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Some people are "lumpers" and others are "splitters" and depending on who named a disease, sometimes the line may be drawn between two diseases that are actually just different versions of the same condition. Even if you disagree with some of these, it is useful to think about it and helpful in remembering different diseases and their similarities and differences by lumping them in this way:
| • | still uncertain whether eosinophilic fasciitis is a distinct entity or if it represents a deep form of scleroderma; differs from scleroderma…. |
| • | absence of Raynaud’s, (-) ANA |
| • | and lesions usually confined to the extremities (sparing fingers and toes) |
| • | Hailey-Hailey was once considered to be the vesicular variant of Darier’s (but Darier’s is chromosome 12q vs. H-H is 3q) |
| • | some view Jessner’s benign lymphocytic infiltrate as a chronic variant of DLE |
| • | Ackerman says tumid LE, Jessner’s, and REM are the same disease (small amounts of mucin present in some Jessner’s) |
| • | actinic granuloma appears like necrobiosis lipoidica but appears on the head and neck, hands, or forearms, commonly in middle-aged, non- diabetic women (a variant of the NLD-GA spectrum) (some say that it is simply GA on sun-damaged skin) |
| • | atrophoderma is simply a variant of morphea (?) with more atrophy than sclerosis |
| • | livedo vasculitis and atrophie blanche (see Ackerman’s Quandaries) |
| • | granuloma faciale and EED appear to be closely related and perhaps different manifestations of the same disease (EED – far more vascular involvement, less epidermal sparing, and fewer eosinophils than granuloma faciale) |
| • | eosinophilic pustular folliculitis may represent a more persistent form of erythema toxicum neonatorum |
| • | Mal de Meleda is essentially Papillon-Lefevre syndrome (i.e. palmoplantar keratoderma with transgradiens) but minus the dental abnormalities |
| • | Focal acral hyperkeratosis is the same as Acrokeratoelastoidosis of Costa but lacks elastorrhexis on biopsy |
REM a variant of tumid LE (?):
| • | both respond to antimalarial therapy (i.e. Plaquenil) |
| • | both with similar histology: superficial and deep, perivascular and periadnexal lymphocytic infiltrate with interstitial mucin deposition |
REM (reticular erythematous mucinosis):
| • | mainly localized on central chest and upper back |
| • | young to middle aged women |
| • | can be induced by sun exposure, but provocative phototesting often negative |
tumid LE:
| • | sun exposed areas (especially face, V area of neck, upper back) |
| • | provocative phototesting positive in 70% of patients |
I have trouble understanding the difference, or the need for distinction, between (i.e. I’m a lumper):
| • | palmoplantar pustulosis and acrodermatitis continua of Hallapeau |
| • | large plaque parapsoriasis and patch stage MF |
| • | perioral dermatitis, FACE, granulomatous rosacea, and lupus miliaria disseminata faceii |
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