PSEUDOEPITHELIOMATOUS HYPERPLASIA

By Gary M. White, MD

Pseudoepitheliomatous hyperplasia in blastomycotic like pyoderma 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]

Infections

Neoplastic conditions

Chronic inflammation/irritation

Miscellaneous

Clinical

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.

Treatment

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].

Additional Pictures

Pseudoepitheliomatous hyperplasia as seen in hypertrophic lichen planus.
Pseudoepitheliomatous hyperplasia in hypertrophic lichen planus

References

J Cutan Aesthet Surg. 2014 Oct-Dec; 7(4): 232–234.

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