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[Bullous paraneoplastic acrokeratosis].

A Schoeffler1, V Sagot, A Marzin

  • 1Service de Dermatologie, Centre Hospitalier de Valence.

Annales De Dermatologie Et De Venereologie
|August 4, 2006
PubMed
Summary

This study details a rare case of Bazex's syndrome (acrokeratosis paraneoplastica) presenting with bullous lesions. Treatment of the underlying cancer led to the resolution of these unusual acral bullae.

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Area of Science:

  • Dermatology
  • Oncology
  • Immunology

Background:

  • Bazex's syndrome, or acrokeratosis paraneoplastica, is a rare paraneoplastic condition.
  • Bullous lesions on the extremities are an uncommon manifestation of Bazex's syndrome.

Observation:

  • A 65-year-old male with a history of alcohol and smoking presented with acrokeratosis paraneoplastica and a cervical lymph node mass, later diagnosed as piriform sinus epidermoid carcinoma.
  • The patient developed worsening acral keratotic lesions, accompanied by painful, hemorrhagic bullous lesions on his feet and toes.
  • Histopathology revealed subepidermal blisters with eosinophils, and direct immunofluorescence showed C3, IgA, and IgM deposits.

Findings:

  • The patient exhibited blood eosinophilia and elevated IgE levels.
  • Treatment with radiation and chemotherapy for the epidermoid carcinoma resulted in the healing of bullous lesions and regression of keratotic lesions.

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  • The bullous lesions mimicked autoimmune bullous diseases, suggesting an immunological basis.
  • Implications:

    • This case highlights that bullous lesions, though rare, can be an early sign of Bazex's syndrome.
    • The findings suggest an immunological reaction involving the dermal-epidermal junction and eosinophils in the pathogenesis of these bullous lesions.
    • Successful cancer treatment led to the resolution of paraneoplastic dermatological manifestations.