Granuloma Faciale

Nodular dermatitis with neutrophils, eosinophils, and plasma cells prominent.

Clinical Presentation:

■ Uncommon to rare condition

■ Solitary or several reddish brown nodules to plaques (Fig. 3A)

■ Typically on the face although rarely extrafacial

■ Persistent and asymptomatic

Histopathology:

■ Nodular mixed infiltrate with characteristic sparing of the papillary and periadnexal dermis (together known as the adventitial dermis) (Fig. 3B).

■ Polymorphous infiltrate consisting of numerous neutrophils, many of them with fragmented nuclei (leukocytoclasis), eosinophils, plasma cells, as well as lymphocytes (Fig. 3C).

■ Despite its name (which is based on the clinical appearance), histiocytes are not a histologic feature.

Differential Diagnosis:

■ Erythema elevatum diutinum—shares a similar pattern (nodular to diffuse predominantly neutrophilic infiltrate with leukocytoclasis) although fewer eosinophils and plasma cells.

Pathophysiology:

■ No known cause although in view of the presence of vas-culitis in early lesions, a localized Arthus-like process has been suggested.

References:

1. Lever WF, Leeper RW. Eosinophilic granuloma of the skin. Arch Dermatol 1950; 62:85-96.

2. Selvaag E, Roald B. Immunohistochemical findings in granuloma faciale. The role of eosinophilic granulocytes. J Eur Acad Dermatol Venereol 2000; 14:517-518.

CUTANEOUS HODGKIN'S DISEASE

Nodular mixed infiltrate with eosinophils, plasma cells, and lymphocytes.

Clinical Presentation:

■ Cutaneous involvement by Hodgkin's disease is rare and controversial

■ Late manifestation of the lymphoma (rarely the initial manifestation)

■ Cutaneous involvement often adjacent to the vicinity of involved lymph nodes

Histopathology:

■ Nodular to diffuse infiltrate involving the dermis and subcutaneous tissue (Fig. 4B)

■ Mixed infiltrate with characteristic large atypical lymphocytes, some of them binucleate (Reed-Sternberg cells) (Fig. 4C)

■ Small lymphocytes, eosinophils, plasma cells, and neutrophils

■ Occasional epithelioid granulomas

Differential Diagnosis:

■ Lymphomatoid papulosis/anaplastic large cell lymphoma. Both are characterized by CD 30 positive, CD15 positive lymphocytes.

Pathophysiology:

■ Epstein Barr virus is a suspected causative agent in Hodgkin's disease.

References:

1. Cerroni L, Behim-Schmid C, Kerl H. Cutaneous Hodgkin's disease: an Immunohistochemical Analysis. J Cutan Pathol 1995; 22:229-235.

2. Guitart J, Fretzin D. Skin as the primary site of Hodgkin's disease. Am J Dermapathol 1998; 20:218-222.

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How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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