Violaceous Macules Research Articles

Acroangiodermatitis: a study of ten cases.

Acroangiodermatitis is a benign vesicular process encountered on the lower extremities that histologically resembles the superficial form of stasis dermatitis, but is clinically characterized by circumscribed violaceous, brown or dusky macules, papules, or plaques. Furthermore, unlike stasis dermatitis, acroangiodermatitis is usually associated with minimal epidermal changes and eosinophils in the inflammatory infiltrate in the dermis. Kaposi's sarcoma, pigmented purpura, vasculitis, and lichen planus are other conditions that should be considered when making a diagnosis of acroangiodermatitis. Ten patients with acroangiodermatitis were referred to us by area physicians. Hematoxylin and eosin, periodic acid-Schiff, Pearl's (an iron stain), and an immunoperoxidase stain for Factor VIII were performed on routinely embedded paraffin sections. All cases showed new vessel proliferation, perivascular inflammation of superficial and mid-dermis, consisting of lymphocytes, histiocytes, eosinophils, occasional plasma cells, extravasation of red blood cells, and hemosiderin pigment deposition. Dermal fibrosis was observed in all cases. None of the patients showed changes of vasculitis or Kaposi's sarcoma. Only one patient displayed significant epidermal changes of spongiosis and mild acanthosis. Acroangiodermatitis is an uncommon entity with peculiar clinical and histologic features and should be confirmed by histologic tests.

Ulcerative Lesions and Herpes Simplex Virus Type 2 in a Patient With Evansʼs Syndrome

We have described a case of herpes genitalis in a patient with Evans's syndrome who had violaceous macules leading to deep ulcerations. This case serves as a reminder that HSV infection may be atypical and have an unusual course in immunocompromised patients. With the availability of specific therapy for this infection, it is important to consider HSV in the differential diagnosis of all ulcerative skin lesions.

Violaceous papules and macules in a newborn. Dermal erythropoiesis associated with congenital cytomegalovirus infection

Violaceous papules and macules in a newborn. Dermal erythropoiesis associated with congenital cytomegalovirus infection

Violaceous Papules and Macules in a Newborn

REPORT OF A CASE A female infant born with thrombocytopenia, hepatosplenomegaly, jaundice, and a generalized nonblanching violaceous eruption was transferred to The Johns Hopkins Hospital Pediatric Intensive Care Unit, Baltimore, at 8 hours of life for evaluation. The mother was a 35-year-old woman, gravida 1 and para 1, with blood group 0+, a nonreactive serologic test for syphilis, and a normal platelet count and rubella titer. During the fourth month of pregnancy, the mother had a brief febrile, diarrheal illness, which was not further evaluated. Delivery occurred at term, 34 hours after the membranes had ruptured, and was assisted by low forceps. The family history was significant for systemic lupus erythematosus, and there was no family history of bleeding disorders. Physical examination revealed a female infant in no acute distress, who was in the 25th percentile for length, below the fifth percentile for weight, and in the second percentile for

Graft-Versus-Host Reaction

The distinctive cutaneous changes that occur in both the acute and chronic forms of the graft-vs-host reaction (GVHR) are described in two living patients in whom the GVHR developed after bone marrow transplantation for aplastic anemia. In the skin, the mild form of the acute GVHR is recognized as a subtle macular erythema, and the severe form appears as erythematous papules and violaceous macules with scale. Skin biopsy specimens in both of the acute forms show vacuolar alterations of the epidermal basal-cell layer with a perivenular infiltrate of lymphocytes. The chronic GVHR evolves from generalized scaling to diffuse areas of aclerotic and atrophic skin with a curious reticulated hyperpigmentation, ulcerations, and alopecia. Histopathologic study shows collagenization of the dermis that can be correlated with the clinical sclerodermoid changes. Owing to its visibility, the skin offers a unique opportunity for the early recognition of the GVHR.

THE CLEVELAND DERMATOLOGICAL SOCIETY

<b>Idiopathic Atrophoderma.</b>Presented byDr. A. F. Piraino. A 39-year-old white man was seen in my office for the first time on Nov. 4, 1957. He complained of discolored patches on the body of about two years' duration. He had no subjective symptoms. He stated that he had been in the Philippines for about eight months several years ago. He had had no previous therapy. Examination revealed round and oval, slightly depressed, bluish, violaceous macules especially located on the back, chest, hips, inguinal areas, and proximal portions of the lower extremities. The lesions varied considerably in size, and there is no real atrophy. The deeper vessels seem to be visible. Borders of the lesions are sharply defined, and the skin surrounding the patches is normal in appearance. Histologic examination of a section from the lower back shows the horny layer to be relatively normal. The rete layer is

Exfoliative dermatitis and hepatitis due to phenobarbital.

Phenobarbital, which was introduced clinically in 1911, is still one of the most frequently prescribed drugs in the United States. The fact that it can provoke an extremely severe and grave reaction may be easily overlooked by the busy practitioner, who is more aware of its great clinical utility. That it does so on relatively rare occasions (considering the vast amounts of it which are used) is most fortunate. Nevertheless, the literature contains numerous reports of a wide variety of eruptions attributed to phenobarbital; these include the generalized morbilliform or scarlatiniform rash, the bullous erythema multiforme, the discrete coin-sized violaceous macules of the fixed eruption type, urticaria and the generalized or universal exfoliative dermatitis, which may be fatal. It is clear, then, that every physician who prescribes this drug (or any other barbiturate) should be familiar with and constantly on the watch for the early warning signs of intolerance. Although

THROMBOPENIA IN ACUTE DISSEMINATED LUPUS ERYTHEMATOSUS

Instances of the extremely acute, frequently fatal exanthematic type of lupus erythematosus are seen so infrequently by one observer that I feel justified in reporting my hematologic finding in three such cases. This consisted of marked thrombopenia. In case 1 the thrombocytes varied in number somewhat in proportion to the clinical condition of the patient. During periods of clinical improvement the thrombocytes increased, only to decrease again when the patient became worse. In the two fatal cases the thrombocytes reached a low point before death. REPORT OF CASES Case 1.— Mrs. M. E., aged 28, first noted violaceous macules and papules on her finger-tips in 1929. Since that time they had appeared and disappeared intermittently. On June 1, 1932, her face was sunburned. The burn failed to disappear and gradually spread, involving the whole face and neck. Since the onset of this acute phase she had suffered from arthritic pains.