Telangiectasia macularis eruptiva perstans: an old terminology, still frequently used

The term telangiectasia macularis eruptiva perstans (TMEP) was originally used to describe a rare form of cutaneous mastocytosis (CM) that was limited to the skin with lesions consisting of irregular, telangiectatic macules ranging in color from red to brown. Recent guidelines, however, recommended that the sole presence of telangiectasias should not form the basis of a distinct variant of CM. We conducted a review of the literature from 1930 to 2017 and found 76 cases that were reported as TMEP. Owing to a general misconception about diagnosis of CM and SM, there is a need for further discussion and awareness of the newly proposed World Health Organization (WHO) guidelines.

[Mastocytosis--diagnostic criteria and treatment]

Mastocytosis is a heterogeneous group of rare diseases characterized by the proliferation and accumulation of mast cells in one or more organs such as the skin, bone marrow, liver, spleen, and lymph nodes. According to the WHO classification, mastocytosis is divided into seven subvariants. The symptoms are associated with mediator release and impaired organ function due to infiltration by neoplastic mast cells. There is a higher risk of anaphylactic shock; therefore education of the patients is very important. Patients may be asymptomatic. Symptomatic treatment is used in cutaneous mastocytosis and in indolent systemic mastocytosis. More aggressive subvariants of mastocytosis are treated with chemotherapy, targeted therapy, and bone marrow transplantation.

Diffuse cutaneous mastocytosis: pseudoxanthomatous variant

Diffuse cutaneous mastocytosis is one of the extremely rare benign forms of mastocytosis that have varied clinical presentations. The pseudoxanthomatous variant is an extremely rare multinodular nonpigmented entity. Only two cases have been reported so far in the literature. We report a 21 year old female patient who had diffusely infiltrated skin with multiple papulo-nodular lesions resembling xanthomas and the classical histopathological features of mastocytosis.

A proposed classification of mastocytosis incorporating molecular genetics

As an understanding of the molecular genetic causes of different forms of mastocytosis is developed, the therapy of choice may depend on the specific genetic abnormalities expressed by a patient's neoplastic mast cells. The authors propose a new classification system for mastocytosis that incorporates both molecular-genetic and clinical data. This system provides a theoretic framework for mast cell researchers and helps practicing physicians in estimating prognosis and determining therapeutic options for individual patients.

[Classification and management of mastocytosis in the child]

OBJECTIVE

Mastocytosis is a frequently observed condition in children. We analyzed the initial manifestations and clinical course.

PATIENTS AND METHODS

We restrospectively studied 49 cases of mastocytosis in children (29 boys and 20 girls) managed in our unit between 1985 and 1995. All of the children had typical manifestations. Photographic documents were available in all cases.

RESULTS

There was pigmentary urticaria in 32 cases and a mastocytoma in 17. Axanthelasmoid aspect and bullae were observed in some cases in both of these clinical forms. Complementary explorations demonstrated one case of duodenal mast cell infiltration. Excepting the case with skin and duodenal manifestation, all of our patients improved and clinical cure was obtained during growth.

DISCUSSION

The association of dermal atopia and mastocytosis does not influence the clinical course of these two conditions. The development of bullae does not appear to be a factor of poor prognosis. The xanthelasmoid aspect of the lesions and the similar course in childhood mastocytosis and juvenile xanthogranulma would suggest that a common process with a histological spectrum including mastocytoma and xanthoma is involved. In our experience, counselling against the use of anti-cough medicines containing codeine is an essential part of management. Antihistamine agents may be prescribed for pruritus.

[Systemic mastocytosis]

The systemic mastocytosis is a rare disorder, however, the authors recently diagnosed two cases causing diagnostic problems. The diagnosis was proved by bone marrow biopsy in both patients. The authors review the diagnostic pathway considering the pitfalls. According to their conclusion, the most important factor in the diagnosis of systemic mastocytosis is to think of the possibility of systemic mastocytosis.

[Immunologic studies in chronic urticaria]

Chronic urticaria is considered to be a heterogeneous disease, which can be divided into several subclasses. The authors investigated 126 patients suffering from chronic urticaria with 41 of unknown origin. The aim of the present study was to work out a strategy for the complete investigation of patients with chronic urticaria. The findings of the immunological study modified the results obtained by medical assessment of the 126 chronic urticaria cases, diminished the number of the patient with chronic urticaria unknown etiology.

[Cutaneous mastocytosis with bullous changes simulating xanthoma tuberosum]

A 20-year-old female patient is reported with urticaria pigmentosa and coexisting nodules (mastocytoma) resembling clinically lesions of the type of xanthoma tuberosum. An analysis of microscopic image and ultrastructural changes was carried out and modern views on treatment of cutaneous mastocytosis are discussed.

Mastocytosis

Mastocytosis implies involvement by excessive numbers of mast cells, of skin and/or other organs. Symptoms may be absent to severe, even occasionally life-threatening. H1- and H2-blocking agents potentially may relieve symptoms, but do nothing to prevent systemization. At present no specific combination chemotherapy regimen has been shown to be markedly effective in a large controlled study. Mithramycin may be of benefit in relieving localized bone pain, although confirmation of this observation in large numbers of patients is needed. PUVA may be a viable approach to symptomatic treatment of otherwise poorly controlled urticaria pigmentosa. In children, urticaria pigmentosa is a relatively benign disease without an increased risk of later systemic involvement. In adults, however, other organs by be involved, with resultant increased morbidity and mortality. Without specific symptoms to a particular organ system, elaborate and expensive staging work-up is not indicated, at least until there is evidence that a reproducibly effective therapy for systemic disease exists.