Zosteriform Distribution Research Articles

Zosteriform Atrophoderma of Pasini and Pierini: A Case Report

Atrophoderma of Pasini and Pierini (APP) is a rare cutaneous entity of unknown etiology. It usually presents with sharply demarcated dermal atrophy, giving a “cliff-drop” appearance. Very few cases occurring in a zosteriform distribution have been reported. In this article, the author reports a rare case of APP in a 42-year-old women where the lesions presented in a zosteriform distribution on the trunk. Diagnosis is made with high clinical suspicion and confirming histopathology.

Ulcerated nodules with zosteriform distribution on the upper extremity.

Eccrine porocarcinoma (EPC) is a rare skin adnexal malignancy with a high potential for metastases. The most common metastatic sites are the lymph nodes and lungs. CCutaneous metastasis is extremely rare, particularly the zosteriform variant, with fewer than 5 cases reported in the literature. Here, we report a unique case of EPC in a 71-year-old male, clinically presenting with multiple clusters of ulcerated nodules distributing as a zosteriform pattern throughout his upper left limb, along with draining lymphatic metastases and lymphedema.

Pigmented cutaneous metastasis of breast carcinoma: florid case with zosteriform distribution

Pigmented cutaneous metastasis of breast carcinoma: florid case with zosteriform distribution

Multiple angiokeratomas with zosteriform distribution: a rare entity.

Multiple angiokeratomas with zosteriform distribution: a rare entity.

Postherpetic Pink, Smooth, Annular Convalescing Plaques.

An 82-year-old man presented with painful, pink, smooth, annular convalescing plaques on the right back, flank, and abdomen in a zosteriform distribution involving the T10/11 dermatome. He had a history of hypertension and type 2 diabetes mellitus, and 12 months prior to presentation he had an outbreak of herpes zoster virus in the same distribution that was treated with valacyclovir 1000 mg 3 times daily for 7 days.

26232 Cutaneous metastatic breast cancer in zosteriform distribution

An 82-year-old Caucasian female presented with violaceous papules and nodules in a zosteriform distribution across her abdomen. A punch biopsy was performed which demonstrated a dermal neoplasm with nests of poorly differentiated pleomorphic cells with focal areas of ductal differentiation. These findings are consistent with metastatic breast carcinoma in a zosteriform distribution. Cutaneous metastasis from primary breast cancer is typically nodular, with lesions being single or multiple. Cutaneous metastasis represents late disease findings, and is indicative of advanced disease progression.

Erythematous plaques with zosteriform distribution in a patient treated with TNF-α inhibitor adalimumab for psoriasis.

Erythematous plaques with zosteriform distribution in a patient treated with TNF-α inhibitor adalimumab for psoriasis.

Herpes simplex: Zosteriform primary infection.

Only laboratory investigations (PCR and IgM antibody assay) supported by anamnestic data make it possible to distinguish Herpes zoster from HSV zosteriform primary infection. In fact, in children the symptoms are scarce or absent in both infections, in both there may be fever and satellite adenopathy, and their skin lesions are superimposable. The distinction between the two diseases is practically useful in order to provide epidemiological suggestions and to predict possible recurrences. The zosteriform distribution in HSV infection is due to its neurotropism (2): its comings and goings between the skin and nerve ganglia is linked to its ability to reproduce in Schwann cells and to propagate through these cells to the neurons of the sensory ganglia. It has been shown that the zosteriform lesions observed in primary HSV infection occur during the path of the virus from the nerve ganglion to the epidermis (1).

Multiple brown papules on the chest in a zosteriform distribution.

International Journal of DermatologyVolume 60, Issue 5 p. e181-e183 Clinicopathologic challenge Multiple brown papules on the chest in a zosteriform distribution Stav Hartshtark MD, Stav Hartshtark MD Department of, Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, IsraelSearch for more papers by this authorYuval Ramot MD, MSc, Corresponding Author Yuval Ramot MD, MSc yramot@gmail.com orcid.org/0000-0002-8606-8385 Department of, Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel Correspondence Yuval Ramot, md, MSc Department of Dermatology The Faculty of Medicine Hadassah Medical Center Hebrew University of Jerusalem Jerusalem 9112001 Israel E-mail: yramot@gmail.comSearch for more papers by this authorAlexander Maly MD, Alexander Maly MD Department of, Pathology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, IsraelSearch for more papers by this authorLaurent Klapholz MD, Laurent Klapholz MD Department of, Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, IsraelSearch for more papers by this author Stav Hartshtark MD, Stav Hartshtark MD Department of, Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, IsraelSearch for more papers by this authorYuval Ramot MD, MSc, Corresponding Author Yuval Ramot MD, MSc yramot@gmail.com orcid.org/0000-0002-8606-8385 Department of, Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel Correspondence Yuval Ramot, md, MSc Department of Dermatology The Faculty of Medicine Hadassah Medical Center Hebrew University of Jerusalem Jerusalem 9112001 Israel E-mail: yramot@gmail.comSearch for more papers by this authorAlexander Maly MD, Alexander Maly MD Department of, Pathology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, IsraelSearch for more papers by this authorLaurent Klapholz MD, Laurent Klapholz MD Department of, Dermatology, The Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, IsraelSearch for more papers by this author First published: 27 October 2020 https://doi.org/10.1111/ijd.15276 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume60, Issue5May 2021Pages e181-e183 RelatedInformation

Nevus Comedonicus With Acne Vulgaris and Obesity

Nevus comedonicus is a rare hamartoma of the pilosebaceous unit, first described by Kofmann in 1895 [1]. In most cases it is present at birth but may also develop later, usually before the age of 10 years, without racial or sexual preponderance. When appearing in adults, although rare, it is frequently associated with irritation or trauma [2]. The lesions typically present a linear or zosteriform distribution, but extensive areas have already been described, including variant with bilateral involvement. The most frequently affected sites are the face, trunk, neck, and upper limbs. It may affect areas without hair follicles, such as the palms, soles, and the glans penis. Scalp involvement is rare [3]. There may be associations with other skin lesions or abnormalities of the central nervous, musculoskeletal, and ocular system [4]. We present a case of nevus comedonicus in a woman suffering from obesity and acne vulgaris.

Zosteriform idiopathic atrophoderma of Pasini and Pierini

Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a rare disease of unknown etiology characterized by well-defined atrophic plaques with a “cliff-drop” border that show no signs of inflammation, sclerosis, and induration. The trunk is most commonly affected site. It usually affects the body in a bilaterally symmetrical distribution, although asymmetric involvement has also been reported. Very few cases occurring in a zosteriform distribution have been reported. In this article, the author reports a rare case of IAPP in an 18-year-old male where the lesions are distributed in a zosteriform distribution on the trunk.

A case report of adult-onset multiple angiokeratomas with zosteriform distribution

Angiokeratomas are benign vascular ectasias in the papillary dermis associated with epidermal changes in the form of hyperkeratosis and/or acanthosis. Clinically, angiokeratomas appear as solitary or multiple dark red to purple-black macules and/or papules, mostly with a verrucous surface. Five subtypes of angiokeratoma have been proposed - angiokeratoma corporis diffusum, angiokeratoma of Mibelli, angiokeratoma of Fordyce, angiokeratoma circumscriptum, and "solitary and multiple" angiokeratomas. We report an unusual case of multiple angiokeratomas in a zosteriform distribution with onset at age 74.

Cutaneous Metastatic Rectal Adenocarcinoma in Zosteriform Distribution.

Dear Editor: A 54-year-old woman presented with mildly stinging, painful, grouped nodules on the left vulvar area. It shows unilateral localized grouped papulonodular lesions, resembling a zosteriform aspect (Fig. 1). The patient had a history of stage IV rectal adenocarcinoma with liver and lung metastases treated 17 months earlier with ultra-low anterior resection and chemotherapy. The patient also received external pelvic irradiation of 180 cGy/day, up to total 6,300 cGy/35 fractions, for recurrent adenocarcinoma at the anastomosis site. She presented with a zosteriform eruption on the left vulvar area during hospitalization, with no prior history of herpes zoster. The skin lesions exhibited predominantly nodular infiltration, inadequate for the tzanck test. A skin punch biopsy was performed under the differential diagnosis of herpes zoster on the left S2 dermatome, postherpetic granuloma, and cutaneous metastasis. Histopathology revealed metastatic adenocarcinoma (Fig. 2). The chest computed tomography (CT), abdomen CT, and positron emission tomographic-CT images showed consistent results of an increasing size of lung and hepatic nodules with lymph node metastasis. Pain around the vulva area was aggravated after repetitive chemotherapy and radiotherapy. Wide excision was performed to resect the visible cutaneous nodules with patient consent. The patient died eight months after the diagnosis of cutaneous metastasis, which was three years after the initial diagnosis of rectal adenocarcinoma. While the mean survival time from the diagnosis of cutaneous metastasis of colorectal cancer is 18 months1, our patient died in a shorter time span. Cutaneous metastasis from an internal malignancy is rare and can appear in many different forms, including the multiple nodular type, inflammatory or erysipeloid form, sclerodermoid form, alopecia neoplastica, or bullous form. The nodular type is the most common clinical appearance, while the zosteriform pattern is very rare2. The exact mechanism of zosteriform cutaneous metastasis is unknown. A Koebner-like phenomenon at the site of herpes zoster, invasion of the perineural lymphatic or dorsal root ganglion, direct invasion of tumor cells, and accidental surgical implantation have all been proposed 2,3. Colonofiberscopy and magnetic resonance imaging revealed an ulcerated fungating mass located on the left posterolateral wall of rectum. The metastatic lesion of the vulva was observed about 17 months later after a laparoscopic resection. However, an asymptomatic skin lesion may have appeared earlier. It is possible that the metastatic skin lesions may have been due to direct seeding of the tumor cells to the left side, but the exact mechanism remains unclear. The patient was undergoing chemotherapy when the metastatic lesions were observed, and herpes zoster occurs more frequently in immunosuppressed patients. It has been reported that many patients with cutaneous metastasis of zosteriform distribution are initially misdiagnosed with herpes zoster and treated with antiviral drugs4. Considering the pain and unilaterality, this may be easily misdiagnosed as herpes zoster. Herein, we report an unusual case of cutaneous metastasis of rectal adenocarcinoma that mimicked herpes zoster. This must be considered in any patient with a history of malignant neoplasm experiencing non-healing zosteriform lesions. Therefore, early biopsy for suspicious skin lesions is very important. Fig. 1 Stinging painful erythematous grouped nodules on the left vulvar area. Fig. 2 Dermal infiltration by intestinal type atypical glands, showing metastatic skin adenocarcinoma (H&E, ×100).

Palisaded Encapsulated Neuroma in a Zosteriform Distribution.

Palisaded Encapsulated Neuroma in a Zosteriform Distribution.

Multiple eccrine spiradenomas in zosteriform distribution involving three dermatomes

Eccrine spiradenoma is an uncommon benign tumor of the sweat glands, most frequently characterized by a solitary, painful, deep-seated nodule. A case of multiple spiradenomas in a zosteriform distribution involving three dermatomes is described with its clinico-pathological features.

Zosteriform impetigo: Wolf's isotopic response in a cutaneous immunocompromised district.

Background:Impetigo can result from Staphylococcus aureus (S. aureus). Wolf’s isotopic response is the occurrence of a new cutaneous disorder at the site of a previously healed disease. A cutaneous immunocompromised district is an area of skin that is more vulnerable than the rest of the individual’s body.Purpose:To describe a man with impetigo localized to a unilateral dermatome and review the clinical features of other patients with zosteriform Staphylococcus aureus cutaneous infection.Methods:PubMed was used to search the following terms, separately and in combination: cutaneous, dermatome, dermatomal, district, herpes, immunocompromised, impetigo, infection, isotopic, response, skin, staphylococcal, Staphylococcus aureus, Wolf, zoster, zosteriform. All papers were reviewed and relevant manuscripts, along with their reference citations, were evaluated.Results:Crusted, eroded and intact, erythematous papules and nodules acutely presented localized to the mandibular branch of the left trigeminal nerve on the face of a 66-year-old man; he did not recall a prior episode of varicella-zoster virus infection in that area. A bacterial culture isolated methicillin-susceptible S. aureus. Viral cultures and direct fluorescent absorption studies were negative for herpes simplex and herpes zoster virus. All of the lesions resolved after oral treatment with cefdinir. Impetigo and/or furunculosis in a zosteriform distribution have also been described in 3 additional patients. The bacterial culture showed either methicillin-susceptible or methicillin-resistant S. aureus; the skin infection resolved after treatment with oral antibiotics; however one man experienced 2 recurrences in the same area.Conclusions:Zosteriform cutaneous staphylococcal impetigo may be an example of Wolf’s isotopic response in a cutaneous immunocompromised district

A Child With Morphea in a Zosteriform Distribution

Morphea is a localized form of scleroderma which is characterized by sclerotic plaques, limited to the skin. Although its cause is unknown, various (genetic, infectious and autoimmune) mechanisms have been suggested. It is more common among children and young women. Although clinical outcome is good, sometimes it can be prominent. Morphea have five subtypes, which are known as plaque, generalized, bullous, deep and linear forms. Zosteriform morphea is a recently described pattern and it is rarely observed. A six years old female, was admitted with multiple brown and white asymptomatic plaques arranged in a zosteriform pattern, confined to the right back since two months, without history of herpes zoster at the same location. We aimed to report the first pediatric case of morphea with zosteriform pattern in the absence of herpes zoster history.

A case of mucinous nevus clinically mimicking nevus lipomatosus superficialis.

Dear Editor: Mucinous is a very rare entity and can be classified as both a cutaneous mucinosis and a connective tissue nevus1. The term nevus was proposed because of its nevoid appearance and the characteristic pattern of mucin deposits in the papillary dermis1. We report the case of a mucinous diagnosed in a young Korean man. A previously healthy 24-year-old man visited our clinic because of confluent flesh-colored to brownish non-firm nodules on his left lower back, with a zosteriform distribution (Fig. 1). The skin lesions had been present since adolescence without any symptom; however, they slowly grew in size. He had no history of trauma, and the lesion was not treated before. He also denied any familial history. Biopsy was taken, with the first impression of lipomatosus superficialis (NLS) according to clinical features. Histologically, the findings consisted of a band-like deposit of mucin mainly in the superficial dermis, with papillomatosis, hyperkeratosis, and elongation of the rete ridge in the epidermis (Fig. 2A). The mucin deposited in the dermis stained positive with alcian blue at pH 2.5 (Fig. 2B). Finally, the lesion was confirmed as a mucinous (epidermal-connective tissue of proteoglycan [epidermal-CTNP]). For the treatment, a first-stage operation was done without any complication, and a second-stage operation is planned 4 months later. Most of the lesions were removed with the first-stage operation and no recurrence has occurred. Fig. 1 Confluent flesh-colored to brownish non-firm papules and nodules on the left lower back, with a zosteriform distribution. Fig. 2 (A) The band-like deposition of mucin was mainly observed in the superficial dermis, with papillomatosis, hyperkeratosis, and elongation of the rete ridge in the epidermis (H&E, ×40). (B) Mucin deposited in the papillary dermis stained ... Mucinous is a neoplastic hamartoma and a rare form of primary cutaneous mucinosis2. Mucinous clinically presents as grouped brownish papules and confluent plaques, usually with a unilateral, linear, zosteriform, or grouped distribution. It usually appears at birth or in early childhood and mainly occurs on the back2. Although most cases are sporadic, the possibility of familial association has been suggested2. The nevoid feature of mucinous needs to be clinically differentiated from epidermal or NLS. In mucinous nevus, the band-like deposit of mucin is limited mainly in the superficial dermis, like in our case3. However, recently, a case of mucinous with mature fat cells in the upper dermis similar to NLS has been reported, making the diagnosis more confusing3. Mucinous is divided into two histopathologic types: CTNP type and combined epidermal-CTNP type4. The difference between the two types lies in whether the epidermis is normal or shows hyperkeratosis and acanthosis, with elongation of the rete ridge indicating epidermal nevus4. After reviewing the histopathologic changes of the reported cases of mucinous nevus, Chi et al.4 found that approximately half of the mucinous cases were CTNP. Here, we report a rare case of mucinous nevus, the epidermal-CTNP type, presenting similar to NLS.

Multiple unilateral zosteriform syringomas on the abdomen.

Dear Editor: Syringomas are benign adnexal tumors of eccrine sweat duct origin. Clinically, they usually present as multiple, soft, skin-colored or yellowish papules and generally measure 1 to 2 mm in diameter. The sites of predilection are the face (especially the lower eyelids), cheeks, thigh, and axilla in a symmetrical or bilateral fashion1. A 39-year-old female patient presented with asymptomatic multiple flesh-colored papules on her trunk. The lesions had developed in crops about a month previously. Without spontaneous regression or improvement, the lesions had increased in number gradually. The patient's medical history was unremarkable, and she was not on any medication. She had no family history of similar skin lesions. Physical examination revealed multiple, flesh-colored to light-brownish, 2 to 4-mm-diameter papules across the right side of the trunk (Fig. 1). The lesions had a zosteriform distribution along the right T8 and T9 dermatomes. No other lesions were observed elsewhere on the whole body. Histopathological examination of the abdomen revealed numerous epithelial strands and small ducts in a fibrous stroma of the upper dermis (Fig. 2). Taking the clinicopathological features into consideration, the lesions were diagnosed as zosteriform syringomas and were successfully treated with carbon dioxide laser. The patient was followed for 6 months after the treatment, without any sign of recurrence and new lesion formation elsewhere on the whole body. Fig. 1 (A, B) Multiple, flesh-colored to light-brownish papules across the right side of the trunk in a zosteriform distribution (arrows). (C) Close-up view of the lesion. Fig. 2 Histopathological findings showing numerous epithelial strands and ductal differentiation in a fibrous stroma of the upper dermis (HE A: ×40, B: ×100). Syringomas usually present with a bilateral or symmetrical distribution. Although Hayashi et al.2 and Goday et al.3 reported about unilateral linear syringomas on the arm, until now cases of zosteriform syringomas have not been reported in the Korean literature. There was only one case report by Ceulen et al.4 in 2008 in Europe. In that case, the syringomas were distributed on the left side of the chest of an 18-year-old Caucasian male patient. Here, we report the first case of unilateral zosteriform syringomas on the right side of the abdomen. Typical periorbital syringomas may be easy to diagnose; however, when they show an unusual clinical manifestation, they could be misdiagnosed as sebaceous hyperplasia, milia, acne vulgaris, or lichen planus5. When encountering unilateral, zosteriform, popular dermatosis, dermatologists should consider syringomas in the differential diagnosis. The case presented here is a rare clinical form of syringomas that occurred in a zosteriform fashion. Although further investigations of the cellular and molecular levels are needed to uncover the precise pathogenesis of syringomas, we suggest that unilateral zosteriform patterns may well provide clues to the pathogenesis of syringomas with unknown etiology.

An unusual presentation of a progressive zosteriform macular pigmented lesion.

Dear Editor: Rower et al.1 defined progressive cribriform and zosteriform hyperpigmentation (PCZH) in 1978 as a disease that fulfils the following criteria: 1) cribriform pigmented macules that form a zosteriform distribution, 2) no history of skin disease or injury that would suggest postinflammatory hyperpigmentation, 3) an onset that arises well after birth, followed by gradual extension, 4) an onset that has no association with other skin diseases or internal abnormalities, and 5) characterized histologically by a mild increase in melanin pigment in the basal layer without nevus cells. In 1980, Simoes and Piva2 described the progressive zosteriform macular pigmented lesion (PZMPL) as a chronic pigmentary dermatosis with similar clinical findings to PCZH. Although PZMPL is not completely understood, it is thought to be a variant of PCZH. PZMPL is distinguishable from PCZH because it presents with pruritus as a prodromal symptom and is characterized clinically by its abrupt spreading and histologically by pigmentary incontinence. A 12-year-old boy presented with congenital brown pigmented skin lesions along Blaschko's lines on the right side of his trunk and upper extremities (Fig. 1). He complained of occasional mild itching. The lesions had recently extended to the left side across the midline. The histopathological findings showed increased levels of melanin pigment in the basal layer and focal pigmentary incontinence in the upper dermis (Fig. 2). Fig. 1 Linear macular pigmented lesion extending from right to left, across the midline of the trunk. Fig. 2 (A) Increased pigmentation in the basal layer and some melanophages in the upper dermis (H&E, ×400), (B) Immunohistochemical staining is positive for Fontana-Masson (×200). The etiology of PZMPL is unknown. It has been speculated that its pathogenesis might be the same as other diseases that develop along Blaschko's lines. Among the many inherited and some acquired skin conditions that develop along Blaschko's lines, sporadic cases like the present one are often explained as inherited mosaicism. Further studies of similar cases are necessary to determine the pathogenesis of the disease. PCZH arises after birth and follows the dermatomes. In terms of its hyperpigmentation and its asymptomatic nature, the case described in this report seems to align with the characteristics of PCZH, but the cribriform arrangement of small scattered macules is one particular characteristic of PCZH that differs from the extensive patches seen in the present case3. The similarities of PZMPL to the present case include the presence of extensive plaques along Blaschko's lines and macules that converged and became bigger. Simoes and Piva2 reported that PZMPL is accompanied by itching, and that the condition remains static for a certain period of time followed by an abrupt enlargement of the lesions, which is similar to the present case. The histological features, the extensive patches along Blaschko's lines, and the abrupt enlargement of the skin lesions suggested a diagnosis of PZMPL. Since the first case of PZMPL described by Simoes and Piva2 three more cases have been investigated, including the present one. Given that the diagnosis of PZMPL is not well established, we hope that this case report contributes towards elucidating a standard definition, the pathophysiology, and the progression of PZMPL. We recommend that dermatologists consider this disease when they encounter patients with chronic hyperpigmented dermatoses.