Papulovesicular Lesions Research Articles

Pseudovaríola e estomatite papular em bovinos no Estado de Rondônia, Brasil

Casos de doença vesicular, suspeitos de febre aftosa ou estomatite vesicular, foram acompanhados em rebanhos de cria e recria de bovinos no município de Nova Brasilândia do Oeste, região centro-sul do Estado de Rondônia, nos meses de outubro e novembro de 2012. Os casos ocorreram em 13 rebanhos próximos, sendo que amostras de nove rebanhos foram submetidas ao diagnóstico laboratorial. O surto afetou 25 do total de 482 animais, a maioria com idade inferior a seis meses. Os animais apresentaram lesões papulares e vesiculares, principalmente na cavidade oral, mas também no focinho e na pele, com curso aproximado de 7 a 10 dias. Após diagnóstico negativo para febre aftosa, suabes e fragmentos de tecidos das lesões e crostas foram submetidos à pesquisa de outros vírus associados com doença vesicular: parapoxvírus bovinos, vírus da vaccínia e herpesvírus bovino tipo 2 por isolamento em cultivo celular e PCR. Amostras de animais de quatro propriedades foram positivas no PCR para o gene B2L dos parapoxvírus. Sequenciamento e análise filogenética dos produtos de PCR revelaram similaridade de nucleotídeos de 97-99% com o vírus da pseudovaríola (PCPV) em material de animais de três propriedades, e amostras de um rebanho apresentaram a mesma similaridade com o vírus da estomatite papular (BSPV). As demais amostras foram negativas para os vírus pesquisados. Esses resultados demonstram a circulação desses parapoxvírus em bovinos de Rondônia e alertam para a necessidade de diagnóstico etiológico rápido e correto para evitar e/ou abreviar as consequências de medidas restritivas em relação à febre aftosa, e também, para planejar estratégias de combate a essas infecções.

Phototoxic Dermatoses in Pediatric BMT Patients Receiving Voriconazole

We investigated the incidence of phototoxic skin reactions in pediatric BMT recipients treated with voriconazole. Nine out of 40 patients (22.5%), all Caucasian, developed skin lesions in sun-exposed distributions. Dermatologic findings included sunburn-like erythema, pseudo-porphyria, linear papulovesicular lesions, severe erosive cheilitis, dermatoheliosis and lentigines. Patients were treated with sun avoidance, high-potency sunscreens, and topical steroids with significant improvement in all cases. Prolonged voriconazole use requires close monitoring for chronic skin toxicities. Long-term risks including the risk of skin cancer need to be investigated. Pediatr Blood Cancer 2014;61:1325–1328. © 2014 Wiley Periodicals, Inc.

Antinuclear antibody levels in Polymorphic Light Eruption and their relation to the severity of disease

Introduction: PLE is an idiopathic photodermatosis characterised by a polymorphic eruption ranging from papulo-vesicular lesions to large plaques, located predominantly in a photoexposed distribution. It is an acquired disease and is the most common idiopathic photodermatosis. It is characterised by recurrent abnormal delayed reaction to sunlight. PLE is the most common idiopathic photodermatosis, the prevalence of which has been estimated to be around 10-20% in USA, England and Ireland. Previous studies have shown elevated levels of ANA in 2.9-19% of patients with PLE. Aim: The aim of our study was to determine the frequency of ANA positivity in a cohort of patients of ethnic kashmiri origin with Polymorphic light eruption and to examine whether there is any relation of their levels with the severity of disease. Methods: Patients with Polymorphic light eruption clinically who attended the Outpatient Deptt. of Dermatology GMC Srinagar were referred to the Deptt. of Biochemistry GMC Srinagar where patients blood samples were analysed for ANA index by ELISA method (BRIO SEAC ITALY). Results: Our study consisted of 36 patients (with 23 males and 13 females with age group ranging between 15-65 years) presenting with typical clinical features of PLE without associated autoimmune connected tissue diseases like discoid lupus erythematosus or systemic lupus erythematosus and 20 healthy age and sex matched controls. Two patients (1 male and 1female) showed positive results and 1 patient (female) showed equivocal results. Among the control group one patient showed ANA positivity. Thus total frequency of ANA positivity of of 5.55% was observed among the cases and 5% among the controls with frequency of 4.34% in males and 7.69% in females. Conclusions: ANA levels were found in 5.55% of patients with PLE, however there is no relation between the levels of ANA in PLE and with the severity of disease (p value >0.05).

Pruritic urticarial papules and plaques of pregnancy: epidemiological, clinical, and histopathological study of 18 cases from Lebanon

Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a benign pruritic inflammatory skin disorder that usually affects primigravidae in their third trimester of pregnancy. Studies on this condition from our area are lacking. To describe the epidemiological, clinical, and histopathological findings of all patients diagnosed with PUPPP at the American University of Beirut Medical Center (AUB-MC) between 1998 and 2009 and compare our findings with those published in the literature. PUPPP mainly affected primigravidae (72%) in the third trimester of pregnancy (89%). Multiple gestation pregnancies were observed in 50% of cases. The abdomen and proximal thighs were the most commonly involved sites (67%), with exclusive involvement of the extremities in four cases. Although pruritic urticarial papules and plaques were the main morphological feature of PUPPP observed (98%), five cases had additional features, and one case presented exclusively with papulovesicular lesions. Microscopically, all cases biopsied showed the typical features of PUPPP, including negative direct immunofluorescence findings. Emollients, topical corticosteroids, and/or oral antihistamines were generally adequate to control symptoms in all cases, in which skin lesions resolved in an average of three weeks. This study showed a lower incidence of PUPPP in our population compared with its incidence in other populations. It also confirmed the previously described clinical features, benign course, and excellent outcome of the condition, although variations may occur. Significant associations mainly included multiple gestation pregnancies, excessive maternal weight, and Rh-positive blood type, while fetal gender and weight gain did not contribute.

Fatal Canid herpesvirus 1 infection in an adult dog

Canid herpesvirus 1 (CaHV-1) is a well-known cause of fatal hepatic and renal necrosis in neonatal puppies. In adult dogs infected with CaHV-1, papulovesicular genital lesions may be observed. CaHV-1 infection during pregnancy can lead to embryonic resorption, abortion, and stillbirth. In high-density dog populations, CaHV-1 can also contribute to kennel cough. Furthermore, recent literature has clearly documented that CaHV-1 can induce ocular disease in immature and adult dogs. The current study describes a case of fatal CaHV-1 infection in a 9-year-old spayed female Bichon Frise dog. Following a history of vomiting and diarrhea, the dog deteriorated and subsequently died. The main lesions were multifocal areas of necrosis with intranuclear inclusion bodies in the liver, adrenal gland, and small intestine, similar to the lesions observed in CaHV-1-infected puppies. Infection with CaHV-1 was confirmed on samples of liver by polymerase chain reaction, immunohistochemistry, and in situ hybridization. There was no indication of immunosuppression in this dog. Based on the results presented herein, CaHV-1 should be included in the list of differential diagnoses of hepatic necrosis in adult dogs.

Acquired lymphangioma circumscriptum of the vulva

A lymphangioma is a rare proliferation of the lymphatic system. The condition is unpleasant but benign. There are 3 types of lymphangioma: circumscriptum, cavernous, and cystic. Lymphangioma circumscriptum is considered primary if it is present at birth or it develops in early childhood, or secondary or acquired if it is caused by impaired lymph flow. Involvement of the vulva is rare [1,2]. The differential diagnosis of lymphangioma circumscriptum of the vulva includes genital warts, molluscum contagiosum, tuberculosis verrucosa cutis, lymphogranuloma venereum, and filariasis [3]. Lymphangioma circumscriptum can be caused by infections (filariasis, sexually transmitted infections, tuberculosis, erysipelas, lymphogranuloma venereum); Crohn's disease; surgical or radiotherapy procedures (radical hysterectomy, pelvic lymphadenectomy, radiation for cervical cancer); trauma; keloids; scleroderma; dermopathy from penicillamine or corticosteroids; and lymphatic obstruction associated with neoplasia [1,4]. A 44-year-old woman presented with vesicles in the vulvar region, watery discharge, and itching. The patient reported occasional foul-smelling white vaginal discharge and no history of sexual contact. Clinical examination revealed well-defined, multiple, grouped, dome-shaped papulovesicular lesions over the labia majora and mons pubis. The lesions were not tender and showed diffuse induration. Inguinal lymph nodes were absent. The perianal region was without lesions (Fig. 1). Speculum examination revealed copious foul-smelling white discharge around the cervix. Other general examination was unremarkable. Histologic examination of the lesions revealed acanthosis and prominent elongation of epidermal rete ridges. The spaces between the rete pegs were distended by dilated spaces lined by endothelium and contained pale secretory material. Adjacent dermis showed infiltration by lymphocytes. The diagnosis of lymphangioma circumscriptum was proposed. Pap smear ruled out intraepithelial malignancy.

An outbreak of pseudocowpox in fattening calves in southern Brazil

Pseudocowpox virus is a parapoxvirus frequently associated with papulovesicular and scabby lesions on the teats and udders of milking cows and is often transmitted to human beings. An unusual outbreak of skin disease in fattening calves in southern Brazil is described. Fourteen of 17 male cattle (82%), aged 6-48 months, feeding on grass pastures were affected. Animals developed papules, vesicles, and scabby proliferative lesions on the muzzle in a clinical course of approximately 10-15 days. The scabby lesions often presented with exudation and bleeding. Histological examination of mucocutaneous tissue in detached scabs revealed acanthosis with thickening of the corneal layer and premature keratinization (parakeratotic hyperkeratosis). The dermis had multifocal lymphoplasmacytic infiltrates. Electron microscopic examination of scab specimens revealed typical parapoxvirus particles: oval shaped (260 nm × 160 nm), enveloped, and covered with a helical layer. Polymerase chain reaction using a set of pan-parapoxvirus primers for the B2L gene amplified a 590-bp product out of DNA extracted from scabs. Nucleotide sequencing of the amplicons revealed a nucleotide homology of 97% with Pseudocowpox virus and lower homology with other parapoxviruses: Bovine papular stomatitis virus (84%) and Orf virus (94%). A phylogenetic tree based on the B2L sequence was constructed, showing that the virus clustered with Pseudocowpox virus isolates.

Lipoid proteinosis: Histopathological characterization of early papulovesicular lesions

Lipoid proteinosis: Histopathological characterization of early papulovesicular lesions

Leukemia Cutis: An Unusual Presentation

Leukemia cutis is the term used for cutaneous manifestations of leukemia, which can have varied clinical presentations. A skin biopsy can help in diagnosing such condition and differentiating it from other skin diseases. We present a case where a 45years old man presented with diffuse papulovesicular skin lesions mimicking dessiminated herpes. Further workup revealed patient having acute myeloid leukemia (AML-M2) and skin biopsy showed infiltration by myeloblasts. With chemotherapy patient went into remission and skin lesions healed.

Intractable itching resistant to topical steroids

A 6-month-old otherwise healthy baby presents with a widespread pruritic rash that has persisted for 2 months despite treatment with moisturizing lotions and hydrocortisone 2.5% cream twice daily. Several dozen papules and papulovesicular lesions 0.5 to 1.5 mm in diameter surrounded by a flare of macular erythema are present on the trunk, palms, and soles, and nodules 10 to 12 mm in diameter are noted in the axillae and on the penis (Figs 1 and 2). Many lesions are excoriated. No itching or eczematous rash was present during the development of this rash.

Candidose congénitale systémique, forme rare de candidose néonatale : à propos d’une observation chez un nouveau-né prématuré

Congenital cutaneous candidiasis presenting at birth is very uncommon and is due to intra-uterine infection. The systemic form has to be considered when cutaneous signs are associated with sepsis symptoms. A female infant was born by vaginal delivery at 35 weeks' gestation to a mother whose pregnancy had been complicated by urinary tract infection treated 3 days before delivery. The infant was admitted because of respiratory distress. Clinical features consisted of respiratory retraction signs associated with hepatomegaly and rash on the trunk. The white blood cell (WBC) count was 50 × 10(9)/L and C-reactive protein was negative. Maternofetal bacterial infection was suspected and intravenous antibiotics were prescribed. Over the next 6h, macules appeared on the trunk, back, and limbs, which changed after 24h into papulovesicular lesions over the trunk, back, limbs, palms, and scalp. Congenital candidiasis was suspected, confirmed by cultures from vesicle swabs and maternal vaginal discharge. The systemic form was considered because of respiratory distress requiring oxygen therapy for 4 days, hepatomegaly, elevated WBC count, and chest X-ray infiltrates. The infant was started on intravenous systemic antifungal therapy (fluconazole, 6 mg/day). Treatment was continued for 3 weeks. The rash resolved by desquamation after about 1 week and hepatomegaly disappeared. The infant remained well at follow-up.

T cell lymphoma with disseminated herpes zoster on presentation and subsequent recurrence leading to blindness—a case report

Dear Editor, Lymphomas are known to be associated with immunologic defects [1, 2]. Immunosuppressive chemotherapy often aggravates the problem. Reactivation of varicella zoster virus may occur in immunocompromised patients. Depending on the level of immunodeficiency, this may either present as localized herpes zoster or disseminated herpes infection. Conventional chemotherapy for lymphomas, except for regimens containing fludarabine or alemtuzumab, is not considered profoundly immunosuppressive. Antiviral prophylaxis is not routinely recommended with these regimens [3]. We report a case of peripheral T cell lymphoma, who developed disseminated herpes zoster infection on initial presentation of lymphoma and subsequently developed recurrent infection after few weeks of salvage chemotherapy, which led on to bilateral choroidoretinitis, retinal detachment, and blindness. A 50-year-old diabetic lady presented with a 2-week history of fever, night sweats, generalized lymphadenopathy, and multiple papulovesicular skin lesions on the back, buttocks, and right. lower limb, proved to be due to disseminated herpes zoster infection. She had a history of chickenpox in childhood. Excision biopsy of the cervical node reported as peripheral T cell lymphoma—

Cervicofacial actinomycosis mimicking lymphangioma circumscriptum

Primary cutaneous actinomycosis caused by Actinomyces israelii occurs most commonly in the cervicofacial area. It commonly presents as “lumpy jaw” with draining sinuses which discharge the characteristic “sulfur granules”. A low index of suspicion and a low sensitivity in culturing the organism, due to its fastidious nature often delays the diagnosis. An atypical clinical presentation mimicking lymphangioma circumscriptum with grouped papulovesicular and nodular lesions along the lower jaw extending from skin to the inner buccal mucosa, confirmed on histology and an excellent therapeutic response to penicillin is reported.

Acute Disseminated Erythematous Papulovesicular Skin Lesions in a 7-year-old Child: A Quiz

A 7-year-old girl presented with moderately pruritic cutaneous lesions that had developed suddenly a week previously and that were accompanied by subfebrility in the evenings (Fig. 1). In addition, tense blisters were found on the hands and feet, including the palms and soles. The face and mucous membranes were not affected. The patient had not suffered from previous illness, atopy or infections and had not received any recent vaccinations. A physical examination revealed no other pathological findings. Laboratory tests, including a blood cell count and measurement of serum C-reactive protein levels, revealed no abnormalities. Bullous autoimmune dermatoses were excluded by the results of direct and indirect immunofluorescence analyses. A punch biopsy of the leg was performed. The epidermis displayed focal acanthosis with spongiosis and pseudoPautrier abscesses. A moderate superficial perivascular infiltrate of lymphocytes and small numbers of eosinophils was also present. Oral corticosteroid (methylprednisolone; initial dose 32 mg/day – subsequently reduced) and an oral antihistamine were administered, and an antiseptic cream (triclosan 2%) was applied topically. The skin lesions subsided within a week without relapse.

Dysregulation of T H type cytokines in the patients of Parthenium induced contact dermatitis

Background Parthenium contact dermatitis is a major health problem caused by a cosmopolitan weed Parthenium hysterophorus. It is a T cell-mediated immune injury and disease manifests as itchy erythematous papules, papulovesicular and plaque lesions on exposed areas of the body. We studied the involvement of T H1/T H2/T H17/Treg type responses by assaying various cytokines in Parthenium dermatitis. Methods The study includes 50 patients of Parthenium dermatitis confirmed by patch testing and 50 healthy subjects. The serum levels of T H1, T H2, T H17 and Treg cytokines were estimated by high sensitivity sandwich ELISA and were compared statistically between groups using ANOVA. Results The mean concentration of T H1 cytokines (p < 0.001) and IL-17 (p < 0.001) were increased significantly as compared to controls. In contrast, decrease in levels of IL-10 (p < 0.002) and TGF-β (p < 0.001) were significant and levels of IL-4 (p < 0.262) were insignificant whereas no alterations in the total IgE concentrations (p < 0.976) was observed. Conclusion The induction of T H1 and T H17 cytokines reinforce the need of detailed analysis of immune dysregulation in Parthenium dermatitis and might add some insight in the pathogenesis, diagnosis and current treatment modalities of this disease.

Demodex mites: Facts and controversies

Because Demodex mites are ubiquitous, their potential as human pathogens has often been ignored. This contribution focuses on the growing body of evidence linking Demodex mites with various skin disorders. Histologically, spongiosis and lymphoid inflammation are regularly seen in follicles containing Demodex mites. In animals, they are well established as a cause of mange, and a human counterpart–demodectic alopecia–appears to exist. There is also a statistical association between Demodex mite density and rosacea, facial itching, and chronic blepharitis. Papulovesicular rosacealike lesions and spiny blepharitis often respond to agents that reduce Demodex numbers. Although these observations are not sufficient to fulfill Koch's postulates, Koch's postulates are also not fulfilled for the association between brown recluse spiders and dermal necrosis or the association between streptococci and guttate psoriasis. The evidence linking Demodex mites to human disease has implications regarding treatment.

Study of pro‐ and anti‐inflammatory cytokine profile in the patients with parthenium dermatitis

Parthenium dermatitis is a common airborne allergic contact dermatitis induced by exposures to the weed Parthenium hysterophorus. The disease manifests as itchy erythematous papules, papulovesicular and plaque lesions on exposed areas of the body. The aim of this study was to show the alterations in pro/anti-inflammatory cytokines in parthenium dermatitis. The study included 50 patients with parthenium dermatitis confirmed by patch testing using aqueous extracts of P. hysterophorus and 50 age-matched healthy controls. The levels of pro-inflammatory [tumour necrosis factor-α (TNF-α), interleukin (IL)-6, IL-8, and IL-17] and anti-inflammatory (IL-4 and IL-10) cytokines were estimated by commercially available high sensitivity enzyme-linked immunosorbent assay (ELISA) kits. All the dermatitis patients showed significantly (P < 0.001) elevated levels of TNF-α, IL-6, IL-8, and IL-17 levels as compared to healthy controls. In contrast, the anti-inflammatory cytokine IL-4 showed an insignificant decrease (P < 0.217) and a decrease in level of IL-10 was statistically significant (0.001) compared with controls. The present study suggests the involvement of pro-inflammatory cytokines in the pathogenesis of parthenium dermatitis. A decrease in levels of anti-inflammatory cytokines was demonstrated, which could not downregulate pro-inflammatory cytokines in parthenium dermatitis.

Efficacy of N-methanocarbathymidine Against Herpes Simplex Virus is Cell Cycle Dependent

Exanthematic and papulo-vesicular lesions in the udder and teats of milking cows are fairly common in some Brazilian dairies, especially those with poor sanitary conditions and hand milking. The orthopoxvirus Vaccinia virus (VACV) and the parapoxviruses Pseudocowpox virus (PCPV) and Bovine popular stomatitis virus (BPSV) have been frequently associated with such conditions. Elsewhere, Bovine herpesvirus 2 (BoHV-2) has also been associated with similar clinical signs. Thus, we herein describe a conventional multiplex PCR designed to detect the genome of these viruses in clinical samples while differentiating among them by amplicon size. For this, primer sets targeting the orthopoxvirus vascular growth factor (amplicon size 292 bp), PCPV (374 bp) and BSPV (607 bp) B2L genes, and the BoHV-2 DNA polymerase gene (138 bp) were selected. The chosen primers anneal within the same temperature range and do not interfere with each other during the PCR amplification. PCR conditions were initially standardized for each agent in individual PCR reactions firstly using the target virus as positive control followed by using a mixture of all four virues. Lastly, a multiplex PCR containing the four sets of primers was set up to amplify all four targeted viruses in one reaction. The multiplex PCR was able to detect DNA extracted from cell culture supernatants containing 20 TCID50 of BoHV-2 and 50 TCID50 of VACV. Further, the test could detect the viral genomes in 1:10, 1:50 and 1:1000 dilutions of total DNA extracted from clinical specimens (e.g. scabs, crusts) of natural cases (PCPV, VACV and BPSV) and 1:10 dilutions of DNA extracted from scabs collected from BoHV-2 experimentally infected cattle. A possible amplification of other orthopoxviruses, predicted by in silico analysis, was considered to not represent an important pitfall since these are exotic in Brazil, very rare, or viruses not associated with cattle. For definitive agent identification amplicon sequencing needs to be conducted. Thus, this multiplex PCR seems suitable for initial detection and identification of the agents involved in exanthematic and vesicular disease, providing a sensitive and specific diagnosis for such conditions in dairy cows.

Dermatitis Herpetiformis and Vitiligo

Dermatitis herpetiformis (DH) is a rare immunobullous disorder of the skin that is associated with gluten hypersensitivity. Subepidermal IgA-type antibody deposition against tissue transglutaminase leads to dense neutrophilic microabscess and eventually into vesicles in dermal papillae, which may occasionally merge into bullae. Being a subepidermal vesiculobullous disorder, DH is frequently associated with postinflammatory pigmentary changes, particularly hypopigmentation. However, the association of DH with true vitiligo is extremely rare. Here, we report a 21-year-old male with vitiligo and comorbid DH, and review the literature. This new case had severely pruritic, papular and papulovesicular lesions that were localized symmetrically and partly confined to the pre-existing vitiliginous areas. The skin biopsy specimen taken from an erythematous papule on the elbow showed characteristic findings of DH and vitiligo. Direct immunofluorescence microscopy of the perilesional skin revealed granular IgA deposition of dermal papillae. There are only 10 reports in the literature of DH and vitiligo comorbidity.

Éruptions varioliformes aiguës: aspects diagnostiques et évolutifs

Abrupt onset of papular lesions, with ulcero necrotic evolution could refers to many dermatitis. Febrile ulceronecrotic Mucha-Habermann disease is an unusual severe form of pityriasis lichenoides and varioliform acuta (PLEVA) characterized with ulceronecrotic eruption potentially associated with high fever and systemic symptoms leading to death. Lymphomatoid papulosis is a recurrent papulonodular eruption with an initial presentation close to PLEVA. While this disorder usually has a benign course, about 10% of the patients develop lymphoproliferative disorders such as CD30+ lymphoma. The authors reported an acute form of PLEVA in a young man hospitalized in internal medicine unit with fever and ulcero-necrotic papulo-vesicular lesions. Treatment with tetracycline was successful. They also report a case of lymphomatoïd pustulosis that occurred in a 34 years old woman with an extensive nodulo-pustular eruption characterized by central necrosis and ulceration. Histopathological examination revealed CD30 lymphocytic infiltration leading to diagnosis. Theses two dermatosis, uncommon and clinically similar, are both characterized with an unpredictable evolution that to be known by internist.