Hyaluronidase in the treatment of papular dermal mucinosis: First case reported in North America

  • Arathi Ramamurthi Texas A&M Science Center School of Medicine
  • Lindsay Bicknell 1Texas A&M Health Science Center College of Medicine, Temple, Texas, United States of America 2 Baylor Scott & White Health Department of Dermatology, Temple, Texas, United States of America
  • Morgan McCarty 1Texas A&M Health Science Center College of Medicine, Temple, Texas, United States of America 2 Baylor Scott & White Health Department of Dermatology, Temple, Texas, United States of America
Keywords: papular mucinosis, discoid lupus erythematosus, systemic lupus erythematosus, monoclonal gammopathy, paraproteinemia, hyaluronidase

Abstract

Papular mucinosis is an uncommon, idiopathic disorder characterized by dermal mucin deposition and increased collagen in the skin and internal organs. Its clinical presentation is characterized by dome-shaped, flesh colored papules that are closely spaced or linearly arranged. Papular mucinosis has been individually associated with several entities that include discoid lupus erythematosus, systemic lupus erythematosus and monoclonal gammopathy of undetermined significance. We encountered a 60-year-old woman with papular mucinosis in the setting of three concurrent disorders: discoid lupus erythematous, systemic lupus erythematosus and IgG paraproteinemia. Furthermore, we have reported the first case in North America of papular mucinosis being successfully treated with intralesional hyaluronidase.

References

Cokonis Georgakis CD, Falasca G, Georgakis A, Heymann WR. Scleromyxedema. Clin Dermatol 2006; 24(6): 493– 497. doi: 10.1016/j.clindermatol.2006.07.011.

Cather C, Menter MA. Diffuse eruption of pigmented papules. Proc (Bayl Univ Med Cent) 2001; 14(2): 185–186.

Thatte SS, Dongre AM, Chikhalkar SB, Khopkar US. Papular mucinosis associated with monoclonal gammopathy of undetermined significance. Indian J Dermatol Vene¬reol Leprol 2015; 81(2): 213–214. doi: 10.4103/0378- 6323.152308.

Shekari AM, Ghiasi M, Ghasemi E, Kani ZA. Papulonod-ular mucinosis indicating systemic lupus erythematosus. Clin Exp Dermatol 2009; 34(8): e558–e560. doi: 10.1111/j.1365-2230.2009.03235.x.

Rongioletti F, Parodi A, Rebora A. Papular and nodular mucinosis as a sign of lupus erythematosus. Dermatologica 1990; 180(4): 221–223. doi: 10.1159/000248034.

Pandya AG, Sontheimer RD, Cockerell CJ, Takashima A, Piepkorn M. Papulonodular mucinosis associated with systemic lupus erythematosus: Possible mechanisms of in-creased glycosaminoglycan accumulation. J Am Acad Dermatol 1995; 32(2 Pt 1): 199–205. doi: 10.1016/0190- 9622(95) 90126-4.

Lamberts RJ, Lynch PJ. Nodular cutaneous mucinosis associated with lupus erythematosus. Cutis 1981; 28(3): 294–295, 297–299.

Jackson BA, Norum RA, Lowe L, Fivenson DP. Pap-ulonodular dermal mucinosis in systemic lupus erythema-tosus. J Rheumatol 1994; 21(5): 940–941.

Maruyama M, Miyauchi S, Hashimoto K. Massive cuta-neous mucinosis associated with systemic lupus erythema-tosus. Br J Dermatol 1997; 137(3): 450–453. doi: 10.1111/ j.1365-2133.1997.tb03757.x.

Gold SC. An unusual papular eruption associated with lupus erythematosus. Br J Dermatol 1954; 66(12): 429–433. doi: 10.1111/j.1365-2133.1954.tb12574.x.

Lowe L, Rapini RP, Golitz LE, Johnson TM. Papulonodu-lar dermal mucinosis in lupus erythematosus. J Am Acad Dermatol 1992; 27(2 Pt 2): 312–315. doi: 10.1016/0190- 9622(92)70188-L.

Weigand DA, Burgdorf WHC, Gregg LJ. Dermal mucino-sis in discoid lupus erythematosus. Arch Dermatol 1981; 117(11): 735–738. doi: 10.1001/archderm.1981.01650110¬057022.

Ortiz VG, Krishnan RS, Chen LL, Hsu S. Papulonodular mucinosis in systemic lupus erythematosus. Dermatol On-line J 2004; 10(2): 16.

Mandell JA, Glick JB, Kaur RR. Scleromyxedema: A rare disorder associated with monoclonal gammopathy. J Drugs Dermatol 2014; 13(5): 619–620.

Ertam I, Karaca N, Ceylan C, Kazandi A, Alper S. Discrete papular dermal mucinosis with hashimoto thyroiditis: A case report. Cutis 2011; 87(3): 143–145.

Abbott RA, Calonje E, Almaani N, Kulasegram R, McGibbon D. Widespread papules in a patient with human immunodeficiency virus. Papular mucinosis in association with HIV infection. Clin Exp Dermatol 2010; 35(7): 801– 802. doi: 10.1111/j.1365-2230.2010.03830.x.

Azaña JM, De Misa RF, Casado J, Muñoz E, Ledo A. Papular mucinosis associated with human-immunodefici-ency-virus infection. Int J Dermatol 1996; 35(9): 652–654. doi: 10.1111/j.1365-4362.1996.tb03693.x.

Biro DE, Lynfield YC, Heilman ER. Papular mucinosis and human immunodeficiency virus infection. Cutis 1995; 55(2): 113–114.

Ruiz-Rodriguez R, Maurer TA, Berger TG. Papular mu-cinosis and human immunodeficiency virus infection. Arch Dermatol 1992; 128(7): 995–996. doi: 10.1001/archderm. 128.7.995.

Gildersleeve RF, Krik JF, Cooper PH, Greer KE. Papular mucinosis associated with acquired immunodeficiency syndrome. Cutis 1995; 55(3): 174-176.

Yokoyama E, Muto M. Adult variant of self-healing papu-lar mucinosis in a patient with rheutmatoid arthritis: Pre-dominant proliferation of dermal dendritic cells expressing CD3 or factor XIIIa in association with dermal deposition of mucin. J Dermatol 2006; 33(1): 30–35. doi: 10.1111/j. 1346-8138.2006.00005.x.

Lee A, Grummer SE, Kriegel D, Marmur E. Hyaluronidase. Dermatol Surg 2010; 36(7): 1071–1077. doi: 10.1111/j. 1524-4725.2010.01585.x.

Menon P, Smith KJ, Crittenden J, Skelton H. Adjuvant therapy with hyaluronidase prior to excision of dermatofi-brosarcoma protuberans. Dermatol Surg 1999; 25(3): 205– 209. doi: 10.1046/j.1524-4725.1999.08148.x.

Höbarth K, Maier U, Marberger M. Topical chemoprophy-laxis with mitromycin C and adjuvant hyaluronidase. Eur Urol 1992; 21(3): 206–210.

Beckenlehner K, Bannke S, Spruß T, Bernhardt G, Sch-önen¬berger H, et al. Hyaluronidases enhance the activity of adriamycin in breast cancer models in vitro and in vivo. J Can¬cer Res Clin Oncol 1992; 118(8): 591–596. doi: 10.1007/BF01211802.

Smith KJ, Skelton HG, Turiansky G, Wagner KF. Hyalu-ronidase enhances the therapeutic effect of vinblastine in intralesional treatment of Kaposi’s sarcoma. J Am Acad Dermatol 1997; 36(2 Pt1): 239–242. doi: 10.1016/S0190- 9622(97)70288-3.

Published
2019-01-22
Section
Short Communications