Nicole M. Burkemper

Immunohistochemical differentiation of four benign eccrine tumors

Background:  The histogenesis and differentiation of eccrine tumors, including cylindroma, poroma, spiradenoma and syringoma, remains controversial. This controversy may be because of sporadic and incomplete studies of these neoplasms.

Cutaneous rosai-dorfman disease and morphea: coincidence or association?

Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is a rare disease. A third of patients with this disease have extranodal involvement affecting the skin. Of these individuals, only around 3% will have purely cutaneous Rosai-Dorfman disease, which is limited to skin manifestations without systemic involvement. Cutaneous (localized) scleroderma or morphea, on the other hand, is a more common disease that most often affects women of all ages. Both conditions have unknown etiologies. Presented here is a case of a 60-year-old white woman with cutaneous Rosai-Dorfman disease and coexisting morphea. Representative biopsies from both areas were performed: one showing a dermal S-100+ histiocytic infiltrate with emperipolesis and the other showing a deep perivascular and interstitial plasma cell infiltrate with dermal sclerosis and loss of perieccrine fat. A laboratory and radiologic workup revealed no evidence of systemic involvement by either entity. The diagnosis of coexisting cutaneous Rosai-Dorfman disease and morphea was established. To our knowledge, this is the first report of these 2 entities found simultaneously in 1 patient.

Cutaneous Fungal Infections in the Elderly

This article summarizes the common, superficial, cutaneous, fungal infections that are found in older adults. The epidemiology, classic appearance, and current treatments of these fungal infections are discussed. These common skin pathogens occur in many older adults.

Clinicopathologic Evaluation of Cardiofaciocutaneous Syndrome: Overcoming the Challenges of Diagnosing a Rare Genodermatosis

We report the case of a 2‐year‐old boy from a family with limited financial resources who presented with cutaneous abnormalities, a history of congenital heart defect, and a presumptive diagnosis of Noonan syndrome. Genetic testing had been deferred because of a lack of funds. Skin findings were characteristic of cardiofaciocutaneous syndrome, including keratosis pilaris, ichthyosis, sparse eyebrows, and multiple nevi. A biopsy of a perifollicular thick papule with background hyperpigmentation was obtained to further characterize the cutaneous findings. Clinical evaluation allowed rapid, cost‐effective, specific diagnosis in this patient with a RASopathy‐spectrum genetic disorder who did not have access to genetic testing. This time‐honored clinical approach is adequate for providing information important for prognosis, follow‐up, and counseling. We will also discuss available resources for genetic testing and specialized care for patients with RASopathies.

Cavernous hemangioma-like Kaposi sarcoma: a unique histopathologic variant.

Kaposi sarcoma (KS) is an angiolymphatic neoplasm with multifactorial etiology. Clinically, KS has been divided into 4 distinct types and 3 well-defined histologic stages. Rare reports in the literature have characterized additional unique histopathologic variants. The authors report a case of KS, confirmed with human herpesvirus type 8 and D2-40 staining, which resembled a cavernous hemangioma on histopathology.

Lichenoid reaction as a potential immune response marker of intratreatment histological response during successful vismodegib treatment for a giant basal cell carcinoma.

We report an 83 year‐old patient with a 13 × 7.5 cm2 basal cell carcinoma (BCC) successfully treated with the combination of vismodegib and minimal surgery. On Day 109, a 0.9 cm papule suspicious for residual BCC was seen centrally within a large pink atrophic plaque. This lesion was excised; pathology confirmed BCC with negative surgical margins. Simultaneously, suspecting noncontiguous histologic response, we performed 21 biopsies at the periphery of the pretreatment tumor location. Seventeen (17/21, 81%) revealed lichenoid dermatitis. No tumor was seen on any. We believe the lichenoid dermatitis observed is a novel finding for two reasons. First, it may be considered a marker of a positive intratreatment response. This may help guide clinicians on the optimal treatment duration of vismodegib to maximize efficacy and mitigate side effects. Second, we think it suggests an additional mechanism of vismodegib action, possibly via local immune effects. Further investigations are warranted.

Prominent follicular mucinosis with diffuse scalp alopecia resembling alopecia areata

A 56‐year‐old Caucasian female presented with a 2‐month history of alopecia. On examination, she had diffuse hair loss of her scalp with some discrete patches of nonscarring alopecia. Histopathology revealed an inflammatory nonscarring alopecia with prominent follicular mucinosis and findings suggestive of alopecia areata. The patients alopecia completely resolved with oral prednisone. The histopathologic findings and clinical presentation are most consistent with a diagnosis of alopecia areata with follicular mucinosis, although the differential diagnosis is broad. As follicular mucinosis may be associated with both benign and malignant conditions, it is important to be cautious regarding the clinical diagnosis when this reaction pattern is observed histopathologically.

The association of smoking with contact dermatitis and hand eczema – a review

Given the high prevalence of allergic contact dermatitis (ACD), irritant contact dermatitis (ICD), hand eczema (HE), and smoking, and the impact that smoking has on skin disease, the authors reviewed the existing literature to assess the association between smoking and contact dermatitis or hand eczema. Using the PubMed and SCOPUS databases, a literature search identified articles related to allergic contact dermatitis, irritant contact dermatitis, and hand eczema and a possible association with smoking. The search period included articles prior to and including April 2016. Seven of eight articles described a positive relationship between smoking and allergic or irritant contact dermatitis, while nine of nineteen articles found a positive association between smoking and hand eczema. Published studies document that smoking may be an important risk factor for both allergic and irritant contact dermatitis as well as hand eczema.

Methotrexate use in allergic contact dermatitis: a retrospective study: METHOTREXATE USE IN ALLERGIC CONTACT DERMATITIS

Methotrexate, a folate antimetabolite, is used to treat atopic dermatitis and psoriasis. Although methotrexates therapeutic efficacy has been noted in the literature, there are few data on the efficacy of methotrexate treatment for allergic contact dermatitis.

Ulcerative necrobiosis lipoidica in the setting of anti–tumor necrosis factor-α and hydroxychloroquine treatment for rheumatoid arthritis

NL: necrobiosis lipoidica RA: rheumatoid arthritis INTRODUCTION Necrobiosis lipoidica (NL) is a rare, chronic granulomatous disease that affects the dermis with collagen degeneration. It can be associated with several conditions including diabetes mellitus, sarcoidosis, rheumatoid arthritis (RA), inflammatory bowel disease, autoimmune thyroiditis, and monoclonal gammopathy. NL typically develops in the third to fourth decade of life with a slight female predominance. In about one-third of cases, ulceration can develop as a complication, which poses unique treatment challenges to providers, as it is often recalcitrant to treatment. The literature suggests that antietumor necrosis factor-a medications represent a promising therapeutic strategy for ulcerative disease. Here we present a case of ulcerative NL that developed in the setting of etanercept and hydroxychloroquine treatment, and subsequently re-epithelialized with aggressive local treatment and discontinuation of etanercept.