Penicillamine-induced cutaneous elastosis perforans serpiginosa associated with a large air-cyst in the right lung is described in a 29-year-old female patient with Wilson disease. Identical light and electron-microscopic changes were present in both dermal and pulmonary elastic tissue, suggesting a disseminated drug-induced cutaneo-visceral elastosis. Lung cysts have not been previously reported in association with long term penicillamine treatment. The electron-microscopic morphology of the elastic fibers was found to be "specific" enough to allow separation of penicillamine-induced elastosis perforans serpiginosa from other forms of this disease.
A case of hidroacanthoma simplex, suggesting malignant transformation into porocarcinoma in situ is reported. It represents further evidence that epidermotropic eccrine carcinoma may originate from the acrosyringium. This lesion demonstrates that the upper portion of the dermal eccrine duct may participate in the oncogenesis of hidroacanthoma simplex. It may also provide the missing link in the chain of evolution of benign eccrine poroacanthoma into porocarcinoma.
Fourteen patients with digital mucoid cysts were treated by cryosurgery with liquid nitrogen using an intermittent spray technique. The cysts were punctured and the contents expressed preoperatively. Treatment was well tolerated without local anesthesia. Cysts ranged in size from 0.4 to 1.5 cm. Average follow-up was 18.6 months. Twelve patients were cured to date, in some instances after many prior unsuccessful attempts with other treatment modalities. In one patient a cyst recurred after 10 months and was retreated by cryosurgery. In another patient a much smaller cyst recurred after 12 months. Cosmetic results were gratifying, with absent or minimal scarring. From these preliminary observations it may be concluded that liquid nitrogen cryospraying of digital mucoid cysts is a valuable therapeutic modality in these notoriously recalcitrant lesions.
A skin biopsy from an 8-year-old boy with generalized lichen nitidus revealed a transepidermal perforating lesion never observed before in this disorder. A disturbance in dermo-epidermal interaction with alterations of epidermal cell kinetics could explain this finding in a disease which, curiously, shows many histologic features conducive to transepidermal perforation. A clear distinction should be made between primary and secondary perforating dermatoses, since perforation per se is a non-specific cutaneous reaction pattern occurring in the course of many unrelated disorders.
In recent years the phenomenon of transepithelial elimination has been found to be the underlying mechanism in a variety of skin disorders. "Perforating dermatoses" may show transepidermal or transfollicular elimination or a combination of the two. A case of papular granuloma annulare is reported, where in one lesion the pilary apparatus actively participated in the elimination of necrobiotic collagen from the dermis. To our knowledge, perforating granuloma annulare with a transfollicular pathway has not previously been described. Also, a classification of perforating dermatoses is presented.
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