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Background Chronic spontaneous urticaria (CSU) may occasionally exhibit long‐lasting lesions with bruising, usually considered a hallmark of urticarial vasculitis (UV). Histopathology of these chronic urticarial lesions has not been extensively studied. Methods Skin biopsies from patients with anti‐H1 resistant CSU were evaluated for several parameters (edema, location, intensity, and cell composition of the inflammatory infiltrate, and abnormalities in the blood vessels). Results We studied 45 patients (37 female/8 male, mean age 49.3 years) with CSU, 60% of whom with occasional bruising lesions and 3 patients with hypocomplementemic UV. Histopathology in CSU showed mainly perivascular and interstitial inflammatory infiltrate (91.1%), including eosinophils (80%), neutrophils (77.8%), and lymphocytes (71.1%), vasodilatation (88.9%), intravascular neutrophils (95.6%), dermal edema (51.1%), swelling of endothelial cells (51.1%), and minor and rare fibrinoid necrosis and karyorrhexis (6.7%). Significant karyorrhexis and frank fibrinoid necrosis were observed, respectively, in two and three cases of UV. In patients with occasional bruising, mast cells occurred in fewer cases whereas eosinophils were more frequent, but no statistically significant difference was found for other parameters. Conclusions Histopathological findings were not significantly different between CSU with or without bruising lesions. Bruising may be associated with more severe forms of CSU with no histopathological signature, although UV cannot be completely excluded based on histopathology.

DISCUSSIONThis relatively low reactivity to IPBC, and the higher prevalence in males and those aged >40 years, are consistent with results from another European centre, 7 but are distinct from results from the last 10 years in North America. They showed higher reactivity to IPBC (between 3.1% and 4.7%), possibly because of the inclusion of doubtful results and the higher patch test concentration (0.5% pet). 8 Low IPBC reactivity contrasts with high reactivity to isothiazolinones (>14%), 9 which is still found among our patients in many household and professional products and occasional

Endometriosis is a chronic disorder characterized by the presence of ectopic functional endometrial tissue outside the uterine cavity and which affects about 10% of all women of reproductive age. Cutaneous endometriosis, usually localized in the abdominal wall, is a rare entity. We report the case of a nulliparous woman with an acute painful umbilical nodule that slowly increased in size during the days prior to observation. The lesion was surrounded by a painful periumbilical subcutaneous plaque. The patient denied associated constitutional symptoms and reported two similar episodes in the previous two years. A skin biopsy was performed, and histopathologic examination was consistent with the diagnosis of endometriosis. This article reviews this disease particularly rare in nulliparous and highlights the importance of recognizing this clinical presentation of endometriosis due to its frequent association with pelvic disease that can lead to reduced fertility.

We present a 6-year-old girl with skin hyperpigmentation, leukoplakia, and onychodystrophy, the classic mucocutaneous triad usually associated with dyskeratosis congenita. The patient also had premature graying of the hair, bone marrow failure, hepatitis, exudative retinopathy, osteopenia with multiple long bone fractures, and intracranial calcifications and brain cysts. Coats plus syndrome is a rare disease with a clinical and genetic overlap with dyskeratosis congenita. This disease is reviewed, with a focus on the pathogenesis of the genetic anomalies and its background as a telomere biology disorder.