A distinctive variant of pernio. Clinical and histopathologic study of nine cases

ÖZ GİrİŞPerniyo soğuk maruziyetinden sonra kaşıntılı veya ağrılı viyolese akral lezyonlarla ortaya çıkan inflamatuvar bir deri hastalığıdır. İdyopatik olabileceği gibi altta yatan bir sistemik hastalığa bağlı da oluşabilir. Eritemli papüllerden vesiküler tarzda lezyonlara kadar çok çeşitli olabilen deri lezyonları, akral bölge-lerde yerleşir (1) . Burada perniyo tanısı alan bir olgu sunularak, perniyonun klinik ve histopatolojik özel-liklerine değinilmiş ve ayırıcı tanılar gözden geçiril-miştir. OLGUOtuz iki yaşında erkek hasta polikliniğimize 11 yıl-dır el ve ayaklarında, kış aylarında ortaya çıkan ağ-rılı papül ve plaklar nedeniyle başvurdu. Hasta iki yıl önce özel bir dermatoloji kliniğine başvurmuş ve ekzema tanısı ile topikal steroidler verilmişti. Ancak lezyonlarında herhangi bir gerileme olmamıştı. Hasta kış aylarında oluşan bu lezyonların kızarık bir şekilde başladığını, daha sonra sarımsı bir renk oluştuğunu ve son aşamada kabuklanarak kaybolduğunu ifade ediyordu. Eklem ağrıları ve eklem bölgelerinde şişlik olduğunu da söyleyen hastanın anamnezi sorgulandı-ğında herhangi bilinen bir hastalığının olmadığı öğ-

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“…Perniyoda temel histolojik özellik lenfositik vaskülittir (12,13) . Lenfosit infiltrasyonu, yüzeyel ve derin dermal yapıları tutar.…”

Section: Discussionunclassified

Pernio: A case report and the review of the differantial diagnosis

Topal¹,

Güngör²,

Topal³

et al. 2016

Okmeydani Medical Journal

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“…4 The mononuclear cell infiltrate of the vascular walls is reminiscent of lymphocytic vasculitis. 4–5 In deep‐type pernio, the intense perivascular mononuclear cell infiltrate extends throughout the dermis and into the subcutaneous fat. The blood vessels show similar changes to the superficial form.…”

Section: Discussionmentioning

confidence: 99%

Papular perniosis mimicking erythema multiforme: the first case report in Thailand

2000

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A healthy 23‐year‐old man of Thai descent presented with skin lesions on the acral part of the feet, which developed after exposure to an Australian winter with an average temperature of 5 °C. Immediately after the exposure, the patient developed mild anesthesia around the toes which was accentuated after a bath. During the exposure, warm winter clothes, including boots and socks, were worn. Several hours later, a few itchy bumps were noted bilaterally on the fifth toes. The patient then cleansed and immersed his feet in an over‐the‐counter antiseptic preparation. By the next day, the lesions had enlarged and formed blisters filled with clear fluid. The lesions gradually progressed to cover the dorsal part of the feet within the next few days. He applied an over‐the‐counter antibacterial/antifungal cream to the lesions for 3 days without any improvement. Five days later the lesions became purplish red. Itching was the only symptom experienced. The patient was a nonsmoker who was in good health and denied a history of skin diseases, herpes simplex viral infection, or any intake of oral medication. Physical examination, performed in Thailand, revealed symmetrically distributed, discrete, purplish papules, some with dusky red centers, on the dorsal surfaces of all toes without blisters or erosion ( Fig. 1). No lesions were detected on the plantar surfaces of the feet, the legs, hands, or elsewhere on the body. Complete blood cell count, erythrocyte sedimentation rate (ESR), venereal disease research laboratory (VDRL) test, cryoglobulin, hepatitis B surface antigen (HBsAg), and anti‐hepatitis core immunoglobulin M (anti‐HBC IgM) were within normal limits or negative. 1 Erythema multiforme‐like lesions on the acral part of the feet The clinical diagnosis at the initial visit was cold injury; however, the differential diagnosis included contact erythema multiforme and vasculitis. Skin biopsy performed on one of the purplish papules revealed proliferation of thick‐walled blood vessels and edema of the dermal papillae. The lumens of these vessels were narrow. There was a superficial and deep perivascular lymphocytic infiltrate in the upper dermis. The epidermis revealed only mild spongiosis and focal lymphocytic exocytosis without necrotic keratinocytes ( Fig. 2). The findings were consistent with perniosis. The patient was treated with topical triamcinolone acetonide 0.1% cream with significant improvement observed within a few days ( Fig. 3).

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“…Patients with acrocyanosis and cutis marmorata are predisposed 70,71 . Bullous and ulcerative forms of chilblains are rare, but they have been described in the literature 72 . Histopathologically, fibrosing inflammation in the corium, vascular dilatation, necrosis and/or subepidermal blistering, and infiltrates composed of lymphocytes and macrophages are observed 72 .…”

Section: Aetiopathogenetic Aspectsmentioning

confidence: 99%

“…Bullous and ulcerative forms of chilblains are rare, but they have been described in the literature 72 . Histopathologically, fibrosing inflammation in the corium, vascular dilatation, necrosis and/or subepidermal blistering, and infiltrates composed of lymphocytes and macrophages are observed 72 . The occurrence of chilblains in the legs can mimic the erythema nodosum that accompanies Löfgren syndrome.…”

Section: Aetiopathogenetic Aspectsmentioning

confidence: 99%

See 1 more Smart Citation

Sarcoidosis of the skin – A dermatological puzzle: important differential diagnostic aspects and guidelines for clinical and histopathological recognition

Tchernev¹,

Nenoff³

et al. 2010

Acad Dermatol Venereol

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Sarcoidosis of the skin may have an extremely heterogeneous clinical presentation, so that the definitions of 'great imitator' and 'clinical chameleon' have long been used. There is, in fact, a large group of skin diseases that can enter the differential diagnosis with cutaneous sarcoid manifestations, either clinically or/and pathologically. As the clinical consequences and the prognosis of these groups of diseases are often very different, it is important to correctly plan the diagnostic workup. The diagnostic process in this case often presents a challenge as no single test is sufficiently specific, so that a certain diagnosis can be only made in the presence of a compatible clinical and radiographic picture, along with histopathological evidence of non-necrotizing, epithelioid cell granulomas, and exclusion of other potential aetiologies. For practical reasons, four main groups of skin conditions capable of mimicking sarcoidosis can be identified: (i) transmissible, infectious diseases; (ii) allergic and immunological manifestations of various aetiologies; (iii) granulomatous diseases of various aetiologies; and (iv) lymphomas and pseudolymphomas. The aim of this article is to describe the main clinical and histopathological findings of such disease entities, and to discuss the role of those features (morphological, pathological and laboratory) that can help distinguish them from sarcoidosis of the skin.

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A distinctive variant of pernio. Clinical and histopathologic study of nine cases

Cited by 12 publications

References 0 publications

Pernio: A case report and the review of the differantial diagnosis

Pernio: A case report and the review of the differantial diagnosis

Papular perniosis mimicking erythema multiforme: the first case report in Thailand

Sarcoidosis of the skin – A dermatological puzzle: important differential diagnostic aspects and guidelines for clinical and histopathological recognition

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