“Acquired epidermodysplasia verruciformis” in kidney transplant patients

AbstractBackgroundEpidermodysplasia verruciformis (EV) is a well known inherited autosomal recessive skin disease associated with numerous early onset viral warts on the sun exposed parts of the body that usually progress into skin malignancies. Kidney transplant patients are also commonly associated with viral warts that might change into skin cancers.ObjectiveTo describe the clinical pictures of extensive viral warts with skin malignancies in kidney transplant patients in comparison with inherited (EV) features.Patients and methodsThis case controlled study that included 130 patients with kidney transplantation was done in kidney transplantation centers in Baghdad and Al-Karma Teaching Hospitals during December 2002 to September 2004. All recruited patients were receiving multiple immunosuppressive drugs like methyl prednisolone succinate, oral prednisolone, azathioprine and cyclosporine. History was taken from all patients including all the relevant points. These patients were divided into three groups according to the duration of kidney transplant: group A 1–10years, group B 11–20years and group C more than 20years. Biopsies were performed from the viral warts lesions and the associated tumors.Two hundred and sixty apparently healthy individuals, 206 males and 54 females had been examined as control cases for the presence of viral warts and tumors. These control cases had been taken randomly from general population in multiple regions in Baghdad.ResultsSixty-five patients out of 130 with kidney transplantation had viral warts. Their ages ranged from 20 to 71 (45.49±SD 10.82) years, 51 males and 14 females, while the duration of the warts ranged from 0.5 to 10 (3.74±SD 2.67) years. The distribution of patients with viral warts among the groups was as follows: group A 28 (43.1%), group B 30 (46.2%) and group C 7 (10.7%) cases. Viral warts were seen in 10 (3.8%) of the control group. There were statistically significant differences between patients and control cases (P value <0.001). Most of the viral warts in patients with kidney transplantation were multiple and of the verrucae vulgaris type. They were mainly located on the exposed areas of the body, mostly on the face and dorsa of hands.Skin malignancies were observed in 6 (9.2%) cases: five squamous cell carcinomas and one case of basal cell carcinoma. Squamous cell carcinoma was mainly located on the lower lips in 3 cases and 2 on the dorsa of hands, while basal cell carcinoma was observed on the nose. Two cases (7.1%) of squamous cell carcinoma were seen in group A, 2 (6.6%) in group B and 1 (14%) in group C. One case of basal cell carcinoma was noted in group B .No skin malignancy was observed in the control group.ConclusionKidney transplant patients have an increased susceptibility to infection with human papilloma virus and have served as a model for viral induced carcinogenesis. This collection of features deserves the term “acquired epidermodysplasia verruciformis”

Treatment of perniosis with oral tadalafil, pentoxifylline or prednisolone A therapeutic comparative study

Background: perniosis is a common dermatological problem. Different modalities of treatment are available with conflicting results and no single effective therapy is universally accepted. Objective: To evaluate the effectiveness of oral tadalafil and compare it with pentoxyfylline or prednisolone in treatment of perniosis Patients and methods: This was a therapeutic comparative trial conducted in the department of Dermatology, Baghdad Teaching hospital, Baghdad, Iraq between November 2011 and March 2014. Fifty eight patients with perniosis were enrolled in this study, and divided into 3 groups. Group (A) comprised 19 patients who received oral tadalafil (5 mg once daily); group (B) comprised 18 patients who received pentoxifylline tablet (400 mg three times daily) and group (C) included 21 patients who received prednisolone 15 mg twice daily. The treatment duration was 2 weeks. All patients did not receive any treatment before the study. A severity score was proposed taken in consideration the number of finger/ toes, type of lesion, coldness, cyanosis and itching Results: Forty seven patients completed the study. Their ages ranged from 13-43 with a mean ± SD of 22.38 ±6.99 years. Thirty three patients were females (70.21%) and 14 were males (29.79%). The percentage of improvement was 50.65, 44.16 and 31.51% for the groups A, B and C respectively. Conclusion: Tadalafil has a superior effect over pentoxyfylline. The latter has a better effect than prednisolone

Panniculitis Is an Important Feature of Cutaneous Leishmaniasis Pathology

Background. Cutaneous leishmaniasis is an inflammatory parasitic infection characterized by superficial and deep perivascular infiltration with or without granuloma formation. Clinical diagnosis usually requires seeing Leishmania bodies. Methods. We report two cases of cutaneous leishmaniasis with unusual histological finding of panniculitis. Case 1: a 36-year-old male presented with multiple ulcerative nodules involving the left leg for two months duration which was greatly responsive to antimony intralesional therapy. Case 2: A 45-year-old woman presented with painless nodules on her upper chest of a 10-week duration which were successfully treated with oral and topical zinc sulphate. Results. Diagnosis of both cases was confirmed by finding the Leishmania bodies with Gimesa stain in addition to the diffuse dermal inflammatory cellular infiltration of the dermis forming granulomatous dermatitis. Mixed cellular infiltration of lymphocytes, histiocytes, and plasma cells of the panniculus caused both septal and lobular panniculitis. Conclusion. Cutaneous leishmaniasis can cause panniculitis and this could be seen more commonly if deep biopsies were taken. So cutaneous leishmaniasis must be considered in evaluating pathology of panniculitis especially in endemic regions

Follicular vitiligo: the present clinical status

Vitiligo is a common autoimmune inflammatory disease where there is damage to the basal melanocytes of the epidermis. Hair follicles are the main reservoir of the melanocytes, and melanocytes stem cells, and these cells will supply the melanocytes for the basal layer of the epidermis when these cells are lost. But when these follicular melanocytes are damaged, this will cause follicular vitiligo either in a form gray/white hair or in form of follicular leukoderma. Although follicular vitiligo is not uncommon variant of vitiligo but rarely discussed and classified

Cupping (Hijama) in Skin diseases with positive Koebner’s Phenomenon: What is New?

Background: Cupping therapy is an ancient traditional and complementary medicine used in the treatment of a broad range of medical conditions. It is very popular in many countries, especially in China, Korea, and Japan. It is used in the Muslim world, as well as in North Africa, Eastern Europe and Latin America. Cupping involves applying a heated cup to generate a partial vacuum that mobilizes the blood flow and promotes effective healing. Till now, there is no certain scientific base for using cupping in treating any medical problem especially skin diseases. Many skin diseases have tendency to appear at the site of injury or damage to the skin, the so called koebners phenomena. Our observation is that hijama induces skin diseases at the site of cupping in patients with skin dis-eases with koebner phenomenon. Objective: to present cases with koebner phenomenon after cupping with primary lesions seen at the site of cupping. Patients and method: a total of 24 male patients previously diagnosed with skin diseases; 16 with psoriasis, 6 with lichen planus, one patient with dermatitis herpetiformis, and one with seborrheic dermatitis. Results: All patients had stable skin diseases prior to cupping but new lesions appeared at the site of cupping around two weeks after the procedure. Conclusion: cupping should not be encouraged for skin diseases with positive koebner phenomenon commonly psoriasis and lichen planus and possibly contraindicated as till now there is no scientific basis for using this procedure

Panniculitis is a common unrecognized histopathological feature of cutaneous leishmaniasis

Background: Cutaneous leishmaniasis (CL) is a parasitic cutaneous infection caused by Leishmania parasite. The histopathology is usually granulomatous in nature. Aims: The aim of the present study is to elucidate the histology of CL and evaluate the presence and the frequency of panniculitis among the affected patients. Settings and Design: Case series interventional study. Materials and Methods: Thirty-five patients with CL were diagnosed clinically between December-2012 and May-2013. Diagnostic confirmation established by smears, culture, and polymerase chain reaction (PCR). The histopathological assessment was carried out to study the general pathology and to look for the presence of panniculitis. Statistical Analysis Used: Simple statistics utilized via SPSS version 16.0 (SPSS, Inc., Chicago, USA). Results: Eighteen women and 17 men with CL were enrolled in the present work with a mean duration of their disease was 3 months. The results of the diagnostic tests were as follow: The smear was positive in 21 (60%) of cases, Leishman-Donovan (LD) bodies were seen in 7 (20%) patients, culture was positive in 24 (68%), and PCR was positive in 32 (91.4%) patients. The epidermal changes included acanthosis, pseudoepitheliomatous hyperplasia, ulceration, focal spongiosis, and interface dermatitis while the dermal changes were dependent on the spectrum of the disease, so in the ulcerative lesions there was lymphohistiocytic infiltration with foci of plasma cells and sometimes aggregate of LD bodies, whereas in the dry lesions the pathology is mainly of epithelioid granuloma. Panniculitis was seen in 16 (46%) cases as a diffuse lymphohistiocytic infiltration of both the septum and lobules of the subcutaneous layer of the skin. Conclusion: Panniculitis is an important feature of CL that must be differentiated from other diseases that can simulate CL such as chronic skin infections, Discoid lupus erythematosus, and cutaneous lymphoma

Clinical Evaluation of 80 Patients with Solar Keratosis Vs 43 Patients with Squamous Cell Carcinoma of Lower Lips: Basal Cell Carcinoma is a Commonly Associated Disease with no Causal Relation

Background Solar keratosis, also known as actinic keratosis or senile keratosis, is a skin condition that results from repeated sun exposure and damage, particularly in middle-aged and elderly individuals. It is characterized by rough, scaly, and warty lesions that may be pigmented, erythematous, or both, and can occur as macules, patches, or plaques. Solar keratosis lesions are most commonly found on the face and scalp and can be associated with basal cell carcinoma but not squamous cell carcinoma or solar keratosis of the lower lip. It is more prevalent in fair-skinned individuals who live in areas with high UV radiation, particularly those over 40 years of age. Objective The aim of this study was to document all instances of solar keratosis in patients with Fitzpatrick skin types III and IV, using a comprehensive clinical evaluation. Patients with xeroderma pigmentosum were excluded from the study. The study was conducted between 2014-2021 and involved 80 patients with solar keratosis and 43 patients with squamous cell carcinoma of the lower lips. Demographic information, complete medical history, and clinical evaluations were collected, and biopsies were performed on select patients for histopathological confirmation. This was a cross-sectional descriptive study. Results The study included 80 patients with solar keratosis, with ages ranging from 50 to 65 years and a mean age of 58 years. Of these patients, 41 (51.3%) were male and 39 (48.7%) were female. The lesions were predominantly located on the face, affecting 58 (72.5%) patients, while 12 (15%) patients had lesions on both the face and scalp, 4 (5%) had lesions on the scalp, forearms, and hands, and 2 (2.5%) had lesions on the eye sclera. Multiple lesions were present in 62 (77.5%) cases, and a butterfly-shaped distribution on the cheeks was observed in 18 (22.5%) patients (8 females and 10 males). The study identified rough, scaly, warty, and pigmented-erythematous rashes in the form of macules, patches, and plaques as the most common characteristics of the solar keratosis lesions. Among the 80 patients with solar keratosis, only 4 (5%) had the condition on their lower lip, and none of them had squamous cell carcinoma. In contrast, basal cell carcinoma was observed in 50 (62.5%) of patients affecting both faces and scalps, but no squamous cell carcinoma was detected. Among the 43 patients with squamous cell carcinoma of the lower lips, 2 (4.65%) had associated solar keratosis of the face. The age range of the patients with squamous cell carcinoma was 20-78 years, with a mean of 50 years, and the majority (83.7%) were males. Conclusions Solar keratosis is a common condition affecting the face and scalp of elderly patients of both sexes, and is often found in conjunction with basal cell carcinoma but not squamous cell carcinoma. This association between solar keratosis and basal cell carcinoma is coincidental rather than causal, as both are common conditions that often occur together. Importantly, solar keratosis of the face does not transform into basal cell carcinoma. Conversely, squamous cell carcinoma of the lower lip is predominantly a disease of males and is not associated with either solar keratosis or cancers of the face