This book has numerous photomicrographs and illustrations with six full-color plates and is printed on heavy white paper with large margins. The author explains the genesis of the book thus: "There is need for a textbook that weds the gross and microscopic features of skin diseases and simultaneously provides a logical systematic and reproducible method of histologic diagnosis." The book is aimed at "all students of skin disease be they dermatologists, pathologists, surgeons, residents, or medical students." This approach, however, "presumes a rudimentary knowledge of general pathology and hardly any of dermatology." The dilemma posed by writing for such a readership is that trained pathologists and dermatologists will find much of the content elementary, while those without such knowledge will find large sections difficult to comprehend.

Histologic Diagnosis of Inflammatory Skin Diseases: A Method by Pattern Analysis

Acute hemorrhagic edema of infancy (AHEI) is a benign type of leukocytoclastic vasculitis. It is a benign phenomenon although it manifests with fever, large palpable purpuric skin lesions, and edema. The presentation of AHEI can often resemble that of Henoch-Schonlein purpura. Since AHEI is a self-limited disease, conservative management is the most commonly followed approach. Our patient had complete resolution of AHIE without medical treatment.

/pdf/acute-hemorrhagic-edema-of-infancy-a-worrisome-presentation-kx75q9sr8x.pdf

Acute hemorrhagic edema of infancy: a worrisome presentation, but benign course.

Basal cell carcinoma (BCC) is a common, locally invasive epithelial malignancy of skin and its appendages. Every year, close to 10 million people get diagnosed with BCC worldwide. While the histology of this lesion is mostly predictable, some of the rare histological variants such as cystic, adenoid, morpheaform, infundibulocystic, pigmented and miscellaneous variants (clear-cell, signet ring cell, granular, giant cell, adamantanoid, schwannoid) are even rarer, accounting for <10% of all BCC's. Adenoid BCC (ADBCC) is a very rare histopathological variant with reported incidence of only approximately 1.3%. The clinical appearance of this lesion can be a pigmented or non-pigmented nodule or ulcer without predilection for any particular site. We share a case report of ADBCC, a rare histological variant of BCC that showed interesting features not only histologically but also by clinically mimicking a benign lesion.

/pdf/adenoid-basal-cell-carcinoma-a-rare-facet-of-basal-cell-c7o5210j6z.pdf

Adenoid basal cell carcinoma: a rare facet of basal cell carcinoma.

Grover's disease (GD) is an itchy acantholytic disorder occurring on the trunk of middle-aged men. Based on the best evidence, this study aimed to provide a summary of the clinical characteristics, disease course and treatments of GD. A systematic review was performed according to PRISMA guidelines for original articles published between 01.01.1970-08.15.2019, assessing clinical features and/or any type of intervention for GD. A total of 263 articles were retrieved, and 116 original reports that were deemed relevant and satisfied the inclusion criteria were included in the analysis (88 case reports, 26 case series and two retrospective reviews). From these articles, 317 patients were identified, with a male-to-female ratio of 3.95. The mean age was 59 years (range 11-92). Typical lesions were itchy papules and vesicle-papules, generally located on the trunk. Spontaneous resolution within one week to eight months was described in 42 % of cases. Topical corticosteroids (TCSs) were the most frequent treatment (response rate of 70 %) followed by systemic retinoids and corticosteroids with response rates of 86 % and 64 %, respectively. According to the results of this review, TCS appears to be the most frequently employed treatment, and we suggest TCS as first-line therapy. Second-line treatments could include systemic retinoids or systemic corticosteroids.

Clinical features and treatments of transient acantholytic dermatosis (Grover's disease): a systematic review.

Grover's disease (GD) is a transient or persistent, monomorphous, papulovesicular, asymptomatic or pruritic eruption classified as non-familial acantholytic disorder. Contribution of autoimmune mechanisms to GD pathogenesis remains controversial. The purpose of this study was to investigate antibody-mediated autoimmunity in 11 patients with GD, 4 of which were positive for IgA and/or IgG antikeratinocyte antibodies by indirect immunofluorescence. We used the most sensitive proteomic technique for an unbiased analysis of IgA- and IgG-autoantibody reactivities. Multiplex analysis of autoantibody responses revealed autoreactivity of all 11 GD patients with cellular proteins involved in the signal transduction events regulating cell development, activation, growth, death, adhesion and motility. Semiquantitative fluorescence analysis of cultured keratinocytes pretreated with sera from each patient demonstrated decreased intensity of staining for desmoglein 1 and/or 3 and PCNA, whereas 4 of 10 GD sera induced BAD expression, indicating that binding of autoantibodies to keratinocytes alters expression/function of their adhesion molecules and activates apoptosis. We also tested the ability of GD sera to induce visible alterations of keratinocyte shape and motility in vitro but found no specific changes. Thus, our results demonstrated that humoral autoimmunity in GD can be mediated by both IgA and IgG autoantibodies. At this point, however, it is impossible to conclude whether these autoantibodies cause or are caused by the disease. Antidesmoglein antibodies may be triggered by exposure to immune system of sequestered antigens due to disintegration of desmosomes during primary acantholysis. Clarifying aetiology of GD will help improve treatment, which currently is symptomatic and of marginal effectiveness.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/exd.12266

Is Grover's disease an autoimmune dermatosis?

Basal Cell Carcinoma (BCC) is almost exclusively seen in head-neck region with rare involvement of trunk and extremities. The tumour is commonly seen on nose, eyelids, at the inner canthus of eyes and behind the ears. Adenoid type of BCC is one of the rare histopathological types of BCC which has not found to have any site predilection. We report two cases of BCC occurring at an unusual site i.e., lower back and both of them showed adenoid type of BCC on histopathology. Morphologically they were pigmented and ulcerative type of BCC respectively.

Adenoid type of basal cell carcinoma: Rare histopathological variant at an unusual location

exposure to chlorine-containing materials. Histologically, there was a cyst filled with keratin materials, which were surrounded with several layers of stratified epithelium, so we diagnosed the present patient as primary milia. Although the connection with the infundibulum in vellus hair was not found on serial sections, it was thought that the location of the lesion was the penile shaft where there are fewer hair follicles. There have been two reports regarding cases of primary milia involving the external genitalia, a rare site, by Kanekura et al. and Lim et al., but both cases involved female genitals. They were different from this case in that primary milia appeared on the penile shaft. For this case of a 55-year-old man, primary milia developed on the penile shaft, an unusual spot. Because this case was not only rare, but also unreported, we deemed it worthy of reporting.

Transient acantholytic dermatosis associated with pemphigus foliaceus.

Sudden onset purpura in a healthy infant: acute hemorrhagic edema of infancy.

Hereditary angioedema is a genetic disorder due to a deficiency or malfunction of C1 esterase inhibitor. We herein describe a case of 25-year-old male who presented with swelling over face since one day. There was history of similar episodes since two years with gradual subsidence of swelling without any treatment. Investigations revealed grossly reduced complement C4 and C1 esterase inhibitor level. Patient was diagnosed to have hereditary angioedema type 1 and started on stanozolol 2 mg three times a day with no recurrence in one year of follow-up. Hereditary angioedema resembles angioedema of an allergic reaction. However, the cause is different.

Hereditary angioedema: Not an allergy

predominance of centroblasts and immunoblasts. B-cell markers like CD20 and CD79a are expressed by neoplastic cells. Bcl-2 protein is positive in almost all the cases.[5] Some tumors may be positive for Bcl-6. Primary cutaneous follicular center cell lymphoma (PCFCL) with diffuse growth pattern may mimic PCLBCL. Characteristically, PCFCLs do not express Bcl-2 protein or show faint Bcl-2 staining in a minority of tumor cells and unlike PCFCL, most PCLBCL, leg types, express MUM-1/IRF4 protein.

Smita S. Ghate

Papers

Adenoid type of basal cell carcinoma: Rare histopathological variant at an unusual location

Transient acantholytic dermatosis associated with pemphigus foliaceus.

Sudden onset purpura in a healthy infant: acute hemorrhagic edema of infancy.

Hereditary angioedema: Not an allergy

Exacerbation reaction (hypersensitivity) in post-kala-azar dermal leishmaniasis with miltefosine.