- Email: [email protected]
Multinucleate cell angiohistiocytoma
P6426
P6020
Multinucleate cell angiohistiocytoma Karina Ribeiro, MD, FTESM, S~ao Paulo, Brazil; Ana Paula Bucciaroni, MD, FTESM, S~ao Paulo, Brazil; Bruna Graziano, MD, FTESM, S~ao Paulo, Brazil; Gabriela Cezar, FTESM, S~ao Paulo, Brazil; Maria Cristina Camargo, FTESM, S~ao Paulo, Brazil; Ricardo Villa, FTESM, S~ao Paulo, Brazil; Sabrina Ribeiro, FTESM, S~ao Paulo, Brazil
Scleroderma-like reaction to red tattoo ink Jacqueline Fussell, MD, Geisinger Medical Center, Danville, PA, United States; Tammie Ferringer, MD, Geisinger Medical Center, Danville, PA, United States; Victor John Marks, MD, Geisinger Medical Center, Danville, PA, United States Background: Hypersensitivity reactions to tattoos are variable. They can occur immediately after tattooing up to decades later. The most commonly reported types of reactions are lichenoid, granulomatous, sarcoidal, eczematous, and pseudolymphomatous. Rarely have there been reports of scleroderma-like reactions. Case report: A 38-year-old man presented with tenderness and pruritus isolated to the red areas of a tattoo on his forearm. The black, red, and green skull had been tattooed at a professional tattoo parlor approximately 12 months before presentation. Pruritus started about 2 months after tattooing. The red areas of the tattoo then became warm, tender, and scaly. He was treated with oral clindamycin by his primary care physician due to concern for cellulitis, with no resolution of symptoms. He denied use of any topical medications to the area. At presentation, a punch biopsy of the affected area revealed features resembling lupus erythematosus, including interface dermatitis and follicular plugging but also deeper sclerodermoid features were noted. He was treated with intralesional triamcinolone acetonide 10 mg/mL and topical clobetasol 0.05% cream twice daily. At the 3-week follow-up, there was marked improvement of pruritus, tenderness, scaling, and erythema. Interestingly, he had no problem with previous red tattoos not performed at a professional tattoo parlor. Also, patient had no history or symptoms of scleroderma or other connective tissue disease and there were no lesions of morphea noted on examination.
Background: a patient with multinucleate cell angiohistiocytoma (MCAH). Case report: a 74-year-old white woman presented with an asymptomatic purple patch for 1 year. During the examination, a solitary, violaceous plaque of 1.5 cm was observed on the upper third of the left thigh. An excisional biopsy was performed, in view of the suspicion of Kaposi sarcoma (KS). The histopathologic examination revealed findings compatible with multinucleate cell angiohistiocytoma, with orthokeratotic epidermis, acanthosis, proliferation of well formed vascular channels on the reticular dermis, discretely desmoplastic, besides dendritic cells (fibrohistiocytic) with several nuclei on the dermis, discrete inflammatory infiltrated, made of lymphocytes, mast cells, and occasional hemosiderophages. Discussion: MCAH is a benign vascular proliferation of unknown etiology characterized by a solitary or multiple violaceous papules or plaques, between 1 and 15 cm in diameter. It generally affects the extremities of the body and most rarely trunk and face. There is a higher incidence among women after their fourth decade. The histology reveals vascular hyperplasia, with proliferation of the cells of the conjunctive tissue, associated with the presence of multinucleated giant cells. It is clinically similar to KS. Conclusion: MCAH is a benign, rare vascular disorder, an important differential diagnosis from KS, largely differing in prognosis and treatment. Commercial support: None identified.
Conclusion: This is an unusual case of lupus erythematosus and scleroderma-like reaction to red tattoo pigment. Dermal sclerosis and fibrosis have been noted in areas of tattoo months to years after tattooing but are throughout rather than restricted to a single pigment. Scleroderma-like hypersensitivity is a rarely reported reaction to tattoo pigment and can occur in patients without signs of morphea or systemic disease. Commercial support: None identified.
P7117 Necrotising infundibular crystalline folliculitis Arif Aslam, MBChB, Salford Royal NHS Foundation Trust, Manchester, United Kingdom; Lynne Jamieson, MBChB, Salford Royal NHS Foundation Trust, Manchester, United Kingdom; Rebecca Brooke, MD, Salford Royal NHS Foundation Trust, Manchester, United Kingdom A 73-year-old woman was referred to our dermatology department with a 12-month history of an asymptomatic follicular papular eruption which had failed to respond to topical corticosteroids and oral antibiotics provided in primary care. Her significant medical history included a superficial spreading malignant melanoma treated 12 years ago. On examination there were well circumscribed widespread waxy erythematous crusted papules affecting the back and both lower legs (see photos). Histologic examination was performed on an incisional biopsy on a lesion from the left lower leg (see photos). It showed partially squamous or fully squamous lined craters with appear to be centerd on follicular units. Within the crater there is keratin, parakeratin, inflammatory, necrotic debris and amorphous material which in some instances appears fibrillar. Calcification is also apparent. A PAS stain for fungal organisms was negative. The histologic appearances are those of a perforating disorder. The differential diagnosis includes perforating folliculitis, elastosis perforans serpiginosa and a newly described entity necrotising infundibular crystalline folliculitis (NICF). The histologic features in this case bear a striking resemblance to necrotising infundibular crystalline folliculitis. Our patient responded to a 6-week course of metronidazole with complete resolution of all the lesions (see photos). NICF is a folliculocentric disorder associated with filamentous crystalline deposits, enclosed by parakeratotic columns within partly necrotic follicular ostium and infundibulum. It is an extremely rare condition with very few reported cases. It was first reported in 2001 and it has been hypothesised that either physical or chemical injury or bacteria and Malassezia yeasts in the infundibulum of follicles may induce the crystalline structures.
P6331
Commercial support: None identified.
Commercial support: None identified.
APRIL 2013
Seasonal variation in the incidence of lichen planuselike keratosis Anne Neeley, MD, Saint Louis University, Saint Louis, MO, United States; Nicole Burkemper, MD, Saint Louis University, Saint Louis, MO, United States Background: LPLK was first described in 1966 as solitary form of lichen planus. It is believed to represent chronic inflammatory involution of a solar lentigo or seborrheic keratosis. While many believe UV radiation plays a role in the pathogenesis of LPLK, the true provocative stimulus is unknown. Objective: The aim of this study was to demonstrate variation in the incidence of LPLK from season to season. If LPLK are stimulated by exposure to UV radiation, there should be variation in their incidence in a climate with distinct seasons. Methods: A search for all cases of LPLK signed out at our institution’s dermatopathology laboratory during the years 2007 to 2010 was performed usingour PowerPath database. Total number of specimens processed for hematoxylineeosin per month was used as a control. LPLK as ratio of total specimens was plotted month by month using data from all 4 years. Results: The search yielded 1680 cases diagnosed as LPLK. A statistically significant difference (P \ .001) between the first 6 months and the last 6 months of the calendar year was seen. There was no significant difference when the results were compared season to season. Limitations: The main limitation of this study is the variable lag time between onset of a lesion and the date a biopsy was performed. Conclusion: We found a significantly higher incidence of LPLK during the months of January-June when compared to July-December. The highest incidence was seen for the months of February-June, suggesting a potential relationship with increased UV exposure during springtime months.
J AM ACAD DERMATOL
AB87
P6020
Multinucleate cell angiohistiocytoma Karina Ribeiro, MD, FTESM, S~ao Paulo, Brazil; Ana Paula Bucciaroni, MD, FTESM, S~ao Paulo, Brazil; Bruna Graziano, MD, FTESM, S~ao Paulo, Brazil; Gabriela Cezar, FTESM, S~ao Paulo, Brazil; Maria Cristina Camargo, FTESM, S~ao Paulo, Brazil; Ricardo Villa, FTESM, S~ao Paulo, Brazil; Sabrina Ribeiro, FTESM, S~ao Paulo, Brazil
Scleroderma-like reaction to red tattoo ink Jacqueline Fussell, MD, Geisinger Medical Center, Danville, PA, United States; Tammie Ferringer, MD, Geisinger Medical Center, Danville, PA, United States; Victor John Marks, MD, Geisinger Medical Center, Danville, PA, United States Background: Hypersensitivity reactions to tattoos are variable. They can occur immediately after tattooing up to decades later. The most commonly reported types of reactions are lichenoid, granulomatous, sarcoidal, eczematous, and pseudolymphomatous. Rarely have there been reports of scleroderma-like reactions. Case report: A 38-year-old man presented with tenderness and pruritus isolated to the red areas of a tattoo on his forearm. The black, red, and green skull had been tattooed at a professional tattoo parlor approximately 12 months before presentation. Pruritus started about 2 months after tattooing. The red areas of the tattoo then became warm, tender, and scaly. He was treated with oral clindamycin by his primary care physician due to concern for cellulitis, with no resolution of symptoms. He denied use of any topical medications to the area. At presentation, a punch biopsy of the affected area revealed features resembling lupus erythematosus, including interface dermatitis and follicular plugging but also deeper sclerodermoid features were noted. He was treated with intralesional triamcinolone acetonide 10 mg/mL and topical clobetasol 0.05% cream twice daily. At the 3-week follow-up, there was marked improvement of pruritus, tenderness, scaling, and erythema. Interestingly, he had no problem with previous red tattoos not performed at a professional tattoo parlor. Also, patient had no history or symptoms of scleroderma or other connective tissue disease and there were no lesions of morphea noted on examination.
Background: a patient with multinucleate cell angiohistiocytoma (MCAH). Case report: a 74-year-old white woman presented with an asymptomatic purple patch for 1 year. During the examination, a solitary, violaceous plaque of 1.5 cm was observed on the upper third of the left thigh. An excisional biopsy was performed, in view of the suspicion of Kaposi sarcoma (KS). The histopathologic examination revealed findings compatible with multinucleate cell angiohistiocytoma, with orthokeratotic epidermis, acanthosis, proliferation of well formed vascular channels on the reticular dermis, discretely desmoplastic, besides dendritic cells (fibrohistiocytic) with several nuclei on the dermis, discrete inflammatory infiltrated, made of lymphocytes, mast cells, and occasional hemosiderophages. Discussion: MCAH is a benign vascular proliferation of unknown etiology characterized by a solitary or multiple violaceous papules or plaques, between 1 and 15 cm in diameter. It generally affects the extremities of the body and most rarely trunk and face. There is a higher incidence among women after their fourth decade. The histology reveals vascular hyperplasia, with proliferation of the cells of the conjunctive tissue, associated with the presence of multinucleated giant cells. It is clinically similar to KS. Conclusion: MCAH is a benign, rare vascular disorder, an important differential diagnosis from KS, largely differing in prognosis and treatment. Commercial support: None identified.
Conclusion: This is an unusual case of lupus erythematosus and scleroderma-like reaction to red tattoo pigment. Dermal sclerosis and fibrosis have been noted in areas of tattoo months to years after tattooing but are throughout rather than restricted to a single pigment. Scleroderma-like hypersensitivity is a rarely reported reaction to tattoo pigment and can occur in patients without signs of morphea or systemic disease. Commercial support: None identified.
P7117 Necrotising infundibular crystalline folliculitis Arif Aslam, MBChB, Salford Royal NHS Foundation Trust, Manchester, United Kingdom; Lynne Jamieson, MBChB, Salford Royal NHS Foundation Trust, Manchester, United Kingdom; Rebecca Brooke, MD, Salford Royal NHS Foundation Trust, Manchester, United Kingdom A 73-year-old woman was referred to our dermatology department with a 12-month history of an asymptomatic follicular papular eruption which had failed to respond to topical corticosteroids and oral antibiotics provided in primary care. Her significant medical history included a superficial spreading malignant melanoma treated 12 years ago. On examination there were well circumscribed widespread waxy erythematous crusted papules affecting the back and both lower legs (see photos). Histologic examination was performed on an incisional biopsy on a lesion from the left lower leg (see photos). It showed partially squamous or fully squamous lined craters with appear to be centerd on follicular units. Within the crater there is keratin, parakeratin, inflammatory, necrotic debris and amorphous material which in some instances appears fibrillar. Calcification is also apparent. A PAS stain for fungal organisms was negative. The histologic appearances are those of a perforating disorder. The differential diagnosis includes perforating folliculitis, elastosis perforans serpiginosa and a newly described entity necrotising infundibular crystalline folliculitis (NICF). The histologic features in this case bear a striking resemblance to necrotising infundibular crystalline folliculitis. Our patient responded to a 6-week course of metronidazole with complete resolution of all the lesions (see photos). NICF is a folliculocentric disorder associated with filamentous crystalline deposits, enclosed by parakeratotic columns within partly necrotic follicular ostium and infundibulum. It is an extremely rare condition with very few reported cases. It was first reported in 2001 and it has been hypothesised that either physical or chemical injury or bacteria and Malassezia yeasts in the infundibulum of follicles may induce the crystalline structures.
P6331
Commercial support: None identified.
Commercial support: None identified.
APRIL 2013
Seasonal variation in the incidence of lichen planuselike keratosis Anne Neeley, MD, Saint Louis University, Saint Louis, MO, United States; Nicole Burkemper, MD, Saint Louis University, Saint Louis, MO, United States Background: LPLK was first described in 1966 as solitary form of lichen planus. It is believed to represent chronic inflammatory involution of a solar lentigo or seborrheic keratosis. While many believe UV radiation plays a role in the pathogenesis of LPLK, the true provocative stimulus is unknown. Objective: The aim of this study was to demonstrate variation in the incidence of LPLK from season to season. If LPLK are stimulated by exposure to UV radiation, there should be variation in their incidence in a climate with distinct seasons. Methods: A search for all cases of LPLK signed out at our institution’s dermatopathology laboratory during the years 2007 to 2010 was performed usingour PowerPath database. Total number of specimens processed for hematoxylineeosin per month was used as a control. LPLK as ratio of total specimens was plotted month by month using data from all 4 years. Results: The search yielded 1680 cases diagnosed as LPLK. A statistically significant difference (P \ .001) between the first 6 months and the last 6 months of the calendar year was seen. There was no significant difference when the results were compared season to season. Limitations: The main limitation of this study is the variable lag time between onset of a lesion and the date a biopsy was performed. Conclusion: We found a significantly higher incidence of LPLK during the months of January-June when compared to July-December. The highest incidence was seen for the months of February-June, suggesting a potential relationship with increased UV exposure during springtime months.
J AM ACAD DERMATOL
AB87