Journal of Cutaneous Pathology最新文献

{"title":"Novel Potential Histologic Clues to Mechanical Alopecia: A Comparative Study of Traction Alopecia, Trichotillomania, and Approximately Age/Gender Matched Controls.","authors":"Zoe Ting, Lillian Spear, Joshua Smith, Caroline Porter, Stephen J Krivda, Jason F Solus, Leonard C Sperling, Jonathan J Lee","doi":"10.1111/cup.70236","DOIUrl":"https://doi.org/10.1111/cup.70236","url":null,"abstract":"<p><p>Mechanical stress on the pilosebaceous unit can contribute to mechanical alopecia (MA) as seen with traction alopecia (TA) and trichotillomania (TTM). While some histological features that point to TA and TTM have been described, these may be absent in biopsies obtained at earlier stages of disease. Additional anomalies of the pilosebaceous unit have been observed that may assist in the histopathological detection of MA. A blinded, retrospective, qualitative, and semiquantitative study was performed comparing horizontally processed scalp biopsy sections of clinicopathologically confirmed TA (n = 16) and TTM (n = 9) to nearly matched controls (n = 15). Translocation of sebocytes into the follicular canal was seen in both TA and TTM, supporting a shared underlying mechanism. Vectorially warped sebaceous lobules were observed predominately in TA (p = 0.0002), while collapse of the inner root sheath of the lower follicular isthmus and surface lichenification were primarily seen in TTM (p < 0.0002). Lateral impingement of the follicular canal was seen in both TA and TTM (p < 0.0001), although more commonly in TA. These alterations were observed in the absence of other previously described features. Further validation studies in larger cohorts are warranted to assess their diagnostic utility in the recognition of MA.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mast Cell Infiltration Helps Distinguish Fibrosing Alopecia in a Pattern Distribution From Androgenetic Alopecia in Scalp Biopsy.","authors":"Azadeh Rakhshan, Fateme Ashjaazade, Sahar Dadkhahfar, Farnaz Araghi","doi":"10.1111/cup.70238","DOIUrl":"https://doi.org/10.1111/cup.70238","url":null,"abstract":"<p><strong>Background: </strong>Mast cells are key regulators of cutaneous inflammation and are known to accumulate in response to various immunological stimuli. Although their role in several dermatological conditions has been established, their specific contribution to different forms of alopecia-particularly scarring versus nonscarring types-remains incompletely understood. This study aimed to compare the degree of mast cell infiltration across three distinct types of alopecia: androgenetic alopecia (AGA), fibrosing alopecia in a pattern distribution (FAPD), and lichen planopilaris (LPP).</p><p><strong>Method: </strong>A total of 56 patients diagnosed with AGA, FAPD, or LPP were enrolled. Scalp biopsies were obtained from all participants, and diagnoses were confirmed through histopathological examination. Mast cell distribution and infiltration density were quantified and analyzed using SPSS and Stata software. The study was conducted with full ethical approval.</p><p><strong>Result: </strong>The majority of participants (91%) were female, with a mean age of 44.3 years. FAPD was the most prevalent diagnosis (42.9%). LPP demonstrated the highest degree of mast cell infiltration, while AGA exhibited the lowest (ANOVA, p < 0.001). Post hoc analysis revealed significant differences between AGA and FAPD (-17.7%, p = 0.001) and between AGA and LPP (-20.1%, p = 0.001). Although mast cell infiltration was higher in patients over 40 years of age, this difference did not reach statistical significance. No significant association was identified between mast cell infiltration and patient sex.</p><p><strong>Conclusion: </strong>Mast cell infiltration is significantly more pronounced in scarring alopecias (LPP and FAPD) compared to non-scarring AGA, suggesting a shared immunopathological mechanism underlying follicular destruction in scarring subtypes. These findings also raise important questions regarding the potential inflammatory contribution of mast cells to AGA pathogenesis.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Alopecia Secondary to Dupilumab in a Patient With Atopic Dermatitis.","authors":"Jacob Myhre, Jayson Miedema, Rami N Al-Rohil","doi":"10.1111/cup.70242","DOIUrl":"https://doi.org/10.1111/cup.70242","url":null,"abstract":"<p><p>Dupilumab inhibits the signaling pathway of interleukins 4 and 13, and can be effective in the management of treatment-refractory atopic dermatitis, with alopecia areata being uncommonly reported as a side effect and only limited to several cases. This is the case of a patient who experienced dupilumab-induced alopecia in treatment for atopic dermatitis and whose histological exam represented findings distinct from classical alopecia areata, telogen effluvium, or underlying psoriatic alopecia, with a potential explanation being inhibition of the Th2 pathway, enhancing a Th1-mediating response by the immune system leading to marked atrophy of the sebaceous glands, which is not reported in alopecia areata. While there is literature describing the potential growth effect of dupilumab in patients with alopecia, there are select reports, along with our case, that suggest its negative effects on the pilosebaceous unit and overall hair growth.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IgA Pemphigus in a Patient With Systemic Lupus Erythematosus (SLE): A Novel Association, With Combined Epidermal Intercellular IgA and Nuclear IgG Deposition on Skin Direct Immunofluorescence.","authors":"Kelley Sharp, Tessora Chang, Jun Lu, Michael Murphy","doi":"10.1111/cup.70240","DOIUrl":"https://doi.org/10.1111/cup.70240","url":null,"abstract":"<p><p>We describe the novel occurrence of IgA pemphigus in a patient with long-standing systemic lupus erythematosus (SLE). SLE can be associated with the development of other autoimmune conditions, including cutaneous immunobullous disorders. To our knowledge, the co-occurrence of IgA pemphigus and SLE has not been previously reported in the literature. Potential common pathophysiological mechanisms are discussed.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PRAME Immunohistochemistry and Molecular Profiling in Undifferentiated Cutaneous Pleomorphic Neoplasms: A Case Series of 8 Tumors.","authors":"Dylan J Parker, Meghana Agni, Jeffrey M Cloutier, Aravindhan Sriharan, Robert E LeBlanc, Shaofeng Yan, Shabnam Momtahen","doi":"10.1111/cup.70239","DOIUrl":"https://doi.org/10.1111/cup.70239","url":null,"abstract":"<p><strong>Background: </strong>Undifferentiated cutaneous pleomorphic neoplasms are diagnostically challenging, as histopathology and immunohistochemistry often fail to identify undifferentiated melanoma in lesions that instead remain classified provisionally as atypical fibroxanthoma (AFX) or pleomorphic dermal sarcoma (PDS). Given the prognostic and therapeutic implications of melanoma, additional ancillary tools may be helpful in selected cases.</p><p><strong>Methods: </strong>We studied eight patients with undifferentiated pleomorphic neoplasms using molecular profiling and PRAME immunohistochemistry, correlating findings with clinical behavior.</p><p><strong>Results: </strong>Molecular findings varied across the cohort. Two tumors harbored NRAS hotspot mutations and were associated with aggressive clinical courses. In one patient, the tumor showed focal melanoma in situ associated with an undifferentiated intradermal tumor harboring NF1, TERT, and TP53 variants. The remaining tumors lacked melanoma-associated hotspot mutations. Diffuse PRAME expression was seen in three patients with an established diagnosis of melanoma and three patients with AFX/PDS. Two patients with AFX/PDS were negative for PRAME expression.</p><p><strong>Conclusions: </strong>Molecular profiling may provide supportive diagnostic evidence for melanoma lineage in a subset of undifferentiated cutaneous pleomorphic neoplasms when interpreted in conjunction with morphology, immunohistochemistry, and clinical findings. In contrast, diffuse PRAME expression was observed in a nonspecific fashion both in cases with melanoma driver mutations and molecularly nonspecific cases in this cohort, limiting its utility as a standalone screening test for triaging molecular analysis.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proof-of-Concept Evaluation of T-Cell Receptor Beta Constant Region 1 and 2 Transcript in Situ Hybridization for Clonality Assessment in Mycosis Fungoides.","authors":"Vrinda Madan, Jonathan Lai, Sima Rozati, Suman Paul, Jaroslaw Jedrych","doi":"10.1111/cup.70235","DOIUrl":"https://doi.org/10.1111/cup.70235","url":null,"abstract":"<p><strong>Background: </strong>Mycosis fungoides (MF) may be difficult to distinguish from inflammatory dermatoses. T-cell receptor (TCR) gene rearrangement assays provide ancillary evidence of clonality but lack spatial resolution. We evaluated the feasibility of RNA in situ hybridization (RNA-ISH) targeting TCR beta constant isoforms, TRBC1 and TRBC2, in routine skin biopsies.</p><p><strong>Methods: </strong>We retrospectively analyzed 15 MF biopsies, predominantly Stage IA-IB, and 11 inflammatory controls using TRBC1 and TRBC2 RNA-ISH on separate sections. Expression was assessed semiquantitatively in matched intraepidermal regions using exploratory thresholds. Available TCR gamma PCR results were reviewed.</p><p><strong>Results: </strong>RNA-ISH was successful in all 26 samples. Nine MF cases (60%) showed TRBC skewing, three (20%) were indeterminate, and three (20%) were double negative. All controls showed balanced polytypic expression. Exploratory sensitivity was 60% (95% CI, 32.3%-83.7%) and specificity 100% (95% CI, 71.5%-100%). Substantial discordance with available PCR results was observed.</p><p><strong>Conclusions: </strong>TRBC1/TRBC2 RNA-ISH is technically feasible in archival skin and can demonstrate spatial isoform skewing in a subset of MF biopsies. Technical and interpretive limitations preclude diagnostic validation; larger multiplexed studies are warranted.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lichen Sclerosus-Like Changes in Acrochordons: A Case Series.","authors":"Tamar Gomolin, Alison T Varano, Andrew Desrosiers, Jerad M Gardner, Jacqueline M Junkins-Hopkins","doi":"10.1111/cup.70228","DOIUrl":"https://doi.org/10.1111/cup.70228","url":null,"abstract":"<p><p>Lichen sclerosus (LS) is a chronic inflammatory skin disease typically affecting anogenital regions, with occasional extragenital involvement; however, its occurrence in acrochordons is seldom reported. We present eight cases of LS-like changes within acrochordons in patients with no prior history of LS elsewhere. Histopathologic examination confirmed characteristic LS features localized to the acrochordons. These findings raise questions about whether such changes represent a localized response to friction and/or chronic intermittent pressure-type trauma or a form of primary extragenital LS. Current literature suggests trauma as a key pathogenic mechanism in both classic LS and its manifestation within acrochordons, and our cases further support this hypothesis. Notably, neither our patients nor previously reported cases had documented LS at other sites, suggesting that LS-like changes in acrochordons may represent an incidental histopathologic finding that should not necessarily raise concern for the development of LS elsewhere.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Granuloma Annulare-Like Lesions in a Patient With Sarcoidosis: Case Report and Review of Literature.","authors":"Maira A Bhatty, Noreen Mohsin, Maximillian A Weigelt, Melissa Piliang","doi":"10.1111/cup.70227","DOIUrl":"https://doi.org/10.1111/cup.70227","url":null,"abstract":"<p><p>Sarcoidosis and granuloma annulare (GA) are two granulomatous skin conditions with significant clinical and histopathologic overlap, whose diagnosis may be further complicated by their potential to co-exist within a similar patient. Evolving literature supports the utility of special staining and immunohistochemistry (IHC) to aid in distinguishing these and other granulomatous skin disorders. Herein we report an interesting case of GA-like lesions in a patient with sarcoidosis, the elucidation of which was aided by immunohistochemical analysis. A 50-year-old man with an established history of sarcoidosis presented to the clinic with erythematous papules and plaques on his left elbow. Skin biopsy showed a granulomatous infiltrate consisting of histiocytes palisading around necrobiotic collagen with an accompanying perivascular lymphohistiocytic infiltrate. Staining with colloidal iron (increased mucin), CD123 (clusters of plasmacytoid dendritic cells), and adipophilin (highlighting histiocytes and necrobiosis), along with the histologic features supported a diagnosis of GA. The distinction between these two entities is important, as sarcoidosis may manifest systemically. Our case adds to the limited existing literature on GA-like lesions in sarcoidosis, underscoring the utility of special stains and IHC to help render the most accurate diagnosis for the patient.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GVHD-Associated Angiomatosis: An Overlooked Vascular Sequela of Chronic Graft-Versus-Host Disease.","authors":"William E Mbongo, Michael R Stephens, Ruth Foreman, Rosalyn M Nazarian","doi":"10.1111/cup.70232","DOIUrl":"https://doi.org/10.1111/cup.70232","url":null,"abstract":"<p><p>Graft-versus-host disease-associated angiomatosis (GVHD-AA) is a rare clinicopathologic variant of chronic GVHD characterized by benign vascular proliferations arising within areas of sclerodermatous skin change. The entity was formally named in 2014 and presents clinically as red-to-violaceous papules or nodules, confined to fibrotic GVHD skin. We present a case of GVHD-AA in a 29-year-old man with Philadelphia chromosome-positive acute lymphoblastic leukemia, diagnosed in 2017 and treated with matched unrelated donor allogeneic peripheral blood stem cell transplantation. His posttransplant course has been notable for severe chronic GVHD of the skin, eyes, mouth, and lungs, refractory to multiple systemic agents. His dermatologic symptoms began as sclerosis of the skin in the hands, arms, shoulders, and upper thighs, and have since progressed to involve 80% of his body surface area in 2025. Since 2023, he began developing numerous scaly red nodules overlying the scleroderma, which have been managed by shave removal, cauterization, and β-blocker therapy. Histological examination of shave biopsies from the arms and back shows an angiomatous proliferation with angiokeratoma-like features and Masson-like change. Endothelial cells are cytologically bland, and HHV8 immunohistochemistry is negative. This case adds to the limited body of histologically documented GVHD-AA and underscores the importance of recognizing this entity in sclerodermatous GVHD skin and relaying its prognosis and management to multidisciplinary clinical teams.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unmasking Iododerma: A Distinctive Histopathologic Pattern of Neutrophil-Rich Dermatosis With Haloed Cryptococcoid Bodies in the Setting of Hydralazine Exposure and Autoimmune Serologic Abnormalities.","authors":"Volha Lenskaya, Ana M Ciurea, Mika Tabata, Teny M John, Woo Cheal Cho","doi":"10.1111/cup.70234","DOIUrl":"https://doi.org/10.1111/cup.70234","url":null,"abstract":"<p><p>Cutaneous iododerma is a rare adverse reaction to iodine-containing compounds that may clinically and histopathologically mimic infection, vasculitis, malignancy, and other neutrophilic dermatoses. Although most commonly associated with iodinated contrast exposure, a variety of predisposing factors and potential associations have been reported, including impaired renal function, repeated iodine exposure, and more recently, hydralazine therapy in isolated cases. We report two women with chronic kidney disease and recent iodinated contrast exposure who developed rapidly progressive, painful, bullous, erosive, and retiform eruptions after contrast administration. Both patients had concurrent hydralazine exposure. Initial clinical considerations included deep fungal infection, ecthyma, Sweet syndrome, drug eruption, and vasculitis. Histopathologic examination demonstrated a neutrophil-rich dermal infiltrate with numerous basophilic haloed cryptococcoid bodies and vasculitis with fibrinoid necrosis. Fungal, bacterial, and acid-fast stains were negative, and extensive infectious evaluations were unrevealing. Markedly elevated serum and urine iodine levels supported the diagnosis of iododerma. Both patients exhibited multiple immunologic abnormalities, including positivity or elevated levels of p-ANCA and antinuclear, anti-histone, anti-myeloperoxidase, and anti-proteinase 3 antibodies. These findings were interpreted cautiously given concurrent hydralazine exposure, the absence of definitive systemic autoimmune vasculitis, and the potential for reactive serologic abnormalities in the setting of intense neutrophilic inflammation. Both patients improved following corticosteroid therapy, iodine clearance, and discontinuation of hydralazine. These cases emphasize the diagnostic importance of recognizing haloed cryptococcoid bodies within a neutrophil-rich infiltrate associated with vasculitic injury as part of the histopathologic spectrum of iododerma. The significance of hydralazine exposure in the pathogenesis of iododerma remains uncertain and warrants further investigation.</p>","PeriodicalId":15407,"journal":{"name":"Journal of Cutaneous Pathology","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}