A Bullous Pilomatricoma Developed after Hepatitis-A Vaccination

Abstract

A Bullous Pilomatricoma Developed after Hepatitis A VaccinationThe Editor, Sir, Pilomatricomas originate from hair matrix cells and usually appear as firm, solitary and asymptomatic nodules beneath the skin. These tumours occur mostly in children. They are generally located on the face and neck (1). Bullous pilomatricoma is an uncommon lesion and only few cases of this variant have been reported in the literature (1, 2). We report a 7-year old girl with a pilomatricoma showing bullous appearance. The patient suffered from a dome shaped, bullous mass on the left arm. The 1.5 × 1.5 cm lesion presented one month previously and progressively enlarged. In the history of the patient, there was a hepatitis A vaccination to the same area with the bullous lesion, about four months earlier. Two days after the vaccination, severe inflammation occured in the same region. The patient did not have any family history of such or mechanical trauma. On dermatologic examination, a dome shaped, red-brown coloured, semi-translucent bullae was noted (Fig. 1A).The bullae collapsed inward with palpation and a firm, small, painless mass was felt at the bottom of the lesion. When the lesion was pressed with the tip of a pen, it had a wrinkledatrophic appearance (Fig. 1B). The other physical and systemic examination findings were normal and there was no lymphadenopathy. Routine haematological and biochemical examinations of the patient were within the normal limits. With dermatoscopy, red-coloured tortuous small vessels on an irregular white opacity, which settled on a livid-red background, were observed (Fig. 1C).Needle aspiration material of the bullae was haemorrhagic and its microbiological culture was sterile. With these findings, the diagnosis of the lesion was made as a "bullous pilomatricoma". The mass was totally removed with surgical excision. On histopathological examination, the tumour nests were composed of eosinophilic shadow cells, basophilic cells and surrounded by a fibrous capsule in the deep dermis. Calcium salt depositions were observed in the tumour mass. In the superficial dermis, marked lymphoedema and increased numbers of dilated lymphatics filled with eosinophilic lymph fluid were observed (Fig. 2). Bullous pilomatricoma is a very rare form of pilomatricoma (3). Their incidence is between 3% and 6% (1). Although pilomatricomas can be associated with other genetic disorders such as myotonic dystrophy and Gardner's syndrome, the bullous variant is not associated with these syndromes (2). The bullous lesions are located mostly in the shoulder and upper extremity and predominantly in females. They are usually asymptomatic lesions (1, 2). Clinical characteristics reported include semi-transparent, erythematous, bluish or skin-coloured, heavily folded or striae-like, flaccid blisters overlying a solitary, firm-to-hard nodule (2, 4). Mechanical irritations such as continuous mechanical stimulation, scratching and pinching trauma and continuous pressure play an important role in the development of bullous pilomatricomas ...

Bullous Pilomatricoma After Influenza Vaccination

“… 3 In a bullous pilomatricoma, in addition to these findings, lymphoedema and dilated lymphatic vessels in the superficial dermis can be found in most cases. 5 , 8 These lymphatic findings have been described as standard pathologic features.…”

“…Here we described a case of bullous pilomatricoma arising after influenza vaccination. Although there has been a report about an association between bullous pilomatricoma and hepatitis A vaccination, 5 an association with influenza vaccination has not been reported previously.…”

Multiple Postvaccinal Pilomatrixomas in a Child

“…9 Finally, a bullous pilomatrixoma that appeared a few days after a hepatitis A vaccination was described in a 7-year-old child. 10 All 3 were located on the outer arms and were surgically removed with histological confirmation. More generally, postvaccination tumors such as keratoacanthoma, epithelial cyst, cutaneous B-cell pseudolymphoma, basal cell carcinoma, or squamous cell carcinoma could be induced by injection trauma, persistent inflammation/wound healing, scarring, and/or the inoculated inactivated/attenuated infectious agent itself.…”

Enlarging tumor of the lateral chest wall in a 14‐year‐old boy

“…Based on a review of the literature available in 2014 [ 6 ] , the following clinical and epidemiological data on 45 patients with anetodermic pilomatricoma were obtained: average age: 19 years; female predominance; average tumor size: 29 × 23 mm; most frequent location: arm (37.8 %); average interval between onset and surgery: 12 months; occasionally, there was a history of trauma (5/45). Since then, there have been four case reports of females with such a tumor on the upper arm [7][8][9][10] and one report of a 24-year old man with a pilomatricoma on the right shoulder [ 11 ] . Our patient was also male, and developed said tumor on the right chest wall at the age of 14.…”

“…The tumor produces enzymes that degrade collagen and elastic fi bers and cause lymphatic dilatation [ 12,14 ] . Task et al described a 7-year-old girl who had developed an anetodermic pilomatricoma at the same site on the left arm where a hepatitis A vaccination had been administered four months earlier [ 7 ] . Proposed trigger factors for the development of the tumor included both trauma due to the injection as well as an infl ammatory immune response due to the vaccine.…”