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  • br Herpes zoster is a

    2018-11-12


    Herpes zoster is a benign and usually self-limiting disease, although herpes zoster has a notorious reputation among lay people because of the acute pain during an attack and because of the common myth that herpes zoster located circumferentially on the trunk is fatal. We report an unusual case of bilateral symmetric herpes zoster on the trunk. A 57-year-old woman presented with intermittent shooting pain (with a visual analog scale of 8) on the low back for 2 days. She went to an orthopedic outpatient department where a lumbar X-ray image revealed no abnormal findings. Muscle sprain or psychogenic pain was suspected. Five days later, she came to our dermatology department where grouped vesicles on erythematous bases were present bilaterally along the T10 dermatome on both sides (). Severe pain led to sleep disturbance at night and lethargy in the daytime. There were no other associated systemic symptoms.
    A 19-year-old man presented with multiple asymptomatic lobulated and cerebriform papulonodules and plaques over his left lower trunk that had been present since childhood. The lesions first appeared at the age of 1 month 3-Methyladenine manufacturer as several tiny red macules over his left lower back and then gradually spread to his abdomen in a linear fashion and became elevated. The lesions progressed more rapidly during his early teens and then remained stationary. There was no relevant family history. A physical examination revealed many soft, erythematous to slightly brownish papules and nodules coalescing into pebbly plaques and soft, cerebriform, polypoid tumors over the left lower trunk in a linear pattern (A and B). Most of the papules had a central umbilication or hair follicular openings (C). There were also some keratinous plugs intermingled with the nodular lesions. All other physical and laboratory examinations were normal. A shave biopsy was performed on a papule (B, arrow) and showed a fibrocollagenous polyp with vertical or intersecting collagen bundles and many small blood vessels in the 3-Methyladenine manufacturer (A), where small clusters of mature fat cells were found around the blood vessels (A, inset). In addition, there were a few sebaceous lobules and eccrine glands in the polyp. The findings were suggestive of a hamartoma with epithelial and mesenchymal components. He then underwent curettage and carbon dioxide laser treatment for the complete removal of the skin lesions. Repeated histopathological examination revealed fibrocollagenous polypoid lesions with the presence of sweat glands, sweat ducts, pilosebaceous units (B), and perivascular fat cells within the polyps. The scars remained flat with a few small residual keratinous plugs and draining fistulas eight years after the operation.
    A 37-year-old man was diagnosed with psoriasis and psoriatic arthritis in February 2006. Previous treatment with sulfasalazine, leflunomide, nonsteroidal anti-inflammatory drugs, etanercept, and topical steroids showed limited effects. Adalimumab at 40 mg every 2 weeks was given since April 2013. His skin condition and arthritis improved during the treatment, with the Psoriasis Area and Severity Index decreasing from 2.2 to 0.3 and tender joint counts from 5 to 0. However, asymptomatic whitish linear patches and pinpoint lichenoid papules were noted over the right arm (A) and shoulder area (B) 3 months later. According to the patient, mild erythema preceded the appearance of the eruptions, and he denied viral infection or local trauma history on the right upper extremity in recent 3 months. Laboratory data were all within normal limits and he was otherwise healthy, without atopy history. A skin biopsy showed psoriasiform hyperplasia with basal vacuolization and pigment incontinence. Superficial perivascular and perieccrine lymphocytic infiltration was noted as well (C and D). Lichen striatus was diagnosed. Adalimumab was discontinued since December 2013, owing to the improvement of psoriasis and psoriatic arthritis. We followed this patient regularly, and the linear skin lesions improved spontaneously. E shows the significant improvement 6 months after the patient stopped taking adalimumab.