Subcutaneous Induration Research Articles

The fasciitis-panniculitis syndrome: Clinical spectrum and response to cimetidine

The term fasciitis-panniculitis syndrome (FPS) is proposed as a novel compilation encompassing several disorders, common to which is subcutaneous induration caused by cicatrizing fasciitis as well as septal and lobular panniculitis and perimysial fibrosis. Included herein are Shulman's eosinophilic fasciitis, morphea profunda, lupus profundus, venous lipodermatosclerosis, toxic oil syndrome, altered tryptophane-related eosinophilic myositis, graft-versus-host reaction, and fasciitis reactive to subjacent basal cell carcinoma. FPS should be differentiated from scleroderma, which primarily affects the dermal structures and in which arterioles are injured. In contrast, vasculopathy of the subcutaneous medium-sized veins accompanies the hypodermal lesions of FPS. The importance of recognizing and grouping these disorders lies in their different histopathology, characterization as reactive phenomena, enhanced responsiveness to treatment, and better prognosis than scleroderma. In view of the excellent prognosis of FPS, steroid treatment is not warranted. Long-term therapy with cimetidine appears to benefit the majority of patients.

A CASE OF ADENOCARCINOMA GROWING IN THE SUBCUTIS OF THE PERIANAL REGION

A case of adenocarcinoma growing in the subcutis of the perianal region is reported. A 66-year-old man showed a symptom of subcutaneous induration. Histological evaluation after preoperative biopsy revealed adenocarcinoma. Based on a preoperative diagnosis of rectal cancer, the patient underwent abdominoperineal resection, partial resection of the gluteal muscle, lateral lymphnode dissection and right inguinal lymphnode dissection. Histological examination of the resected specimens revealed no abnormalities in the rectal mucous membrane and epithelium of the anal canal. There was no connection between the anal gland and the tumor. Moreover, in pathological and biochemical examination using PATS/PBT/KOH/PAS staining, the tumor was found to have originated not in the anal gland but rather in the rectal mucous membrane. These results suggest that in the initial stage of development, a portion of the hindgut had intruded the subcutis in the perianal region and had later become cancerous.

Development of Diffuse Fasciitis with Eosinophilia during L-Tryptophan Treatment: Demonstration of Elevated Type I Collagen Gene Expression in Affected Tissues

We describe the cases of four women who developed a scleroderma-like syndrome during L-tryptophan treatment for insomnia or tinnitus. The illness was characterized by swelling of the extremities, skin rash, myalgia, and elevation of the peripheral blood eosinophil count, followed by rapidly progressive cutaneous and subcutaneous induration. The histopathologic examination of affected skin showed thickening of the fascia, deep dermal fibrosis, and accumulation of mononuclear cells and abundant eosinophils. The expression of the type I procollagen gene was examined by in-situ hybridizations of affected skin with a human sequence-specific complementary DNA (cDNA). Increased hybridization signals were detected in the deep dermis and fascia, indicating enhanced expression of the collagen gene. The temporal association of L-tryptophan use and the development of a scleroderma-like illness in these four patients suggests a causal relation between L-tryptophan or its metabolites and the stimulation of fibroblast collagen gene expression that results in dermal and fascial fibrosis.

Dissemination in Cutaneous Leishmaniasis

In a field study of cutaneous leishmaniasis (CL) due to Leishmania major, zymodeme Lon-4, in an endemic focus in Saudi Arabia, 80 patients in a group of 643 patients (12.44%) were found to have multiple, inflammatory, satellite papules (SP) around one or more CL lesions. The SP often appeared to erupt after commencement of antileishmanial treatment. They showed a range of morphology and pathology, and comparisons with corresponding CL lesions showed important differences. Amastigotes were seen in only one of seven biopsy specimens. Another morphologic feature, subcutaneous induration (SCI), was noted on routine palpation in 20 patients in the same patient group (3.11%). The SCI either was radiating all around the lesion and appeared as an "iceberg nodule" or was present as a "tonguelike" process proximal to the CL lesion. Amastigotes were seen in four of nine biopsy specimens of SCI. SP and SCI represent reactions to local dissemination of the parasite or its antigenic products, and as morphologic features aid in the clinical diagnosis of CL.

BCG vaccination as a cause of osteomyelitis and subcutaneous abscess.

Ten patients with osteomyelitis and three with a subcutaneous abscess, all caused by BCG vaccination, are described. All patients were less than 3 years old and had as newborns been vaccinated intracutaneously in the left gluteal or hip area. Pain, limping, or a slightly tender subcutaneous induration were the primary symptoms. The sites of predilection of osteomyelitis were the metaphysis or epiphysis of the femur, these being affected in five out of 10 cases. All three subcutaneous abscesses were in the thoracic region. Prolonged (up to 30 months) combined tuberculostatic medication, in addition to appropriate surgical procedures, resulted in healing, but two cases of arthritis and two of secondary abscesses developed. In addition, sequestrectomy and two late operations, for coxa valga and hip subluxation, were deemed to be necessary. Radiographs showed femoral overgrowth of up to 1 cm in two symptomless patients three to seven years after the first discharge. We conclude that the benefits of BCG vaccination should be weighed against the risk of complications, especially in countries with a low incidence of tuberculosis.

Diffuse fasciitis with eosinophilia: histological and electron microscopic study

A female case of diffuse fasciitis with eosinophilia (or eosinophilic fasciitis) is reported. This disease is characterized by suddenly developed circumscribed subcutaneous indurations on the extremities, hyalinized fibrosis of the fascia and peripheral eosinophilia. Our patient further displayed Raynaud's phenomenon preceded by thrombophlebitis, and histological and electron microscopical features of her subcutaneous hyalinized area centering at the fascia closely resembled those of morphaea.

Eosinophilic Fasciitis: A Scleroderma-like Illness

To the Editor.— Shulman 1 recently described two patients with scleroderma-like illnesses characterized by subcutaneous induration of the extremities, eosinophilia, hypergammaglobulinemia, and absence of visceral disease. Biopsy specimens showed fascial thickening and mononuclear cell infiltration between tela subcutanea and muscle; the skin was normal. The appearance of 15 additional cases, 2-5 occasionally with prominent eosinophilic connective tissue infiltration, has justified consideration of a new entity: eosinophilic fasciitis (Shulman syndrome). A patient with the typical clinical and histopathologic features of eosinophilic fasciitis is reported. Report of a Case.— AA 36-year-old male physician sought medical attention in April 1976, for possible scleroderma. Previously healthy and enjoying daily vigorous exercises and jogging, he first noted the onset of hand paresthesiae in January 1976. Digital stiffness and progressive subcutaneous induration of the hands and distal forearms ensued shortly thereafter. Over the next month, induration involving the upper arms and anterior neck was noted. Preceding

Surgical method for removing wrinkles

This is a report on a method for removing wrinkles, under development since 1957. The method involves direct subcutaneous undercutting of the wrinkled skin areas with a long, slender, stilette-like stable scalpel. To avoid hematoma formation, a pressure dressing is applied for 2 to 3 days, and then the skin is abraded. During healing, the skin becomes smooth. We explain this amazing change in appearance and structure of the skin to our patients with the illustration of “drumskin”. After removing the epidermis and mobilizing the dermis, there is probably new growth of cohesive collagenous fibers which, possibly supported by an elasticfibre effect during their muturation time, i.e. including the period of epidermal regeneration, produces the wrinkle-free smoothness of the skin. The follow-up, varying from 6 weeks to 7 years, showed very satisfying results in all of our cases. Except for slight hematoma formation, with subsequent subcutaneous induration for several months, no postoperative or late complication occurred. In a few cases wrinkles reappeared only after many years, but always much fewer than before treatment. If stretching of the facial skin is indicated, we combine this with undercutting. Acne and pockmarked skin and similar scar areas can be treated successfully in the same way. The patient should be warned of the depigmentation of the regenerated skin zones. This may take place after any abrasion treatment and also after “chemical skin peeling”.

Subcutaneous phycomycosis responding to oral iodide therapy

Subcutaneous phycomycosis due to Basidiobolus ranarum was diagnosed in 2 Ugandan children by biopsy and culture of the fungus. The clinical picture was one of a slowly increasing, painless area of subcutaneous induration without other symptoms. Treatment of the two cases with oral potassium iodide (30 mg. per kilogram per day) for 2 weeks and 4 weeks, respectively, resulted in a striking improvement in the size of the induration. Biopsies and cultures after therapy failed to show the organism.

Subcutaneous phycomycosis in an East African child

<h2>Summary</h2> A case of subcutaneous phycomycosis in a 6-year-old African boy from northern Uganda is presented. The main characteristic features were: (1) a slowly spreading, painless, subcutaneous induration, (2) no other obvious clinical signs or positive routine laboratory tests (and, in particular, no <i>marked</i> eosinophilia), and (3) histologic appearance, at biopsy, of eosinophilic granulomatous tissue and the presence of the branched hyphae of phycomycosis.

SUBCUTANEOUS FAT NECROSIS OF THE NEW-BORN

The various types of subcutaneous induration occurring in new-born or young infants have been the source of a good deal of confusion. During the past decade, however, knowledge of the subject has been considerably increased by histologic and chemical examinations. The type of induration that is the subject of this paper should. I think, be termed subcutaneous fat necrosis of the new-born, though it is still spoken of as sclerema neonatorum by some British and American writers. In many of these cases at the present time the confusion is merely one of nomenclature. Much confusion has also resulted from the reports of cases of scleroderma neonatorum which were manifestly not scleroderma but in all probability cases of subcutaneous fat necrosis. I shall discuss this subject later. The four principal types of subcutaneous induration to be considered are the following: adiponecrosis subcutanea neonatorum, sclerema adiposum (sclerema neonatorum),