Gottron's carcinoid papillomatosis: symptoms and treatment of the disease

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There are diseases whose development is provoked by other pathologies. The lack of treatment for provoking diseases aggravates the general state of health, causing severe conditions that directly affect a person’s life.

Gottron's papillomatosis is a severe and intractable disease

Gottron's carcinoid papillomatosis of the skin is a difficult-to-treat pathology caused by other skin diseases, the development of which can be prevented. Let's try to figure out: what is this disease, what causes it, and how is it treated with surgery?

Gottron's skin papillomatosis

Papillomatosis is a skin disease that does not have a clear etiology and is characterized by a chronic course with a tendency to complications.

The pathology is difficult to treat conservatively and is localized on the surface of the skin, most often on the lower extremities, where it forms large lesions (plaques), the size of the surface of the palm.

Diagnostics

Helps diagnose the disease:

• examination of the patient;
• collecting anamnesis (information about the disease);
• examination of affected tissues (histological).

Reasons for the development of the disease

Papillomatosis is a consequence of long-term inflammatory processes of the skin of the lower extremities; the following diseases provoke the appearance of pathology:

The disease is quite rare, men are more often affected, and first appears between the ages of 30 and 58 years. The skin is affected symmetrically, but a single manifestation of the disease may occur in a specific area of ​​the skin.

Eczema is one of the prerequisites for the development of the disease

Treatment options

Treatment of the pathology, aimed at eliminating the causes of its occurrence, is under development, but supportive therapeutic treatment is used, which includes:

• antibiotic therapy;
• vitamin therapy;
• antiseptic drugs.

Clinical picture

The clinical manifestations of papillomatosis are similar to cancer and can be easily confused with malignant carcinoma. It is important to remember that this pathology does not have oncological symptoms; so far, not a single case of malignancy (degeneration) of skin tumors into any form of cancer has been identified.

The process of development of papillomatosis, the main manifestations

Specific causes of the pathology have not been found, but medical studies confirm the dependence of the appearance of skin neoplasms in papillomatosis on inflammatory processes on the skin that occur earlier, such as:

• lichen planus;
• eczema;
• ichthyosis;
• psoriasis;
• lupus.

The genetic and hereditary nature of the disease has not been confirmed. Many experts are convinced that the formation of pathology is caused by tissue reactivity and a predisposition to the development of papillomas.

Lichen planus in some cases precedes the onset of the disease

Disease progression factor

Provoking factors for the rapid progression of the disease and the development of plaques are:

• constant trauma to the skin due to eczema, psoriasis;
• the presence of a sluggish inflammatory process.

The patient's condition worsens if the following is connected:

• saprophytic microflora;
• secondary infection.

The main symptom of progressive pathology is plaques located on the skin and having characteristic structural and location features:

• large sizes – 9-12 cm;
• neoplasms rise above the skin (0.8-1.6 cm);
• develop on the lower extremities, symmetrically;
• the consistency of the plaques is soft, dough-like;
• the secretion of plaques has an unpleasant odor;
• neoplasms have a dark yellow tint;
• Erosion forms in place of the plaques.

The development of saprophytic microflora aggravates the course of the disease

Diagnosis of pathology

Identification of pathology and diagnosis is carried out by a specialist after carrying out certain actions:

• examination of the patient;
• collecting information about the disease (history);
• histological examination.

Questioning and examining the patient are the first steps of a specialist in the process of correct diagnosis; during the survey, it is established that the patient’s skin has been exposed to an inflammatory reaction and trauma for a long time.

Histological examination and biopsy of the affected skin areas confirm the diagnosis. Research results reveal:

• pronounced thickening of the epidermis;
• the appearance of a cord on the entire surface of the affected area;
• strands penetrate the dermis in the form of threads;
• Epithelial conglomerates (small clusters) are visible deep in the dermis;
• there is no atypia (a sign of a precancerous condition), it is not detected at the cellular level.

In compacted areas of the epidermis and conglomerates of the epithelium, the process of keratinization occurs. In the affected areas of the skin it is easy to detect:

• lymphocytic;
• histiocytic infiltration.

Comparative diagnosis of pathology is carried out with the following diseases:

• chronic ulcerative pyoderma;
• squamous cell skin cancer;
• chromomycosis.

Chromomycosis has manifestations similar to papillomatosis

Treatment of Gottron's papillomatosis

Carcinoid papillomatosis is treated conservatively and surgically (surgical treatment). Drug therapy is aimed at:

• pain relief;
• elimination of the inflammatory process;
• maintaining the body with vitamin therapy.

Complex treatment includes the use of:

• antibiotics to prevent re-infection of tissues;
• cytostatic drugs;
• vitamins, in order to increase the regenerative properties of tissues.

There is also a secondary therapy that uses the following drugs:

• antidiabetic medications (use of xanthinol, theonicol), to improve nutrition and microcirculation in tissues;
• local antiseptic therapy (furacilin, potassium permanganate in solutions) to dry tissues, eliminate unpleasant odors and remove crusts;
• local injection therapy using hormones (corticosteroids).

This pathology is difficult to treat, and the use of drug therapy may not improve the patient’s condition.

Xanthinol can be prescribed to treat pathology

Carcinoid papillomatosis surgical treatment

There are other methods of treating Gottron's papillomatosis, which eliminate tumors on the skin by removing them; surgical methods of treatment are used:

• laser photocoagulation;
• radical removal (excision);
• method of “burning out” tumors (using thermocoagulation);
• exposure to high frequency electric current (use of electrocoagulation).

Removal of any tumor requires indications, since surgical intervention must be justified from the point of view of a specialist and the impact of the consequences of removal on the patient’s health.

Removal of tumors is carried out on the basis of:

• medical (first category);
• cosmetic indications (second category).

The first category of indications includes:

• easily injured neoplasms located on the face (trauma occurs due to shaving);
• neoplasms located in places of contact with clothing;
• neoplasms on the palms and soles (prophylactic removal to prevent the formation of cancer (melanoma);
• neoplasms caused by a virus (condyloma).

Neoplasms should be removed surgically if drug treatment is not effective. The second category of indications includes:

• elimination of any neoplasms in order to preserve the aesthetically favorable appearance of the skin.

Laser photocoagulation allows you to remove Gottron's growths

A variety of methods of surgical treatment of pathology

Removal of tumors using laser photocoagulation involves:

• abrasion of the affected areas of the skin;
• direct laser exposure.

The mechanism of action is to destroy the affected area through local exposure to light energy (laser).

Surgical removal is one of the most effective treatment methods

The radical method of treatment is surgical removal of tumors. The operation can be performed in two variations:

• under local anesthesia (removal of a small tumor);
• under general anesthesia (removal of tumors that are large and deeply penetrate the dermis).

Excision of a large tumor requires certain preparation of the patient for the procedure:

• comprehensive examination for the presence of concomitant diseases in order to prevent complications in the postoperative period;
• collecting an allergy history to prevent complications during premedication (anesthesia) before surgery (allergy to medications).

Excision of the tumor is performed with a scalpel; after the direct removal procedure, a skin suture is applied. Surgical treatment (removal) of tumors is carried out in a number of cases:

• the neoplasm is large in size - from 1.5 cm in diameter;
• the neoplasm is not benign.

Surgical removal of Gottron's papillomatosis is used to eliminate complications in the process of growth of pathology that is large in size and causes pain to the patient.

Surgical removal is performed under anesthesia

Method of “burning out” tumors (non-surgical method)

The effect of this treatment method involves:

• removal of the tumor with a special device heated to a high temperature - a metal loop “burns” the tumor, preventing its appearance in the future;
• pathological cells are “blocked” due to exposure to high temperature.

High frequency electric current method

Electrocoagulation is a method of surgical treatment that affects the neoplasm using high-frequency electric current.

Removal of the tumor occurs by cutting the affected area of ​​the skin with a high-frequency electrode. This procedure is carried out in two ways: the first is contact, which involves contact of the electrode with the skin.

The second method does not involve contact of the electrode with the skin; the current passes through the air space.

The procedure for removing tumors with high-frequency electric current has a number of advantages:

• no blood loss during surgery;
• the ability to carry out the procedure without prior preparation;
• quick recovery period after surgery.

Each of the above methods of surgical treatment is used in medical practice, but the choice of method and its effectiveness depends on the characterological characteristics of the tumor:

• sizes;
• structures;
• the presence or absence of atypia (a sign of a precancerous condition) of neoplasm cells;
• prognosis of the disease based on a comprehensive examination;
• the presence or absence of medical contraindications for the use of one of the methods.

Electrocoagulation of papillomatosis is a virtually bloodless operation

Preventive measures to prevent the development of Gottron's papillomatosis

This pathology does not have a tendency to degenerate (malignancy), but the main side effect for the body is a secondary infection, which can become a serious problem in the future. Secondary infection can cause the development of:

• purulent inflammation;
• toxic shock;
• sepsis.

Gottron's papillomatosis is difficult to treat, the disease is highly prone to relapse, and the period of remission ranges from several weeks to a year.

External manifestations of the disease - plaques and the discomfort associated with their development - adversely affect the psychological state of the patient. The main preventive measures are:

timely treatment of diseases that provoke the development of Gottron's papillomatosis: psoriasis, eczema, lichen planus;

• strengthening the immune system (skin diseases appear more often in people with weak immunity);
• prevention of trauma to the skin of the lower extremities;
  no exposure to high and low temperatures on the skin of the feet;
• timely contact a specialist if the first symptoms of diseases that provoke the development of papillomatosis appear.

Compliance with simple preventive measures will help maintain health and activity throughout life, prevent the development of complications, and protect against the occurrence of pathologies that have an unfavorable outcome.

Source: https://kozhmed.ru/papillomy/karcinoidnyj-papillomatoz-gottrona-hirurgicheskoe-lechenie.html

Gottron's carcinoid papillomatosis

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Papillomatosis is a skin disease that does not have a clear etiology and is characterized by a chronic course with a tendency to complications.

The pathology is difficult to treat conservatively and is localized on the surface of the skin, most often on the lower extremities, where it forms large lesions (plaques), the size of the surface of the palm.

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Diagnostics

Helps diagnose the disease:

• examination of the patient;
• collecting anamnesis (information about the disease);
• examination of affected tissues (histological).

Reasons for the development of the disease

Papillomatosis is a consequence of long-term inflammatory processes of the skin of the lower extremities; the following diseases provoke the appearance of pathology:

The disease is quite rare, men are more often affected, and first appears between the ages of 30 and 58 years. The skin is affected symmetrically, but a single manifestation of the disease may occur in a specific area of ​​the skin.

Treatment options

Treatment of the pathology, aimed at eliminating the causes of its occurrence, is under development, but supportive therapeutic treatment is used, which includes:

• antibiotic therapy;
• vitamin therapy;
• antiseptic drugs.

Clinical picture

The clinical manifestations of papillomatosis are similar to cancer and can be easily confused with malignant carcinoma. It is important to remember that this pathology does not have oncological symptoms; so far, not a single case of malignancy (degeneration) of skin tumors into any form of cancer has been identified.

Gottron's cutaneous carcinoid papillomatosis

Gottron's carcinoid papillomatosis of the skin is a rare type of skin disease that develops against the background of post-traumatic scars, long-persistent dermatoses (eczema, lichen planus, neurodermatitis, ichthyosis, tuberculous lupus, blastomycosis, etc.).

1. The name of this skin disease is given in honor of the German dermatologist Heinrich Gottron, who made a huge contribution to the study of this pathology.
2. Gottron's carcinoid papillomatosis of the skin develops predominantly in men aged 40-80 years.
3. As shown in the photo, with this skin disease, the pathological process symmetrically or unilaterally affects the lower extremities, less often the upper extremities, torso, face, and oral mucosa:
4. 
5. The clinic is characterized by sharply demarcated flat plaques the size of the palm, protruding 1-1.5 cm above the skin level, and tumor formations, doughy consistency, the color of raw meat with vegetations similar in shape to cauliflower.

Maceration and ulcerations form in the interpapillary spaces, and exudate with a foul odor accumulates.

When the lesion is squeezed from the sides, creamy purulent contents with an unpleasant odor are released from the depths.

These symptoms of Gottron's skin disease gradually replace the signs of background dermatosis, which can sometimes be observed only at the periphery of the lesion. The process can be unilateral or symmetrical.

When describing this skin disease, it is worth noting that sometimes there is a detachment of epithelial cells, as well as a tendency to keratinization and the formation of “tubular-like horny masses.”

In the papillary layer of the dermis there is a massive infiltrate consisting of lymphocytes with an admixture of epithelioid cells, histiocytes and fibroblasts.

Diagnosis is based on the symptoms of this skin disease, as well as clinical and histological findings.

Differential diagnosis is carried out with well-differentiated squamous cell skin cancer, chronic vegetative pyoderma, warty skin tuberculosis, chromomycosis.

In this human skin disease, the pathological process continues for decades without malignancy, then transforms into squamous cell skin cancer.

Treatment for this skin disease consists of surgical excision followed by plastic surgery. The effect of cryo- and laser destruction, ingestion of aromatic retinoids, intralesional interferon injections, and PDT is described.

Source: https://zhenshchina.papilloma-vpch.ru/simptomy/kartsinoidnyj-papillomatoz-gottrona/

Gottron's cutaneous carcinoid papillomatosis

Gottron's carcinoid papillomatosis of the skin is a rare dermatological disease of unknown etiology, which has a long chronic course and is quite difficult to treat. As it develops, large, palm-sized, raised plaques appear on the surface of the skin, mainly of the lower extremities. Diagnosis of Gottron's carcinoid papillomatosis of the skin is made by examining the patient, studying his medical history and histological examination of tissue in the lesion. No etiotropic treatment has been developed; symptomatic and supportive therapy is carried out using antibiotics, vitamin preparations, antiseptic and cytostatic agents.

Gottron's carcinoid papillomatosis of the skin is a chronic skin disease that occurs against the background of long-term inflammatory tissue lesions (eczema, psoriasis and a number of others). It was first described by the German dermatologist G. Gottron in 1932.

This condition is quite rare, mainly in middle-aged and older people - the onset of the disease in most cases occurs in the age range of 32-60 years.

Men are affected somewhat more often than women; skin lesions are usually symmetrical, but sometimes single lesions can be observed.

According to its clinical symptoms, Gottron's carcinoid papillomatosis of the skin is quite similar to malignant carcinoma, but no signs of oncological pathology are detected upon careful study. There are also no cases of malignant degeneration of plaques and other rashes with this disease.

Gottron's cutaneous carcinoid papillomatosis

The etiology and pathogenesis of this disease still remain unclear. It was possible to find out that skin manifestations in the form of plaques arise at the site of long-term dermatological pathologies - psoriasis, lichen planus, eczema, ichthyosis, and some forms of skin tuberculosis.

Assumptions about the genetic or hereditary nature of this condition have not been confirmed. Some experts support the opinion that this disease is caused by the peculiarities of the body's reactivity and its tendency to papillomatous growths.

At the same time, tissues react to long-term constant trauma or irritation of the skin (which occurs in the above diseases) by developing plaques characteristic of Gottron's carcinoid papillomatosis of the skin.

The addition of saprophytic microflora and secondary infection to this aggravates the pathological process.

The most pronounced and practically the only manifestation of Gottron's carcinoid papillomatosis of the skin is the formation of significant plaques (up to 10-15 centimeters), raised above the surrounding surface by 1-1.5 centimeters.

Their predominant localization is the lower extremities in areas that have been exposed to other dermatological diseases. The location of the plaques is usually symmetrical, their surface is covered with tumor-like formations and numerous vegetations.

Tumor-like formations in Gottron's carcinoid papillomatosis of the skin easily undergo maceration, in which case erosive foci form in their place.

Diagnosis of the disease is carried out based on the results of an examination by a dermatologist, a study of the patient’s medical history, and histological studies.

Examination reveals plaques with a surface resembling cauliflower due to tumor-like nodules and vegetations and covered with a dirty yellow secretion and crusts with an unpleasant odor.

The lesions in Gottron's carcinoid papillomatosis of the skin are located symmetrically; in the case of a long course of the disease, erosions and ulcers can be found on their surface at the site of vegetations that have undergone maceration.

Upon questioning, it turns out that the patient had various inflammatory diseases on the affected areas of the skin for a long time before the development of the present condition. Similar data can be obtained by studying a person's medical history or outpatient card.

When performing a skin biopsy and subsequent histological examination of the tissue, pronounced acanthosis is revealed with the formation of cords, which, in the form of thin processes, penetrate deep into the dermis.

Some of them then lose contact with the epidermis, forming epithelial “islands” and clusters in the dermis. Severe pseudocarcinomatous hyperplasia of the epidermis is also detected; atypia characteristic of malignant neoplasms is not found in the cells.

Differential diagnosis of the disease should be carried out with chronic ulcerative-vegetative pyoderma, squamous cell skin cancer, and chromomycosis.

No etiotropic treatment for this pathology has been developed in dermatology; cytostatic drugs, broad-spectrum antibiotics, and vitamin supplements are used to relieve symptoms. Prospidin is the most widely used cytostatic agent for Gottron's carcinoid papillomatosis of the skin.

A secondary drug for the treatment of this condition is xanthinol nicotinate, a drug that has the ability to improve microcirculation and tissue trophism.

Vitamin supplements are necessary to normalize metabolism and improve the regenerative properties of the body; antibiotics help to avoid secondary infection and, according to some data, also help reduce the severity of symptoms.

Locally, for Gottron's carcinoid papillomatosis of the skin, a variety of antiseptic solutions are used - furatsilin, potassium permanganate, etc.

Regular lotions with such preparations can somewhat reduce the rate of formation of crusts, reduce the amount of secretion released and remove the unpleasant odor.

Also, according to some data, local intradermal injections of corticosteroids made around the plaques promote recovery. However, in general, this dermatological condition is difficult to treat and does not always respond to therapeutic measures taken.

It can provoke severe purulent inflammation and resulting toxic shock or sepsis. But the prognosis for recovery is unfavorable - the development of vegetations and plaques can last for many years, either subsiding or intensifying.

In addition, the unpleasant odor and unsightly appearance of skin manifestations can cause psychological problems in the patient.

To prevent Gottron's carcinoid papillomatosis of the skin, it is necessary to promptly and fully treat dermatological pathologies that may become the basis for the development of this condition.

Source: https://www.KrasotaiMedicina.ru/diseases/zabolevanija_dermatologia/Gottron-papules

Gottron's carcinoid papillomatosis of the skin :: Symptoms, causes, treatment and code according to ICD-10

 Title: Gottron's carcinoid papillomatosis of the skin.

Gottron's cutaneous carcinoid papillomatosis

Gottron's carcinoid papillomatosis of the skin. A rare dermatological disease of unknown etiology, which has a long chronic course and is quite difficult to treat. As it develops, large, palm-sized, raised plaques appear on the surface of the skin, mainly of the lower extremities.

Diagnosis of Gottron's carcinoid papillomatosis of the skin is made by examining the patient, studying his medical history and histological examination of tissue in the lesion.

No etiotropic treatment has been developed; symptomatic and supportive therapy is carried out using antibiotics, vitamin preparations, antiseptic and cytostatic agents.

 Gottron's carcinoid papillomatosis of the skin is a chronic skin disease that occurs against the background of long-term inflammatory tissue lesions (eczema, psoriasis and a number of others). It was first described by the German dermatologist G. Gottron in 1932.

This condition is quite rare, mainly in middle-aged and older people - the onset of the disease in most cases occurs in the age range of 32-60 years.

Men are affected somewhat more often than women; skin lesions are usually symmetrical, but sometimes single lesions can be observed.

According to its clinical symptoms, Gottron's carcinoid papillomatosis of the skin is quite similar to malignant carcinoma, but no signs of oncological pathology are detected upon careful study. There are also no cases of malignant degeneration of plaques and other rashes with this disease.

Gottron's cutaneous carcinoid papillomatosis

 The etiology and pathogenesis of this disease still remain unclear. It was possible to find out that skin manifestations in the form of plaques arise at the site of long-term dermatological pathologies - psoriasis, lichen planus, eczema, ichthyosis, and some forms of skin tuberculosis.

Assumptions about the genetic or hereditary nature of this condition have not been confirmed. Some experts support the opinion that this disease is caused by the peculiarities of the body's reactivity and its tendency to papillomatous growths.

At the same time, tissues react to long-term constant trauma or irritation of the skin (which occurs in the above diseases) by developing plaques characteristic of Gottron's carcinoid papillomatosis of the skin.

The addition of saprophytic microflora and secondary infection to this aggravates the pathological process.

 Diagnosis of the disease is carried out based on the results of an examination by a dermatologist, a study of the patient’s medical history, and histological studies. Examination reveals plaques with a surface resembling cauliflower due to tumor-like nodules and vegetations and covered with a dirty yellow secretion and crusts with an unpleasant odor.

The lesions in Gottron's carcinoid papillomatosis of the skin are located symmetrically; in the case of a long course of the disease, erosions and ulcers can be found on their surface at the site of vegetations that have undergone maceration.

Upon questioning, it turns out that the patient had various inflammatory diseases on the affected areas of the skin for a long time before the development of the present condition. Similar data can be obtained by studying a person's medical history or outpatient card.

 When performing a skin biopsy and subsequent histological examination of the tissue, pronounced acanthosis is revealed with the formation of cords, which, in the form of thin processes, penetrate deep into the dermis. Some of them then lose contact with the epidermis, forming epithelial “islands” and clusters in the dermis.

Severe pseudocarcinomatous hyperplasia of the epidermis is also detected; atypia characteristic of malignant neoplasms is not found in the cells. Some of the acanthosis cords and epithelial islands undergo keratinization. Also, in the tissues of the pathological focus in Gottron's carcinoid papillomatosis of the skin, pronounced lymphocytic and histiocytic infiltration is detected.

 Differential diagnosis of the disease should be carried out with chronic ulcerative-vegetative pyoderma, squamous cell skin cancer, and chromomycosis.

A secondary drug for the treatment of this condition is xanthinol nicotinate, a drug that has the ability to improve microcirculation and tissue trophism.

Vitamin supplements are necessary to normalize metabolism and improve the regenerative properties of the body; antibiotics help to avoid secondary infection and, according to some data, also help reduce the severity of symptoms.

 Locally, for Gottron's carcinoid papillomatosis of the skin, a variety of antiseptic solutions are used - furatsilin, potassium permanganate, etc. Regular lotions with such drugs can somewhat reduce the rate of crust formation, reduce the amount of secretion discharged and remove the unpleasant odor.

Also, according to some data, local intradermal injections of corticosteroids made around the plaques promote recovery. However, in general, this dermatological condition is difficult to treat and does not always respond to therapeutic measures taken.

 Despite the severity of the symptoms and the severity of the manifestations, this condition rarely poses a threat to the patient’s life - Gottron’s carcinoid papillomatosis of the skin does not degenerate into a malignant neoplasm, the only threat is the risk of secondary infection.

It can provoke severe purulent inflammation and resulting toxic shock or sepsis. But the prognosis for recovery is unfavorable - the development of vegetations and plaques can last for many years, either subsiding or intensifying.

In addition, the unpleasant odor and unsightly appearance of skin manifestations can cause psychological problems in the patient.

42a96bb5c8a2acfb07fc866444b97bf1 Content moderator: Vasin A.S.

Source: https://kiberis.ru/?p=33579

Gottron's carcinoid skin papillomatosis

Gottron's carcinoid cutaneous papillomatosis is a rare precancerous disease characterized by pseudoepitheliomatous hyperplasia of the epidermis [1].

In 1932-1936. Gottron described 2 patients who had tumor-like and papillomatous growths on the skin of the legs and feet, histologically characterized by invasive growth of the epidermis, hyperkeratosis, but without other signs of malignancy.

The author identified this disease under the name “skin papillomatosis.” Nicolowski and Eisenlohr (1950), taking into account the clinical and histological similarity of lesions in skin papillomatosis with squamous cell carcinoma, gave it the name “Gottron’s carcinoid papillomatosis of the skin” [2].

By 1980, about 40 observations were described in the world literature (Nicolowsky and Eisenlohr, 1950; Frank, 1959; Wodniansky, 1960; L.I. Khristin et al., 1963; Schimpf and Seller, 1963; K.F. Fomin et al. .

, 1971; Fischer, 1975; Riboldi and Pozzo, 1976; B.A. Berenbein, 1980; Quednow et al., 1983, etc.).

Civatte (1967) and other authors classify carcinoid papillomatosis of the skin as chronic vegetative pyoderma Azu [3].

The histogenesis of the disease has not been definitively identified. Thus, according to H. Gottron (1932), carcinoid papillomatosis of the skin is an independent disease that is not related to squamous cell carcinoma. Other authors see no difference between carcinoid papillomatosis and well-differentiated squamous cell carcinoma [4]. L.I. Christan et al.

(1963) provide data from Gonin, who observed metastases and death in a patient with carcinoid papillomatosis 10 years after diagnosis of the disease [2]. R. Raichev, V. Andreev (1965) consider this disease to be a precancer. P.

Wodniansky (1960) emphasized that in such cases we are talking about the development of pseudocarcinomatous hyperplasia against the background of etiologically different chronic inflammatory skin diseases [4, 5]. Interesting clinical observations were described in their articles by R.A. Kapkaev (1999), A.M. Katkhanov and M.M. Tlish (2003) [7, 8]. E.A. Batkaev, L.T. Togoeva, O.V. Dordzhieva et al.

The etiology and pathogenesis of the disease have been little studied. In its development, mechanical trauma, chronic inflammation with long-term dermatoses, as well as circulatory disorders and acroasphyxia, the body’s tendency to papillomatous reactions, are of great importance [1, 5, 6]. Men get sick more often than women. The age of patients varies from 40 to 85 years [2, 4, 5].

The clinical picture is presented as symmetrically located in the area of ​​the legs (usually on the anterior surfaces), against the background of foci of long-existing dermatosis or scars, papillomatous warty growths and vegetations in the form of plaques the size of a palm or more.

The lesions protrude sharply above the skin level by 1-1.5 cm. On the surface of the plaques there may be tumor-like formations with a doughy consistency the color of raw meat and vegetation, reminiscent of cauliflower.

The grooves between vegetations are filled with yellowish-white sticky masses with an unpleasant odor [1, 2, 4, 5].

In some areas they shrink into yellowish-gray crusts. Sometimes erosions, superficial ulcers, and easily bleeding granulations occur. Signs of background dermatosis can be observed only along the periphery of the lesion.

Depending on the clinical characteristics, ulcerative-infiltrative (endophytic), tumor-like (exophytic) and hyperkeratotic forms are distinguished [4-6].

The course of the disease is long with possible transformation into squamous cell carcinoma [1, 4, 5].

Acanthotic cords are represented by elongated or irregularly shaped spinous cells without signs of atypia, which penetrate into the deep layers of the dermis, but do not violate the integrity of the basement membrane.

Sometimes detachment of epithelial cells is observed, as well as a tendency to keratinization and the formation of “tubular-like horny masses” [1-4].

This disease must be differentiated from chromomycosis, chronic vegetative pyoderma, warty skin tuberculosis, and squamous cell carcinoma.

From squamous cell carcinoma, Gottron's carcinoid papillomatosis of the skin is clinically distinguished by the absence of a dense ridge-like edge characteristic of cancer, and histologically by the absence of cell atypia, hyperchromic nuclei and their polymorphism.

Gottron's carcinoid papillomatosis of the skin differs from chronic ulcerative vegetative pyoderma by the absence of pustular elements and fistulous tracts, the presence of intraepithelial abscesses containing a large number of leukocytes, and nuclear detritus.

In warty skin tuberculosis, in contrast to carcinoid papillomatosis, the tuberculoid structure of the infiltrate is histologically detected. In foci of chromomycosis, chromomycetes are detected during culture [2, 4, 5].

To treat this disease, prospidin is used (parenteral administration 50-100 mg per injection, 2.0-2.5 g per course), antibiotics, vitamins, and small doses of antidiabetic drugs.

In severe cases, surgical excision followed by plastic surgery or close-focus radiotherapy is indicated [1, 2, 4, 5].

Considering the rarity of this disease and the difficulty of diagnosis, we present a description of three cases of clinical observation.

Patient Sh .

, 68 years old, a resident of a rural area, consulted a dermatologist with complaints of rashes in the form of ulcerating warty growths, oozing, profuse purulent discharge on the skin of both legs and feet, accompanied by burning and pain, swelling in the legs, shortness of breath during exercise and at rest . These manifestations developed slowly over 2 years. For 5 years, shortness of breath has been bothering him, and therefore the patient constantly sleeps in a forced position - sitting in a chair with his legs down. He did not seek medical help. She does not notice any skin diseases before the rash appears.

Objectively: the condition is of moderate severity; consciousness is clear. The patient has a high nutritional status, the fat layer is expressed mainly on the abdomen and thighs. The musculoskeletal system is not deformed, there is no muscle atrophy. Moves with difficulty due to warty growths and severe swelling of the legs and feet.

Lymph nodes are not palpable.

Respiratory organs: shortness of breath during physical exertion and at rest, respiratory rate (RR) 20 per minute; cardiovascular system: rhythmic, muffled tones, heart rate (HR) 74 beats per minute. The abdomen is soft, painless, the liver protrudes from under the costal arch by 1.5-2 cm; Pasternatsky's symptom is negative on both sides. Stool and urine output are normal.

Local status: the process is widespread, localized on both legs and the back of the feet. Against the background of congestive erythema and infiltration, there are multiple papules up to 0.5 cm, rising above the surface of the skin, prone to grouping and merging, with a bumpy surface. Some papules are covered with dry serous-purulent crusts.

In addition, there are single nodes, pustules, superficial ulcers with purulent-necrotic discharge, and oozing. The grooves between vegetations are filled with yellowish-white sticky masses with an ichorous odor. On the right shin there is a dense gray node with a diameter of up to 1 cm. Swelling of both legs, stagnation and lymphostasis are noted (Fig.

1).

Rice. 1. Patient Sh., 68 years old. Diagnosis: Gottron's carcinoid papillomatosis of the skin. Papular-erythematous rash on the skin of the legs with ulceration, serous-purulent discharge, lymphostasis, lymphorrhea.

Pathohistological conclusion of a skin biopsy: in the epidermis, acanthotic cords are represented by elongated spinous cells without signs of atypia, which penetrate into the deep layers of the dermis, but do not violate the integrity of the basement membrane. There is a detachment of epithelial cells, as well as a tendency to keratinization and the formation of “tubular-like” horny masses (Fig. 2).

Rice. 2. Pathohistological conclusion of a skin biopsy of patient Sh. Tubular horny masses in the epidermis. Acanthotic cords penetrating into the deep layers of the dermis.

Complete blood count (CBC): hemoglobin 135 g/l, leukocytes 6.3·109 g/l, erythrocytes 4.36·1012 g/l, platelets 302·109 g/l, ESR 28 mm/h.

General urine analysis (UCA): specific gravity 1020, protein 0, glucose 0, leukocytes 1-4 per field of view, epithelium 2-6 per field of view.

Biochemical blood test: bilirubin 14.7 µmol/l, alanine aminotransferase (ALT) 12.0 U/l, aspartate aminotransferase (AST) 16.0 U/l; total protein 75 g/l; glucose 6.4 mmol/l; cholesterol 5.3 mmol/l.

Microscopy for fungi was carried out twice - negative. There is no growth of mushrooms when sowing twice.

Duplex scanning of the vessels of the lower extremities: during testing, the mouths of the large and small saphenous veins on both sides are consistent. Incompetence of the perforating veins of the legs on both sides, in the Boyd and Cockett zone 2 with a diameter of up to 5 mm.

No hemodynamic disturbances in the deep veins of the lower extremities were detected. The lumen of the veins is free. The compressibility of the veins is satisfactory. The blood flow in the veins is phasic. There is no data for thrombosis and postthrombophlebetic syndrome.

Swelling of the subcutaneous fatty tissue of the legs is pronounced lymphostasis.

Taking into account the clinical manifestations, data from studies and histology, it is possible to conduct a differential diagnosis and exclude diseases such as squamous cell skin cancer, chronic pyoderma vegetans, warty skin tuberculosis, chromomycosis, and confirm the presence of the disease - Gottron's carcinoid papillomatosis of the skin.

The treatment caused a significant improvement: infiltration on the skin of the legs decreased somewhat, weeping stopped, serous and purulent crusts were completely rejected. Areas of gray-brown lenticular papules merging into large foci of lenticular papules remain.

On the right shin there is a dense gray node with a diameter of up to 1 cm.

After discharge from the hospital, the patient is recommended to undergo treatment by an oncologist and additional examination by a cardiologist, vascular surgeon, and endocrinologist. Continue local treatment: lotions if there is weeping, Akriderm GK cream on the legs and feet.

Patient M. , 48 years old, a resident of a rural area, contacted a dermatologist at the clinic of the Krasnoyarsk Regional Dermatovenerological Dispensary with complaints of warty rashes, weeping, swelling of both legs and feet, and difficulty moving.

For 5 years he has been suffering from encephalo-polyneuropathy due to chronic alcoholism, chronic hepatitis, and chronic cholecystitis. Rashes in the area of ​​the legs and feet first appeared at the beginning of 2011. I went to see a dermatologist at my place of residence.

She received treatment for erysipelas (although she did not notice pain or fever) with penicillin 600 thousand 3 times a day for 10 days. I did not notice any effect from the treatment.

On September 26, 2011, I went to the clinic of the regional dispensary with complaints of swelling of the legs, warty rashes, ulcerations, and weeping.

Local status: pronounced infiltration, vegetations with tissue disintegration, serous-purulent discharge, ichorous odor, dirty-gray skin color of the legs, difficulty walking were revealed on both legs and feet. Presumable diagnosis: chromomycosis.

Source: https://www.mediasphera.ru/issues/klinicheskaya-dermatologiya-i-venerologiya/2017/3/1199728492017031029

Gottron's skin carcinoid papillomatosis: diagnosis and treatment of the disease

Gottron's carcinoid papillomatosis of the skin is a rare skin disease with an unknown etiology, which appears against the background of chronic dermatological diseases such as psoriasis, eczema, ichthyosis and a number of others. It lasts a long time and has a chronic form, which is difficult to treat.

Characteristic manifestations are large plaques that rise above the skin, which in size can be compared to the palm of an adult. Localized mainly on the lower extremities.

Diagnosis of the disease is as follows:

• the patient is examined;
• his medical history is carefully studied;
• A histological examination of a tissue sample from the lesion is performed.

Due to the fact that etiotropic treatment has not yet been developed, therapy is carried out aimed at eliminating symptoms. For this, the following drugs are prescribed:

• antibiotics;
• vitamins;
• antiseptics;
• cytostatics.

Symptoms

With this disease, extensive (up to 10-15 cm) plaques are formed, rising above the epidermis (approximately 1-1.5 cm). They are mainly localized in areas of the lower extremities that have been affected by other skin diseases.

Plaques are often located symmetrically, on top they are covered with tumor-like formations, as well as multiple vegetations.

The surface of the plaques and areas located between vegetations is covered with a viscous secretion of a dirty yellow color. When it dries, crusts form that adhere tightly to the surface. Tumor-like lesions are easily amenable to maceration, after which erosive areas appear in their place.

Causes

The etiology of this disease is not fully understood. It was possible to find out that the lesions arise at the site of chronic dermatological pathologies (eczema, psoriasis, ichthyosis, lichen planus and certain forms of tuberculosis of the skin).

• The genetic theory was not confirmed.
• Some experts believe that this pathology is associated with the special reactivity of the body, as well as its predisposition to papillomatous growths.
• In cases with the above skin diseases, there is constant trauma or irritation of the affected areas of the skin, so the tissue reaction to these external manifestations is the development of plaques, which are characteristic of Gottron's carcinoid papillomatosis of the skin.
• This pathological process is aggravated by the addition of saprophytic microflora.

Diagnosis and treatment

The basis for the diagnosis are:

• results of examination by a dermatologist;
• studying the patient's medical history;
• histological studies.

1. Upon examination, symmetrical plaques are revealed, which, due to tumor-like formations and vegetations, resemble cauliflower, covered with a dirty yellow secretion and crusts that emit an unpleasant odor.
2. If the affected lesions have been subjected to maceration, then erosions are found in their place.
3. During the interview, it turns out that the patient had various dermatological diseases on the affected areas of the skin for a long time before the current condition appeared.
4. A skin biopsy and histological examination of the affected tissue reveals acanthosis with the formation of cords that penetrate in the form of thin processes deep into the layers of the dermis.

Some of them are subsequently detached from the epidermis and form epithelial accumulations in the dermis.

Some of the cords and epithelial areas undergo keratinization. Histiocytic and lymphocytic infiltration is also found in the tissues of the affected area. Additionally, pseudocarcinomatous hyperplasia of the epidermis is detected.

But malignant neoplasm cells are not detected.

Differential diagnosis of the disease is carried out with the following diseases:

• squamous cell skin cancer;
• ulcerative-vegetative pyoderma.

Until medications have been developed to treat the cause of the disease, remedies are used to eliminate the symptoms: cytostatic drugs, antibiotics, antiseptics and vitamins.

Of the cytostatics, prospidin is the most effective, followed by xanthinol nicotinate, which improves microcirculation in tissues.

Vitamin preparations normalize metabolism and improve the regenerative properties of the body. Antibiotics are prescribed to prevent secondary infections and have been shown to reduce symptoms.

Various antiseptics are used locally for this disease: furatsilin, potassium permanganate and others, from which lotions are made. Such regular procedures reduce the rate of crust formation, reduce the amount of substance discharged and eliminate the unbearable odor.

Also, according to certain data, intradermal injections of corticosteroid drugs, which are injected around the plaques, reduce pathological manifestations.

However, despite all therapeutic measures, this pathology is difficult to cure and does not in all cases respond to the medications used.

Despite the extensive symptoms and severity of pathological manifestations, this disease extremely rarely threatens the patient’s life, because it does not transform into a malignant disease.

The only dangerous thing is the risk of a secondary infection, which can become a source of severe purulent inflammation and the resulting toxic shock or sepsis.

In addition, the unbearable smell and ugly appearance of the emerging manifestations poison the patient’s life and can cause psychological disorders in him.

Prevention

Prevention of this disease consists of timely and complete treatment of skin pathologies, which in the future may become the cause for the development of this condition.

Source: https://profmedblog.ru/kozhnye-zabolevaniya/karcinoidnyy-papillomatoz-kozhi-gottrona