Friedrich Breier

Increased dermal angiogenesis after low-intensity laser therapy for a chronic radiation ulcer determined by a video measuring system

Acute and chronic radiation-induced dermatitis can occur after high doses of ionizing radiation of the skin. We describe a patient with a long-lasting radiotherapy-induced ulcer that healed after low-intensity laser therapy. A video measuring system was used to determine the number of dermal vessels in the ulcer before and after laser treatment. We found a statistically significant increase in the number of dermal vessels after low-intensity laser therapy in both the central and marginal parts of the ulcer compared with its pretreatment status.

Pseudoporphyria cutanea tarda induced by furosemide in a patient undergoing peritoneal dialysis

We report on a 32-year-old female patient undergoing peritoneal dialysis for diabetic nephropathy who developed blisters and cutaneous fragility on the dorsa of the hands. Histopathology of an early lesion showed a subepidermal cleft under a regular epidermis with single necrotic keratinocytes and normal dermal structures. In an advanced lesion, a subepidermal bulla and caterpillar bodies were found in the epidermis. Dermal vessel walls were normal and surrounded by a discrete lymphocytic infiltrate. Direct immunofluorescence revealed perivascular deposits of C3. Uroporphyrin and coproporphyrin levels of serum, urine and dialysate were repeatedly normal, confirming pseudoporphyria. The patient took furosemide (500 mg daily). Replacement of furosemide by ethacrynic acid led to spontaneous healing of the blisters. The patient was free of further lesions at the 1-year follow-up.

Papular xanthoma: a clinicopathological study of 10 cases

Background: Papular xanthoma (PX) is one of several clinicopathologic variants of normolipemic cutaneous non‐Langerhans cell histiocytoses (n‐LCH). PX represents a monomorphous reaction pattern of n‐LCH characterized by the presence of predominantly xanthomatized macrophages.

Schönlein-Henoch purpura during pregnancy with successful outcome for mother and newborn

AbstracBackgroundSchönlein-Henoch purpura is a systemic vasculitis that affects vessels of a small caliber and rarely reported in the literature.Case presentationWe report on a 35-year-old woman who developed palpable purpura with necrotizing cutaneous lesions on the lower limbs at 27 weeks of gestation. She also complained of epigastric pain and arthralgias. Histologic examination of a skin biopsy showed leukocytoclastic vasculitis with intravascular fibrin thrombi. The direct immunofluorescence analysis evidenced vascular deposits of IgA and C3 in the upper and mid-dermis. These findings were consistent with Schönlein-Henoch purpura. There was no evidence of renal involvement or placental dysfunction. The patient was treated with low-dose oral corticosteroids and a healthy infant was delivered by cesarean section. Examination of the placenta and the navel string disclosed no signs of vasculitis or infarction.ConclusionSchönlein-Henoch purpura is rarely reported in pregnancy. Treatment with orally administred corticosteroids may lead to a beneficial outcome for mother and newborn.

Sarcoidal granulomas in a cosmetic tattoo in association with pulmonary sarcoidosis.

Sarcoidosis is a granulomatous disease of unknown etiology, which may affect multiple organ systems. The skin is involved in up to one‐third of cases. The development of granulomatous lesions within tattoos is a well‐recognized phenomenon in patients with sarcoidosis. The characteristic histology shows non‐caseating granulomas; however similar findings may be seen in foreign body granulomas. We report on a patient, who developed sarcoidal granulomas within the black pigment of his tattoos. This subsequently led to the diagnosis of pulmonary sarcoidosis.

Lichen striatus oder Blaschkitis des Erwachsenen Variationen derselben Entität

ZusammenfassungWir berichten über eine 64-jährige Patientin, die ausgedehnte erythematopapulosquamöse Läsionen an der rechten Hälfte des Rumpfes sowie am rechten Bein im Verlauf der Blaschko-Linien aufwies. Das klinische und histologische Bild führte zur Diagnose eines Lichen striatus, einer Dermatose, die üblicherweise im Kindesalter auftritt. Unter Behandlung mit Acitretin kam es zu einem deutlichen Rückgang der Läsionen. Der Lichen striatus und seine Differentialdiagnosen – insbesondere die 1990 erstmals beschriebene “Blaschkitis des Erwachsenen”– werden diskutiert.AbstractA 64-year-old woman presented with extensive erythematous papulosquamous lesions along the lines of Blaschko on the right half of the trunk and the right leg. The clinical and histological features led to the diagnosis of lichen striatus, a dermatosis which usually appears during childhood. Treatment with acitretin led to marked improvement. Lichen striatus and its differential diagnoses – particulary “blaschkitis of adulthood” as first described in 1990 – are discussed.

Cutaneous Malakoplakia on the Forehead

A case of cutaneous malakoplakia in an 81-year-old woman in reported. A reddish slowly growing plaque had appeared on her forehead 13 years previously. Histopathology revealed a dense dermal granulomatous infiltrate consisting of lymphocytes and numerous histiocytes containing Michaelis-Gutmann bodies. Ciprofloxacin treatment resulted in partial involution of the lesion.

Primary Cutaneous Amyloidoma: A Case Report

Amyloidoma is defined as solitary, localized, tumor-like deposit of amyloid in diverse organs without evidence of systemic amyloidosis. Here we report the case of a 49-year-old male patient with a solitary amyloidoma of the skin seated on the left upper lip. Full medical examination showed no signs of systemic amyloidosis. The mass was removed surgically with tangential shave and so far no signs of recurrence have been found.

Intravascular Large B-Cell Lymphoma of the Skin: Typical Clinical Manifestations and a Favourable Response to Rituximab-Containing Therapy

Intravascular large B-cell lymphoma (IVBCL) is a rare malignant neoplasm characterized by the proliferation of large B cells within the blood vessels. The disease can be limited to the skin, but involvement of other organs is common. We report a case of cutaneous IVBCL in a 62-year-old man with minimal histological changes in contrast to prominent skin lesions. The patient was successfully treated with rituximab in combination with CHOP chemotherapy.

Necrobiotic Xanthogranuloma in a Patient with Multiple Myeloma

An 82-year-old woman presented with a 9-month history of multiple, well-defined skin lesions on her neck and upper chest, progressively increasing in size. Histological examination of a skin biopsy showed a regular epidermis. In the dermis, granulomatous changes with central necrobiosis were found which extended focally into the subcutaneous fat. The necrobiotic areas were surrounded by Touton cells and foreign-body giant cells. Laboratory analysis revealed leucopenia. Serum electrophoresis and immunofixation disclosed the presence of an IgG-λ paraprotein. Bone marrow aspiration cytology showed 20% plasmatic cells. The skeletal X-ray revealed frontal and occipital osteolytic skull lesions as well as pubic osteolysis. Urinalysis was unremarkable without proteinuria. Based on the clinical, laboratory, and histological findings, necrobiotic xanthogranuloma in association with multiple myeloma was diagnosed. The patient was treated with bortezomib combined with oral dexamethasone. Follow-up at week 13 revealed the complete disappearance of the IgG paraproteinemia. However, the skin lesions remained unchanged. Therefore, bortezomib treatment was discontinued, and systemic corticosteroids were continued at a higher dosage. After the steroid treatment, the lesions markedly flattened.