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April 2010

An Erythematous Plaque Filled With Open and Closed Comedones—Diagnosis

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Arch Dermatol. 2010;146(4):439-444. doi:10.1001/archdermatol.2010.38-b

Histopathologic examination revealed multiple cystic spaces lined by flattened squamous epithelium and filled with keratin. Also, there was an inflammatory infiltrate composed of mononuclear cells and neutrophils. No intervention was undertaken given the very mild associated symptoms and the patient's poor prognosis. During his hospital stay, the patient was diagnosed as having recurrent esophageal cancer. He died shortly thereafter.

Radiation-induced skin injury is a well-known sequela of radiation therapy. Skin changes have been reported with the use of all forms of therapeutic radiation (superficial, cobalt, deep, and fluoroscopy).1 Radiation dermatitis is traditionally classified as acute or chronic. Acute radiation dermatitis usually occurs within 90 days of radiation exposure and is graded based on clinical presentation.1 The continuum spans grade 1 erythema and dry desquamation and culminates with grade 4 skin necrosis and ulceration.1 Chronic radiation dermatitis occurs months to years after the initial radiation exposure and is characterized by pigmentary disruption, xerosis, hyperkeratosis, and persistent telangiectasia or poikiloderma.1 In addition to traditional radiation dermatitis, there are multiple case reports of other skin processes confined to a radiation field, including asteatotic eczema, Sweet syndrome, lichen planus, and pemphigus.14

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