{'fraction_non_alphanumeric': 0.031288800595977155, 'fraction_numerical': 0.006208095356344674, 'mean_word_length': 5.517799352750809, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Lichen planopilaris and dermatitis herpetiformis: a fortuitous association?

EJD, vol. 29, n◦ 4, July-August 2019 from the forehead showed dense superficial, deep perivascular, and interstitial infiltration of the dermis. Infiltrates consisted of numerous lymphocytes without nuclear atypia, eosinophils, histiocytes, and some neutrophils (figure 1D, E). A follicular eosinophilic infiltrate was not observed. PAS staining was negative. Most of the lymphocytes were CD3+, and only some were CD79a+ (figures 1F, G). Most CD3+ cells were CD4+ and a small number of cells were CD8+. There were no PD-1-expressing cells, and chromogenic in situ hybridization for EBV-encoded RNA was negative. T-cell receptor-Υ gene rearrangement was not analysed. Based on these findings, an insect bite-like reaction (IBLR) was diagnosed. We prescribed a corticosteroid ointment, but the patient did not use it and applied a ketoconazole lotion, which had previously been prescribed for another lesion instead. The papules gradually became smaller and had almost disappeared after four months. IBLR, which is a synonym for eosinophilic dermatoses of haematological malignancies, is a rare skin condition associated with haematological malignancies [1]. IBLR most frequently presents as pruritic papules or nodules, but in some cases, vesicles arise on both exposed and nonexposed areas of the body. Histopathologically, the lesions exhibit superficial and deep dense perivascular lymphocyte infiltration, which predominantly involves T lymphocytes, accompanied by numerous interstitial eosinophils. The skin lesions usually appear months to years after a neoplasm is diagnosed. Although the clinical and histopathological features of IBLR resemble those of insect bites, few patients recall having been bitten by an arthropod. In our case, specific lesions associated with AITL were excluded, since many cases of AITL present with a skin manifestation with a histological pattern of skin infiltration that may involve lymphocytic perivascular infiltrates or diffuse infiltrates, reminiscent of angioimmunoblastic T-cell lymphoma, and most of these cells are positive for PD1 and ICOS [2]. In our case, the skin infiltrates showed a perivascular and interstitial pattern, and were negative for PD-1. T-cell pseudolymphoma should also be considered. Histologically, our case showed numerous interstitial eosinophilic infiltrations with some neutrophils and no plasma cells, which are not typical of pseudolymphoma. The pathogenesis of IBLR remains unknown, although the cytokine imbalance and altered immunoreactivity that accompany neoplasms are possible causes. A study based on fluorescence in situ hybridization analysis revealed the presence of neoplastic cells within the skin infiltrates, indicating that tumour cells play a role in IBLR [3]. However, such skin lesions are usually not related to the course or activity of the neoplasm and sometimes even precede the diagnosis. Most cases of IBLR are associated with B-cell haematological malignancies, especially chronic lymphocytic lymphoma. Although some cases of acute monocytic leukaemia-, myelofibrosis-, or myelodysplastic syndromeassociated IBLR have been reported [4, 5], there are no case reports regarding T-cell malignancy-associated IBLR in the English literature. Recently, the term “T-cell papulosis associated with B-cell malignancy” has been proposed for IBLR [6]. However, dermatologists should keep in mind that haematological malignancies other than B-cell malignancies, including T-cell malignancies, might also be associated with this condition. A variety of treatment modalities have been employed against IBLR, but treatment is usually difficult and recurrence is common. In our case, the skin lesions disappeared after topical application of ketoconazole lotion. However, it would appear that the condition took its natural course rather than the ketoconazole lotion being effective against IBLR. Although rare, spontaneous resolution has been observed for IBLR [4].