Luc Durand

Pseudoepitheliomatous epidermal hyperplasia in tattoos: report of three cases.

Cutaneous reactions to tattoos are not uncommon and various histologic patterns have been reported, including lichenoid, granulomatous, eczematous, and pseudolymphomatous reactions. Such patterns may develop with highly variable delay after the tattooing procedure. We report three strikingly similar cases of a fast-occurring, tattoo-induced, cutaneous reaction strictly restricted to the red parts of the tattoos in two cases and displaying an unusual histologic pattern, i.e. pseudoepitheliomatous hyperplasia. Clinical differential diagnosis of this rare condition includes viral warts, keratoacanthoma, and verrucous carcinoma. It may be difficult to rule out the last two diagnoses and making the diagnosis usually requires full excision of the lesion, comprehensive histologic analysis, and careful follow-up.

Subcutaneous phaeohyphomycosis due to Pyrenochaeta romeroi in a patient with leprosy

Sir,Opportunistic subcutaneous fungus infections arecurrently increasing in incidence, partly due to thegrowing number of patients receiving immunosuppres-sive therapies. Accordingly, these infections, formerlymostly encountered in hot and dry areas, are now morewidely distributed and may challenge clinical andbiological diagnosis when occurring in areas wherephysicians are not accustomed to them. We report onthe first case of non-mycetoma deep cutaneous infec-tion due to Pyrenochaeta romeroi, a rarely isolatedagent only reported in mycetomas to date, in animmunocompromised patient originating from westernAfrica.CASE REPORTA 45-year-old patient was first referred to our depart-ment for evaluation of non-inflammatory, painful anddeep lesions of both lower limbs reminiscent of coldabcesses. He originated from Senegal and had beenliving in France for the previous 10 years. His medicalhistory was remarkable for a multibacillary leprosytreated by sequential antibiotics for more than 20years, with painful neurological sequelae for whichhe self-administered intramuscular dexamethasone ona monthly or bi-monthly basis. Clinical examinationshowed a large subcutaneous, flaccid lesion of thelateral side of the left leg, of at least 4 years’ duration,with an occasional purulent white-yellow dischargethrough superficial sinus tracts, a 2-cm-large noduleof the right tibial crest and two crusted papulo-nodulesof the left foot. No discharge of granules was seen fromthe main lesion. A four-limbs distal hypoaesthesia wasotherwise obvious, likely related to the post-leprosyneuropathy. Biological tests revealed an inflammatorysyndrome (ESR 86 mm at first hour, C-reactive protein189 g/l (normal: 0–5 g/l), a rise in WBC (14.10

Wegener's granulomatosis mimicking facial granulomatous rosacea: a separate subset?

Sir, Wegener’s granulomatosis (WG) is an aggressive vasculitis that can affect the skin, among other targets such as the kidneys and upper respiratory tract. Recently, Steinhoff et al. (1) reported an unusual and potentially deceitful subset of WG in a 70-year-old patient, featuring initial cutaneous inflammatory centro-facial lesions that closely mimicked papulo-pustular rosacea, but which eventually proved to correspond to WG. We report here a new observation of this atypical presentation, raising the possibility that this clinical pattern is perhaps not exceptional and should be brought to the attention of physicians dealing with red facial lesions.

Lymphome T cutané épidermotrope cytotoxique CD8+ « agressif» : difficultés de prise en charge chez un malade atteint d'une dystrophie myotonique de Steinert

Resume Introduction Le lymphome cutane T epidermotrope CD8+ « agressif » est une entite rare faisant partie du groupe des lymphomes cutanes a phenotype T cytotoxique et/ou NK et qui se differencie nettement du mycosis fongoide qu’il soit CD4+ ou CD8+ par ses lesions tumorales d’emblee rapidement evolutives, la presence de necroses keratinocytaires, un immunophenotype T cytotoxique et un pronostic defavorable. Observation Un homme de 33 ans atteint d’une myotonie de Steinert etait adresse pour des lesions tumorales ulcerees d’evolution rapide dans un contexte d’alteration marquee de l’etat general. Les donnees cliniques, histologiques et immunohistologiques permettaient de conclure a un lymphome cutane epidermotrope CD8+ « agressif ». Le traitement par CHOP etait efficace malgre une tolerance cardiaque moyenne liee a la myotonie mais l’evolution se faisait vers une recidive cutanee puis vers un deces par infection pulmonaire apres reprise de la chimiotherapie. Discussion Le traitement du lymphome cutane epidermotrope CD8+ « agressif » n’est pas codifie. Il fait appel en general a une chimiotherapie systemique de type CHOP mais la recidive est la regle avec une mediane de survie ne depassant pas 34 mois. Chez le malade presente, la presence d’une myopathie induisait une difficulte supplementaire en raison de la toxicite cardiaque du traitement cytostatique rendant difficile une intensification et conduisant a une modification de protocole.

Diagnostic value of STMN1, LMO2, HGAL, AID expression and 1p36 chromosomal abnormalities in primary cutaneous B cell lymphomas

Distinction between primary cutaneous follicular lymphoma (PCFL) and primary cutaneous marginal zone lymphoma (PCMZL) is challenging, as clear‐cut immunophenotypical and cytogenetic criteria to segregate both entities are lacking.

Idiopathic localized involutional lipoatrophy: a lupus profunds-like condition.

Sir, Idiopathic localized involutional lipoatrophy (ILIL) is a rare and nosologically imprecise condition characterized by a focal loss of subcutaneous tissue on one or several sites, occurring without any significant triggering factor or auto-immune background, and regressing spontaneously within a few months (1, 2). We report here on a new observation of ILIL that emphasizes its deceitful clinical resemblance to lupus profundus and the necessity for clinicians to be aware of this unusual differential diagnosis of better prognosis.

Leg ulcers revealing systemic sarcoidosis with splenomegaly and thrombocytopenia.

Some of the most used techniques derive from the original technique of Gillies and Millard, who based their method on the excision of two triangles above the vermilion and advancing the mucosa to create the Cupid’s bow. Other later techniques, such as that of Onizuka et al., involve making a more curvaceous cut from the center of the vermilion to provide more emphasis to Cupid’s bow. Alternatively, repair may be accomplished using a bilateral vermilion flap and a triangular excision of skin from the base of each philtral column with which to create the new Cupid’s bow. Each vermilion flap is then sutured by planes to the opposite side. V-Y advancement flaps have also been used, and although these are easy to perform and involve minimal morbidity, their main disadvantage relates to the scars remaining on the skin of the upper lip. However, in the older age group, in whom this technique has greater applicability, this problem is less visible. Finally, small total skin grafts have also been used for reconstruction in this area. The technique described here was published by Paniker and Mellete. These authors established certain indications and recommendations in order to achieve optimal results. The first aspect to consider is the size of the lesion, as this technique cannot be used for all defects involving Cupid’s bow. It is not recommended if the resulting defect is greater than one-third the length of the philtrum or if it is situated further than one-third from the midline towards the commissure. In addition, it is recommended that the design is done before infiltration of anesthesia or with the use of minimally reactive suture material. We have presented a simple technique consisting of a variant of advancement mucosal flaps. The use of this advancement flap in certain selected patients achieves reconstruction of Cupid’s bow with acceptable cosmetic and functional results.

Spontaneous cutaneous cholesterol embolism

1. Université Montpellier I, Service de Dermatologie, Hôpital Saint-Eloi, CHU de Montpellier, 80, avenue Augustin Fliche, F-34295 Montpellier, France 2. Université Montpellier I, Service d’Immuno-Rhumatologie, Hôpital Lapeyronie, CHU de Montpellier, 371 avenue du Doyen Gaston Giraud, F-34090 Montpellier, France 3. Université Montpellier I, Service d’Anatomo-pathologie, Hôpital Gui de Chauliac, CHU de Montpellier, 80 avenue Augustin Fliche, F-34295 Montpellier, France

Solitary sclerotic fibroma of the skin: a possible clue for Cowden syndrome

ejd.2012.1655 Auteur(s) : Charlotte Pernet1,2, Luc Durand2, Didier Bessis1, Bernard Guillot1, Olivier Dereure1 o-dereure@chu-montpellier.fr 1 Department of Dermatology 2 Laboratory of Pathology University of Montpellier I, Hopital Saint-Eloi, 80 avenue Augustin Fliche, 34295 Montpellier Cedex 5, France Sclerotic fibroma (SF) or storiform collagenoma of the skin is a rare subset of dermal fibroma that may occur either as a solitary sporadic nodule in healthy individuals, or as solitary or multiple nodule(s) [...]

Malformations capillaires associées à un angiome caverneux cérébral

Resume Introduction Les malformations capillaires a type de telangiectasies hereditaires benignes constituent une affection familiale, de transmission autosomique dominante, caracterisee par la survenue progressive de telangiectasies cutanees au cours de la petite enfance. L’association a des malformations vasculaires cutanees, arterioveineuses ou lymphatiques, est exceptionnelle et de description recente. Nous rapportons la premiere observation de malformations capillaires a type de telangiectasies hereditaires benignes associees a une malformation vasculaire cerebrale. Observation Une enfant de 5 ans etait vue en consultation pour des macules erythemateuses disseminees, telangiectasiques pour la plupart, congenitales et acquises apres l’âge de 1 an. Ses antecedents etaient marques par une hemorragie cerebrale temporale droite survenue a l’âge de 4 ans, revelant une malformation vasculaire a type de cavernome temporal droit. Les antecedents de macules telangiectasiques familiales et l’examen clinique et histologique permettait de porter le diagnostic de telangiectasies hereditaires benignes. Commentaires Cette observation remet en cause le caractere exclusivement cutane des malformations capillaires de type telangiectasies hereditaires benignes. Elle illustre par ailleurs la possibilite d’une forme clinique particuliere de cette affection associant des telangiectasies typiques et des macules a type d’angiomes plans. La recente localisation du locus implique dans cette affection en 5q14, dans le meme intervalle chromosomique que le locus CMC1 incrimine dans les malformations capillaires familiales, laisse supposer que ces deux affections constituent en fait des variations phenotypiques d’une seule et meme entite clinique.