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Calabrese L, Romagnuolo M, D'Onghia M, Rubegni P, Marzano AV, Moltrasio C. Molecular Characteristics of Sweet Syndrome: A Systematic Review. Exp Dermatol 2024; 33:e70022. [PMID: 39704328 DOI: 10.1111/exd.70022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 11/25/2024] [Accepted: 11/26/2024] [Indexed: 12/21/2024]
Abstract
Sweet syndrome (SS), originally described as acute febrile neutrophilic dermatosis, is a rare inflammatory skin condition, considered the prototype of neutrophilic dermatoses. It is characterised by the sudden onset of well-defined tender papules, plaques and nodules often accompanied by fever, neutrophilia and elevated markers of inflammation. Several variants have been described both clinically and histopathologically. Classifications include idiopathic, malignancy-associated, and drug-induced SS. The exact pathogenesis of SS is still unclear; however, recent findings have shed light on the role of dermal infiltrating neutrophils-in the context of innate immunity, and signalling pathways related to adaptive immunity. To critically analyse the current molecular landscape of SS and discuss the recent evidence supporting novel potential immune mediators and biological signalling pathways involved in SS pathogenesis. The methodology followed PRISMA guidelines and included two bibliographical databases, searching articles published until 17 December 2023. Titles, abstracts and full text were reviewed independently by two assessors, while other two investigators resolved any opinion differences. Of 3303 records identified through database search, 22 articles met the eligibility criteria for inclusion. We considered experimental studies that performed molecular analysis, in terms of cytokines quantification, gene expression and/or immunofluorescence/immunohistochemistry. As for the latter, only studies aimed at characterising the nature of the inflammatory infiltrate and potential mechanisms leading to distinct forms of cutaneous inflammatory cell influx were included. Overall, we described research on 202 SS patients (177 skin biopsies and 25 blood specimens) revealing the predominant role of neutrophil activation and abnormal proliferation as unifying mechanisms in different SS subtypes. Interestingly, we found that hyperactivation of the IL-1 pathway might occur only in a subset of SS patients and adaptive immunity could also play a role in the pathogenic scenario of SS, with a potential significant role of IL-17 axis. This systematic review provides a wealth of evidence on the molecular landscape of SS, although further research is needed to a deeper understanding of the patho-mechanisms of this rare disease and hopefully lead to targeted therapeutic approaches.
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Affiliation(s)
- Laura Calabrese
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, Siena, Italy
- Institute of Dermatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Romagnuolo
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina D'Onghia
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Sciences, Dermatology Section, University of Siena, Siena, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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2
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Rijal H, Bouadi N, Bourkas AN, Geng R, Molin S. Outcomes of JAK Inhibitor Therapy in Pyoderma Gangrenosum: A Systematic Review. J Cutan Med Surg 2024; 28:602-603. [PMID: 39198979 DOI: 10.1177/12034754241277503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2024]
Affiliation(s)
- Hibo Rijal
- Queen's University School of Medicine, Kingston, ON, Canada
| | - Naïla Bouadi
- Faculty of Medicine, Université Laval, Québec City, QC, Canada
| | | | - Ryan Geng
- Temerty School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sonja Molin
- Queen's University School of Medicine, Kingston, ON, Canada
- Division of Dermatology, Department of Medicine, Queen's University, Kingston, ON, Canada
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3
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Teixeira J, Martins F, Mateus-Pinheiro A, Marques B, Brites MM, Cardoso JC, Calvão J. Vulvar ulcers as a rare manifestation of hematologic malignancy. JAAD Case Rep 2024; 52:98-100. [PMID: 39319190 PMCID: PMC11421344 DOI: 10.1016/j.jdcr.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Affiliation(s)
- João Teixeira
- Dermatology and Venereology Department, Coimbra Local Health Unit, Coimbra, Portugal
| | - Francisco Martins
- Dermatology and Venereology Department, Coimbra Local Health Unit, Coimbra, Portugal
| | | | - Bárbara Marques
- Hematology Department, Coimbra Local Health Unit, Coimbra, Portugal
| | - Maria Manuel Brites
- Dermatology and Venereology Department, Coimbra Local Health Unit, Coimbra, Portugal
| | - José Carlos Cardoso
- Dermatology and Venereology Department, Coimbra Local Health Unit, Coimbra, Portugal
| | - Joana Calvão
- Dermatology and Venereology Department, Coimbra Local Health Unit, Coimbra, Portugal
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4
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Glennon CM, Tan AJ, Prabhu M, Kroshinsky D. Sweet syndrome in pregnancy: A narrative review. Int J Gynaecol Obstet 2024; 166:538-550. [PMID: 38881204 DOI: 10.1002/ijgo.15713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/18/2024] [Indexed: 06/18/2024]
Abstract
The aim of this review is to increase obstetrician awareness of pregnancy-associated Sweet syndrome. Patients present with fever, leukocytosis, and skin eruption, which can mimic other infectious or inflammatory conditions, but do not respond to antibiotics. A search using PubMed, EMBASE, and Web of Science Core Collection was conducted to review all reported cases of pregnancy-associated Sweet syndrome, an acute febrile neutrophilic dermatosis occurring during pregnancy or postpartum. A total of 33 episodes among 30 patients were identified, with the majority (54.5% [18]) of cases occurring within the second trimester. Among the 30 patients, skin lesions most commonly affected the head and neck (73.3% [22]), with rare oral or ocular involvement. Leukocytosis was the most common laboratory finding, reported in 96.7% [29] of patients, with neutrophil predominance noted in 70.0% [21]. The diagnosis was confirmed for all patients with pathognomonic results of skin biopsies. Of the 27 cases detailing treatment, systemic corticosteroids were most frequently used (19 cases), followed by conservative management (seven cases), and dapsone (one case). The dapsone-treated patient and 15 of the 19 steroid-treated patients experienced resolution, but additional management strategies were required in the remaining four individuals. Spontaneous resolution occurred during pregnancy in six of the seven conservatively managed individuals, with one patient experiencing spontaneous abortion shortly after skin eruption at 10 weeks of gestation. No associated maternal deaths were reported. Obstetric complications of pregnancy-associated Sweet syndrome included endomyometritis, sterile placental abscesses, and abdominal wall necrosis. Delivery of healthy infants occurred in 24 of the 25 cases that presented fetal outcome, which included two infants who underwent medically indicated preterm deliveries.
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Affiliation(s)
- Colleen M Glennon
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alice J Tan
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malavika Prabhu
- Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniela Kroshinsky
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
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Merola JF, Cochran RL, Kroshinsky D, Prabhu M, Kwan MC. Case 22-2024: A 30-Year-Old Woman with Postpartum Fever, Abdominal Pain, and Skin Ulcers. N Engl J Med 2024; 391:260-271. [PMID: 39018536 DOI: 10.1056/nejmcpc2309500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Affiliation(s)
- Joseph F Merola
- From the Departments of Medicine and Dermatology, UT Southwestern Medical Center, and Peter O'Donnell School of Public Health - both in Dallas (J.F.M.); the Departments of Radiology (R.L.C.), Dermatology (D.K.), Pediatrics (D.K.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Massachusetts General Hospital, and the Departments of Radiology (R.L.C.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Harvard Medical School - both in Boston; and the Department of Dermatology, Duke University Medical Center, and Duke University School of Medicine - both in Durham, NC (D.K.)
| | - Rory L Cochran
- From the Departments of Medicine and Dermatology, UT Southwestern Medical Center, and Peter O'Donnell School of Public Health - both in Dallas (J.F.M.); the Departments of Radiology (R.L.C.), Dermatology (D.K.), Pediatrics (D.K.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Massachusetts General Hospital, and the Departments of Radiology (R.L.C.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Harvard Medical School - both in Boston; and the Department of Dermatology, Duke University Medical Center, and Duke University School of Medicine - both in Durham, NC (D.K.)
| | - Daniela Kroshinsky
- From the Departments of Medicine and Dermatology, UT Southwestern Medical Center, and Peter O'Donnell School of Public Health - both in Dallas (J.F.M.); the Departments of Radiology (R.L.C.), Dermatology (D.K.), Pediatrics (D.K.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Massachusetts General Hospital, and the Departments of Radiology (R.L.C.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Harvard Medical School - both in Boston; and the Department of Dermatology, Duke University Medical Center, and Duke University School of Medicine - both in Durham, NC (D.K.)
| | - Malavika Prabhu
- From the Departments of Medicine and Dermatology, UT Southwestern Medical Center, and Peter O'Donnell School of Public Health - both in Dallas (J.F.M.); the Departments of Radiology (R.L.C.), Dermatology (D.K.), Pediatrics (D.K.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Massachusetts General Hospital, and the Departments of Radiology (R.L.C.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Harvard Medical School - both in Boston; and the Department of Dermatology, Duke University Medical Center, and Duke University School of Medicine - both in Durham, NC (D.K.)
| | - Melanie C Kwan
- From the Departments of Medicine and Dermatology, UT Southwestern Medical Center, and Peter O'Donnell School of Public Health - both in Dallas (J.F.M.); the Departments of Radiology (R.L.C.), Dermatology (D.K.), Pediatrics (D.K.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Massachusetts General Hospital, and the Departments of Radiology (R.L.C.), Obstetrics, Gynecology, and Reproductive Biology (M.P.), and Pathology (M.C.K.), Harvard Medical School - both in Boston; and the Department of Dermatology, Duke University Medical Center, and Duke University School of Medicine - both in Durham, NC (D.K.)
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Saito Y, Kewalramani A, Peng XP, Magnarelli A, Lederman HM. Sweet syndrome associated with moderate leukocyte adhesion deficiency type I: a case report and review of the literature. Front Immunol 2024; 15:1425289. [PMID: 39081307 PMCID: PMC11286406 DOI: 10.3389/fimmu.2024.1425289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024] Open
Abstract
Sweet syndrome is an acute febrile neutrophilic dermatosis characterized by the infiltration of neutrophils into the skin. It may occur idiopathically or be linked to malignancies, inflammatory or autoimmune diseases. Leukocyte adhesion deficiency type I (LAD-I) is an inborn error immunity wherein leukocytes lack adhesion molecules necessary for migration to infection sites due to mutations in the CD18 gene encoding β2 integrins. We present a case of a 16-month-old female initially diagnosed and treated for Sweet syndrome based on histopathological findings with recurrent flare episodes. Subsequent workup revealed LAD-I, making this case the first documented association between Sweet syndrome and LAD-I. Moreover, we reviewed the pertinent literatures detailing the concurrence of neutrophilic dermatosis and immunodeficiency disorders. This case underscores the significance of comprehensive evaluation for Sweet syndrome patients who are refractory to conventional treatments.
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Affiliation(s)
- Yoshine Saito
- University of Maryland School of Medicine, Baltimore, MD, United States
| | - Anupama Kewalramani
- Department of Pediatrics, Division of Pulmonology/Allergy, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Xiao P. Peng
- Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aimee Magnarelli
- Eudowood Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Howard M. Lederman
- Eudowood Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Guirguis J, Iosim S, Jones D, Likhite M, Chen F, Kesserwan C, Gindin T, Kahn PJ, Beck D, Oza VS, Hillier K. Neutrophilic dermatosis in a patient with an IKZF1 variant and a review of monogenic autoinflammatory disorders presenting with neutrophilic dermatoses. Pediatr Dermatol 2024; 41:707-713. [PMID: 38413050 DOI: 10.1111/pde.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024]
Abstract
Monogenic diseases of immune dysregulation should be considered in the evaluation of children presenting with recurrent neutrophilic dermatoses in association with systemic signs of inflammation, autoimmune disease, hematologic abnormalities, and opportunistic or recurrent infections. We report the case of a 2-year-old boy presenting with a neutrophilic dermatosis, found to have a novel likely pathogenic germline variant of the IKAROS Family Zinc Finger 1 (IKZF1) gene; the mutation likely results in a loss of function dimerization defective protein based on reports and studies of similar variants. IKZF1 variants could potentially lead to aberrant neutrophil chemotaxis and development of neutrophilic dermatoses. Long-term surveillance is required to monitor the development of hematologic malignancy, autoimmunity, immunodeficiency, and infection in patients with pathogenic IKZF1 germline variants.
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Affiliation(s)
- Justina Guirguis
- Department of Dermatology, The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Sonia Iosim
- Department of Pediatrics, Hassenfeld Children's Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Derek Jones
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Maryel Likhite
- Center for Human Genetics and Genomics, NYU Grossman School of Medicine, New York, New York, USA
| | - Fei Chen
- Department of Pathology, NYU Langone Health, New York, New York, USA
| | - Chimene Kesserwan
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Tatyana Gindin
- Department of Pathology, NYU Grossman School of Medicine, New York, New York, USA
| | - Philip J Kahn
- Department of Pediatrics, Division of Pediatric Rheumatology, Hassenfeld Children's Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
| | - David Beck
- Division of Rheumatology, Department of Medicine, New York University Grossman School of Medicine, New York, NY 10016, USA; Center for Human Genetics and Genomics, New York University Grossman School of Medicine, New York, New York, USA
| | - Vikash S Oza
- Department of Dermatology and Pediatrics, The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA
| | - Kirsty Hillier
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Hassenfeld Children's Hospital at NYU Langone Health, NYU Grossman School of Medicine, New York, New York, USA
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8
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Lenga M, Erickson T, Nguyen CV. Retiform Ulceration and Bullae on the Bilateral Thighs. JAMA Dermatol 2024; 160:773-774. [PMID: 38691375 DOI: 10.1001/jamadermatol.2024.0486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
A man with a history of polysubstance use presents with new bullae on his bilateral lower extremities. What is your diagnosis?
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Affiliation(s)
- Marisa Lenga
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Taylor Erickson
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Cuong V Nguyen
- Department of Dermatology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
- Assistant Section Editor, JAMA Dermatology
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9
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Alshiyab D, Ba-Shammakh SA, Al-Fakih AA. Isolated Neutrophilic Urticarial Dermatosis in a Previously Healthy Male: A Case Report. Cureus 2024; 16:e59750. [PMID: 38841022 PMCID: PMC11152566 DOI: 10.7759/cureus.59750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/07/2024] Open
Abstract
Neutrophilic urticarial dermatosis (NUD), a variant falling under the larger umbrella of neutrophilic dermatoses (NDs), is characterized by distinctive clinical and histopathological attributes often associated with systemic conditions. This report presents a case of a 45-year-old male with no prior health issues who exhibits both clinical and pathological hallmarks of NUD without any concurrent systemic illness. This singular case illuminates the intricate aspects of NUD, emphasizing the necessity for accurate diagnostic methods and effective treatment strategies.
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Affiliation(s)
- Diala Alshiyab
- Department of Dermatology, King Abdullah University Hospital, Irbid, JOR
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | - Saleh A Ba-Shammakh
- Department of General Surgery, Ministry of Health, Amman, JOR
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, JOR
| | - Abdulqudos A Al-Fakih
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, JOR
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, JOR
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Wang Y, Chen E, Iyer P. Neutrophilic dermatoses as a manifestation of a systemic lupus erythematosus flare. Lupus 2024; 33:409-413. [PMID: 38235694 DOI: 10.1177/09612033231226350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Neutrophilic dermatoses (NDs) refer to a group of cutaneous conditions histologically characterized by the dense accumulation of neutrophils in the skin in the absence of infection. NDs have been associated with underlying autoimmune connective tissue disorders (CTDs) such as systemic lupus erythematosus (SLE), Sjogren's syndrome, and dermatomyositis. We describe a case of neutrophilic dermatoses as a manifestation of a SLE flare.
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Affiliation(s)
- Yingxue Wang
- Department of Internal Medicine, UCI Medical Center, Orange, CA, USA
| | - Eugenia Chen
- Division of Rheumatology, UCI Medical Center, Orange, CA, USA
| | - Priyanka Iyer
- Division of Rheumatology, UCI Medical Center, Orange, CA, USA
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11
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Gil-Lianes J, Luque-Luna M, Alamon-Reig F, Bosch-Amate X, Serra-Garcia L, Mascaró JM. Sweet Syndrome: Clinical Presentation, Malignancy Association, Autoinflammatory Disorders and Treatment Response in a Cohort of 93 Patients with Long-term Follow-up. Acta Derm Venereol 2023; 103:adv18284. [PMID: 38112209 PMCID: PMC10753595 DOI: 10.2340/actadv.v103.18284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 12/21/2023] Open
Abstract
Sweet syndrome is a neutrophilic dermatosis associated with multiple disorders. This retrospective case-series study of patients with Sweet syndrome in a tertiary hospital in Spain from 2001 to 2021, explores clinicopathological characteristics of Sweet syndrome and variables associated with malignancy, presence of autoinflammatory disorders and differences between histological subtypes. A total of 93 patients were identified: 30% idiopathic, 34% malignancy-associated, 29% reactive to infections or drug-associated, and 6% with an autoimmune/inflammatory condition. Acute myeloid leukaemia was the most common malignancy (16/93) followed by myelodysplastic syndrome (7/93). Patients with acute myeloid leukaemia presented isolated flares, marked cytopaenia and rapid response to treatment, whereas myelodysplastic syndrome followed a chronic-recurrent course. The most frequent associated medications and inflammatory disorders were filgrastim and hydroxyurea (n = 2); and inflammatory bowel disease (n = 4). In addition, 3 patients were diagnosed with VEXAS syndrome. Male sex (p = 0.006), fever (p = 0.034), increased erythrocyte sedimentation rate (p < 0.001), anaemia (p < 0.001), and thrombocytopaenia (p < 0.001) were associated with malignancy. Histologically, patients were classified as classic (60%), histiocytoid (22.5%) or subcutaneous (15%), with pain (p = 0.011) and nodules (p < 0.001) being associated with subcutaneous-Sweet syndrome. Sweet syndrome in the context of cytopaenia should alert the presence of malignancy. An acquired autoinflammatory condition should be explored in relapsing Sweet syndrome with myelodysplastic syndrome. A minimum follow-up of 6 months is recommended.
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Affiliation(s)
- Javier Gil-Lianes
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Mar Luque-Luna
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Francesc Alamon-Reig
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Xavier Bosch-Amate
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - Laura Serra-Garcia
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain
| | - José M Mascaró
- Department of Dermatology, Hospital Clínic de Barcelona, Universitat de Barcelona, Spain.
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12
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Prieto-Torres L, Requena L, Rodríguez-Pinilla SM. Clinical, Histopathological and Molecular Spectrum of Cutaneous Lesions in Myelodysplastic Syndrome and Myeloproliferative Neoplasms (MDS/MPN): An Integrative Review. Cancers (Basel) 2023; 15:5888. [PMID: 38136431 PMCID: PMC10742063 DOI: 10.3390/cancers15245888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/16/2023] [Indexed: 12/24/2023] Open
Abstract
Myeloid neoplasms and acute leukemias include different entities that have been recently re-classified taking into account molecular and clinicopathological features. The myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) category comprises a heterogeneous group of hybrid neoplastic myeloid diseases characterized by the co-occurrence of clinical and pathological features of both myelodysplastic and myeloproliferative neoplasms. The most frequent entity in this category is chronic myelomonocytic leukemia (CMML) which is, after acute myeloid leukemia (AML), the main myeloid disorder prone to develop cutaneous manifestations. Skin lesions associated with myelodysplastic and myeloproliferative neoplasms include a broad clinical, histopathological and molecular spectrum of lesions, poorly understood and without a clear-cut classification in the current medical literature. The aim of this review is to describe and classify the main clinical, histopathological and molecular patterns of cutaneous lesions in the setting of MDS/MPN in order to improve the diagnostic skills of the dermatologists, hematologists and pathologists who deal with these patients.
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Affiliation(s)
- Lucía Prieto-Torres
- Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Universidad de Zaragoza, 50009 Zaragoza, Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, 28040 Madrid, Spain;
| | - Socorro Maria Rodríguez-Pinilla
- Department of Pathology, Fundación Jiménez Díaz, Universidad Autónoma, 50019 Zaragoza, Spain;
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), 28040 Madrid, Spain
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13
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Avcı C, Akın G, Akarsu S, Lebe B. Pyoderma gangrenosum and Behçet's-like disease induced by secukinumab: a paradoxical drug reaction. J DERMATOL TREAT 2023; 34:2235040. [PMID: 37449310 DOI: 10.1080/09546634.2023.2235040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/03/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Ceylan Avcı
- Faculty of Medicine, Department of Dermatology, Dokuz Eylul University, İzmir, Turkey
| | - Gülfem Akın
- Faculty of Medicine, Department of Dermatology, Dokuz Eylul University, İzmir, Turkey
| | - Sevgi Akarsu
- Faculty of Medicine, Department of Dermatology, Dokuz Eylul University, İzmir, Turkey
| | - Banu Lebe
- Pathology Department, Dokuz Eylul University, İzmir, Turkey
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14
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Starita-Fajardo G, Lucena-López D, Ballester-Martínez MA, Fernández-Guarino M, González-García A. Treatment Strategies in Neutrophilic Dermatoses: A Comprehensive Review. Int J Mol Sci 2023; 24:15622. [PMID: 37958609 PMCID: PMC10649056 DOI: 10.3390/ijms242115622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Neutrophilic dermatoses (NDs) are a group of noninfectious disorders characterized by the presence of a sterile neutrophilic infiltrate without vasculitis histopathology. Their physiopathology is not fully understood. The association between neutrophilic dermatoses and autoinflammatory diseases has led some authors to propose that both are part of the same spectrum of diseases. The classification of NDs depends on clinical and histopathological features. This review focuses on the recent developments of treatments in these pathologies.
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Affiliation(s)
- Grisell Starita-Fajardo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
| | - David Lucena-López
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
| | | | | | - Andrés González-García
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain; (G.S.-F.); (D.L.-L.)
- Faculty of Medicine and Health Sciences, Universidad de Alcalá (UAH), 28801 Alcalá de Henares, Spain
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15
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Koska MC, Karadağ AS, Durdu M. Annular neutrophilic dermatoses. Clin Dermatol 2023; 41:340-354. [PMID: 37423267 DOI: 10.1016/j.clindermatol.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Neutrophilic dermatoses (NDs) constitute a group of diseases characterized by sterile neutrophilic infiltrations. Many NDs usually present with infiltrated erythematous plaques, nodules, urticarial plaques, or pustules. Lesions may show variability, and atypical presentations may develop among NDs. Annular lesions have been reported in many NDs and may lead to diagnostic problems. Clinical features and histopathologic findings such as localization of the neutrophilic infiltrate, existence of other cell types, and absence of true vasculitis may be helpful to distinguish NDs. Some of these NDs are associated with infections, inflammatory diseases, and malignancies. In most NDs, systemic steroids and dapsone are very effective and usually first choices. Colchicine, antimicrobials such as doxycycline, tetracycline, and sulfapyridine, and other immunosuppressants such as cyclosporin, methotrexate, and mycophenolate mofetil have been used successfully in treating many NDs. Tumor necrosis factor α inhibitors have also been used successfully in treating many NDs. Janus kinase inhibitors are effective in CANDLE (chronic atypical neutrophilic dermatosis with lipodystrophy and elevated temperature) syndrome, anakinra in neutrophilic urticarial dermatosis, and intravenous immunoglobulin in resistant pyoderma gangrenosum. We discuss the diagnosis and management of NDs that may present with annular lesions.
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Affiliation(s)
- Mahmut Can Koska
- Dermatology and Venereology Clinic, Artvin State Hospital, Artvin, Turkey.
| | - Ayşe Serap Karadağ
- Department of Dermatology, Istanbul Arel University Medical Faculty, Istanbul, Turkey
| | - Murat Durdu
- Department of Dermatology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Application and Research Center, Adana, Turkey
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16
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Joncour AL, Cacoub P, Boulaftali Y, Saadoun D. Neutrophil, NETs and Behçet's disease: A review. Clin Immunol 2023; 250:109318. [PMID: 37019424 DOI: 10.1016/j.clim.2023.109318] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
Behçet's disease (BD) is a chronic systemic vasculitis characterized by recurrent oral and genital ulcers, skin lesions, articular, neurological, vascular and sight-threatening ocular inflammation. BD is thought to share both autoimmune and autoinflammatory disease features. BD is triggered by environmental factors such as infectious agents in genetically predisposed subjects. Neutrophils seem to play an instrumental role in BD and recent works regarding the role of neutrophils extracellular traps (NETs) provides new insight in the pathophysiology of BD and the mechanisms involved in immune thrombosis. This review provides a recent overview on the role of neutrophils and NETs in the pathogenesis of BD.
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17
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Al Bshabshe A, Mousa WF, Nor El-Dein N. An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of? Diagnostics (Basel) 2023; 13:1290. [PMID: 37046508 PMCID: PMC10093365 DOI: 10.3390/diagnostics13071290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition.
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Affiliation(s)
- Ali Al Bshabshe
- Department of Medicine/Adult Critical Care, King Khalid University, Abha 61413, Saudi Arabia
| | - Wesam F. Mousa
- College of Medicine, Tanta University, Tanta 31512, Egypt
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18
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Bañares J, Aceituno L, Jiménez A, Maynard A, Escobar ED, Alemán C. Pseudovesicular appearance in Sweet's syndrome: important yet easily missed - Authors' reply. Lancet 2023; 401:104. [PMID: 36641197 DOI: 10.1016/s0140-6736(22)02462-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Juan Bañares
- Internal Medicine Department, Vall d'Hebron University Hospital, Barcelona 08035, Spain.
| | - Laia Aceituno
- Internal Medicine Department, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | - Alba Jiménez
- Department of Gastroenterology, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | - Avonello Maynard
- Department of Gastroenterology, Vall d'Hebron University Hospital, Barcelona 08035, Spain
| | | | - Carmen Alemán
- Internal Medicine Department, Vall d'Hebron University Hospital, Barcelona 08035, Spain
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19
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Pyoderma gangrenosum after deep inferior epigastric perforator flap: how prompt diagnosis and treatment can avoid surgical debridement and further morbidity. JPRAS Open 2022; 33:42-46. [PMID: 35722167 PMCID: PMC9204653 DOI: 10.1016/j.jpra.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a skin disorder characterized by painful, enlarging necrotic ulcers with bluish borders surrounded by advancing zones of erythema. The key histologic feature is neutrophilic infiltration of the superficial and deep layers of the dermis and the absence of microorganisms. Although rare and associated with autoimmune diseases such as rheumatoid arthritis, ulcerative colitis and Crohn's disease, the diagnosis is commonly missed at presentation and patients are often treated for infection with antibiotics and surgical debridement. We present a case of PG in a 51 year-old woman after a deep inferior epigastric perforator (DIEP) flap for breast reconstruction who was promptly diagnosed and treated with steroids with appropriate response. Our case highlights the importance of rapid diagnosis and treatment of this disease to avoid incorrect management including surgical debridement, which can exacerbate the disease and increase its morbidity.
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