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Hypereosinophilic syndrome (HES) is a rare haematologic disorder characterised by unexplained, persistent eosinophilia with organ involvement. We report the case of a 74-year-old patient who presented with a pemphigoid-like bullous rash as the only manifestation of an HES. This report highlights the importance of the dermatological manifestations of this potentially life-threating condition that may initially present as a skin-limited disease. Bullous pemphigoid (BP) is a very common autoimmune blistering dermatosis that may share common clinical and histological features or associate with an HES. HES should be considered when patients diagnosed with BP demonstrate atypical course under corticosteroids and/or recalcitrant blood eosinophilia., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Competing Interests: Competing interests: None declared.

Competing Interests: None disclosed.

Background: Blood eosinophilia is often associated with various dermatoses, such as atopic eczema, urticaria, drug eruption, bullous pemphigoid, and hypereosinophilic syndrome (HES). Differential diagnosis is very challenging due to the similarities of clinical and pathological characteristics.Purpose: To investigate and analyze the clinical characteristics of dermatoses associated with blood eosinophilia (DABE) to further optimize disease management.Patients and Methods: We conducted a retrospective analysis on 397 DABE patients with blood absolute eosinophil count (AEC) greater than or equal to 0.5× 109/L. Clinical characteristics, laboratory values, treatment course, and associated diagnoses were evaluated. All DABE patients were grouped based on the severity of eosinophilia as mild group (0.5 ≤ AEC× 109/L < 1.5), moderate group (1.5 ≤ AEC× 109/L < 3), and severe group (AEC× 109/L ≥ 3).Results: Our study revealed three distinct patterns: (1) Mild eosinophilia associated with localized skin lesions, atopic history, mildly elevated total serum IgE level, diagnosed with eczema/dermatitis, and frequent antihistamines use. (2) Moderate eosinophilia has the characteristics of both mild group and severe group. (3) The severe eosinophilia group had a high proportion of elderly people without atopic history, but with acute onset, generalized skin lesions, and high level of lactate dehydrogenase, and the majority of them were diagnosed with systemic diseases (HES or tumor).Conclusion: We summarize the clinical rules of dermatoses associated with blood eosinophilia, hoping to facilitate the diagnosis and treatment for patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: As dermatologists, we must be aware that even limited localized lesions may signal a life‐threatening condition, for which early diagnosis and treatment can improve the prognosis. Bullous pemphigoid is an autoimmune disorder characterized by blister formation. Hypereosinophilic syndrome is a myeloproliferative disorder featuring papules, nodules, urticarial lesions, and blisters. The coexistence of these disorders may highlight the involvement of common molecular and cellular factors. Here, we describe a 16‐year‐old patient with hypereosinophilic syndrome and bullous pemphigoid. [ABSTRACT FROM AUTHOR]

A collision tumour is characterized by the presence of at least two different skin neoplasms in the same lesion. Collision skin tumours develop quite rarely. The case presents a 58-year-old woman in whom an asymmetric skin lesion of undetermined duration was noted during routine dermoscopy. The skin lesion consisted of two clinically distinct components. The patient remained under a 4-month follow-up. At the next visit, a change in the appearance of the previously present lesion was observed. The lesion was excised and submitted for histopathological examination, which was consistent with the diagnosis of a collision tumour composed of dysplastic nevus and basal cell carcinoma. This article discusses the characteristics and diagnostic difficulties in the diagnosis of collision tumours based on the available English literature. Furthermore, highlighted is the value of a non-invasive imaging modality which is dermoscopy in diagnosing not only melanoma and non-melanoma skin cancer but also complex lesions such as collision tumours. [ABSTRACT FROM AUTHOR]

Background: Hypereosinophilic syndrome (HES) encompasses a group of diseases with blood hypereosinophilia and eosinophil‐mediated organ dysfunction. HES‐associated skin abnormalities, termed cutaneous HES (cHES) here, may influence diagnosis of HES. We sought to better define clinical and histopathological features of cHES. Methods: We retrospectively reviewed clinical records and cutaneous histopathology of adult patients with HES evaluated at our institution from 2007 to 2018. Results: Forty‐one percent (61/150) patients with HES had cHES. The most common clinical morphologies were urticarial (30%) and eczematous (26%). Skin specimens most often showed a spongiotic pattern (31%) with abundant inflammation (50%) including eosinophils (85%). Two specimens (8%) showed interstitial granulomatous dermatitis, and two specimens showed eosinophilic fasciitis (8%). Vasculitis was not identified in any specimen. Eighty‐four percent of patients with cHES had ≥1 other organ system involved: pulmonary 41%, ENT 26%, and nervous 23%. Sixty percent (53/89) of non‐cHES patients had at least two organ systems involved. Cardiac or gastrointestinal involvement was more common in non‐cHES than cHES (p < 0.05). Conclusion: Our review confirms that there are no specific clinical or histopathological cHES patterns, but HES should be considered in patients who have eczematous or urticarial reactions of unknown etiology and persistent peripheral hypereosinophilia. [ABSTRACT FROM AUTHOR]

Follicular psoriasis (FP) is an uncommon clinical subtype of psoriasis that presents with discrete or grouped, follicular, hyperkeratotic papules.[1] FP is generally underdiagnosed and can be confused with other diseases such as lichen planopilaris, keratosis pilaris, papular atopic dermatitis, and pityriasis rubra pilaris (PRP).[[2]] Because of shared histopathological findings, FP can also mimic seborrheic dermatitis. (d) Beneath an epidermis with confluent parakeratosis, there is a dense perifollicular lymphohistiocytic infiltrate adjacent to a follicle with parakeratosis and neutrophilic pustule (H&E, ×50). [Extracted from the article]

Primary cutaneous γδ T-cell lymphoma (PCGD-TCL) is an extremely rare and aggressive T-cell neoplasm with complex heterogeneity. We present a series of two patients who presented with firm, subcutaneous nodules and were diagnosed with PCGD-TCL. In both cases, biopsies demonstrated a both superficial and deep adnexotropic infiltrate comprised of angiocentric, medium- to large-sized atypical lymphocytes. The infiltrate extended into the panniculus. Immuno–histochemical stains highlighted atypical lymphocytes that expressed CD3, CD8 and CD56 but were negative for EBV ISH. A brisk histiocytic response with focal aggregation into granulomas was highlighted with a PG-M1 stain. The atypical lymphocytes were positive for gene rearrangements on a TCR delta stain and negative for βF-1. CT and PET scan in one of the two patients demonstrated diffuse, subcutaneous, ground-glass foci; hypermetabolic soft tissue nodules; and lymphadenopathy in the lungs, as well as splenomegaly. A diagnosis of histiocyte-rich PCGD-TCL was rendered. A histiocyte-rich, granulomatous variant of γδ T-cell lymphoma is extremely rare. Its potentially misleading resemblance to inflammatory granulomatous conditions could pose a diagnostic pitfall in this already challenging condition. This variant may resemble granulomatous mycosis fungoides and granulomatous slack skin syndrome, but it has a distinct, aggressive clinical outcome. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that there is no conflict of interest.

The aim of this study was to assess the impact of three sources of pollution (landfill leachate, wastewater and mining activities) on the physico-chemical characteristics of surface water and groundwater in the northern region of Marrakech (Morocco). Numerous groundwater samples and surface water (Tensift River) samples were collected during the dry season and analysed. The groundwater samples had a high conductivity, which varied between 0.95 and 7.40 mS/cm; the conductivity of the surface water samples varied between 1.31 and 15.84 mS/cm. pH varied between 6.64 and 8.10 for groundwater and between 6.70 and 8.40 for surface water. The results showed that groundwater and surface water had a degraded quality in the region. Principal component analysis (PCA) enabled identification of the impact of pollution sources by combining the upstream and the downstream points. These results also showed that, in the study area, the effect of wastewater and the mine were dominated those of the landfill. [ABSTRACT FROM PUBLISHER]

We present a case study for Bayesian analysis and proper representation of distributions and dependence among parameters when calibrating process-oriented environmental models. A simple water quality model for the Elbe River (Germany) is referred to as an example, but the approach is applicable to a wide range of environmental models with time-series output. Model parameters are estimated by Bayesian inference via Markov Chain Monte Carlo (MCMC) sampling. While the best-fit solution matches usual least-squares model calibration (with a penalty term for excessive parameter values), the Bayesian approach has the advantage of yielding a joint probability distribution for parameters. This posterior distribution encompasses all possible parameter combinations that produce a simulation output that fits observed data within measurement and modeling uncertainty. Bayesian inference further permits the introduction of prior knowledge, e.g., positivity of certain parameters. The estimated distribution shows to which extent model parameters are controlled by observations through the process of inference, highlighting issues that cannot be settled unless more information becomes available. An interactive interface enables tracking for how ranges of parameter values that are consistent with observations change during the process of a step-by-step assignment of fixed parameter values. Based on an initial analysis of the posterior via an undirected Gaussian graphical model, a directed Bayesian network (BN) is constructed. The BN transparently conveys information on the interdependence of parameters after calibration. Finally, a strategy to reduce the number of expensive model runs in MCMC sampling for the presented purpose is introduced based on a newly developed variant of delayed acceptance sampling with a Gaussian process surrogate and linear dimensionality reduction to support function-valued outputs. [ABSTRACT FROM AUTHOR]