By Gary M. White, MD
Pseudoepitheliomatous hyperplasia here occurring in blastomycotic like pyoderma.
Pseudoepitheliomatous hyperplasia (PEH) is a type of exuberant proliferation of the epithelium with down-growth into the dermis occurring in a variety of settings.
Conditions associated with PEH [modified from Am J Dermatopathol 2011;33:112–126]
- Mycobacterial (M. marinum, M. tuberculosis, Leprosy)
- Deep fungal (Blastomycosis, Paracoccidioidomycosis, Sporotrichosis, Chromomycosis, Coccidioidomycosis, Aspergillus)
- Viral (Genital and perianal herpes simplex in patients with AIDS, Chronic verrucous varicella zoster virus infection in patients with AIDS)
- Bacterial (Blastomycosis-like pyoderma, Bacillary angiomatosis, Actinomycosis, Granuloma inguinale, Osteomyelitis)
- Protozoal (Leishmaniasis)
- Spirochetal (Gumma)
- Basal cell carcinoma
- Lymphoproliferative disorders (Nasal NK/T lymphoma, Anaplastic Large Cell Lymphoma, Mycosis fungoides, Lymphomatoid papulosis)
- Granular cell tumor
- Spitz nevus
- Prurigo nodularis
- Hypertrophic lupus erythematosus
- Hypertrophic lichen planus
- Perianal pseudoverrucous papules and nodules in children
- Elephantiasis nostras verrucosa
- Chronic cutaneous wounds
- Chondrodermatitis nodularis helicis
- Lichen sclerosus
- Pyodermatitis–pyostomatitis vegetans
- Pemphigus vegetans and pemphigoid vegetans
- After Mohs surgery
A well-demarcated nodule or plaque with a verrucous surface is characteristic. Variable degrees of scaling and crusting may be seen. Ulceration may be present. Smaller papules measuring less than a centimeter (e.g. granular cell tumor), to very large, multi centimeter plaques (e.g., halogenoderma deep fungal infection) may be found. The lesion is usually skin colored or tan pink. However, a whitish color is common when there is much scale or overlying hyperkeratosis. They may be pigmented when overlying melanoma. Pustules and comedone-like pits may be seen.
In general, treating the underlying disease treats the PEH. Occasionally however, the cause is unknown or is resistant to treatment (e.g. tattoo). In that case, specific treatment modalities directed against the PEH may be tried and include: topical steroid therapy, cryotherapy, topical 5-FU, CO2 laser and excision. Photodynamic therapy was tried in 3 resistant cases and was unsuccessful [Photomed Laser Surg. 2011 Feb; 29(2): 127–130].
Pseudoepitheliomatous hyperplasia as seen in hypertrophic lichen planus.
J Cutan Aesthet Surg. 2014 Oct-Dec; 7(4): 232–234.
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