Eosinophilic annular erythema limited on the palms and the soles and possibly associated with thymoma

Abstract

and an antibody response to L1 HPV proteins. HPV 16 and HPV 18 (high-risk genotype) cause cervical cancer and squamous cell carcinoma (tonsils, larynx, anus, vulva and penis) whereas HPV 6 and HPV 11 (low-risk genotype) cause warts and condylomas. Conventional treatments for HPV infection involve topical drugs (podophyllotoxin, imiquimod, retinoid acid derivatives) and, in case of failure, CO2 laser ablation. The two HPV vaccines, the bivalent vaccine (Cervarix, Glaxo Smith Kline) and the quadrivalent vaccine (Gardasil, Sanofi Aventis MerckSharp&Dome) remain the only preventive measure against most HPV-related diseases. Several immunodeficiencies (epidermodysplasia verruciformis, WHIM syndrome, SCID, CVID, HIV, etc.) result in severe HPV. 1,2 In the immunocompromised, treatment and cure of HPV may represent a complex and challenging task.The identification of a high-risk HPV genotype in our patient prompted us to investigate the potential effect of the quadrivalent vaccine (HPV 6/11/16/18 subtypes). Our observation of a complete remission of plantar warts after the second dose with absence of genital response is intriguing.To our knowledge, the treatment with HPV vaccine of a few anecdotal cases with recalcitrant warts and condylomas has produced ambiguous results. 3-6 Although spontaneous regression of warts may occur, a role for HPV vaccination in the immunocompromised is undefined. A thorough analysis of HPV innate and adaptive immune response will help guide a prudent answer to this unexpected dual response. Yet, prospective randomized multicentre clinical trials are warranted to investigate whether HPV vaccines can treat common warts and/or prolong their progression time with significant advances on the immune mechanisms that control HPV infection and potential impact on the quality of life of our patients.

Eosinophilic Annular Erythema Localized to the Palms and the Soles

“…EAE generally involves trunk or extremities. A case of EAE limited to palms and soles that showed similar features to our cases was recently reported5. That case was associated with thymoma, although the pathogenetic correlation between them was unclear.…”

“…That case was associated with thymoma, although the pathogenetic correlation between them was unclear. The case of Iga et al5 and our cases suggest that EAE migrating mainly to palms and soles may be a unique clinical spectrum of EAE. In addition, hydroxychloroquine with prednisolone is suggested to be first-line treatment for EAE localized to palms and soles.…”

Annular erythematous plaques on the trunk

“…As the name indicates, the disease is characterized by recurrent annular, polycyclic, or gyrate plaques with central clearing and erythematous border that may turn violaceous with long standing disease. The cutaneous lesions occur predominantly on the trunk and extremities, with possible involvement of the palms and soles . Laboratory tests may be noncontributory although in some cases may show peripheral eosinophilia.…”

“…Laboratory tests may be noncontributory although in some cases may show peripheral eosinophilia. Histopathology is characterized by dense superficial and deep perivascular and interstitial inflammatory infiltrate of lymphocytes and abundant eosinophils . The etiology has not yet been determined, although a possible hypersensitive reaction to an unknown antigen was postulated …”

“…Similar to WS, the cases of EAE have been reported to be associated with various systemic diseases. Underlying neoplasm (prostate and renal carcinoma, thymoma), autoimmune disease (thyroiditis) and infections (chronic borreliosis, chronic hepatitis C) were reported, therefore an exhaustive investigation is required …”