Chronic Erythematous Desquamative Plaques of the Eyelids

Epidermodysplasia verruciformis (EV) is a genodermatosis characterized by widespread and persistent cutaneous lesions caused by β-papillomaviruses. Rare cases of acquired EV-like eruption associated with β-papillomavirus infection have been reported in immunosuppressed patients. We report a case of acquired EV-like eruption in an immunosuppressed patient with adult T-cell leukemia. The cutaneous lesions clinically resembled pityriasis versicolor and exhibited the typical histological features of EV, but in some areas of the same biopsy specimen characteristic homogeneous intracytoplasmic inclusion bodies were observed. Although β-papillomavirus was not detected by highly sensitive polymerase chain reaction, a putative novel type of γ-papillomavirus was identified. This is the first documentation of an association between EV-like eruption and γ-papillomavirus infection.

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Epidermodysplasia-Verruciformis-Like Eruption Associated with Gamma-Papillomavirus Infection in a Patient with Adult T-Cell Leukemia

Kawai

Egawa²,

Kiyono³

et al. 2009

“…The question arises concerning the symptoms of EV in HIV-positive patients. One of the 16 cases described in the literature demonstrated atypical clinical morphology and localization [15] (table 1). Our analysis of data from the literature has not been able to confirm the form of pityriasis versicolor previously observed by Hultgren et al [10 ]as the primary clinical manifestation in patients with HIV.…”

Section: Discussionmentioning

confidence: 99%

“…In the past 2 decades, 16 cases of EV in HIV-positive patients have been reported [10,11,12,13,14,15,16,17,18,19,20]. In addition, patients with immunodeficiency states, e.g.…”

Section: Introductionmentioning

confidence: 99%

Epidermodysplasia Verruciformis in a HIV-Positive Patient Homozygous for the c917A→T Polymorphism in the <i>TMC8/EVER2 </i>Gene

Hohenstein¹,

Rády²,

Hergersberg³

et al. 2008

Background: Epidermodysplasia verruciformis (EV) is a rare autosomal-recessive disorder characterized by widespread and persistent infection with human papilloma virus (HPV) and a risk of malignant degeneration. Most cases of EV are caused by mutations in the two EV genes, EVER1/TMC6 and EVER2/TMC8. The clinical presentation of EV takes two different forms, which coexist in most cases. Over a period of years, patients develop plane warts and pityriasis versicolor-like lesions. Sixteen cases of EV in HIV-positive patients have been clinically investigated and reported in the literature. However, different inherited susceptibilities towards HPV infection in immunodeficient patients, like HIV-positive patients, have only rarely been addressed. Observation: We describe a 22-year-old female patient with a congenital HIV infection, who presented with slowly progressing and confluent erythematous papules on her hands and hypopigmented macules on her extremities. The histopathology was typical for EV, and HPV5 was detected by PCR and reverse hybridization. The 44-year-old HIV-positive mother has no typical EV lesions. The patient is homozygous for an A to T single nucleotide polymorphism (SNP) at position 917 of the TMC8/EVER2 gene. The mother of the patient is heterozygous for this SNP. Conclusion: These results support the hypothesis that the combination of immunodeficiency and a susceptibility allele may contribute to the differences in occurrence of EV in HIV-positive patients.

“…Various hypotheses have tried to explain the pathophysiology of this phenomenon, claiming structural or microenvironmental changes in the spared skin. Knowing the diversity of conditions implicated in the different cases reported (table 1) [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32], the mechanisms implicated might be multiple and complex.…”

Section: Introductionmentioning

confidence: 99%

The ‘Sparing Phenomenon' of Purpuric Rash over Tattooed Skin

Pinal‐Fernandez

Soláns-Laqué²

2013

Cutaneous complications associated with decorative tattooing are well known. However, the inhibition of a purpuric reaction by a tattoo is a fact that, as far as the authors know, has not been described before, fitting the definition of a ‘sparing phenomenon', the absence of manifesting a particular skin disease in an area previously affected by another condition. From the clinical observation of purpuric lesions apparently inhibited by a tattoo in a 26-year-old patient, we performed an exact binomial test on the observed and expected proportion of purpuric lesions inside (0%, 95% confidence interval, CI, 0-2.6%) and outside (100%, 95% CI 97.4-100%) the tattooed skin, demonstrating a nonrandom distribution respecting the tattooed area (p < 0.001) and identifying the composition of the ink used in the tattoo (color pigment, glycerine, Hamamelis virginiana extract, water and alcohol). Moreover, we reviewed the cases of sparing phenomenon described in the literature. In conclusion this is the first report of a sparing phenomenon of purpuric lesions over tattooed skin.