Papular Eruption Research Articles

Papulo-purpuric dermatitis of childhood: a distinct PLEVA-like eruption associated to SARS-CoV-2 infection. Clinical, histopathological and immunohistochemical study of 10 cases.

We observed ten children with a papular eruption with purpuric features during the SARS‐CoV‐2 pandemic in Northern Italy (May‐December 2020). Histological examination showed signs of SARS‐CoV‐2‐related dermatosis. Evidence of nucleocapsid viral proteins using SARS‐CoV‐2 (2019‐nCoV) nucleocapsid antibody revealed cuticular staining of the deep portion of the eccrine glands in all cases.

Papular eruption in an adolescent with a mood disorder.

Papular eruption in an adolescent with a mood disorder.

A Clinicopathological Study of Mucocutaneous Lesions in Correlation with CD4 Counts in HIV Seropositive Cases at a Tertiary Care Centre in South India

Background: Mucocutaneous lesions are one of the first clinical presentations of immunosuppression in Human Immunodeficiency Virus (HIV) seropositive patients that manifest at different stages of the infection that requires early diagnosis along with prompt treatment(1). Objectives: (1) To study the prevalence of mucocutaneous manifestations in HIV‑seropositive patients attending the ART center of our hospital in Visakhapatnam, Andhra Pradesh. (2) To correlate mucocutaneous manifestations with CD4 cell counts. Materials and methods: 150 HIV positive patients above 18 year old with definite cutaneous manifestations attending ART center and OPD in the Department of Dermatology and venereology in a tertiary care centre Visakhapatnam (Andhra Pradesh, India) were studied from May 2020 to May 2021. Results: Out of 150 HIV patients, who aged 20 -80 years with a mean age of 25, (23.8%) were 60 (40%) female and 90 (60%) were males, majority of the patients were labourers 50 (33.3%) by occupation , 41 (27.3%) had CD4 counts < 200, 73 (48.6%) had CD4 counts of 200–500, and 54 (36%) had CD4 counts > 500. The most common dermatological presentation was pruritic papular eruptions 24 (16.%) followed by cutaneous drug reaction 19(12.67%) and scabies 12 (8%). Conclusion: At the end of study we concluded that cutaneous manifestations can be considered as good clinical indicators for the progression of disease and underlying immune status in resource poor settings

Cutaneous infections among Human Immunodeficiency Virus (HIV) - infected patients in a single center in Kuala Lumpur, Malaysia

Background: Human immunodeficiency virus (HIV) infection is frequently associated with cutaneous infections. Objective: To determine the spectrum of dermatological infections among HIV positive patients, identify the causative microorganisms and CD4 count. Methods: This is a retrospective study conducted in a tertiary center. HIV-positive patients registered in 2013 to 2018 were identified from casemix database, those with suspected cutaneous infection were selected. Data was obtained from electronic and physical medical records. Results: A total of 27 patients were enrolled. Mean age was 38.61±11 years, 22(81.5%) were males and 5(18.5%) were females. Most patients 14(52%) developed more than one skin disease, there were a total of 46 diagnoses. The skin infections were fungal 11(24%), viral 4(8.7%) and bacterial 4(8.7%). Disseminated mycoses were mostly due to Penicillium marneffei 4(8.7%). Superficial fungal infections were due to Fusarium sp, Candida sp and Trichosporum sp . Cutaneus candidiasis constituted 3(6.47%). The average CD4 count in patients with fungal infections was 79 cells/mm3. Other skin diseases documented were adverse cutaneous drug reactions 8(17.4%) and pruritic papular eruption 5(11%). CD4 count was <200 cell/mm3 in 34(73.9%) of the dermatological illnesses encountered by the patients. Conclusion: Both disseminated and superficial fungal infections were common in our cohort. Penicillium marneffei caused majority of disseminated infections while superficial infections are due to moulds.

Pathophysiology, clinical findings, and management of Fox-Fordyce disease: A systematic review.

Fox-Fordyce (FFD), also known as apocrine military, is an uncommon chronic inflammation of the apocrine sweat glands. It is characterized by pruritic, papular eruptions in apocrine-gland-bearing regions. FFD was described a century ago, but the exact pathogenesis of the disease and the management are not well understood. This paper provides a wide understanding of the pathophysiology, clinical findings, and management of Fox-Fordyce disease. Its aim is to help the physician to diagnose and manage this entity accordingly. A research was done using PubMed database on 12 April 12, 2020, and in order to retrieve all case reports, case series, cohort studies, randomized, and nonrandomized clinical trials were included describing FFD among patients. A total of 43 articles and 68 patients were included in the study. The majority of patients were young females. The disease was bilateral in 90%, affected the axillae and to a lesser extent the pubic and the periareolar areas and rarely the thoracic area, the abdominal area, and the face. FFD followed a relapsing and remitting course, and an evident improvement in disease course was noted after menopause. The typical FFD patient is a post-pubertal female and pre-menopause, presenting with pruritic papules in apocrine-gland-bearing regions. FFD can be sporadic or occurs in family, and it can be asymptomatic in 1/(3-4) of patients and can be triggered by laser hair removal and hormonal changes. Further randomized clinical trials assessing different treatment of FFD are now warranted.

Cutaneous manifestations of patients with Human Immunodeficiency Virus (HIV) Infection: A retrospective review of a tertiary referral centre with clinicopathological correlation.

The majority of patients with Human Immunodeficiency Virus (HIV) will have cutaneous manifestation during their disease course. We report the spectrum of cutaneous manifestations and clinicopathological concordance in the diagnosis of skin diseases in patients with HIV. A retrospective review of all cutaneous manifestations of HIV-infected patients with skin biopsy-proven histopathological confirmation, treated in the University of Malaya Medical Centre, from 2016 till 2018, was performed. Clinical characteristics and histopathological correlation of these patients were reviewed. A total of 38 cases were included where the median age was 40.5 (interquartile range (IQR) 13.3). The median duration of HIV diagnosis to the development of skin disease was 3years (IQR 7.8). Majority of our patients were male (89.5%, n=34), and the commonest mode of transmission is men who have sex with men (36.8%, n=14). Most patients (92.1%, n=35) had Acquired Immunodeficiency Syndrome when they presented with skin diseases, predominantly non-infectious types (51.4%, n=19). Commonest skin diseases include eczema (n=7) and pruritic papular eruption of HIV (n=6). Papules and plaques were the commonest morphology for both infectious and non-infectious skin diseases. Duration of HIV diagnosis (P=0.018) and non-compliance to Highly Active Antiretroviral Therapy (HAART) (P=0.014) were significantly associated with the development of non-infectious skin diseases. Overall, clinicopathological concordance was 84.2% in our centre. A wide spectrum of cutaneous diseases can occur in HIV patients depending on the degree of immunosuppression. skin biopsy along with appropriate stains, and microbiological cultures are important in helping clinicians clinch the right diagnosis.

Dapsone as corticosteroid-sparing therapy for Sweet syndrome

To the Editor: Sweet syndrome is a rare cutaneous condition that typically presents as a painful, pruritic, erythematous papular eruption with histologic evidence of dense neutrophilic infiltrates in the upper dermis.1 Classical Sweet syndrome is often associated with a preceding respiratory infection, although the condition can also be induced by hematologic malignancies, medications, and autoimmune diseases.2 While Sweet syndrome can spontaneously resolve, many patients undergo medical management.

AB025. Acute arthritis with dermatitis: a case of multicentric reticulohistiocytosis

A 56-year-old woman presented with a 5-day history of arthralgias and an erythematous papular eruption affecting the face, arms, chest, and upper back, for which she was started on high potency topical corticosteroids. She was noted to have associated synovitis of the hands and wrists bilaterally and was started on celecoxib. One week later, the patient returned with worsening pain and swelling in her hands in addition to new confluent, somewhat firm, erythematous papulonodules on the face, trunk, forearms, and dorsal hands. Two biopsies were performed with evidence of dermal histiocytic proliferation consistent with multicentric reticulohistiocytosis (MRH). Mycobacterial and malignancy screening were completed, and the patient was started on hydroxychloroquine, methotrexate, and systemic corticosteroids. MRH is a rare histiocytic disorder predominantly affecting Caucasian women in the fourth decade of life. Associations include arthritis, which can be mutilating in nature, and malignancy. Given the frequently destructive nature of the associated arthritis, timely diagnosis and treatment is crucial and may prevent long-term disability. Teaching points: (I) highlight the clinical manifestations of MRH, including the differential diagnosis of arthritis-dermatitis syndromes. (II) Underscore that MRH can mimic dermatomyositis. (III) Describe the differential diagnosis of arthritis mutilans (e.g., RA, PsA, gout, MRH). (IV) Examine the evidence for therapeutic options in MRH.

Telangiectatic cutaneous metastasis from breast carcinoma

Cutaneous metastasis from breast cancer has varied clinical presentations. Herein, we present the case of a middle-aged female with a large erythematous patch and an itchy bluish-red papular eruption on the left side of the breast. The patient had a history of ductal breast carcinoma at age 40. Histology from one of the red papules revealed an atrophic epidermis and emboli of carcinomatous cells in the dermal and subcutaneous blood vessels. The morphology of the tumor cells was similar to that of the primary ductal carcinoma of the breast. The diagnosis of telangiectatic metastatic breast cancer was reached.

Lupus miliaris disseminatus faciei with complete response to isotretinoin

Lupus miliaris disseminatus faciei is an uncommon type of granulomatous rosacea characterized by a papular eruption in the central regions of the face. A 43-year-old woman presented with an asymptomatic papular eruption on the face that had developed over a period of five months. Physical examination revealed multiple, small, reddish-brown papules, distributed symmetrically on the central area of the face. A biopsy was taken, showing dermal epithelioid cell granulomas with central necrosis and surrounding lymphocytic infiltrate with multinucleate giant cells. No foreign bodies were found in granulomas and no mycobacterial or fungal components were detected. On the basis of these findings, the diagnosis of lupus miliaris disseminatus faciei was made. The patient was given oral isotretinoin 20mg/day with initial slow response. After 6 months' treatment the lesions completely disappeared. Many authors consider this entity to be a variant of granulomatous rosacea. It is a chronic condition that primarily affects young adults. Treatment is usually unsatisfactory. Therapies with corticosterois, tetracyclines, retinoids, clofazimine or topical tacrolimus have been described but there is a lack of controlled studies and convincing results. Our success with a 6-month course of low dose isotretinoin suggests consideration of a longer trial prior to abandoning this as treatment.

Lichen planus pemphigoides versus bullous pemphigoid: A diagnostic dilemma of cutaneous adverse event in a case of nonsmall cell lung cancer treated with durvalumab

Monoclonal antibodies targeting the immune checkpoint pathways including programmed cell death 1 and programmed cell death ligand-1 have been used in several malignancies. Dermatological toxicities ranging from more common pruritus to rare autoimmune bullous reactions and lichenoid eruptions are an emerging consequence. We report a case of a 74-year-old male diagnosed with nonsmall cell lung carcinoma. He was treated with injection durvalumab following which he developed an itchy, erythematous to hyperpigmented, papular eruption over body. It was diagnosed as a lichenoid drug eruption based on clinicohistopathological correlation and was treated with topical corticosteroids and emollients. Following this, he presented with tense bullae all over the body including the areas of previous lichenoid eruption, associated with pruritus. The histopathology, immunofluorescence, and serology were diagnostic of bullous pemphigoid. However, considering the history, lichen planus pemphigoides (LPP) was the closest differential diagnosis. We treated him with systemic corticosteroids and tetracycline with resolution of the lesions in few weeks and was advised against the continuation of durvalumab therapy. In this article, we have highlighted this adverse event as well as a way to differentiate between LPP and bullous pemphigoid.

Grover’s disease: a rare bullous dermatosis spontaneously regressing

Grover's diseaseis an itchy acantholytic disorder occurring on the trunk of middle-aged men. It is a transient dermatosis of unknown cause manifesting clinically as a papular skin eruption located usually on the anterior chest and abdomen and histologically with dyskeratosis and acantholysis. This disease has occasionally been reported in patients with chronic renal failure, some infections, hematological malignancies, and many other anomalies. We report herein a new case of Grover's disease that developed in a female patient after a fever episode.

Acrokeratosis verruciformis of Hopf in an immunosuppressed adult: an exclusive occurrence

Acrokeratosis verruciformis of Hopf (AKV) is a rare autosomal dominant genodermatosis. It can be characterized by warty papules with a symmetrical distribution involving dorsae of hands and feet. It can also involve elbows, knees, nails, and palms. It is more frequently seen in childhood but can also occur in adults. Various treatment methods have been tried, but superficial ablation is known to be the treatment of choice. In this case, an adult male with breast carcinoma who was also hepatitis B and C reactive presented with flesh-colored papular eruptions over bilateral hands and feet. No familial association was another unusual finding in this case. It has to be differentiated from Darier’s disease. Histopathology helped to confirm the diagnosis of AKV. Moreover, the findings pointed toward the sporadic form of AKV in our patient. Rarity of data regarding the association of immunosuppression and AKV makes this an intriguing case.

Kyrle’s disease (KD): “An Update with review of literature” A Spongebob Skin pores simulation

Kyrle’s disease (KD) is a Chronic skin condition first described by Austrian pathologist Josef Kyrle in 1916. Kyrle referred to this condition as hyperkeratosis follicularis &amp; parafollicularis in cutem penetrans. These diseases are characterized by the phenomenon of transepidermal elimination of denatured dermis an acquired form of perforating dermatosis [14]. It is characterized by keratotic crater plugs that develop in hair follicles penetrating the epidermis and extending into the dermis [4]. This trans epithelial migration and elimination of proteinaceous components is associated with systemic disorders like renal, liver diseases, chronic heart failure and diabetes mellitus. We present two case scenarios of a young Males with multiple chronic papular eruptions along with a review of literature for Kyrle’s disease (KD).

Prurigo Simplex or "Itchy Red Bump" Disease: Review and Case Series.

Prurigo simplex or “itchy red bump” disease is a controversial pruritic papular eruption. The objective of this study was to delineate the diagnostic criteria for this disease. A PubMed search was performed for: “prurigo simplex”, “prurigo simplex subacuta”, “subacute prurigo”, “chronic papular dermatitis in adults” and “itchy red bump disease”. Medical charts of patients with prurigo diagnoses in a university setting were analysed. The literature search revealed 32 relevant studies (431 patients) on different aspects of the disease. Out of 50 patients with prurigo diagnoses, 5 patients (4 women, mean age at onset 54 years) matched the description in literature. Small, severely itchy papules without secondary skin lesions continued to appear for years (mean 5.6 years). Skin biopsies revealed lymphocytic perivascular infiltrates, few eosinophils and occasionally spongiosis. Treatment with long-term methotrexate or cyclosporine cleared the symptoms. Some major and minor diagnostic criteria for prurigo simplex are proposed and compared with chronic prurigo.

Dermoscopy of “lichenoid pseudovesicular papular eruption on nose”

Dermoscopy of “lichenoid pseudovesicular papular eruption on nose”

Plasma cell–directed therapies in monoclonal gammopathy–associated scleromyxedema

AbstractScleromyxedema is a rare skin and systemic mucinosis that is usually associated with monoclonal gammopathy (MG). In this French multicenter retrospective study of 33 patients, we investigated the clinical and therapeutic features of MG-associated scleromyxedema. Skin molecular signatures were analyzed using a transcriptomic approach. Skin symptoms included papular eruptions (100%), sclerodermoid features (91%), and leonine facies (39%). MG involved an immunoglobulin G isotype in all patients, with a predominant λ light chain (73%). Associated hematologic malignancies were diagnosed in 4 of 33 patients (12%) (smoldering myeloma, n = 2; chronic lymphoid leukemia, n = 1; and refractory cytopenia with multilineage dysplasia, n = 1). Carpal tunnel syndrome (33%), arthralgia (25%), and dermato-neuro syndrome (DNS) (18%) were the most common systemic complications. One patient with mucinous cardiopathy died of acute heart failure. High-dose IV immunoglobulin (HDIVig), alone or in combination with steroids, appeared to be quite effective in nonsevere cases (clinical complete response achieved in 13/31 patients). Plasma cell–directed therapies using lenalidomide and/or bortezomib with dexamethasone and HDIVig led to a significant improvement in severe cases (HDIVig refractory or cases with central nervous system or cardiac involvement). The emergency treatment of DNS with combined plasmapheresis, HDIVig, and high-dose corticosteroids induced the complete remission of neurological symptoms in 4 of 5 patients. Quantitative reverse-transcriptase polymerase chain reaction analysis of 6 scleromyxedema skin samples showed significantly higher profibrotic pathway levels (transforming growth factor β and collagen-1) than in healthy skin. Prospective studies targeting plasma cell clones and/or fibrotic pathways are warranted for long-term scleromyxedema management.

The prevalence and spectrum of mucocutaneous disease in South African people living with HIV and accessing care at a district-level hospital.

BackgroundAlthough the association between human immunodeficiency virus (HIV) and mucocutaneous diseases has been well studied within South African specialist centres, there is limited data from district-level hospitals. Available data may, therefore, fail to reflect the prevalence and full spectrum of dermatoses seen in people living with HIV (PLWH).ObjectivesTo determine the prevalence and spectrum of dermatoses seen in PLWH.MethodWe conducted a cross-sectional, descriptive study of 970 PLWH (men and women, ≥ 18 years old) accessing care at Karl Bremer Hospital, a district-level hospital located in the Western Cape province, South Africa, between 01 September 2016 and 28 February 2017.ResultsThe prevalence of mucocutaneous disease in this sample was 12.7% (95% confidence interval [CI] 0.11–0.15). Non-infectious dermatoses comprised 71.0% of the disorders. Pruritic papular eruption (20.0%) and seborrheic dermatitis (6.0%) were the most common non-infectious dermatoses. Tinea corporis (8.0%) and oral candidiasis (6.0%) were the most prevalent infectious dermatoses. There was no significant association between skin disease category (infectious or non-infectious dermatoses) and patient demographics (gender and ethnicity) or HIV-disease characteristics (CD4+ cell count, viral load and duration of antiretroviral therapy [ART]).ConclusionThis study provides valuable scientific data on the prevalence and spectrum of mucocutaneous disease in PLWH attending a South African district-level hospital. Prospective studies conducted in other district-level centres across the country are required to determine the lifetime prevalence and spectrum of dermatoses in PLWH in the ART era.

Scleromyxedema in a 21\xa0year old female patient with acute lymphoblastic leukemia: a case report

BackgroundScleromyxedema is a rare, para-neoplastic, chronic, progressive condition of the Lichen myxedematosus (LM) family. The clinical picture consists of generalized confluent papular eruptions with possible systemic manifestations, which may be fatal as it still constitutes a therapeutic dilemma. Histologically, it is characterized by dermal mucin deposition, fibroblast proliferation with fibrosis, with monoclonal gammopathy in the absence of thyroid disease. Some atypical forms of the disease were reported in the literature, but none were reported in acute leukemia.Case presentationHerein, we report a case of a 21 years old female patient, known case of acute lymphoblastic leukemia (ALL), who developed numerous hyper-pigmented erythematous papules and plaques, mainly over her thighs, lower abdomen, and sub-mammary flexures. Histopathology of skin lesions confirmed the diagnosis of atypical scleromyxedema. Her symptoms significantly improved with the use of high dose intravenous immunoglobulin (IVIG).ConclusionsDespite that scleromyxedema is associated with many hematologic disorders, it is very rarely associated with acute lymphoblastic leukemia, and a high index of suspicion is needed for diagnosis. IVIG remains a reasonable management of such a disabling disease.

Hemorrhagic Papular Eruption on the Dorsal Hands

Hemorrhagic Papular Eruption on the Dorsal Hands