Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Widespread Unilateral Plaques in a 68-Year-Old Woman After Neurosurgery—Diagnosis

Widespread Unilateral Plaques in a 68-Year-Old Woman After Neurosurgery—Diagnosis Diagnosis: Unilateral psoriasis. Microscopic findings The biopsy specimen revealed regular psoriasiform epidermal hyperplasia. The granular layer was diminished, and confluent parakeratosis was present in the stratum corneum. An inflammatory cell infiltrate, composed of lymphocytes, histiocytes, and neutrophils, was observed around the vessels of the superficial plexus. Also, spongiform pustules were present within the epidermis. Discussion Psoriasis is a multifactorial disease with an uncertain etiology. The pathogenesis of the disease seems to involve both environmental and genetic factors.1 Yet, the striking symmetry of psoriatic plaque distribution and the widely recognized role of psychological stress in triggering worsening psoriatic symptoms have fueled research into the neuropathogenesis and neuropharmacology of psoriasis.2 The skin responds to numerous psychological stimuli. Previous clinical studies have linked stressful events, psychological distress, and social readjustment to worsening of several skin diseases, including psoriasis.3,4 These findings have evolved into the concept of “neurogenic inflammation.”5 This theory suggests that the peripheral sensory nerves release neuropeptides, such as substance P, into the skin, triggering a multitude of cellular changes, including mast cell degranulation, keratinocyte proliferation, and interleukin secretion.5,6 These changes can lead to the onset or worsening of psoriasis in a genetically predisposed person.5 The neuropeptides, therefore, are thought to serve as the biochemical link between the psyche and the skin.7 The role of the peripheral nervous system in psoriasis has been supported by several reports describing the local clearing of psoriasis after surgical resection of cutaneous nerves.5,8 Also, in patients with leprosy, a disease causing peripheral nerve damage and cutaneous anesthesia, psoriasis is quite rare.9 The present case, however, draws attention to the less studied role of the central nervous system (CNS) in psoriasis. After our patient’s craniotomy, the psoriasis plaques became widespread but were confined to the right side of her body. Her medical history and the presentation of the disease make it very likely that an aberration of some CNS processes was responsible for the manifestation of her psoriasis. To our knowledge, there are no other published reports linking CNS pathology to worsening of psoriasis. Clearly, it remains uncertain in the present case whether the surgery acted as a stimulus for the outbreak of unilateral psoriasis or whether it somehow inhibited the manifestation of psoriasis on the spared side. A recent report describing the spontaneous clearing of psoriasis in a patient after stroke supports the latter theory.7 As that patient regained cognitive function, the psoriasis returned, further highlighting a possible link between CNS processes and manifestations of psoriasis. Article Submissions Clinicians, local and regional societies, and residents and fellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced. Photomicrographs and illustrations must be clear and submitted as 3 positive color transparencies and as 3 color prints. Material should be accompanied by the required copyright transfer statement, as noted in “Instructions for Authors.” Material for this section should be submitted to Michael E. Ming, MD, Department of Dermatology, University of Pennsylvania Health System, 2 Maloney Bldg, 3600 Spruce St, Philadelphia, PA 19104-4283. Reprints are not available from the authors. References 1. Watson WCann HMFarber EMNall ML The genetics of psoriasis Arch Dermatol 1972;105197- 207PubMedGoogle ScholarCrossref 2. Farber EMNickoloff BJRecht BFraki JE Stress, symmetry and psoriasis: possible role of neuropeptides J Am Acad Dermatol 1986;14305- 311PubMedGoogle ScholarCrossref 3. Farber EMNall ML The natural history of psoriasis in 5,600 patients Dermatologica 1974;1481- 18PubMedGoogle ScholarCrossref 4. Gaston LLassonde MBernier-Buzzanga JHodgins SCrombez JC Psoriasis and stress: a prospective study J Am Acad Dermatol 1987;1782- 86PubMedGoogle ScholarCrossref 5. Raychaudhuri SPRein GFarber EM Neuropathogenesis and neuropharmacology of psoriasis Int J Dermatol 1995;34685- 693PubMedGoogle ScholarCrossref 6. Koblenzer CS Neuropeptides Int J Dermatol 1995;34694- 695PubMedGoogle ScholarCrossref 7. Stratigos AJKatoulis AKStavrianeas NG Spontaneous clearing of psoriasis after stroke J Am Acad Dermatol 1998;38768- 770PubMedGoogle ScholarCrossref 8. Farber EMLanigan SWBoer J The role of cutaneous sensory nerves in the maintenance of psoriasis Int J Dermatol 1990;29418- 420PubMedGoogle ScholarCrossref 9. Kumar BRaychaudhuri SPVossough SFarber EM Rare coexistence of leprosy and psoriasis Int J Dermatol 1992;31551- 554PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Widespread Unilateral Plaques in a 68-Year-Old Woman After Neurosurgery—Diagnosis

Archives of Dermatology , Volume 140 (12) – Dec 1, 2004

Widespread Unilateral Plaques in a 68-Year-Old Woman After Neurosurgery—Diagnosis

Abstract

Diagnosis: Unilateral psoriasis. Microscopic findings The biopsy specimen revealed regular psoriasiform epidermal hyperplasia. The granular layer was diminished, and confluent parakeratosis was present in the stratum corneum. An inflammatory cell infiltrate, composed of lymphocytes, histiocytes, and neutrophils, was observed around the vessels of the superficial plexus. Also, spongiform pustules were present within the epidermis. Discussion Psoriasis is a multifactorial disease with an...
Loading next page...
 
/lp/american-medical-association/widespread-unilateral-plaques-in-a-68-year-old-woman-after-nX6YkZiTHO
Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.140.12.1531-f
Publisher site
See Article on Publisher Site

Abstract

Diagnosis: Unilateral psoriasis. Microscopic findings The biopsy specimen revealed regular psoriasiform epidermal hyperplasia. The granular layer was diminished, and confluent parakeratosis was present in the stratum corneum. An inflammatory cell infiltrate, composed of lymphocytes, histiocytes, and neutrophils, was observed around the vessels of the superficial plexus. Also, spongiform pustules were present within the epidermis. Discussion Psoriasis is a multifactorial disease with an uncertain etiology. The pathogenesis of the disease seems to involve both environmental and genetic factors.1 Yet, the striking symmetry of psoriatic plaque distribution and the widely recognized role of psychological stress in triggering worsening psoriatic symptoms have fueled research into the neuropathogenesis and neuropharmacology of psoriasis.2 The skin responds to numerous psychological stimuli. Previous clinical studies have linked stressful events, psychological distress, and social readjustment to worsening of several skin diseases, including psoriasis.3,4 These findings have evolved into the concept of “neurogenic inflammation.”5 This theory suggests that the peripheral sensory nerves release neuropeptides, such as substance P, into the skin, triggering a multitude of cellular changes, including mast cell degranulation, keratinocyte proliferation, and interleukin secretion.5,6 These changes can lead to the onset or worsening of psoriasis in a genetically predisposed person.5 The neuropeptides, therefore, are thought to serve as the biochemical link between the psyche and the skin.7 The role of the peripheral nervous system in psoriasis has been supported by several reports describing the local clearing of psoriasis after surgical resection of cutaneous nerves.5,8 Also, in patients with leprosy, a disease causing peripheral nerve damage and cutaneous anesthesia, psoriasis is quite rare.9 The present case, however, draws attention to the less studied role of the central nervous system (CNS) in psoriasis. After our patient’s craniotomy, the psoriasis plaques became widespread but were confined to the right side of her body. Her medical history and the presentation of the disease make it very likely that an aberration of some CNS processes was responsible for the manifestation of her psoriasis. To our knowledge, there are no other published reports linking CNS pathology to worsening of psoriasis. Clearly, it remains uncertain in the present case whether the surgery acted as a stimulus for the outbreak of unilateral psoriasis or whether it somehow inhibited the manifestation of psoriasis on the spared side. A recent report describing the spontaneous clearing of psoriasis in a patient after stroke supports the latter theory.7 As that patient regained cognitive function, the psoriasis returned, further highlighting a possible link between CNS processes and manifestations of psoriasis. Article Submissions Clinicians, local and regional societies, and residents and fellows in dermatology are invited to submit quiz cases to this section. Cases should follow the established pattern and be submitted double-spaced. Photomicrographs and illustrations must be clear and submitted as 3 positive color transparencies and as 3 color prints. Material should be accompanied by the required copyright transfer statement, as noted in “Instructions for Authors.” Material for this section should be submitted to Michael E. Ming, MD, Department of Dermatology, University of Pennsylvania Health System, 2 Maloney Bldg, 3600 Spruce St, Philadelphia, PA 19104-4283. Reprints are not available from the authors. References 1. Watson WCann HMFarber EMNall ML The genetics of psoriasis Arch Dermatol 1972;105197- 207PubMedGoogle ScholarCrossref 2. Farber EMNickoloff BJRecht BFraki JE Stress, symmetry and psoriasis: possible role of neuropeptides J Am Acad Dermatol 1986;14305- 311PubMedGoogle ScholarCrossref 3. Farber EMNall ML The natural history of psoriasis in 5,600 patients Dermatologica 1974;1481- 18PubMedGoogle ScholarCrossref 4. Gaston LLassonde MBernier-Buzzanga JHodgins SCrombez JC Psoriasis and stress: a prospective study J Am Acad Dermatol 1987;1782- 86PubMedGoogle ScholarCrossref 5. Raychaudhuri SPRein GFarber EM Neuropathogenesis and neuropharmacology of psoriasis Int J Dermatol 1995;34685- 693PubMedGoogle ScholarCrossref 6. Koblenzer CS Neuropeptides Int J Dermatol 1995;34694- 695PubMedGoogle ScholarCrossref 7. Stratigos AJKatoulis AKStavrianeas NG Spontaneous clearing of psoriasis after stroke J Am Acad Dermatol 1998;38768- 770PubMedGoogle ScholarCrossref 8. Farber EMLanigan SWBoer J The role of cutaneous sensory nerves in the maintenance of psoriasis Int J Dermatol 1990;29418- 420PubMedGoogle ScholarCrossref 9. Kumar BRaychaudhuri SPVossough SFarber EM Rare coexistence of leprosy and psoriasis Int J Dermatol 1992;31551- 554PubMedGoogle ScholarCrossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Dec 1, 2004

Keywords: psoriasis,neurosurgery specialty,neurosurgical procedures

References