In reviewing the English literature we have

In reviewing the English literature, we have found reports of only 11 patients with lichen aureus in a segmental, linear, or zosteriform pattern (). The pathomechanism of lichen aureus remains unknown, but several possible pathomechanisms of pigmented purpuric dermatosis have been proposed, including increased venous pressure or stasis, capillary fragility, infection, drugs, and involvement of T-cell immunity. As to our case, the pattern closely followed the venous drainage of hand circulation. Including the present case, four cases of segmental lichen aureus displayed this pattern, suggesting that segmental lichen aureus is a hemosiderin “tattoo,” resulting from impaired local venous return. The persistence of the tattoo pigment has to do with altered hemodynamics that favor continued microscopic extravasation of red ag1478 in a delimited area. There is a controversy between segmental lichen aureus and unilateral linear capillaritis (ULC). ULC was first reported in 1992 by Riordan et al. The differences between ULC and segmental lichen aureus are as follows: (1) lesions of ULC often resolve within 2 years, unlike the typical chronic course of lichen aureus; and (2) histopathologically, only a focal superficial perivascular lymphocytic inflammation is interspersed with mild extravasated erythrocytes in ULC. However, both entities follow linear or segmental distribution and an individual lesion of ULC is similar to lichen aureus. Therefore, we propose that ULC might represent a milder form of segmental lichen aureus, which may explain why spontaneous resolution is much often seen in ULC. Treatment of segmental lichen aureus can be challenging. Without treatment, it is considered to be a highly chronic dermatosis; only two cases showed partial spontaneous resolution. In general, potent oral and topical corticosteroids are ineffective, although two cases showed good response to topical 0.1% methylprednisolone aceponate ointment. Pulsed-dye laser and oral pentoxifylline in combination with prostacyclin have shown variable success.
Scrofuloderma represents a direct extension to the skin of an underlying tuberculous infection of lymph nodes or bone. Cervical lymphadenopathy is the most common clinical manifestation of tuberculous lymphadenitis. Since lymphadenopathy can be attributed to multiple etiologies, including malignancy, autoimmune disease, and infection, it is often difficult to differentiate the etiology of tuberculous lymphadenitis. A 78-year-old Japanese woman was referred to the Department of Medical Oncology in our hospital with a 2-month history of a left cervical mass. Her medical history included atrial fibrillation, hypertension, mild renal insufficiency, and diabetes mellitus. At presentation, she was 146.2 cm tall and weighed 40.7 kg with a body mass index of 19.1 kg/m. Her body temperature was 36.9°C, and she denied experiencing chills or night sweats. Examination revealed painless swellings and lesions in the left cervical area and the supraclavicular area bilaterally (A). The cervical lesions had formed ulcers with irregular, undermined borders. Computed tomography of the neck and chest revealed multiple enlarged lymph nodes, including in the left cervical, bilateral supraclavicular, and mediastinal regions (B). Examination via positron emission tomography demonstrated enlargement of the left cervical, bilateral supraclavicular, and mediastinal lymph nodes. Laboratory tests revealed that her soluble interleukin-2 receptor (sIL-2R) level was 2010 U/mL (range, 124–466U/mL). The result of the T-SPOT.TB (T cell enzyme-linked immunospot assay) test—a type of interferon-γ release assay activated by antigens—yielded positive findings.
Various forms of carcinogenesis of melanoma have been proposed. Among them, Wang and DuBois reported that chronic inflammation could generate an immunosuppressive microenvironment favorable to tumor formation and progression.