Algün Polat Ekinci

Vernachlässigte klinische Merkmale der follikulotropen Mycosis fungoides: eine große klinische Fallserie

Als seltene Form der Mycosis fungoides (MF), ist die follikulotrope MF (FMF) durch ein breites Spektrum klinischer Symptome gekennzeichnet. Dazu gehören, neben den vorherrschenden follikulären Läsionen, auch viele atypische Manifestationen. Das Ziel der vorliegenden Studie war eine klinische Bewertung von FMF‐Patienten, unter besonderer Berücksichtigung von vernachlässigten dermatologischen Merkmalen.

Underrecognized clinical features of folliculotropic mycosis fungoides: a large clinical series

A rare variant of mycosis fungoides (MF), folliculotropic MF (FMF) is characterized by a broad clinical spectrum that primarily includes follicle‐based lesions but also many atypical clinical manifestations. The objective of the present study was to conduct a clinical analysis of patients with FMF, with a particular focus on highlighting underrecognized dermatological features.

Unguales Plattenepithelkarzinom bei einem Patienten mit Mal de Meleda.

Plattenepithelkarzinome (squamous cell carcinoma, SCC) betreffen selten die Nagelregion. Das humane Papillomvirus (HPV) ist der in diesem Kontext am häufigsten vorgeschlagene ätiologische Faktor [1]. Ein Zusammenhang zwischen einem ungualem SCC und Palmoplantarkeratosen (PPK) wurde bisher noch nicht beschrieben. Plattenepithelkarzinome an Händen und Füßen können in Verbindung mit dem autosomal-dominanten Huriez-Syndrom auftreten, das durch Skleroatrophie an den distalen Extremitäten und hypoplastische Veränderungen der Nägel gekennzeichnet ist [2]. Der Pathomechanismus der Tumorentstehung bei diesem Syndrom ist immer noch unbekannt. Die meisten anderen PPK-Syndrome sind nicht mit einem erhöhten Risiko für Hautkrebs assoziiert [3, 4]. Es gibt allerdings gelegentliche Berichte über einen Zusammenhang zwischen anderen PPK-Syndromen Clinical Letter mit SCC oder verrukösem Karzinom, einschließlich Mal de Meleda (OMIM 248300) [5–8].

Low sensitization rate but good clinical relevance of preservatives in Turkey: evaluation of 1256 patients over 10 years (1996-2006).

Dear Editor, Preservatives are common contact sensitizers in many European countries and in the USA; however, recent reports from Turkey indicated a relatively low sensitization rate. Our study aimed to investigate positive patch test reactions to common preservatives in a large series of patients in Turkey during a 10-year period with special emphasis on their clinical relevance in view of the previously proposed patch test parameter. From 1996–2006, 1256 patients with suspected allergic contact dermatitis were consecutively patch tested with the extended European baseline series (EBS) including seven preservatives (quinoline mix, paraben mix, Quaternium 15, thimerosal, methyldibromoglutaronitrile ⁄phenoxyethanol [MDBGN ⁄PE], methylchloroisothiazolinone ⁄ methylisothiazolinone [MCI ⁄ MI] and formaldehyde). Three hundred of them were additionally tested with the cosmetic series (CS) including a further 25 preservatives. Patch testing was performed after informed consent of the patients. Test allergens were supplied by Brial Allergen (Greven, Germany) and Chemotechnique Diagnostics (Vellinge, Sweden), and were applied in IQ Chambers (Chemotechnique Diagnostics) to the upper back of the patients for 2 days (D). Test sites were evaluated at D2 and D3, and if necessary also at D4-D5-D7 according to recommendation from the International Contact Dermatitis Research Group. Patients with positive patch test reaction to a cosmetic preservative were asked to bring their skin care products so that their label could be checked for the presence of a specific preservative. Additional occlusive patch testing were performed with patients’ leave-on products (as is), or open testing with rinse-

The clinical spectrum of xanthomatous lesions of the eyelids

Yellowish papules, nodules, or plaques, namely “xanthomatous” lesions, may be seen on the eyelids in the course of various disorders. The prototype is “xanthelasma palpebrarum” (XP) that is localized only to the eyelids and may be associated with hyperlipidemia. On the other hand, different types of normolipemic disorders may also cause xanthomatous eyelid lesions. Among these, Langerhans cell histiocytosis, diffuse normolipemic xanthoma, and non‐Langerhans cell histiocytoses (papular xanthoma, juvenile xanthogranuloma, xanthoma disseminatum, adult‐onset xanthogranuloma, adult‐onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, Erdheim‐Chester disease, Rosai‐Dorfman disease, and reticulohistiocytosis) can be listed. The eyelid findings of this heterogeneous group of disorders are challenging to differentiate from each other due to common clinical aspects that may even sometimes mimic XP. Nodularity, induration, ulceration, diffuse eyelid involvement, and extension from eyelids to the neighboring skin may represent the clinical features of xanthomatous lesions other than XP. It is necessary to obtain a thorough history and exclude XP and then perform detailed dermatological and systemic examination, biopsy for histopathologic confirmation, and appropriate specific imaging screens. As some of the conditions may be associated with other systemic disorders, especially malignancies, the differentiation of xanthomatous eyelid lesions has a critical importance, and clinical signs can be guiding.

Annular Erythematous Patches as the Presenting Sign of Extranodal Natural Killer/T-Cell Lymphoma

Extranodal natural killer/T-cell lymphoma (ENKTL) is a distinct type of lymphoma strongly associated with Epstein-Barr virus (EBV) infection and showing an aggressive course [1]. It usually presents as a localized disease in the upper aerodigestive tract, from the nasal cavity to the hypopharynx [2,3], but it may rapidly extend to the neighboring tissues and disseminate to various organs such as the small intestine, epiglottis, testes, adrenal gland, kidneys, and breasts [4,5]. As nasal/upper aerodigestive tract involvement may only cause nonspecific symptoms in the early period, diagnosis may be initially established based upon skin lesions [6]. We present two ENKTL patients with unusual dermatological findings.

Ungual squamous cell carcinoma in a patient with Mal de Meleda.

Squamous cell carcinoma (SCC) rarely involves the nail unit. Human papilloma virus (HPV) is the most commonly suggested etiological factor in this area [ 1 ] . The association of ungual SCC with palmoplantar keratoderma (PPK) has not been described. Squamous cell carcinoma of the hands and feet may occur in the setting of autosomal dominant Huriez syndrome, which is characterized by scleroatrophy of the distal extremities and hypoplastic nail changes [ 2 ] . The pathogenic mechanism of tumor development in this syndrome is still unknown. Most other PPK syndromes are not associated with an increased risk of skin cancer [ 3, 4 ] , although there are occasional reports of associations of other PPK syndromes with SCC or verrucous carcinoma, including Mal de Meleda (OMIM 248300) [ 5–8 ] .

Foot contact dermatitis: nitrofurazone as the main cause in a retrospective, cross-sectional study over a 16-year period from Turkey.

The major causative agents in allergic contact dermatitis of the foot may differ from country to country. Sufficient data on foot eczema in patients from Turkey are lacking.

The Dilemma of Coexisting Nevoid Hyperkeratosis of the Nipple and Areola in Mycosis Fungoides: A Report of Three Cases.

Nevoid hyperkeratosis of the nipple and areola (NHNA) is a rare clinicopathological entity showing persistent and strictly localized hyperkeratotic lesions of the nipple, areola or both with unknown etiopathogenesis. A similar clinical appearance may also be seen in different diseases with specific histopathological features. There are a few anecdotal reports on the association of NHNA with mycosis fungoides (MF), but they do not describe a uniform condition. In this report, we present 3 patients with hyperkeratotic lesions of the nipple and areola associated with MF but showing different histopathological features. We also review similar cases in the literature and discuss possibilities concerning this association. Two of our cases represent the association between MF and NHNA without histopathological features of MF on the nipple-areola complex. The other case represents hyperkeratosis of the nipple and areola with specific histological and immunohistochemical features of MF. Hence, we would like to hypothesize that MF may involve the nipple and areola and have an appearance similar to NHNA. Intriguingly, however, NHNA may occasionally also be seen in association with MF. However, this peculiar association requires further explanation.

Novel Clinical Observations on Benign Cephalic Histiocytosis in a Large Series

Benign cephalic histiocytosis (BCH) is a rare form of non‐Langerhans cell histiocytosis in infants and young children characterized by self‐healing macules and papules occurring primarily in the head and neck region. So far there have been nearly 60 reported cases in the English‐language literature.