Drug-related eruptions that appear only on intertriginous or flexural folds and in gluteal areas have recently been termed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE). We report a case of a 56-year-old woman with acute erythematous rash in the intertriginous areas after treatment with the L-valine ester of acyclovir, valacyclovir. Oral-challenge tests resulted in erythematous pruritic rash in the intertriginous area by valacyclovir. The patient was diagnosed as having SDRIFE due to valacyclovir.
Activated platelets form platelet–leukocyte aggregates in the circulation in inflammatory diseases. We investigated whether activated platelets in inflamed skin tissues are phagocytized and removed by neutrophils. To investigate the kinetics of platelets and neutrophils, we immunohistochemically examined the spatiotemporal distribution of them in a murine model of 2,4,6-trinitro-1-chlorobenzene (TNCB)-induced dermatitis by using confocal and structured illumination microscopy. Four hours after elicitation, aggregates of CD41-positive platelets were adhered to CD31-positive endothelial cells within the vessels, and CD62P and PF4, markers of activated platelets, were expressed on platelet aggregates. At 8 hour post-elicitation, fragmented CD41-positive platelets were located both inside and outside vessels. Twenty-four hours after elicitation, the number of Ly-6G-positive neutrophils ingesting fragmented CD41-positive platelets outside vessels was increased, and CD62P and PF4 expression on the phagocytosed platelets was no longer observed. Disc-shaped CD41-positive platelets were not found outside vessels at any time during the experiment. Our data revealed that aggregates of activated platelets inside vessels were ingested and removed by neutrophils in the early stage of TNCB-induced dermatitis, suggesting that the process of removal of activated platelets by neutrophils may play an important role not only in the early phase of skin inflammation but also in other types of acute inflammation.
Interstitial granulomatous dermatitis (IGD) is a reactive phenomenon accompanying disorders including autoimmune disease, lymphoproliferative disorders and drug reactions. Histologically, IGD shows a granulomatous infiltrate surrounding piecemeal fragmentation of collagen in the diffuse interstitium. IGD presents with linear cords, papules and plaques mainly on the trunk and extremities. Herein, we report a case with peculiar clinical features that were histopathologically consistent with IGD. A 74-year-old man presented with periungual painful erythema, nail deformity of all fingers and labial, penile and anal erosive erythema. Histopathological examination of the lesions showed interface dermatitis and a diffuse interstitial granulomatous infiltrate mainly composed of CD68-positive histiocytes and lymphocytes. Degenerative collagen bundles were also observed in granulomas. C-reactive protein and the white blood cell count were elevated, but further examinations did not reveal systemic inflammatory disorders such as autoimmune disease, lymphoproliferative disorder, inflammatory bowel disease or drug hypersensitivity. The lesions were successfully treated with oral and topical steroids.
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