Lichen nitidus (LN) is an uncommon, usually asymptomatic cutaneous eruption characterized by the presence of multiple, small, flesh-colored papules. The epidemiologic and pathophysiologic characteristics of LN have not yet been defined. Furthermore, LN has rarely been described in association with other cutaneous diseases. We herein report 3 cases of LN associated with various cutaneous diseases, including lichen striatus, oral lichen planus, and psoriasis vulgaris.
Spitzoid melanoma is a subtype of melanoma that, clinically and histologically, resembles a Spitz nevus. Clinically, spitzoid melanomas usually evolve from amelanotic nodular lesions, growing to 1 cm or more in diameter. They often remain clinically undiagnosed because of their wide variety of clinical appearances and a lack of pigmentation. Distinguishing a Spitz nevus from a spitzoid melanoma can be extremely difficult. Features that favor the diagnosis of a spitzoid melanoma are asymmetrical shape, diameter greater than 1 cm, a lesion with a deep invasive component, and a high degree of cytologic atypia. There have been only rare reports in the literature of the presence of giant cells in malignant melanoma, and the presence of these cells may result in its misdiagnosis as a histiocytic tumor. We present a case of spitzoid melanoma on the right ankle of a 22-year-old-woman.
a b s t r a c tVulvitis circumscripta plasmacellularis (VCP) is a rare, benign vulvar disorder that presents with erythematous patches and erosions. Patients with VCP usually experience vulvodynia, pruritus, or dyspareunia, which may cause severe discomfort. A 72-year-old woman presented with 10 years of vulvar pruritus and whitish patches on the labia minora and majora. A biopsy was performed on the labia minora and lichen sclerosus was diagnosed. Her condition improved after treatment with a topical steroid. After 5 months, however, her symptoms reappeared with aggravated skin lesions. A rebiopsy was performed and VCP was diagnosed. There have only been two reported cases of concurrence of VCP with lichen sclerosus. We herein report an unusual case of VCP in pre-existing lichen sclerosus. IntroductionVulvitis circumscripta plasmacellularis (VCP) was first described by Garnier 1 in 1954. It is a relatively rare chronic inflammatory disease. It is clinically and histopathologically similar to balanitis circumscripta plasmacellularis in males. Clinical symptoms of VCP are vulvodynia, pruritus, or dyspareunia, but VCP may be asymptomatic. 2 Only two cases have been reported on concurrent VCP and vulvar lichen sclerosus. 2,3 In this report, we describe an unusual case of VCP in pre-existing lichen sclerosus. Case reportA 72-year-old woman presented with 10 years of vulvar pruritus. She had localized whitish patches on the labia minora and majora ( Figure 1A). Her medical history included hypertension for 1 year. Laboratory test results were within normal limits. A biopsy was performed on the labia minora, including the majora, the results of which revealed pronounced edema and homogenization of collagen in the upper dermis. Hyperkeratosis and follicular plugging in the epidermis and inflammatory infiltrate in the middermis were observed (Figure 2). Lichen sclerosus was diagnosed, and the patient was treated with a topical potent corticosteroid (clobetasol-17-propionate) for 2 weeks. Her condition improved, but her symptoms were aggravated after 5 months. She presented with severe pruritus and pain in the vulvar area. A physical examination revealed localized whitish to erythematous eroded patches on the labia minora ( Figure 1B). A rebiopsy on the eroded patches of the labia minora was performed to rule out squamous cell carcinoma. The biopsy specimen showed epidermal thinning, absence of the stratum corneum, irregular acanthosis, and spongiosis in the epidermis. A dense dermal lichenoid infiltrate with many plasma cells and lymphocytes was observed (Figure 3). Results of an immunohistochemical analysis revealed that plasma cells were polyclonal for kappa and lambda light chains, and syphilis testing with venereal disease research laboratory was negative. Based on the results of the biopsy, VCP was diagnosed. After treatment with a systemic and topical corticosteroid, the patient's condition temporarily improved; however, her symptoms recurred, and she was advised to apply imiquimod 5% cream two to three times a wee...
Palmar digital vein thrombosis causing one or more nodules seems to be a relatively rare condition, judging by the dearth of reports in the literature. It should always be considered in a patient who presents with a painful, firm, blue nodule located at or in close proximity to one of the flexion crease of the finger. Common lesions presenting as one or more solid digital nodules are ganglions, epidermal inclusion cysts, giant cell tumors, and lipomas. Thrombosis of the palmar digital veins should, however, be part of the differential diagnosis of palmar digital nodules because it is possible to manage it conservatively. We report two cases of thrombosis of palmar digital vein in a 33-year-old woman and a 78-year-old man.
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