Soo Il Chun

Kimura's disease and angiolymphoid hyperplasia with eosinophilia: Clinical and histopathologic differences

BACKGROUND There has been considerable controversy about the relation between Kimuras disease and angiolymphoid hyperplasia with eosinophilia (ALHE). OBJECTIVE We describe the clinical and histopathologic differences between the two diseases. METHODS We reviewed clinical findings and histopathologic changes in two cases of Kimuras disease and three cases of ALHE. RESULTS Kimuras disease shows typical lymphoid follicles. It is associated with lymphadenopathy and is always accompanied by peripheral eosinophilia. ALHE shows typical changes in endothelial cells. It is characterized by superficial papules or nodules with no lymphadenopathy and is less frequently accompanied by peripheral eosinophilia. CONCLUSION Kimuras disease and ALHE are separate entities.

Histopathologic study of cutaneous lesions in Behçet's syndrome.

Light microscopic studies of 55 patients with complete and incomplete types of Behçets syndrome were reviewed. We reported here 39 skin biopsies from 30 patients with cutaneous lesions of oral, and genital ulcers, folliculitis, erythema multiforme, and thrombophlebitis.

Generalized anhidrosis associated with Fabry's disease

A 28-year-old Korean man suffered from generalized acquired anhidrosis and heat intolerance that were confirmed by a sweat test. Other clinical features consistent with Fabrys disease were fever and severe pain of the lower extremities and leg edema. Although the patients lacked cutaneous angiokeratomas, ultrastructural studies of the normal skin demonstrated diagnostic intracytoplasmic inclusions in the endothelial cells and pericytes of dermal vessels, fibroblasts, perineural cells, and secretory cells of eccrine glands. alpha-Galactosidase assay of the patients leukocytes showed markedly decreased activity, which confirms the diagnosis.

Acquired cutis laxa associated with chronic urticaria

A 31-year-old man had cutis laxa after an urticarial eruption. He had no systemic manifestations. In urticarial lesions, elastolysis occurred only within the inflammatory infiltrate of neutrophils around the vessels and between the collagen bundles. In lax skin, elastolysis occurred throughout the entire dermis. Electron microscopic study showed a markedly decreased number of elastic fibers, with elastolysis most predominant near the inflammatory cells. These findings suggest that the neutrophil plays a significant role in the destruction of elastic fibers and subsequent development of cutis laxa.

Membranous lipodystrophy: Secondary type

BACKGROUND A peculiar type of fat necrosis was noted in some patients with various skin diseases. OBJECTIVE We attempted to develop a classification of membranous lipodystrophy combining the results of our study and a review of other articles. METHODS Five cases of skin diseases with membranous lipodystrophy were studied and their clinical and histopathologic features were analyzed. Previous reports of similar findings were reviewed. RESULTS Membranous lipodystrophic changes were noted in morphea profunda, lupus panniculitis, and factitial ulcer. Microcysts were formed by the coalescence of the destroyed fat cells and were lined by amorphous, eosinophilic material. Some of the linings had a crenelated appearance. Microgranules were found in the histiocytes and in the hyalinized collagen stroma. The linings and microgranules stained positively with periodic acid-Schiff, were resistant to diastase, and also stained with Sudan black B. CONCLUSION We propose the use of the term secondary membranous lipodystrophy to describe the local subcutaneous membranous lipodystrophic change that occurs as a result of other skin diseases, in contrast to primary idiopathic membranous lipodystrophy, which occurs without any antecedent factors.

Treatment of Verruca plana with 5% 5-FIuorouraciI Ointment

11 patients with verruca plana were treated with 5% 5-Fluorouracil ointment as a twice daily topical application with open dressing. The patients were chosen among those who failed to be cured with avrious topical agents such as salicylic acid, vitamin A acid and dinitrochlorobenzene (DNCB), or even with carbon dioxide cryotherapy, oral administration of methotrexate and intramuscular injection of sodium cacodylate. In 9 patients, all the treated warts completely disappeared within 3--5 weeks. 2 of these patients had recurrence after 3 weeks and 2 months, respectively. In 2 patients, some lesions disppeared while others failed to be healed. The major clinical adverse reactions were hyperpigmentation (8 cases), erythema (5 cases) and erosion (5 cases).

Membranous lipodystrophy: Primary idiopathic type

A 20-year-old woman had a pea-sized, tender subcutaneous nodule on the leg. Histopathologically, the panniculus showed multiple microcysts lined by membranes and light brown granules in the histiocytes. Histochemical studies of the membranes of the microcysts and the granules in the histiocytes indicated that they were composed of ceroid. Electron microscopy revealed that the membrane of the microcyst was composed of electron-dense areas of a regular 18.6 nm lamellar array and reticulated vacuolated areas suggestive of degenerating fat cells of unknown origin. Membranous lipodystrophy has been associated with many local and systemic diseases, but it may be idiopathic, as in our patient.

Disseminated Epidermolytic Acanthoma with Disseminated Superficial Porokeratosis and Verruca Vulgaris in an Immunosuppressed Patient

A 40‐year‐old man who had received long term immunosuppressive treatment for 14 years following kidney transplantation developed multiple skin lesions on both antecubital fossae, scalp, and both lower extremities. Histopathologic findings from three skin regions revealed characteristic features of epidermolytic hyperkeratosis, verruca vulgaris, and disseminated superficial porokeratosis, respectively.

Therapeutic Effect of Dinitrochlorobenzene (DNCB) on Verruca Plana and Verruca Vulgaris

ABSTRACT: Fifty‐nine patients with verrucae (45 with verrucae plana and 14 with verrucae vulgaris) were treated with dinitrochlorobenzene (DNCB) as a topical application on the normal uninvolved skin of the shoulder for sensitization and challenge. The patients were sensitized with 0.5 ml of 0.4% DNCB solution and then challenged with 0.1% DNCB ointment twice a week. Six cases of verrucae plana and 1 case of verrucae vulgaris were completely cured by sensitization only and 32 cases of verrucae plana and 7 cases of verrucae vulgaris were completely resolved by repeated challenges. The therapeutic effect was better in verrucae plana (84.4%) than in verrucae vulgaris (57.1%), and the verrucae were completely resolved within 10 weeks in more than 90% of the patients cured by challenge. The side effects of DNCB were mild allergic contact dermatitis and slight transitory hyperpigmentation at the site of application.

Solitary sclerotic fibroma of the skin: degenerated sclerotic change of inflammatory conditions, especially folliculitis.

Two cases showing changes of sclerotic fibroma developed in association with an inflammatory process, especially folliculitis. The lesion in the first case showed a well-circumscribed, nonencapsulated nodule in the dermis, which consisted of a perifollicular fibrotic area and a peripheral sclerotic area. In addition to the usual findings of sclerotic fibroma, spindle cells were heavily infiltrated in a storiform and fascicular pattern around the degenerated hair follicle, suggestive of dermatofibroma. The lesion in the second case showed the typical findings of sclerotic fibroma in association with folliculitis and hair follicle remnants. Our observations suggest that solitary sclerotic fibroma of the skin may be a degenerated or sclerotic end stage of other fibrous conditions, such as dermatofibroma, and that it may be induced by inflammation, especially folliculitis.