Wen-Yuan Zhu

DETECTION WITH THE POLYMERASE CHAIN REACTION OF HUMAN PAPILLOMAVIRUS DNA IN CONDYLOMATA ACUMINATA TREATED WITH CO2 LASER AND MICROWAVE

Background. The recurrence rates of condyloma acuminata are high. The reasons for the relatively high relapse rates with different treatments are unknown.

A clinical analysis of 58 chinese cases of pigmented fungiform papillae of the tongue

Backgroundu2002 Pigmented fungiform papillae of the tongue (PFPT) is a disorder in which the fungiform papillae of the tongue have abnormal coloration. However, Chinese‐specific clinical data for PFPT are lacking.

Recall urticaria related to levofloxacin

Two cases of RU to Levofloxacin are herein reported. Case 1: A 31-year-old male driver had intermittent urticarial reactions confined to the wrist of previous injection site for more than 2 years. He had an intravenous injection of Levofloxacin on his right wrist thrice successively in 2003. There were no localized or generalized pruritus or eruptions until evanescent hives presented about once per month 40 days after initial injection. During the following 2 years, he had to take Norfloxacin capsules to treat respiratory tract infection and diarrhoea as had been prescribed. An hour after intake, weals presented circumscribed to the sites of previous subcutaneous injection area for Levofloxacin. There was no other noticeable triggering factor for the remaining 21 attacks. Antihistamine drugs had an improvement for the clearing of hives, but no influence on its recurring. On examination, a solitary oval weal was noted on the right wrist, of which the centre was affirmed to be injection site by the patient. Localized hyperpigmentation was not obvious (fig. 1). Histology of the lesions revealed oedema of the superficial layer. Perivascular mononuclear cells infiltration and dilation of the small blood vessels were noted (fig. 2). Case 2: A 37-year-old female presented with a 9-week recurrence of hives on her right wrist. She had an intravenous injection of Levofloxacin twice daily for 2 days on the right wrist at her own request for the treatment of upper respiratory infection 3 months before. Two weeks after, episodes of weal occurred on the injection site and lasted for several hours, with intervals of 2 to 4 days. There was no residue hyperpigmentation. The patient denied any history of medication prior to the first attack of urticaria. There were no indications of other precipitants. On examination, the patient had urticarial weal on her right wrist. Skin biopsy revealed similar changes as the previous one. Antihistamine drugs seem to have no effect on recurrence. A diagnosis of RU was finally made with two cases. Most of the patients with RU were adult with an average onset age of 29 years. 2–7 Prevalence of RU seems to be related to immunological therapy or injection of polypeptides. Cases induced by low molecular weight drugs, as herein shown, have not been documented yet. RU can be induced when the same or similarly structured drugs or antigen is introduced through intravenous injection, intramuscular injection or intake of it. Pathologically, it is characterized with perivascular mononuclear cell infiltration. 7 In the male patient, we reported that two of the successive RU attacks can be ascribe to Norfloxacin, which has a similar structure with the initial offending drug, indicating there is cross-sensitivity in the pathogenesis of RU. Our cases had recurring weal confined to the area that had an injection previously, from which it can be easily differentiated from other forms of recall phenomenon fig. 1 A solitary oval weal was noted on the wrist, of which the centre was affirmed to be the injection site by the patient. Localised hyperpigmentation was not obvious.

Spectrum of dermoscopic patterns in lichen planus: a case series from China.

Background: Dermoscopy has been shown to be a promising method to facilitate the diagnosis of lichen planus (LP) outside of China. Objective: To investigate the spectrum of dermoscopic patterns in Chinese LP patients. Methods: The clinical data and dermoscopic patterns of nine LP cases with a total of 43 lesions were evaluated. Results: To the naked eye, 20.97% of the lesions exhibited graying Wickham striae (WS); however, 37.5% presented with white streaks of annular, reticular, or leaf venation patterns under dermoscopy. Blue-white veils were occasionally observed in the center. Pigment patterns varied from dots, globules, and peppered pigment to pigmented lines, which were unrelated to the pigment network of the skin. At the periphery of the WS, red fine lines ran parallel to the delicate white streaming lines. Conclusions: WS exhibits five morphological patterns (leaf venation, reticular, white dots, circular and radial streaming) and three color patterns (homogeneous crystalline white, blue-white veil and yellowish-white). The pigment patterns consisted of dots/globules, peppered pigments and pigment. streaming lines.

Papular elastorrhexis located on occipito-cervical and mandibular regions

Auteur(s) : Cheng Tan1, Wen-Yuan Zhu2, Zhong Sheng Min1 1Department ofxa0Dermatology, first Affiliated Hospital ofxa0Nanjing University ofxa0TCM, HanZhong Road, Jiang Su Province, Nanjing, China, 210029 2Department ofxa0Dermatology, first Affiliated Hospital ofxa0Nanjing Medical University, GuangZhou Road, Jiang Su Province, Nanjing, China Papular elastorrhexis (PE) is characterized by non-follicular white papules distributed predominantly over the trunk and extremities [1]. The [...]

A Case of Recurrent Eruptive Pseudoangiomatosis That Responded Well to Pimecrolimus 1% Cream

Eruptive pseudoangiomatosis (EPA) is a benign, asymptomatic and self-resolving disorder that is characterized by the sudden appearance of angiomatous-like papules [1, 2] . The consensus that EPA preferentially affects children had not been queried until Navarro et al. [3] reported their first adult case in 2000. We herein report a frequently relapsing adult case that was successfully controlled with pimecrolimus 1% cream. A 69-year-old Chinese female complained of angiomatous papules on the face and the dorsal surfaces of her hands. The lesions had first appeared on the face and the extensor surface of the hands 6 months earlier, however they had not been accompanied by a high fever or other prodromal symptoms. Since then, similar lesions had relapsed at the same site after a quiescent period of approximately 10 days. Each occurrence lasted 12–18 days, and occurred without sequelae. There was no itching or other abnormal sensations, nor were there urticaria, purpura, ulceration, papulovesicle or overlying scales. The patient was otherwise well and she denied a previous history of insect bites or drug use. Previous treatment with oral citirizine tablets had been unsuccessful and had not prevented relapses. On examination, angiomatous papules with diameters of between 2 and 5 mm were noted on the face and dorsal surfaces of the hands. Scales, ulcerations and crusts were not observed ( fig. 1, 2 ). There were no similar lesions on other parts of the body. The red papules blanched completely with pressure and rapidly refilled from the center after release. Analyses of the lymph nodes, spleen and liver revealed no abnormalities. Routine laboratory tests were normal, and serological testing for echovirus, cytomegalovirus, parvovirus B19, hepatitis B and C viruses and human immunodeficiency virus were all negative. Autoantibodies and a serial of tumor markers (AFP, CEA, FER, 2Mg, CA50, CA125) were all in normal ranges. A skin biopsy revealed diPublished online: December 5, 2008

Hirsutoid papillomas of vulvae: Absences of human papilloma virus (HPV) DNA by the polymerase chain reaction

We have analyzed the specimens from 16 women with hirsutoid papillomas of the vulvae for the presence of HPV DNA using the polymerase chain reaction. The subjects ages ranged from 27 to 43 years. In all cases, smooth or filiform papules were symmetrically located on the inner surface of both labia minora. Histologically, the lesions consist of acanthosis or papillomatosis without koilocytes and mitotic activity. Eight of 16 specimens were studied by transmission electron microscopy (TEM). No HPV granules were found in the nuclei of keratinocytes. HPV DNA could not be detected in all specimens. Positive controls were present in each assay. These results suggest that the papules of hirsutoid papillomas of the vulvae are unrelated to HPV. Chronic irritants and inflammation may play an important role in pathogenesis.

A case of patchy alopecia areata sparing lesional greying hairs

A case of patchy alopecia areata sparing lesional greying hairs Alopecia areata (AA) is a sudden appearance of round or oval patches of nonscarring hair loss with spontaneous remissions. The involved skin is usually smooth and almost always totally devoid of hair. 1 Patchy AA sparing lesional graying hairs as we herein report is a rare demonstration. A 45-year-old Chinese man presented with a 1 week history of patchy alopecia on the scalp. His hair had formally been black and mingled with a few white hairs (no more than 5% of the total). He stated that it had been 1 week before this sudden loss of pigmented hair on the scalp appeared, and it ultimately formed a round, nontotally balding patch sparing lesional graying hairs. There was no accompanied itching or other abnormal sensation. He had no medical problems and was not taking any medications or applying any topical agents. He also denied any previous trauma or stress. There was no family history of AA or vitiligo. On physical examination, a round, well-defined alopecic patch presented on the vertex of the scalp with a diameter of about 5 cm. Some graying hairs were randomly distributed among the balding patch, which showed the similar diameter and length with neighboring unshedding pigmented hairs. A few pigmented hairs on the peripheral patch could be pulled out easily, while the remaining white hairs among the lesion were firmly attached. There were a few scattered pigmented “exclamation point” hairs within the alopecic patch (Fig. 1a,b). The nails and skin of other part of the scalp showed no abnormalities. Microscopic examination of a few lesional graying hairs and normal pigmented hairs revealed identical appearance, with the exception of the hair pigment. The pigment was distributed evenly over cortex and medulla in the dark hair, and the white hairs were transparent, with no pigment in the medulla. Skin biopsy was not performed without approval of the patient. Blood test of treponema pallidum haemagglutination (TPHA), triiodothyronine (T 3 ), thyroxine (T 4 ) and thyroid stimulating hormone (TSH) were normal. Regrowth hairs were not observed with a year’s topical application of 2% minoxidil. AA is a type of hair loss that clinically presents as a round or oval, totally bald, smooth patch involving the scalp or any hair-bearing area on the body. It can be subcategorized clinically as patchy AA, reticular AA, ophiasis band-like AA, ophiasis inversus, diffuse AA, AA totalis and AA universalis. 2

Confluent and reticulated papillomatosis manifested as vertically rippled and keratotic plaques

Confluent and reticulated papillomatosis (CRP) is a rare dermatosis of uncertain etiology that preferentially affects young adults. Eruptions usually present as grayish brown, flat elevated, keratotic papules and plaques that are confluent centrally and reticulated peripherally. It most commonly involves the intermammary and epigastric regions. We reported a young boy of CRP manifesting vertically rippled and keratotic streaks on his trunk. n nAn 18-year-old boy was admitted to our dermatology department with vertically rippled and keratotic eruptions on the trunk. Two years ago, the patient noticed light brown and rippled streaks on his epigastric area. It became abruptly spreading on the chest, the back and waist during recent 6 months. There were no itching or other complaints. His past medical history was noncontributory. At the time of our observation, his height and weight were 170 cm and 89 kg, respectively, with a body mass index equal to 30.8 kg/m2 (normal value < 25 kg/m2). Cutaneous examination showed brownish-black, vertically rippled and keratotic streaks involving his abdomen and the waist. In addition, red papules and plaques were seen around the axilla and antecubital fossae (Figures 1 and u200band2).2). An unstained specimen and culture of fine scale obtained from skin scrapings was negative. No fluorescence was observed in the affected skin under a Wood light examination. The biopsy specimens taken from the epigastric region revealed slight basket-weave hyperkeratosis, squat papillomatosis and a slight perivascular mononuclear infiltration in the upper dermis (Figure 3). Amyloid deposition was not identified with Congo red stain. The results of the laboratory evaluation and chemistry profile were within normal limits, and no endocrine imbalance including diabetes mellitus was detected. n n n nFigure 1 n nMost of the lesions were present on the abdomen and the waist n n n n n nFigure 2 n nThe lesions were brownish-black keratotic streaks that rippled vertically n n n n n nFigure 3 n nSlight basket-weave hyperkeratosis, squat papillomatosis and a slight perivascular mononuclear infiltration in the upper dermis (H + E 100×) n n n nThe diagnosis of CRP was finally made on the basis of supportive histology and characteristic clinical features except its rippled appearance. We initiated treatment with Calcipotriol cream twice daily for 2 months. There was no improvement, and treatment was switched to isotretinoin with an initial dose of 30 mg on alternate days. In the 3rd month of follow-up, partial flattening and fading of the lesions was observed. Complete resolution was still not obtained at the time of the 5th month and the patient was unwilling to accept any further treatment. n nConfluent and reticulated papillomatosis is an uncommon skin disorder initially described by Gougerot and Carteaud in 1932 [1]. The disease begins in the late teens or early twenties, and has been reported worldwide and in all racial groups. n nThe lesions typically begin as round, flat-topped, sharply defined red or brown papules that can become hyperkeratotic and verrucous. It spreads centrifugally, leading to confluent lesions in the center and reticulated ones at the periphery. It can also manifest as atrophic macules with a shiny quality or with surface change resembling cigarette paper. The most common sites of involvement are the inframammary area, breasts, axillae, neck, abdomen, interscapular area and inguinal region. Rarely, CRP develops at the other sites, such as the knee, elbow, hand, and antecubital and popliteal fossae. Eruptions in CRP are usually asymptomatic, but mild pruritic ones had also been described. Rarely CRP can manifest as rippled reticulated erythema in Caucasians [2, 3]. In our case, the eruption initially consisted of confluent, flat, brown papules localized primarily in the epigastric area with a subsequent spread to the waist. Most lesions were vertically rippled. To the best of my knowledge, this is the second CRP case manifesting as rippled streaks and the first non-Caucasian one as well. Skin biopsy in CRP showed hyperkeratosis, slight papillomatosis with acanthosis, with few inflammatory cells infiltration in the dermis. A acid-Schiff stain is predicted to be negative [1, 3]. Electron microscopic study revealed that increased melanin pigmentation in CRP is resulted from increased melanosomes present in the hyperkeratotic horny layer [4]. Our patient met these criteria with the exception of its rippling appearance. n nThe differential diagnosis for our patient was wide and included acanthosis nigricans, Prurigo pigmentosa, Dariers disease, tinea versicolor and amyloidosis etc. [1, 5]. Acanthosis nigricans was not favored due to lack of histologic evidence of papillomatosis resulting from the upward projection of finger-like dermal papillae which are covered by thinned epidermis. Prurigo pigmentosa can be excluded due to the lack of histological evidence for vacuolar alteration, dyskeratotic cells or a lichenoid infiltrate of lymphocytes. Dariers disease was ruled out due to the lack of suprabasal acantholysis and dyskeratotic cells. Tinea versicolor was unlikely considering its absence of organisms on KOH examination and Periodic acid-Schiff (PAS) staining. Macular amyloidosis was not possible without pathological signs of amyloid deposits. n nThe etiology and pathogenesis of CRP are not precisely known. Several theories for the cause of CRP have been suggested, including hereditary predisposition, exposure to ultraviolet, endocrine imbalances, disturbance of keratinization and infection of the skin with Pityrosporum ovale or other fungal [2]. As far our patient is concerned, no triggering factor had been hitherto identified. n nConfluent and reticulated papillomatosis can be recalcitrant to present therapies, including salicylic acid, topical or systemic steroids, vitamin D3 analogues, vitamin A derivatives, selenium sulfide, liquid nitrogen, progesterone, coal tar, dermabrasion, hydroquinone, phototherapy, 5-fluorouracil, thyroid extracts, anti-fungal agents, and antibiotics such as minocycline. However, we observed a marked improvement with the administration of isotretinoin for a period of 5 months. n nConfluent and reticulated papillomatosis might present with rippled keratotic streaks, and every dermatologist should be aware of such rare demonstrations.

Lichen planus runs along cutaneous superficial veins on the forearms : supravenous lichen planus?

References 1 Kamp H, Tietz H-J, Lutz M, et al. Antifungal effect of 5-amilolevulinic acid PDT in Trichophyton rubrum. Mycoses 2005; 48: 101–107. 2 Smijs TGM, Bouwstra JA, Schuitmaker HJ, Talebi M, Pavel S. A novel ex vivo skin model to study the susceptibility of the dermatophyte Trichophyton rubrum to photodynamic therapy in different growth phases. J Antimicrobial Chemotherapy 2007; 59: 433–440. 3 Calzavara PG, Pinton Venturini M, Sala R. A comprehensive overview of photodynamic therapy in the treatment of superficial fungal infections of the skin. J Photochem Photobiol B Biol 2005; 78: 1–6. 4 Donelly RF, McCarron PA, Tunney MM. Antifungal photodynamic therapy. Microbiol Res 2008; 163: 1–12. 5 Smijs TGM, Schuitmaker HJ. Photodynamic inactivation of the dermatophyte Trichophyton rubrum. Photochem Photobiol 2003; 77: 556–560.