Contiguous cutaneous inflammation

Contiguous cutaneous inflammation (CIS) is a circumscribed, often painful, erysipelas-like inflammation of the skin superimposed on a pathologic process that has a direct topical relationship to a deeper pathologic process (bacterial or sterile abscess, neoplasm-associated inflammation, foreign body, osteomyelitis, sinusitis, etc.).

Contiguous cutaneous inflammation is characterized by a circumscribed inflammatory reaction of the skin that is adjacent to and directly superimposed on a pathologic process, thus having a direct topographic relationship to a deeper pathologic process, and exhibiting a parallel clinical evolution to it (e.g., healing after its remediation). The inflammatory cutaneous process is sterile, lacking clinicopathologic specificity.The underlying, initiating pathologic process is diverse. It may be tumorous or infectious. Direct and thus propagated migration of inflammatory cells and/or diffusion of mediators is conceivable. CIS has been described in association with ethmoidal carcinoma with superinfection, postoperative mediastinal abscess, odontogenic staphylococcal abscess, and purulent sinusitis (Helmbold P et al. 1999).

The main clinical symptom is an asymmetric, localized and painful erythema or an ensuing flat plaque in combination with the various symptoms caused by the inducing pathological process.

Contiguous inflammation may also occur in non-cutaneous structures, such as the orbit in chronic inflammatory rhinopathies (R A Goldberg RA 1989). An "inverse" CIS is also conceivable, i.e. a continuation of an inlfammatory process from the skin to underlying structures (e.g. tendons and bones).

A 77-year-old woman with history of rhinorrhea and chronic headache presents for an erythematous and mildly verrucous nonpainful plaque on the right cheek. This had persisted for two months. Preliminary treatments with numerous topical antibiotics were unsuccessful. Histopathologic examination revealed nonspecific dermatitis. A CT of the skull revealed evidence of pansinusitis.

Therapy: After surgical treatment of the sinusitis, the skin lesions regressed completely.

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