Pityriasis rubra pilaris in the setting of HIV infection: clinical behaviour and association with explosive cystic acne.

The development of pityriasis rubra pilaris (PRP) in three patients with human immunodeficiency virus (HIV) infection is described. Two of the patients had onset of severe generalized cystic acne concomitant with their development of PRP. PRP and acne conglobata should be added to the group of cutaneous disorders that can present in a more virulent manner in the setting of HIV infection.

Widespread cutaneous and systemic calcification (calciphylaxis) in patients with the acquired immunodeficiency syndrome and renal disease.

Background: Calciphylaxis is a form of widespread calcification that may occur in patients with renal disease and hyperparathyroidism. The skin is often affected secondary to vascular compromise and ischemia. Patients infected with the human immunodeficiency virus (HIV) are predisposed to renal failure and thus may develop this serious complication.

An unusual presentation of secondary syphilis in a patient with human immunodeficiency virus infection. A case report and review of the literature.

Background: Syphilis has been reported to assume unusual clinical appearances and to exhibit unusual courses in patients infected with the human immunodeficiency virus (HIV) type 1. We recently observed a distinct manifestation of syphilis in an HIV-infected patient with features not previously described.

Observations: A 38-year-old HIV-seropositive homosexual man presented with fever, chills, malaise, and a cutaneous eruption consisting of indurated, shiny, erythematous plaques that were confluent on the face and scalp leading to alopecia and extreme tautness of the skin.

Histologic features and sensitivity of diagnosis of clinically unsuspected cutaneous melanoma.

The purpose of this study was to assess the sensitivity of clinical diagnosis of cutaneous malignant melanoma and to evaluate histologic characteristics of lesions not clinically diagnosed as such. Of 1,784 cases of histologically proven cutaneous malignant melanoma submitted routinely to a university dermatopathology laboratory between 1985 and 1990, 583 (33%) were not clinically suspected. The overall sensitivity in clinical diagnosis was 67%.

Cutaneous Pneumocystis carinii infection in patients with acquired immunodeficiency syndrome.

Extrapulmonary infection with Pneumocystis carinii is an uncommon event in which the skin may be affected rarely. All cases heretofore described in immunocompromised hosts have involved the external auditory canal and mastoid areas. We describe two patients with acquired immunodeficiency syndrome and extrapulmonary cutaneous P carinii infection that involved the glabrous skin.

Clinical, histologic, microbiologic, and biochemical characterization of the causative agent of bacillary (epithelioid) angiomatosis: a rickettsial illness with features of bartonellosis.

It has been suggested that bacillary (epithelioid) angiomatosis (BEA) is a manifestation of cat scratch disease (CSD). Because of clinical similarity between this condition and the verruga peruana phase of bartonellosis, we sought to further characterize this disease as well as its causative agent and to compare it to bartonellosis. We isolated a small flagellated pleomorphic bacillus from skin lesions of two patients with BEA.

Reliability of prognostic models in malignant melanoma. A 10-year follow-up study.

Certain histologic and clinical features of malignant melanoma have been shown to be indicators of prognosis, both collectively and individually. Even though the predictive value of these features is well established, long-term survival is occasionally seen in individuals with multiple poor prognostic factors. To further examine this phenomenon, histologic sections from 53 patients with malignant melanoma excised between the years 1977 and 1980 in whom reliable clinical follow-up data were obtained were evaluated for the presence of features associated with a poor prognosis (thickness greater than 1.

Clinical features of dysplastic nevi.

The clinical features of 100 dysplastic nevi were tabulated. Although certain characteristics were present in most or all of these melanocytic nevi, there was a marked heterogeneity of other clinical features. The preponderant type of large (greater than or equal to 8 mm) melanocytic nevus in patients with classic dysplastic nevi is a papule or plaque with the following characteristics: multicoloration (various shades of tans, browns, reds, or black); slightly raised height for its broad diameter; mamillated surface; and lack of hypertrichosis.

Human immunodeficiency virus infection and the skin.

The skin is commonly affected in the course of human immunodeficiency virus (HIV) infection. In many cases, skin findings may be the earliest sign of HIV disease or acquired immunodeficiency syndrome. When cutaneous diseases occur in unusual settings, such as zoster in a young individual, are increased in severity or fail to respond to routine therapy, the possibility of underlying immunodeficiency should be suspected.

Noninfectious inflammatory skin diseases in HIV-infected individuals.

Noninfectious inflammatory skin diseases are often a persistent problem for patients with infection with the human immunodeficiency virus (HIV), and they present both diagnostic and therapeutic challenges for the dermatologist. Well-defined diseases such as granuloma annulare, reactions to insect bites, and leukocytoclastic vasculitis may be more severe in these individuals and may be refractory to therapy. More poorly defined conditions with psoriasiform and papular morphologies have also been described.

Accuracy in diagnosis of lymphomatoid papulosis.

This study was undertaken to assess the accuracy of histologic diagnosis of lymphomatoid papulosis (LyP), which may be confused with malignant lymphoma or other entities. It is essential that accurate diagnoses be made because LyP may be a marker for malignant lymphoma. All 15 examples of LyP reviewed in a dermatopathology laboratory during a 14-year period and 180 histologic sections of tissue that could be confused with LyP were reviewed.

Histopathological features of Kaposi's sarcoma in HIV infected individuals.

Kaposi's sarcoma is the neoplasm most commonly associated with HIV infection. Since its presence in the proper clinical context is an AIDS defining event, histopathological confirmation is often required for diagnosis. It is essential that clinicians know the criteria for histopathological diagnosis.

Bacillary epithelioid angiomatosis occurring in an immunocompetent individual.

Within the last several years, a newly characterized condition known as bacillary epithelioid angiomatosis (BEA) has been described in a number of patients with human immunodeficiency virus (HIV) infection. All cases heretofore described have been seen in patients with the HIV infection. We recently evaluated a 37-year-old healthy man who had a localized form of BEA confirmed by biopsy, special strains, electron microscopy, and culture.

Cutaneous manifestations of HIV infection other than Kaposi's sarcoma: clinical and histologic aspects.

The skin is commonly affected in patients with human immunodeficiency virus (HIV) infection. Viral, bacterial, fungal, and protozoal infections and ectoparasitic infestations may affect the skin primarily or secondarily in this patient population. In addition, common inflammatory dermatoses may be severe and persistent.

Bacillary angiomatosis: a newly characterized, pseudoneoplastic, infectious, cutaneous vascular disorder.

Bacillary angiomatosis (also called epithelioid angiomatosis) is a newly recognized disease most often characterized by a cutaneous infection with reddish papules of vascular origin. It is caused by a weakly reactive gram-negative bacillus, which can be easily demonstrated in tissue sections with the Warthin-Starry stain. Bacillary angiomatosis usually responds readily to treatment with oral erythromycin, 250 to 500 mg, taken four times a day for 2 weeks to 1 month.

Quantification of histologic features of dysplastic nevi.

We quantified the histologic features of 100 consecutive dysplastic nevi. Although there is heterogeneity in the microscopic attributes of dysplastic nevi, certain features that are seen repeatedly should enable the histologic identification of these melanocytic neoplasms. These features include a central dermal nevocytic component with a peripheral extension of a junctional component, elongated epidermal rete ridges, bridging of nests of melanocytes at the dermo-epidermal junction, nests of melanocytes at the sides of rete ridges as well as at their bases, and concentric eosinophilic fibrosis.

Skin manifestations of HIV infection.

The skin is quite commonly involved in patients with HIV infection and the resulting diseases may serve as presenting signs of AIDS or ARC. The most common infectious and non-infectious inflammatory disorders as well as common neoplasms that are seen in this patient population are reviewed and depicted in detail.

Induction of tumor-infiltrating lymphocytes in human malignant melanoma metastases by immunization to melanoma antigen vaccine.

We report a statistically significant increase in tumor-infiltrating lymphocytes in subcutaneous melanoma metastases removed from patients immunized with a melanoma vaccine. Dense cellular infiltrates were seen in 10 of 11 nodules from vaccine-immunized patients, compared with 9 of 22 nodules from non-immunized patients (p = 0.02).