Choi Jh

Cutaneous adverse effects in patients treated with the multitargeted kinase inhibitors sorafenib and sunitinib

Summary Background  The multitargeted kinase inhibitors sorafenib and sunitinib have improved treatment of solid tumours including renal cell carcinoma and hepatocellular carcinoma by offering better clinical responses. However, sorafenib and sunitinib are commonly associated with cutaneous toxicity.

Viral folliculitis on the face.

The common clinical presentations of herpes simplex virus (HSV) and molluscum contagiosum (MC) are well known to dermatologists. However, folliculitis due to these viruses is an infrequently reported entity and might be considered a sign of immunosuppression [such as infection with human immunodeficiency virus, (HIV)], especially in cases of folliculitis due to MC. The purpose of this study was to describe the clinical and histopathological characteristics of viral folliculitis due to HSV and MC. We retrospectively collected all our cases with histologically proven folliculitis due to HSV and MC between 1994 and 1999. A total of seven patients aged 7–54 years was identified. Prior to establishment of the diagnosis of folliculitis due to HSV and MC, they were treated with topical antibiotics or topical steroids, without improvement. Tentative diagnoses were bacterial folliculitis, syringoma, perifollicular fibrosis, contact dermatitis or pseudolymphoma. Biopsy of the lesions revealed multiple molluscum bodies in the follicular epithelium with sparing of the epidermis in four patients, and ballooning degeneration and intranuclear viral inclusions in the follicular epithelium in the other three. Three patients had evidence of underlying immune suppression, such as pregnancy, chronic viral hepatitis B and nasopharyngeal carcinoma. One patient had suffered from epilepsy for 4 years. Testing for HIV by enzyme‐linked immunosorbent assay was negative in the four patients in whom this was performed, and T‐cell subsets were normal in the three patients in whom these were quantified. In cases of molluscum folliculitis treated with simple curettage, the lesions cleared without scarring or recurrence. In cases of herpetic folliculitis, the lesions improved with antihistamines or aciclovir. MC or HSV should be considered in cases that present with folliculitis‐like dermatoses but which are refractory to anti‐infective and anti‐inflammatory treatment.

Clinicopathological features of CD56+ nasal‐type T/natural killer cell lymphomas with lobular panniculitis

Nasal‐type T/natural killer cell lymphoma (TNKCL) shows frequent extranodal involvement including the skin, and is associated with a poor prognosis. We have studied six patients with nasal‐type TNKCL presenting with inflammatory subcutaneous nodular lesions with a subcutaneous lymphoid infiltrate. Clinical information was obtained from the medical records of the patients and at follow‐up. All cases showed features of angiocentric lymphoma on histology, although there was diffuse cellular infiltration rather than an angiocentric pattern in the subcutis. All six patients were similar in immunophenotype: positive for CD56 and either cytoplasmic CD3 or CD45RO, but negative for B‐cell markers and CD30. In situ hybridization using an anti‐sense Epstein–Barr virus early regions probe showed a positive reaction in all cases. All patients either died with progressive disease or showed no response to combined chemotherapy. The diagnosis of nasal‐type TNKCL, which has a fatal outcome, is facilitated by detection of CD56‐positive tumour cells. In evaluating lobular panniculitis including apparently benign inflammatory subcutaneous nodules, nasal‐type TNKCL should be considered in the differential diagnosis, especially in Asian countries.

CD30‐positive T‐cell‐rich pseudolymphoma induced by gold acupuncture

Summary Cases of pseudolymphoma induced by intradermal gold injection or gold piercing have previously been described. Most of these cases showed the histopathological finding of B‐lymphocyte predominant lymphocytoma cutis. We describe a patient with gold acupuncture‐induced T‐cell‐rich pseudolymphoma. Some T cells showed positive staining with CD30. The lesions responded to an intralesional injection of triamcinolone acetonide.

Hypereosinophilic syndrome presenting as cutaneous necrotizing eosinophilic vasculitis and Raynaud's phenomenon complicated by digital gangrene.

Cutaneous necrotizing eosinophilic vasculitis is a recently identified type of vasculitis that is characterized by an eosinophil‐predominant necrotizing vasculitis affecting small dermal vessels. Clinically, it presents with pruritic erythematous and purpuric papules and plaques, peripheral eosinophilia and a good response to systemic steroid therapy. This vasculitis can be idiopathic or associated with connective tissue diseases. Although the pathogenic roles of eosinophil‐derived granule proteins and interleukins have been documented in diseases associated with eosinophilia, a role of CD40 (a glycoprotein of the tumour necrosis factor receptor superfamily) has rarely been described. We describe two patients with idiopathic hypereosinophilic syndrome (HES) presenting with multiple erythematous patches and plaques on the lower extremities and Raynauds phenomenon. They satisfied the criteria for the diagnosis of HES by clinical and laboratory investigations. Histopathology of the cutaneous lesions revealed prominent eosinophilic infiltration with local fibrinoid change in vessel walls in the dermis and subcutis. Immunohistochemical detection of CD3, CD4, CD8 and CD40 was performed. Infiltrating eosinophils were strongly stained by anti‐CD40 monoclonal antibody. One patient improved with prednisolone, pentoxifylline and nifedipine, without recurrence. The other patient initially improved with steroids, but after self‐withdrawal of steroid developed digital ischaemia that evolved to severe necrosis and required amputation. Cutaneous necrotizing eosinophilic vasculitis, Raynauds phenomenon and digital gangrene may develop as cutaneous manifestations of HES. CD40 may play a part in the pathogenesis of eosinophilic vasculitis in HES.

Majocchi's granuloma of the vulva caused by Trichophyton mentagrophytes

We report a case of Majocchis granuloma caused by Trichophyton mentagrophytes on the vulva in a 23‐year‐old girl who had used topical steroids for many years. Her dog was a source of the infection.

Kikuchi-Fujimoto disease with papulopustular skin manifestations

Kikuchi‐Fujimoto disease commonly presents with cervical lymphadenopathy accompanied by fever, myalgia, neutropaenia, and rarely cutaneous eruption. Most cutaneous lesions present as erythematous macules, papules, plaques, nodules, or ulcers on the upper part of the body such as trunk, upper extremities, and face. We present a case of Kikuchi‐Fujimoto disease with a papulopustular eruption on the whole body including the lower extremities.

Pseudomelanoma following laser therapy.

1 Gimènez Garcìa R, de la Lama Lòpez-Areal J, Avellabeda Martinez C. Scabies in the elderly. J Eur Acad Dermatol Venereol 2004; 18 : 105–107. 2 Bergin O, O’Reilly M, Goha J, O’Neill M. Incidence of sexually transmitted diseases amongst a elderly cohort attending a genito-urinary clinic. J Eur Acad Dermatol Venereol 1995; 5 : 218–221. 3 Gordon SM, Thompson S. The changing epidemiology of human immunodeficiency virus infection in older persons. J Am Geriatric Soc 1995; 43 : 7–9. 4 Tan HH, Goh CL. Parasitic skin infestations in the elderly: recognition and drug treatment. Drugs and Aging 2001; 18 : 165–176. 5 Morin C, Joly P, Courville P et al. Chronic eczematiform eruption in the elderly. Ann Dermatol Venereol 2002; 129 : 19–22. 6 Iehl-Robert M, Monnier F, North C. Scabies, a pathology still present in the elderly. Soins Gerontol 2001; 18 : 165–176.

A case of guttate psoriasis following Kawasaki disease

We report a case of guttate psoriasis following Kawasaki disease, in a patient with Staphylococcus aureus demonstrated in a throat swab. We suggest that preceding staphylococcal infection can play a key role in the pathogenesis of some cases of guttate psoriasis, possibly by the production of superantigens.

Linear basaloid follicular hamartoma on the Blaschko's line of the face

We report a 5‐year‐old girl with localized basaloid follicular hamartoma. The lesion consisted of a linear, hypopigmented, atrophic patch on the right lateral side of nose. Of great interest is that the linear distribution of lesion may follow the Blaschkos line of the face.