Infiltrative Erythemas and Nodules on a Unilateral Cheek Following Inappropriate Use of a Topical Steroid

A 50-year-old Japanese woman referred to us with erythematous nodules on her left cheek. She had been treated with topical corticosteroids on her left cheek at a previous local clinic for 4 years. A skin biopsy specimen from a nodule showed perifolliculitis and folliculitis with a destruction of hair follicle without epidermal involvement. Based on the patient’s history of the long-term topical corticosteroids and physical examination, we finally diagnosed this case as unilateral steroid-induced rosacea-like dermatitis (SIRD). She stopped topical steroid and was treated with topical application of benzoyl peroxide. One and a half year after starting the treatment, the nodules were flattened. Use of long-term and only unilateral application of topical corticosteroids probably resulted in unique clinical findings in our case. Given the broad clinical differential diagnosis, our case highlights the importance of appropriate application of topical steroids as well as histopathological analysis on any facial erythematous nodules

Subcutaneous Panniculitis-like T-Cell Lymphoma Without Erythema and Subcutaneous Tumors

We report a case of subcutaneous panniculitis-like T-cell lymphoma with diffuse indurated lesions without erythema. A 27-year-old man was referred to us with a 1-month history of fever, general fatigue and indurated skin lesions. The initial examination revealed indurated skin lesions without erythema and subcutaneous tumors in the right lower abdomen, back and buttocks. Histopathology showed a panniculitis predominantly in lobular pattern, and infiltration of atypical lymphocytes in the subcutaneous tissue. Characteristically, there was rimming of individual fat cells by surrounding atypical lymphocytes. Results of laboratory examinations showed hemophagocytic syndrome (HPS). Based on these findings, we made a diagnosis of subcutaneous panniculitis-like T-cell lymphoma without erythema and subcutaneous tumors with HPS. To our knowledge, there has been no report of SPTCL with diffuse indurated lesions without erythema, tumors, or plaque, all of which are considered to be typical characteristics of SPTCL. Positron emission tomography / computed tomography (PET/CT) showed noticeable thickening of diffuse subcutaneous involvement throughout the body. Hence, PET/CT is a useful for the detection of SPTCL as well as its distribution

Limitation of Using Ultrasonography After Positive Sentinel Lymph Node Biopsy in a Patient with Melanoma in the Detection of Lymph Node Metastasis

Recent studies have shown that complete lymph node dissection (CLND) performed immediately did not improve the overall survival in patients with sentinel lymph node (LN)-positive melanoma. According to these results, nodal observation with ultrasonography becomes standard. However, it still has some limitations for detection of metastatic LNs. A 74-year-old woman was diagnosed with acral lentiginous melanoma of her left sole. The sentinel LN was positive for metastasis, but she refused CLND. Sixteen months after operation, ultrasonography showed an abnormal LN in the inguinal region. There was no other abnormal LNs around the LN. We resected the abnormal LN. The resected LN was black in color, and the adjacent LN that showed normal appearance in ultrasonography was also black. A recent study showed only 6.6% sensitivity in preoperative ultrasonographic detection of metastatic melanoma in a LN. We should keep in mind the limitation of ultrasonography for detection of a metastatic LN

Simultaneous Occurrence of Lichen Nitidus and Morphea

Lichen nitidus and morphea are common diseases, but an associated localization of both lesions is rare. Here, we describe the first case of lesions distributed along Blaschko's lines. A 24-year-old Japanese woman was referred to our clinic for evaluation of band-like plaques of 18-months history on the right lateral side of her abdomen. In addition, multiple milky-white papules were seen within the plaques. Histopathological examination showed there was sclerosis in the lower half of the dermis and well-circumscribed, dense, papillary dermal lymphohistiocytic aggregations showing a so-called "claw clutching a ball." Immunohistochemical analysis revealed that the morphea and lichen nitidus had similar characteristics. We speculated that unique immunologic events led to the development of lichen nitidus and morphea in our patient

Early Stage of Pilomatricoma with an Empty Cyst Cavity and Unusual Clinical Appearance

We present an unusual case of cystic pilomatricoma. A 13-year-old Japanese boy was referred to our department for evaluation of a 10-day history of a small reddish nodule on his right cheek. Histopathological examination showed a well-circumscribed cystic structure showing a central empty cavity in the dermis. The wall of the cyst was composed of basophilic cells. Inner layers of the wall were covered with flattened epithelial cells having trichohyalin granules. Based on these findings, a diagnosis of cystic pilomatricoma was made. To our knowledge, there has been no report of cystic pilomatricoma with an empty cavity. Dermatologists should be aware of pilomatricoma in the early stage showing a central empty cavity

CD4/CD8 Double-negative Mycosis Fungoides: A Case Report and Literature Review

Mycosis fungoides, the most common subtype of cutaneous T-cell lymphoma, displays a broad spectrum of clinical, histological and phenotypic variants with different prognostic impacts. The classic immunophenotype is CD3+/CD4+/CD45RO+memory T cells. CD4/CD8 double-negative mycosis fungoides is rare. Here we describe the clinicopathological features of CD4/CD8 double-negative mycosis fungoides in a 55-year-old female with a review of the literature. Although the CD4/CD8 double-negative phenotype appears to be associated with an unusual clinical presentation, it does not appear to confer prognostic significance

Shiitake Dermatitis-like Eruption Due to Tegafur/Gimeracil/Oteracil Combination Usage

S-1 is a combination drug of tegafur, gimeracil and oteracil potassium that is designed on the basis of 5-fluorouracil. We report here for the first time that S-1 is a causative agent of drug eruption mimicking shiitake dermatitis. A 58-year-old Japanese man presented with pruritic erythemas arranged in a linear fashion. He had been treated with S-1 for esophageal cancer. Although differential diagnosis included shiitake dermatitis and dermatomyositis, he had not eaten raw shiitake mushroom, and he did not have other cutaneous lesion such as Gottron’s sign and abnormalities of peripheral blood examination including Jo-1 antibody and antinuclear antibody. Histopathological examination revealed necrotic keratinocytes in the Malpighian layer, vacuolar change in the basal layer, and lymphocytic and eosinophilic infiltration in the upper dermis. Based on clinical and histological findings, we made a diagnosis of drug eruption due to S-1