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His antinuclear antibody titers were slightly elevated to 40 U (normal Small molecule library negative. Therefore, we performed a skin biopsy of his right cheek, and cutaneous histopathological analysis with hematoxylin and eosin staining revealed parakeratosis and hyperkeratosis of the horny layer. Hydropic degeneration and vacuolar changes to the basal layer were also observed. However, in the dermis, typical dense lymphoid cells were observed around the follicles and eccrine glands (fig. ?(fig.3).3). Mucin depositions were observed in the dermal stroma, and periodic acid-Schiff stain revealed that the basement membranes were thicker than those in normal skin. A direct immunofluorescence histopathology test revealed IgG deposition on the basement membrane zone and perifollicular areas (not shown). Based on these findings, we diagnosed his eruption as DLE. He used tacrolimus ointment, with good response. Fig. 3 Histopathological findings. Parakeratosis and hyperkeratosis of the horny skin layer as well as hydropic degenerations and vacuolar changes to the basal layer are visible. In the dermis, typical Sunitinib cost dense lymphoid cells are visible around the follicles or ... Discussion From the lateral view, our case was Fossariinae clinically characterized by facial DLE that originally appeared to be tinea faciei or granulomatous cutaneous disease (fig. ?(fig.2)2) [5, 6, 7]. Only one case of coexisting DLE and tinea faciei [5] and two cases of tinea faciei mimicking lupus erythematosus have been reported [6, 7]. A previous report also showed that DLE confused sarcoidosis, granuloma annulare and granuloma faciale [4]. In addition, our case exhibited bilateral eyelid involvement (fig. ?(fig.1),1), and the eyelid DLE appeared to be blepharitis or allergic dermatitis. However, eyelid involvement is rare for DLE (only 6% of cases), and it is typically accompanied by other cutaneous eruptions [1]. Similar to our case, Gupta et al. [1] stated that the diagnosis of eyelid DLE can be significantly delayed due to difficulty in obtaining histopathology samples. DLE has various uncommon subtypes [1, 2, 3, 4, 5], although the causes of these peculiar DLE subtypes are not clear [2]. The symptoms of facial DLE may mimic tinea faciei [6, 7] and other granulomatous cutaneous diseases [4]. Histopathologically, our case showed hyperkeratosis with parakeratosis, and no severe epidermal atrophy.