him with folliculitis decalvans. Once the diagnosis was made, isotretinoin (20mg) treatment was implemented for a year and a half, achieving complete remission of the lesions. Conclusion: Although this case has some limitations, such as the lack of histopathology images and some control laboratory tests, it clearly shows the difficulties faced when treating this type of skin disorders and presents an overview of the use of isotretinoin, evidencing that although this drug is well tolerated, possible adverse reactions from drug interactions with trimethoprim/sulfamethoxazole may arise. In addition, this case is of great importance since the possible presence of a familial cluster of folliculitis decalvans could be confirmed, if further genetic testing is performed.

Juxta-articular nodules with transepidermal elimination in a patient with Raynaud’s phenomenon: the challenging differential diagnosis between rheumatoid nodule and granuloma annulare

We report the case of a 51-year-old female who presented with firm, painful papules and nodules for 9 months, in the extensor proximal metacarpophalangeal and interphalangeal joints in both hands. She did not have a previous diagnosis of rheumatoid arthritis. She also denied arthralgia or arthritis. The patient had livedo reticularis and a history compatible with Raynaud’s phenomenon was reported. The histopathological exam showed well- developed confluent palisaded granulomas with homogenous eosinophilic necrobiosis, with signs of initial transepidermal elimination and no mucin. Thus, we are faced withthe challenging differential diagnosis of rheumatoid nodule preceding rheumatoid arthritis versus perforating juxta-articular granuloma annulare (pseudorheumatoid nodule).

Chilblain-like acral lesions

A 70-year-old Asian female presented to the rheumatology clinic with a 5-year history of tender papules on fingers and toes aggravated under cold exposure. She also reported polyarthralgia and Raynaud phenomenon for 3 years. On examination, red painful papules were present on index fingers, middle fingers, thumbs, and toes, with central crust and ulceration (Fig. 1A-D). The toenail plates were partially or completely destroyed with hyperkeratosis of the nail bed (Fig. 1D). The extremities were cool to the touch.

Dermatologic Manifestations of Systemic Diseases in Childhood

Dermatologic Manifestations of Systemic Diseases in Childhood

SQuiz your Knowledge! Long-standing multiple painful keratotic papules on the palms and soles.

sQuiz your Knowledge! Long-standing multiple painful keratotic papules on the palms and soles.

Effect of add-on Ayurveda treatment in the management of chickenpox

BACKGROUND: Chickenpox is a contagious infection caused by the Varicella-zoster virus with the clinical manifestation of itchy rashes with fluid-filled blisters and fever. Although it is a self-limiting disease, to shorten the recovery period as well as to avoid complications, Ayurveda medicine could be effectively used in the management of chickenpox. In the present case study, the effects of Ayurveda add-on treatment are studied in treating chickenpox and in healing papules. CLINICAL PRESENTATION AND DIAGNOSIS: A 38-year-old woman presented to the Out-Patient Department (OPD) of Central Ayurveda Research Institute, Kolkata, with severe itchy and painful papules all over the body and malaise along with difficulty in swallowing because of pain in the throat since 15 days. On the basis of clinical presentation, it was diagnosed as a case of chickenpox. INTERVENTION AND OUTCOME: Before visiting the Ayurveda OPD, the patient took allopathic medicine (acyclovir 800 mg TID, paracetamol SOS, and calamine lotion local application) for 15 days, but the disease continued to progress and developed painful lesions with itching and other difficulties. The Ayurveda intervention started after 2 weeks of the onset of the disease. The patient was advised to take Tribhuvankirti Rasa (250 mg BD) before food for 7 days, Haridrakhanda (3 g BD) after food, Panchatiktaghrita (5 mL BD) after food, and Guduchyadi Taila for local application for 15 days. RESULTS: Papules of chickenpox were healed in 15 days of the treatment. After taking Ayurveda medicines, the patient got relief from severe itching and pain within 2 days and also completely recovered within 15 days. CONCLUSION: Results suggest that the Ayurveda interventions effectively reduced the signs and symptoms of chickenpox and hastened the healing process. It may be concluded that Ayurveda medicines either alone or as add-on give promising therapeutic results in the management of chickenpox.

Plantar Papules and Plaques: A Dermoscopic-Histopathological Correlation

Background: Painful lesions affecting the plantar aspect of the foot are routinely encountered in daily practice, and plantar wart, corn, and callus are the most common conditions. Although the clinical examination is sufficient to clinch an accurate diagnosis, atypical presentations indicate the need for invasive investigations like skin biopsy. Here we evaluated dermoscopic patterns of painful lesions affecting the plantar surface. Objectives: The current study aimed to, firstly, investigate the dermoscopic patterns and differentiate between painful papules and plaques on the foot, and, secondly, to analyze the histopathological correlation of these dermoscopic patterns. Methods: Following a cross-sectional design, the current study was carried out on patients with the clinical diagnosis of painful lesions of foot suggestive of plantar wart, corn, and callus referring to a tertiary care center from June 2019 to Jan 2020. Dermoscopy analysis and biopsy were performed for all participants. Results: Among 92 patients with painful plantar lesions, 56, 22, and 15 had a plantar wart, corn, and callus, respectively. Dermoscopy of warts revealed red dots (89.28%) and yellow halo (82.14%). A translucent central core (100%) and whitish ring (81.81%) on dermoscopy of patients with corn. Dermoscopy of callus demonstrated opaque yellow area in all (100%) the patients. Dermatoglyphics were absent in plantar wart in contrast to corn and callus, wherein they were preserved. Conclusions: Dermoscopy can be considered as a rapid, non-invasive, diagnostic tool in the daily practice of a dermatologist. Here, it assisted in distinguishing clinically akin painful plantar papules and plaques. These dermoscopic patterns also were well correlated histopathologically.

Vulvar Fordyce adenitis: A cohort of 45 women

BackgroundRecurrent episodes of painful papules and nodules, mostly located on the labia minora, have been reported under the denominations of vulvar sebaceous adenitis (14 published cases) and vulvar acne (16 published cases). ObjectivesThe primary aim of this study was to delve further into the clinical and pathological features of this condition. The secondary aim was to collect therapeutic data. MethodsIn this retrospective cohort study, files and photographs of patients with papules or nodules on the labia minora or the inner labia majora were extracted from a vulvar clinic database. Clinical, pathological and therapeutic data were analysed. ResultsForty-five women were included from 2002 to 2018. The median age at the time of diagnosis was 36 years (range: 16–60). The median time to diagnosis was 6.5 years. Clinical features included recurrent painful papules, pustules or nodules, suppuration (n=22), and pitted scars (n=10) on the labia minora (n=41), the inner labia majora (n=19), the outer labia majora (n=1), and the clitoral hood (n=1). Associated acne vulgaris was seen in 17 out of 26 patients for whom data were available. Hidradenitis suppurativa, androgenic alopecia and hirsutism were observed in 3, 1 and 1 cases respectively. Neutrophilic infiltrates were observed in the 4 available biopsies within or around the Fordyce sebaceous glands in 2 patients. Treatment with tetracyclines and oral zinc was not consistently effective. Isotretinoin led to complete remission in 4 patients unresponsive to tetracyclines. DiscussionVulvar sebaceous adenitis/vulvar acne is a clinically identifiable cause of painful recurrent inflammatory lesions affecting the labia minora and the inner labia majora, which are coincidentally sites of Fordyce granules. We therefore suggest a more specific denomination: “vulvar Fordyce adenitis”. The relationship with acne vulgaris and hidradenitis suppurativa requires further investigation. We suggest use of an oral anti-acne therapeutic strategy to reduce inflammation and to decrease the secretion of the sebaceous glands.

Piloleiomyoma Presented by Multiple Cutaneous Nodules: a Case Report

Abstract Introduction. Piloleiomyoma is a rare benign tumor which is caused by erector pili muscle and makes up 5% of all leiomyomas. They can be solitary and multiple. Multiple lesions still pose challenges for clinicians since their treatment option is very limited. Case report. We report a case of a 25-year-old male patient who had painful papules and nodules on the neck and chest for three years. Multiple red-brown papules and nodules in the skin of regio mammaria dextra and regio submandibularis on the left were seen on physical examination. Histopathological examination of punch bi-were seen on physical examination. Histopathological examination of punch biopsy sample revealed well-circumscribed nodule composed of spindle cells. The case was reported as cutaneous leiomyoma (piloleiomyoma). The patient was given 5 mg/day amlodipin and kept under control. Conclusion. The ideal treatment option for piloleiomyoma is surgical excision, but the problem with that treatment is that the lesions have tendency to recur. Medicamentous therapy plays a limited role; however, calcium-channel blockers and α-adrenergic blockers may help in palliating or eliminating associated pain through inhibition of smooth muscle contraction.

Sarcoïdose cutanée ulcérée et diffuse survenant sur cicatrices

Sarcoidosis in patients of African or Afro-Caribbean origin presents semiological characteristics, together with polymorphic skin lesions, more extensive forms and a poorer prognosis. Ulcerated and particularly diffuse skin forms are very rare. Herein we report a case of diffuse ulcerated skin sarcoidosis appearing on top of old scars in a female patient of Afro-Caribbean origin. A 16-year-old Caribbean girl consulted for multiple painful papules that appeared on old burns scars. The skin biopsy was consistent with sarcoidosis. At the same time, the patient developed sarcoid uveitis, and sarcoid dactylitis was suspected. Shortly thereafter, painful and diffuse ulcerations appeared on pre-existing skin lesions. Systemic corticosteroid therapy resulted in clinical improvement, but corticosteroid-dependency warranted subsequent initiation of methotrexate. Ulcerated cutaneous forms of sarcoidosis are rare and are often associated with severe forms, and they should prompt screening for systemic damage. There do not appear to be any previous reports of the presentation of ulcerated and extensive skin sarcoidosis presenting on scars, as described in the present study.

Vulval acne: a case series describing clinical features and management.

Intermittent inflammation of the vulval pilosebaceous units is common and usually self-limiting, but some patients experience recurrent and more troublesome symptoms. There is a scarcity of information on this problem. We describe the clinical and histological features in these patients and the response to treatment. A retrospective, observational study of 16 patients with this phenomenon of recurrent, protracted folliculocentric inflammation of the vulval pilosebaceous unit was performed. Details on the clinical features, histology and response to treatment were collected. Mean age at presentation was 32years (range 21-45). All patients reported recurrent painful papules and pustules on the labia majora and labia minora. Nine patients reported a cyclical pattern to the development of lesions, with premenstrual exacerbation being most common. Histological examination of these lesions showed a folliculocentric microabscess formation surrounded by an acute and chronic inflammatory cell infiltrate, with a focal foreign-body granulomatous reaction. All our patients responded well to tetracycline, antiandrogenic or retinoid therapy. We propose the term 'vulval acne' for this condition and propose a stepwise approach to its management. We hope to highlight this as a common but underreported entity.

Painful papules on the arms.

Painful papules on the arms.

SUN-165 Acnes Fulminans in a Very Young Patient with Adrenal Carcinoma After Surgical Treatment

Introduction:Acne fulminans is a rare disease, which most often affects teenagers and young adults, being described associated with exogenous testosterone use and with elevated adrenal androgens in congenital adrenal hyperplasia. We describe a case of acne fulminans in a toddler with adrenocortical carcinoma.Clinical Case:A 2.3 years-old male diagnosed with adrenocortical tumor presenting pubarche, increased penis and body hair, severe acne lesions in face, chest and back and also arterial hypertension. He was previously healthy, with normal development at his first year. The investigation showed adrenal hyperandrogenism and hypercortisolism. Serum values of Total Testosterone >1500 ng/dL (<7,00 - 25,91 ng/dL), ACTH: 7,2 pg/mL (<46 pg/mL), DHEAS: 682 µg/dL (<15 µg/dL), Aldosterone: 11 ng / dL (2.5-39.2 ng /dL), Serum Cortisol 8AM: 30.65µg/dL (5.27 to 22.45 µg/dL), Salivary midnight cortisol: 29.5nmol/L (11:30PM-00:30AM < 7.6 nmol/L). The abdominal computed tomography (CT) showed the left suprarenal gland with a 5,1 x 3,9 cm lesion. Left adrenalectomy was performed, whose histology confirmed adrenocortical carcinoma, without exceeding the capsule, but with a vascular invasion focus and Ki-67 rate of 20%. Hormonal levels in the early follow up were normal and prophylactic corticosteroid therapy was progressively removed. At the three months after surgery outpatient follow-up, worsening of his skin acneiform lesions was observed. He presented painful papules, pustules and crusts at face, chest and back, with purulent exudation and bleeding lesions, associated with axillary and inguinal adenomegaly and acne fulminans was diagnosed. Clinical and ultrasonographic examination also showed the presence of hepatosplenomegaly,. The treatment was initially made with oral corticosteroids and antibiotics. At this time, laboratory tests of androgens, DHEAS and salivary cortisol were normal, but inflammatory markers were high. A new postoperative abdominal CT showed, at the left adrenal topography, two lesions, 47HU attenuation, 1.5 x 1.2 x 1.1cm and 2.3 x 1.7 x 2.0cm, and also confirmed mild hepatosplenomegaly. Biopsy of inguinal lymph nodes was performed, and histology showed lymphoid follicles hyperplasia.Conclusions:This case report showing the association between acne fulminans and adrenocortical carcinoma, at postoperative time, when the child already had normal serum androgens and after hypercortisolism resolution, without oral corticosteroid therapy. Disordered immune response and/or hypersensitivity reaction to Propionibacterium acnes antigens, are also considered as possible triggering factors, although the etiology for this cases is not well established. The description of an acne fulminans case in such a young patient with adrenocortical carcinoma seems unusual and such association deserves further elucidation.

Afebrile and Leukopenic Sweet's Syndrome Following Partial Ileectomy in an Elderly Woman

Afebrile and Leukopenic Sweet's Syndrome Following Partial Ileectomy in an Elderly Woman

Envenomation by an arachnid (Latrodectus or Steatoda): Case report involving a woman and her female dog

Introduction: Accidents involving spiders bites usually cause mild medical reactions that lead to local symptoms and, less commonly, systemic effects. The most medically significant spiders belong to the genera Latrodectus and Loxosceles. This paper presents a posible case of steatodism in a young woman and her pet.Case description: 26-year-old female patient, who reports a clinical history characterized by paresthesia, malaise, fever, diarrea and a painful papule in the left cheek after being bitten by a spider. Immediately after being bit, the patient hit the spider with the back of her hand and it fell to the ground, where her dog swallowed it. The dog presented with vomiting and general discomfort after ingestion. Symptomatic therapy was given for comfort, and neither the patient nor the dog required antivenin therapy. Both evolved favorably.Discussion: The relevance of this case is the involvement of two mammals (a human and her dog) due to the accidental contact with a spider, possibly of the genus Latrodectus or Steatoda.Conclusion: Two possible cases of steatodism are described. Since spider bites are a relatively frequent reason for medical consultation in Colombia, it is important to diagnose and manage them properly.

Pediatric chondrodermatitis nodularis helicis (CNH) in a child with Beckwith‐Wiedemann syndrome (BWS)

Chondrodermatitis nodularis helicis is an idiopathic degenerative process that presents as a painful nodule, papule, or ulcer on the helix or antihelix. It predominantly affects adults and is thought to be associated with trauma to the ear. We describe a case of pediatric chondrodermatitis nodularis helicis occurring in a child with a history of Beckwith-Wiedemann syndrome that was successfully treated with an excisional biopsy and relief from a recurrent source of pressure on the ear.