Jun Oh Paek

Comparison of cure rates and durations of treatment with diphenylcyclopropenone immunotherapy for warts in children/adolescents and adults

Immunotherapy has been used for many years in the treatment of warts. Diphenylcyclopropenone is frequently used as an immunotherapeutic agent.

A Case of Myopericytoma on the Lower Leg

Myopericytoma (MP) is a benign tumor composed of cells that show apparent differentiation towards putative perivascular myoid cells called myopericytes. It arises most commonly in the dermis or subcutaneous tissue of the extremities in adults. The most common presentation is a well-circumscribed, slow-growing painless firm mass. A 45-year-old woman presented with a 2-year history of a painless, slowly growing 0.9×0.7 cm sized firm mass in the subcutaneous tissue of the posterior side of the right lower leg. We presumed this lesion to be an epidermal cyst, pilomatricoma or calcinosis cutis and performed an excisional biopsy. The histologic examination showed that it was composed of spindle-shaped myoid-appearing cells in a concentric arrangement, intimately associated with thin-walled vascular channels. Lesional spindle cells were diffusely positive for smooth muscle actin and were negative for CD34, desmin and S100 protein. From these findings, we diagnosed this lesion as a myopericytoma.

Anetoderma developing in generalized granuloma annulare in an infant.

Dear Editor: Anetoderma is a rare cutaneous disorder characterized by localized depressions or the outpouchings of the skin caused by laxity and the weakening of the dermal connective tissue as a result of the focal loss of elastic fibers1. Anetoderma has two forms: primary and secondary. Primary anetoderma develops on clinically normal skin without any preceding dermatoses. Secondary anetoderma develops on exactly the same area as a previous specific pathology1. A 3-month-old girl presented with an increasing number of multiple atrophic and brownish scaly macules on her trunk and both extremities, which had begun to develop 3 weeks previously. She had erythematous asymptomatic papules that changed to brownish scaly macules. On clinical examination, the otherwise healthy-looking girl was presented with 40 to 50 atrophic and round-to-oval shaped brownish macules on her trunk and both extremities (Fig. 1). The lesions were 2 to 10 mm in diameter and were relatively well circumscribed, presenting as depressions below the level of the normal skin. A biopsy was taken from a typical-looking lesion on her leg. Since the clinical features including the lesions and the patients age closely resembled primary anetoderma and looked just like a case we had previously reported, we presumed that this was a case of primary anetoderma. However, a histopathological examination revealed degenerated collagen bundles along with histiocytes, lymphocytes and Touton giant cells in the dermis (Fig. 2A). An alcian blue staining was positive in the degenerated collagen fibers. Fig. 1 Multiple atrophic and brownish scaly macules (black arrows) can be seen on the abdomen (A) and left leg (B). Fig. 2 (A) Skin biopsy showing pale-staining, well-circumscribed, haphazardly arranged degenerated collagen bundles surrounded by inflammatory cells in the dermis (H&E, ×100). (B) Loss of elastic fibers in the superficial and mid dermis (elastic ... The diagnosis was therefore granuloma annulare. The elastic stain also revealed a complete elastolysis or fragmented elastic fibers in the superficial and the mid dermis (Fig. 2B). These findings were consistent with anetoderma. Thus, histopathologic features of granuloma annulare and anetoderma coexisted in this patient. Anetoderma occurs mainly in women aged 20 to 40 years, but is occasionally reported in younger and older patients of both sexes1. It has also occasionally been described/reported in premature infants, which may be related to the use of cutaneous monitoring leads or adhesives1. Granuloma annulare generally resolves spontaneously without leaving any atrophic scars2. However, there are some reported cases manifesting the development of mid-dermal elastolysis and anetoderma following granuloma annulare3,4. Gunes et al.2 found that elastic fiber damage is one of the main accompanying features of granuloma annulare, which may develop from delayed type hypersensitivity. Thus, elastic fiber destruction may be intrinsic to granuloma annulare and can be severe enough to cause visible skin atrophy like anetoderma2,4. In addition, elastolytic enzymes released from inflammatory cells are thought to be responsible for the fragmentation of elastic fibers. Vibronectin and decay acceleration factor have also been implicated5. Anetoderma should be distinguished from several elastolytic disorders including acquired cutis laxa, mid-dermal elastolysis, and perifollicular elastolysis4. Acquired cutis laxa differs from anetoderma by its generally widespread sagging or lax skin. Mid-dermal elastolysis is characterized by wrinkly patches and follicular papules, and the selective loss of elastic fibers limited to the mid dermis. Perifollicular elastolysis are presented as small papules centered around the follicles on the face or the upper back. We report an interesting case of anetoderma developing in generalized granuloma annulare, with the earliest known age of onset and displaying coexisting histopathologic features of granuloma annulare and anetoderma.

Lipomembranous changes associated with systemic lupus erythematosus

Lipomembranous changes are distinctive histopathological findings, which include the presence of cystic cavities lined by crenulated, hyaline membranes in adipose tissue. It is likely that ischaemia is fundamental to the development of these lesions, and that lipomembranes are formed from the products of degenerating fat cell membranes by some unknown mechanism. Such changes may be seen, although rarely, in many types of subcutaneous inflammatory processes. However, an association with systemic lupus erythematosus (SLE) is rare. We report a patient with SLE who had the histological features of lipomembranous changes associated with vasculopathy.

Unusual manifestation of cutaneous cytomegalovirus infection: a nodular cutaneous lesion on the finger in a healthy adolescent girl

Cytomegalovirus (CMV), a member of the herpes viridae family, is a well-described opportunistic virus and a potential pathogen in immunocompromised patients with AIDS, malignant neoplasms, or immunosuppression after organ transplantation. Infection by CMV in the immunocompromised individual can be severe and even fatal, with pneumonitis, hepatitis, encephalitis, gastroenteritis, chorioretinitis, or widely disseminated disease as possible complications. However, infection in immunocompetent individuals is usually asymptomatic or subclinical. Therefore, cutaneous CMV infection is observed very rarely in immunocompetent individuals, and only a few cases have been reported in the dermatologic literature. Case report

An eccrine angiomatous hamartoma with histopathological features of a papillary haemangioma in a neonate

Eccrine angiomatous hamartoma (EAH) is a benign hamartomatous tumour characterized by a combination of proliferative eccrine and vascular elements. Papillary haemangioma (PH) is a distinct cutaneous haemangioma with predominantly intravascular capillary proliferation within dilated thin‐walled blood vessels. EAHs have been reported in combination with various vascular components. We present the first case in the dermatological literature, to our knowledge, of a patient with congenital EAH with the histopathological features of a PH.