Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Observation Letter
doi: 10.4103/ijdvl.IJDVL_306_19
PMID: 31823900

A case of multiple eruptive dermatofibromas in a Chinese man with chronic inactive hepatitis B infection

Conghui Li, Wenju Wang, Liwen Zhang, Lei Xu
 Department of Dermatology, Chengdu Second People's Hospital, Chengdu, Sichuan, China

Correspondence Address:
Conghui Li
No. 165 of Caoshi Street, Department of Dermatology, Chengdu Second People's Hospital, Chengdu 610000, Sichuan
Published: 04-Dec-2019
How to cite this article:
Li C, Wang W, Zhang L, Xu L. A case of multiple eruptive dermatofibromas in a Chinese man with chronic inactive hepatitis B infection. Indian J Dermatol Venereol Leprol 2020;86:72-75
Copyright: (C)2020 Indian Journal of Dermatology, Venereology, and Leprology


We report the case of multiple eruptive dermatofibromas in a Chinese man with chronic inactive hepatitis B infection. We were unable to find any previous reports of such association.

A 35-year-old man presented for evaluation of multiple asymptomatic lesions on his trunk, which appeared within a period of approximately 6 months [Figure - 1]a, [Figure - 1]b, [Figure - 1]c. On physical examination, more than 100 reddish-brown papules were observed on his trunk, mainly on the chest. They ranged in size from 2 to 10 mm, were symmetrical, firm, reddish-brown, nonconfluent and remained stable over time. No lesions were found on the head, limbs or mucous membranes. There was no regional lymphadenopathy. The patient had no antecedent trauma. He was in good health previously, and both medical history and family history were unremarkable.

Figure 1:

Dermoscopy of a representative lesion showed a central reddish-brown patch with peripheral light brown network. In some lesions linear or arborizing telangiectasia were seen, and in some, both the features were noted [Figure - 2]a, [Figure - 2]b. Histopathological examination of a representative lesion revealed a fibrous spindle-cell proliferation in the dermis with a swirling storiform appearance and the periphery had entrapment of dermal collagen fibers [Figure - 3]. The diagnosis of multiple eruptive dermatofibromas was made, based on the clinical manifestation and dermatoscopic findings, along with histopathological confirmation.

Figure 2:
Figure 3: Bundles of fibrous spindle cells in the dermis (H and E, ×100)

Laboratory tests showed a raised triglycerides level (1.91 mmol/L; normal range 0.4–1.73 mmol/L); ultrasonography showed densely enhanced liver parenchyma echo; and further investigation revealed that HBsAg, HBcAb, and HBeAb were positive. HBV-DNA level was less than 1000 IU/ml. Other laboratory investigations including full blood count, liver function tests, renal function tests and blood glucose were normal. Lymphocyte subgroup detection revealed decreased CD3 + T cell count (456.00; normal range 770.00–2860.00), CD4 + T cell count (308.00; normal range 500.00–1440.00), CD8 + T cell count (116.00; normal range 238.00–1250.00), and a raised CD4/CD8 ratio (2.66; normal range 1.00–2.47).

No other abnormal laboratory results were noted, including human immunodeficiency virus test and autoimmunity tests such as antinuclear antibody, antihepatocyte membrane antibody, antismooth muscle antibody, antiliver and kidney microsomal antibody, antisoluble liver antigen, antimitochondrial antibody and antimitochondrial antibody M2. As the patient recounted no other remarkable symptoms, he was diagnosed as chronic inactive hepatitis B infection and hypertriglyceridemia based on the laboratory examination. The patient was recommended for follow-up every 3 months with no active treatment.

Dermatofibroma is a benign cutaneous lesion which generally occurs as a solitary reddish-brown or dark-brown firm papule or nodule on lower legs in middle-aged individuals with a slight female preponderance. However, multiple eruptive dermatofibromas is a rare skin condition, defined as presence of more than 15 lesions or 5-8 dermatofibromas that appear within a period of 4 months.[1] Less than 100 cases of multiple eruptive dermatofibromas have been reported in the literature, and it is usually associated with autoimmune diseases and immunosuppression.[2]

The presence of multiple eruptive dermatofibromas is frequently associated with systemic lupus erythematosus or, less commonly, other autoimmune diseases, such as myasthenia gravis, pemphigus vulgaris, ulcerative colitis, sarcoidosis and Graves' disease.[2],[3],[4] The association of multiple eruptive dermatofibromas with hepatitis B infection has not been described previously. The pathogenesis of dermatofibroma is unclear. Some patients developed multiple eruptive dermatofibromas after the intake of immunosuppressive drugs[5] and in the context of human immunodeficiency virus infection,[1] suggesting an immunopathogenic etiology. It was proposed that dermatofibroma represents an abortive immunoreactive process mediated by dermal dendritic cells, and the development of multiple eruptive dermatofibromas can be triggered by the inhibition of regulatory T cells in immunodeficiency states or as an exaggerated response to a putative pathogen that could not be cleared by the suppressed immune system.

Studies have revealed defective T-cell immunity in hepatitis B virus infection, which is described as the 'exhaustion' state, characterized by poor effector cytotoxic activity, impaired cytokine production, and sustained expression of multiple inhibitory receptors, such as programmed cell death-1, lymphocyte activation gene-3, cytotoxic T-lymphocyte-associated antigen-4, and CD244.[6]

In our case, the patient showed decrease in regulatory T cells. Although some previous studies reported multiple eruptive dermatofibromas developing in patients with diabetes mellitus, obesity, hypertension, and hypertriglyceridemia as in our case, it seems to be questionable whether there is any correlation between multiple eruptive dermatofibromas and these diseases.[2] In conclusion, more cases and research are required to speculate on the pathogenesis and it is important to screen for altered immunity in patients with multiple eruptive dermatofibromas.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

Ammirati CT, Mann C, Hornstra IK. Multiple eruptive dermatofibromas in three men with HIV infection. Dermatology 1997;195:344-8.
[Google Scholar]
Niiyama S, Katsuoka K, Happle R, Hoffmann R. Multiple eruptive dermatofibromas: a review of the literature. Acta Derm Venereol 2002;82:241-4.
[Google Scholar]
Goldbach H, Wanat K, Rosenbach M. Multiple eruptive dermatofibromas in a patient with sarcoidosis. Cutis 2016;98:E15-9.
[Google Scholar]
Lopez N, Fernandez A, Bosch RJ, Herrera E. Multiple eruptive dermatofibromas in a patient with Graves-Basedow disease. J Eur Acad Dermatol Venereol 2008;22:402-3.
[Google Scholar]
Llamas-Velasco M, Fraga J, Solano-López GE, Steegmann JL, García Diez A, Requena L. Multiple eruptive dermatofibromas related to imatinib treatment. J Eur Acad Dermatol Venereol 2014;28:979-81.
[Google Scholar]
Ye B, Liu X, Li X, Kong H, Tian L, Chen Y. T-cell exhaustion in chronic hepatitis B infection: Current knowledge and clinical significance. Cell Death Dis 2015;6:e1694.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections