Keratotic Plug (keratotic + plug)

Distribution by Scientific Domains


Selected Abstracts


Multiple keratoacanthomas in a young woman: report of a case emphasizing medical management and a review of the spectrum of multiple keratoacanthomas

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2007
Ron J. Feldman MD
A 27-year-old white woman was referred for consultation with regard to the presence of extensive multiple keratotic lesions. She began to develop these lesions at the age of 9 years, with healing of the lesions resulting in scar formation. A biopsy was performed at the age of 16 years, but the patient was unsure of the results. Since then, she had not had any treatment or biopsies, and stated that she had not suffered from any health problems during the intervening period. She was most concerned about the tumors on her heels and soles, which caused difficulty with ambulation. The family history was negative for skin diseases, including melanoma, nonmelanoma skin cancer, psoriasis, and eczema, and positive for Type II diabetes mellitus. A relative reported that the patient's grandfather had similar lesions, but the patient's parents and siblings were healthy. She was married and had one child, a 9-year-old daughter. Her child had no skin lesions. The patient's only medication was Ortho-Tricyclene birth control pills. She had no known drug allergies. Physical examination revealed the presence of multiple lesions on her body (Fig. 1). Her left superior helix contained a well-demarcated, dome-shaped nodule with a rolled, mildly erythematous border with a central hyperkeratotic plug. A similar lesion was present in the scaphoid fossa of the left ear and smaller lesions were scattered on her face. Numerous lesions were present on the arms and legs bilaterally, with the majority of lesions being located on the anterior lower legs. There were also lesions present on the palms and soles. The lesions ranged in size from 5 mm to 3 cm, the largest being a verrucous exophytic nodule on the anterior aspect of her left leg. Overall, there appeared to be two distinct types of lesion. One type appeared round, oval, and symmetric with a central keratotic plug, similar to that on the ear. The other type was larger, more exophytic, and verrucous, including the lesions on the volar surfaces. Also present were numerous, irregularly shaped atrophic scars where previous lesions had healed spontaneously. There were no oral lesions or lesions on her fingernails or toenails, and her teeth and hair were normal. Figure 1. Initial presentation of left ear and anterior legs before treatment A biopsy was obtained from an early lesion on the right dorsal forearm. Histology revealed an exo-/endophytic growth having a central crater containing keratinous material (Fig. 2). The crater was surrounded by markedly hyperplastic squamous epithelium with large squamous epithelial cells having abundant glassy cytoplasm. Some cells were dyskeratotic. Within the dermis was a dense, chiefly mononuclear inflammatory infiltrate. A buttress of epidermis surrounded the crater. The clinical and pathologic data were consistent with keratoacanthomas. Figure 2. Keratoacanthoma exhibiting an exo- and endophytic growth pattern with a central crater containing keratin (hematoxylin and eosin; original magnification, 40) Initial laboratory screenings revealed elevated triglycerides and total cholesterol, 537 mg/dL (normal, < 150 mg/dL) and 225 mg/dL (normal, < 200 mg/dL), respectively, with all other laboratory results within normal limits. In anticipation of starting oral retinoid therapy for her multiple keratoacanthomas, she was referred to her primary care physician for control of hyperlipidemia. After her lipids had been controlled, she was placed on isotretinoin (Accutane) 40 mg/day. There was some interval improvement with regression of some lesions leaving atrophic scars. She was also started on topical application of tazarotene (Tazorac) for all nonresolving lesions. Possible side-effects from the isotretinoin occurred, including dry mouth and eyes. After 8 months of isotretinoin, the patient was switched to acitretin (Soriatane) 25 mg to determine whether it might have a more beneficial effect on the resistant lesions. Many of the larger lesions regressed leaving atrophic scars. The dose of acitretin was subsequently increased to 35 mg because the lesions on her heel and the ball of her foot persisted. Almost all of the lesions resolved, except those on her feet, which are slowly regressing. Currently, the patient is on a regimen of acitretin 25 mg once a day with tazarotene 0.1% gel applied directly to the few residual keratoacanthomas on her feet, which are slowly improving. [source]


Lichen planopilaris [cicatricial (scarring) alopecia] in a child

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2001
FNASC, FRAS (Lond.), Virendra N. Sehgal MD
A mother of a 12-year-old boy, 2 years ago, noticed that he showed patchy loss of hair on the vertex of the scalp. It was asymptomatic and progressive. Subsequently, similar patches appeared elsewhere on the scalp. Some of these patches joined to form a large bald patch. This was accompanied by dusky blue eruptions over the left upper lip and eyebrows. Later, there was localized loss of hair. A family history of a similar ailment was absent. Examination of the scalp revealed plaques of alopecia with mild to moderate erythema. The skin was smooth, shiny, and atrophic (Fig. 1). Atrophy was apparent by the presence of wrinkles in places, and by holding the skin between the thumb and the index finger. The periphery of the lesions was well demarcated and was occupied by erythematous, scaly, follicular papules. Lesions were also located on the patches of alopecia. In addition, flat-topped, dusky blue, papules/plaques were present over the upper lip. Figure 1. Lichen planopilaris: plaques of alopecia showing smooth, shiny, atrophic skin with erythema A study of hematoxylin and eosin-stained microsections prepared from the upper lip and vertex of the scalp was undertaken. The former revealed hyperkeratosis, hypergranulosis, sawtooth irregular acanthosis, and destruction of the basal cell layer which, in turn, was embraced by a lymphohistiocytic infiltrate disposed in a band-like fashion. A few cells were seen invading the epidermis. Pigment-laden histiocytes were found intermingled with the infiltrate. In the scalp skin, on the other hand, atrophy of the epidermis with punctuation of keratin plugs, together with fibrosis of the dermis, was prominent. The walls of the hair follicles were hyperkeratotic, while their lumina were conspicuous by their dilatation and contained keratotic plugs (Fig. 2a,b). Sebaceous and sweat glands were absent. Figure 2. Lichen planopilaris showing atrophy of the epidermis, fibrosis of the dermis, dilatation of the hair follicle lumina containing keratotic plug(s), and hyperkeratosis of the wall of the follicle (hematoxylin and eosin: a , ,40; b , ,100) Response to treatment, comprising ultramicronized griseofulvin (Gris O.D.) 375 mg/day (Sehgal VN, Abraham GJS, Malik GB. Griseofulvin therapy in lichen planus ,- a double blind controlled trial. Br J Dermatol 1972; 86: 383,385; Sehgal VN, Bikhchandani R, Koranne RV et al. Histopathological evaluation of griseofulvin therapy in lichen planus. A double blind controlled study. Dermatologica 1980; 161: 22,27) and prednisolone 20 mg/day for 6 months, was excellent (Fig. 3). Topical betamethasone dipropionate (Diprovate) lotion was used as a supplement. Figure 3. Perceptible decline in band-like lymphohistiocytic inflammatory infiltrate (hematoxylin and eosin, a, 40; b, ,100) [source]


Two cases of reactive perforating collagenosis arising at the site of healed herpes zoster

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 3 2001
Hye Nam Lee MD
Case 1 A 67-year-old South Korean woman presented with a painful eruption on the left trunk. Several groups of vesicles with an erythematous and edematous base were situated unilaterally within the distribution of the left T9 dermatome; they had been present for 7 days. A diagnosis of herpes zoster was made, and treatment with acyclovir, analgesics, tranquilizers, and wet dressings produced a moderate response. Two weeks after onset, the lesions appeared to have healed with a scar. Four months later, however, the patient noticed another eruption of papules in the postherpetic area (Fig. 1A,B). Figure 1. Case 1. (A) Multiple erythematous papules on the left trunk along the T9 dermatome. (B) Multiple erythematous papules with a keratotic central plug The biopsy specimen showed a cup-shaped epidermal invagination filled with a keratotic plug containing basophilic debris and collagen, with perforation of the epidermis. Masson's trichrome stain identified refractile fibers within the epidermis as hyalinized and degenerating collagen. Van Gieson staining for elastic fibers was negative in the epidermis and in the crater. These findings are consistent with reactive perforating collagenosis (RPC). Case 2 A 66-year-old South Korean woman developed herpes zoster of the left neck and shoulder, which resolved after an uncomplicated course. Two months later, a zosteriform, pink, papular eruption developed at the site of the resolved herpes zoster. Examination revealed multiple, erythematous papules with a central umbilication containing a firmly adherent keratotic plug on the left shoulder and neck (Fig. 2A). Figure 2. Case 2. (A) Multiple erythematous papules on the left neck and shoulder along the C4 dermatome. (B) Cup-shaped epidermal invagination filled with keratotic plug containing basophilic debris and degenerated collagen, with perforation of the epidermis (hematoxylin and eosin stain, ,100) The biopsy specimen showed a dome-shaped lesion with a central crater that extended from the epidermis to the papillary dermis and contained degenerated collagen in vertical strands (Fig. 2B). [source]


Chloracne: histopathologic findings in one case

JOURNAL OF CUTANEOUS PATHOLOGY, Issue 4 2002
Maria Antonia Pastor
Background: Chloracne is an acneiform eruption due to poisoning by halogenated aromatic compounds having a specific molecular shape. This condition is always a symptom of systemic poisoning by chemical chloracnegens and not just a cutaneous disorder. Methods: We have studied a patient with severe chloracne who showed cutaneous lesions involving mostly the face and the axillae. Results:, Histopathologic study of the facial lesions demonstrated that almost every vellus hair follicle was involved, showing a dilated infundibulum filled by a keratotic plug. This keratotic material was mostly composed of orthokeratotic basket-weave basophilic corneocytes, namely infundibular keratin, although there were also some dilated infundibula containing eosinophilic laminated or granular sebum at their center. Small infundibular cysts were more numerous than comedones. Mature and well-developed sebaceous glands were seen at the base of many of the dilated infundibula and no squamous metaplasia of the sebaceous glands or ducts could be demonstrated. Hyperpigmentation of the lesions resulted from hyperproduction of melanin by a normal number of melanocytes along the basal layer of the epidermis and infundibular epithelium. Abundant melanin granules also impregnated the corneocytes of the infundibular plugs. Conclusions:, Our findings support the notion that tiny infundibular cysts rather than comedones represent the basic lesions of chloracne. [source]


Atrophodermia vermiculata: case report and review of the literature

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2003
T Jansen
ABSTRACT A 21-year-old woman with an 11-year history of symmetric reticular atrophy on both cheeks, pre-auricular areas, and forehead is presented. The depressions gave a worm-eaten appearance to the skin. Histopathological findings from a biopsy specimen of lesional skin revealed an atrophic follicle. The connective tissue showed mild inflammation in perifollicular and perivascular distribution. The hair follicle was widely dilated and was filled with a keratotic plug. This case points out many of the outstanding clinical and histopathological features of atrophodermia vermiculata as described previously. Atrophodermia vermiculata appears to be one of a group of closely related conditions characterized by keratosis pilaris and atrophy of the skin. [source]


Lichen planopilaris [cicatricial (scarring) alopecia] in a child

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 7 2001
FNASC, FRAS (Lond.), Virendra N. Sehgal MD
A mother of a 12-year-old boy, 2 years ago, noticed that he showed patchy loss of hair on the vertex of the scalp. It was asymptomatic and progressive. Subsequently, similar patches appeared elsewhere on the scalp. Some of these patches joined to form a large bald patch. This was accompanied by dusky blue eruptions over the left upper lip and eyebrows. Later, there was localized loss of hair. A family history of a similar ailment was absent. Examination of the scalp revealed plaques of alopecia with mild to moderate erythema. The skin was smooth, shiny, and atrophic (Fig. 1). Atrophy was apparent by the presence of wrinkles in places, and by holding the skin between the thumb and the index finger. The periphery of the lesions was well demarcated and was occupied by erythematous, scaly, follicular papules. Lesions were also located on the patches of alopecia. In addition, flat-topped, dusky blue, papules/plaques were present over the upper lip. Figure 1. Lichen planopilaris: plaques of alopecia showing smooth, shiny, atrophic skin with erythema A study of hematoxylin and eosin-stained microsections prepared from the upper lip and vertex of the scalp was undertaken. The former revealed hyperkeratosis, hypergranulosis, sawtooth irregular acanthosis, and destruction of the basal cell layer which, in turn, was embraced by a lymphohistiocytic infiltrate disposed in a band-like fashion. A few cells were seen invading the epidermis. Pigment-laden histiocytes were found intermingled with the infiltrate. In the scalp skin, on the other hand, atrophy of the epidermis with punctuation of keratin plugs, together with fibrosis of the dermis, was prominent. The walls of the hair follicles were hyperkeratotic, while their lumina were conspicuous by their dilatation and contained keratotic plugs (Fig. 2a,b). Sebaceous and sweat glands were absent. Figure 2. Lichen planopilaris showing atrophy of the epidermis, fibrosis of the dermis, dilatation of the hair follicle lumina containing keratotic plug(s), and hyperkeratosis of the wall of the follicle (hematoxylin and eosin: a , ,40; b , ,100) Response to treatment, comprising ultramicronized griseofulvin (Gris O.D.) 375 mg/day (Sehgal VN, Abraham GJS, Malik GB. Griseofulvin therapy in lichen planus ,- a double blind controlled trial. Br J Dermatol 1972; 86: 383,385; Sehgal VN, Bikhchandani R, Koranne RV et al. Histopathological evaluation of griseofulvin therapy in lichen planus. A double blind controlled study. Dermatologica 1980; 161: 22,27) and prednisolone 20 mg/day for 6 months, was excellent (Fig. 3). Topical betamethasone dipropionate (Diprovate) lotion was used as a supplement. Figure 3. Perceptible decline in band-like lymphohistiocytic inflammatory infiltrate (hematoxylin and eosin, a, 40; b, ,100) [source]


Necrotizing infundibular crystalline folliculitis

BRITISH JOURNAL OF DERMATOLOGY, Issue 1 2001
S. Kossard
We describe a 22-year-old woman with a background of acne who developed multiple folliculocentric facial papules associated with sharply demarcated waxy, keratotic plugs. Multiple skin biopsies showed umbilicated craters that were filled with dispersed bundles of eosinophilic filaments embedded in a pale amorphous matrix forming a plug. The plugs bulged into the upper dermis. Serial sections showed vacuolar and filamentous destruction of the infundibular and adjacent perifollicular epithelium and a close relationship of the crystalline necrosis to follicles. Electron microscopy revealed that the filamentous bundles were tonofilaments. No fresh material was available for polarization and the paraffin sections failed to polarize. The clinical and pathological findings of the lesions in our patient were identical to those reported as a new perforating disorder with urate-like crystals. Our case indicates that the process may represent crystalline folliculocentric necrosis rather than a primary perforating disorder. The nature and basis of the crystals that have a urate-like appearance remain to be determined. [source]