Salah Salman

Cutaneous leishmaniasis: clinical features and diagnosis.

Leishmaniasis is a protozoan disease of multiple clinical manifestations, present in the Old and New Worlds. The disease is caused by more than 20 Leishmania species. The protozoa are transmitted to humans by the bite of the infected female sandflies belonging to genus Phlebotomus in the Old World and Lutzomyia in the New World. Around 30 species of sandflies are recognized as vectors. The reservoir hosts are usually certain domestic and wild animals. The relative tropism (visceral vs. dermal) of Leishmania organisms is used in the classic classification of the disease into cutaneous (the subject of this review), mucocutaneous, and visceral leishmaniasis. Although each of the Leishmania species may have its peculiar manifestations and areas of endemicity, yet none of the clinical manifestations is unique to a particular species because of considerable clinical diversity and overlap. This is because the clinical picture is dependent on determinants related to the infecting species of Leishmania and the host. These include infectivity, virulence of the parasite, extent of lymphatic and hematogenous spread in addition to immune response, and genetic susceptibility of the host.

Lichen planopilaris: A clinicopathologic study

Three clinicopathologic variants of lichen planopilaris are described. The first is characterized clinically by individual keratotic follicular papules and histologically by a lichenoid inflammatory cell infiltrate confined to the follicular epithelium. The second variant consists of erythematous to violaceous plaques, some of which show follicular prominence; the histologic appearance is that of a lichenoid inflammatory cell infiltrate that affects both follicular and interfollicular areas. The third variant manifests as follicular papules of the scalp with concomitant or subsequent cicatricial alopecia. In this variant the histologic hallmark is a lichenoid, follicular and interfollicular inflammation, associated with or followed by scarring. Overlap among the three variants exists, and hence the concept of a disease spectrum ranging from pure follicular involvement without evidence of clinical scarring to cicatricial alopecia of the scalp is advocated.

Actinic lichen planus. A clinicopathologic study of 16 patients.

The clinical and histopathologic features of actinic lichen planus in 16 patients were studied. The majority of the patients were young, and men and women were almost equally affected. The relative incidence of this condition, compared with the incidence of all forms of lichen planus, was smaller than that reported in the literature. The eruption was distributed over sun-exposed areas, with particular predilection for the face. Covered areas and mucous membranes were spared except for one patient who had involvement of the vermilion border of the lower lip. In most cases the lesions consisted of erythematous brownish plaques with an annular configuration. Less commonly, discrete and confluent papules and hypermelanotic patches, sometimes assuming a melasma-like appearance, were present. The prominent histopathologic features consisted of an interface dermatitis characterized by coarse vacuolar degeneration of the basal cell layer, a mid-dermal perivascular predominantly lymphocytic inflammatory cell infiltrate, and a significant degree of pigment incontinence. Parakeratosis, eczematous changes confined to the follicular epithelium, and a variable degree of solar elastosis were seen in some patients. Mucin deposition was noted in the reticular dermis in two cases.

Autoerythrocyte sensitization (Gardner-Diamond) syndrome.

Abstract: We describe the clinical presentation and course of a patient with autoerythrocyte sensitization (Gardner–Diamond) syndrome, and review the literature for similar cases. A 37‐yr‐old female presented with recurrent episodes of painful ecchymotic bruising over the anterior aspect of both thighs. These episodes were precipitated by emotional stress. The diagnosis was confirmed by induction of similar lesions by intradermal injection of the patients own washed red blood cells and hemoglobin. The lesions did not recur for 6 months after the cause of her emotional stress was relieved. Autoerythrocyte sensitization (Gardner–Diamond) syndrome should be considered in the differential diagnosis of purpura, especially in patients with psychiatric problems.

Actinic lichen planus mimicking melasma: A clinical and histopathologic study of three cases

Three cases of actinic lichen planus mimicking melasma are presented. Although the clinical similarity to melasma is striking, the histopathologic picture is distinctive. It is suggested that actinic lichen planus be considered in the differential diagnosis of melasma.

Vascular reactions in children

It has been estimated that 10–20% of the general population experiences an episode of urticaria during their lifetime.1 Urticaria is a common disease of childhood, and the incidence in children is reported to range between 2.4% and 8.3%.2 Chronic urticaria, defined arbitrarily as lesions present for longer than 6 weeks, develops in a variable proportion of patients ranging, from 5% to 30%. Between 42% and 50% of children with chronic urticaria continue to have symptoms for 1 year. Within the chronic category, it is suggested that children under the age of 8 years have a higher resolution rate.1,2

CHRONIC CUTANEOUS LEISHMANIASIS: LEISHMANIA PARASITES IN BLOOD

Two patients with chronic cutaneous leishmaniasis had positive blood cultures. The diagnosis was established by the clinical picture, skin biopsy, and culture for Leishmania major and tropica.

Localized involutional lipoatrophy with epidermal and dermal changes

Localized involutional lipoatrophy (LIL) was first described in 1986 as a distinctive idiopathic form of localized lipoatrophy characterized by loss of adipose tissue without antecedent inflammation. Clinically, LIL usually presents as a solitary, asymptomatic, well-demarcated, atrophic depression and often involves areas of antecedent intramuscular or intra-articular injections. Histologically, changes in the subcutaneous fat in LIL resemble fetal adipose tissue. Only rarely has there been any description of epidermal or dermal changes occurring with LIL. We describe two cases of LIL with overlying hypopigmentation and atrophy, and with morphea-like changes on histology. Recognition of these changes may have clinical and diagnostic implications.

Eosinophilic fasciitis terminating as progressive systemic sclerosis in a child.

A child with clinicopathological features of eosinophilic fasciitis terminated in progressive systemic sclerosis. The clinical and laboratory similarities and disparities between these two conditions are presented.

Linear bowenoid papulosis of the genitalia. A possible Koebner phenomenon.

A sexually active, circumcized, 40-year-old man was seen at the American University of Beirut-Medical Center in 1983 because of asymptomatic lesions over tbe penis. He denied any preceding penile eruption such as herpes simplex or condyloma acuminatum. There was no history of irradiation, trauma, or application of topical remedies including podophyllin to the affected area. There also was no history of arsenic ingestion. Physical examination revealed several 2-3 mm closely-set, discrete, blue-brown papules, arranged linearly over the dorsal aspect of the penile shaft, adjacent to the coronal sulcus (Fig. 1). A biopsy specimen displayed mild hyperkeratosis, epidermal hyperplasia with elongation, widening and anastomosis of the rete ridges (Fig. 2A). The hyperplastic epidermis was composed of keratinocytes showing various degrees of cellular atypia, loss of polarity, and individual cell keratinization (Fig. 2B). Few mitotic figures were present at various levels of the epidermis. The papillary dermis contained a mild degree of perivascular lymphocytic inflammatory cell infiltrate and melanophages. A clinicopatbologic correlation was done, and the diagnosis of bowenoid papulosis of the genitalia was made. A limited surgical excision of the lesions was done. Four years later, tbe lesions reappeared at the same site, however, they lacked the linear arrangement. A second biopsy specimen showed bistologic changes similar to those seen in the first.