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The Journal of Clinical and Aesthetic... Nov 2023Basaloid follicular hamartoma is an uncommun benign neoplasm of the hair follicule. The linear form of basaloid follicular hamartoma can be associated with basal cell...
BACKGROUND
Basaloid follicular hamartoma is an uncommun benign neoplasm of the hair follicule. The linear form of basaloid follicular hamartoma can be associated with basal cell carcinoma. We report a case of a patient with multiple basal cell carcinomas developing on a congenital lesion allowing the diagnosis of basaloid follicular hamartoma on histopathology.
METHODS
Each lesion was evaluated by two dermatologists. All biopsy specimens were routinely stained with hematoxylin-eosin.
RESULTS
A 76 year-old-man consulted our dermatology departement for erythematous papules spread over the left lower limb. The lesion had been evolving since birth with flesh-colored to pinkish papules following Blaschko's lines from the root of the thigh to the foot. Three months before consultation, the papules increased in size leading to nodules with sometimes an ulcerated center. Dermoscopy under polarized mode displayed for ulcerated lesions (A) yellow-brownish crusts and ulceration surrounded by blue-grey ovoid nests, subtle short white streaks, brown dots and linear/arborising vessels. For nodular lesions (B), dermoscopic features are white pinkish hue, dotted and linear vessels, brown dots, blue-grey structureless areas and white prominent shiny streaks. There were some more erythematous inflamed and eroded areas in the background with a reversed honeycomb white network on dermoscopy (C), polymorphous vessels, whitish scales, ulcerations and milia-like cysts. The background lesion showed varied dermoscopic structures on a flesh colored slightly pinkish bottom (D). Histolopathology concluded for lesions A to an infiltrating and nodular basal cell carcinoma, (B) and (C) to fibroepithelioma of Pinkus and (D) to basaloid follicular hamartoma.
CONCLUSION
Several case reports have documented dermoscopic features of a solitary basaloid follicular hamartoma. However, further studies are required to specify any reproducible features.
PubMed: 38076655
DOI: No ID Found -
Frontiers in Medicine 2021To investigate the application of reflectance confocal microscopy (RCM) imaging in diagnosis of vulva syringoma. Patients with lesions suspicious of syringoma on vulva...
To investigate the application of reflectance confocal microscopy (RCM) imaging in diagnosis of vulva syringoma. Patients with lesions suspicious of syringoma on vulva were enrolled in the study. After informed consent was taken, the lesions were photographed and imaged with RCM. The features of the lesion in confocal images were then analyzed and compared with the biopsy findings for histology correlation. Eleven cases in total were included in the study. The typical RCM features observed in syringoma are the presence of round to oval high refractive, and relatively monomorphous mass of varying sizes in the superficial and middle dermis, usually surrounded with 1-2 layers of light-dark line structures, which were further confirmed by histological evaluation. Ten cases showed classic features of syringoma and 1 case exhibited milia in RCM images. Syringoma has distinct features in RCM imaging, which correlates well with histological findings, highlighting the potential role of RCM in the diagnosis and differential diagnosis of vulva syringoma.
PubMed: 33732725
DOI: 10.3389/fmed.2021.649438 -
Indian Dermatology Online Journal Oct 2014
PubMed: 25396166
DOI: 10.4103/2229-5178.142573 -
World Journal of Clinical Cases May 2021Dystrophic epidermolysis bullosa pruriginosa (DEB-Pr) is a rare subtype of DEB, characterized by recurrent pruritus of the extremities, pruritus papules, nodules, and...
BACKGROUND
Dystrophic epidermolysis bullosa pruriginosa (DEB-Pr) is a rare subtype of DEB, characterized by recurrent pruritus of the extremities, pruritus papules, nodules, and mossy-like plaques. To date, fewer than 100 cases have been reported. We report a misdiagnosed 30-year-old man with sporadic late-onset DEB-Pr who responded well to tacrolimus treatment, thereby serving as a guide to correct diagnosis and treatment.
CASE SUMMARY
A 30-year-old man presented with recurrent itching plaques of 1-year duration in the left tibia that aggravated and involved both legs and the back. Examination revealed multiple symmetrical, purple, and hyperpigmented papules and nodules with surface exfoliation involving the tibia and dorsum of the neck with negative Nissl's sign, no abnormalities in the skin, mucosa, hair, or fingernail, and no local lymph node enlargement. Blisters were never reported prior to presentation. Serum immunoglobulin E level was 636 IU/mL. Clinical manifestations suggested DEB-Pr. Histological examination showed subepidermal fissure, scar tissue, and milia. Direct immunofluorescence showed no obvious abnormalities. However, we were unable to perform electron microscopy or genetic research following his choice. We treated him with topical tacrolimus. After 2 wk, the itching alleviated, and the skin lesions began to subside. No adverse reactions were observed during treatment.
CONCLUSION
Topical tacrolimus is a safe treatment option for patients with DEB-Pr and can achieve continuous relief of severe itching.
PubMed: 33969095
DOI: 10.12998/wjcc.v9.i13.3090 -
Current Treatment Options in Oncology Jun 2019Targeted therapies and more recently immune checkpoint inhibitors (ICI) have transformed the treatment landscape of advanced NSCLC. Clinical trials investigating immune... (Review)
Review
Targeted therapies and more recently immune checkpoint inhibitors (ICI) have transformed the treatment landscape of advanced NSCLC. Clinical trials investigating immune checkpoint inhibitors (ICI) have usually excluded patients with oncogenic drivers, so that the outcome of these agents in this population is poorly known. In patients with oncogenic addiction, targeted therapy remains clearly the best option, and the place of immunotherapy in this population has not been clearly defined yet.Based on available data, we suggest that (i) immunotherapy single agent should be proposed only after exhaustion of more validated treatments, (ii) combinations of immunotherapy with targeted therapies are of interest provided that we can manage toxicity and find the best sequence, (iii) a combination of immunotherapy with chemotherapy may be appealing in patients pretreated with targeted agents. The best way to opt in for the best strategy will depend upon the identification of adequate biomarkers. New basic and clinical research is awaited in this field.
Topics: Antineoplastic Agents; Antineoplastic Agents, Immunological; Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Molecular Targeted Therapy; Oncogenes; Protein Kinase Inhibitors; Randomized Controlled Trials as Topic
PubMed: 31172347
DOI: 10.1007/s11864-019-0652-3 -
Indian Journal of Dermatology 2016Seborrheic keratosis (SK) is the most common benign epidermal tumor of the skin. Even though SK has been well characterized clinically, dermoscopically, and...
BACKGROUND
Seborrheic keratosis (SK) is the most common benign epidermal tumor of the skin. Even though SK has been well characterized clinically, dermoscopically, and histopathologically, data regarding clinical dermoscopic and histopathological correlation of different types of SK are inadequate.
AIM
We carried out this study to establish any correlation between the clinical, dermoscopic, and histopathological appearance of SK and its variants.
METHODS
This was a descriptive study. Patients with SK were evaluated with respect to age, sex, family history of similar lesions, site of lesions, and symptoms associated with the lesions. Dermoscopy was performed in all cases. Biopsies were taken from the lesions and assessed for histopathology.
RESULTS
The most common age group affected by SK was 31-50 years (42%). A female preponderance of 76% was seen. Majority of our patients had a positive family history (62%), though Sun exposure was not seen to be a major factor. The most common clinical variant was common SK (CSK) (46%). The most common dermoscopic findings seen in CSK were comedo-like (CL) openings, fissures and ridges (FR), and milia-like (ML) cysts. Dermatosis papulosa nigra and pedunculated SK had characteristic FR and CL openings on dermoscopy. Stucco keratoses showed network-like (NL) structures and sharp demarcation. CL opening on dermoscopy corresponded to papillomatosis and pigmentation, ML cysts corresponded to horn cysts, FR corresponded to papillomatosis, and NL structures corresponded to an increase in basal layer pigmentation.
CONCLUSIONS
This study emphasizes the use of dermoscopy in improving the diagnostic accuracy of SK. The correlation between the various histological and dermoscopic features is described.
PubMed: 27904179
DOI: 10.4103/0019-5154.193667 -
International Journal of Environmental... Mar 2021Heat stress provokes thermal discomfort to people living in semiarid and arid climates. This study evaluates thermal discomfort levels, building design concepts, and...
Heat stress provokes thermal discomfort to people living in semiarid and arid climates. This study evaluates thermal discomfort levels, building design concepts, and some heat mitigation strategies in low-income neighborhoods of Faisalabad, Pakistan. The outdoor and indoor weather data are collected from April to August 2016 using a weather station installed ad hoc in urban settings, and the 52 houses of the five low-income participating communities living in congested and less environment-friendly areas of Faisalabad. The values, related to the building design concepts, including (i) house orientation to sunlight and (ii) house ventilation, are calculated from outdoor and indoor dry-bulb and wet-bulb temperatures. Our results show that although June was the hottest month of summer 2016, based on the monthly mean temperature of the Faisalabad region, the month of May produced the highest discomfort levels, which were higher in houses exposed to sunlight and without ventilation. The study also identifies some popular heat mitigation strategies adopted by the five participating low-income communities during various heat-related health complaints. The strategies are gender-biased and have medical, cultural/customary backgrounds. For example, about 52% of the males and 28% of the females drank more water during dehydration, diarrhea, and eye infection. Over 11% and 19% of the males and females, respectively, moved to cooler places during fever. About 43% of the males and 51% of the females took water showers and rested to combat flu (runny nose), headache, and nosebleed. The people did not know how to cure muscular fatigue, skin allergy (from a type of Milia), and mild temperature. Planting trees in an area and developing open parks with greenery and thick canopy trees can be beneficial for neighborhoods resembling those evaluated in this study.
Topics: Cities; Female; Heat Stress Disorders; Hot Temperature; Humans; Male; Pakistan; Temperature
PubMed: 33806383
DOI: 10.3390/ijerph18052535 -
Cancers Dec 2021Malignant melanomas resembling seborrheic keratosis (SK-like MMs) are atypical, challenging to diagnose melanoma cases that carry the risk of delayed diagnosis and...
Malignant melanomas resembling seborrheic keratosis (SK-like MMs) are atypical, challenging to diagnose melanoma cases that carry the risk of delayed diagnosis and inadequate treatment. On the other hand, SK may mimic melanoma, producing a 'false positive' with unnecessary lesion excisions. The present study proposes a computer-based approach using dermoscopy images for the characterization of SΚ-like MMs. Dermoscopic images were retrieved from the International Skin Imaging Collaboration archive. Exploiting image embeddings from pretrained convolutional network VGG16, we trained a support vector machine (SVM) classification model on a data set of 667 images. SVM optimal hyperparameter selection was carried out using the Bayesian optimization method. The classifier was tested on an independent data set of 311 images with atypical appearance: MMs had an absence of pigmented network and had an existence of milia-like cysts. SK lacked milia-like cysts and had a pigmented network. Atypical MMs were characterized with a sensitivity and specificity of 78.6% and 84.5%, respectively. The advent of deep learning in image recognition has attracted the interest of computer science towards improved skin lesion diagnosis. Open-source, public access archives of skin images empower further the implementation and validation of computer-based systems that might contribute significantly to complex clinical diagnostic problems such as the characterization of SK-like MMs.
PubMed: 34944920
DOI: 10.3390/cancers13246300 -
Journal of Infection in Developing... Oct 2022Tuberculosis is a communicable disease that is a major cause of ill health. It is one of the top ten causes of death worldwide and the leading cause of death from a...
Tuberculosis is a communicable disease that is a major cause of ill health. It is one of the top ten causes of death worldwide and the leading cause of death from a single infectious agent. Its most common clinical presentation is pulmonary involvement. However, approximately 23-30% of tuberculosis patients have extrapulmonary symptoms. A rare (1%) clinical presentation of tuberculosis is foot and ankle infection. This is complicated by the fact that the diagnosis of osteoarticular tuberculosis is difficult. Our case was a 66-year-old multi-pathological pensioner, who, while working in the countryside, had an ankle sprain on the left foot, with a lacerated wound of about 2 cm diameter. The non-endemic area and the negative chest X-ray made the diagnosis extremely complex. However, a multidisciplinary approach with the radiologists and the infectious disease department led to clinical stabilization of the patient. Therefore, awareness and high index of suspicion of the disease is essential and referral to experts should be made if diagnosis is indeterminate despite extensive investigations. The knowledge allows early identification of the disease and prompt therapy in order to avoid long-standing untreated infections which typically cause bone destruction and loss of function. The knowledge is also mandatory for western physicians due to increasing international travel, immigration from less developed countries and increased use of immunosuppressive medications. We believe that this article can bring awareness around osteoarticular tuberculosis and help with improving outcome and eradication of the infection. Level of clinical evidence: 4.
Topics: Humans; Aged; Tuberculosis, Osteoarticular; Osteomyelitis; Radiography
PubMed: 36332222
DOI: 10.3855/jidc.15891 -
Indian Journal of Dermatology,... 2023Introduction Tattoo-associated complications are on the rise due to the popularity of decorative tattoos in recent years. The exact pathogeneses of various tattoo...
Clinicodermoscopic and immunopathological profile of non-infectious non-eczematous inflammatory tattoo reactions: A retrospective study from a tertiary care centre of East India.
Introduction Tattoo-associated complications are on the rise due to the popularity of decorative tattoos in recent years. The exact pathogeneses of various tattoo reaction patterns are still unclear, and their dermoscopic details are sparsely reported. Aim We aimed to retrospectively study the clinical, dermoscopic and immunopathological details of patients with non-infectious, non-eczematous inflammatory tattoo reaction patterns in a tertiary care centre of East India. Method The clinical, dermoscopic and pathological details of all the patients who had non-infectious, non-eczematous inflammatory tattoo reactions were collected. In all the cases, immunohistochemistry was done for CD1a, CD3, CD4, CD8, FoxP3, CD20 and CD56. Results A total of five patients of skin phototypes IV and V and six tattoo reactions were analysed. Five lesions had reactions at the site of a black tattoo, and one at the site of red tattoo. Clinically, the patients presented with erythematous or blue-grey flat-topped to verrucous papules and plaques. Dermoscopic features were dominated by a central white to pink-white structureless area, a peripheral grey-white to bluish-white structureless area, white scales, comedo-like opening with keratotic plugging, milia-like cysts and shiny white structures. Pathologically, except for one lesion that only showed a lichenoid reaction pattern in the red tattoo, all had a combination of reaction patterns. Immunohistochemistry showed increased epidermal and dermal Langerhans cells, predominantly CD8 positive T cells in the epidermis and dermis, sparse dermal B cells and CD4 positive T cells, reduced T regulatory cells and a complete absence of CD56 positive NK cells. Limitations Small sample size was the limitation of the study. Conclusion The clinical morphology and dermoscopy may not differentiate between various types of non-infectious non-eczematous inflammatory tattoo reactions. The immunological profile supports a delayed hypersensitivity reaction due to contact sensitisation to tattoo pigment, and CD8 positive T cells play a central role in executing various pathological reaction patterns, both in the epidermis and dermis.
Topics: Humans; Tattooing; Retrospective Studies; Tertiary Care Centers; Skin; Inflammation; India
PubMed: 36331839
DOI: 10.25259/IJDVL_85_2022