Persistent Skin Lesions Research Articles

Vorinostat approved for rare lymphoma

FDA announced October 6 that it had approved the marketing of vorinostat, or Zolinza, for the treatment of persistent skin lesions arising from cutaneous T-cell lymphoma. Cutaneous T-cell lymphoma is a type of non-Hodgkin’s lymphoma that affects fewer than 20,000 Americans, said Merck & Co. Inc

Chronic Disseminated Cutaneous Blastomycosis in an 11‐Year Old, with a Brief Review of the Literature

Chronic disseminated cutaneous blastomycosis is rare in children. We discuss an 11-year-old immunocompetent boy who presented with a history of persistent and multiple skin lesions of >1 year's duration. These lesions proved to be secondary to chronic Blastomyces dermatitidis infection. Complete resolution of clinical disease occurred after a 6-month course of oral itraconazole. We also present a brief review of the literature focusing on the epidemiology, manifestations, diagnosis, and treatment of pediatric blastomycosis.

Hypocomplementemic urticarial vasculitis: a rare presentation of systemic lupus erythematosus

Urticarial vasculitis is a small-vessel vasculitis, presenting clinically as persistent urticarial skin lesions and microscopically as leucocytoclastic vasculitis. Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a distinct type of urticarial vasculitis with multiorgan involvement, whose etiology and link with other diseases are still unknown. Some authors have suggested that HUVS can be accompanied by systemic lupus erythematosus (SLE), and others believe that it is a rare subtype of SLE. Urticarial vasculitis is seen in 7-8% of SLE, while 50% of HUVS patients are diagnosed with SLE. We report a case of HUVS associated with SLE with fatal outcome unresponsive to the combination of systemic corticosteroids and azathioprine. SLE and HUVS share both clinical and laboratory features and are probably not separate entities. It is mostly likely that HUVS and SLE fall into the same spectrum of autoimmune diseases. HUVS is probably a subset of SLE. As both diseases can fatally, it should be kept in mind that the overlap of SLE and HUVS may exhibit a relatively rapid progression and poor prognosis.

Human Papillomaviruses Associated with Epidermodysplasia Verruciformis in Non-Melanoma Skin Cancers: Guilty or Innocent?

Abbreviations: AK, actinic keratoses; EV, epidermodysplasia verruciformis; HPV, human papillomavirus; ISH, in situ hybridization; NMSC, non-melanoma skin cancers; OTR, organ transplant recipients; SCC, squamous cell carcinomas; UVR, ultraviolet radiation

Update: Cutaneous Leishmaniasis in U.S. Military Personnel—Southwest/Central Asia, 2002-2004

Cutaneous leishmaniasis (CL) is a sand fly-borne parasitic infection. Preliminary data about cases of CL in military personnel deployed to three countries (Afghanistan, Iraq, and Kuwait) in Southwest/Central Asia have been published previously. During August 2002-February 2004, Department of Defense (DoD) staff identified 522 parasitologically confirmed cases of CL in military personnel. Leishmania major was the etiologic agent for all 176 cases for which species data, obtained by isoenzyme electrophoresis of cultured parasites, are available. This update focuses on the 361 cases (69% of 522) in patients whose demographic data were collected systematically under treatment protocols for therapy with the pentavalent antimonial compound sodium stibogluconate (Pentostam(R); GlaxoSmithKline, United Kingdom) at Walter Reed Army Medical Center, District of Columbia. U.S. health-care providers should consider CL in persons with persistent skin lesions who were deployed to Southwest/Central Asia or who were in other areas where leishmaniasis is endemic.

Leishmania (Viannia) braziliensis-induced chronic granulomatous cutaneous lesions affecting the nasal mucosa in the rhesus monkey (Macaca mulatta) model.

The present studies on infections with Leishmania (Viannia) braziliensis in rhesus macaques were made to characterize the evolution of different parasite strains and the immune responses they elicited in this experimental host. A standardized inoculum of promastigotes was injected intradermally either above the eyelid or on the forearm of each monkey. Sixteen infected monkeys developed longstanding infections which lasted until the end of the observation period (33 months). The time required for lesion development was very variable, not only for the isolates showing molecular differences but also for individual animals in groups infected with the same parasite strain. The inocula produced lesions of variable severity, ranging from localized cutaneous leishmaniasis (CL) with a tendency to spontaneous healing to non-healing disease. One infected animal developed persistent metastatic skin and mucosal lesions. Anti-Leishmania antibodies and parasite-specific T-cell responses were induced by the experimental infections. As the granulomatous inflammatory response found at the lesions in L. (V.) braziliensis-infected M. mulatta was similar to that in patients with CL, this primate model could be useful for studying the pathophysiology and immunoregulatory events associated with disease evolution, as well as for the evaluation of new drugs or candidate vaccines.

Persistent eosinophilia and skin lesions as presenting symptoms of ulcerative colitis

Persistent eosinophilia and skin lesions as presenting symptoms of ulcerative colitis

Papular-purpuric gloves and socks syndrome in HIV-positive patients

Three HIV-positive women showed clinical signs of papular-purpuric gloves and socks syndrome and serologic evidence of acute Parvovirus B19 infection. The course of the disease was complicated by anemia and persistent skin lesions, probably related to inadequate immune response. Because anemia in AIDS patients may be due to many causes, the history of recent Parvovirus B19 infection is helpful in suggesting the etiologic diagnosis. (J Am Acad Dermatol 2000;43:916-7.)

Papular-purpuric gloves and socks syndrome in HIV-positive patients

Three HIV-positive women showed clinical signs of papular-purpuric gloves and socks syndrome and serologic evidence of acute Parvovirus B19 infection. The course of the disease was complicated by anemia and persistent skin lesions, probably related to inadequate immune response. Because anemia in AIDS patients may be due to many causes, the history of recent Parvovirus B19 infection is helpful in suggesting the etiologic diagnosis. (J Am Acad Dermatol 2000;43:916-7.)

Ultrastructure of epidermis of mice with chronic proliferative dermatitis.

C57BL/Ka mice with chronic proliferative dermatitis (cpdm/cpdm) develop chronic persistent skin lesions characterized by epidermal hyperplasia, infiltration by granulocytes and macrophages, and vascular dilatation. Similar lesions are present in other orthokeratotic epithelia in affected mice, in particular the esophagus and forestomach. Here, we report on further characterization of epidermal hyperplasia and the granulocytes. Keratinocytes of lesional skin, but not of normal skin, show round and electron-dense mitochondrial inclusions that are present in all layers of the epidermis. Similar inclusions are also present in the esophagus and forestomach of affected mice. There appears to be a direct relation between the presence of intramitochondrial inclusions and epidermal hyperplasia in the mouse. Furthermore, the presence of keratinocyte-derived apoptotic bodies in the epidermis, esophagus, and forestomach was frequently observed in the lesions, which is consistent with previous light microscopic observations of single cell death of keratinocytes. The granulocytes present in the skin, esophagus, and forestomach were mainly eosinophils. There were widespread gaps observed in the lamina densa in the epidermis that were mostly directly associated with dermal or epidermal eosinophils. This type of gap is also observed in psoriasiform diseases in humans. This electron microscopic study demonstrated that this mouse model should be useful to screen potential therapeutic strategies for psoriasiform and other inflammatory skin disorders.

Disseminated ecthymatous herpes varicella-zoster virus infection in patients with acquired immunodeficiency syndrome

Herpesvirus infections are among the most common and debilitating opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), and they may have atypical clinical features. We describe the cases of three patients with AIDS in whom atypical persistent ulcerative skin lesions developed as a result of varicella-zoster virus infection, Two patients had disseminated infection without a vesicular stage; one patient had underlying asteatotic eczema. All responded well to acyclovir. One patient was treated with azidothymidine, and typical dermatomal herpes zoster subsequently developed. The profound loss of helper T cell function in AIDS may lead to multiple abnormalities in local immune response to cutaneous herpesvirus infections and may be responsible for the atypical morphology and a prolonged course.

口腔粘膜疹が認められた第２期梅毒の１例

The patient was a 38-year-old female complaining of soreness of the oral mucosa. When she came to our out-patient clinic she had erythematous papular eruption on the limbs for 2 months. On the lips, tongue and fauces were well-defined, slightly raised lesions with a grayish white or erosive surface. Skin and oral lesions were suggestive of syphilis. The labial lesion histologically showed nonspecific inflammation and serologic examination confirmed syphilis.The patient was referred to the department of dermatology for further examination and treatment of persistent skin lesions. After the administration of Bicillin-V2®, the skin lesions disappeared for one month.

Segmental Lichen Aureus: Onset Associated With Trauma and Puberty

<h3>To the Editor.—</h3> Lichen aureus is a chronic and benign capillaritis of unknown cause. The typical lesion is a single golden patch, often localized on the lower extremity. We describe a patient with lichen aureus in a segmental distribution on the left side of the chest and the left upper extremity. The first lesion developed about one month after a surgical procedure on the distal third of the left forearm. The distribution of the lesions did not follow a dermatome or the lines of Blaschko but did loosely follow the course of the brachial and radial veins. <h3>Report of a Case.—</h3> A 15-year-old girl was seen in January 1987 at the University of Minnesota Hospital and Clinic, Minneapolis, for persistent skin lesions on her left upper shoulder and arm. Her health history was unremarkable, except for a motor vehicle accident on May 9, 1984. She had fractured both her left

Factitial cutaneous ulcers and nodules: The use of electron-probe microanalysis in diagnosis

Two cases are reported in which persistent nodular or ulcerative skin lesions with granulomatous histology suggested possible injection of foreign material. Electron-probe microanalysis was used to determine the presence and nature of foreign materials present in the skin. This technic identified specific agents used as fillers in tablets, indicating the injection of pulverized tablet material. The patients were counseled regarding this evidence, and psychotherapy and drug rehabilitation were recommended in each instance. This technic provides a valuable tool for accurate identification of foreign substances in the skin.