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Paracheratosi granulare
No full textGranular parakeratosis is an acquired disorder of keratinization of unknown origin affecting mainly flexures of adults. A 48-year-old woman presented a 1-year history of keratotic papules on the infra- and submammary regions. A skin biopsy revealed granular parakeratosis confined to epidermal foci. The patient's eruption resolved completely with topical steroid therapy. Etiopathogenesis and differential diagnosis are discussed
Sindrome di Churg-Strauss
No full textWe report the case of a 54-year-old man admitted to the emergency unit of our hospital with severe asthma, arthralgias, fever, paresthesias and asymptomatic purpuric lesions on the upper and lower extremities. His past history was remarkable for recurrent episodes of asthma, nasal polyposis, hypertensive cardiopathy and comitial attacks. Laboratory findings were leukocytosis with prominent eosinophilia, elevated erythrocyte sedimentation rate and increase of anti-neutrophil cytoplasmic antibodies (p-ANCA). Urine analysis revealed mild proteinuria. A chest radiograph revealed bilateral pulmonary infiltrates; multiple necrotic areas in the kidneys and liver were detected by tomographic scan and nuclear magnetic resonance. Histopathologic examination of a purpuric papule was striking for the presence of foci of basophilic collagen degeneration surrounded by histiocytes with many neutrophils and eosinophils. Based on the clinical, histopathologic and laboratory findings, the diagnosis of Churg-Strauss syndrome was made and prednisone 1mg/kg/die was started with dramatic response. Churg-Strauss syndrome is an uncommon multi-system disease with clinical and histopathologic features that sometimes overlap with other ANCA-vasculitides. Diagnosis is often difficult because the clinicopathologic findings evolve according to the different phases of the disease. The skin holds particular significance because it serves as a useful site for histopathologic diagnosis
Ocronosi esogena da idrochinone
No full textA case of exogenous ochronosis associated with topical application of a hydroquinone-containing preparation is reported. The patient was a 42-year-old Nigerian woman who had intermittently applied a bleanching cream to her skin for 5 year. Examination revealed numerous discrete, pin-point, blue-black macules distributed in a symmetric fashion on the zygomatic regions and, to a lesser extent, the nose, chin, and upper and lower extremities. The sclerae, conjunctivae, ears, and oral mucosa were normal. Histopathologic examination of a skin biopsy from a dyscromic area revealed within the papillary dermis and mid reticular dermis, multiple scattered, banana-shaped or arciform, yellow-brown, swollen collagen bundles. Scrutiny of the epidermis overlying the ochronotic deposits showed evidence of a vacuolar interface dermatitis with some necrotic keratinocytes. To the best of our knowledge, these findings have not been described in patients with the endogenous form of ochronosis and could be related to the toxic effects of hydroquinone on the epidermal keratinocytes and melanocytes
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