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Fashionable Pathology

Fashionable Pathology Morphological descriptions of cutaneous lesions lend themselves to comparisons with the world around us, such as the realms of food,1 animals, or plants.2 Over the ages, the dermatology literature has also been draped with descriptive terms that conjure up ideas of style and fashion. Mycosis fungoides is often described as having a bathing suit distribution, as are the lesions of angiokeratoma corporis diffusum in Fabry disease. Giant congenital melanocytic nevi were called garment nevi, and hypertrichosis lanuginose aquisita has been likened to a downy coat. Coxsackie virus may manifest as papular-purpuric gloves and socks syndrome, and this distribution is also observed in the peripheral neuropathy of patients with diabetes mellitus. The shawl sign and holster sign are well reported in dermatomyositis, and venous ulcers are typically found over the gaiters’ area. The mitten deformity is observed in recessive dystrophic epidermolysis bullosa, and the distribution of lesions in allergic contact dermatitis naturally draws on the culprit garb, such as belt buckle or shoe dermatitis. Cylindromas are also known as turban tumors, chloasma is sometimes called the mask of pregnancy, and patients with keratosis pilaris rouge appear to be wearing blusher. Morphologically, the buttonhole sign is classically observed in neurofibromas and anetoderma, and the boutonnière deformity is seen in advanced rheumatoid arthritis. The photosensitive nature of pellagra gives rise to a characteristic gauntlet on the forearms as well as Cassal’s necklace over the décolletage. Similarly, the hypomelanotic macules of secondary syphilis are known as the necklace of Venus and the term monilethrix is derived from the Latin term for necklace. The periungual papules of reticulohistiocytosis have been liked to coral beads, and the annular bullae of linear IgA bullous dermatosis are often described as a crown of jewels. Tactile descriptions of cutaneous diseases also draw on comparisons with fabric. In tuberous sclerosis, the description shagreen patch likens pathognomonic hamartomas to leather. Acanthosis nigricans is said to feel like velvet, and woolly hair is observed in a number of genodermatoses. The reticulate pattern of Wickham striae in lichen planus is often described as lacy, as is the exanthem of erythema infectiosum. Beyond the realm of the naked eye, trichoscopic examination of patients with loose anagen syndrome demonstrates a characteristic “floppy sock” appearance. Dermoscopically, numerous references to fashion are reported, such as the blue-gray veil seen in melanoma or the hairpin vessels of keratinizing tumors.3 Pathologists are well versed in the findings of perivascular cuffing, the coat sleeve changes of erythema annulare centrifugum, and the signet ring cells of adenocarcinoma metastases. The dermatological literature brims with descriptions derived from the sartorial world. Given the visual nature of our specialty, it is little wonder that such descriptions came into vogue. Back to top Article Information Corresponding Author: Deshan F. Sebaratnam, MBBS(Hons), Skin and Cancer Foundation Australia, 7 Ashley Ln, Westmead, New South Wales, Australia 2145 (d.sebaratnam@hotmail.com). Published Online: February 4, 2015. doi:10.1001/jamadermatol.2014.5205. References 1. Burgdorf WH, Hoenig LJ. Dermatologic food for thought: a word search challenge. JAMA Dermatol. 2014;150(6):620.PubMedGoogle ScholarCrossref 2. Sebaratnam DF. Apple of the dermatologist’s eye. JAMA Dermatol. 2014;150(12):1280.PubMedGoogle ScholarCrossref 3. Lallas A, Moscarella E, Argenziano G, et al. Dermoscopy of uncommon skin tumours. Australas J Dermatol. 2014;55(1):53-62.PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Dermatology American Medical Association

Fashionable Pathology

Abstract

Morphological descriptions of cutaneous lesions lend themselves to comparisons with the world around us, such as the realms of food,1 animals, or plants.2 Over the ages, the dermatology literature has also been draped with descriptive terms that conjure up ideas of style and fashion. Mycosis fungoides is often described as having a bathing suit distribution, as are the lesions of angiokeratoma corporis diffusum in Fabry disease. Giant congenital melanocytic nevi were called garment nevi, and...
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Publisher
American Medical Association
Copyright
Copyright © 2015 American Medical Association. All Rights Reserved.
ISSN
2168-6068
eISSN
2168-6084
DOI
10.1001/jamadermatol.2014.5205
pmid
25651528
Publisher site
See Article on Publisher Site

Abstract

Morphological descriptions of cutaneous lesions lend themselves to comparisons with the world around us, such as the realms of food,1 animals, or plants.2 Over the ages, the dermatology literature has also been draped with descriptive terms that conjure up ideas of style and fashion. Mycosis fungoides is often described as having a bathing suit distribution, as are the lesions of angiokeratoma corporis diffusum in Fabry disease. Giant congenital melanocytic nevi were called garment nevi, and hypertrichosis lanuginose aquisita has been likened to a downy coat. Coxsackie virus may manifest as papular-purpuric gloves and socks syndrome, and this distribution is also observed in the peripheral neuropathy of patients with diabetes mellitus. The shawl sign and holster sign are well reported in dermatomyositis, and venous ulcers are typically found over the gaiters’ area. The mitten deformity is observed in recessive dystrophic epidermolysis bullosa, and the distribution of lesions in allergic contact dermatitis naturally draws on the culprit garb, such as belt buckle or shoe dermatitis. Cylindromas are also known as turban tumors, chloasma is sometimes called the mask of pregnancy, and patients with keratosis pilaris rouge appear to be wearing blusher. Morphologically, the buttonhole sign is classically observed in neurofibromas and anetoderma, and the boutonnière deformity is seen in advanced rheumatoid arthritis. The photosensitive nature of pellagra gives rise to a characteristic gauntlet on the forearms as well as Cassal’s necklace over the décolletage. Similarly, the hypomelanotic macules of secondary syphilis are known as the necklace of Venus and the term monilethrix is derived from the Latin term for necklace. The periungual papules of reticulohistiocytosis have been liked to coral beads, and the annular bullae of linear IgA bullous dermatosis are often described as a crown of jewels. Tactile descriptions of cutaneous diseases also draw on comparisons with fabric. In tuberous sclerosis, the description shagreen patch likens pathognomonic hamartomas to leather. Acanthosis nigricans is said to feel like velvet, and woolly hair is observed in a number of genodermatoses. The reticulate pattern of Wickham striae in lichen planus is often described as lacy, as is the exanthem of erythema infectiosum. Beyond the realm of the naked eye, trichoscopic examination of patients with loose anagen syndrome demonstrates a characteristic “floppy sock” appearance. Dermoscopically, numerous references to fashion are reported, such as the blue-gray veil seen in melanoma or the hairpin vessels of keratinizing tumors.3 Pathologists are well versed in the findings of perivascular cuffing, the coat sleeve changes of erythema annulare centrifugum, and the signet ring cells of adenocarcinoma metastases. The dermatological literature brims with descriptions derived from the sartorial world. Given the visual nature of our specialty, it is little wonder that such descriptions came into vogue. Back to top Article Information Corresponding Author: Deshan F. Sebaratnam, MBBS(Hons), Skin and Cancer Foundation Australia, 7 Ashley Ln, Westmead, New South Wales, Australia 2145 (d.sebaratnam@hotmail.com). Published Online: February 4, 2015. doi:10.1001/jamadermatol.2014.5205. References 1. Burgdorf WH, Hoenig LJ. Dermatologic food for thought: a word search challenge. JAMA Dermatol. 2014;150(6):620.PubMedGoogle ScholarCrossref 2. Sebaratnam DF. Apple of the dermatologist’s eye. JAMA Dermatol. 2014;150(12):1280.PubMedGoogle ScholarCrossref 3. Lallas A, Moscarella E, Argenziano G, et al. Dermoscopy of uncommon skin tumours. Australas J Dermatol. 2014;55(1):53-62.PubMedGoogle ScholarCrossref

Journal

JAMA DermatologyAmerican Medical Association

Published: May 1, 2015

References