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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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Vignon-Pennamen MD, Battistella M. From Histiocytoid Sweet Syndrome to Myelodysplasia Cutis: History and Perspectives. Dermatol Clin 2024; 42:209-217. [PMID: 38423682 DOI: 10.1016/j.det.2023.08.004] [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: 03/02/2024]
Abstract
In 2005, a new histologic variant of Sweet syndrome (SS) has been described and termed histiocytoid SS (HSS). Clinically, patients had a typical SS, but on skin biopsy, the infiltrates were composed of immature nonblast myeloid cells. Nearly 50% of patients with HSS have myelodysplastic syndrome (MDS). HSS may be the first manifestation leading to the diagnosis of MDS. In 2015, a new category of myeloid dermatosis has been proposed, called myelodysplasia cutis, describing the specific skin infiltration by myelodysplastic cells in patients with MDS.
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Affiliation(s)
| | - Maxime Battistella
- Pathology Department, APHP Nord, Hopital Saint-Louis, Université Paris Cité, Paris, France; INSERM U976 "Human Immunology, Pathophysiology, and Immunotherapy", Paris, France.
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Babakoohi S, Gu SL, Ehsan H, Markova A. Dermatologic complications in transplantation and cellular therapy for acute leukemia. Best Pract Res Clin Haematol 2023; 36:101464. [PMID: 37353285 PMCID: PMC10291442 DOI: 10.1016/j.beha.2023.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
Adoptive cellular immunotherapy, mainly hematopoietic stem cell transplant and CAR-T cell therapy have revolutionized treatment of patients with acute leukemia. Indications and inclusion criteria for these treatments have expanded in recent years. While these therapies are associated with significant improvements in disease response and overall survival, patients may experience adverse events from associated chemotherapy conditioning, engraftment, cytokine storm, supportive medications, and post-transplant maintenance targeted therapies. Supportive oncodermatology is a growing specialty to manage cutaneous toxicities resulting from the anti-cancer therapies. In this review, we summarize diagnosis and management of the common cutaneous adverse events including drug eruptions, graft-versus-host disease, neoplastic and paraneoplastic complications in patients undergoing cellular therapies.
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Affiliation(s)
- Shahab Babakoohi
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA.
| | - Stephanie L Gu
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA
| | - Hamid Ehsan
- Levine Cancer Institute, Atrium Health Wake Forest Baptist, Charlotte, NC, USA
| | - Alina Markova
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, USA.
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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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Jung EH, Park JH, Hwan Kim K, Kim JS, Sil Choi I, Byun JM, Koh Y, Shin DY, Hong J, Yoon SS, Park H, Kim I. Characteristics of Sweet syndrome in patients with or without malignancy. Ann Hematol 2022; 101:1499-1508. [PMID: 35482090 DOI: 10.1007/s00277-022-04850-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022]
Abstract
Sweet syndrome is a neutrophilic dermatosis occasionally associated with malignancies. Due to its rarity, the clinical features of Sweet syndrome are still unclear. Thus, we aimed to analyze clinical features, treatment, and outcomes of these patients according to associated disease. We conducted a retrospective, longitudinal cohort study from January 2000 to August 2020. We reviewed the medical records of 52 patients with Sweet syndrome. The median age of patients was 57.5 years old (range, 17-84), and 48.1% were female. Of the 52 patients analyzed, 27 patients (51.9%) had malignancy-associated Sweet syndrome. Sweet syndrome was diagnosed concurrently with (N = 8), before (N = 5), and after (N = 14) the diagnosis of malignancy. The idiopathic Sweet syndrome was most common in the non-malignancy group (56.0%). Myelodysplastic syndrome was the most common malignancy associated with Sweet syndrome (47.6%). Leukopenia (p = 0.005), anemia (p < 0.001), and thrombocytopenia (p = 0.008) were significantly associated with malignancy. The majority of patients showed rapid improvement of symptoms after steroid administration. The symptoms of some patients with malignancy did not improve with steroid alone; however, their symptoms often improved when steroids were combined with a treatment for the associated malignancy. Relapse and aggravation of Sweet syndrome were common in the malignancy group. Sweet syndrome showed a broad spectrum of clinical features related to various diseases. Sweet syndrome often occurred as a paraneoplastic feature. Therefore, active systemic evaluation is needed in the first diagnosis of Sweet syndrome without clear etiology.
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Affiliation(s)
- Eun Hee Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jin Hyun Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ki Hwan Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - In Sil Choi
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Hyunkyung Park
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea.
- Department of Hematology and Oncology, Seoul National University, Boramae Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, South Korea.
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, 03080, South Korea.
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Dong RJ, Huang SZ, Upadhyay P, Shrestha S, Zhai YJ, Li YY. Thalidomide in the Treatment of Sweet's Syndrome and Eosinophilic Folliculitis Associated With Immune Reconstitution Inflammatory Syndrome. Front Med (Lausanne) 2020; 6:343. [PMID: 32039221 PMCID: PMC6985142 DOI: 10.3389/fmed.2019.00343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/27/2019] [Indexed: 12/02/2022] Open
Abstract
Sweet's syndrome and eosinophilic folliculitis are aseptic inflammatory dermatitis mainly because of infiltrated neutrophils and eosinophils on skin, respectively. These diseases rarely overlap or coexist in the same patient, especially co-occur in HIV infected patient. Here, we report a rare case of an AIDS patient who developed eosinophilic folliculitis and Sweet's syndrome within 1 month of initial antiretroviral therapy, presumably due to immune reconstitution inflammatory syndrome. The CD4+ T cell counts increased dramatically from 70 to 249 cells/μL within a period of 1 month. Interestingly, the patient was rapidly and strikingly responsive to thalidomide, which has anti-inflammatory, immune regulation, inhibition of neutrophil chemotaxis etc. Moreover, we focused our attention on discussing the clinical, pathological, and possible pathogenic aspects of the rare overlap of HIV complicated with neutrophilic and eosinophilic dermatosis.
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Affiliation(s)
- Rong-Jing Dong
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shi-Zhen Huang
- Yunnan Provincial Hospital of Infectious Disease/Yunnan AIDS Care Center (YNACC), Anning, China
| | - Pratishtha Upadhyay
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Samip Shrestha
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ya-Jie Zhai
- Department of Dermatology and Venereology, Jining Second People's Hospital, Jining, China
| | - Yu-Ye Li
- Department of Dermatology and Venereology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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PĂtraŞcu V, Geoloaica LG, Ciurea RN. Recurrent Idiopathic Sweet Syndrome - Case Report and Literature Review. CURRENT HEALTH SCIENCES JOURNAL 2020; 46:90-98. [PMID: 32637170 PMCID: PMC7323719 DOI: 10.12865/chsj.46.01.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/15/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Sweet syndrome (SS), also denominated as acute febrile neutrophilic dermatosis, is a rare disease characterized by the sudden onset of painful, erythematous, firm skin lesions (papules, plaques, and nodules) which show, upon histologic examination, the presence of a diffuse infiltrate of mature neutrophils. The cutaneous manifestation typically involves the face, neck, trunk, and upper limbs and is associated with fever, general malaise, arthralgia. CASE REPORT A female patient, 60 years old, attended the Dermatology Clinic due to the appearance of violaceous erythematous-oedematous infiltrated plaques, located on the face, neck, upper limbs, trunk and knees. The onset of the cutaneous manifestation had occurred 2 months prior, accompanied by pain, chills, flares of fever and arthralgia. The onset coincided with the surgical treatment of an umbilical hernia. From the medical history we note that the patient was diagnosed in 2014 with histiocytoid SS. She followed a treatment with methylprednisolone, with positive response, but had many relapses after the discontinuation of treatment. In 2017, due to a new episode, the histopathological examination was repeated, which revealed classical SS. She received treatment with Disulone and Colchicine. She had not been administered any treatment throughout the previous year. Laboratory tests revealed leukocytosis with neutrophils, increased ESR, elevated C4, hyperglycemia. The current histopathological examination revealed lymphocytic SS. Under treatment with methylprednisolone 32mg/day, the evolution was favorable. DISCUSSIONS The first case of SS was described by Robert Douglas Sweet in 1964. As known aetiological factors there have been described gastrointestinal and urinary tract infections, pregnancy, inflammatory bowel disease, drugs or malignancies. There have been described cases of SS that appeared after surgical treatment, as in our case, which registered a new outbreak following the umbilical hernia treatment. The histopathological variants of SS described in the literature are: subcutaneous, eosinophilic, histiocytoid, lymphocytic type. The first line-therapy consists in systemic corticosteroids, which induce a fast remission of lesions and general symptoms. Recurrence may occur in approximately 50% of patients and is common in idiopathic or paraneoplastic cases. CONCLUSIONS In addition to the neutrophilic infiltrate that is typical for Sweet syndrome, different types of histological manifestations have been described in the literature: subcutaneous, eosinophilic, histiocytoid, lymphocytic. In our case, we noted that the histological profile changed over time, from a histiocytoid SS recorded in 2014, to a classical SS in 2017, followed by the appearance of lymphocytic SS in 2019. Due to the fact that SS can be associated with a numerous other disorders, our patient requires regular monitoring with a view to eliminate them, and potentially to make a diagnosis and initiate early specific treatment.
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Affiliation(s)
- Virgil PĂtraŞcu
- Department of Dermatology, Emergency County Hospital, Craiova, University of Medicine and Pharmacy of Craiova, Romania
| | - Liliana Gabriela Geoloaica
- Department of Dermatology, Emergency County Hospital, Craiova, University of Medicine and Pharmacy of Craiova, Romania
| | - Raluca Niculina Ciurea
- Department of Pathology, Emergency County Hospital, Craiova, University of Medicine and Pharmacy of Craiova, Romania
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Lepelletier C, Bouaziz JD, Rybojad M, Bagot M, Georgin-Lavialle S, Vignon-Pennamen MD. Neutrophilic Dermatoses Associated with Myeloid Malignancies. Am J Clin Dermatol 2019; 20:325-333. [PMID: 30632096 DOI: 10.1007/s40257-018-00418-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Neutrophilic dermatoses (ND) are a group of conditions characterized by an aseptic accumulation of polymorphonuclear leukocytes in the skin. Occurrence of ND in association with myeloid malignancies, mainly myelodysplastic syndrome and myelogenous acute leukemia, is not rare and is often associated with a poor prognosis. Recent findings have improved understanding of the pathophysiology of myeloid malignancy-associated ND. We review the clinical spectrum of myeloid malignancy-associated ND with an emphasis on recently identified mechanisms. Myeloid leukemia cells retain the potential for terminal differentiation into polymorphonuclear leukocytes in the skin. Many studies suggest a clonal link between myeloid malignancies and ND. Activation of autoinflammatory pathways (NOD-like receptor family pyrin domain-containing-3, Familial Mediterranean Fever Gene) in the clonal cells of myeloid disorders may also be involved in this setting.
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Shahid Z, Kalayanamitra R, Patel R, Groff A, Jain R. Refractory Sweet Syndrome Treated with Anakinra. Cureus 2019; 11:e4536. [PMID: 31263644 PMCID: PMC6592472 DOI: 10.7759/cureus.4536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Sweet syndrome, otherwise known as acute febrile neutrophilic dermatosis, is an uncommon disorder characterized by the abrupt onset of painful cutaneous lesions, often with fever and leukocytosis, in patients with underlying infection, malignancy, pregnancy, or drug exposure. We present a case of a young female with long-standing Sweet syndrome refractory to standard treatments and several immunomodulators whose symptoms were ultimately controlled with anakinra.
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Affiliation(s)
- Zainab Shahid
- Internal Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Ricci Kalayanamitra
- Emergency Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Ravi Patel
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Andrew Groff
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Rohit Jain
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
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Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol 2018; 79:987-1006. [PMID: 29653210 DOI: 10.1016/j.jaad.2017.11.064] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 12/24/2022]
Abstract
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.
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Affiliation(s)
- Caroline A Nelson
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sasha Stephen
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hovik J Ashchyan
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D James
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert G Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Garcovich S, De Simone C, Berti E, Marzano AV. Drug management of neutrophilic dermatoses. Expert Rev Clin Pharmacol 2017; 10:1119-1128. [PMID: 28715916 DOI: 10.1080/17512433.2017.1356719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Neutrophilic dermatoses are a heterogenous group of chronic, cutaneous inflammatory conditions characterized by the accumulation of neutrophils in the skin and by systemic inflammation. Neutrophilic dermatoses can be idiopathic or associated with other inflammatory or systemic diseases, including the group of the hereditary, autoinflammatory syndromes. Clinical management is challenging, due to limited clinical evidence and lack of clinical practice guidelines. Areas covered: This review provides an overview of current therapeutic management of the three prototypical neutrophilic dermatoses, aseptic pustulosis of the folds, Sweet syndrome and pyoderma gangrenosum. In addition, we describe innovative, pathogenesis-oriented treatment approaches, which are based on recent advances in the pathophysiology of neutrophilic dermatoses and autoinflammatory syndromes. The increasing role of the IL-1 cytokine family in initiating neutrophilic inflammation in both idiopathic and syndromic disease opened the way for the use of targeted biological treatment. Another promising treatment strategy is aimed at blocking downstream effector cytokines, such as IL12/23 and IL-17, involved in the autoinflammatory immune cascade. Expert commentary: In chronic-recurrent and syndromic cases of neutrophilic dermatoses, there is an unmet clinical need for long-term, continuous disease control. Future controlled clinical studies will optimize the use of targeted-biological agents in sequential or combination treatment strategies.
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Affiliation(s)
- Simone Garcovich
- a Institute of Dermatology , Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart , Rome , Italy
| | - Clara De Simone
- a Institute of Dermatology , Policlinico A. Gemelli University Hospital, Catholic University of the Sacred Heart , Rome , Italy
| | - Emilio Berti
- b UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , Università Degli Studi di Milano , Milan , Italy
| | - Angelo Valerio Marzano
- b UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti , Università Degli Studi di Milano , Milan , Italy
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12
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Braun T, Fenaux P. Myelodysplastic Syndromes (MDS) and autoimmune disorders (AD): Cause or consequence? Best Pract Res Clin Haematol 2013; 26:327-36. [DOI: 10.1016/j.beha.2013.09.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Mathieu S, Soubrier M, Tournadre A, Dubost JJ. Neutrophilic dermatosis of the dorsal hands during thalidomide treatment. Int J Dermatol 2013; 53:1133-5. [DOI: 10.1111/j.1365-4632.2012.05714.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sylvain Mathieu
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
| | - Martin Soubrier
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
| | - Anne Tournadre
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
| | - Jean-Jacques Dubost
- Department of Rheumatology, Gabriel Montpied Teaching Hospital; Clermont 1 University; Clermont-Ferrand France
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14
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Paydas S. Sweet's syndrome: A revisit for hematologists and oncologists. Crit Rev Oncol Hematol 2013; 86:85-95. [DOI: 10.1016/j.critrevonc.2012.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 08/09/2012] [Accepted: 09/06/2012] [Indexed: 12/26/2022] Open
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Abstract
Neutrophilic dermatoses, including Sweet's syndrome, pyoderma gangrenosum, and rheumatoid neutrophilic dermatitis, are inflammatory conditions of the skin often associated with underlying systemic disease. These are characterized by the accumulation of neutrophils in the skin. The associated conditions, potential for systemic neutrophilic infiltration, and therapeutic management of these disorders can be similar. Sweet's syndrome can often be effectively treated with a brief course of systemic corticosteroids. Pyoderma gangrenosum, however, can be recurrent, and early initiation of a steroid-sparing agent is prudent. Second-line treatment for both of these conditions includes medications affecting neutrophil function, in addition to immunosuppressant medications.
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Affiliation(s)
- Courtney R Schadt
- Division of Dermatology, University of Louisville, 310 East Broadway, Louisville, KY 40202, USA.
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Tageja N, Giorgadze T, Zonder J. Dermatological complications following initiation of lenalidomide in a patient with chronic lymphocytic leukaemia. Intern Med J 2011; 41:286-8. [DOI: 10.1111/j.1445-5994.2011.02426.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dabade TS, Davis MDP. Diagnosis and treatment of the neutrophilic dermatoses (pyoderma gangrenosum, Sweet's syndrome). Dermatol Ther 2011; 24:273-84. [DOI: 10.1111/j.1529-8019.2011.01403.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Farah C, Bulai Livideanu C, Jegu J, Paul C, Viraben R, Lamant L, Delavigne K, Adoue D, Laurent G, Beyne Rauzy O. Prevalence and prognostic value of cutaneous manifestations in patients with myelodysplastic syndrome. J Eur Acad Dermatol Venereol 2011; 24:1171-5. [PMID: 20202054 DOI: 10.1111/j.1468-3083.2010.03614.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin manifestations associated with myelodysplastic syndrome (MDS) may reveal bone marrow transformation into acute myeloid leukaemia. OBJECTIVE The objective of this study was to assess the prevalence of skin manifestations associated with MDS. In addition, we evaluated the risk of acute myeloid leukaemia transformation associated with skin manifestations. METHODS We studied a cohort of 157 patients with primary MDS followed up prospectively for a median of 44 months. Skin lesions were prospectively assessed as part of medical examination every 6 months by a board certified dermatologist. Survival analyses were performed to assess the association between the presence of skin lesions and the risk of acute myeloid leukaemia. RESULTS Fifteen patients (9.55%) experienced skin lesions previously reported as associated with MDS. These were neutrophilic dermatosis (7, 4.46%), specific lesions (5, 3.18%), cutaneous vasculitis (2, 1.27%) and Behçet disease (1, 0.63%). Survival analysis showed that the risk of transformation into acute myeloid leukaemia was slightly but not significantly increased in patients with skin lesions as compared with patients without skin lesions with a relative risk of 2.08 (95% CI 0.92-4.67). CONCLUSION The prevalence of skin lesions, mostly neutrophilic dermatosis and specific lesions, is relatively high in patients with MDS. There is a trend for a higher risk of transformation into acute myeloid leukaemia in patients with skin lesions.
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Affiliation(s)
- C Farah
- Department of Dermatology, Toulouse University Hospital, , Toulouse Cedex 9, France
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Elbuluk N, Martiniuk F, Levis WR. Erythema nodosum leprosum, Sweet's syndrome, and human immunodeficiency virus may be related through an overlap in immunopathogenesis. Int J Dermatol 2010; 49:1344-5. [PMID: 20964666 DOI: 10.1111/j.1365-4632.2009.04066.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Soutou B, Vignon-Pennamen D, Chosidow O. [Neutrophilic dermatoses]. Rev Med Interne 2010; 32:306-13. [PMID: 20933309 DOI: 10.1016/j.revmed.2010.08.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 01/23/2010] [Accepted: 08/25/2010] [Indexed: 01/13/2023]
Abstract
Neutrophilic dermatoses are inflammatory disorders where normal neutrophils infiltrate the skin without infection. Sweet's syndrome, pyoderma gangrenosum, subcorneal pustulosis, erythema elevatum diutinum and a few other conditions are included in the spectrum of neutrophilic dermatoses. In addition to their typical presentation, atypical and overlap forms of these disorders may be observed. According to the location of the neutrophilic infiltrate, three clinical forms are distinguished: superficial (epidermal), en plaques (dermal) and deep (dermal and hypodermal). During the disease course, other tissues can be affected by the same neutrophilic infiltrate. An association with other systemic diseases including malignant blood disorders, inflammatory bowel diseases and autoimmune disorders is frequent. The mechanisms leading to the invasion of the skin by neutrophils remains not completely elucidated. Treatment depends on the intensity and the acute or chronic form of the disease. In acute and severe forms, systemic corticosteroids are first-line therapy, whereas colchicine, dapsone, and even topical corticosteroids could be used in milder presentations of the disease.
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Affiliation(s)
- B Soutou
- Centre hospitalier du Nord, 100, Jdeidet, Zgharta, Liban
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Stem cell transplant for myelodysplastic syndrome-associated histiocytoid sweet's syndrome in a patient with arthritis and myalgias. ACTA ACUST UNITED AC 2008; 59:1832-4. [DOI: 10.1002/art.24061] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Anavekar NS, Williams R, Chong AH. Sweet's syndrome in an Australian hospital: A retrospective analysis. Australas J Dermatol 2007; 48:161-4. [PMID: 17680966 DOI: 10.1111/j.1440-0960.2007.00371.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A retrospective analysis was performed of patients meeting the clinicopathological diagnosis of Sweet's syndrome identified over a 10-year period, in a metropolitan hospital. Nine patients met the inclusion criteria. Two patients had preceding streptococcal infection, two had associated inflammatory bowel disease, two had idiopathic Sweet's syndrome, and three had an underlying malignancy, one of whom was receiving granulocyte colony-stimulating factor. Although only three patients were found to have an elevated white cell count, erythrocyte sedimentation rate or C-reactive protein was elevated in all patients when measured. There was a wide spectrum of clinical presentations, with variations in lesion distribution and the presence/absence of systemic symptoms such as fever and arthralgia. Fever was observed in two-thirds of cases. Seven patients responded to oral corticosteroids, while one patient cleared spontaneously and one patient was lost to follow up. As erythrocyte sedimentation rate or C-reactive protein was elevated in all cases when measured, it may be a useful diagnostic tool.
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Affiliation(s)
- Namrata S Anavekar
- Department of Medicine (Dermatology), St Vincent's Hospital, 41 Victoria Parade, Fitzroy, Melbourne, VIC 3065, Australia
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23
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Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007; 2:34. [PMID: 17655751 PMCID: PMC1963326 DOI: 10.1186/1750-1172-2-34] [Citation(s) in RCA: 499] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/26/2007] [Indexed: 01/19/2023] Open
Abstract
Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis. Several hundreds cases of Sweet's syndrome have been published. Sweet's syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. Classical Sweet's syndrome (CSS) usually presents in women between the age of 30 to 50 years, it is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy. Approximately one-third of patients with CSS experience recurrence of the dermatosis. The malignancy-associated Sweet's syndrome (MASS) can occur as a paraneoplastic syndrome in patients with an established cancer or individuals whose Sweet's syndrome-related hematologic dyscrasia or solid tumor was previously undiscovered; MASS is most commonly related to acute myelogenous leukemia. The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's cancer. Hence, MASS can be the cutaneous harbinger of either an undiagnosed visceral malignancy in a previously cancer-free individual or an unsuspected cancer recurrence in an oncology patient. Drug-induced Sweet's syndrome (DISS) most commonly occurs in patients who have been treated with granulocyte-colony stimulating factor, however, other medications may also be associated with DISS. The pathogenesis of Sweet's syndrome may be multifactorial and still remains to be definitively established. Clinical and laboratory evidence suggests that cytokines have an etiologic role. Systemic corticosteroids are the therapeutic gold standard for Sweet's syndrome. After initiation of treatment with systemic corticosteroids, there is a prompt response consisting of dramatic improvement of both the dermatosis-related symptoms and skin lesions. Topical application of high potency corticosteroids or intralesional corticosteroids may be efficacious for treating localized lesions. Other first-line oral systemic agents are potassium iodide and colchicine. Second-line oral systemic agents include indomethacin, clofazimine, cyclosporine, and dapsone. The symptoms and lesions of Sweet's syndrome may resolved spontaneously, without any therapeutic intervention; however, recurrence may follow either spontaneous remission or therapy-induced clinical resolution.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Houston, Texas, USA.
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Raj K, Ho A, Creamer JD, du Vivier AWP, Salisbury JR, Mufti GJ. Complete response of deep neutrophilic dermatosis associated with myelodysplastic syndrome to 5-azacytidine. Br J Dermatol 2007; 156:1039-41. [PMID: 17408390 DOI: 10.1111/j.1365-2133.2007.07831.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cutaneous manifestations of myelodysplastic syndromes (MDS) may predict disease progression and a poorer prognosis. We describe a patient in whom a deep neutrophilic dermatosis preceded evolution of disease from refractory anaemia to RAEB (refractory anaemia with excess blasts) and resolved completely on treating the disease with 5-azacytidine. The dermatological response was accompanied by complete bone marrow remission and trilineage haematological improvement. We suggest that 5-azacytidine should be considered in the treatment of immune mediated cutaneous manifestations of MDS.
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Affiliation(s)
- K Raj
- Department of Haematological Medicine, King's College London and King's College Hospital, Denmark Hill, London, UK
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Franco M, Giusti C, Malieni D, Ferrario D, Galimberti G, Hidalgo Parra I, Kowalczuk A, Galimberti R. Síndrome de Sweet asociado a neoplasias. An Bras Dermatol 2006. [DOI: 10.1590/s0365-05962006000500011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
El síndrome de Sweet fue descrito en el año 1964 por Robert Douglas Sweet, como una entidad a la cual denominó dermatosis neutrofílica febril y aguda. Se caracteriza por cinco rasgos principales: 1) aparición brusca de placas eritemato-dolorosas en cara, cuello y extremidades; 2) fiebre; 3) leucocitosis polimorfonuclear; 4) denso infiltrado dérmico a predominio neutrofilico; 5) rápida respuesta al tratamiento esteroideo. Se puede clasificar en cinco grupos: idiopático, parainflamatorio, paraneoplásico, secundario a drogas y asociado a embarazo. En el 20% de los casos se asocia a enfermedades malignas, representando las hematológicas el 85% y los tumores sólidos el 15% restante. Se presenta una serie de siete casos de síndrome de Sweet asociado a neoplasias, diagnosticados durante el período 2002-2006, de los cuales seis correspondieron a enfermedades oncohematológicas y el restante a tumores sólidos. Como comentario de dicha casuística, se hace hincapié en la importancia del diagnóstico de este síndrome, debido a que puede anunciar la recaída del tumor o la progresión de la enfermedad de base. De esta manera, mediante el uso de métodos de diagnóstico y tratamiento oportunos, se lograría mejorar la calida de vida de estos pacientes. También debe tenerse en cuenta, que los pacientes oncológicos reciben múltiples medicaciones (factor estimulante de colonias), que pueden estar implicadas en la aparición de esta entidad, debiendo ser las mismas descartadas como posibles causas.
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