Virginia I. Sulica

A double-blind evaluation of topical capsaicin in pruritic psoriasis

BACKGROUNDnSubstance P, an undecapeptide neurotransmitter, has been implicated in the pathophysiology of psoriasis and pruritus.nnnOBJECTIVEnSafety and efficacy of topical capsaicin, a potent substance P depletor, were evaluated in patients with pruritic psoriasis.nnnMETHODSnPatients applied capsaicin 0.025% cream (n = 98) or vehicle (n = 99) four times a day for 6 weeks in this double-blind study. Efficacy was based on a physicians global evaluation and a combined psoriasis severity score including scaling, thickness, erythema, and pruritus.nnnRESULTSnCapsaicin-treated patients demonstrated significantly greater improvement in global evaluation (p = 0.024 after 4 weeks and p = 0.030 after 6 weeks) and in pruritus relief (p = 0.002 and p = 0.060, respectively), as well as a significantly greater reduction in combined psoriasis severity scores (p = 0.030 and p = 0.036, respectively). The most frequently reported side effect in both treatment groups was a transient burning sensation at application sites.nnnCONCLUSIONnTopically applied capsaicin effectively treats pruritic psoriasis, a finding that supports a role for substance P in this disorder.

The nature of hyaline (eosinophilic) globules and vascular slits of Kaposi's sarcoma.

Ultrastructural studies of Kaposis sarcoma (KS) from skin biopsies of 24 patients (eight with acquired immunodeficiency syndrome (AIDS) and 16 without) were performed to delineate the nature of hyaline globules and vascular slits. These structures have been regarded as one of the important criteria for the recognition of KS under light microscopy. Histochemical and immunochemical studies were also performed to correlate with the electron microscopic (EM) observations. The most remarkable EM findings of KS were the intracytoplasmic lumen formation and erythrophagocytic activities of the neoplastic cells, particularly in the mature nodular, or neoplastic stage. The spindle-shaped or ovoid neoplastic cells frequently contained one to several intact and fragmented red blood cells. The intracellular and extravasated erythrocytes were often arranged in single files, giving these vascular slits an elongated appearance on longitudinal sections. The phagocytic activities of the neoplastic cells were demonstrated by the presence of membrane-bound lysosomes containing phagocytized erythrocytes and their partially digested forms (erythrophagosomes) adjacent to pinocytotic vesicles, prominent rough endoplasmic reticulum, and Golgi apparatus, as well as scattered, small, membrane-bound lysosomal granules, some of which were attached to the erythrophagosomes. The erythrophagosomes underwent various stages of disintegration. The partially digested red cells varied from 0.4 to 10 μm in diameter. The results of histochemical and immunochemical findings also strongly suggested that erythrophagosomes were most likely the hyaline globules (bodies) seen in light microscopy. The exact mechanism of erythrophagocytosis is uncertain. However, its consequences, erythrophagosomes, and intracytoplasmic lumen formation, particularly in the nodular or neoplastic stage in patients with and without AIDS, are among the important histologic features of KS.

Eccrine angiomatous hamartoma (nevus): immunohistochemical findings and review of the literature

Eccrine angiomatous hamartoma (nevus) is a rare form of congenital tumorous malformation with proliferation of eccrine secretory coils and duels, surrounding capillary angiomatous channels and occasionally oilier minor elements. To date, there have been only about 24 cases reported in the literature. We report an additional case with more detailed description of the microscopic Endings, including immunohistochemical observations. The patient was a 28‐year‐old female who presented with painless, flesh to reddish brown‐colored, violaceous or bluish subcutaneous nodules on the extremities and trunk. The tumors did not show sweating following exertion. The histologic features were comparable lo the previously reported cases. The hamartomatous eccrine sweat glands and duels and a few apocrine glands demonstrated qualitatively diminished antigens commonly found in the eccrine sweat apparatuses, such as carcinoembryonic antigen (CEA) and S–100 protein. The. findings of CD34, CD44, human nerve growth factor receptor and Ulex europacus antigens have not been previously reported. The histologic features suggested a “hamartomatous” growth rather than a true neoplastic process.

Squamous-cell carcinoma of the scalp arising in lesions of discoid lupus erythematosus.

Squamous-cell carcinoma may arise in scars of chronic discoid lupus erythematosus. Although there have been 19 cases reported previously, detailed histopathologic features of this entity have not been recorded. We report a patient with extensive chronic discoid lupus erythematosus involving the scalp with subsequent development of multiple squamous-cell carcinomas. The tumors were locally aggressive with recurrences and invasion into the underlying skull and dura. The patient died of respiratory failure 4 1/2 years after initial surgical treatment. There was no clinical evidence of metastasis. Squamous carcinoma arising in discoid lupus erythematosus can be regarded as a low-grade carcinoma. Although about 20% of patients developed local recurrences and metastasis developed in about 30%, fatality occurred in only two patients (10.5%). Pertinent literature is reviewed, and the histopathologic findings, differential diagnosis, and biologic behavior of this tumor are discussed.

Focal Acantholytic Dyskeratosis Occurring in Pityriasis Rubra Pilaris

Focal acantholytic dyskeratosis (FAD) is a distinctive histologic pattern characterized by suprabasilar clefts surrounding dermal papillae (villi), acantholytic and dyskeratotic cells at all levels of the epidermis, hyperkeratosis, and parakeratosis. The features of FAD are typically seen in Dariers disease, warty dyskeratoma, and transient acantholytic dermatosis; they are also present in a variety of cutaneous neoplastic and nonneoplastic lesions. FAD, however, has not been previously described in lesions of inflammatory dermatoses. We report a case of FAD occurring in lesions of pityriasis rubra pilaris (PRP). To the best of our knowledge, this is the first reported case of this kind. We also review the pertinent literature.

Double-blind comparison of naftifine cream and clotrimazole/betamethasone dipropionate cream in the treatment of tinea pedis

chenoid infiltrate of lymphocytes. Immunofluorescence examination of a perivesicular papule was characterized by numerous ovoid bodies scattered in the papillary dermis. These stained for IgM, IgG, and fibrinogen. IgG, C3, and fibrinogen were also deposited linearly along the dermoepidermal junction. Immunofluorescence studies on normal-appearing skin showed a strong linear band of IgG and C3 at the dermoepidermal junction without staining of colloid bodies. Serum and blister fluid were positive at a titer of 1:80 for basement membrane zone (BMZ) antibodies. A diagnosis ofLPP was made. She was initially treated with prednisone, 40 mg daily (1.5 mg/kg/day), with a good response, no new vesicles appeared and the papular lesions cleared. After 2 weeks circulating BMZ antibodies decreased to a titer of 1:20. The dosage of prednisone was reduced to 20 mg daily for 14 days and then discontinued. Topical fluorinated corticoids were administered for an additional month. At that time she had resolution of all lesions. Two months later, she had a relapse of LP, without blistering, on both ankles. At the time of relapse circulating BMZ antibodies were absent.

Cutaneous metastasis from a parotid adenocarcinoma. Report of a case with immunohistochemical findings and review of the literature.

We present a rare case of metastatic adenocarcinoma of the parotid gland to the skin. Reviewing the histologic features of the primary parotid gland and comparing the microscopic sections and immunohistochemical studies, we concluded the skin tumor to be metastases from the parotid adenocarcinoma. By histologic examination alone, it is difficult to distinguish an eccrine sweat gland carcinoma from a metastatic carcinoma of the salivary gland. Immunohistochemical analysis may not be conclusive. Therefore, clinical history and clinicopathologic correlation are essential in arriving at an accurate diagnosis in these cases.

Case Report: Kaposi’s Sarcoma in a Renal Transplant Patient Receiving Cyclosporine

A patient of Middle-Eastern descent developed Kaposis sarcoma of the skin and lymph nodes after renal transplantation while receiving medical immunosuppression, including the use of cyclosporine. The clinical presentation of this patient resembled that of the HTLV-III-associated Kaposis sarcoma. The tumors totally regressed seven weeks after cessation of immunotherapy. This case, along with other recently reported cases of Kaposis sarcoma in postrenal transplant patients receiving cyclosporine, illustrates a rare complication of current immunosuppressive therapy.

Generalized pediculosis corporis. Microscopic study of hairs

A case of generalized pediculosis corporis is presented. Microscopic study of sectioned hairs stained with hematoxylin and eosin and of hairs under polarized light allowed identification of larval content and eggs. The value of microscopic examination of hairs is shown.