Paul K. Shitabata, M.D. Dermatopathology Institute

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 SAPHO Syndrome  Synovitis   Pustulosis  Hyperostosis  Osteitis

Thursday, May 23, 13  Severe form of acne characterized by burrowing and interconnecting abscesses and irregular scars  Chest, shoulders, back, buttocks, upper arms, thighs, and face  Sudden deterioration of existing active papular or pustular acne  Recrudescence of quiescent acne

Thursday, May 23, 13  Toxic chemicals exposure (dioxins)  Few months after swallowing, inhaling or touching  Occupational exposure, enviromental poisoning  Ukrainian President Victor Yushchenko

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology  with varying degrees of the following depending upon the stage and temporal progression  Telangiectasia  Sebaceous hyperplasia  Fibrosis  Granulomas

Thursday, May 23, 13 Disease Associaons of Acne  Steroid rosacea  HIV-1  Pyoderma faciale 

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology  Hair shaft infiltrated by fungal yeast and hyphae  May have epidermal involvement  Suspect with acute suppurative folliculitis  Woods lamp negative  PAS/GMS to confirm  T. tonsurans most common

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology  Folliculitis with variable degree of eosinophils  Clinical correlation  CD4 count correlation  Rule out other infection

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology  Viral cytopathic changes in the hair follicle  May not have epidermal involvement

Thursday, May 23, 13 Exclusive involvement of folliculosebaceous units by herpes: a reflecon of early herpes zoster.  Three patients with non-vesicular eruptions on the head and neck

 Bx: Exclusive folliculosebaceous involvement by herpes

 All developed typical herpes zoster within days of the biopsy

 Virus is transported from dorsal root or trigeminal ganglia via myelinated nerves to the skin which terminate at the isthmus of hair follicles and primary infection of follicular and sebaceous epithelium occurs

 Spread of infection to the epidermis follows

 In contrast, data pertaining to recurrent herpes simplex indicates that axonal transport of the virus from sensory ganglia to the skin is directed primarily to the epidermis, via terminal non-myelinated nerve twigs

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology  Folliculitis with transepidermal elimination of collagen  May have dermal collection of neutrophils adjacent to follicle  Consider elastic stains  Deeper levels may be necessary

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology  Follicle expanded or obliterated by mucin  Associated lymphocytic infiltrate  May lead to scarring alopecia  Rule out MF

Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Thursday, May 23, 13 Histopathology  May lack epidermal involvement  May be associated with follicular mucinosis  Confirm by IHC or gene rearrangement

Thursday, May 23, 13 Quesons

 Retirement at sixty- five is ridiculous. When I was sixty-five I still had pimples.

George Burns (1896 - 1996)

Thursday, May 23, 13