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- Presentation
Three Dermatopathology Cases: Herpes and Syphilis Coinfection, Paraneoplastic Granuloma Annulare, and Keratosis Follicularis Spinulosa Decalvans
Description
The presentation reviewed three dermatopathology cases. The first involved a 39-year-old woman with painful perineal erosions whose biopsy showed herpetic cytopathic changes, but careful review and additional stains also revealed syphilis, illustrating that herpes and syphilis can coexist and that syphilis should be considered in atypical or chronic genital lesions, especially as cases are rising and risk factors may be missed. The second case was a 12-year-old girl with widespread annular pink plaques initially thought to be benign, but she later developed cervical lymphadenopathy and was diagnosed with Hodgkin lymphoma; the skin lesions were ultimately interpreted as granuloma annulare, likely a paraneoplastic manifestation that improved as the malignancy was treated. The third case described a man with lifelong follicular papules, scarring alopecia, and ocular disease, whose biopsy and history supported keratosis follicularis spinulosa decalvans, an uncommon X-linked genodermatosis associated with MBTPS2 mutation, characteristic follicular hyperkeratosis, cicatricial alopecia, and eye involvement. Overall, the talk emphasized staying alert for infectious mimics, paraneoplastic skin disease, and rare inherited keratodermas based on clinicopathologic correlation.
View moreConclusions
- The presentation concludes that herpes and syphilis can coexist in the same lesion, so clinicians and pathologists should actively consider both infections and order appropriate stains when symptoms or histology suggest them.
- It concludes that syphilis is rising, including among women, and that incarceration, drug use, unprotected sex, multiple partners, and pregnancy are important risk factors that warrant heightened screening and vigilance.
- It concludes that granuloma annulare can be a paraneoplastic sign, sometimes preceding or coinciding with malignancy, so sudden widespread or atypical granuloma annulare should prompt evaluation for an underlying cancer.
- It concludes that generalized or atypical granuloma annulare may improve when the associated malignancy is treated, supporting a causal paraneoplastic relationship in at least some cases.
- It concludes that disorganized superficial dyskeratosis with a keratoderma-like pattern should raise suspicion for rare genodermatoses rather than routine inflammatory dermatoses.
- It concludes that keratosis follicularis spinulosa decalvans is a rare inherited disorder with scarring alopecia, follicular papules, and ocular findings, and that clinical-pathologic correlation with genetic testing can confirm the diagnosis.
- It concludes that many of these rare hereditary follicular disorders have limited histologic documentation, so recognizing their broader clinical pattern is essential for diagnosis.
- It concludes that dermatopathology can uncover diagnoses that are missed clinically, especially when lesions are atypical, painless, chronic, or occurring in immunosuppressed patients.
- Bellet J, Kaplan A, Selim MA, Olsen E. Keratosis follicularis spinulosa decalvans in a family. JAAD 58:3;499-502. 2008.#10.1016/j.jaad.2007.03.028