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A study of 100 cases of vitiligo showed the frequency of associated skin and visceral lesions. A skin disease was associated in 24 cases: psoriasis 4 cases, alopecia 4 cases, eczema 3 cases, malignant melanoma 2 cases, dermatitis herpetiformis 1 case, lichen planus 9 cases. However, only one case of Sutton's naevus was noted. Among other associations noted in 28 cases, there were 7 cases of thyroid disease, 5 cases of diabetes, 1 case of chronic rheumatoid arthritis and 3 gastric disorders. The frequency of these various associations was discussed in the light of other authors' reports. If one compares the 21 cases associated with auto-immune disease and the other cases of vitiligo, there was no significant difference for the various parameters studied. Thus the significance of the various biological signs of autoimmunisation remains doubtful and even the precise definition of vitiligo remains uncertain.
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PMID:[Clinical and statistical study of 100 patients with vitiligo. II. Associated lesions]. 18 47

Clinical observations on two cases of staphylodermia superficialis circinata are reported. This rare variation of superificial staphylococcal skin infection is identical with the "erythema necroticans migrans". As this cutaneous manifestation is highly associated with malignant internal diseases it must be regarded as a "cutaneous paraneoplasia". Out of 14 cases of erythema necroticans migrans, so far published this dermatosis occured in 13 patients suffering from pancreatic cancer. Association with pancreatitis was demonstrated in one case. In both cases herein reported the cutaneous manifestations were associated with a carcinoma of the pancreas and with cervix cancer. Extreme loss of weight, atrophic glossitis, therapy-resistant anemia and a slight diabetes are extra-cutaneous symptoms of this paraneoplastic syndrom.
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PMID:[Staphylodermia superficialis circinata. The 5th obligatory cutaneous paraneoplasia]. 19 72

We performed ultrastructural studies of skin lesions in seven adults with acquired perforating dermatosis. Three of the patients had diabetes mellitus and two were undergoing hemodialysis. Lesions in an early stage showed exocytosis of inflammatory cells and alteration of elastic fibers. Lesions in an intermediate stage featured discontinuities of the basement membrane and aggregates of electron-dense material lateral to the perforated focus, together with dermal edema, scattered macrophages, and densely aggregated collagen fibers that focally filled the papillary dermis. Later-stage lesions showed fibroblasts in the dermis and degenerated elastic fibers within transepidermal channels. In most cases there was a single large epidermal channel lined by flattened epithelial cells, and containing a variety of cellular and extracellular materials. Small "secondary" channels without abnormal keratinization were also observed within the epidermis. The findings suggest that altered keratinization is limited to the immediate vicinity of well-formed transepidermal channels, and that exocytosis of inflammatory cells and alterations of elastica are early and possibly key changes in lesion development. The unexpected discovery of hair fragments in one case suggests that curled hairs may play a role in the pathogenesis of some cases of acquired perforating dermatosis.
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PMID:Ultrastructural changes in acquired perforating dermatosis. 137 7

Localized granuloma annulare is the commonest form of a granulomatous dermatosis characterized by flesh coloured or violaceous papules often arranged in rings. Several rare atypical variants are also reported including disseminated or generalized, subcutaneous and perforating types. There is a predilection for females and a documented association with diabetes mellitus in some cases. Recently it has been suggested that atypical variants of granuloma annulare might be associated with the acquired immunodeficiency syndrome (AIDS). We describe a patient presenting with extensive generalized granuloma annulare in whom an underlying diagnosis of Human Immunodeficiency Virus (HIV) disease was confirmed.
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PMID:Disseminated granuloma annulare as a presentation of acquired immunodeficiency syndrome (AIDS). 142 65

Pyoderma gangrenosum is an uncommon skin disorder characterised by deep ulcers surrounded by a violaceous over-hanging edge. Although in many instances there is no clear association with any underlying disease, pyoderma gangrenosum has been described in ulcerative colitis, Crohn's disease, polyarthritis, diabetes mellitus and myeloma. Pyoderma gangrenosum may also be seen as a rare manifestation of myeloproliferative disease including leukaemia. In children, as in our case, it may be the presenting feature.
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PMID:Pyoderma gangrenosum with large circumferential perianal skin loss in a child. 180 22

A patient had acquired perforating dermatosis and suffered from renal disease, diabetes mellitus, and lupus vulgaris. Histologic and immunohistochemical studies revealed that the bulk of the coarse granular basophilic material being extruded by transepidermal elimination was of nuclear origin obviously derived from polymorphonuclear leukocytes that were particularly abundant in an early, nonperforated lesion. At the lower boundary of the material being eliminated transepidermally, leukocytes were seen to accumulate, to undergo pyknosis and karyorrhexis, and to transform into nuclear debris. As a minor component, the material contained collagen fibers with altered staining qualities and, in an early lesion, elastic fibers. We speculate that accumulation, disintegration, and enzyme release from polymorphonuclear leukocytes may represent an important, hitherto disregarded driving force in transepidermal elimination. Lysosomal enzymes may later be responsible for the alteration of staining properties in collagen fibers, the degradation of elastic fibers, and for opening up the transepidermal route by impairing intercellular keratinocyte cohesion.
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PMID:Acquired perforating dermatosis. Transepidermal elimination of DNA material and possible role of leukocytes in pathogenesis. 202 88

558 episodes of bacteremia were detected in our medical center during a 2-year period. 17 of them (3%) were of cutaneous origin. 12 cases were community-acquired and 5 were hospital-acquired. The patients median age was of 65 years. 15 patients had a baseline disease, the most frequent being diabetes mellitus and neoplastic disease. The most common bacteria isolated were group A beta-hemolytic Streptococcus, Staphylococcus aureus, and Escherichia coli; 2 patients had multibacterial episodes. Decubitus ulcer and cellulitis were the most frequently associated skin disease. Global mortality was of 47% and was sepsis related in 29% of the cases. Death prognosis factors were old age, diabetes mellitus, gram-negative causal bacteria, nonappropriate antibiotic therapy, low index of clinical suspicion.
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PMID:[Bacteremia of cutaneous origin]. 210 66

A newly recognized disease in dogs, ulcerative dermatosis associated with diabetes mellitus (diabetic dermatopathy), was diagnosed in 2 dogs with pancreatic endocrine tumors that had immunohistologic evidence of glucagon production. Dogs developed diabetes mellitus in the later stages of the illness, months after the skin disease was first observed. Liver disease was identified and characterized by high serum alkaline phosphatase and alanine transaminase activities. Clinically, erythema and crusting involved the footpads, the face, perioral and genital skin, and ventrum. Histologically, skin lesions were intercellular and intracellular edema and necrosis of the upper half of the epidermis and diffuse parakeratosis. Clinically and histologically, skin lesions closely resembled necrolytic migratory erythema of people, a skin disease that usually is associated with a glucagon-secreting pancreatic endocrine tumor and diabetes mellitus (glucagonoma syndrome): The morphologically descriptive term, superficial necrolytic dermatitis, was preferred over the previously proposed names hepatocutaneous syndrome and diabetic dermatopathy, which each connote only a single feature of the disease.
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PMID:Glucagon-producing pancreatic endocrine tumors in two dogs with superficial necrolytic dermatitis. 227 59

After 6 months on hemodialysis, a 58-year-old male patient with diabetes developed photosensitive bullous dermatosis on his hands and face. There was no evidence of liver diseases although the patient had a history of excessive alcohol consumption. He was suspected to have iron overload in the liver. Analysis of porphyrins in plasma, hemofiltrate, urine and feces by high performance liquid chromatography revealed significantly high levels in these samples with a porphyrin profiles which is consistent with porphyria cutanea tarda. The fluorometric assays of plasma also disclosed an elevated plasma porphyrin level. And it seemed that there were correlation between the fluctuation of vesicle formation, serum ferritin level and plasma porphyrin level. Small volume plasma exchange temporarily reduced the plasma porphyrin level and prevented vesicle formation.
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PMID:[Porphyria cutanea tarda in a chronic hemodialysis patient]. 239 21

Patients with renal disease or diabetes mellitus often have an acquired perforating disease of the skin develop that is characterized by hyperkeratotic papules with transepidermal elimination of degenerated material, including collagen or elastic fibers. There is disagreement regarding the most appropriate name for this disease. The pathologic process has been identified by various authors as reactive perforating collagenosis, elastosis perforans serpiginosa, perforating folliculitis, or Kyrle's disease. We have seen four patients with renal disease and/or diabetes whose skin biopsy specimens demonstrated combined transepidermal elimination of both collagen and elastic fibers. This finding is not characteristically seen in any of the previously defined perforating diseases. Since the histologic findings vary greatly in different lesions from different patients with renal disease, we recommend referring to this process as "acquired perforating dermatosis." It is best not to create a new category of perforating disease or to say that a given patient has one of the other four diseases based on random sampling of only a few lesions.
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PMID:Acquired perforating dermatosis. Evidence for combined transepidermal elimination of both collagen and elastic fibers. 1282 63


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