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Cutaneous extravascular necrotizing granuloma (CENG) about a case
Posters - Miscellutteous
developed typical lesions on her tongue and buccal mucosa with a lacy white pattern. There were no erosions. Clinically, the lesions on the patient’s neck were similar to lichen striatus or lichenoid epidermal nevus, a variant of linear verrucous epidermal nevus. However, the histologic features and the fact that later in the course of her disease the patient developed typical LP of the oral mucosa suggest that this patient has the rare condition of linear LP. I P278
Cutaneous extravascular necrotizing granuloma (CENG) about a case
L. Cartron. H. Adamski, .I. Chevrant-Breton, E Le Gall, G. Chales. Hospital Pontchaillott Rettttes, France A 22 year-old female presented in June 1995 with a diffuse subacute polyarthritis, erythematoviolaceous papules of the elbow and a violaceous plaque on a burn scar of the left thigh. Histology showed a deep dermal palisading granuloma with central inhomogen necrobiotic collagen surrounded by neutrophils sometimes leukocytoclastic, and lymphohistiocytes. The ESR was 100 mmlhr. No evidence of sarcoidosis. Crohn disease or connective tissue disease was discovered. Rheumatoid arthritis was ruled out on the clinical features, seronegativity and aspecific synovial histology. A lymphopathy was suspected on blood and skin molecular biology but this result was not confirmed later Treatment with PLAQUENIL* and N S.A.I. drugs was first eflicient (on the skin and joint symptoms) but in November 1996. arthralgias reappared after an hepatitis B vaccination. The skin lesions were stable but became chalazodermic on the thigh. Discussion: Our case can be integrated into the CENG which has many clinical aspects but its histology is well defined. It can precede for many years various pathologies such as infection, myelo proliferative disease or connective tissue disease References 1I] Long D et al. J Am Acad Dermatol, 1996. 34, 957-961 I P279
A systematic approach to the specific dermatoses of pregnancy
S. Hern, C.F. Alves, S.A. Vaughan Jones, M.M. Black. St Johtt :s Institute SEI 7EH. UK
of Dertttalology,
St Thotnas
’ Hospital,
London,
The specific dermatoses of pregnancy are a group of inflammatory dermatoses occurring only in the pregnant state. Prior to 1982, the terminology had become increasingly confused. However, in 1982. Holmes and Black proposed an updated classification, subdividing this group into 4 main categories: pemphigoid (herpes) gestationis; polymorphic eruption of pregnancy (PEP); prurigo of pregnancy and pruritic folliculitis of pregnancy. In addition to these specific dermatoses, other common skin disorders such as acne, eczema and psoriasis can also occur in pregnancy and may mimic the above conditions. Therefore a systematic approach is important to diagnose and differentiate those conditions specific to pregnancy from other more common diagnoses. Also, apart from pemphigoid gestationis, no reliable laboratory criteria exist to differentiate these disorders, thus making clinical differentiation additionally important.
S2-51
One method of differentiating this group is to categorize patients according to parity, gestation at presentation, distribution of lesions and clinical appearance. For example, PEP occurs more frequently in the third trimester and in primiparous women. However, eczema occurs with equal frequency in all three trimesters, with a high prevalence of atopy. In these individuals where the diagnosis is still not apparent then laboratory investigations may help to clarify the situation. These can include blood tests to obtain sera for indirect immunofluorescence which may be positive in, for example, pemphigoid gestationis. Skin biopsies may also be useful and can be submitted for both histology and direct immunofluorescence depending on the clinical picture. We discuss in detail a systematic, algorithmic approach and indicate where laboratory investigations may be of additional benefit in diagnosing and differentiating these conditions. ElP280
Granuloma faciale: Clinical type of the granuloma annulare
M. Matid’, M. PoljaEki’, N. VuEkovi@. ‘Clinicalcenrer; Dermatovenereological Ittsriture of pathology,
Clinic, Novi Sad; 2Clinical Novi Sad, Yugoslavia
center;
Granuloma faciale is a rear, benign skin disease, of the unknown etiology, characterized by the appearance of the single or multiple skin changes of the macular, papular, nodular or plaque type, localized on the face. The disease is more common in middle age males. It usually begins with slowly growing macules, brownish-red to purple in color, which are slowly elevated, do not ulcerate, and are resistant to therapy. Spontaneous regression is rear. We are presenting a case of a 38 year-old, female patient with 2 asimptomatic skin changes of annular appearance, brown red in color, with an accentuated and slightly elevated border, 1.5 x 2-cm in size, localized on the face on the right cheek. Skin changes first appeared 3 years ago, as a nodule of the size of a pepper seed slowly growing, and with a central depression of the skin changes after 2 years. All laboratory findings were within normal values, without eosinofilia. and antinuclear antibodies were negative. Histological analysis of the skin specimen showed a moderately dense, polimorlic cell infiltrate in papillary and reticular dermis, a gnmz zone stretching towards epidermis and around adneksal organs and, in some places signs of vasculitis. After applied therapy (Dapson tbl a 100 mg/day during 4 months), regression of skin changes was noticed, but relapse occurred 2 months after the therapy was discontinuitated. I P281 Alcohol and cutaneous manifestations C. Diaz, M. Cucurell, J.G. Camarasa. Department of Dertnatology, Barcelona,
Hospital Spain
del Mar;
Universitar
Auronoma,
Alchol ,abuse produce a wide spectrum .of diseases. The ,organ skin also suffer from alcohol intoxication. Jaundice, vascular changes: palmar erythema, spider nevus. pseudo-Gushing syndrome, lichen simplex, prtuigo nodularis, Terry’s nail, porphyria cutanea tarda, urticaria, vasculitis, lichen planus,~n~crolytic migratory erythema, necrolytic acml erytema, scuruy,, pellagra,
developed typical lesions on her tongue and buccal mucosa with a lacy white pattern. There were no erosions. Clinically, the lesions on the patient’s neck were similar to lichen striatus or lichenoid epidermal nevus, a variant of linear verrucous epidermal nevus. However, the histologic features and the fact that later in the course of her disease the patient developed typical LP of the oral mucosa suggest that this patient has the rare condition of linear LP. I P278
Cutaneous extravascular necrotizing granuloma (CENG) about a case
L. Cartron. H. Adamski, .I. Chevrant-Breton, E Le Gall, G. Chales. Hospital Pontchaillott Rettttes, France A 22 year-old female presented in June 1995 with a diffuse subacute polyarthritis, erythematoviolaceous papules of the elbow and a violaceous plaque on a burn scar of the left thigh. Histology showed a deep dermal palisading granuloma with central inhomogen necrobiotic collagen surrounded by neutrophils sometimes leukocytoclastic, and lymphohistiocytes. The ESR was 100 mmlhr. No evidence of sarcoidosis. Crohn disease or connective tissue disease was discovered. Rheumatoid arthritis was ruled out on the clinical features, seronegativity and aspecific synovial histology. A lymphopathy was suspected on blood and skin molecular biology but this result was not confirmed later Treatment with PLAQUENIL* and N S.A.I. drugs was first eflicient (on the skin and joint symptoms) but in November 1996. arthralgias reappared after an hepatitis B vaccination. The skin lesions were stable but became chalazodermic on the thigh. Discussion: Our case can be integrated into the CENG which has many clinical aspects but its histology is well defined. It can precede for many years various pathologies such as infection, myelo proliferative disease or connective tissue disease References 1I] Long D et al. J Am Acad Dermatol, 1996. 34, 957-961 I P279
A systematic approach to the specific dermatoses of pregnancy
S. Hern, C.F. Alves, S.A. Vaughan Jones, M.M. Black. St Johtt :s Institute SEI 7EH. UK
of Dertttalology,
St Thotnas
’ Hospital,
London,
The specific dermatoses of pregnancy are a group of inflammatory dermatoses occurring only in the pregnant state. Prior to 1982, the terminology had become increasingly confused. However, in 1982. Holmes and Black proposed an updated classification, subdividing this group into 4 main categories: pemphigoid (herpes) gestationis; polymorphic eruption of pregnancy (PEP); prurigo of pregnancy and pruritic folliculitis of pregnancy. In addition to these specific dermatoses, other common skin disorders such as acne, eczema and psoriasis can also occur in pregnancy and may mimic the above conditions. Therefore a systematic approach is important to diagnose and differentiate those conditions specific to pregnancy from other more common diagnoses. Also, apart from pemphigoid gestationis, no reliable laboratory criteria exist to differentiate these disorders, thus making clinical differentiation additionally important.
S2-51
One method of differentiating this group is to categorize patients according to parity, gestation at presentation, distribution of lesions and clinical appearance. For example, PEP occurs more frequently in the third trimester and in primiparous women. However, eczema occurs with equal frequency in all three trimesters, with a high prevalence of atopy. In these individuals where the diagnosis is still not apparent then laboratory investigations may help to clarify the situation. These can include blood tests to obtain sera for indirect immunofluorescence which may be positive in, for example, pemphigoid gestationis. Skin biopsies may also be useful and can be submitted for both histology and direct immunofluorescence depending on the clinical picture. We discuss in detail a systematic, algorithmic approach and indicate where laboratory investigations may be of additional benefit in diagnosing and differentiating these conditions. ElP280
Granuloma faciale: Clinical type of the granuloma annulare
M. Matid’, M. PoljaEki’, N. VuEkovi@. ‘Clinicalcenrer; Dermatovenereological Ittsriture of pathology,
Clinic, Novi Sad; 2Clinical Novi Sad, Yugoslavia
center;
Granuloma faciale is a rear, benign skin disease, of the unknown etiology, characterized by the appearance of the single or multiple skin changes of the macular, papular, nodular or plaque type, localized on the face. The disease is more common in middle age males. It usually begins with slowly growing macules, brownish-red to purple in color, which are slowly elevated, do not ulcerate, and are resistant to therapy. Spontaneous regression is rear. We are presenting a case of a 38 year-old, female patient with 2 asimptomatic skin changes of annular appearance, brown red in color, with an accentuated and slightly elevated border, 1.5 x 2-cm in size, localized on the face on the right cheek. Skin changes first appeared 3 years ago, as a nodule of the size of a pepper seed slowly growing, and with a central depression of the skin changes after 2 years. All laboratory findings were within normal values, without eosinofilia. and antinuclear antibodies were negative. Histological analysis of the skin specimen showed a moderately dense, polimorlic cell infiltrate in papillary and reticular dermis, a gnmz zone stretching towards epidermis and around adneksal organs and, in some places signs of vasculitis. After applied therapy (Dapson tbl a 100 mg/day during 4 months), regression of skin changes was noticed, but relapse occurred 2 months after the therapy was discontinuitated. I P281 Alcohol and cutaneous manifestations C. Diaz, M. Cucurell, J.G. Camarasa. Department of Dertnatology, Barcelona,
Hospital Spain
del Mar;
Universitar
Auronoma,
Alchol ,abuse produce a wide spectrum .of diseases. The ,organ skin also suffer from alcohol intoxication. Jaundice, vascular changes: palmar erythema, spider nevus. pseudo-Gushing syndrome, lichen simplex, prtuigo nodularis, Terry’s nail, porphyria cutanea tarda, urticaria, vasculitis, lichen planus,~n~crolytic migratory erythema, necrolytic acml erytema, scuruy,, pellagra,