- Email: [email protected]
Reply to: Summertime elbow eruptions
J AM ACAD DERMATOL
Letters 485
VOLUME 69, NUMBER 3
We propose that friction may play a role regarding the unexplained striking localization to the elbows. The published images in the article by Molina-Ruiz and colleagues1 of cases 2 and 3 appear to show a lichenoid clinical appearance, a notion reinforced by the demonstration of a lichenoid inflammatory infiltrate in histopathologic sections from 1 case. This suggests at least some overlap with the pediatric entity, and friction may be the common thread. A similar seasonal eruption in children can also occur on the knees, perhaps reflecting trauma to those surfaces inherent to play in that demographic. The relationship between mechanical trauma and ultraviolet radiation in these cases merits further investigation. Joseph C. Pierson, MD, and Jefferson T. Hunt, DO Dermatology Service, Guthrie Army Health Clinic, Fort Drum, New York Funding sources: None. Conflicts of interest: None declared. Correspondence to: Joseph C. Pierson, MD, Dermatology Service, Guthrie Army Health Clinic, 11050 Mt Belvedere Blvd, Fort Drum, NY 13602 E-mail: [email protected]
5. Rasmussen JE. Sutton’s summer prurigo of the elbows. Acta Derm Venereol 1978;58:549-51. http://dx.doi.org/10.1016/j.jaad.2013.03.039
Reply to: Summertime elbow eruptions To the Editor: We appreciate the interest of Pierson and Hunt in our article. In our opinion, however, there are 2 reasons that do not support the pathogenic role of friction in the development of the lesions of spring and summer eruption of the elbows: 1. The lesions developed only during the spring and summer, and we suppose that friction on the back of the elbows is the same during the entire year. 2. If friction was an etiologic factor in this process, we would expect to see some histopathologic features indicative of lichen simplex chronicus, such as psoriasiform hyperplasia of epidermis, compact hyperorthokeratosis, and vertical collagen bundles in the dermal papillae. All of these features were absent in our cases. Ana M. Molina-Ruiz, MD, and Luis Requena, MD Department of Dermatology, Fundacion Jime nez Diaz, Universidad Autonoma, Madrid, Spain
REFERENCES 1. Molina-Ruiz A, Sanmartın O, Santonja Kutzner K, Requena L. Spring and summer eruption of the elbows: a peculiar localized variant of polymorphous light eruption. J Am Acad Dermatol 2013;68:306-12. 2. Sutton RL Jr. Summertime pityriasis of the elbow and knee. In: Sutton RL Jr, editor. Disease of the skin. 2nd ed. St Louis (MO): CV Mosby Co; 1956. p. 898. 3. Waisman M, Sutton RL Jr. Frictional lichenoid eruption in children: recurrent pityriasis of the elbow and knees. Arch Dermatol 1966;94:592-3. 4. Goldman L, Kitzmiller KW, Richfield DF. Summer lichenoid dermatitis of the elbow in children. Cutis 1974;13:836-8.
RESEARCH CD41CD251FOXP31 malignant T cells in S ezary syndrome are not necessarily functional regulatory T cells To the Editor: FOXP3 expression by malignant cells in cutaneous T-cell lymphoma (CTCL) is controversial. Berger et al1 induced FOXP3 expression and suppressor activity in CTCL cells cultured with dendritic cells fed with apoptotic T cells, thus suggesting that CTCL may represent a proliferation of Tregs.
Funding sources: None. Conflicts of interest: None declared. Correspondence to: Ana Maria Molina, MD, Department of Dermatology, Fundacion Jime nez Diaz, Avenida Reyes Catolicos 2, Universidad Autonoma, Madrid, Spain 28040 E-mail: [email protected] http://dx.doi.org/10.1016/j.jaad.2013.03.038
LETTERS FOXP3 expression in CTCL has been observed in a subset of cases.2,3 Immortalized CTCL cells expressed a low-molecular splice form of FOXP3; cells produced inhibitory cytokines and exerted suppressive effects on nonmalignant T cells derived from patients with CTCL.2 Another study4 reported that a subset of circulating CD41CD251 peripheral blood mononuclear cells, derived from patients with leukemic CTCL, exerted suppressive function in vitro.
Letters 485
VOLUME 69, NUMBER 3
We propose that friction may play a role regarding the unexplained striking localization to the elbows. The published images in the article by Molina-Ruiz and colleagues1 of cases 2 and 3 appear to show a lichenoid clinical appearance, a notion reinforced by the demonstration of a lichenoid inflammatory infiltrate in histopathologic sections from 1 case. This suggests at least some overlap with the pediatric entity, and friction may be the common thread. A similar seasonal eruption in children can also occur on the knees, perhaps reflecting trauma to those surfaces inherent to play in that demographic. The relationship between mechanical trauma and ultraviolet radiation in these cases merits further investigation. Joseph C. Pierson, MD, and Jefferson T. Hunt, DO Dermatology Service, Guthrie Army Health Clinic, Fort Drum, New York Funding sources: None. Conflicts of interest: None declared. Correspondence to: Joseph C. Pierson, MD, Dermatology Service, Guthrie Army Health Clinic, 11050 Mt Belvedere Blvd, Fort Drum, NY 13602 E-mail: [email protected]
5. Rasmussen JE. Sutton’s summer prurigo of the elbows. Acta Derm Venereol 1978;58:549-51. http://dx.doi.org/10.1016/j.jaad.2013.03.039
Reply to: Summertime elbow eruptions To the Editor: We appreciate the interest of Pierson and Hunt in our article. In our opinion, however, there are 2 reasons that do not support the pathogenic role of friction in the development of the lesions of spring and summer eruption of the elbows: 1. The lesions developed only during the spring and summer, and we suppose that friction on the back of the elbows is the same during the entire year. 2. If friction was an etiologic factor in this process, we would expect to see some histopathologic features indicative of lichen simplex chronicus, such as psoriasiform hyperplasia of epidermis, compact hyperorthokeratosis, and vertical collagen bundles in the dermal papillae. All of these features were absent in our cases. Ana M. Molina-Ruiz, MD, and Luis Requena, MD Department of Dermatology, Fundacion Jime nez Diaz, Universidad Autonoma, Madrid, Spain
REFERENCES 1. Molina-Ruiz A, Sanmartın O, Santonja Kutzner K, Requena L. Spring and summer eruption of the elbows: a peculiar localized variant of polymorphous light eruption. J Am Acad Dermatol 2013;68:306-12. 2. Sutton RL Jr. Summertime pityriasis of the elbow and knee. In: Sutton RL Jr, editor. Disease of the skin. 2nd ed. St Louis (MO): CV Mosby Co; 1956. p. 898. 3. Waisman M, Sutton RL Jr. Frictional lichenoid eruption in children: recurrent pityriasis of the elbow and knees. Arch Dermatol 1966;94:592-3. 4. Goldman L, Kitzmiller KW, Richfield DF. Summer lichenoid dermatitis of the elbow in children. Cutis 1974;13:836-8.
RESEARCH CD41CD251FOXP31 malignant T cells in S ezary syndrome are not necessarily functional regulatory T cells To the Editor: FOXP3 expression by malignant cells in cutaneous T-cell lymphoma (CTCL) is controversial. Berger et al1 induced FOXP3 expression and suppressor activity in CTCL cells cultured with dendritic cells fed with apoptotic T cells, thus suggesting that CTCL may represent a proliferation of Tregs.
Funding sources: None. Conflicts of interest: None declared. Correspondence to: Ana Maria Molina, MD, Department of Dermatology, Fundacion Jime nez Diaz, Avenida Reyes Catolicos 2, Universidad Autonoma, Madrid, Spain 28040 E-mail: [email protected] http://dx.doi.org/10.1016/j.jaad.2013.03.038
LETTERS FOXP3 expression in CTCL has been observed in a subset of cases.2,3 Immortalized CTCL cells expressed a low-molecular splice form of FOXP3; cells produced inhibitory cytokines and exerted suppressive effects on nonmalignant T cells derived from patients with CTCL.2 Another study4 reported that a subset of circulating CD41CD251 peripheral blood mononuclear cells, derived from patients with leukemic CTCL, exerted suppressive function in vitro.