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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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2
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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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3
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Delaleu J, Bouaziz JD. Overview of Neutrophilic Biology, Pathophysiology, and Classification of Neutrophilic Dermatoses. Dermatol Clin 2024; 42:147-156. [PMID: 38423677 DOI: 10.1016/j.det.2023.08.002] [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
Neutrophilic dermatoses are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. These conditions present with a wide range of clinical manifestations, including pustules, bullae, abscesses, papules, nodules, plaques, and ulcers. The classification of neutrophilic dermatoses is based on the localization of neutrophils in the skin. The pathogenic mechanisms of neutrophilic dermatoses involve autoinflammation, neutrophilic dysfunction, clonal somatic mutation and differentiation of the myeloid precursors as encountered in myeloid neoplasm.
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Affiliation(s)
- Jérémie Delaleu
- Dermatology Department, Saint Louis Hospital, APHP Nord Université Paris Cité and INSERM u976 "Human Immunology, Pathophysiology and Immunotherapy", Paris, France
| | - Jean-David Bouaziz
- Dermatology Department, Saint Louis Hospital, APHP Nord Université Paris Cité and INSERM u976 "Human Immunology, Pathophysiology and Immunotherapy", Paris, France.
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4
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Wallach D. The Neutrophilic Dermatoses, or the Cutaneous Expressions of Neutrophilic Inflammation. Dermatol Clin 2024; 42:139-146. [PMID: 38423676 DOI: 10.1016/j.det.2023.08.001] [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
Acute febrile neutrophilic dermatosis, or Sweet syndrome, has been described in 1964 and is now considered as a prototypical condition of the group of the neutrophilic dermatoses. Since this time, many clinical conditions have been included in this group and a clinical-pathological classification in 3 subgroups has been proposed. Neutrophilic infiltrates can localize in all internal organs. This defines the neutrophilic disease, which induces difficult diagnostic and therapeutic problems. Autoinflammation is the main pathophysiological mechanism of the neutrophilic dermatoses. There is a special link between myeloid malignancies (leukemia and myelodysplasia) and the neutrophilic dermatoses.
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5
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Kipers T, Tolkachjov SN. Postoperative and Peristomal Pyoderma Gangrenosum: Subtypes of Pyoderma Gangrenosum. Dermatol Clin 2024; 42:171-181. [PMID: 38423679 DOI: 10.1016/j.det.2023.12.001] [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
Postoperative pyoderma gangrenosum and peristomal pyoderma gangrenosum are 2 subtypes of pyoderma gangrenosum. The diagnosis is made as a clinicopathologic correlation when assessing a rapidly progressing ulcer with irregular and undermined borders following a surgical procedure, trauma, or the creation of a stoma. Familiarity with the associated risk factors and distinguishing features of these disorders can facilitate prompt recognition, proper diagnosis, and the initiation of treatment. Management usually involves the use of corticosteroids and steroid-sparing agents as immunomodulators to shift the inflammatory neutrophilic dermatoses to chronic noninflammatory wounds and eventual healing.
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Affiliation(s)
- Théodora Kipers
- School of Medicine, Texas A&M University School of Medicine, 5536 Tremont Street, Dallas, TX 75214, USA
| | - Stanislav N Tolkachjov
- Mohs Micrographic & Reconstructive Surgery, Epiphany Dermatology; Department of Dermatology, Baylor University Medical Center; University of Texas at Southwestern; Texas A&M University School of Medicine, 1640 FM 544, Suite 100, TX 75056, USA.
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6
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Łyko M, Ryguła A, Kowalski M, Karska J, Jankowska-Konsur A. The Pathophysiology and Treatment of Pyoderma Gangrenosum-Current Options and New Perspectives. Int J Mol Sci 2024; 25:2440. [PMID: 38397117 PMCID: PMC10889749 DOI: 10.3390/ijms25042440] [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: 01/05/2024] [Revised: 02/08/2024] [Accepted: 02/15/2024] [Indexed: 02/25/2024] Open
Abstract
Pyoderma gangrenosum (PG) is an uncommon inflammatory dermatological disorder characterized by painful ulcers that quickly spread peripherally. The pathophysiology of PG is not fully understood; however, it is most commonly considered a disease in the spectrum of neutrophilic dermatoses. The treatment of PG remains challenging due to the lack of generally accepted therapeutic guidelines. Existing therapeutic methods focus on limiting inflammation through the use of immunosuppressive and immunomodulatory therapies. Recently, several reports have indicated the successful use of biologic drugs and small molecules administered for coexisting diseases, resulting in ulcer healing. In this review, we summarize the discoveries regarding the pathophysiology of PG and present treatment options to raise awareness and improve the management of this rare entity.
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Affiliation(s)
- Magdalena Łyko
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Anna Ryguła
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Michał Kowalski
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
| | - Julia Karska
- Student Research Group of Experimental Dermatology, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (A.R.); (M.K.); (J.K.)
- Department of Psychiatry, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Alina Jankowska-Konsur
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
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7
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Irie K, Yamamoto T. A Case of Pyoderma Gangrenosum-Like Ulcers Progressing into Neutrophilic Panniculitis in a Patient With Myelodysplastic Syndrome. ACTAS DERMO-SIFILIOGRAFICAS 2023:S0001-7310(23)00926-2. [PMID: 38008246 DOI: 10.1016/j.ad.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
- K Irie
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan.
| | - T Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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8
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Bugaut H, Barete S, Bagot M, Bouaziz JD, Le Pelletier de Glatigny F, Gallien Y, Biard L, Domont F, Cacoub P, Saadoun D, Comarmond C. Neutrophilic dermatosis and hidradenitis suppurativa in patients with Behçet's disease: A neutrophilic disease in the spectrum of autoinflammatory syndromes. Semin Arthritis Rheum 2023; 61:152224. [PMID: 37207416 DOI: 10.1016/j.semarthrit.2023.152224] [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: 02/06/2023] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Association of neutrophilic dermatosis (ND), hidradenitis suppurativa (HS) and Behçet's disease (BD) and shared efficacy of TNFα axis blockade suggests common physiopathology. OBJECTIVES To investigate the clinical features and therapeutic response of ND and HS associated with BD. METHODS We identified 20 patients with ND or HS associated with BD among 1462 patients with BD. RESULTS We analysed 20 (1.4%) patients diagnosed with ND or HS associated with BD: 13 HS, 6 pyoderma gangrenosum (PG), and 1 SAPHO. Our 6 PG cases over 1462 BD patients accounts for 400/100 000 prevalence. Thirteen had bipolar aphthosis, 6 vascular, 5 neurologic, and 4 ocular involvements. All PG occurred on limbs and had typical histology with constant dermal neutrophilic infiltrate. All HS had the classical axillary-mammary phenotype. Sixty-nine percent (69%) of HS were Hurley 1 stage. Treatment consisted mainly in colchicine (n = 20), glucocorticoids (n = 12), and anti-TNFα (n = 9). Interesting results with complete or partial responses were obtained with anti-TNFα (9 cases), ustekinumab (3 cases) and tocilizumab (1 case) to treat refractory ND or HS associated with BD. CONCLUSION PG seems overrepresented in patients with BD. Biotherapies such as anti-TNFα, ustekinumab and tocilizumab appear to be promising to treat refractory ND or HS associated with BD.
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Affiliation(s)
- Hélène Bugaut
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Stéphane Barete
- Unit of Dermatology, Pitié-Salpêtrière Hospital, APHP, DMU3ID, Sorbonne Université, Paris 75013, France
| | - Martine Bagot
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Jean-David Bouaziz
- Dermatology, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | | | - Yves Gallien
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Lucie Biard
- Biostatistic, Saint-Louis Hospital, Université Paris Cité, Paris 75010, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, 75013 Paris France, Centre de référence Maladies Autoimmunes systémiques rares, Centre de référence Maladies Autoinflammatoires et amylose, 83 boulevard de l'hôpital, Paris 75013, France.
| | - Cloé Comarmond
- Department of Internal Medicine and Clinical Immunology, Lariboisière Hospital, Université Paris Cité, Paris 75010, France
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9
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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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10
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Muacevic A, Adler JR, Eusébio SP, Prayce R, Pires P. From the Deep: Overlap of Neutrophilic Dermatoses Disorders Associated With Acute Myeloid Leukemia. Cureus 2023; 15:e33456. [PMID: 36751214 PMCID: PMC9897686 DOI: 10.7759/cureus.33456] [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: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
We report the case of a man in his 50s with refractory acute myelomonocytic leukaemia (AML) who presented with neck swelling, fever, and elevated levels of C-reactive protein (CPR) after venous punctures. An infected haematoma was presumed, but the patient showed no signs of improvement under broad-range antibiotics, and microbiological results were negative. The subsequent development of a rapidly evolving erythematous-violaceous plaque around a site that had previously punctured on the extensor surface of the right arm prompted us to reconsider the clinical setting as a whole and consider the hypothesis of deep neutrophilic dermatosis (ND) associated with haematologic malignancy. A biopsy of the arm lesion showed an aseptic neutrophilic infiltrate, confirming this diagnosis. The patient was initially treated with high-dose intravenous corticosteroids, resulting in a dramatic improvement of the skin lesions.
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11
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Dermatological manifestations of hematologic neoplasms. Part II: nonspecific skin lesions/paraneoplastic diseases. An Bras Dermatol 2023; 98:141-158. [PMID: 36682966 PMCID: PMC9984718 DOI: 10.1016/j.abd.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 01/21/2023] Open
Abstract
Cutaneous manifestations occur in the course of hematologic malignancies and precede, accompany or occur late in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, immunosuppression resulting from the hematologic disease itself or its treatment. The dermatologist must be aware of these conditions that may be helpful both in the diagnosis of the underlying disease and in reducing patient morbidity. This review (part II) addresses the paraneoplastic dermatological changes associated with systemic hematologic malignancies.
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12
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Delaleu J, Lepelletier C, Calugareanu A, De Masson A, Charvet E, Petit A, Giurgea I, Amselem S, Karabina S, Jachiet M, Mahevas T, Ram-Wolff C, Vignon-Pennamen MD, Bagot M, Battistella M, Bouaziz JD. Neutrophilic dermatoses. Rev Med Interne 2022; 43:727-738. [PMID: 35870984 DOI: 10.1016/j.revmed.2022.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/27/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
Neutrophilic dermatoses (ND) are a group of inflammatory skin conditions characterized by a neutrophilic infiltrate on histopathology with no evidence of infection. ND are classified based upon the localization of neutrophils within the skin and clinical features. Recent findings suggest that ND are due to two main mechanisms: i) a polyclonal hereditary activation of the innate immune system (polygenic or monogenic); or ii) a clonal somatic activation of myeloid cells such as encountered in myelodysplastic syndrome or VEXAS syndrome. ND belong to internal medicine as a great number of patients with ND suffer from an underlying condition (such as hematological malignancy, inflammatory bowel disease, auto-immune and auto-inflammatory diseases). ND are diagnoses of exclusion and physicians should always consider differential diagnoses, particularly skin infections. Here, we review the pathophysiology and classification of the main ND (i.e., subcorneal pustular dermatosis (Sneddon-Wilkinson Disease) and Intercellular IgA dermatoses, aseptic pustulosis of the folds, Sweet syndrome, neutrophilic eccrine hidradenitis, pyoderma gangrenosum, erythema elevatum diutinum, neutrophilic urticarial dermatosis and neutrophilic panniculitis), their clinical and histopathological features, and we highlight the investigations that are useful to identify ND-associated diseases and to exclude the differential diagnoses.
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Affiliation(s)
- J Delaleu
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - C Lepelletier
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - A Calugareanu
- Service de dermatologie, Severe Cutaneous Adverse Reaction (SCAR) Regional Center, HCL, CHU de Lyon Centre, Lyon, France
| | - A De Masson
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - E Charvet
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - A Petit
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - I Giurgea
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - S Amselem
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - S Karabina
- Inserm u933, "Childhood genetic disorders", service de génétique, Sorbonne université, hôpital Armand-Trousseau, AP-HP, Paris, France
| | - M Jachiet
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - T Mahevas
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - C Ram-Wolff
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - M-D Vignon-Pennamen
- Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - M Bagot
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France
| | - M Battistella
- Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France; Service d'anatomie pathologique, hôpital Saint-Louis, AP-HP, Paris, France
| | - J-D Bouaziz
- Service de dermatologie, hôpital Saint-Louis, AP-HP, Paris, France; Inserm u976 "Human Immunology, Pathophysiology and Immunotherapy", université Paris Cité, Paris, France.
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13
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Neutrophilic Dermatoses in a Clinical Practice of Wound Care Professionals. Adv Skin Wound Care 2022; 35:1-8. [PMID: 35703854 DOI: 10.1097/01.asw.0000826832.69141.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Diagnosing and treating neutrophilic dermatoses (NDs) in clinical practice can be challenging because of various presentations and stubborn treatment responses. Establishing a diagnosis is necessary, though, because many NDs are associated with underlying conditions, including malignancy. In this article, the authors provide information about Sweet syndrome, pyoderma gangrenosum, and other NDs and describe their clinical presentation, pathophysiology, diagnostic criteria, and associated conditions. The authors also present a case report describing the coexistence of two NDs and hidradenitis suppurativa in one patient and review the treatment modalities for those conditions.
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14
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Xing F, Chiu KHY, Yang J, Ye H, Zhang L, Liu C, Yuen KY. Pyoderma gangrenosum with pulmonary involvement: a pulmonary special report and literature review. Expert Rev Respir Med 2022; 16:149-159. [PMID: 35034556 DOI: 10.1080/17476348.2022.2027756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is the prototypical neutrophilic dermatosis, commonly associated with inflammatory bowel disease, with pulmonary involvement being the commonest extracutaneous manifestation. PG with tracheobronchial involvement may present as upper airway obstruction and can be life-threatening. AREAS COVERED To evaluate the clinical characteristics and predictors of PG with pulmonary involvement, we reported a case of PG with tracheobronchial involvement in China, and performed a literature retrieval on PG with pulmonary involvement. Demographic data, clinical presentations, underlying diseases, radiological and histopathological findings, treatments, and clinical outcomes were collected and subjected to statistical analysis. Forty-seven cases (including ours) were identified. Diseases associated with PG with pulmonary involvement were similar. Clinical presentation of PG with pulmonary involvement was non-specific, with cough and dyspnea being the most common clinical symptoms, and pulmonary infiltrates and cavitation being the most common radiological signs. Further univariate analysis suggested stridor and young age (p < 0.01) may be predictors of tracheobronchial involvement in PG. EXPERT OPINION PG with tracheobronchial involvement can be life-threatening, with young age and stridor being possible predictors. Therefore, prompt airway assessment and management are required in younger patients with PG with pulmonary involvement presenting with stridor.
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Affiliation(s)
- Fanfan Xing
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - Jin Yang
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Haiyan Ye
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lijun Zhang
- Department of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chenjing Liu
- Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kwok-Yung Yuen
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
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15
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Suárez EU. Not so “sweet” . . . and so painful. BRITISH MEDICAL JOURNAL 2022. [DOI: 10.1136/bmj-2021-067671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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16
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Agrawal A, Arif SH, Kumarasan K, Janjua D. Sweet's Syndrome: An Update. Curr Pediatr Rev 2022; 18:265-273. [PMID: 35209834 DOI: 10.2174/1573396318666220223100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/20/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
Sweet's syndrome is a serious dermatological disorder characterized by a rapid onset of tender plaques or nodules, fever, joint pain, headache, and oral and genital lesions. According to the clinical features and underlying causes, Sweet's syndrome is divided into three categories, i.e., classical (or idiopathic), malignancy-associated Sweet's syndrome, and drug-induced Sweet's syndrome. It is multifactorial in etiology, and the exact cause is still undetermined. The diagnosis can be confirmed by the routine histopathologic evaluation of skin biopsy from the lesions. The first-line treatment options are topical and systemic steroids. Multiple databases, like Medline/PubMed, Scopus, and Google, were used to identify resources for this literature review. The relevant information was collected from various case reports, case series, reviews, meta-analyses, and large clinical trials reporting clinical description, etiology, diagnosis, and management of Sweet's syndrome. This narrative review aimed to discuss recent understandings related to Sweet's syndrome, both in terms of clinical presentation and management approach.
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Affiliation(s)
- Amit Agrawal
- Department of Pediatrics, Gandhi Medical College, Bhopal, MP, India
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17
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Piqué-Duran E, Morera Molina J, Limeres-González MÁ, Espejo-Gil AM. Cranial aseptic osteomyelitis associated with pyoderma gangrenosum. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:46-50. [PMID: 34955434 DOI: 10.1016/j.neucie.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/21/2020] [Indexed: 06/14/2023]
Abstract
Neutrophilic dermatoses include a heterogeneous group of entities. Uncommonly, they can accumulate aseptic neutrophilic abscesses in other tissues in addition to the skin. A 34-year-old female complained of a headache which was unresponsive to usual drugs. A TAC revealed an osteolytic lesion in the right parietal bone. The biopsy showed osteomyelitis. One year later, pyoderma gangrenosum appeared in the anterior aspect of both legs. The headache and the cutaneous lesions disappeared after treatment with oral prednisone. The bone involvement in the background of neutrophilic dermatoses is exceptional. Usually, it involves children in the context of chronic recurrent multiple osteomyelitis (CRMO). Only two cases have been described in adults. One of them was a 26-year-old woman who had had CRMO since childhood, and the other one in contiguity with the cutaneous lesions of pyoderma gangrenosum.
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Affiliation(s)
- Enric Piqué-Duran
- Sección de Dermatología, Hospital Dr. José Molina Orosa, Lanzarote, Provincia de Las Palmas, Spain.
| | - Jesús Morera Molina
- Servicio de Neurocirugía, Hospital Universitario de Gran Canaria Doctor Negrín, Provincia de Las Palmas, Spain
| | | | - Ana María Espejo-Gil
- Servicio de Medicina Interna, Hospital Dr. José Molina Orosa, Lanzarote, Provincia de Las Palmas, Spain
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18
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Croia C, Dini V, Loggini B, Manni E, Romanelli M, Migliorini P. Evaluation of neutrophil extracellular trap deregulated formation in pyoderma gangrenosum. Exp Dermatol 2021; 30:1340-1344. [PMID: 34057268 PMCID: PMC8453546 DOI: 10.1111/exd.14397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/16/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatose (ND) characterized by a dense neutrophilic infiltrate in the affected tissue. Neutrophil extracellular traps (NETs) are web-like structures released by neutrophils and composed of cytosolic and granule proteins assembled on a scaffold of decondensed chromatin. Very little is known about the role of NETosis in PG. Here, we assessed the possible implication of NETosis in the pathogenesis of PG by investigating the NETosis in the ulcers of 26 PG patients. We demonstrated that neutrophils in the PG skin lesions undergo an aberrant level of NETosis in 100% of the analysed cases (N = 26). All control and abscess biopsies were instead negative for the NETosis. In addition, neutrophils from peripheral blood of PG patients showed a significantly higher rate of spontaneous, but not induced, NETosis. Overall, this study suggests that the NETosis may contribute to systemic inflammation and tissue destruction in PG, thus representing a possible novel therapeutic target.
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Affiliation(s)
- Cristina Croia
- Immuno-Allergology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valentina Dini
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Loggini
- Pathology Unit, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Elisabetta Manni
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Romanelli
- Dermatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paola Migliorini
- Immuno-Allergology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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19
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Hooton TA, Hanson JF, Olerud JE. Recalcitrant cutaneous pyoderma gangrenosum with pulmonary involvement resolved with treatment of underlying plasma cell dyscrasia. JAAD Case Rep 2021; 9:28-30. [PMID: 33604440 PMCID: PMC7873383 DOI: 10.1016/j.jdcr.2020.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Tyler A Hooton
- University of Washington, School of Medicine, Seattle, Washington
| | - Josiah F Hanson
- University of Washington, School of Medicine, Seattle, Washington
| | - John E Olerud
- University of Washington, School of Medicine, Seattle, Washington
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20
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Piqué-Durán E, Morera Molina J, Limeres-González MÁ, Espejo-Gil AM. Cranial aseptic osteomyelitis associated with pyoderma gangrenosum. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00001-4. [PMID: 33546980 DOI: 10.1016/j.neucir.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/21/2020] [Indexed: 11/21/2022]
Abstract
Neutrophilic dermatoses include a heterogeneous group of entities. Uncommonly, they can accumulate aseptic neutrophilic abscesses in other tissues in addition to the skin. A 34-year-old female complained of a headache which was unresponsive to usual drugs. A TAC revealed an osteolytic lesion in the right parietal bone. The biopsy showed osteomyelitis. One year later, pyoderma gangrenosum appeared in the anterior aspect of both legs. The headache and the cutaneous lesions disappeared after treatment with oral prednisone. The bone involvement in the background of neutrophilic dermatoses is exceptional. Usually, it involves children in the context of chronic recurrent multiple osteomyelitis (CRMO). Only two cases have been described in adults. One of them was a 26-year-old woman who had had CRMO since childhood, and the other one in contiguity with the cutaneous lesions of pyoderma gangrenosum.
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Affiliation(s)
- Enric Piqué-Durán
- Sección de Dermatología, Hospital Dr. José Molina Orosa, Lanzarote, Provincia de Las Palmas, España.
| | - Jesús Morera Molina
- Servicio de Neurocirugía, Hospital Universitario de Gran Canaria Doctor Negrín, Provincia de Las Palmas, España
| | | | - Ana María Espejo-Gil
- Servicio de Medicina Interna, Hospital Dr. José Molina Orosa, Lanzarote, Provincia de Las Palmas, España
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21
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Antonelli E, Bassotti G, Tramontana M, Hansel K, Stingeni L, Ardizzone S, Genovese G, Marzano AV, Maconi G. Dermatological Manifestations in Inflammatory Bowel Diseases. J Clin Med 2021; 10:jcm10020364. [PMID: 33477990 PMCID: PMC7835974 DOI: 10.3390/jcm10020364] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) may be associated with extra-intestinal manifestations. Among these, mucocutaneous manifestations are relatively frequent, often difficult to diagnose and treat, and may complicate the course of the underlying disease. In the present review, a summary of the most relevant literature on the dermatologic manifestations occurring in patients with inflammatory bowel diseases has been reviewed. The following dermatological manifestations associated with IBDs have been identified: (i) specific manifestations with the same histological features of the underlying IBD (occurring only in Crohn's disease); (ii) cutaneous disorders associated with IBDs (such as aphthous stomatitis, erythema nodosum, psoriasis, epidermolysis bullosa acquisita); (iii) reactive mucocutaneous manifestations of IBDs (such as pyoderma gangrenosum, Sweet's syndrome, bowel-associated dermatosis-arthritis syndrome, aseptic abscess ulcers, pyodermatitis-pyostomatitis vegetans, etc.); (iv) mucocutaneous conditions secondary to treatment (including injection site reactions, infusion reactions, paradoxical reactions, eczematous and psoriasis-like reactions, cutaneous infections, and cutaneous malignancies); (v) manifestations due to nutritional malabsorption (such as stomatitis, glossitis, angular cheilitis, pellagra, scurvy, purpura, acrodermatitis enteropathica, phrynoderma, seborrheic-type dermatitis, hair and nail abnormalities). An accurate dermatological examination is essential in all IBD patients, especially in candidates to biologic therapies, in whom drug-induced cutaneous reactions may assume marked clinical relevance.
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Affiliation(s)
| | - Gabrio Bassotti
- Gastroenterology Section, Perugia General Hospital, 06156 Perugia, Italy;
- Gastroenterology & Hepatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy
- Correspondence:
| | - Marta Tramontana
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Katharina Hansel
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, 06156 Perugia, Italy; (M.T.); (K.H.); (L.S.)
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
| | - Giovanni Genovese
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCSS Cà Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (G.G.); (A.V.M.)
- Department of Pathophysiology and Transplantation, University of Milano, 20122 Milano, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” Hospital, 20157 Milano, Italy; (S.A.); (G.M.)
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22
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Abstract
Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient’s quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon.
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23
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Feldmeyer L, Ribero S, Gloor AD, Borradori L. Neutrophilic dermatoses with unusual and atypical presentations. Clin Dermatol 2020; 39:261-270. [PMID: 34272020 DOI: 10.1016/j.clindermatol.2020.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neutrophilic dermatoses (NDs) are a group of reactive, noninfectious autoinflammatory diseases characterized by (1) infiltration of the epidermis, dermis, and or/hypodermis by neutrophils; (2) their association with distinct diseases (eg, hematologic malignancy and chronic inflammatory diseases); (3) potential extracutaneous involvement; and (4) response to anti-inflammatory drugs, such as corticosteroids, dapsone, colchicine, and novel biologic therapies, such as the anti-interleukin-1 blockade. Although distinct NDs have been described, transitional forms with overlapping features are often identified. These justify a simplified classification of NDs with three major forms: superficial (epidermal or pustular) NDs, dermal (en plaques) NDs, and deep NDs. We review selected or novel variants of NDs, including subcorneal pustular dermatosis, the group of immunoglobulin A neutrophilic dermatoses, amicrobial pustular dermatosis of the folds, and neutrophilic urticarial dermatosis, as well as atypical forms of Sweet syndrome and pyoderma gangrenosum closely mimicking severe infectious diseases. Knowledge of these variants is essential for proper diagnosis, adequate management, and avoidance of a dangerous escalation of therapy, such as unnecessary immunosuppression or extensive surgery.
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Affiliation(s)
- Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, Turin, Italy
| | - Andrea D Gloor
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Borradori
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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24
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Perazzio SF, Allenspach EJ, Eklund KK, Varjosalo M, Shinohara MM, Torgerson TR, Seppänen MRJ. Behçet disease (BD) and BD-like clinical phenotypes: NF-κB pathway in mucosal ulcerating diseases. Scand J Immunol 2020; 92:e12973. [PMID: 32889730 DOI: 10.1111/sji.12973] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
Behçet's disease (BD) is a heterogeneous multi-organ disorder in search of a unified pathophysiological theory and classification. The disease frequently has overlapping features resembling other disease clusters, such as vasculitides, spondyloarthritides and thrombophilias with similar genetic risk variants, namely HLA-B*51, ERAP1, IL-10, IL-23R. Many of the BD manifestations, such as unprovoked recurrent episodes of inflammation and increased expression of IL-1, IL-6 and TNFα, overlap with those of the hereditary monogenic autoinflammatory syndromes, positioning BD at the crossroads between autoimmune and autoinflammatory syndromes. BD-like disease associates with various inborn errors of immunity, including familial Mediterranean fever, conditions related to dysregulated NF-κB activation (eg TNFAIP3, NFKB1, OTULIN, RELA, IKBKG) and either constitutional trisomy 8 or acquired trisomy 8 in myelodysplastic syndromes. We review here the recent advances in the immunopathology of BD, BD-like diseases and the NF-κB pathway suggesting new elements in the elusive BD etiopathogenesis.
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Affiliation(s)
- Sandro F Perazzio
- Seattle Children's Research Institute, University of Washington and Center for Immunity and Immunotherapies, Seattle, WA, USA.,Division of Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eric J Allenspach
- Seattle Children's Research Institute, University of Washington and Center for Immunity and Immunotherapies, Seattle, WA, USA
| | - Kari K Eklund
- Division of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,ORTON Orthopaedic Hospital of the Orton Foundation, Helsinki, Finland
| | - Markku Varjosalo
- Division of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,ORTON Orthopaedic Hospital of the Orton Foundation, Helsinki, Finland.,Molecular Systems Biology Research Group and Proteomics Unit, Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Michi M Shinohara
- Divisions of Dermatology and Dermatopathology, University of Washington, Seattle, WA, USA
| | | | - Mikko R J Seppänen
- Rare Disease and Pediatric Research Centers, Hospital for Children and Adolescents and Adult Immunodeficiency Unit, Inflammation Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
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25
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Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that presents with rapidly developing, painful skin ulcers hallmarked by undermined borders and peripheral erythema. Epidemiological studies indicate that the average age of PG onset is in the mid-40s, with an incidence of a few cases per million person-years. PG is often associated with a variety of other immune-mediated diseases, most commonly inflammatory bowel disease and rheumatoid arthritis. The cause of PG is not well understood, but PG is generally considered an autoinflammatory disorder. Studies have focused on the role of T cells, especially at the wound margin; these cells may support the destructive autoinflammatory response by the innate immune system. PG is difficult to diagnose as several differential diagnoses are possible; in addition to clinical examination, laboratory tests of biopsied wound tissue are required for an accurate diagnosis, and new validated diagnostic criteria will facilitate the process. Treatment of PG typically starts with fast-acting immunosuppressive drugs (corticosteroids and/or cyclosporine) to reduce inflammation followed by the addition of more slowly acting immunosuppressive drugs with superior adverse event profiles, including biologics (in particular, anti-tumour necrosis factor (TNF) agents). Appropriate wound care is also essential. Future research should focus on PG-specific outcome measures and PG quality-of-life studies.
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26
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Bhargava S, Kumar U, Kroumpouzos G. Subcorneal pustular dermatosis: Comprehensive review and report of a case presenting during pregnancy. Int J Womens Dermatol 2020; 6:131-136. [PMID: 32637535 PMCID: PMC7330443 DOI: 10.1016/j.ijwd.2020.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/21/2020] [Accepted: 02/06/2020] [Indexed: 01/06/2023] Open
Abstract
Subcorneal pustular dermatosis (SPD), also known as Sneddon-Wilkinson disease, is a rare, relapsing, sterile pustular eruption of unknown etiology that develops most commonly in middle-aged or mature women. This article reviews the presentation, associations, and management of the condition and highlights advances in pathophysiology. Onset of SPD during pregnancy has not been reported. Herein, we report a case of SPD that developed during pregnancy. The patient was treated with dapsone without complications for her or the fetus. An association between T helper (Th) 17 and Th2 environments in the development of SPD has been advocated. Pregnancy is characterized by a predominance of Th2 responses and increased interleukin-17 levels and thus may favor the development of the condition.
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Affiliation(s)
- Shashank Bhargava
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, India
| | - Ujjwal Kumar
- Department of Dermatology, R.D. Gardi Medical College, Ujjain, India
| | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School, Brown University, Providence, Rhode Island, India
- GK Dermatology, PC, S Weymouth, Massachusetts, United States
- Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil
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27
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Sandhu JK, Albrecht J, Agnihotri G, Tsoukas MM. Erythema elevatum et diutinum as a systemic disease. Clin Dermatol 2019; 37:679-683. [PMID: 31864448 DOI: 10.1016/j.clindermatol.2019.07.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Erythema elevatum et diutinum (EED) is a rare, chronic dermatosis. It has been associated with extracutaneous findings, including arthralgias, scleritis, panuveitis, peripheral ulcerative keratitis, oral and penile ulcers, and neuropathy. Additionally, EED is connected with various systemic diseases, including HIV, IgA paraproteinemia, myelomas, neutrophilic dermatoses, and inflammatory bowel diseases. The presence of such extracutaneous manifestations in EED patients suggests that EED may be a multiorgan entity. Extracutaneous manifestations in EED may involve deposition of circulating immune complexes; thus, patients with EED should be evaluated for systemic manifestations to ensure targeted management.
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Affiliation(s)
- Jeena K Sandhu
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Joerg Albrecht
- Department of Dermatology, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Gaurav Agnihotri
- University of Illinois-Chicago College of Medicine Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois-Chicago School of Medicine, Chicago, Illinois, USA.
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28
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Kuhn D, Strong J, Bontempo L, Dezman Z. 75-year-old Woman with a Fever and Rash. Clin Pract Cases Emerg Med 2019; 3:178-184. [PMID: 31404370 PMCID: PMC6682233 DOI: 10.5811/cpcem.2019.7.44064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/19/2019] [Accepted: 07/04/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Diane Kuhn
- University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Jonathan Strong
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Laura Bontempo
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Zachary Dezman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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29
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Salem I, Kimak M, Conic R, Bragazzi NL, Watad A, Adawi M, Bridgewood C, Pacifico A, Santus P, Rizzi M, Petrou S, Colombo D, Fiore M, Pigatto PDM, Damiani G. Neutrophilic Dermatoses and Their Implication in Pathophysiology of Asthma and Other Respiratory Comorbidities: A Narrative Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7315274. [PMID: 31281845 PMCID: PMC6590566 DOI: 10.1155/2019/7315274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/14/2019] [Indexed: 01/20/2023]
Abstract
Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions.
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Affiliation(s)
- Iman Salem
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Mark Kimak
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Rosalynn Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
| | - Nicola L. Bragazzi
- Department of Health Sciences (DISSAL), School of Public Health, University of Genoa, Genoa, Italy
| | - Abdulla Watad
- Department of Medicine “B”, Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Mohammad Adawi
- Padeh and Ziv Hospitals, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Charlie Bridgewood
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | | | - Pierachille Santus
- Department of Biomedical Sciences L. Sacco, University of Milan, Milan, Italy
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Maurizio Rizzi
- Respiratory Unit, Center for Sleep and Respiratory Disorders, “Luigi Sacco” University Hospital, Milan, Italy
| | - Stephen Petrou
- Emergency Medicine, Good Samaritan Hospital Medical Center, New York, USA
| | - Delia Colombo
- Department of Pharmacology, University of Milan, Milan, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Paolo D. M. Pigatto
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Giovanni Damiani
- Department of Dermatology, Case Western Reserve University, Cleveland, USA
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- Young Dermatologists Italian Network, Centro Studi GISED, Bergamo, Italy
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Bucchia M, Barbarot S, Reumaux H, Piram M, Mahe E, Mallet S, Balguerie X, Phan A, Lacour JP, Decramer S, Hatchuel Y, Jean S, Begon E, Joubert A, Merlin E, Wallach D, Meinzer U, Bourrat E. Age-specific characteristics of neutrophilic dermatoses and neutrophilic diseases in children. J Eur Acad Dermatol Venereol 2019; 33:2179-2187. [PMID: 31166045 DOI: 10.1111/jdv.15730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our suggested 'modern' concepts of 'neutrophilic dermatoses' (ND) and 'neutrophilic disease' were based on observations in adult patients and have not been studied in paediatric patients. Only a minority of ND occurs in children, and little is known about age-specific characteristics. OBJECTIVES To describe age-specific characteristics of ND in children and to study whether our suggested 'modern' classification of ND may be applied to children. METHODS We conducted a retrospective multicentre study in a French cohort of 27 paediatric patients diagnosed with pyoderma gangrenosum (PG) or Sweet's syndrome (SS). RESULTS Demographics and distribution of typical/atypical forms were similar in patients diagnosed with PG and SS. Atypical ND were more frequent in infants (90%), when compared to young children (60%) and adolescents (33%). Neutrophilic disease was observed in 17/27 patients and was most frequent in infants. Neutrophilic disease of the upper respiratory tract, as well as cardiac neutrophilic disease, was only observed in infants, whereas other locations were similarly found in infants, young children and adolescents. In infants and young children, ND were associated with a large spectrum of general diseases, whereas in adolescents associations were limited to inflammatory bowel disease and Behçet's disease. CONCLUSIONS Our study describes the concept of ND in paediatric patients and shows that they have some characteristics different from ND occurring in adults. ND occurring in infants can be associated with a large spectrum of general diseases. Occurrence of neutrophilic disease is frequent in children. Thus, ND occurring in young paediatric patients should incite clinicians to schedule complementary explorations in order to search for involvement of other organs and to rule out monogenetic autoinflammatory syndromes.
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Affiliation(s)
- M Bucchia
- Centre Hospitalier Le Mans, Service Urgences pédiatriques, Le Mans, France.,Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France
| | - S Barbarot
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - H Reumaux
- Service de Pédiatrie et médecine générale, CHRU de Lille, Hôpital Jeanne de Flandre, Lille, France
| | - M Piram
- CHU de Bicêtre, Service de Rhumatologue Pédiatrique, CEREMAIA, Le Kremlin-Bicêtre, France.,CESP, U1018 Inserm, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - E Mahe
- Service de Dermatologie, Unité de Soutien à la Recherche Clinique, Argenteuil, France
| | - S Mallet
- Service de Dermatologie de l'hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - X Balguerie
- Clinique Dermatologique, CHU de Rouen, Rouen, France
| | - A Phan
- Service de Néphro-Rhumato-Dermatologie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - J-P Lacour
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - S Decramer
- Centre Hospitalier Universitaire de Toulouse, Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, Centre De Référence des Maladies Rénales Rares du Sud Ouest, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Y Hatchuel
- Service de Pédiatrie, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - S Jean
- Service de pédiatrie Centre Hospitalier universitaire de Rennes, Rennes, France
| | - E Begon
- Service de Médecine, Centre Hospitalier René-Dubois, Cergy Pontoise, France
| | - A Joubert
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - E Merlin
- CHU Clermont-Ferrand, Pédiatrie Générale Multidisciplinaire, CIC INSERM 1405, Clermont-Ferrand, France
| | - D Wallach
- Médecin (honoraire) des Hôpitaux de Paris, Paris, France
| | - U Meinzer
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,INSERM UMR1149, Université Paris Diderot, Paris, France.,Institut Pasteur, Unité Biologie et génétique de la paroi bactérienne, Paris, France
| | - E Bourrat
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,Service de Dermatologie, Centre Hospitalier Universitaire Saint-Louis, Paris, France
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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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32
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Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol 2019; 10:414. [PMID: 30930894 PMCID: PMC6424218 DOI: 10.3389/fimmu.2019.00414] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
Sweet's syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. It is considered to be the prototype disease of neutrophilic dermatoses, and presents with acute onset dermal neutrophilic lesions, leukocytosis, and pyrexia. Several variants have been described both clinically and histopathologically. Classifications include classic Sweet's syndrome, malignancy associated, and drug induced. The cellular and molecular mechanisms involved in Sweet's syndrome have been difficult to elucidate due to the large variety of conditions leading to a common clinical presentation. The exact pathogenesis of Sweet's syndrome is unclear; however, new discoveries have shed light on the role of inflammatory signaling, disease induction, and relationship with malignancy. These findings include an improved understanding of inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic contributions. Continued investigations into effective treatments and targeted therapy will benefit patients and improve our molecular understanding of inflammatory diseases, including Sweet's syndrome.
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Affiliation(s)
- Michael S Heath
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| | - Alex G Ortega-Loayza
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
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33
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Della Valle V, Maggioni M, Carrera C, Cattaneo A, Marzano AV, Damiani G. A mysterious abdominal pain during active psoriasis. Intern Emerg Med 2018; 13:889-892. [PMID: 29086113 DOI: 10.1007/s11739-017-1765-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Valentina Della Valle
- Dipartimento di Fisiopatologia Medico-Chirurgica E dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, via Pace 9, 24125, Milan, Italy
| | - Marco Maggioni
- Pathology, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Carlo Carrera
- Dipartimento di Fisiopatologia Medico-Chirurgica E dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, via Pace 9, 24125, Milan, Italy
| | - Angelo Cattaneo
- Dipartimento di Fisiopatologia Medico-Chirurgica E dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, via Pace 9, 24125, Milan, Italy
| | - Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica E dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, via Pace 9, 24125, Milan, Italy
| | - Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica E dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, via Pace 9, 24125, Milan, Italy.
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Marzano AV, Raimondo MG, Berti E, Meroni PL, Ingegnoli F. Cutaneous Manifestations of ANCA-Associated Small Vessels Vasculitis. Clin Rev Allergy Immunol 2018; 53:428-438. [PMID: 28578472 DOI: 10.1007/s12016-017-8616-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Skin lesions are frequent manifestations of underlying systemic conditions, including systemic autoimmune vasculitis. In particular, anti-neutrophil cytoplasmic antibodies (ANCA) are associated with distinct forms of vasculitis characterized by inflammatory cell infiltration of the walls of small and medium-sized vessels leading to vascular destruction and tissue necrosis. ANCA-associated vasculitis is rare and systemic diseases, which can be classified based on different distribution of vascular inflammation and presence or absence of granulomatosis and asthma. Despite their diversities, ANCA-associated vasculitis, namely microscopic polyangiitis, granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis, can all display a broad variety of cutaneous manifestations, which can appear during the course of the disease or even as first sign at the time of onset. Different skin manifestations might coexist in the same patient and occur in different occasions during the course of the vasculitis. Thus, a deep knowledge of the spectrum of skin lesions as part of ANCA-associated vasculitis is mandatory for a correct diagnostic process, whenever cutaneous vasculitis is suspected. Due to this broad variety of manifestations, the diagnosis of skin involvement in ANCA-associated vasculitis is very challenging and it must be supported by a detailed medical history, accurate physical examination, specific histopathological analysis of skin biopsy and the presence of ANCA serology. In this review, we focus on the cutaneous manifestations that can develop in the context of ANCA-associated vasculitis, detailing the clinical features, the histopathological aspects as well as the direct immunofluorescence studies for each of the three conditions. Moreover, we acknowledged the differential diagnoses that must be ruled out in the diagnostic process and the main therapeutic approaches available for treatment of ANCA-associated vasculitis.
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Affiliation(s)
- Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Unità Operativa di Dermatologia, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Maria Gabriella Raimondo
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Emilio Berti
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Unità Operativa di Dermatologia, IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Pier Luigi Meroni
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy. .,Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Milan, Italy.
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Nicolas P, Guerrier O, Benoit A, Durand-Dubief F, Raverot G, Debarbieux S, Delteil C, Vasiljevic A, Jouanneau E, Cotton F, Marignier R, Vukusic S. Unusual neurologic presentation of aseptic abscesses syndrome. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e469. [PMID: 29888299 PMCID: PMC5991774 DOI: 10.1212/nxi.0000000000000469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Philippe Nicolas
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Olivier Guerrier
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Amandine Benoit
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Francoise Durand-Dubief
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Gerald Raverot
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Sebastien Debarbieux
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Clemence Delteil
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Alexandre Vasiljevic
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Emmanuel Jouanneau
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Francois Cotton
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Romain Marignier
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
| | - Sandra Vukusic
- Service de Neurologie, sclérose en plaques (P.N., O.G., A.B., F.D.-D., R.M., S.V.), pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron; Centre des Neurosciences de Lyon (A.V., R.M.), INSERM 1028 et CNRS UMR5292, Equipe FLUID et Observatoire Français de la Sclérose en Plaques; Université de Lyon (A.V., R.M.); INSERM U1052 (G.R., E.J.), CNRS UMR5286, Cancer Research Center of Lyon; Fédération d'Endocrinologie (G.R., E.J.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon1, Université de Lyon, Pierre Bénite; CREATIS (F.D.-D., F.C.), UMR 5220 CNRS & U1044 Inserm, Université Claude Bernard Lyon1, Université de Lyon, Villeurbanne; Service d'anatomie et cytologie pathologiques (C.D.), Centre Hospitalier de la Timone, France; Centre de Pathologie et Neuropathologie Est (A.V.), Groupement Hospitalier Est, Hospices Civils de Lyon, Bron; Service de dermatologie (S.D.), Centre Hospitalier Lyon Sud, 69495 Pierre Bénite; and Service de Neurochirurgie B (E.J.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France
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Pyoderma gangrenosum-like ulcerations in granulomatosis with polyangiitis: two cases and literature review. Rheumatol Int 2018; 38:1139-1151. [PMID: 29721696 DOI: 10.1007/s00296-018-4035-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/26/2018] [Indexed: 12/16/2022]
Abstract
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing small vessel vasculitis associated with circulating anti-neutrophil cytoplasmic antibodies (ANCAs). Skin manifestations, mostly represented by palpable purpura, papulonodular lesions and livedo reticularis, are present in up to 50% of the cases. Ulcerations with undermined, raised erythematous-violaceous border resembling pyoderma gangrenosum (PG) have rarely been reported as skin involvement in GPA. The presence of circulating ANCAs with a cytoplasmic labelling pattern, the involvement of internal organs, particularly of the lung, and the absence on histology of a mainly neutrophilic infiltrate in early phases of the cutaneous lesions may be regarded as clues to rule out true PG and confirm the diagnosis of GPA skin ulcerations simulating PG. Herein, we describe two paradigmatic cases of such a unique presentation of GPA and a literature review focusing on clinicopathological features of GPA presenting with PG-like ulcerations in the skin has been provided. Moreover, referring to the scenario observed in these two cases, an easy-to-use working approach for the differential diagnosis between the two conditions has also been proposed.
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Sato K, Miura T, Ohtsuka M, Yamamoto T. Bullous Sweet's syndrome with myositis. ACTAS DERMO-SIFILIOGRAFICAS 2018. [DOI: 10.1016/j.adengl.2017.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Bullous Sweet's syndrome with myositis. ACTAS DERMO-SIFILIOGRAFICAS 2018; 109:284-285. [DOI: 10.1016/j.ad.2017.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/06/2017] [Accepted: 07/14/2017] [Indexed: 11/19/2022] Open
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Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is a complex neutrophilic dermatosis that can occur as an idiopathic disease, in association with systemic conditions such as inflammatory bowel disease, as part of an inherited inflammatory syndrome. It can be challenging to treat, as it occurs in a wide variety of clinical settings and there is a lack of a standardized treatment approach. The main limitations to treatment have been an incomplete understanding of the pathogenesis. However, recent advances have been made in understanding the pathogenesis of this condition, and PG is now considered an autoinflammatory disease process. Areas covered: This review discusses the newest studies that further define our understanding of this disease and the relevant literature on treatment options for pyoderma gangrenosum. Expert commentary: The presence of abnormal neutrophils and T-cells lead to immune dysregulation, leading to lesions of PG. Increased levels of inflammatory mediators including IL-1β, IL-8, IL-17, and TNF-α contribute to the development of the disease but there are still several unknown factors, including the trigger for immune dysregulation and additional contributory components of the immune system. We provide our approach to the management of PG lesions, which involves a multi-faceted approach including wound care, topical therapy, and systemic medications in most cases.
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Affiliation(s)
- Christine Ahn
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , North Carolina , USA
| | - Deborah Negus
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , North Carolina , USA
| | - William Huang
- a Department of Dermatology , Wake Forest School of Medicine , Winston Salem , North Carolina , USA
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Marzano AV, Ortega-Loayza AG, Ceccherini I, Cugno M. LPIN2 gene mutation in a patient with overlapping neutrophilic disease (pyoderma gangrenosum and aseptic abscess syndrome). JAAD Case Rep 2018; 4:120-122. [PMID: 29387759 PMCID: PMC5789524 DOI: 10.1016/j.jdcr.2017.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Angelo V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University School of Medicine, Portland, Oregon
| | | | - Massimo Cugno
- Medicina Interna, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milan, Italy
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Damiani G, di Meo N, Marzano AV. A unique pneumopathy in a patient with skin nodules and abscesses. Intern Emerg Med 2017; 12:637-640. [PMID: 28389858 DOI: 10.1007/s11739-017-1658-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/28/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Giovanni Damiani
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milan, Italy.
| | - Nicola di Meo
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Angelo Valerio Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale maggiore Policlinico, Milan, Italy
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Yildiz H, Munting A, Komuta M, Danse E, Lefebvre C. Aseptic lung and liver abscesses: a diagnostic challenge. Acta Clin Belg 2017; 72:259-263. [PMID: 27498958 DOI: 10.1080/17843286.2016.1215888] [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: 10/21/2022]
Abstract
A 67-year-old man known with systemic sarcoidosis was admitted to the department of internal medicine because of cough and chest pain for several weeks. Thoracic tomodensitometry demonstrated multiple pulmonary nodules. Biopsies revealed features compatible with abscesses. Cultures and serologic tests were negative and the patient was successfully treated with prednisone. Three years later, a thoraco-abdominal tomodensitometry showed a relapse in the lung and also the apparition of similar lesions in the liver. Blood test revealed elevated CRP level at 40 mg/L and mild cholestasis. Biopsies of the liver excluded neoplastic or infectious diseases and showed inflammatory granulation tissue with abscess formation. A diagnosis of sarcoidosis-associated aseptic abscesses syndrome was then made, which was successfully treated with corticosteroids.
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Affiliation(s)
- Halil Yildiz
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Aline Munting
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Mina Komuta
- Department of pathology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne Danse
- Department of Radiology, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Chantal Lefebvre
- Department of Internal Medicine, Cliniques Universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
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Chua-Aguilera CJ, Möller B, Yawalkar N. Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides. Clin Rev Allergy Immunol 2017; 53:371-393. [DOI: 10.1007/s12016-017-8632-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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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: 9] [Impact Index Per Article: 1.3] [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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Inflammatory Joint Disorders and Neutrophilic Dermatoses: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 54:269-281. [DOI: 10.1007/s12016-017-8629-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chern CM, Royer M, Turnage W. Sweet's Syndrome Arising in a Scar. Case Rep Dermatol 2017; 9:86-90. [PMID: 28868006 PMCID: PMC5567122 DOI: 10.1159/000477456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/10/2017] [Indexed: 11/19/2022] Open
Abstract
Acute febrile neutrophilic dermatosis (Sweet's syndrome) is an uncommon inflammatory cutaneous disorder. It presents with lesions which are tender, erythematous, edematous papules and under histologic examination show dense neutrophilic infiltration of the dermis. These lesions are often accompanied by leukocytosis and fever. This paper reports a unique case of acute febrile neutrophilic dermatosis presenting as a Koebner response to a linear scar.
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Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Moran B, Sweeney CM, Hughes R, Malara A, Kirthi S, Tobin AM, Kirby B, Fletcher JM. Hidradenitis Suppurativa Is Characterized by Dysregulation of the Th17:Treg Cell Axis, Which Is Corrected by Anti-TNF Therapy. J Invest Dermatol 2017; 137:2389-2395. [PMID: 28652108 DOI: 10.1016/j.jid.2017.05.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 01/05/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, and debilitating disease of hair follicles with 1-4% prevalence and high morbidity. There is a dearth of information on the pathogenesis and immune dysregulation underlying HS; therefore, we carried out a detailed analysis of skin-infiltrating T cells. Cells isolated from skin biopsy samples and blood from HS patients and healthy control subjects were analyzed by 16-parameter flow cytometry to provide detailed profiles of CD4 T-cell subsets. We observed substantial infiltration of inflammatory T cells with a striking T helper (Th) type 17-skewed cytokine profile in HS skin; these cells expressed the Th17 lineage marker CD161 and IL-17, as well as proinflammatory cytokines GM-CSF, IL-22, IFN-γ, and tumor necrosis factor. Regulatory T cells were also enriched in HS lesional skin; however, the ratio of Th17 to regulatory T cells was nonetheless highly dysregulated in favor of Th17 cells. In contrast, lesional skin from anti-tumor necrosis factor-treated HS patients who showed substantial clinical improvement exhibited a significant reduction in the frequency of Th17 cells and normalization of the Th17 to regulatory T cell ratio. These data suggest that inhibition of pathogenic IL-17 via tumor necrosis factor blockade is associated with improvement in immune dysregulation in HS and may provide a rationale for targeting IL-17 in the disease.
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Affiliation(s)
- Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Cheryl M Sweeney
- Dermatology Research, Education and Research Centre, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Rosalind Hughes
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Anna Malara
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | - Anne-Marie Tobin
- Department of Dermatology, Tallaght Hospital, Dublin 24, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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Stockinger T, Richter L, Kanzler M, Melichart-Kotik M, Pas H, Derfler K, Schmidt E, Rappersberger K. [Systemic lupus erythematosus : Unusual cutaneous manifestations]. Hautarzt 2017; 67:970-981. [PMID: 27878308 DOI: 10.1007/s00105-016-3893-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Various different mucocutaneous symptoms may affect up to 80 % of systemic lupus erythematosus (SLE) patients. OBJECTIVES To investigate, various unspecific, but otherwise typical clinical symptoms of skin and mucous membranes that arise in SLE patients other than those defined as SLE criteria such as butterfly rash, chronic cutaneous lupus erythematosus, oral ulcers, and increased photosensitivity. MATERIALS AND METHODS Extensive search of peer-reviewed scientific articles was performed, medical histories of several SLE patients seen in our department were analyzed, and the rare disease courses in three SLE patients are presented. RESULTS Here we present a variety of unspecific but typical mucocutaneous manifestations in SLE patients: periungual erythema, periungual telangiectasia and periungual splinter hemorrhage, papules on the dorsum of the hands, scaling erythema, sometimes associated with necrosis, especially of the ears, along with complement deficiency, and the bizarre necroses of antiphospholipid syndrome. Furthermore, we show the typical clinico-histological features of neutrophilic urticarial dermatosis, as well as those of bullous SLE and finally a severe course of bacterial sepsis with Neisseria flavescens/macacae. CONCLUSIONS Here we show several unspecific but rather typical mucocutaneous symptoms in lupus patients that are indicative of SLE and thus may lead to an early diagnosis. Also, life-threatening bacterial sepsis may occur with microorganisms that are commonly considered "apathogenic", such as Neisseria flavescens/macacae, which exclusively affect immunosuppressed patients.
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Affiliation(s)
- T Stockinger
- Abteilung Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich.
| | - L Richter
- Abteilung Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich
| | - M Kanzler
- Abteilung Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - M Melichart-Kotik
- Abteilung Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - H Pas
- Abteilung Dermatologie, Zentrum für blasenbildende Erkrankungen, Universitätsklinik Groningen, Groningen, Niederlande
| | - K Derfler
- Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Allgemeines Krankenhaus Wien, Wien, Österreich
| | - E Schmidt
- Abteilung Dermatologie, Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Lübeck, Deutschland
| | - K Rappersberger
- Abteilung Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich
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Marzano AV, Damiani G, Ceccherini I, Berti E, Gattorno M, Cugno M. Autoinflammation in pyoderma gangrenosum and its syndromic form (pyoderma gangrenosum, acne and suppurative hidradenitis). Br J Dermatol 2017; 176:1588-1598. [PMID: 27943240 DOI: 10.1111/bjd.15226] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a rare skin disease characterized clinically by ulcers with undermined borders, and histologically by neutrophil-rich infiltrates. PG may occur alone, in syndromic forms or associated with systemic diseases, such as inflammatory bowel disease and haematological or rheumatological disorders. OBJECTIVES To determine a specific genetic background related to autoinflammation for PG. METHODS We assessed autoinflammation by evaluating the cytokine profile and genes involved in classic autoinflammatory diseases in 13 patients with PG and in seven patients with the syndromic form, known as PASH (pyoderma gangrenosum, acne and suppurative hidradenitis). RESULTS In skin samples, the expression of interleukin (IL)-1β and its receptors, IL-17 and its receptor, and tumour necrosis factor-α and its receptors were significantly higher in both PG (P = 0·001) and in PASH (P < 0·001) than in controls. The chemokines IL-8; chemokine (C-X-C motif) ligand 1/2/3; chemokine (C-X-C motif) ligand 16; and RANTES (regulated on activation, normal T-cell-expressed and secreted) were also overexpressed. Cases of PG and PASH showed mutations in the autoinflammatory genes MEFV, NLRP3, NLRP12, NOD2, LPIN2 and PSTPIP1. CONCLUSIONS Overexpression of cytokines/chemokines, along with genetic changes, supports the hypothesis that PG and its syndromic form, PASH, are a spectrum of polygenic autoinflammatory conditions.
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Affiliation(s)
- A V Marzano
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | - G Damiani
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | | | - E Berti
- IRCCS Cà Granda Foundation, Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, Milan, 20122, Italy
| | - M Gattorno
- Istituto Gaslini, Genetica Medica, Genoa, Italy
| | - M Cugno
- Internal Medicine, University of Milan, Milan, 20122, Italy
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