Spontaneous regression of hidroacanthoma simplex after skin biopsy

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

Download Full-text

Obtaining a Skin Biopsy Specimen and Interpreting the Results

Dermatologic Clinics ◽

10.1016/s0733-8635(18)30203-1 ◽

1994 ◽

Vol 12 (1) ◽

pp. 83-91 ◽

Cited By ~ 9

Author(s):

Ronald P. Rapini

Keyword(s):

Skin Biopsy ◽

Biopsy Specimen ◽

Skin Biopsy Specimen

Download Full-text

Lasertechniques treatment of vascular malformations

Phlebologie ◽

10.1055/s-0037-1622304 ◽

2010 ◽

Vol 39 (03) ◽

pp. 167-175

Author(s):

M. Poetke ◽

P. Urban ◽

H.-P. Berlien

Keyword(s):

Endothelial Cells ◽

Spontaneous Regression ◽

Vascular System ◽

Vascular Malformations ◽

Clinical Importance ◽

Vascular Structure ◽

Laser Application ◽

Vascular Morphogenesis ◽

Structural Abnormalities

SummaryVascular malformations are structural abnormalities, errors of vascular morphogenesis, which can be localized in all parts of the vascular system. All vascular malformations by definition, are present at birth and grow proportionately with the child; their volume can change. In contrast to the haemangiomas, which only proliferate from the endothelial cells the division in stages is of clinical importance. Vascular malformations are divided from the part of vascular system, which is affected.In principle the techniques of laser application in congenital vascular tumours like haemangiomas and in vascular malformations are similar, but the aim is different. In tumours the aim is to induce regression, in vascular malformations the aim is to destroy the pathologic vascular structure because there is no spontaneous regression. This means that the parameters for treatment of vascular malformations must be more aggressive than for vascular tumours.

Download Full-text