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Kwan Z, Han WH, Yong SS, Faheem NAA, Choong RKJ, Zainuddin SI, Lam CL, Tan MP, Capelle DP. Dermatological Issues Among Individuals Receiving Palliative Care - A Review. Am J Hosp Palliat Care 2024; 41:952-964. [PMID: 37625380 DOI: 10.1177/10499091231198752] [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: 08/27/2023] Open
Abstract
Skin disorders among individuals receiving palliative care may be associated with the primary condition or underlying comorbidities and patients may experience pruritus, discomfort or pain. Common conditions include xerosis, pressure ulcers, intertrigo, superficial fungal infections, telogen effluvium, pruritus, herpes zoster, eczematous disorders and edema. During end-of-life care, there is reduced skin perfusion and metabolism hence leading to susceptibility to infection, pressure and injury. Other factors affecting the skin include limited mobility, nutritional deficits and immunosuppression. Although treatment strategies for each skin condition are usually aligned with standard protocols, considerations among these patients include limited life-expectancies, potential treatment burden, drug-drug interactions as well as comfort-directed rather than cure-directed therapy. For patients with xerosis cutis, the regular use of moisturisers is recommended. The management and prevention of pressure ulcers include the strategies of skin assessment and care, pressure redistribution, nutrition and hydration and ulcer care. Superficial fungal infections require treatment with appropriate topical and/or systemic antifungals while antivirals and adjunctive treatment can be prescribed for herpes zoster. Treatment and symptom control of skin disorders in this population can improve quality of life and patients' comfort level.
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Affiliation(s)
- Zhenli Kwan
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Winn Hui Han
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shin Shen Yong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nik Aimee Azizah Faheem
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Rebecca Kai Jan Choong
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sheriza Izwa Zainuddin
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Chee Loong Lam
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - David Paul Capelle
- Division of Palliative Medicine, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
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Pesqué D, Aerts O, Bizjak M, Gonçalo M, Dugonik A, Simon D, Ljubojević-Hadzavdić S, Malinauskiene L, Wilkinson M, Czarnecka-Operacz M, Krecisz B, John SM, Balato A, Ayala F, Rustemeyer T, Giménez-Arnau AM. Differential diagnosis of contact dermatitis: A practical-approach review by the EADV Task Force on contact dermatitis. J Eur Acad Dermatol Venereol 2024. [PMID: 38713001 DOI: 10.1111/jdv.20052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/15/2024] [Indexed: 05/08/2024]
Abstract
The diagnosis of eczema ('dermatitis') is mostly clinical and depends on the clinical history and exploratory objective findings (primary lesions, patterns). Contact dermatitis remains as an important condition in the group of eczematous disorders, with important socioeconomic and occupational relevance. Although irritant and allergic contact dermatitis have a different pathogenesis, both are characterized by a rather typical morphology, are triggered by external factors and tend to occur primarily in the area of contact with the exogenous agent. In addition, allergic and irritant dermatitis may also co-exist. The importance of diagnosing contact dermatitis, especially when allergic in nature, is both due to the possibility of avoiding the trigger, and due to its role in aggravating other skin conditions. Nevertheless, the heterogeneity of clinical presentations in daily practice may pose an important challenge for the suspicion and correct diagnosis of contact dermatitis. Furthermore, other conditions, with different pathogenesis and treatment, may clinically simulate contact dermatitis. The Task Force aims to conduct a review of the unifying clinical features of contact dermatitis and characterize its main clinical phenotypes, and its simulators, in order to contribute to an early suspicion or recognition of contact dermatitis and enable a correct differential diagnosis.
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Affiliation(s)
- David Pesqué
- Dermatology Department, Hospital del Mar Research Institute, Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA) and Research Group Immunology, University of Antwerp, Antwerp, Belgium
| | - Mojca Bizjak
- Division of Allergy, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Aleksandra Dugonik
- Department of Dermatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Dagmar Simon
- Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland
| | - Suzana Ljubojević-Hadzavdić
- Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Laura Malinauskiene
- Faculty of Medicine, Institute of Clinical Medicine, Clinic of Chest Diseases, Immunology and Allergology, Vilnius University, Vilnius, Lithuania
| | - Mark Wilkinson
- Leeds Centre for Dermatology, Leeds Teaching Hospitals NHS Trust, Chapel Allerton Hospital, Leeds, UK
| | | | - Beata Krecisz
- Collegium Medicum, Jan Kochanowski University Kielce, Kielce, Poland
| | - Swen M John
- Department of Dermatology, Environmental Medicine, Osnabrueck University, Osnabrueck, Germany
| | - Anna Balato
- Dermatology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Ayala
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Thomas Rustemeyer
- Dermato-Allergology and Occupational Dermatology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ana M Giménez-Arnau
- Dermatology Department, Hospital del Mar Research Institute, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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Sheikh HM, Jha RK. Triggered Skin Sensitivity: Understanding Contact Dermatitis. Cureus 2024; 16:e59486. [PMID: 38826956 PMCID: PMC11142925 DOI: 10.7759/cureus.59486] [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: 07/27/2023] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Dermatitis, the incendiary reaction of the skin to various components, can manifest in various types, including atopic dermatitis, contact dermatitis, nummular eczema, seborrhoea, and stasis dermatitis. Atopic dermatitis is the most common skin disease in children and has a growing prevalence in recent years. It is characterized by extreme tingling, eczemous skin injuries, dryness of the skin, and a family history of atopic illnesses. Contact dermatitis (CD) is a common, irritating skin disorder caused by allergens and aggravating elements in the environment. It is the most common cause of work-related dermatitis and plays a substantial role in hand and face dermatitis. A complete restorative history is essential for establishing CD and identifying the allergies that cause it. Fix testing, skin tests for fast contact reactions, serum allergen-specific IgE testing, subjective and quantitative evaluation of allergens inside probable items patients were exposed to, and challenge testing are among the other diagnostic techniques. To avoid a breakdown and the continuation of the skin illness, early and suitable therapy is critical. Allergic dermatitis to contact (ACD) develops during the normal, delayed incendiary reaction and has a perplexing etiology. Accurate identification of the allergen that is causing the reaction allows for adequate individual avoidance. The major treatment alternatives continue to be corticosteroids. Nickel-contact dermatitis is an allergic reaction that affects both children and adults. Adverse contact dermatitis (ACD) is a frequent skin reaction to a common allergen that can affect both children and adults. Less than 10% of all diagnostic procedures in pediatric patients involve checking for ACD symptoms. To answer the clinical question, a thorough history is gathered based on appearance, age group, and dermatitis type. According to pediatricians in the US, metals, perfumes, topical antimicrobials, excessive chemicals, and fabric softeners are the most typical allergens.
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Affiliation(s)
- Haris M Sheikh
- College of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan K Jha
- Biochemistry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yang X, Shen Y. Arteriovenous Malformation Mimicking Dermatitis® in the Lower Limb. Dermatitis 2024; 35:197. [PMID: 37883651 DOI: 10.1089/derm.2023.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Xitao Yang
- From the Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuchen Shen
- From the Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ortiz de Frutos FJ, Silvestre JF. Recommendations on the Use of Moisturizing Products Prepared by Spanish Dermatologists Using the Delphi Method. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00266-7. [PMID: 38554751 DOI: 10.1016/j.ad.2024.03.020] [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: 12/28/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Moisturizing products are widely used in conditions affecting skin hydration. However, the lack of scientific evidence leads to discrepancies and great variability in the recommendations used by different health professionals. The aim of this consensus document is to generate recommendations based on the evidence and experience of dermatologists to unify and facilitate the use of moisturizing products in the routine clinical practice. MATERIALS AND METHODS A 49-statement questionnaire on moisturizing products was prepared and, then, arranged in 5 blocks: 1) concept; 2) characteristics, 3) frequency and quantity, 4) product use and areas of application, and 5) special populations. Twenty-two expert dermatologists in the management of patients with eczema answered to the survey using a 2-round Delphi methodology (adding an item on the 2nd round). RESULTS Consensus was reached on 27 statements (54%), most (n=23) via agreement. The highest level of agreement was reached in the blocks on quantity, product use and areas of application (77.8%), followed by the blocks on characteristics (73%) and frequency (62.5%). Regarding the blocks on concept and special populations, the level of consensus on the items proposed was 37.5% and 10%, respectively. Consensus on the use of emollients for xeroderma (71%) was higher vs atopic dermatitis (64%) and inflamed skin (33.3%). CONCLUSIONS Consensus recommendations can help all prescribers and improve the available evidence regarding their use.
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Affiliation(s)
- F J Ortiz de Frutos
- Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España.
| | - J F Silvestre
- Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, España
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Chaudhry S, Lee K. Diagnosing and Managing Venous Stasis Disease and Leg Ulcers. Clin Geriatr Med 2024; 40:75-90. [PMID: 38000863 DOI: 10.1016/j.cger.2023.09.004] [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: 11/26/2023]
Abstract
Venous insufficiency is a common medical condition that affects many individuals, especially those with advanced age. Chronic venous insufficiency can lead to secondary cutaneous changes that most commonly present as stasis dermatitis but can progress to more serious venous ulcers. Although venous ulcers are the most common cause of lower extremity ulcers, the differential diagnosis of leg ulcers is broad. This article will discuss clinical clues to help guide patient workup and will review basic clinical evaluation and management of common leg ulcers.
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Affiliation(s)
- Sofia Chaudhry
- Department of Dermatology, Saint Louis University School of Medicine, 1225 South Grand Boulevard, 3rd Floor, Saint Louis, MO 63104, USA.
| | - Kathryn Lee
- Saint Louis University School of Medicine, 1402 South Grand Boulevard, Saint Louis, MO 63104, USA
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Sánchez-García V, Silvestre JF. Successful Treatment of Severe Stasis Dermatitis With Dupilumab: A Case Report. Dermatitis 2024. [PMID: 38193793 DOI: 10.1089/derm.2023.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Verónica Sánchez-García
- Dermatology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Juan Francisco Silvestre
- Dermatology Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Awad N, Hetzel JD, Bhupalam V, Nestor MS. Stasis Dermatitis: Pathophysiology, Current Treatment Paradigms, and the Use of the Flavonoid Diosmin. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2024; 17:15-23. [PMID: 38298753 PMCID: PMC10826834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Objective We sought to examine the role of flavonoids, particularly diosmin, as a therapeutic agent for stasis dermatitis (SD) through discussion of pathophysiology, current treatment paradigms, potential mechanisms of action, and a systematic review of evidence on clinical efficacy. Methods In addition to articles on pathophysiology and standard treatment, a search of PubMed was conducted using the following query: ("Diosmin" OR "MPFF" OR "Micronized Purified Flavonoid Fraction" OR "Flavonoid") AND ("Stasis Dermatitis" OR "Venous Ulcer" OR "Lipodermatosclerosis"). Emphasis was placed on studies that were randomized controlled trials examining an oral flavonoid against a placebo or standard of care. Results Diosmin is effective at improving stasis changes, increasing ulcer healing frequency, decreasing the time to ulcer healing, and reducing tissue edema. They also cause significant improvement in patient quality of life and reduction of venous symptoms. Diosmin has been shown to have a favorable safety profile with very few mild adverse events which did not differ significantly from placebo. Flavonoids also appear to be effective for other dermatologic conditions, including rosacea and senile purpura. Conclusion There is a growing body of evidence indicating that diosmin has therapeutic efficacy in managing stasis dermatitis. Data from studies in diseases with pathogenic similarities suggests the potential for even broader dermatologic applications.
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Affiliation(s)
- Nardin Awad
- All authors are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - John D. Hetzel
- All authors are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Vishnu Bhupalam
- All authors are with the Center for Clinical and Cosmetic Research in Aventura, Florida
| | - Mark S. Nestor
- All authors are with the Center for Clinical and Cosmetic Research in Aventura, Florida
- Additionally, Dr. Nestor is with the Department of Dermatology and Cutaneous Surgery, as well as the Department of Surgery, Division of Plastic Surgery, at the University of Miami Miller School of Medicine in Miami, Florida
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Fernandez-Flores A, Fernandez-Parrado M, Alzoghby-Abi Chaker J, Angulo AG. Axillary Cutaneous Hemosiderosis in a Patient With Hyperhidrosis, After Intravenous Iron Infusion. Am J Dermatopathol 2023; 45:463-465. [PMID: 37249371 DOI: 10.1097/dad.0000000000002461] [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: 05/31/2023]
Abstract
ABSTRACT Hemosiderosis consists of an iron deposit in tissues, which does not cause organic damage to them. However, in the case of the skin, being an organ exposed to sight, siderosis can produce a brownish coloration that is aesthetically discomforting for the individual. Most cutaneous sideroses are because of venous insufficiency with hemorrhagic extravasation. There is also a group secondary to iron extravasation in the injection site of the transfusion. However, there are very few cases in which an intravenous injection of an iron preparation has produced diffuse siderosis in extensive areas of the skin. We present the case of a 31-year-old woman with hyperhidrosis, who was transfused as a result of postpartum hemorrhage and, shortly after receiving an intravenous iron infusion, developed extensive hyperpigmentation in both axillae.
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Affiliation(s)
- Angel Fernandez-Flores
- Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain
- Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain
- Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain
| | | | | | - Ana Graciela Angulo
- Department of Dermatology, Serveis Mèdics Penedès, Vilanova i la Geltrú, Barcelona, Spain
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Kubicki SL, Hansen TJ, MacFarlane DF. Cutaneous Squamous Cell Carcinoma Mimickers: Beware the Pruritic Papule on the Leg of an Older Female. Cureus 2023; 15:e41569. [PMID: 37554602 PMCID: PMC10406154 DOI: 10.7759/cureus.41569] [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: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
Background Correctly identifying cutaneous squamous cell carcinoma (cSCC) mimickers can be both clinically and histopathologically challenging. We present a series of patients with biopsy-proven cSCCs for whom multiple surgeries were avoided by assessing the clinical situation, recognizing an alternative diagnosis that pathologically mimics cSCC, and prescribing appropriate therapy for the underlying condition. Methodology Seven female patients presented for treatment of biopsy-proven cSCC affecting the lower leg. After further investigation, we observed that these women shared similar characteristics, including age ranging from the 5th to the 9th decade, often experiencing stress, exhibiting associated pruritus with diverse causes, having few or no previous skin cancers, and generally showing minimal photodamage. Results In all cases, surgery was deferred and patients demonstrated complete clinical response to therapies directed toward an alternative diagnosis. Repeat biopsies of treated lesions revealed no evidence of cSCC. Conclusions Not all histologically diagnosed cases of cSCC should be treated with surgery, and each patient should be worked up thoroughly to evaluate for an alternative diagnosis. Possible clinical and histologic cSCC mimickers include allergic contact dermatitis (ACD), stasis dermatitis, hypertrophic lichen planus (LP), and drug eruption, among others. In the described population, pruritic papules on the lower leg should prompt further investigation to prevent the morbidity associated with unnecessary surgery.
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Affiliation(s)
- Shelby L Kubicki
- Dermatology, The University of Texas Health Science Center at Houston (UTHealth), Houston, USA
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Spiewak R. Diseases from the Spectrum of Dermatitis and Eczema: Can "Omics" Sciences Help with Better Systematics and More Accurate Differential Diagnosis? Int J Mol Sci 2023; 24:10468. [PMID: 37445645 DOI: 10.3390/ijms241310468] [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: 05/09/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Researchers active in the field of inflammatory skin diseases from the spectrum of dermatitis and eczema are well aware of a considerable overlap in the clinical pictures and proposed sets of diagnostic criteria for these diseases, which can hardly be overcome through the clinical or epidemiological research. In effect, patients are included in studies based on vague and overlapping criteria, while heterogeneous study populations may, in turn, lead to non-representative outcomes and continued confusion. In this narrative review, a systematics of diseases from the spectrum of dermatitis and eczema is proposed based on the origins of causative factors and the pathomechanisms involved. Difficulties in differentiating between these diseases are discussed, and the extent to which advances in the "omics" sciences might help to overcome them is considered. Of all the "omics" research in this field, more than 90% of the published papers were devoted to atopic dermatitis, with a striking underrepresentation of other diseases from the spectrum of dermatitis and eczema, conditions which collectively exceed the rates of atopic dermatitis by far. A greater "omics" research effort is urgently needed to tackle other dermatitides, like allergic, irritant and protein contact dermatitis, as well as radiation, seborrheic, stasis or autoimmune dermatitis. Atopic dermatitis findings should be validated not only against healthy donors but also other dermatitides. A clinic-oriented approach is proposed for future "omics" studies in the field of dermatitis and eczema.
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Affiliation(s)
- Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of Pharmacy, Jagiellonian University Medical College, ul. Medyczna 9, 30-688 Krakow, Poland
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