THE
PITYRIASIS LICHENOIDES III, AN UPDATE, a link
between PLEVA and PLC with lymphoma... LA PITIRIASIS LIQUENOIDE III, ACTUALIZACION,
un eslabon entre la PLEVA y PLC con el linfoma... !!!
Data-Medicos
Dermagic/Express No. 5-(121)
30 Abril 2.004 / 30 April 2.004
EDITORIAL ESPANOL
================= Hola amigos
DERMAGICOS, hoy 3 años y medio despues de mi ultima publicacion sobre el tema
PITIRIASIS LIQUENOIDE, hice una nueva revision sobre el mismo tratando de
encontrar nuevas publicaciones y brindar nuevas luces en el tratamiento de esta
enfermedad dermatologica que puede afectar tanto a adultos como a niños.
He recibido llamadas telefonicas de varios paises (FRANCIA, ESTADOS UNIDOS,
ALEMANIA), de familiares de pacientes a quienes se les ha diagnosticado
PITIRIASIS LIQUENOIDE en sus formas, aguda (PLEVA) o cronica (PLC), y tengo
algunos pacientes con esta enfermedad.
La razon final que me llevo a esta revision, fue aclarar esa duda que tenemos
todos los dermatologos sobre el hecho de que esta enfermedad puede evolucionar
hacia el linfoma... y segun estas ultimas publicaciones es una REALIDAD.
Las tendencias cambian en la medida que evolucionan las tecnicas de diagnostico
y hoy en dia con la experiencia vivida en esta enfermedad, tenemos que
considerar SERIAMENTE en todo paciente que tenga PITIRIASIS LIQUENOIDE, la
remota probabilidad que evolucione hacia un linfoma.
En pocas palabras ya se ha demostrado cientificamente que existe un eslabon
entre la PITIRIASIS LIQUENOIDE y el LINFOMA, y estas referencias bibliograficas
asi lo demuestran.
Tres revisiones en 4 años ha hecho el DERMAGIC sobre este tema, mas de 150
referencias, leanlas con mucha atencion porque alli encontraran la gran REALIDAD
que rodea a la PITIRIASIS LIQUENOIDE y sus posibles tratamientos y evolucion.
En mi humilde opinion lo mejor para tratar
esta enfermedad: ERITROMICINA, FOTOTERAPIA, Y MINI DOSIS DE ESTEROIDES.
Dedicado con mucho cariño a todos esos pacientes quienes me han llamado
desesperados buscando luces sobre esta enfermedad,
Atentamente
Dr. Jose Lapenta R.
EDITORIAL ENGLISH
================= Hello DERMAGIC
friends , today, 3 and a half years after my last publication on the topic
PITYRIASIS LICHENOIDES, I made a new review on the same one trying to find new
publications and to offer new lights in the treatment of this dermatologic
illness that can affect as much to adults as to children.
I have received telephone calls of several countries (FRANCE, UNITED STATES,
GERMANY), of family of patient to who have been diagnosed Pityriasis Liquenoides
in their forms, acute (PLEVA) or chronic (PLC), and I have some patients with
this illness.
The final reason that I take myself to this review, was to clarify that doubt
that we have all the dermatologist on the fact that this illness can evolve
toward the lymphoma... and according to these publications it is a REALITY.
The tendencies change in the measure that the techniques evolve of I diagnose,
and today in day with the experience lived in this illness, we have to consider
SERIOUSLY in all patient that has PITYRIASIS LICHENOIDES, the remote probability
that evolves toward a lymphoma.
In few words, it has already been demonstrated scientifically that a link exists
among the PYTIRIASIS LICHENOIDES and the LYMPHOMA, and these bibliographical
references demonstrate it.
Three reviews in 4 years have made THE DERMAGIC on this topic, but of 150
references, read them with a lot of attention because you will found the great
REALITY that surrounds the PITYRIASIS LICHENOIDES and their possible treatments
and evolution. In my humble opinion the best
thing to treat this illness: ERYTHROMYCIN, PHOTOTHERAPY, AND SEMIPULSE DOSE OF
STEROIDS.
Dedicated with a lot of affection to all those patients who have called me
desperate looking for lights on this illness ...
Sincerely
Dr. José Lapenta R.
======================================================
HOT LINKS
The Pityriasis
Lichenoides I. (1.999)
The pityriasis
Lichenoides II, a paraneoplastic Syndrome.
(2.000) ======================================================
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
======================================================
1.) [Photochemotherapy for pityriasis lichenoides: 3 cases]
2.) Febrile ulceronecrotic Mucha-Habermann disease with extensive skin necrosis
in
intertriginous areas.
3.) Febrile ulceronecrotic Mucha-Habermann's disease managed with
methylprednisolone
semipulse and subsequent methotrexate therapies.
4.) Febrile ulceronecrotic Mucha-Habermann disease: a case report and a review
of the
literature.
5.) Refractory pityriasis lichenoides chronica successfully treated with topical
tacrolimus.
6.) Pityriasis lichenoides et varioliformis acuta.
7.)Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta with
atypical cells.
8.) Phototherapy in pediatric patients.
9.) A case of febrile ulceronecrotic Mucha-Habermann disease requiring
debridement of
necrotic skin and epidermal autograft.
10.) Absence of Epstein-Barr virus and human herpesvirus-6 in pityriasis
lichenoides and
plaque parapsoriasis.
11.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect
pregnancy
outcome?
12.) Cytotoxic mycosis fungoides evolving from pityriasis lichenoides chronica
in a
seventeen-year-old girl. Report of a case.
13.) Bexarotene is a new treatment option for lymphomatoid papulosis.
14.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect
pregnancy
outcome?
15.) The value of molecular analysis by PCR in the diagnosis of cutaneous
lymphocytic
infiltrates.
16.) Pityriasis lichenoides: a clonal T-cell lymphoproliferative disorder.
17.) Medium-dose ultraviolet A1 therapy for pityriasis lichenoides et
varioliformis acuta and
pityriasis lichenoides chronica.
18.) T-cell clonality in pityriasis lichenoides: evidence for a premalignant or
reactive immune
disorder?
19.) The clonal nature of pityriasis lichenoides.
20.) A Clone Is a Clone Is a Clone?
21.) Differentiation and Clonality of Lesional Lymphocytes in Pityriasis
Lichenoides
Chronica
22.) Is PLC a Clonal T-Cell Lymphoproliferative Disorder?
23.) Cutaneous T-cell lymphoma (parapsoriasis en plaque). An association with
pityriasis
lichenoides et varioliformis acuta in young children
24.) T-Cell Clonality in Pityriasis Lichenoides et Varioliformis Acuta
A Heteroduplex Analysis of 20 Cases
25.) Phototherapy of pityriasis lichenoides
26.) Acral pityriasis lichenoides.
27.) Pityriasis lichenoides in a girl with the granulomatous form of common
variable
immunodeficiency.
28.) Pityriasis lichenoides et varioliformis acuta in pregnancy.
29.) Detection of cytomegalovirus infection in a patient with febrile
ulceronecrotic Mucha-
Habermann's disease.
30.) Expression of cutaneous lymphocyte-associated antigen and TIA-1 by
lymphocytes in
pityriasis lichenoides et varioliformis acuta and lymphomatoid papulosis:
immunohistochemical study.
31.) Medullary CD30+ T cell lymphoma with eosinophilia and hyper-IgE supervening
during the relentless course of pityriasis lichenoides.
32.) Pityriasis lichenoides-like mycosis fungoides in children.
33.) Childhood cutaneous T-cell lymphoma in association with pityriasis
lichenoides
chronica.
34.) Pityriasis lichenoides-like exanthem and primary infection by Epstein-Barr
virus.
35.) Pityriasis lichenoides chronica with acral distribution mimicking
palmoplantar syphilid.
36.) Pityriasis lichenoides and acquired toxoplasmosis.
37.) Paraneoplastic pityriasis lichenoides chronica.
38.) Cutaneous T-cell lymphoma presenting with 'segmental pityriasis lichenoides
chronica'.
39.) Mucha-Habermann disease-like eruptions due to Tegafur.
40.) [Ulcers of the tongue, pityriasis lichenoides and primary parvovirus B19
infection]
41.) Infectious causes of pityriasis lichenoides: A case of fulminant infectious
mononucleosis
42.) Pityriasis lichenoides in children: a long-term follow-up of eighty- nine
cases.
====================================================
====================================================
1.) [Photochemotherapy for pityriasis lichenoides: 3 cases]
====================================================
Ann Dermatol Venereol. 2004 Feb;131(2):201-3.
[Article in French]
Panse I, Bourrat E, Rybojad M, Morel P.
Service de Dermatologie, Hopital Saint-Louis, 1, avenue Claude Vellefaux, 75010
Paris.
[email protected]
BACKGROUND: Pityriasis lichenoides is a rare cutaneous disorder of unknown
origin that
mainly affects children and young people. The disease consists of two variants:
pityriasis
lichenoides et varioliformis acuta, characterized by papular lesions evolving
into necrosis
and pityriasis lichenoides chronica characterized by scaly papules that may last
from several
months to several years. Various types of therapy have been proposed for
pityriasis
lichenoides, to our knockledge, photochemotherapy has never been used. We report
the
first 3 cases of pityriasis lichenoides treated by photochemotherapy. CASE
REPORTS:
Three patients, 6, 15 and 18 years old, presented respectively with a 1 month, 2
years and
3 months history of numerous, papular and necrotic lesions or squally papular
lesions.
Clinical appearance and histopathologic examination of biopsy were consistent
with
pityriasis lichenoides et varioliformis acuta (patients 1 and 3) and with
pityriasis lichenoides
chronica (patient 2). They had received different treatments without significant
effect: topical
corticosteroids, antibiotic, UVB therapy and dapsone. Acitretin associated with
PUVA
were dramatically effective within few weeks. DISCUSSION: Pityriasis lichenoides
can be
a severe scarring disease with significant social, psychological and physical
consequences.
In our opinion, photochemotherapy, which has never been used in pityriasis
lichenoides, is
effective. Therapeutic modalities have to be define.
====================================================
2.) Febrile ulceronecrotic Mucha-Habermann disease with extensive skin necrosis
in
intertriginous areas.
====================================================
Eur J Dermatol. 2003 Sep-Oct;13(5):493-6.
Yang CC, Lee JY, Chen W.
Department of Dermatology, College of Medicine, National Cheng Kung University,
138
Sheng-Li Road, Tainan, Taiwan.
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a severe variant of
pityriasis lichenoides et varioliformis acuta characterized by high fever and
papulonecrotic
skin lesions. Here we report a case of a 14-year-old boy with typical features
of FUMHD
and unusual manifestation of extensive skin necrosis in intertriginous regions
including
axillae, neck, inguinal and antecubital areas. Systemic administration of
corticosteroid and
erythromycin led to rapid healing of ulcerations without residual scar formation.
Review of
the literature showed male-predominance and favorable outcome in pediatric cases
of
FUMHD.
====================================================
3.) Febrile ulceronecrotic Mucha-Habermann's disease managed with
methylprednisolone
semipulse and subsequent methotrexate therapies.
====================================================
J Am Acad Dermatol. 2003 Dec;49(6):1142-8.
Ito N, Ohshima A, Hashizume H, Takigawa M, Tokura Y.
Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu,
Japan.
Febrile ulceronecrotic Mucha-Habermann's disease is an unusual severe form of
pityriasis
lichenoides et varioliformis acuta characterized by abrupt onset of
ulceronecrotic eruption
associated with a high fever and systemic symptoms. To our knowledge, 19 cases
of this
disease have been reported in the literature, and 4 of them were fatal. We
report the case
of a 12-year-old boy with this disorder who had abdominal pain, hypoproteinemia,
and
anemia. Although these associated symptoms are considered life-threatening
factors
according to reported cases, our patient was successfully treated with
methylprednisolone
semipulse and subsequent methotrexate therapies. From a review of the literature
and the
present case, we propose that when patients have these systemic symptoms,
therapeutic
choices include methotrexate, high-dose corticosteroids, and 4,4-diamino-diphenyl-sulfone,
which may depress early development of this disease.
====================================================
4.) Febrile ulceronecrotic Mucha-Habermann disease: a case report and a review
of the
literature.
====================================================
J Clin Pathol. 2003 Oct;56(10):795-7. Related Articles, Links
Miyamoto T, Takayama N, Kitada S, Hagari Y, Mihara M.
Department of Dermatology, Tsuyama Central Hospital, 1756 Kawasaki, Tsuyama 708-
0841, Japan. [email protected]
This report describes the case of a 76 year old man who suffered from febrile
ulceronecrotic Mucha-Habermann disease (FUMHD). Despite this patient's typical
clinical
and histological findings, the fulminating course led to death. Polymerase chain
reaction (
PCR) analysis of the skin lesions showed that the infiltrating cells were
monoclonal in origin
and were from an aberrant clone. FUMHD is a very rare, febrile variant type of
pityriasis
lichenoides et varioliformis acuta, and is characterised by necrotic cutaneous
ulcerations
associated with high fever and systemic manifestations. Including this present
case, only 18
cases of FUMHD have been reported. FUMHD can occur in both adults and children,
although there are several differences between the manifestations of the disease
in the two
groups. One major difference is prognosis: all cases resulting in fatality are
of the adult type,
whereas no fatal cases have been reported among children. The aberrant clone
detected by
PCR may be responsible for host responses, resulting in the severe symptoms
observed in
this disorder.
====================================================
5.) Refractory pityriasis lichenoides chronica successfully treated with topical
tacrolimus.
====================================================
Clin Exp Dermatol. 2003 Jul;28(4):456-8.
Mallipeddi R, Evans AV.
Publication Types:
Case Reports
Letter
====================================================
====================================================
6.) Pityriasis lichenoides et varioliformis acuta.
====================================================
Indian Pediatr. 2003 Mar;40(3):266-7.
Gulati R, Bagga G.
Department of Skin STD and Leprosy, Mahatama Gandhi National Institute of
Medical
Sciences, Sitapura Insitutional Area, Jaipur, India. [email protected]
Publication Types:
Case Reports
====================================================
====================================================
7.)Febrile ulceronecrotic pityriasis lichenoides et varioliformis acuta with
atypical cells.
====================================================
Int J Dermatol. 2003 Jan;42(1):26-8. Related Articles, Links
Rivera R, Ortiz P, Rodriguez-Peralto JL, Vanaclocha F, Iglesias L.
Publication Types:
Case Reports
Letter
Review
Review, Multicase
====================================================
====================================================
8.) Phototherapy in pediatric patients.
====================================================
Pediatr Dermatol. 2003 Jan-Feb;20(1):71-7.
Pasic A, Ceovic R, Lipozencic J, Husar K, Susic SM, Skerlev M, Hrsan D.
Department of Dermatology and Venerology, Zagreb University Hospital Center,
Zagreb,
Croatia. [email protected]
The treatment of children with psoriasis, atopic dermatitis (AD), pityriasis
lichenoides, and
scleroderma poses a therapeutic problem because all therapeutic options are
associated
with numerous side effects. Therefore ultraviolet A and B (UVA and UVB)
phototherapy is
presented as a possible alternative to some of these therapies, primarily
topical and
systemic corticosteroids, in children. Our results in treating children with
phototherapy and
psoralen plus UVA (PUVA) bath phototherapy over the past 5 years are reported.
UVB
therapy (TL01) was used in 20 psoriatic children (6 boys, 14 girls; ages 6-14
years) during
the stage of disease exacerbation and in 9 children (3 boys, 6 girls; ages 8-16
years) with
pityriasis lichenoides. Combined UVA/UVB phototherapy was applied in 21 AD
children
(7 boys, 14 girls; ages 4-15 years). Photochemotherapy with local application of
a PUVA
bath was used in six children (2 boys, 4 girls; ages 9-16 years) with
circumscribed
scleroderma and in one girl with systemic scleroderma. All children received
short courses
of phototherapy with either no maintenance or short maintenance. All three
therapeutic
protocols resulted in a certain degree of improvement in most of the study
patients. None of
the patients exhibited any early phototherapy side effects. We conclude that
phototherapy
and PUVA bath are valuable and safe therapeutic options for selected children
who do not
respond to other treatments.
====================================================
9.) A case of febrile ulceronecrotic Mucha-Habermann disease requiring
debridement of
necrotic skin and epidermal autograft.
====================================================
Br J Dermatol. 2002 Dec;147(6):1249-53.
Yanaba K, Ito M, Sasaki H, Inoue M, Nobeyama Y, Yonemoto H, Ishiji T, Tanaka H,
Kamide R, Niimura M.
Department of Dermatology, The Jikei University School of Medicine, 25-8
Nishishimbashi
3-chome, Minato-ku, Tokyo 105-8461, Japan. [email protected]
We report a case of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) in a
21-
year-old man. This disease is a severe form of pityriasis lichenoides et
varioliformis acuta (
PLEVA) and is characterized by the sudden onset of diffuse ulcerations
associated with
high fever and systemic symptoms. It is sometimes lethal especially in elderly
patients. In the
present case, intense generalized maculopapular erythematous plaques with
central necrosis
developed progressively in association with a high fever. Initial treatment with
systemic
betamethasone had been unsuccessful and the skin lesions, which covered about
50% of
the body surface, became severely ulcerated. Although the development of new
lesions had
ceased spontaneously, widespread ulceration of the skin remained. Debridement of
the
necrotic skin and skin grafting using cultured epidermal autografts and meshed
allografts of
cadaver skin led to prompt reepithelization.
====================================================
10.) Absence of Epstein-Barr virus and human herpesvirus-6 in pityriasis
lichenoides and
plaque parapsoriasis.
====================================================
Eur Acad Dermatol Venereol. 2002 Sep;16(5):536-7.
Erkek E, Sahin S, Atakan N, Kocagoz T, Olut AI.
Publication Types:
Letter
====================================================
====================================================
11.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect
pregnancy
outcome?
====================================================
Saudi Med J. 2002 Aug;23(8):1014-5.
Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect
pregnancy outcome?
Shelleh HH.
Department of Dermatology, Najran General Hospital, Najran, Kingdom of Saudi
Arabia.
====================================================
====================================================
12.) Cytotoxic mycosis fungoides evolving from pityriasis lichenoides chronica
in a
seventeen-year-old girl. Report of a case.
====================================================
Dermatology. 2002;205(2):176-9.
Tomasini D, Zampatti C, Palmedo G, Bonfacini V, Sangalli G, Kutzner H.
Department of Dermatology, Hospital of Busto Arsizio, Italy. [email protected]
Pityriasis lichenoides chronica and its acute form, pityriasis lichenoides et
varioliformis
acuta, are skin diseases of unknown origin, that probably represent a
hypersensitivity
reaction to an infective agent. Pityriasis lichenoides is often a benign
disorder but, because
of the presence of a clonal T cell population detected both in the chronic and
acute forms,
some authors have suggested that it may belong to the group of primary cutaneous
T cell
lymphomas. Although various studies have clearly documented no significant
association
between pityriasis lichenoides and malignant lymphomas, cases of long-standing
pityriasis
lichenoides evolving into mycosis fungoides have been described. Herein we
report the
case of a girl suffering from pityriasis lichenoides since the age of 11 years,
subsequently
developing a CD45RO+, CD8+, TIA-1+ mycosis fungoides. Copyright 2002 S. Karger
AG, Basel
====================================================
13.) Bexarotene is a new treatment option for lymphomatoid papulosis.
====================================================
Dermatology. 2003;206(2):142-7.
Krathen RA, Ward S, Duvic M.
Division of Internal Medicine, Department of Dermatology, The University of
Texas MD
Anderson Cancer Center, Houston, Tex 77030-3597, USA.
BACKGROUND: Lymphomatoid papulosis (LyP) is a clonal T cell proliferation with
large
cell histology, a chronic course, and an increased risk of lymphoma. Bexarotene
(Targretin)
is an RXR-selective retinoid (rexinoid) approved for the cutaneous
manifestations of
cutaneous T cell lymphoma. OBJECTIVE: To determine whether bexarotene is
effective in
treating LyP. METHODS: Ten patients with chronic and symptomatic LyP were
prospectively treated with oral (n = 3) or topical gel (n = 7) formulations of
bexarotene.
RESULTS: A favorable response to bexarotene treatment with decreased numbers or
duration of lesions was seen in all with objective responses in 8 patients.
CONCLUSIONS: Bexarotene may be an effective palliative treatment for LyP,
warranting
further controlled studies.
====================================================
14.) Pityriasis lichenoides et varioliformis acuta in pregnancy. Does it affect
pregnancy
outcome?
====================================================
Saudi Med J. 2002 Aug;23(8):1014-5.
Shelleh HH.
Department of Dermatology, Najran General Hospital, Najran, Kingdom of Saudi
Arabia.
====================================================
====================================================
15.) The value of molecular analysis by PCR in the diagnosis of cutaneous
lymphocytic
infiltrates.
====================================================
J Cutan Pathol. 2002 Sep;29(8):447-52.
Comment in:
J Cutan Pathol. 2003 Sep;30(8):521; author reply 521.
Holm N, Flaig MJ, Yazdi AS, Sander CA.
Department of Dermatology, Ludwig-Maximilians-University Munich, Munich, Germany.
The diagnosis and classification of cutaneous lymphomas remain a challenge for
the clinician
and dermatopathologist. This diagnostic dilemma is mainly encountered in the
distinction
between an early malignant lymphoma and a benign reactive lymphocytic infiltrate
(
pseudolymphoma). Until the beginning of the 1980s, our diagnostic tools were
limited to the
clinical presentation, course, and histopathology in diagnosis and
classification of
lymphocytic infiltrates. Advances in immunology and, in particular, in molecular
genetics
with the introduction of the Southern blot technique and the polymerase chain
reaction (
PCR) have revolutionized the diagnosis of lymphocytic infiltrates by
determination of
clonality. In some series, more than 90% of cutaneous T-cell lymphomas have a
clonal
rearrangement of the T-cell receptor gamma-chain gene, as opposed to very low
percentages of rearrangement in T-cell pseudolymphomas. However, the presence of
clonality does not necessarily imply malignancy. Cases of pseudolymphomas,
lichen planus
and pityriasis lichenoides et varioliformis acuta were reported with clonal
lymphocytic
proliferations. Therefore, care should be exercised in the evaluation of the
results of
molecular analysis, and these should always be correlated with the clinical,
histological and
immunophenotypic picture to arrive at the correct diagnosis. It may be expected
that the
molecular methods for diagnosis of lymphocytic infiltrates will be improved and
refined in
future, and that sensitivity and specificity will increase.
====================================================
16.) Pityriasis lichenoides: a clonal T-cell lymphoproliferative disorder.
====================================================
Hum Pathol. 2002 Aug;33(8):788-95
Magro C, Crowson AN, Kovatich A, Burns F.
Department of Pathology Ohio State University Medical Center, Columbus, OH
43210,
USA.
Pityriasis lichenoides (PL) is a papulosquamous disorder often considered a form
of
reactive dermatosis and classified with small plaque parapsoriasis (digitate
dermatosis).
However, some patients with PL have developed large plaque parapsoriasis (LPP)
and
mycosis fungoides (MF), and lymphoid atypia and T-cell clonality have been
reported in
lesions of PL. We set out to explore the possibility that PL is a form of T-cell
dyscrasia.
Cases were selected by natural language search from an outpatient
dermatopathology
database; 35 cases were reviewed and clinicians and patients were contacted.
Hematoxylin
and eosin-stained sections were examined and immunophenotyping was carried out
on
paraffin-embedded, formalin-fixed tissue using antibodies to CD2, CD3, CD4, CD5,
CD7,
CD8, CD20, CD30, and CD56. In paraffin-embedded tissue, T-cell receptor (TCR)-
gamma chain rearrangement was sought through polymerase chain reaction single
stranded
conformational polymorphism analysis. There were 14 males and 21 females with a
mean
age of 40 years held clinically to have PL chronica (PLC) (28 cases) and/or PL
et
varioliformis acuta (PLEVA) (7 cases). Five patients developed large atrophic
poikilodermatous and/or annular plaques compatible with MF and/or LPP in a
background
of typical PLC. All biopsies showed tropism of lymphocytes to an epidermis
manifesting
psoriasiform hyperplasia, dyskeratosis, parakeratosis, and intraepithelial
collections of
Langerhans' cells and lymphocytes mimicking Pautrier's microabascesses.
Epidermal
atrophy, dermal fibroplasia, poikilodermatous alterations, and a dominance of
intraepidermal cerebriform cells were seen only in patients with chronic
persistent disease (i
.e., PLC) and in some cases corresponded with clinical progression to MF. All
cases had a
T cell-dominant infiltrate, with a CD7 deletion in 21 of 32 biopsies examined;
the CD7-
negative cells were typically the largest and most atypical forms, often in a
cohesive array
within the upper layers of the epidermis. In 17 biopsies in which a CD4 stain
was
satisfactory for evaluation, 50% or more of the intraepidermal population was
CD4 positive
in 8 biopsies, whereas in 11 biopsies 50% or more of the dermal infiltrate was
CD4
positive. The CD4-positive cells frequently had a cerebriform nuclear morphology
and
were CD7 negative. Most cases had an admixture of CD8-positive lymphocytes in
excess
of 40% or more of the intraepidermal and/or dermal infiltrate; it was the
dominant
intraepidermal infiltrate in 10 cases. The CD8-positive cells, typically small,
round, and
CD7 positive, showed a directed pattern of migration into acrosyringia and
suprapapillary
plates, with satellitosis around CD4-positive/CD8-negative/CD7-negative atypical
lymphocytes. CD56 positivity was seen among the intraepidermal lymphoid cells
and
roughly paralleled the CD8 profile. In general, CD8-positive lymphocytes
dominated in
cases of PLEVA, whereas CD4-positive lymphocytes were very conspicuous and
composed the dominant intraepidermal populace only in those biopsies of
progressive PL/
PLC. Clonality was shown in 25 of 27 biopsies in which amplifiable DNA was
obtained.
Intraepithelial atypical lymphocytes, phenotypic abnormalities, and TCR-gamma
rearrangements suggest that PLC and PLEVA are a form of T-cell dyscrasia.
Lesions may
follow a recalcitrant course characteristic of MF and premycotic disorders such
as LPP.
The aberrant phenotype cell is similar to that defining MF: a CD4-positive T
lymphocyte
with a CD5 and CD7 deletion. Directed epidermal migration seen in biopsies
procured
from incipient lesions along with occasional temporal association to viral or
drug exposure
suggests that an abnormal immune response to an antigenic trigger may be the
inciting event.
====================================================
17.) Medium-dose ultraviolet A1 therapy for pityriasis lichenoides et
varioliformis acuta and
pityriasis lichenoides chronica.
====================================================
J Am Acad Dermatol. 2002 Sep;47(3):410-4.
Pinton PC, Capezzera R, Zane C, De Panfilis G.
Department of Dermatology, Azienda Spedali Civili di Brescia, Brescia, Italy.
BACKGROUND: Ultraviolet A1 (340-400 nm) was found to be effective in the
treatment
of cutaneous T-cell-mediated diseases. OBJECTIVE: The purpose of the present
study
was to assess the efficacy of UVA1 phototherapy for pityriasis lichenoides et
varioliformis
acuta (PLEVA) and pityriasis lichenoides chronica (PLC). METHODS: Eight patients
(3
with PLEVA and 5 with PLC) received 60 J/cm(2) UVA1 daily until remission. Four
patients also had lesions inaccessible to UVA1 that were used as control lesions.
Immunocytologic studies of skin infiltrates and circulating T cells were done.
RESULTS:
Six patients showed complete clinical and histologic recovery. Two patients with
PLC had
a partial improvement. Unirradiated control lesions never improved. Serious
short-term
adverse effects were not encountered. No effects on circulating lymphocytes were
reported. CONCLUSION: UVA1 therapy is an effective and well-tolerated treatment
for
PLEVA and PLC. The therapeutic activity seems to be related to direct effects on
cutaneous inflammatory infiltrates because the lesions in nonexposed cutaneous
areas did
not respond
====================================================
18.) T-cell clonality in pityriasis lichenoides: evidence for a premalignant or
reactive immune
disorder?
====================================================
Arch Dermatol. 2002 Aug;138(8):1089-90.
Comment on:
Arch Dermatol. 2002 Aug;138(8):1063-7.
Kadin ME.
Publication Types:
Comment
Editorial
====================================================
====================================================
19.) The clonal nature of pityriasis lichenoides.
====================================================
Arch Dermatol. 2002 Aug;138(8):1063-7.
Comment in:
Arch Dermatol. 2002 Aug;138(8):1089-90.
Weinberg JM, Kristal L, Chooback L, Honig PJ, Kramer EM, Lessin SR.
Department of Dermatology, University of Pennsylvania, Philadelphia, USA. jwein@bway
.net
BACKGROUND: Pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis
lichenoides chronica (PLC) are benign lymphocytic infiltrates of the skin that
classically
present as either a recurrent papulonecrotic eruption (PLEVA) or a persistent,
scaling,
papular eruption (PLC). Observations of both types of lesions present on
individual patients
have led to speculation that both entities are related. Previous studies
evaluating the DNA
of biopsy specimens from patients with PLEVA and PLC revealed clonal T-cell
receptor
beta gene rearrangements. OBJECTIVE: To analyze and compare the T-cell
populations
between lesions of PLEVA and PLC. DESIGN: Retrospective and prospective analysis
of
patient tissue samples, classified by histologic analysis. Extracted DNA from 13
skin biopsy
specimens with the diagnosis of PLC and 14 skin biopsy specimens with the
diagnosis of
PLEVA was analyzed by polymerase chain reaction/denaturing gradient gel
electrophoresis
(PCR/DGGE). SETTING: Molecular diagnostic laboratory at an academic medical
center.
PATIENTS: Twenty-seven tissue samples were obtained from patients with a
histologic
diagnosis of PLEVA or PLC. These samples were analyzed by PCR/DGGE. MAIN
OUTCOME MEASURE: The presence or absence of T-cell receptor gene
rearrangements on PCR/DGGE analysis corresponding to a clonal population of T
cells.
RESULTS: Of 14 PLEVA specimens, 8 (57%) demonstrated monoclonal T-cell receptor
gene rearrangements; 1 (8%) of 13 PLC specimens showed a gene rearrangement (P
=.
008, Fisher exact test). CONCLUSIONS: Our results demonstrate the polyclonal
nature
of the lymphocytic infiltrate found in almost all of the PLC specimens, which
contrasts with
the monoclonal nature found in most of the PLEVA specimens. These differences
may
represent different stages of the clinical evolution of a single entity that
results from varying
host immune responses to pathogenic factors. Specifically, we propose that PLEVA
is a
benign clonal T-cell disorder in which the clone arises from a subset of T cells
in lesions of
PLC. The host immune response to this clone determines the clinical and
histologic findings
in PLEVA.
====================================================
20.) A Clone Is a Clone Is a Clone?
====================================================
— Bruce R. Smoller, MD
Published in Journal Watch Dermatology September 9, 2002
Source
Weinberg JM et al. The clonal nature of pityriasis lichenoides. Arch Dermatol
2002 Aug;
138:1063-7.
The clinical significance of a clonal proliferation of T lymphocytes in the skin
has gradually
become less certain. At first, the laboratory data were promising: Clonality was
identified in
many cases of cutaneous T-cell lymphoma, suggesting that this finding could aid
in early
diagnosis. In recent years, however, the specificity of this finding has been
called into
question. Investigators found clonal populations of T cells in such wide-ranging
conditions
as lymphomatoid papulosis, pityriasis lichenoides, and lichen planus. In this
study, the
authors compared the T-cell populations in 13 biopsy samples from patients with
histologically diagnosed pityriasis lichenoides chronica (PLC) and 14 samples
from patients
with histologically diagnosed pityriasis lichenoides et varioliformis acuta (PLEVA).
Monoclonal T-cell populations were found in 8 (57%) PLEVA cases and 1 (8%) PLC
case. Interestingly, the single PLC case with a monoclonal T-cell infiltrate was
first
diagnosed as PLEVA on clinical examination. The authors conclude that PLEVA
represents a benign monoclonal proliferation that arises from a subset of the
polyclonal T
lymphocytes in PLC lesions.
Comment: The authors' conclusion does not implicate PLC or PLEVA in the
evolution of
T-cell malignancy. Instead, the authors display a rare and admirable ability to
analyze
laboratory results in the context of an entire clinicopathologic setting. PLEVA
rarely (if
ever) progresses to overt lymphoma. Therefore, a finding of clonal proliferation
does not
necessarily imply such a progression. The hypothesis that PLEVA represents a
preferential
monoclonal evolution from polyclonal PLC is intriguing and requires additional
follow-up.
Stay tuned!
====================================================
21.) Differentiation and Clonality of Lesional Lymphocytes in Pityriasis
Lichenoides
Chronica
====================================================
Sherry Shieh, MD; Debra L. Mikkola, MS; Gary S. Wood, MD
Arch Dermatol. 2001;137:305-308.
Background Pityriasis lichenoides chronica (PLC) and pityriasis lichenoides et
varioliformis
acuta (PLEVA) are benign T-cell diseases that share several overlapping
clinicopathologic
features, leading many to believe that they exist as a spectrum rather than as
single entities.
Previous molecular studies have shown that PLEVA is a clonal lymphoproliferative
disorder. To further characterize the immunohistologic features of PLC and to
determine
whether PLC demonstrates clonality, we studied 6 cases of PLC using a frozen
section–
immunoperoxidase technique and polymerase chain reaction/denaturing gradient gel
electrophoresis.
Observations All 6 cases showed a mild to moderate superficial and deep
perivascular
infiltrate composed predominantly of CD4+ T cells, admixed with Langerhans cells
and
macrophages; most were associated with an HLA-DR+ epidermis. Three of 6 cases
involved monoclonal T-cell receptor gamma (TCR) gene rearrangements detected by
V1-
8/J1-2 and V9/J1-2 primers.
Conclusions Our findings enhance existing data showing that PLC shares many
immunohistologic features with PLEVA and indicating that PLC is frequently a
clonal T-cell
disease. This provides further evidence that PLC and PLEVA are interrelated
processes
within the larger group of T-cell lymphoproliferative disorders.
From the Departments of Internal Medicine (Dr Shieh) and Dermatology (Ms Mikkola),
Case Western Reserve University, University Hospitals of Cleveland, and the
Louis Stokes
Cleveland Veterans Affairs Medical Center, Cleveland, Ohio; and the Department
of
Medicine (Dermatology), University of Wisconsin and Middleton Veterans Affairs
Medical
Center (Dr Wood), Madison.
====================================================
22.) Is PLC a Clonal T-Cell Lymphoproliferative Disorder?
====================================================
Summary and Comment
— BR Smoller
Published in Journal Watch Dermatology May 3, 2001
Source
Shieh S et al. Differentiation and clonality of lesional lymphocytes in
pityriasis lichenoides
chronica. Arch Dermatol 2001 Mar; 137:305-
The nature of pityriasis lichenoides chronica (PLC) and its relationship to
pityriasis
lichenoides et varioliformis acuta (PLEVA) and mycosis fungoides (MF) remain
enigmatic.
Recently, evidence of clonal proliferation has been reported in cases of PLEVA,
strengthening the evidence that these entities may be part of a spectrum of
lymphoproliferative disorders. The present study evaluated biopsies from 6
patients with
PLC for the presence of clonal T-cell gene rearrangements. In addition, the
researchers
performed immunophenotyping of the infiltrating lymphocytes.
All patients demonstrated a classic combination of clinical and histologic
features of the
disease. A clonal rearrangement was detected in 3 of the 6 cases. All cases
demonstrated a
predominance of CD4+ infiltrates. The authors suggest that these findings
provide
additional evidence that PLC, PLEVA, and MF are related.
Comment: The data are very convincing, but caution is nonetheless essential in
interpreting
the findings. While clonality has been associated with lymphomas and may portend
an
aggressive clinical course, evidence is mounting that not all clonal processes
result in
adverse outcomes. The/significance of clonality within cutaneous T-cell
infiltrates remains to
be seen. Long-term follow-up studieswith large numbers of patients will be
necessary
before anydefinitive statements can be made.
====================================================
23.) Cutaneous T-cell lymphoma (parapsoriasis en plaque). An association with
pityriasis
lichenoides et varioliformis acuta in young children
====================================================
Arch Dermatol, Nov 1990; 126: 1449 - 1453.
J. S. Fortson, A. L. Schroeter and N. B. Esterly
Department of Dermatology, Wright State University School of Medicine, Dayton,
Ohio
45401-0927.
Pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides
chronica (
PLC) are related benign disorders without recognized association with cutaneous
T-cell
lymphoma (CTCL). We report the cases of two children with documented PLEVA
evolving into CTCL over several years. One child had the clinical lesions of PLC
but the
dermatopathologic findings of PLEVA at age 2 years. At age 12 years, he had skin
changes of poikiloderma atrophicans vasculare and dermatopathologic findings
consistent
with parapsoriasis en plaque. The second child presented at age 7 years with
scaling
dermatitis and dermatopathologic findings of PLEVA. At age 12 years, the
histologic
diagnosis was parapsoriasis. Monoclonal antibody studies performed on biopsy
specimens
from both patients revealed 70% to 100% cells staining with CD5, 80% to 90%
staining
with CD4, 30% to 50% staining with CD8, and an increase in CD1-staining cells in
the
papillary dermis, indicating a predominantly helper T-cell infiltrate. We
believe that PLC
and PLEVA may be part of the spectrum of CTCL. Furthermore, CTCL may be more
common in young children than once thought.
====================================================
24.) T-Cell Clonality in Pityriasis Lichenoides et Varioliformis Acuta
A Heteroduplex Analysis of 20 Cases
====================================================
Olivier Dereure, MD; Edi Levi, MD, PhD; Marshall E. Kadin, MD
Arch Dermatol. 2000;136:1483-1486.
Background Cutaneous lesions of pityriasis lichenoides et varioliformis acuta (PLEVA),
a
T cell–mediated cutaneous inflammatory condition, are clinically similar to
lymphomatoid
papulosis (LyP), leading some authors to hypothesize that they are part of the
same
spectrum of lymphoproliferative disorders, although reports of the development
of
cutaneous lymphoma in patients with PLEVA are not as frequent as they are for
patients
with LyP. Furthermore, unlike in cases of LyP, no systematic search for a
dominant T-cell
clone has been carried out in cases of PLEVA, whereas clones have been detected
in a
few cases of PLEVA using mainly Southern blot analysis.
Objective To investigate T-cell clonality in a series of archival PLEVA lesions.
Tissues Archival paraffin-embedded biopsy specimens from 20 clinically and
pathologically
typical cases of PLEVA were selected.
Main Outcome Measure Identification of a dominant T-cell clone by polymerase
chain
reaction and heteroduplex analysis targeted on the TCR gene. Peripheral blood
mononuclear cells (PBMCs) and Jurkat cells were used as negative and positive
controls.
Serial dilutions of Jurkat T-cell lymphoma DNA in PBMC DNA were used to assess
the
sensitivity of the method.
Results Analysis of 13 (65%) of 20 PLEVA biopsy specimens revealed the presence
of a
dominant T-cell clone. Positive and negative controls confirmed the specificity
of the
procedure. The sensitivity was determined to be between 1% and 5% of the total
T-cell
infiltrate.
Conclusions This study provides further evidence for the presence of a dominant
T-cell
clone in skin lesions of some patients with PLEVA and supports the hypothesis
that
PLEVA is part of the spectrum of clonal–T-cell cutaneous lymphoproliferative
disorders.
From the Department of Pathology, Beth Israel Deaconess Medical Center, Harvard
Medical School, Boston, Mass.
====================================================
25.) Phototherapy of pityriasis lichenoides
====================================================
Arch Dermatol, May 1983; 119: 378 - 380.
M. J. LeVine
Eleven patients with chronic pityriasis lichenoides chronica were treated with
topically
applied bland emollient cream and minimally erthemogenic doses of UV radiation
from
fluorescent sunlamps. The conditions of all patients cleared completely in an
average of 29
treatments, requiring an average UV dose of 388 millijoules/sq cm at clearance.
Phototherapy provides a convenient effective outpatient therapy for pityriasis
lichenoides
chronica.
====================================================
26.) Acral pityriasis lichenoides.
====================================================
Australas J Dermatol. 2002 Feb;43(1):68-71.
Kossard S.
Skin and Cancer Foundation Australia, Sydney, New South Wales, Australia.
[email protected]
Two patients presented with acrally located papulosquamous lesions that were
polymorphic
and had an identical morphology to those of pityriasis lichenoides. The lesions
remained
localized to the feet and ankles for years. Multiple skin biopsies had the
histopathological
features of pityriasis lichenoides. In one biopsy syringotropic lymphocytes and
early
syringolymphoid hyperplasia were observed. This rare variant of pityriasis
lichenoides may
be under-recognized and misdiagnosed as it resembles a variety of papulosquamous
disorders particularly psoriasis.
====================================================
27.) Pityriasis lichenoides in a girl with the granulomatous form of common
variable
immunodeficiency.
====================================================
Pediatr Dermatol. 2002 Jan-Feb;19(1):56-9. Related Articles, Links
Pasic S, Pavlovic M, Vojvodic D, Abinun M.
Pediatric Immunology, Mother and Child Health Institute, Belgrade, Yugoslavia.
Pityriasis lichenoides (PL) is a cutaneous disease of unknown origin. In our 8-year-old
female patient with the granulomatous form of common variable immunodeficiency (CVID),
PL occurred together with massive splenomegaly and intra-abdominal
lymphadenopathy.
Prednisone was efficient for treatment of her splenomegaly and autoimmune
cytopenias.
However, PL was resistant to both topical and systemic steroid treatment.
Healing of PL
was achieved with the use of a super-potent topical steroid, clobetasol
propionate. A
defect of T-cell function in CVID may contribute to development of PL. In the
granulomatous form of CVID, sarcoid-like granulomas are the most commonly
reported
cutaneous lesions. PL has not been previously reported.
====================================================
28.) Pityriasis lichenoides et varioliformis acuta in pregnancy.
====================================================
Saudi Med J. 2001 Dec;22(12):1127-9.
Eskandar MA.
Department of Obstetrics and Gynecology, King Khalid University, College of
Medicine,
PO Box 641, Abha, Kingdom of Saudi Arabia. [email protected]
Pityriasis lichenoides et varioliformis acuta is an uncommon disease, especially
during
pregnancy. In review of the obstetric literature, there was no report of
pityriasis lichenoides
et varioliformis acuta during pregnancy. A 25-year-old female was seen at 24
weeks of
gestation for consultation about a cutaneous disease. She was admitted at 30
weeks of
gestation because of threatened premature labor, and some active cutaneous
papules
presented themselves at that time. After the treatment, cutaneous papules
remitted. But at
35 weeks of gestation, she had spontaneous labor. Both the mother and infant
were doing
well at 5 months postpartum. If pityriasis lichenoides et varioliformis acuta
exists in the
vagina or cervical bone of the uterus, it is due to infections from lymphatic
vasculitis and
necrosis. It may cause threatened premature labor and premature rupture of the
membrane.
====================================================
29.) Detection of cytomegalovirus infection in a patient with febrile
ulceronecrotic Mucha-
Habermann's disease.
====================================================
Int J Dermatol. 2001 Nov;40(11):694-8.
Tsai KS, Hsieh HJ, Chow KC, Lin TY, Chiang SF, Huang HH.
Departments of Dermatology, Medical Research and Pathology, China Medical
College
Hospital and China Medical College, Taichung, Taiwan.
BACKGROUND: Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is a
severe and very rare variant of pityriasis lichenoides et varilioformis acuta,
which is
characterized by large coalescing, and ulceronecrotic maculopapules or plaques.
Morphological changes of the skin accompanied by persistent high fever and
several
constitutional symptoms have suggested virus infection in patients with FUMHD.
However,
the available information of viral origin is limited. In this study we
investigated the
relationship of cytomegalovirus (CMV), Epstein-Barr virus (EBV), human
herpesvirus 8 (
HHV8), type I human T-cell lymphotropic virus (HTLV-I), and parvovirus B19
(PVB19)
with FUMHD in a Taiwanese patient. METHODS: The existence of CMV, EBV, HHV8,
HTLV-I, and PVB19 was determined by polymerase chain reaction (PCR). The
presence
of CMV in the endothelial cells was characterized by in situ hybridization (ISH)
and
immunohistochemistry (IHC). RESULTS: Serologic immunoglobulin to CMV and IHC
identification of CMV late gene in the biopsy specimen indicated that the
patient was
infected with CMV. Detection of CMV was confirmed by PCR and ISH.
CONCLUSIONS: These results indicate that FUMHD is associated with dermal CMV
manifestation. Nonetheless, the induction mechanism of FUMHD with CMV infection
has
yet to be determined.
====================================================
30.) Expression of cutaneous lymphocyte-associated antigen and TIA-1 by
lymphocytes in
pityriasis lichenoides et varioliformis acuta and lymphomatoid papulosis:
immunohistochemical study.
====================================================
J Cutan Pathol. 2001 Oct;28(9):453-9.
Jang KA, Choi JC, Choi JH.
Department of Dermatology, Seoul Paik Hospital, Inje-Univeristy, Seoul, Korea.
BACKGROUND: Pityriasis lichenoides et varioliformis acuta (PLEVA) and
lymphomatoid
papulosis (LyP) are benign self-healing cutaneous eruptions that may be
clinically and
histologically similar. The purposes of this study were to evaluate
immunohistological
characteristics of PLEVA and LyP and to investigate whether Epstein-Barr virus (EBV)
may be present in PLEVA and LyP. METHODS: We performed an immunohistochemical
staining in 12 cases of PLEVA and 8 cases of LyP using nine antibodies for CD3,
CD4,
CD8, CD30, CD45RO, CD56, CD79, cutaneous lymphocyte-associated antigen (CLA),
and TIA-1. In situ hybridization was performed using fluorescein-conjugated
oligonucleotide probes for EBV early regions (EBER). RESULTS: In PLEVA,
immunohistochemical studies revealed that infiltrated lymphocytes consisted of
mainly CD3
-positive (5+), CD8-positive (4+ to 5+), CLA-positive (4+ to 5+) T cells and
partly CD79
positive (+ to 2+) B cells. CD4-positive T cells were less than 25%. In LyP,
immunohistochemical studies revealed that infiltrated lymphocytes consisted of
partly CD3
-positive (5+), CD8-positive (2+ to 3+), CLA-positive (3+ to 4+) T cells and
partly CD
79-positive (2+ to 3+) B cells. CD4-positive T cells were less than 10%. CD8 and
CLA
were more strongly expressed in PLEVA than in LyP. CD30 was strongly expressed
in
LyP but not expressed in PLEVA. CD79 was more expressed in LyP than in PLEVA.
TIA-1 was not expressed in any cases. In situ hybridization using antisense EBER
probe
showed negative reaction in all cases. CONCLUSIONS: Immunohistochemical stains
for
CD8, CD30, CD79 and CLA may be valuable tools in the differential diagnosis
between
PLEVA and LyP. TIA-1 was negative in LyP, which means cytotoxic cells may not be
implicated in the pathogenesis of LyP. It was a contradictory result to the
previous results.
The absence of EBV in PLEVA and LyP suggests that this virus may not be
operative in
the pathogenesis of these diseases. These results suggest that LyP and PLEVA are
separate disorders, thus accounting for their variable prognosis.
====================================================
31.) Medullary CD30+ T cell lymphoma with eosinophilia and hyper-IgE supervening
during the relentless course of pityriasis lichenoides.
====================================================
Dermatology. 2000;200(2):170-2.
Hermanns-Le T, Pierard GE.
Department of Dermatopathology, University of Liege, Belgium.
We report a case of extensive pityriasis lichenoides exhibiting a relentless
course. PUVA
therapy and oral retinoids cleared temporarily the lesions but did not really
halt the course
of the disease. Eosinophilia and hyper-IgE occurred after 50 years of evolution.
An
aggressive medullary CD30+ T cell lymphoma without skin involvement was then
diagnosed when pityriasis lichenoides became more extensive and necrotic. The
disease
was rapidly fatal.
====================================================
32.) Pityriasis lichenoides-like mycosis fungoides in children.
====================================================
Br J Dermatol. 2000 Feb;142(2):347-52.
Ko JW, Seong JY, Suh KS, Kim ST.
Department of Dermatology, Kosin Medical Center, Pusan, South Korea.
We report three children with clinical features of pityriasis lichenoides (scaly
red to brown
papules and macules) in whom there were histopathological findings of mycosis
fungoides
(disproportionate epidermotropism, Pautrier's microabscesses, and wiry and
coarse
collagen bundles). Immunohistochemical staining revealed a prevalence of T
lymphocytes in
the infiltrate. T-cell receptor gene rearrangement analysis in lesional skin
demonstrated
rearrangement of the gamma chain in all cases. Human T-cell lymphotropic virus
type 1
serology was negative in the two patients in whom this test was performed. Thus,
lesions
resembling pityriasis lichenoides can be an unusual and potentially misleading
presentation
of mycosis fungoides.
===================================================
33.) Childhood cutaneous T-cell lymphoma in association with pityriasis
lichenoides
chronica.
====================================================
Br J Dermatol. 1999 Dec;141(6):1146-8.
Comment on:
Br J Dermatol. 1997 Dec;137(6):983-7.
Thomson KF, Whittaker SJ, Russell-Jones R, Charles-Holmes R.
Publication Types:
Case Reports
Comment
Letter
====================================================
====================================================
34.) Pityriasis lichenoides-like exanthem and primary infection by Epstein-Barr
virus.
====================================================
Int J Dermatol. 2000 Feb;39(2):156-9.
Almagro M, Del Pozo J, Martinez W, Silva JG, Pena C, Yebra-Pimentel MT, Fonseca
E.
Departments of Dermatology and Pathology, Hospital Juan Canalejo, La Coruna.
Spain.
Publication Types:
Case Reports
====================================================
====================================================
35.) Pityriasis lichenoides chronica with acral distribution mimicking
palmoplantar syphilid.
====================================================
Acta Derm Venereol. 1999 May;79(3):239.
Chung HG, Kim SC.
Publication Types:
Case Reports
Letter
====================================================
====================================================
36.) Pityriasis lichenoides and acquired toxoplasmosis.
====================================================
Int J Dermatol. 1999 May;38(5):372-4.
Rongioletti F, Delmonte S, Rebora A.
Department of Dermatology, University of Genoa, Italy.
Publication Types:
Case Reports
====================================================
====================================================
37.) Paraneoplastic pityriasis lichenoides chronica.
====================================================
J Eur Acad Dermatol Venereol. 1999 Mar;12(2):189-90.
Lazarov A, Lalkin A, Cordoba M, Lishner M.
Publication Types:
Case Reports
Letter
====================================================
====================================================
38.) Cutaneous T-cell lymphoma presenting with 'segmental pityriasis lichenoides
chronica'.
====================================================
Clin Exp Dermatol. 1998 Sep;23(5):232.
Child FJ, Fraser-Andrews EA, Russell-Jones R.
Publication Types:
Case Reports
Letter
====================================================
====================================================
39.) Mucha-Habermann disease-like eruptions due to Tegafur.
====================================================
J Dermatol. 1999 Mar;26(3):164-7. Related Articles, Links
Kawamura K, Tsuji T, Kuwabara Y.
Department of Dermatology, Nagoya City University Medical School, Japan.
The first case of Mucha-Habermann disease-like drug eruptions due to Tegafur is
reported.
A 59-year-old man noticed various skin lesions after he had taken 300 mg of
Tegafur daily
for about 200 days. The patient had papulonecrotic eruptions on his trunk and
extremities.
The histology from a papular lesion revealed epidermal necrosis surrounded by
spongiosis,
perivascular inflammatory infiltrations composed of lymphocytes and erythrocytes,
and
endothelial swelling. The etiology of Mucha-Habermann disease is not known, but
an
immune mechanism may be supported by our case.
====================================================
40.) [Ulcers of the tongue, pityriasis lichenoides and primary parvovirus B19
infection]
====================================================
Ann Dermatol Venereol. 1996;123(11):735-8.
[Article in French]
Labarthe MP, Salomon D, Saurat JH.
Service de Dermatologie, Hopital Cantonal Universitaire de Geneve, Suisse.
INTRODUCTION: We report a case of parapsoriasis en gouttes (or pityriasis
lichenoides)
which presents two peculiarities. First, the patient had lingual ulcerations and
second, the
eruption appeared during a seroconversion for Parvovirus B19. OBSERVATION: A 25
old woman presented a first episode of characteristic parapsoriasis en gouttes
associated
with purpuric palmoplantar lesions and lingual ulcerations, reaching deep
muscular in
histology. DISCUSSION: This observation of parapsoriasis en gouttes, peculiar
because of
lingual ulcerations, is mostly interesting because of its association with a
primo-infection to
Parvovirus B19. The receptor of the virus is localised on endothelial cells and
that could
explain purpuric lesions and ulcerations observed.
====================================================
41.) Infectious causes of pityriasis lichenoides: A case of fulminant infectious
mononucleosis
====================================================
(J Am Acad Dermatol 2003;49:S151-3.)
Case Reports
Peter A. Klein, MD, MPA* a
Evan C. Jones, MPHa
Jonathan L. Nelson, MDa
Richard A.F. Clark, MDa
Abstract
Pityriasis lichenoides is a rare cutaneous eruption of unknown cause that spans
a spectrum
of clinical severity. Infectious agents have long been suspected as etiologic
factors. The
present case is the first to demonstrate a known EBV-mediated process evolving
and
resolving in concert with pityriasis lichenoides. Epstein-Barr virus, Toxoplasma
gondii, and
HIV are the most frequently reported infectious triggers of pityriasis
lichenoides. Pityriasis
lichenoides may arise secondary to EBV-mediated acute infectious mononucleosis.
====================================================
42.) Pityriasis lichenoides in children: a long-term follow-up of eighty- nine
cases.
====================================================
(J Am Acad Dermatol 1990 Sep;23(3 Pt 1):473-8)
C Gelmetti
C Rigoni
E Alessi
E Ermacora
E Berti
R Caputo
Abstract
Pityriasis lichenoides is usually classified into an acute and a chronic form.
From a review of
89 cases of the disease seen since 1974 it seems that a more realistic
classification into
three main groups, according to the distribution of pityriasis lichenoides
lesions, could be
made, namely, a diffuse, a central, and a peripheral form, each characterized by
a different
clinical course. Conversely, no correlations were detected in our series between
the
severity of skin lesions and their distribution or the overall course of the
disease. None of
our cases suggests the possible evolution of pityriasis lichenoides into
lymphomatoid
papulosis. Although no infectious causative agent has been identified, a viral
origin seems
likely in some cases. Most patients responded favorably to UVB irradiation. Our
conclusions are (1) that pityriasis lichenoides is probably a clinical disorder
with a diverse
etiology and (2) that its classification by distribution seems more useful than
its subdivision
into an acute and a chronic form.
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DATA-MEDICOS/DERMAGIC-EXPRESS No 5-(121) 30/04/2.004 DR. JOSE
LAPENTA R.
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