Koh Jk

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

Summary Backgroundu2002 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.

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.

Clinical and Histologic Features of 64 Cases of Steatocystoma Multiplex

Steatocystoma multiplex (SM) shares many clinical features and may show overlapping histopathological features with eruptive vellus hair cyst (EVHC). Clinical data and pathologic features of 64 patients with SM were evaluated in detail. Most of the cases were sporadic, with an average onset age of 26 years and distribution on the arms, chest, axillae, and neck. All cases exhibited eosinophilic cuticle and lack of granular layer, and 17–42% displayed vellus hair, hair follicles, keratin, and smooth muscle components within the cavity, in the wall, or adjacent to it. The results of this study add further evidence to the hypothesis that SM is a hamartomatous condition and that SM and EVHC are variants of one disorder which originates in the pilosebaceous duct.

Widespread skin-limited adult Langerhans cell histiocytosis: long-term follow-up with good response to interferon alpha.

Summary Langerhans cell histiocytosis (LCH) most frequently involves bone, but also involves the skin in 40% of cases; in 10% of patients it is limited to the skin. Cutaneous findings of skin‐limited LCH are scaly papules, vesicles, nodules, tumours with erosion, ulceration, or crusting and/or purpura. We report a case of widespread adult‐onset LCH confined to skin in which topical carmustine, photochemotherapy, systemic steroids, and 2‐chlorodeoxyadenosine were only partially effective. However, longer remission was achieved by the use of subcutaneous interferon‐α2b.

CD56 expression in a case of primary cutaneous CD30+ anaplastic large cell lymphoma.

We describe clinicopathological features of an unusual case of CD30+/CD56+ T‐cell lymphoma in a 58‐year‐old Korean man who presented with disseminated nodules, papules and hyperpigmented patches. Coexpression of CD30 and CD56 in T‐cell lymphoma is very rare. Our patient did not respond to an intensive chemotherapy regimen, in contrast to the previously reported cases of primary cutaneous CD30+ anaplastic large cell lymphoma. Coexpression of CD56 might therefore identify a subset of CD30+ lymphomas with more aggressive features.

Erythema annulare centrifugum following herpes zoster infection: Wolf's isotopic response?

1 Yamaguchi K. Human T-lymphotropic virus type I in Japan. Lancet 1994; 343:213–6. 2 Johno M, Ohishi M, Kojo Y et al. Cutaneous manifestations of adult T-cell leukemia ⁄ lymphoma. Gann Monogr Cancer Res 1992; 39:33–41. 3 Bazarbachi A, Ghez D, Lepelletier Y et al. New therapeutic approaches for adult T-cell leukaemia. Lancet Oncol 2004; 5:664–72. 4 Setoyama M, Katahira Y, Kanzaki T. Clinicopathologic analysis of 124 cases of adult T-cell leukemia ⁄ lymphoma with cutaneous manifestations: the smouldering type with skin manifestations has a poorer prognosis than previously thought. J Dermatol 1999; 26:785–90. 5 Shimoyama M. Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. A report from the Lymphoma Study Group (1984–87). Br J Haematol 1991; 79:428–37. 6 Pawson R, Mufti GJ, Pagliuca A. Management of adult T-cell leukaemia ⁄ lymphoma. Br J Haematol 1998; 100:453–8. 7 Zhang C, Duvic M. Retinoids: therapeutic applications and mechanisms of action in cutaneous T-cell lymphoma. Dermatol Ther 2003; 16:322–30. 8 Maeda Y, Miyatake J, Sono H et al. New therapeutic effects of retinoid for adult T-cell leukemia. Blood 1996; 88:4726–7. 9 Maeda Y, Naiki Y, Sono H et al. Clinical application of all-trans retinoic acid (tretinoin) for adult T-cell leukaemia. Br J Haematol 2000; 109:677–8. 10 Maeda Y, Yamaguchi T, Ueda S et al. All-trans retinoic acid reduced skin involvement of adult T-cell leukemia. Leukemia 2004; 18:1159–60.

A case of infantile psoriasis with pseudoainhum successfully treated with topical pimecrolimus and low‐dose narrowband UVB phototherapy

1332 JEADV 2006, 20 , 1328–1399

Treatment of Argyria after Colloidal Silver Ingestion Using Q‐Switched 1,064‐nm Nd:YAG Laser

Ingestion of colloidal silver can result in argyria, which appears as a benign blue-to-slate-gray mucocutaneous discoloration caused by silver deposition. The incidence of argyria has decreased due to less occupational exposure to silver. However, cases of argyria are now being reported due to the recent popularity of alternative medicines containing various silver-containing compounds. In Korea, there are numerous websites advertising and marketing colloidal silver that its ingestion has dramatic health benefits.

Case of linear porokeratosis: Successful treatment with topical 5% imiquimod cream

Dear Editor, Linear porokeratosis is an uncommon disorder, which usually presents in childhood along the lines of Blaschko. It often causes distressing cosmetic problems, and is known to have the risk of malignant transformation as an infrequent complication. Many treatment modalities such as surgical excision, cryosurgery, dermabrasion or topical tretinoin have been used. But none of these therapies were universally acceptable, and recurrence or scarring can be complicated. Herein, we report a boy with linear porokeratosis that was successfully treated with topical 5% imiquimod cream (Aldara; 3 M, Loughborough, UK), an immune response modifier. A 6-year-old boy with a 2-year history of linear skin lesions was referred to our department. He also complained of slight enlargement of the lesions. Examination revealed papules, small annular lesions, coalescing hyperkeratotic plaques with central atrophy and the keratotic peripheral ridge, which were linearly arranged and 7–8 cm in length on the upper arm (Fig. 1). Histological examination from the edge showed characteristic cornoid lamella, which were consistent with linear porokeratosis. Given the size and site of the lesions, surgical excision was not favored and his parents did not want any scarring. Topical 5% imiquimod cream was applied to the entire lesions once daily, 5 days/week under occlusion. Within 3 weeks of treatment, a strong inflammatory reaction with erythema was achieved. He tolerated the irritating reaction with intermittent application of 0.05% desonide lotion, or by reducing the frequency of cream application to twice per week without occlusion. After 4 months, the topical imiquimod cream was stopped. Three months later, there had been complete resolution of inflammation and lesions, leaving mild residual hypopigmentation (Fig. 2). During the 1-year follow-up period, the hypopigmented lesions have been improved progressively without the evidence of any new lesions. Porokeratosis is thought to result from faulty keratinization of abnormal mutant clones of keratinocytes producing the characteristic cornoid lamella. It is also recognized that immunosuppression may be associated with the development of the porokeratotic lesions and its malignant transformation. Imiquimod, an imidazoquinoline amine, is an immunomodulating agent, which enhances both acquired

Ichthyosis associated with ARC syndrome: ARC syndrome is one of the differential diagnoses of ichthyosis.

Abstract:u2002 The arthrogryposis, renal tubular dysfunction and cholestasis syndrome is rare. Novel identification of the mutation in VPS33B in this syndrome, which involves intracellular protein trafficking by regulation of vesicle‐to‐target sensory nerve action potential receptor (SNARE) family, might explain the consistent combination of membrane fusion defects. We can guess the defective lamellar body secretion mediated by the soluble N‐ethylmaleimide‐sensitive factor attachment protein receptor or SNARE protein pathway in the epidermis might result in the ichthyosiform phenotype. In the English‐language literature, half of the reported instances of this syndrome are associated with ichthyosis. We report an infant with ichthyosis in association with arthrogryposis, renal tubular dysfunction, and cholestasis syndrome, and review the literature. Our findings suggest that the differential diagnosis of ichthyosis during infancy should include this syndrome.