Correspondence
The location of the glomus tumor on the back in the present case is again unusual. To date, there is only a single report in the English literature wherein a 44-year-old Asian man presented with a solitary painful reddish nodule on the back, which proved to be a solid glomus tumor histopathologically.1 Acknowledgment The authors acknowledge the assistance of Dr. Bhaskar, senior resident, Department of Pathology, AIIMS, for helping with the photomicrographs. Saurabh Singh, MD Neena Khanna, MD M. Ramam, MD Manoj Singh, MD From the Departments of Dermatology and Pathology AIIMS New Delhi 110029 India E-mail: [email protected]
Diagnosis of molluscum contagiosum by crater-like morphology in handheld portable digital microscopy
Molluscum contagiosum is a common cutaneous viral infection that occurs most frequently in children.1 It is caused by the pox virus.2 Individual lesions consist of smooth, shiny, pearly, firm papules up to 5 mm across. They are usually quite characteristic in appearance, showing a central umbilication. However, sometimes it is difficult to confirm them with the naked eye if their size is too small. Recently, we introduced hand-held portable digital microscopy (USB Microscope M2, Scalar Corporation, Japan) for the assessment of skin diseases in an outpatient clinic.3 This has the advantage of obtaining microscopic images on a PC monitor in real time. By using this instrument, we could very easily diagnose molluscum contagiosum in many patients. As shown in Figure 1, the patients with molluscum contagiosum showed a crater-like morphology, that is, a central umbilication in some lesions. Previously, it was reported that the use of dermoscopy is useful in the clinical diagnosis of molluscum contagiosum.4 However, clearly our findings are more impressive. Thus, we think that because the observation of crater-like morphology seems to be pathognomonic, the use of handheld portable digital microscopy of 30 magnifications is practical for the diagnosis of molluscum contagiosum compared with dermoscopy. Perhaps it has to do with the system and the amount of surface reflection (i.e. the absence of polarization or lack of use of optical gel medium). In addition, although it would see the same finding ª 2013 The International Society of Dermatology
Conflicts of interest: None. References 1 Lee IJ, Yoo YM, Lim H, Park MC. Glomus tumor of the back: a rare location. J Craniofac Surg 2009; 20: 2153–2155. 2 Fletcher CDM, Unni K, Meretens F, Folpe AL. Glomus tumors. In: Fletcher CDM, Unni KK, Mertens M, eds. Pathology and Genetics of Tumours of Soft Tissue and Bone. World Health Organization. Lyon: IARC Press, 2002: 136–137. 3 Schiefer TK, Parker WL, Anakwenze OA, et al. Extradigital glomus tumors: a 20-year experience. Mayo Clin Proc 2006; 81: 1337–1344. 4 Ghaly RF, Ring AM. Supraclavicular glomus tumor, 20 year history of undiagnosed shoulder pain: a case report. Pain 1999; 83: 379–382. 5 Hueston JT. Multiple painless glomus tumours. Br Med J 1961; 1: 1210–1212. 6 Yanagi T, Matsumura T. Scalp epithelioid glomus tumor: a rare location. Acta Derm Venereol 2006; 86: 267–268.
using a non-contact dermoscopy in non-polarizing mode, however, most of the standard portable dermoscopy has the ability to zoom up to 10-fold magnification. For 30fold magnification, it is necessary to use an immersion media in most cases, and the majority of magnifiers notwithstanding 30-fold magnification are not portable. Our device is convenient for its portability, easy image storage, and a polarization mode can be selected. Mi-Young Jung, MD Dong-Youn Lee, MD, PhD Department of Dermatology Sungkyunkwan University School of Medicine Samsung Medical Center 50 Ilwon-Dong Gangnam-Gu Seoul South Korea E-mail: [email protected] Conflicts of interest: None. References 1 Diven DG. An overview of poxviruses. J Am Acad Dermatol 2001; 44: 1–14. 2 Brown J, Janniger CK, Schwartz RA, Silverberg NB. Childhood molluscum contagiosum. Int J Dermatol 2006; 45: 93–99.
International Journal of Dermatology 2013, 52, 1398–1461
1411
1412
Correspondence
(a)
(b)
(c)
(d)
(e)
Figure 1. (a–d) Images obtained by
hand-held portable digital microscopy (· 30): a crater-like morphology that was easily noticed in four patients with molluscum contagiosum. (e) An image obtained by hand-held camera of (a)
3 Park JH, Lee DY, Cha HS, Koh EM. Handheld portable digital dermoscopy: routine outpatient use for evaluating nailfold capillary changes in autoimmune connective tissue diseases. J Eur Acad Dermatol Venereol 2009; 23: 207.
4 Zaballos P, Ara M, Puig S, Malvehy J. Dermoscopy of molluscum contagiosum: a useful tool for clinical diagnosis in adulthood. J Eur Acad Dermatol Venereol 2006; 20: 482–483.
Cutaneous plasmacytosis in an 88-year-old woman successfully treated with low-dose oral corticosteroid
An 88-year-old Japanese woman presented with a 2-month history of multiple, pruritic indurated erythemas and plaques over the face, neck and extremities. Drug eruption was suspected at a skin clinic, and all drugs she had taken were stopped. She was then treated with topical steroid, but no improvement was obtained. The patient was referred to the Department of Dermatology of Kobe University Hospital. Physical examination revealed multiple indurated erythemas and plaques over the face, neck, and extremities (Fig. 1a). In addition, a scattering of purplish indurated nodules was apparent on the trunk (Fig. 1b). Asymptomatic superficial lymphadenopathy was identified in the left axillary region. Laboratory findings were as follows: leukocyte count, 6900/mm3
Cutaneous plasmacytosis is a rare skin disorder that is histologically characterized by a benign polyclonal proliferation of mature plasma cells in the skin, producing multiple red-brown to purplish macules and plaques mainly on the trunk.1,2 This condition is also characterized by hypergammaglobulinemia.1,2 Only approximately 60 cases have been reported worldwide.3 Curiously, the vast majority have been from Japan,1,3 and this disorder has not been discussed in English-language textbooks.1 We report a case of cutaneous plasmacytosis in an 88-yearold Japanese woman, which was successfully treated with oral corticosteroid. International Journal of Dermatology 2013, 52, 1398–1461
ª 2013 The International Society of Dermatology
The location of the glomus tumor on the back in the present case is again unusual. To date, there is only a single report in the English literature wherein a 44-year-old Asian man presented with a solitary painful reddish nodule on the back, which proved to be a solid glomus tumor histopathologically.1 Acknowledgment The authors acknowledge the assistance of Dr. Bhaskar, senior resident, Department of Pathology, AIIMS, for helping with the photomicrographs. Saurabh Singh, MD Neena Khanna, MD M. Ramam, MD Manoj Singh, MD From the Departments of Dermatology and Pathology AIIMS New Delhi 110029 India E-mail: [email protected]
Diagnosis of molluscum contagiosum by crater-like morphology in handheld portable digital microscopy
Molluscum contagiosum is a common cutaneous viral infection that occurs most frequently in children.1 It is caused by the pox virus.2 Individual lesions consist of smooth, shiny, pearly, firm papules up to 5 mm across. They are usually quite characteristic in appearance, showing a central umbilication. However, sometimes it is difficult to confirm them with the naked eye if their size is too small. Recently, we introduced hand-held portable digital microscopy (USB Microscope M2, Scalar Corporation, Japan) for the assessment of skin diseases in an outpatient clinic.3 This has the advantage of obtaining microscopic images on a PC monitor in real time. By using this instrument, we could very easily diagnose molluscum contagiosum in many patients. As shown in Figure 1, the patients with molluscum contagiosum showed a crater-like morphology, that is, a central umbilication in some lesions. Previously, it was reported that the use of dermoscopy is useful in the clinical diagnosis of molluscum contagiosum.4 However, clearly our findings are more impressive. Thus, we think that because the observation of crater-like morphology seems to be pathognomonic, the use of handheld portable digital microscopy of 30 magnifications is practical for the diagnosis of molluscum contagiosum compared with dermoscopy. Perhaps it has to do with the system and the amount of surface reflection (i.e. the absence of polarization or lack of use of optical gel medium). In addition, although it would see the same finding ª 2013 The International Society of Dermatology
Conflicts of interest: None. References 1 Lee IJ, Yoo YM, Lim H, Park MC. Glomus tumor of the back: a rare location. J Craniofac Surg 2009; 20: 2153–2155. 2 Fletcher CDM, Unni K, Meretens F, Folpe AL. Glomus tumors. In: Fletcher CDM, Unni KK, Mertens M, eds. Pathology and Genetics of Tumours of Soft Tissue and Bone. World Health Organization. Lyon: IARC Press, 2002: 136–137. 3 Schiefer TK, Parker WL, Anakwenze OA, et al. Extradigital glomus tumors: a 20-year experience. Mayo Clin Proc 2006; 81: 1337–1344. 4 Ghaly RF, Ring AM. Supraclavicular glomus tumor, 20 year history of undiagnosed shoulder pain: a case report. Pain 1999; 83: 379–382. 5 Hueston JT. Multiple painless glomus tumours. Br Med J 1961; 1: 1210–1212. 6 Yanagi T, Matsumura T. Scalp epithelioid glomus tumor: a rare location. Acta Derm Venereol 2006; 86: 267–268.
using a non-contact dermoscopy in non-polarizing mode, however, most of the standard portable dermoscopy has the ability to zoom up to 10-fold magnification. For 30fold magnification, it is necessary to use an immersion media in most cases, and the majority of magnifiers notwithstanding 30-fold magnification are not portable. Our device is convenient for its portability, easy image storage, and a polarization mode can be selected. Mi-Young Jung, MD Dong-Youn Lee, MD, PhD Department of Dermatology Sungkyunkwan University School of Medicine Samsung Medical Center 50 Ilwon-Dong Gangnam-Gu Seoul South Korea E-mail: [email protected] Conflicts of interest: None. References 1 Diven DG. An overview of poxviruses. J Am Acad Dermatol 2001; 44: 1–14. 2 Brown J, Janniger CK, Schwartz RA, Silverberg NB. Childhood molluscum contagiosum. Int J Dermatol 2006; 45: 93–99.
International Journal of Dermatology 2013, 52, 1398–1461
1411
1412
Correspondence
(a)
(b)
(c)
(d)
(e)
Figure 1. (a–d) Images obtained by
hand-held portable digital microscopy (· 30): a crater-like morphology that was easily noticed in four patients with molluscum contagiosum. (e) An image obtained by hand-held camera of (a)
3 Park JH, Lee DY, Cha HS, Koh EM. Handheld portable digital dermoscopy: routine outpatient use for evaluating nailfold capillary changes in autoimmune connective tissue diseases. J Eur Acad Dermatol Venereol 2009; 23: 207.
4 Zaballos P, Ara M, Puig S, Malvehy J. Dermoscopy of molluscum contagiosum: a useful tool for clinical diagnosis in adulthood. J Eur Acad Dermatol Venereol 2006; 20: 482–483.
Cutaneous plasmacytosis in an 88-year-old woman successfully treated with low-dose oral corticosteroid
An 88-year-old Japanese woman presented with a 2-month history of multiple, pruritic indurated erythemas and plaques over the face, neck and extremities. Drug eruption was suspected at a skin clinic, and all drugs she had taken were stopped. She was then treated with topical steroid, but no improvement was obtained. The patient was referred to the Department of Dermatology of Kobe University Hospital. Physical examination revealed multiple indurated erythemas and plaques over the face, neck, and extremities (Fig. 1a). In addition, a scattering of purplish indurated nodules was apparent on the trunk (Fig. 1b). Asymptomatic superficial lymphadenopathy was identified in the left axillary region. Laboratory findings were as follows: leukocyte count, 6900/mm3
Cutaneous plasmacytosis is a rare skin disorder that is histologically characterized by a benign polyclonal proliferation of mature plasma cells in the skin, producing multiple red-brown to purplish macules and plaques mainly on the trunk.1,2 This condition is also characterized by hypergammaglobulinemia.1,2 Only approximately 60 cases have been reported worldwide.3 Curiously, the vast majority have been from Japan,1,3 and this disorder has not been discussed in English-language textbooks.1 We report a case of cutaneous plasmacytosis in an 88-yearold Japanese woman, which was successfully treated with oral corticosteroid. International Journal of Dermatology 2013, 52, 1398–1461
ª 2013 The International Society of Dermatology
