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Dhekariyapak A, Wattanakrai P. Granulomatous Pigmented Purpuric Dermatosis in a Patient with (Inactive) Myasthenia Gravis: A Case Report and Review of the Literature. Case Rep Dermatol 2023; 15:71-84. [PMID: 37383325 PMCID: PMC10293941 DOI: 10.1159/000530034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/20/2023] [Indexed: 06/30/2023] Open
Abstract
Granulomatous pigmented purpuric dermatosis (GPPD) is a rare histologic variant of pigmented purpuric dermatosis (PPD) characterized by dermal histiocyte-rich interstitial infiltration with or without granuloma formation in addition to the other typical features of PPD. GPPD was previously observed more frequently to affect Asians and was reported to be associated with dyslipidemia. However, our literature search of 45 documented GPPD cases revealed an increasing prevalence in Caucasians in addition to dyslipidemia and associated autoimmune diseases. To date, etiopathogenesis of GPPD is unknown but may involve dyslipidemia, genetic and immunological factors such as autoimmune dysregulation or a sarcoidal reaction associated with C. acnes. GPPD is usually persistent and recalcitrant to treatments. We report a case of GPPD in a 57-year-old Thai woman with underlying myasthenia gravis who presented with a pruritic eruption on both lower legs. After treatment with 0.05% clobetasol propionate cream and oral colchicine, the lesion improved with marked flattening and disappeared with residual postinflammatory hyperpigmentation. We provide a literature review of the epidemiology, etiopathogenesis, concomitant comorbidities, clinical symptoms, dermatoscopic features, and treatments of GPPD.
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Affiliation(s)
- Apirada Dhekariyapak
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Penpun Wattanakrai
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Matter AV, Kolm I, Kempf W. Granulomatous pigmented purpuric dermatosis: clinical and histopathologic findings in a series of nine cases. J Cutan Pathol 2022; 49:597-603. [PMID: 35288961 DOI: 10.1111/cup.14224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/18/2022] [Accepted: 03/04/2022] [Indexed: 11/28/2022]
Abstract
We report the largest series so far of granulomatous pigmented purpuric dermatosis (GPPD), a rare variant of pigmented purpuric dermatoses (PPD). GPPD can cause diagnostic difficulties as it can be mistaken clinically and histopathologically with numerous inflammatory and infectious dermatoses or even cutaneous T-cell lymphoma. We compared the histopathological findings of nine cases of GPPD with a control group consisting of ten randomly selected PPD of other subtypes. GPPD seems to predominantly affect the lower extremities of adult male patients; a clear association with hyperlipidemia or other systemic conditions could not be confirmed. Histopathologically, GPPD is characterized by a dermal histiocyte-rich interstitial infiltrate with or without granuloma formation, thickened capillaries, extravasated erythrocytes and/or hemosiderin deposits. In contrast to other forms of PPD, the inflammatory infiltrate of GPPD can extend to the mid or deep dermis and the admixed lymphocytic infiltrate is mainly composed of CD8+ T-cells. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Alexandra Valeska Matter
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Isabel Kolm
- Department of Dermatology, University Hospital Zurich, University Zurich, Zurich, Switzerland
| | - Werner Kempf
- Kempf und Pfaltz Histologische Diagnostik, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, University Zurich, Zurich, Switzerland
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Affiliation(s)
| | - Ana Rita Gameiro
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal
| | | | - José Pedro Reis
- Dermatology Department, Coimbra University Hospital, Coimbra, Portugal
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Aktaş Karabay E, Demir D, Zemheri E, Zindancı İ. Granulomatous pigmented purpuric dermatosis in a young adolescent successfully treated with oral pentoxifylline: A case report. Dermatol Ther 2020; 33:e13995. [PMID: 32648290 DOI: 10.1111/dth.13995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ezgi Aktaş Karabay
- Department of Dermatology, Faculty of Medicine, Bahçeşehir University, Istanbul, Turkey
| | - Damla Demir
- Department of Dermatology, Health Science University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ebru Zemheri
- Department of Pathology, Health Science University, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - İlkin Zindancı
- Department of Dermatology, Health Science University, Ümraniye Training and Research Hospital, Istanbul, Turkey
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Huang YK, Lin CK, Wu YH. The pathological spectrum and clinical correlation of pigmented purpuric dermatosis-A retrospective review of 107 cases. J Cutan Pathol 2018; 45:325-332. [PMID: 29381224 DOI: 10.1111/cup.13118] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 01/21/2018] [Accepted: 01/24/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Various pathological findings have been reported in pigmented purpuric dermatosis, but their clinical significance remains unclear. METHODS We retrospectively reviewed demographics, clinical presentations, pathological patterns and concurrent systemic diseases among biopsy-confirmed cases of pigmented purpuric dermatosis. RESULTS A total of 107 cases were ascertained. Five major pathological patterns were identified: lichenoid (45/107, 42.1%), perivascular (40/107, 37.4%), interface (11/107, 10.3%), spongiotic (7/107, 6.5%) and granulomatous (4/107, 3.7%). Lymphocytic vasculitis was present in 17 patients (15.9%), and Langerhans cell microabscess was seen in 4 (3.7%). Nine patients had partial features mimicking mycosis fungoides but none were confirmed. The lichenoid, perivascular and spongiotic patterns correlated to lichen aureus, Schamberg and eczematoid clinical variants, respectively. The interface pattern was associated with a higher risk of coincident autoimmune diseases (18.2%, P = .0280) and gout (27.3%, P = .0180). CONCLUSIONS This study described the wide pathological spectrum of pigmented purpuric dermatosis among Asians. Physicians should be aware about the clinical and pathological variations to facilitate diagnosis.
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Affiliation(s)
- Yen-Kai Huang
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Kuan Lin
- Department of Environmental Health, Harvard Chan School of Public Health, Boston, Massachusetts
| | - Yu-Hung Wu
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Ozkaya DB, Emiroglu N, Su O, Cengiz FP, Bahali AG, Yildiz P, Demirkesen C, Onsun N. Dermatoscopic findings of pigmented purpuric dermatosis. An Bras Dermatol 2017; 91:584-587. [PMID: 27828629 PMCID: PMC5087214 DOI: 10.1590/abd1806-4841.20165124] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/10/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Pigmented purpuric dermatosis is a chronic skin disorder of unknown aetiology characterised by symmetrical petechial and pigmented macules, often confined to the lower limbs. The aetiology of pigmented purpuric dermatosis is unknown. Dermatoscopy is a non-invasive diagnostic technique that allows the visualisation of morphological features invisible to the naked eye; it combines a method that renders the corneal layer of the skin translucent with an optical system that magnifies the image projected onto the retina. Objectives: The aim of this study is to investigate the dermatoscopic findings of pigmented purpuric dermatosis. Methods: This study enrolled patients diagnosed histopathologically with pigmented purpuric dermatosis who had dermatoscopic records. We reviewed the dermatoscopic images of PPD patients who attended the outpatient clinic in the Istanbul Dermatovenereology Department at the Bezmialem Vakıf University Medical Faculty. Results: Dermatoscopy showed: coppery-red pigmentation (97%, n = 31) in the background, a brown network (34%, n = 11), linear vessels (22%, n = 7), round to oval red dots, globules, and patches (69%, n = 22; 75%, n = 24; 34%, n = 11; respectively), brown globules (26%, n = 8) and dots (53%, n = 17), linear brown lines (22%, n = 7), and follicular openings (13%, n = 4). Conclusion: To our knowledge, this is the first study to report the dermatoscopy of pigmented purpuric dermatosis. In our opinion, dermatoscopy can be useful in the diagnosis of pigmented purpuric dermatosis.
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Affiliation(s)
| | - Nazan Emiroglu
- Bezmialem Vakif University Medical Faculty - Fatih, Istanbul
| | - Ozlem Su
- Bezmialem Vakif University Medical Faculty - Fatih, Istanbul
| | | | | | - Pelin Yildiz
- Bezmialem Vakif University Medical Faculty - Fatih, Istanbul
| | - Cuyan Demirkesen
- Istanbul University, Cerrahpasa Medical Faculty - Fatih, Istanbul
| | - Nahide Onsun
- Bezmialem Vakif University Medical Faculty - Fatih, Istanbul
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Mackenzie AI, Biswas A. Granulomatous Pigmented Purpuric Dermatosis: Report of a Case With Atypical Clinical Presentation Including Dermoscopic Findings. Am J Dermatopathol 2015; 37:311-4. [DOI: 10.1097/dad.0000000000000090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- L. R. Battle
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - S. C. Shalin
- Department of Pathology; University of Arkansas for Medical Sciences; Little Rock AR USA
| | - L. Gao
- Department of Dermatology; University of Arkansas for Medical Sciences; Little Rock AR USA
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Gönül M, Külcü Çakmak S, Ozcan N, Oğuz ID, Gül U, Bıyıklı Z. Clinical and laboratory findings of pigmented purpuric dermatoses. Ann Dermatol 2014; 26:610-4. [PMID: 25324654 PMCID: PMC4198589 DOI: 10.5021/ad.2014.26.5.610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/19/2013] [Accepted: 12/19/2013] [Indexed: 11/08/2022] Open
Abstract
Background Pigmented purpuric dermatoses (PPD) are chronic, recurrent group of disorders characterized by petechial and pigmentary macules usually localized on the lower limbs. Its etiopathogenesis is unknown. There are very few clinical and etiological studies on PPD in the literature. Objective We aim to examine the etiopathogenetic factors of PPD retrospectively. Methods Demographic characteristics, history of co-morbid disorders and drug usage, hepatitis markers, levels of serum lipids, findings of Doppler ultrasonography in lower extremities, and patch test results of the 24 patients of PPD were examined retrospectively. The patch test results, history of drug use, and co-morbid disorders of the patients were compared with those of the control groups. Results The male-to-female ratio was 1 : 2, and 83.3% of the patients had Schamberg disease. Seventeen patients had co-morbid disorders and 16 used various drugs, but there was no statistically significant difference between the controls and patients. One patient was positive for hepatitis B surface antigen and 1, for anti-hepatitis C virus antibody. Nine had elevated total cholesterol levels, and 5 had elevated triglyceride levels. Further, 30% of them were positive for at least 1 allergen, while 16% of the control subjects were positive for at least 1 allergen, but statistically significant difference was not found between the 2 groups. Variable degrees of venous insufficiency were detected in 75% of the patients on Doppler ultrasonography of the lower extremities. Conclusion Venous insufficiency and hypercholesterolemia might be the basic predisposing factors for PPD. Further studies are needed to show if diabetes mellitus and hypertension may cause perivascular inflammation in PPD.
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Affiliation(s)
- Müzeyyen Gönül
- Dermatology Clinic, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Seray Külcü Çakmak
- Dermatology Clinic, Numune Education and Research Hospital, Ankara, Turkey
| | - Nimet Ozcan
- Dermatology Clinic, Numune Education and Research Hospital, Ankara, Turkey
| | - Işıl Deniz Oğuz
- Dermatology Clinic, Numune Education and Research Hospital, Ankara, Turkey
| | - Ulker Gül
- Dermatology Clinic, Numune Education and Research Hospital, Ankara, Turkey
| | - Zeynep Bıyıklı
- Department of Biostatistic, Ankara University Faculty of Medicine, Ankara, Turkey
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Aung PP, J. Burns S, Bhawan J. Lichen Aureus: An Unusual Histopathological Presentation A Case Report and a Review of Literature. Am J Dermatopathol 2014; 36:e1-4. [DOI: 10.1097/dad.0b013e31828b4428] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Paolino S, Cinotti E, Merlo V, Rongioletti F. Progressive Petechial and Pigmented Macules and Papules on the Lower Extremities. Am J Dermatopathol 2013; 35:388. [DOI: 10.1097/dad.0b013e31826e036b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tato BP, Marinero Escobedo S, Pérez González YC, Sánchez Albisua B, Polimón Olabarrieta I, Encabo Mayoral B, López PF. Granulomatous variant of pigmented purpuric dermatosis. Am J Dermatopathol 2012; 34:746-8. [PMID: 23007717 DOI: 10.1097/DAD.0b013e31823f616a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Granulomatous pigmented purpuric dermatosis is a rare entity. Historically, it has been seen in Asians. In this article, we report the case of a white man with this unusual variant. A 65-year-old, white man presented with a 1-year history of asymptomatic purpuric to brown papules on both lower legs and more confluent on dorsum of feet. He had an underlying history of hypertension and hyperlipidemia. Skin biopsy revealed a granulomatous lympho-histocytary inflammatory infiltrate in papillary dermis and superficial reticular dermis with extravasation of red blood cells and siderophages. Periodic acid schiff (PAS), Giemsa and Ziehl-Neelsen stains were negative. A diagnosis of granulomatous pigmented purpuric dermatosis was made. From the 10 cases reported of this granulomatous variant, 6 were associated with hyperlipidemia. We report an additional case with this association.
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Abstract
The complex and fascinating spectrum of inflammatory skin disease, and the comprehension of it, is ever expanding and evolving. During the first decade of the 21st century, numerous advances in the understanding of inflammatory disease mechanisms have occurred, particularly in psoriasis and atopic dermatitis. Continuation of this trend will assure a future in which molecular tests for biomarkers of immediate clinical relevance are used in routine patient care, not only for diagnosis but also for prognosis and management. This article focuses on selected recent or noteworthy developments that are clinically relevant for the histologic diagnosis of inflammatory skin diseases.
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Affiliation(s)
- Maxwell A Fung
- UC Davis Dermatopathology Service, Department of Dermatology, University of California Davis School of Medicine, 3301 C Street, Suite 1400, Sacramento, CA 95816, USA.
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Lee SH, Kwon JE, Lee KG, Roh MR. Granulomatous variant of chronic pigmented purpuric dermatosis associated with hyperlipidaemia. J Eur Acad Dermatol Venereol 2010; 24:1243-5. [DOI: 10.1111/j.1468-3083.2010.03627.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wang J, Wu Y, Hsiao P, Kao C. Granulomatous pigmented purpuric dermatoses: report of three cases and review of the literature. DERMATOL SIN 2010; 28:77-81. [DOI: 10.1016/s1027-8117(10)60016-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lin WL, Kuo TT, Shih PY, Lin WC, Wong WR, Hong HS. Granulomatous variant of chronic pigmented purpuric dermatoses: report of four new cases and an association with hyperlipidaemia. Clin Exp Dermatol 2007; 32:513-5. [PMID: 17535280 DOI: 10.1111/j.1365-2230.2007.02462.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Four patients presenting with chronic pigmented purpuric dermatosis (CPPD) on the limbs were found to have granulomatous inflammation superimposed on the pathological changes of CPPD. Three of the four patients had hyperlipidaemia. Therefore, the granulomatous reaction observed could be associated with hyperlipidaemia. Whether it occurs only in Asian people or not needs further observation.
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Affiliation(s)
- W-L Lin
- Deparment of Dermatology, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Abstract
The term pigmented purpuric dermatosis (PPD) is used for a group of mainly asymptomatic, sometimes pruritic dermatoses that are clinically characterized by an eruption of pinpoint purpuric lesions along with yellow, orange, red and/or brown, often patchy pigmented areas. Traditionally five subtypes have been distinguished, but atypical clinical patterns may also occur. Because of the variable clinical spectrum and the similar histopathologic findings, a strict nosological classification is sometimes difficult or even impossible to achieve. We report a case of PPD with atypical clinical features in a young woman, underlining the difficulties in the clinical classification of this spectrum of diseases.
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Affiliation(s)
- Iris Zalaudek
- Department of Dermatology, Medical University of Graz, Graz, Austria.
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