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Saunders NA, Welch KC, Haefner HK, Rasmussen C, Margesson L. Vulvar Ulcers: An Algorithm to Assist With Diagnosis and Treatment. J Low Genit Tract Dis 2024; 28:73-75. [PMID: 37906578 DOI: 10.1097/lgt.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
OBJECTIVES Vulvar ulcers can be challenging to diagnose, manage, and treat. Ulcers can be nonspecific in appearance and have many etiologies. Description of the lesion is very important. METHODS An interactive vulvar ulcer algorithm was created to aid in the evaluation, diagnosis, and treatment of vulvar ulcers. RESULTS The algorithm flowchart begins with careful history and physical examination. Pending these, specific tests can be obtained to aid in diagnosis. The algorithm also links to appropriate treatments. The algorithm can be accessed on the International Society for the Study of Vulvovaginal Disease Web site ( issvd.org ). Each underlined word in the algorithm is a hyperlink that leads to a wealth of information on the topic that providers can use to direct testing and aid in diagnosis and treatment. CONCLUSIONS The vulvar ulcer algorithm can help clinicians with diagnosis and treatment plans.
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Affiliation(s)
- Natalie A Saunders
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Kathryn C Welch
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
| | - Hope K Haefner
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Beysens S, Wellens J, De Hertogh G, Van Laethem A, Sabino J, Hillary T, Vermeire S. Managing metastatic Crohn's disease: a single center experience, review of the current evidence, and treatment algorithm. Scand J Gastroenterol 2023; 58:1122-1130. [PMID: 37178009 DOI: 10.1080/00365521.2023.2209689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Crohn's disease (CD) is an inflammatory bowel disease (IBD) that, besides gastrointestinal symptoms, may encompass extra-intestinal symptoms, such as dermatological manifestations. Of those, metastatic CD (MCD) is a rare extra-intestinal manifestation for which the management is uncertain. METHODS We conducted a retrospective case series of patients with MCD seen at the University hospital Leuven, Belgium, combined with an overview of the recent literature. Electronic medical records were searched from January 2003 till April 2022. For the literature search, Medline, Embase, Trip Database, and The Cochrane Library were searched from inception to April 1, 2022. RESULTS A total of 11 patients with MCD were retrieved. In all cases noncaseating granulomatous inflammation was found on skin biopsies. Two adults and one child were diagnosed with MCD prior to their diagnosis of CD. Seven patients were treated with steroids (intralesional, topical or systemic). Six patients needed a biological therapy to treat MCD. Surgical excision was performed in three patients. All patients reported a successful outcome and most cases achieved remission. The literature search yielded 53 articles, including three reviews, three systematic reviews, 30 case reports and six case series. A treatment algorithm was generated based on literature and multidisciplinary discussion. CONCLUSION MCD remains a rare entity and diagnosis is often difficult. A multidisciplinary approach including skin biopsy is necessary to diagnose and treat MCD efficiently. Outcome is generally favorable, and lesions respond well to steroids and biologicals. We propose a treatment algorithm based on the available evidence and multidisciplinary discussion.
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Affiliation(s)
- S Beysens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - J Wellens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - G De Hertogh
- KU Leuven Department of Imaging and Pathology, Translational Cell and Tissue Research Unit, Leuven, Belgium
| | - A Van Laethem
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - J Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
| | - T Hillary
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - S Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Chronic Diseases and Metabolism, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium
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Amhis M, Belarbi KN, Bourrat E, Nassif A, Viala J, Martinez-Vinson C. Differential Diagnosis Between Perianal Crohn's Disease and Hidradenitis Suppurativa: A Challenging Teamwork. JPGN REPORTS 2021; 2:e081. [PMID: 37207067 PMCID: PMC10191525 DOI: 10.1097/pg9.0000000000000081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/25/2021] [Indexed: 05/21/2023]
Abstract
Hidradenitis suppurativa (HS) is a rare, debilitating skin disease characterized by the presence of recurrent tender subcutaneous nodules that develop into abscesses and fistulae. Isolated perineal Crohn's disease (CD) is unusual, diagnosis can be difficult, and distinction from HS is a challenge for the gastroenterologist. The aim of this work was to determine the criteria that distinguish perineal CD from perineal HS. Four patients with isolated perineal CD and three with perineal HS were included. Rectal or skin biopsies of all CD patients showed granulomas. No granulomas were found for HS. Fistulae were present in 4/4 CD, extended to the anal canal. All patients with HS had gluteal abscesses. They were bilateral in all cases, superficial. Perineal lesions management should involve a multidisciplinary approach in order to make an accurate diagnosis and ultimately to give the best and most effective treatment.
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Affiliation(s)
- Maya Amhis
- From the Gastroentérologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - K Nadia Belarbi
- Radiologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Emmanuelle Bourrat
- Dermatologie/pédiatrie générale, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Aude Nassif
- Medical Center, Institut Pasteur, Paris, France
| | - Jerome Viala
- From the Gastroentérologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Christine Martinez-Vinson
- From the Gastroentérologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
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López-Llunell C, Romaní J, Garbayo-Salmons P, Agut-Busquet E. Vulvar hidradenitis suppurativa: Clinical cross-sectional study of 25 patients. J Dermatol 2021; 48:457-463. [PMID: 33547675 DOI: 10.1111/1346-8138.15728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/13/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
Hidradenitis suppurativa (HS) involving the vulva is seldom reported in the gynecological or dermatological literature. The aim of this study was to describe the clinical characteristics of HS with vulvar affectation (VHS) and to compare it with patients without vulvar involvement. A cross-sectional study was conducted in a tertiary academic referral centre in Spain from May 1, 2015 to October 1, 2019. This study included 230 women with HS diagnosed in our hospital, 25 of them had vulvar involvement. In order to clinically characterize patients, demographic factors, comorbidities, clinical features, prescribed treatments and complications were recorded. The VHS group presented later median age of onset and lower body mass index (BMI) (P = 0.048), they mainly belonged to latent class 2 (LC2) and LC3 phenotypes involving groins, perineal and pubic area. A higher incidence of psychiatric disease was found in VHS (32% vs 10.7%). Significant positive association with fistula (P < 0.001), LC2 phenotype (P = 0.014), acne (P = 0.021) and thyroid disease (P = 0.006), and negative association with axillar lesions (P = 0.001) were noted. Ultrasonographical study of vulvar lesions demonstrated that most of them were fistulas with high Doppler signal suggestive of high inflammatory load. In conclusion, VHS is mostly seen in women with later onset and lower BMI and higher incidence of psychiatric disease compared to those without vulvar involvement. It is clinically characterized by the presence of fistulas and barely absent axillary involvement. Early diagnosis and treatment could be essential to prevent complications and quality of life impairment.
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Affiliation(s)
- Cristina López-Llunell
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
| | - Jorge Romaní
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
| | - Patricia Garbayo-Salmons
- Department of Dermatology, Consorci Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Sabadell, Spain
| | - Eugènia Agut-Busquet
- Department of Dermatology, Hospital de la Santa Creu i de Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
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Genital ulcer disease - A review for primary care providers caring for adolescents. Curr Probl Pediatr Adolesc Health Care 2020; 50:100834. [PMID: 32859511 DOI: 10.1016/j.cppeds.2020.100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhou XL, Wu X, Zhu RR, Xu H, Li YY, Xu QR, Liu S, Lai SQ, Xu X, Wan L, Wu QC, Liu JC. Notch1-Nrf2 signaling crosstalk provides myocardial protection by reducing ROS formation. Biochem Cell Biol 2020; 98:106-111. [PMID: 32069075 DOI: 10.1139/bcb-2018-0398] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Both the Notch1 and Keap1-Nrf2 signaling pathways have cardioprotective effects, but the role of Notch1-Nrf2 crosstalk in myocardial ischemia-reperfusion injury is unclear. In this study, we established hypoxia-reoxygenation in neonate rat myocardial cells and employed γ-secretase inhibitor and curcumin to inhibit and activate the Notch1 and Keap1-Nrf2 signaling pathways, respectively. We found that the combined action of the Notch1 and Keap1-Nrf2 signaling pathways significantly increased cardiomyocyte viability, inhibited cardiomyocyte apoptosis, reduced the formation of reactive oxygen species, and increased antioxidant activities. In conclusion, these findings suggest that Notch1-Nrf2 crosstalk exerts myocardial protection by reducing the formation of reactive oxygen species.
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Affiliation(s)
- Xue-Liang Zhou
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xia Wu
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Rong-Rong Zhu
- Department of Obstetrics and Gynecology, Jiangxi Province hospital of integrated traditional Chinese and Western medicine, Nanchang, China
| | - Hua Xu
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Yun-Yun Li
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Qi-Rong Xu
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Sheng Liu
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Song-Qing Lai
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Xinping Xu
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Li Wan
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Qi-Cai Wu
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Ji-Chun Liu
- Department of Cardiac Surgery, The First Affiliated Hospital, Nanchang University, Nanchang, China
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