Verrucous Skin Lesions Research Articles

Transformation of Common Warts into Squamous Cell Carcinoma on Sun-Exposed Areas in an Immunosuppressed Patient

We report one case of renal transplant recipient who developed widespread multiple verrucous skin lesions. Histologic examination revealed typical warts and, only from several sites exposed to sun (hands and face), a development of dysplasia within the warts and a transformation of some of them toward infiltrating squamous cell carcinoma (SCC). Human papillomavirus (HPV) testing for DNA by polymerase chain reaction DNA amplification identified HPV type 1 in both warts and SCC. Our findings suggest that classic warts may progress to high-grade lesions and that, in addition to the oncogenic potential of the virus alone, other factors including the host's immunosuppressed state and ultraviolet radiation seem to be essential to malignant transformation.

Cell-matrix Patterns in the Cutaneous Lesion of Chromamyoasis

Chromomycosis is a chronic fungal infection characterized by dermal fibrosis with persisting fungi in situ, generally leading to a verrucous skin lesion. The absence of good clinical results under specific treatment suggests irreversibility of the fibrotic lesion. Frozen and paraffin-embedded skin biopsies of eleven patients with chromomycosis due to Phialophora pedrosoi were studied by immunohistochemistry and electron microscopy. Distinct cell-matrix patterns were found in different tissue localizations: neutrophilic abscesses with oedema and necrotic keratinocytes in the epidermis; dense connective matrix around inflammatory infiltrates, mainly composed of macrophages and giant cells, and organized granuloma in the dermis. Active fibroblasts and mast cells were constantly observed. The inability of fibrotic tissue to be remodelled seems correlated to the nature and the organization of the matrix components but, the factors triggering the initial fibrogenic events remain to be characterized.

Chronic verrucous varicella-zoster virus infection in patients with the acquired immunodeficiency syndrome (AIDS). Histologic and molecular biologic findings.

Verrucous skin lesions have been attributed to various herpes viruses in immunosuppressed patients, including those with human immunodeficiency virus infection (HIV). We examined such lesions from six HIV-infected patients to determine the range of microscopic findings present and to establish which herpesviruses were present. Verrucous epidermal hyperplasia, pseudocarcinomatous hyperplasia, and massive hyperkeratosis correlate with the warty clinical appearance of the lesions. Herpetic cytopathic changes, including multinucleated epidermal giant cells, steel-gray nuclei, necrotic acantholytic keratinocytes, and Cowdry type A nuclear inclusions were seen most prominently in the dells between papillations and in adnexal epithelium. In two cases, increased numbers of spindled cells were seen in the dermis. Immunoperoxidase staining with anti-type IV collagen antibodies demonstrated that these findings were not those of Kaposi's sarcoma, but represent a fibrotic reaction to the infection. Viral cultures of four of the cases demonstrated the presence of varicella-zoster virus, whose presence was detected by the polymerase chain reaction in paraffin-embedded lesional tissue from all six cases. Polymerase chain reaction did not show the presence of cytomegalovirus, herpes simplex, Epstein-Barr, or human papillomavirus. We conclude that these unusual verrucous lesions are a chronic manifestation of herpes zoster infection and that the reported presence of other agents in such lesions is probably coincidental.

足底に典型的なゆう状腫りゅうを呈したプロテウス症候群の２例

足底に典型的なゆう状腫りゅうを呈したプロテウス症候群の２例

Acyclovir-Resistant Varicella Zoster Responsive to Foscarnet

<h3>To the Editor.—</h3> Acyclovir-resistant herpes simplex virus (HSV) in human immunodeficiency virus (HIV)-infected patients has been reported, often after long-term therapy with acyclovir.¹In some cases the lesions responded to foscarnet (trisodium phosphonoformate) therapy.¹Acyclovir-resistant varicella zoster virus (VZV) has also been reported with increasing frequency in HIV-infected patients, and is commonly associated with chronic localized verrucous skin lesions.^2,3Although in vitro sensitivity to foscarnet has been reported, we believe that this is the first report in which chronic lesions due to acyclovir-resistant varicella zoster virus have resolved after treatment with foscarnet. <h3>Report of a Case.—</h3> A 24-year-old white man with acquired HIV infection (Walter Reed Stage VI) presented with a history of herpes-zoster occurring in the left C7-8 dermatome in July 1989. The cutaneous lesions were typical vesicular lesions of VZV. The patient was treated with high-dose oral acyclovir (4 g/d for 10 days) with apparent

PRIMARY CUTANEOUS COCCIDIOIDOMYCOSIS.

Erythema nodosum is the most frequent cutaneous manifestation in coccidioidomycosis. This hypersensitivity reaction usually develops two to three weeks following the initial pulmonary infection. Verrucous skin lesions or subcutaneous abscesses may develop when disseminated disease occurs from a primary pulmonary infection. Primary cutaneous involvement is rare. Wilson et al reviewed this subject and described such an instance.¹They could find only one previous case in the literature described by Guy and Jacob.²Subsequently, three other cases of primary cutaneous disease have been reported.^3-5This report will summarize the findings in three additional individuals with primary cutaneous coccidioidomycosis. <h3>Case 1.</h3> —This 29-year-old white man, a laboratory technician, had been harvesting<i>Coccidioides</i><i>immitis</i>for four months. Two weeks before hospitalization, he received a thorn puncture wound in the right fifth finger while on a picnic. One week later he noted a small accumulation of pus in the wound, which