Congenital cutaneous non-neural granular cell tumor mimicking herpetic infection: Case report and review of the literature

We present a case of a female neonate with a cluster of six skin colored to yellowish pseudovesicular papules on her right forearm present since birth, initially thought to be a herpes simplex virus infection. Punch biopsy with immunostaining revealed a diagnosis of S100-negative, CD163-positive congenital cutaneous non-neural granular cell tumor. Only four other reports are presented in the literature of this entity, three of which also presented on the arm with somewhat similar clinical findings. We briefly reviewed the subtypes of classic and S100-negative non-neural granular cell tumors.

The microbiome in preadolescent acne: Assessment and prospective analysis of the influence of benzoyl peroxide

BACKGROUND/OBJECTIVES

The pathogenesis of preadolescent acne has not been well studied, and it is uncertain if Cutibacterium acnes is a predominant organism in the microbiome in this age group. The aim of this study was to analyze the microbiome of preadolescent females and to assess whether benzoyl peroxide impacts the microbiome.

METHODS

The study enrolled girls, aged 7-12 years, with evidence of at least six acne lesions who had not been previously treated. Participants' skin surface of forehead, cheeks, nose, chin, left retroauricular crease, and extruded contents of a comedonal lesion were sampled at baseline. Participants used benzoyl peroxide 4% wash for 6-8 weeks and returned for skin surface sampling and extraction collection. Microbiome analysis was performed using 16S ribosomal RNA gene amplicon sequencing on all swab and lesional extraction samples.

RESULTS

Fifty-one participants were enrolled with a median IGA score of 2 (mild). Changes in microbiome diversity were associated with increasing age and number of acne lesions (P = 0.001). C. acnes had higher abundances on forehead and nose, as opposed to cheeks and chin (P = 0.009). Bacterial diversity (alpha diversity) of the skin microbiome was comparable between preadolescent at baseline and after treatment with benzoyl peroxide.

CONCLUSION

This is the first large assessment characterizing female acne microbiome in early and late preadolescence. Results show that preadolescent acne can vary in its microbial profile, reflecting surrounding changes associated with the onset of puberty. Although benzoyl peroxide use was associated with decreased acne counts, its effect on microbial diversity was not demonstrated in our study.

Extensive orf infection in a toddler with associated id reaction

Orf is a zoonotic parapoxvirus typically transmitted to humans by a bite from goats or sheep. We present an unusual case of multiple orf lesions on the fingers of a 13-month-old child who was bitten by a goat and subsequently developed progressive swelling, blistering, and necrotic papulonodules of the hand followed by an additional diffuse, pruritic, papular rash. A primary diagnosis of orf infection was confirmed using real-time polymerase chain reaction, and the diffuse eruption was clinically consistent with an id reaction. Extensive necrosis and papular id reaction associated with orf rarely have been described.

5-Fluorouracil-induced exacerbation of rosacea

Background Topical 5-fluorouracil (5-FU) is an antineoplastic antimetabolite used for the treatment of actinic keratosis.Purpose A 66-year-old man with erythematotelangiectatic rosacea and biopsy-confirmed actinic keratoses who experienced a rosacea exacerbation after initiating topical 5-FU treatment of his actinic keratoses is described and this adverse event associated with 5-FU is reviewed.Materials and methods Using PubMed.gov the following terms were searched and relevant citations were assessed: rosacea and 5-fluorouracil. 5-FU drug label information and data sheets also were reviewed.ResultsErythematous facial papules developed within a week of starting topical treatment of his actinic keratoses with 5-FU. The lesions resolved within two weeks of discontinuing the medication. Albeit rarely, exacerbation of rosacea by topical 5-FU treatment has been described when 5-FU was introduced as a topical treatment for actinic keratosis.Conclusion Topical 5-FU has been associated with several adverse cutaneous events, including accentuation of rosacea. Although rosacea flares due to topical 5-FU may be uncommon, the incidence may be greater than reflected in the literature. Physicians should be aware of this potential adverse effect in patients in whom they plan to initiate 5-FU therapy.

Psoriasiform eruptions during Kawasaki disease (KD): A distinct phenotype

BACKGROUND

A psoriasis-like eruption develops in a subset of patients with Kawasaki disease (KD).

OBJECTIVE

We sought to systematically compare KD-associated psoriasiform eruptions with classic psoriasis and the outcomes of KD in children with and without this rash.

METHODS

This was a retrospective study of 11 KD cases with a psoriasiform eruption matched 1:2 by age, gender, and ethnicity with psoriasis-only and KD-only controls. Genotyping was performed in 10 cases for a deletion of 2 late cornified envelope (LCE) genes, LCE3C_LCE3B-del, associated with increased risk for pediatric-onset psoriasis.

RESULTS

Similar to classic psoriasis, KD-associated eruptions were characterized clinically by well-demarcated, scaly pink plaques and histopathologically by intraepidermal neutrophils, suprabasilar keratin 16 expression, and increased Ki-67 expression. They showed less frequent diaper area involvement, more crust and serous exudate, and an enduring remission (91% vs 23% with confirmed resolution; P < .001). Frequency of LCE3C_LCE3B-del and major KD outcomes were similar between cases and controls.

LIMITATIONS

The study was limited by the small number of cases, treatment variation, and availability of skin biopsy specimens.

CONCLUSIONS

Although the overall clinical and histopathologic findings were similar to conventional psoriasis, this appears to be a distinct phenotype with significantly greater propensity for remission. No adverse effect on KD outcomes was noted.

Fibroepithelioma of Pinkus Revisited

Background

Fibroepithelioma of Pinkus (FeP) is considered a variant of basal cell carcinoma (BCC); however, in the past 20 years, some researchers have argued for its classification as a trichoblastoma. Recently, use of a new immunostaining marker and further dermoscopic characterization of FeP have advanced the debate about its proper classification.

Purpose

A review of the evidence for and against classification of FeP as BCC or trichoblastoma is presented.

Methods

Using PubMed, the term FeP was searched and relevant citations were assessed. Additional relevant articles were identified from references of key papers.

Results

FeP shares characteristics of both trichoblastoma and BCC.

Conclusion

Derived from the same cell type, BCC and trichoblastoma may be best considered as representing opposite ends of a spectrum of differentiation, with FeP deserving an intermediate classification.