This study demonstrates the strong psychiatric morbidity in patients with psoriasis, for which further psychiatric evaluation should be considered.

Background Limited information exists regarding survival of Asian patients with mycosis fungoides (MF) and Sézary syndrome (SS). Objective To evaluate the epidemiology, outcome and prognostic factors of these patients. Methods A retrospective review of MF/SS cases diagnosed from 2000 to 2011 at a tertiary referral dermatology centre in Singapore was performed. Results Of 246 patients, 63% were male and the median age at diagnosis was 49 years. 73.2% were Chinese, 12.6% Indian, 6.9% Malay and 7.3% Caucasian. A total of 239 patients (97.2%) had MF and seven had SS. Median follow‐up duration was 6.3 years, and median duration of symptoms at diagnosis was 13 months. For patients with MF, the majority had early disease (92.8% stage IA–IIA). 3.8% were stage IIB, 1.7% stage III and 1.7% stage IV. Complete response to treatment occurred in 78.2%, partial response in 9.6%, persistent but non‐progressive disease in 10.0% and disease progression in 4.1% of patients. Large cell transformation occurred in 4.1% of patients. Mean overall survival during this study was 12.7 years, with death occurring in 2.5% of patients (all ≥stage IIB at diagnosis). For patients with SS, 71.4% presented with stage IVA disease, 28.6% stage IVB. Complete response to treatment occurred in 14.2%, persistent but non‐progressive disease in 28.6% and disease progression in 57.2% of patients. Mean overall survival was 3.3 years within this study, with death occurring in 42.9% of SS patients. Prognostic factors associated with favourable recurrence‐free survival were male gender (P = 0.008), early disease stage (T1) at diagnosis (P < 0.001) and absence of maintenance treatment after remission (P = 0.01). Conclusion Compared to Caucasian and East Asian cohorts, MF in South‐East Asians was diagnosed at a younger age and associated with lower mortality, largely due to greater prevalence of hypopigmented MF.

In this study, we describe the clinicopathologic features of pseudolymphomatous infiltrates found within lesions of acrodermatitis chronica atrophicans (ACA). We studied 11 patients (10 females, 1 male, age range 60-88 years). The diagnosis of ACA in all cases was confirmed by clinicopathologic correlation and positive serology for Borrelia. Histopathologic examination revealed prominent, pseudolymphomatous inflammatory cell infiltrates in all cases, with 2 distinct patterns. Eight of 11 cases showed a band-like lymphocytic infiltrate, exocytosis of lymphocytes and a fibrotic papillary dermis, similar to features seen in mycosis fungoides. The other 3 cases showed dense, nodular-diffuse dermal infiltrates with many plasma cells and without germinal centers. The plasma cells expressed both kappa and lambda immunoglobulin light chains with a polyclonal pattern in all 3 cases. In conclusion, ACA may present with pseudolymphomatous infiltrates showing both a T-cell and, less frequently, a B-cell pattern. These lesions need to be distinguished from a cutaneous lymphoma. In the context of the knowledge of Borrelia-associated cutaneous lymphomas, follow-up seems advisable in these cases.

Some cases of specific cutaneous manifestations of acute myelogenous leukemia (AML) may mimic inflammatory dermatoses both clinically and histopathologically, presenting with an inconspicuous maculopapular eruption and with only sparse dermal infiltrates. The authors studied the histopathological and immunohistochemical features of 17 biopsies from 16 patients (11 men and 5 women, age range 15-85 years) presenting with minimal skin infiltrates as the first manifestation of AML or as first sign of recurrence after complete remission of the disease. In all cases, the diagnosis of leukemia has been confirmed by bone marrow examination. Two of these cases had been sent to one of us for second expert consultation. Patients presented with generalized, exanthematic maculopapular eruptions, sometimes with a hemorrhagic note, that were mostly interpreted clinically as drug reactions. Histopathologically, the lesions showed sparse, superficial, and mid-dermal infiltrates with minimal perivascular and periadnexal accentuation. Infiltrating cells consisted mostly of neoplastic monocytoid elements with only few reactive lymphocytes and histiocytes. Immunohistochemical stainings revealed in the majority of cases positivity for CD68 (14 of 16 patients), naphthol chloroacetate esterase (NaSDCl) (7 of 10 patients), and myeloperoxidase (6 of 9 patients). Other markers tested were positive only in a minority of cases. These cases represent a pitfall both in the clinical and in the histopathological diagnosis of cutaneous AML. Accurate morphologic and phenotypic correlation together with a high index of suspicion allows a precise diagnosis in these unconventional cases.

No abstract

Introduction: This study aimed to assess the frequency of anxiety and depression in a cohort of adult patients with atopic dermatitis (AD) in a tertiary dermatological centre, using the Hospital Anxiety and Depression Scale (HADS). We looked for any correlation between anxiety and depression with skin disease severity. Materials and Methods: Patients with AD were recruited from the National Skin Centre, Singapore, from 2008 to 2009 for a prospective cross-sectional study. The scoring atopic dermatitis (SCORAD) grade was determined and the HADS was administered via interviews. Results: A total of 100 patients (78 males, 22 females) were enrolled (92% Chinese, 4% Malays and 4% Indians). Their average age was 25.7 years. Sixty-five percent used topical steroids, 14% had previously taken oral prednisolone for the control of disease flares, and 20% were on concurrent systemic therapy. The mean SCORAD was 55.0, with 99% of patients having moderate or severe AD. The mean HADS anxiety score was 7.2 and the mean depression score was 5.0. The level of anxiety correlated well with that of depression (Spearman’s rank correlation coefficient, ρ = 0.59, P <0.05); 18% were considered as cases of anxiety and 5% as cases of depression. These patients also had higher SCORAD values compared to other patients with lower scores for anxiety or depression (P <0.05). Linear regression demonstrated a statistically significant positive relationship between anxiety and depression scores, and SCORAD scores. Conclusion: Our study identified, by means of the HADS, the frequency of anxiety and depression amongst a cohort of Singaporean patients with AD. More severe skin disease correlated to greater psychological burden. The HADS is a useful screening tool that can constitute part of the overall holistic management of patients with AD so as to improve patient care. Key words: Eczema, HADS, Mood disorders, SCORAD

A patient in their 50s presented with asymptomatic keratotic papules, first noticed on the left middle and ring fingers and left toe web spaces more than 10 years earlier. The papules progressed proximally over the subsequent decade to involve the forearm, arm, scapular area, ankle, shin, and thigh, but only affected the left side of the body. The patient's face, palms, soles, and entire right side of the body were spared. The patient has a history of rosacea being treated with topical metronidazole gel for flares but was otherwise asymptomatic. The patient did not have any alopecia, night blindness, or dry eyes or skin. There was no history of any exposure to radiation or arsenic, nutritional deficiency, inflammatory skin disease, or malignant neoplasm. There was no family history of a similar condition.Examination revealed multiple, submillimeter, skin-colored to yellowish keratotic spiny projections over the aforementioned areas, only on the left side of the body (Figure , A and B). Punch biopsy from a lesion showed orthokeratosis with parakeratotic columns emerging from an epidermal invagination. The epidermis was mildly acanthotic and with a normal granular layer. There was a sparse superficial perivascular lymphocytic infiltrate. Adjacent hair follicles were unaffected (Figure , C). Diagnosis B. Multiple minute digitate hyperkeratosis

Protothecosis is an uncommon condition resulting from infection by achlorophyllous algae of the Prototheca species. Immunocompromised individuals are generally most susceptible to protothecal infection and tend to develop severe and disseminated disease. However, the association between protothecosis and HIV-induced immunosuppression is not clear, with only a handful of cases having been described to date. Here we report a case of cutaneous protothecosis in a Chinese man with previously undiagnosed HIV infection that responded well to oral itraconazole.