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A Clinicopathological Analysis of Granulomatous
JK SCIENCE ORIGINAL ARTICLE A Clinicopathological Analysis of Granulomatous Dermatitis : 4 Year Retrospective Study Jyotsna Suri, Subhash Bhardwaj, Rita Kumari, Shailija Kotwal Abstract The present study was carried out with an attempt to study the incidence of granulomatous dermatitis in hospital based population and to classify and compare the granulomatous dermatitis on the basis of histopathology and find the etiology. This is a four year retrospective study done on the data available in the dermatopathology section of department of pathology. The cases diagnosed as granulomatous dermatitis were retrieved, clinical data and the histopathological features compared to know the incidence of various etiologies of GD. Out of 310 cases of GD with male to female ratio 2.03:1, leprosy comprised major reported etiology (n-244) followed by tuberculosis (n-44), sarcoidosis (n-4), Leshmania Donovani (n-14)) granuloma annulare (n-1) and 3 granulomatous lesions not further classified. Infections form the commonest form of GD out of which leprosy forms the major group. Role of histopathology(H&E and special stains) is very important in confirming the diagnosis of granulomatous dermatitis . Key Words Granuloma, Dermatitis, Inflammatory, Tissue Injury Introduction Granuloma is defined as a focal chronic inflammatory dermatitis presents a diagnostic challenge, many a times. response to tissue injury, characterised by focal, compact The granulomatous dermatitis comprise a large family collection of inflammatory cells, principally of the activated sharing the common histological denominator of histiocytes, modified epitheloid macrophages & granulomas formation. Rightly said that in granulomatous multinucleate giant cells that may or may not be rimmed dermatitis, an identical histologic picture may be produced by lymphocytes and show central necrosis. -
INTERNATIONAL JOURNAL of LEPROSY Volume 72, Number 1 Printed in the U.S.A
INTERNATIONAL JOURNAL OF LEPROSY Volume 72, Number 1 Printed in the U.S.A. (ISSN 0148-916X) INTERNATIONAL JOURNAL OF LEPROSY and Other Mycobacterial Diseases VOLUME 72, NUMBER 1MARCH 2004 Relapses in Multibacillary Patients Treated with Multi-drug Therapy until Smear Negativity: Findings after Twenty Years1 Gift Norman, Geetha Joseph, and Joseph Richard2 ABSTRACT The Schieffelin Leprosy Research and Training Center at Karigiri, India participated in several of the World Health Organization (WHO) trials. The first trial on combined therapy in multi-bacillary leprosy was initiated in 1981. The main objectives of this field trial were to evaluate the efficacy of WHO recommended regimens in preventing relapses, especially drug resistance relapses. This paper reports on the relapses twenty years after patients were inducted into the WHO field trial. Between 1981 and 1982, 1067 borderline lepromatous and lepromatous patients were in- ducted into the WHO field trial for combined therapy in multi-bacillary leprosy trial. Among them, 357 patients were skin smear positive. During the follow-up in 2002, only 173 of them could be traced and assessed. The mean duration of follow-up was 16.4 ± 1.83 years. Two patients relapsed 14 and 15 years after being released from treatment, the relapse rate being 0.07 per 100 person years follow-up. Drug susceptibility tests done on one of the relapsed patients revealed drug sensitive organisms to all multi-drug therapy drugs. RÉSUMÉ Le centre de recherche et de formation de Schieffelin à Karigiri aux Indes a participé à plusieurs études cliniques sponsorisées par l’Organisation Mondiale de la Santé (OMS). -
Wade Histoid Leprosy: Histological and Immunohistochemical Analysis
Lepr Rev (2013) 84, 176–185 Wade histoid Leprosy: histological and immunohistochemical analysis DANIELA A.M. DA COSTA*, MI´LVIA M.S.S. ENOKIHARA**, SUELY NONOGAKI***, SOLANGE M. MAEDA****, ADRIANA M. PORRO**** & JANE TOMIMORI**** *Medical resident, Escola Paulista de Medicina/UNIFESP, Sa˜o Paulo, Brazil **Department of Pathology, Escola Paulista de Medicina/UNIFESP, Sa˜o Paulo, Brazil ***Pathology Center, Instituto Adolfo Lutz, Sa˜o Paulo, Brazil ****Department of Dermatology, Escola Paulista de Medicina/UNIFESP, Brazil Accepted for publication 1 October 2013 Summary Histoid leprosy is a rare multibacillary form that presents with disseminated papule-nodular cutaneous lesions. To study the inflammatory infiltrate of the histoid form and to compare it with other lepromatous forms, we performed histological and immunohistochemical analysis on skin biopsies. Fifteen patients were included for histopathological analysis (10 histoid and five lepromatous) via the haematoxylin-eosin and Ziehl-Neelsen-Faraco stains. Thus, immunohistochemical techniques using immunoperoxidase assay were performed for: anti-BCG, anti-M. leprae, anti-CD8, anti-CD3, anti-CD20, anti-S100, anti-CD1a, anti-CD68 and anti- vimentin. Spindle cells were present in all histoid patients. A pseudocapsule was observed in half of both studied forms. A comparison using the Ziehl-Neelsen-Faraco stain to evaluate anti-BCG and anti-M.leprae showed no major differences. The CD3þ cells were more pronounced in the histoid form than the lepromatous form. There was greater immunoreactivity toward CD8þ cells in the histoid form, as well as the CD20þ cell count. A similar count of S100þ cells in the epidermis of both leprosy forms was observed. There was a slight increase of dendritic cells in the histoid patients in the superficial and deep dermis. -
Treatment Outcomes for Malassezia Folliculitis in the Dermatology Department of a University Hospital in Japan
Med. Mycol. J. Vol.Med. 57E, Mycol. E 63 J. − Vol. E 66, 57(No. 2016 3), 2016 E63 ISSN 2185 − 6486 Short Report Treatment Outcomes for Malassezia Folliculitis in the Dermatology Department of a University Hospital in Japan Chikako Suzuki, Midori Hase, Harunari Shimoyama and Yoshihiro Sei Department of Dermatology, Teikyo University Hospital ABSTRACT Topical or systemic antifungal therapy was administered to patients diagnosed with Malassezia folliculitis during the 5-year period between March 2007 and October 2013.The diagnosis of Malassezia folliculitis was established on the basis of characteristic clinical features and direct microscopic findings(10 or more yeast-like fungi per follicle).Treatment consisted of topical application of 2% ketoconazole cream or 100 mg oral itraconazole based on symptom severity and patientsʼ preferences. Treatment was given until papules flattened, and flat papules were examined to determine whether the patientʼs clinical condition had “improved” and the treatment had been “effective”.The subjects were 44 patients(35 men, 9 women), with a mean disease period of 25 ± 15 days.In regard to the lesion site, the frontal portion of the chest was the most common, accounting for 60% of all patients.The mean period required for improvement was 27 ± 16 days in 37 patients receiving the topical antifungal agent and 14 ± 4 days in the 7 patients receiving the systemic antifungal agent.The results were “improved” and the treatment was “effective” in all patients.Neither treatment resulted in any adverse reactions.Although administration of oral agents has been recommended for the treatment of Malassezia folliculitis, this study revealed that beneficial results are safely obtained with topical antifungal therapy alone, similar to those of systemic antifungal agents. -
2016 Essentials of Dermatopathology Slide Library Handout Book
2016 Essentials of Dermatopathology Slide Library Handout Book April 8-10, 2016 JW Marriott Houston Downtown Houston, TX USA CASE #01 -- SLIDE #01 Diagnosis: Nodular fasciitis Case Summary: 12 year old male with a rapidly growing temple mass. Present for 4 weeks. Nodular fasciitis is a self-limited pseudosarcomatous proliferation that may cause clinical alarm due to its rapid growth. It is most common in young adults but occurs across a wide age range. This lesion is typically 3-5 cm and composed of bland fibroblasts and myofibroblasts without significant cytologic atypia arranged in a loose storiform pattern with areas of extravasated red blood cells. Mitoses may be numerous, but atypical mitotic figures are absent. Nodular fasciitis is a benign process, and recurrence is very rare (1%). Recent work has shown that the MYH9-USP6 gene fusion is present in approximately 90% of cases, and molecular techniques to show USP6 gene rearrangement may be a helpful ancillary tool in difficult cases or on small biopsy samples. Weiss SW, Goldblum JR. Enzinger and Weiss’s Soft Tissue Tumors, 5th edition. Mosby Elsevier. 2008. Erickson-Johnson MR, Chou MM, Evers BR, Roth CW, Seys AR, Jin L, Ye Y, Lau AW, Wang X, Oliveira AM. Nodular fasciitis: a novel model of transient neoplasia induced by MYH9-USP6 gene fusion. Lab Invest. 2011 Oct;91(10):1427-33. Amary MF, Ye H, Berisha F, Tirabosco R, Presneau N, Flanagan AM. Detection of USP6 gene rearrangement in nodular fasciitis: an important diagnostic tool. Virchows Arch. 2013 Jul;463(1):97-8. CONTRIBUTED BY KAREN FRITCHIE, MD 1 CASE #02 -- SLIDE #02 Diagnosis: Cellular fibrous histiocytoma Case Summary: 12 year old female with wrist mass. -
Histopathological Study of Granulomatous Dermatoses - a 2 Year Study at a Tertiary Hospital
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Original Research Article Histopathological Study of Granulomatous Dermatoses - A 2 Year Study at a Tertiary Hospital Velpula Nagesh Kumar1*, Kotta. Devender Reddy2**, N Ezhil Arasi3** 1Tutor, 2Associate Professor, 3Professor & Head, *Department of Pathology, Rajiv Gandhi Institute of Medical Sciences (RIMS), Govt. Medical Collage, Kadapa, Andhra Pradesh. **Department of Pathology, Osmania Medical Collage, Hyderabad, Telangana. Corresponding Author: Velpula Nagesh Kumar Received: 14/07/2016 Revised: 10/08/2016 Accepted: 11/08/2016 ABSTRACT Granulomatous inflammation is a type of chronic inflammation that has distinctive pattern of presentation with wide etiology and can involve any organ. Pathologists come across this lesion frequently and through knowledge of granulomatous lesions are very much essential to discriminate them from other lesions in the skin as they closely mimic each other. The aim of the present study is know the types of dermal granulomas, their prevalence, age and sex distribution, modes of presentation and histopathological spectrum. This prospective study was undertaken at Osmania General Hospital, Hyderabad from June 2012 to May 2014. A total of 620 skin biopsies were received at the Department of Pathology, histopathological sections of all the cases were critically analyzed and were classified on a “pattern based” approach according to Rabinowitz and Zaim et al. 172 cases were categorized histopathologically as granulomatous dermatoses. Granulomatous dermatoses were more common in males and the peak age of incidence was in 3rd decade. Incidence of Granulomatous dermatoses was 27.7% which was comparable with available literature. In the present study we found that Infections form an important cause of granulomatous dermatoses with majority of cases being leprosy followed by cutaneous tuberculosis and foreign body granulomas. -
UC Davis Dermatology Online Journal
UC Davis Dermatology Online Journal Title Wade histoid leprosy revisited Permalink https://escholarship.org/uc/item/5d78t619 Journal Dermatology Online Journal, 22(2) Authors Coelho de Sousa, Virginia Laureano, Andre Cardoso, Jorge Publication Date 2016 DOI 10.5070/D3222030092 License https://creativecommons.org/licenses/by-nc-nd/4.0/ 4.0 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Volume 22 Number 1 February 2016 Case presentation Wade histoid leprosy revisited Virgínia Coelho de Sousa, André Laureano, Jorge Cardoso Dermatology Online Journal 22 (2): 8 Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos – Centro Hospitalar de Lisboa Central, Lisboa, Portugal Correspondence: Virgínia Coelho de Sousa, MD Hospital de Santo António dos Capuchos – Centro Hospitalar de Lisboa Central, Lisboa, Portugal Alameda Santo António dos Capuchos, 1169-050 Lisboa, Portugal [email protected] +351926826029 Abstract An 18-year-old man presented with a 4-year history of erythematous patches on the trunk, followed 2-years later by multiple nodules, mostly located on the limbs, and distal paresthesias. Two close contacts were treated for leprosy during his childhood. Histopathological examination revealed a histiocytic infiltrate with acid-fast bacilli on Ziehl-Neelsen stain. The slit-skin and nasal smears showed numerous acid-fast bacilli. The correlation between clinical, epidemiological, histopathological, and microbiological features allowed the diagnosis of lepromatous leprosy, histoid variant. Multidrug therapy as recommended by the WHO was initiated. A rapid and sustained improvement was seen. Histoid leprosy is a rare manifestation of lepromatous leprosy, first described by Wade in 1960. Since then few cases have been reported, the majority of them from countries with a high prevalence of the disease. -
Canadian Clinical Practice Guideline on the Management of Acne (Full Guideline)
Appendix 4 (as supplied by the authors): Canadian Clinical Practice Guideline on the Management of Acne (full guideline) Asai, Y 1, Baibergenova A 2, Dutil M 3, Humphrey S 4, Hull P 5, Lynde C 6, Poulin Y 7, Shear N 8, Tan J 9, Toole J 10, Zip C 11 1. Assistant Professor, Queens University, Kingston, Ontario 2. Private practice, Markham, Ontario 3. Assistant Professor, University of Toronto, Toronto, Ontario 4. Clinical Assistant Professor, University of British Columbia, Vancouver, British Columbia 5. Professor, Dalhousie University, Halifax, Nova Scotia 6. Associate Professor, University of Toronto, Toronto, Ontario 7. Associate Clinical Professor, Laval University, Laval, Quebec 8. Professor, University of Toronto, Toronto, Ontario 9. Adjunct Professor, University of Western Ontario, Windsor, Ontario 10. Professor, University of Manitoba, Winnipeg, Manitoba 11. Clinical Associate Professor, University of Calgary, Calgary, Alberta Appendix to: Asai Y, Baibergenova A, Dutil M, et al. Management of acne: Canadian clinical practice guideline. CMAJ 2015. DOI:10.1503/cmaj.140665. Copyright © 2016 The Author(s) or their employer(s). To receive this resource in an accessible format, please contact us at [email protected]. Contents List of Tables and Figures ............................................................................................................. v I. Introduction ................................................................................................................................ 1 I.1 Is a Clinical Practice Guideline -
Seborrheic Dermatitis and Dandruff: a Comprehensive Review
HHS Public Access Author manuscript Author ManuscriptAuthor Manuscript Author J Clin Investig Manuscript Author Dermatol Manuscript Author . Author manuscript; available in PMC 2016 May 02. Published in final edited form as: J Clin Investig Dermatol. 2015 December ; 3(2): . Seborrheic Dermatitis and Dandruff: A Comprehensive Review Luis J. Borda and Tongyu C. Wikramanayake* Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1600 NW 10th Avenue, RMSB 2023A, Miami, Florida 33136, USA Abstract Seborrheic Dermatitis (SD) and dandruff are of a continuous spectrum of the same disease that affects the seborrheic areas of the body. Dandruff is restricted to the scalp, and involves itchy, flaking skin without visible inflammation. SD can affect the scalp as well as other seborrheic areas, and involves itchy and flaking or scaling skin, inflammation and pruritus. Various intrinsic and environmental factors, such as sebaceous secretions, skin surface fungal colonization, individual susceptibility, and interactions between these factors, all contribute to the pathogenesis of SD and dandruff. In this review, we summarize the current knowledge on SD and dandruff, including epidemiology, burden of disease, clinical presentations and diagnosis, treatment, genetic studies in humans and animal models, and predisposing factors. Genetic and biochemical studies and investigations in animal models provide further insight on the pathophysiology and strategies for better treatment. Keywords Seborrheic dermatitis; Dandruff; Sebaceous gland; Malassezia; Epidermal barrier Introduction Seborrheic Dermatitis (SD) and dandruff are common dermatological problems that affect the seborrheic areas of the body. They are considered the same basic condition sharing many features and responding to similar treatments, differing only in locality and severity. -
Leprosy Revisited
Clinical Dermatology: Research and Therapy Open Access Letter to the Editor Leprosy Revisited Virendra N Sehgal* Dermato-Venereology (Skin/VD) Center, Sehgal Nursing Home, India A R T I C L E I N F O Letter to the Editor Article history: Leprosy [1] is a chronic granlomatous disease involves skin peripheral nerves, Received: 26 June 2018 Accepted: 28 June 2018 nasal mucosa affecting tissues and organs. Demonstration of Causative Published: 30 June 2018 Organism through Slit -Skin smear Examination [2] Mycobacterium leprae / M. Copyright: © 2018 Sehgal VN, Clin Dermatol Res Ther leprae (Figure 1) Ziehl-Neelsen stain Acid fast bacilli. Narrative of M. leprae This is an open access article distributed under the Creative Commons Attribution including its characteristics, mode of transmission pathogenesis, and evolution License, which permits unrestricted use, distribution, and reproduction in any of classification are salient pre-requisite to comprehend leprosy and gender. medium, provided the original work is Mycobacterium leprae: characteristics properly cited. • Appear as straight or curved rods Citation this article: Sehgal VN. Leprosy Revisited. Clin Dermatol Res Ther. 2018; • Size is 1-8 microns x 0.5 microns. 2(1):118. • Polar bodies present as clubbed forms. • Lateral buds • Acid fast but less resistant only 5% H2So4 • Live bacilli, solid uniform structure. • Dead appear as fragmented with granules. Investigations for M. Leprae Bacteriological examination Slit-Skin smears: Made by slit and scrape method from the most active looking edge of skin lesion and stained with Ziehl-Neelsen method. Reading of smears: • Bacteriological-index (BI) Indicates density of leprosy bacilli (live & dead) in the smears and range from 0 to 6+ • Morphological-index (MI) It is the percentage of presumably living bacilli in relation to total number of bacilli in the smear. -
Epidemiologic Study of Malassezia Yeasts in Patients with Malassezia Folliculitis by 26S Rdna PCR-RFLP Analysis
Ann Dermatol Vol. 23, No. 2, 2011 DOI: 10.5021/ad.2011.23.2.177 ORIGINAL ARTICLE Epidemiologic Study of Malassezia Yeasts in Patients with Malassezia Folliculitis by 26S rDNA PCR-RFLP Analysis Jong Hyun Ko, M.D., Yang Won Lee, M.D., Yong Beom Choe, M.D., Kyu Joong Ahn, M.D. Department of Dermatology, Konkuk University School of Medicine, Seoul, Korea Background: So far, studies on the inter-relationship -Keywords- between Malassezia and Malassezia folliculitis have been 26S rDNA PCR-RFLP, Malassezia folliculitis, Malassezia rather scarce. Objective: We sought to analyze the yeasts differences in body sites, gender and age groups, and to determine whether there is a relationship between certain types of Malassezia species and Malassezia folliculitis. INTRODUCTION Methods: Specimens were taken from the forehead, cheek and chest of 60 patients with Malassezia folliculitis and from Malassezia folliculitis, as with seborrheic dermatitis, the normal skin of 60 age- and gender-matched healthy affects sites where there is an enhanced activity of controls by 26S rDNA PCR-RFLP. Results: M. restricta was sebaceous glands such as the face, upper trunk and dominant in the patients with Malassezia folliculitis (20.6%), shoulders. These patients often present with mild pruritus while M. globosa was the most common species (26.7%) in or follicular rash and pustules without itching1,2. It usually the controls. The rate of identification was the highest in the occurs in the setting of immuno-suppression such as the teens for the patient group, whereas it was the highest in the use of steroids or other immunosuppressants, chemo- thirties for the control group. -
Histoid Leprosy with Giant Lesions of Fingers and Toes
Biomédica 2015;35:165-70 Lepra histioide doi: http://dx.doi.org/10.7705/biomedica.v35i2.2562 PRESENTACIÓN DE CASO Histoid leprosy with giant lesions of fingers and toes Gerzaín Rodriguez1, Rafael Henríquez2, Shirley Gallo2, César Panqueva2 1 Facultad de Medicina, Universidad de La Sabana, Chía, Colombia 2 Facultad de Medicina, Universidad Surcolombiana, Neiva, Colombia This work was conducted at the Facultad de Medicina, Universidad de La Sabana, and at the Facultad de Medicina, Universidad Surcolombiana. Histoid leprosy, a clinical and histological variant of multibacillary leprosy, may offer a challenging diagnosis even for experts. An 83-year-old woman presented with papular, nodular and tumor-like lesions of 3 years of evolution, affecting fingers, toes, hands, thighs and knees, and wide superficial ulcers in her lower calves. Cutaneous lymphoma was suspected. A biopsy of a nodule of the knee showed a diffuse dermal infiltrate with microvacuolated histiocytes, moderate numbers of lymphocytes and plasma cells. Cutaneous lymphoma was suggested. Immunohistochemistry (IHC) showed prominent CD68-positive macrophages, as well as CD3, CD8 and CD20 positive cells. Additional sections suggested cutaneous leishmaniasis. New biopsies were sent with the clinical diagnoses of cutaneous lymphoma, Kaposi´s sarcoma or lepromatous leprosy, as the patient had madarosis. These biopsies showed atrophic epidermis, a thin Grenz zone and diffuse inflammation with fusiform cells and pale vacuolated macrophages. Ziehl- Neelsen stain showed abundant solid phagocytized bacilli with no globii formation. Abundant bacilli were demonstrated in the first biopsy. Histoid leprosy was diagnosed. The patient received the WHO multidrug therapy with excellent results. We concluded that Ziehl Neelsen staining should be used in the presence of a diffuse dermal infiltrate with fusiform and vacuolated histiocytes, which suggests a tumor, and an IHC particularly rich in CD68-positive macrophages; this will reveal abundant bacilli if the lesion is leprosy.