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focal B (CD20 + ) and dispersed T (CD45RO + ) lymphoalso in adulthood (3), and is seen not just on the digits (1–4) but also on the back (3), and, as in the present cytes. CDw75 antibody, which stains germinal centre B lymphocytes, was negative. Ki-67 was negative. Kappa case, on the wrist. The term ‘‘APACHE’’ does not therefore seem suitable for the condition. Recently, the chain-positive lymphocytes and lambda chain-positive lymphocytes were observed almost equally. The lesion terms ‘‘small lymphoid papules of the extremities’’ (3) and ‘‘small papular pseudolymphoma’’ (3) have been has shown no recurrence for at least 3 years after the surgical removal. put forward for the condition. A kind of mechanical stimulation might be a factor inducing the condition, as suggested by the acral localization of lesions in most DISCUSSION cases of this skin disorder. APACHE has been reported to arise mostly in childhood, and to present as unilateral eruptions of mulREFERENCES tiple angiomatous papules, mostly on acral sites of the hands and feet (1–4). Histologically, APACHE has 1. Ramsay B, Dahl MCG, Malcolm AJ, Wilson-Jones E. Acral pseudolymphomatous angiokeratoma of children. been documented to correspond to pseudolymphoma Arch Dermatol 1990; 126: 1524–1525. (1–4). Immunohistochemical examination of in ltrating 2. Hara M, Matsunaga J, Tagami H. Acral pseudolymphomatlymphocytes did not reveal any monoclonal proliferation ous angiokeratoma of children (APACHE): a case report of T or B cell subsets nor aberrant expression of surface and immunohistological study. Br J Dermatol 1991; 124: markers (1–4). The present case is regarded as belonging 387–388. 3. Kaddu S, Cerroni L, Pilatti A, Soyer HP, Kerl H. Acral to the category of APACHE in both histological and pseudolymphomatous angiokeratoma: a variant of the cutaclinical features, except for the site of the lesion. neous pseudolymphomas. Am J Dermatopathol 1994; 16: As regards the term ‘‘APACHE’’, the disorder has 130–133. not shown any histological features of angiokeratoma 4. Ito K, Fujiwara H, Ito M. Acral pseudolymphomatous (1–4), with the exception of one case of a lichenoid angiokeratoma of children (APACHE) (in Japanese). Hifubyo Shinryo 2000; 22: 979–982. reaction (2). It arises not just in childhood (1–4) but

Prurigo Pigmentosa in Association with Helicobacter pylori Infection in a Caucasian Turkish Woman