Abstract
Meyerson’s nevus and Doucas Kapetanakis pigmented purpuric dermatosis are two completely disparate diseases that both have eczema as a feature. Meyerson’s nevus is an ordinary nevus with eczema surrounding it. Doucas Kapetanakis involves a pigmented purpura along with eczema on the lower legs. Clinically, these two diseases are easily recognizable, but pathologically they are challenging. On hematoxylin and eosin stain we have found occluded sweat ducts in the epidermis adjacent to Meyerson’s nevus. These blockages were periodic acid–Schiff positive. The fact that the findings in both these diseases are similar to ordinary eczema helps substantiate the hypothesis that eczema is associated with occluded sweat ducts and that the occlusions arise from biofilms.
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References
Weedon D. Lentigines, nevi, and melanomas. In: Weedon’s skin pathology. 3rd ed. Philadelphia: Churchill Livingstone Elsevier; 2010. p. 709–56. Weedon describes a Meyerson’s nevus as a junctional, compound, or dermal nevus surrounded by an “eczematous halo” that can be pruritic. Meyerson’s nevus is similar to the halo nevus; however, it does not undergo regression as a result of the inflammation present. Meyerson’s nevus typically occurs in late winter or early spring. Histopathologically, Weedon describes Meyerson’s nevus as a “subacute spongiotic dermatitis” associated with the typical pathology of a nevus. Eosinophils may be present in the infiltrate as well as exocytosis into the epidermis.
Meyerson LB. A peculiar papulosquamous eruption involving pigmented nevi. Arch Dermatol. 1971;103(5):510–2. In his first observations, Dr. Meyerson comments on two of his patients who had pruritic papulosquamous lesions exclusively involving nevi. One of the patients was a 22-year-old white man who had a round, 2-cm pruritic lesion on the right upper part of the chest. The other patient was a 23-year-old white man who had a pruritic eruption involving nevi on the trunk and upper arms. Meyerson noted that these are similar to halo nevi, but they are different in that the nevi persist once the eruption has cleared. He noted that histologically these lesions demonstrate pigmented nevi with overlying parakeratosis, focal spongiosis, acanthosis, and a lymphocytic perivascular infiltrate in the dermis. At that time a similar disorder had not yet been reported in the literature.
Sardana K, Sarkar R, Sehgal VN. Pigmented purpuric dermatoses: an overview. Int J Dermatol. 2004;43(7):482–8. Pigmented purpuric dermatoses are chronic disorders that are usually found on the lower limbs. They classically have five main clinical variants: Majocchi’s disease (purpura annularis telangiectodes), Schamberg’s disease, pigmented purpuric lichenoid dermatosis of Gougerot and Blum, eczematid-like purpura of Doucas and Kapetanakis, and a localized variant called lichen aureus. Numerous factors have been suggested to cause PPD, including exercise, clothing, alcohol ingestion, and contact allergy to dyes and drugs. PPD tends to be resistant to treatment; cases have been reported of successful treatment of PPD using griseofulvin, psoralen photochemotherapy, oral rutoside, ascorbic acid, pentoxifylline, and cyclosporine.
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Allen, H.B. (2015). Diseases in Which Eczema Is a Secondary Component (Meyerson’s Nevus and Doucas Kapetanakis Pigmented Purpuric Dermatosis). In: The Etiology of Atopic Dermatitis. Springer, London. https://doi.org/10.1007/978-1-4471-6545-3_8
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DOI: https://doi.org/10.1007/978-1-4471-6545-3_8
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