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Zahn C, Puga C, Malik A, Khanna D. Painful Raynaud's mimics. Best Pract Res Clin Rheumatol 2024:101948. [PMID: 38704280 DOI: 10.1016/j.berh.2024.101948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
Raynaud's syndrome is a common finding in many autoimmune conditions. Accurately diagnosing Raynaud's, and differentiating it from mimicking conditions, is imperative in rheumatologic diseases. Raynaud's syndrome and Raynaud's mimickers, especially painful Raynaud's mimickers, can prove a diagnostic challenge for the practicing rheumatologist. Painful Raynaud's mimickers can lead to increased patient stress and unnecessary medical work up; Healthcare providers need to be aware of Raynaud's mimickers when evaluating patient concerns of skin color changes and pain. The present narrative review aims to highlight Raynaud's syndrome, important painful mimickers that may be seen, diagnosis, and updated management recommendations.
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Affiliation(s)
- Carleigh Zahn
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
| | - Cindy Puga
- Cedars Sinai Internal Medicine Residency, 8700 Beverly Blvd, Becker Bldg. B105 A, Los Angeles, CA, 90048, USA.
| | - Aroosa Malik
- Department of Internal Medicine, Division of Vascular Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
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2
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Kluger N. Annular Erythemas and Purpuras. Life (Basel) 2023; 13:1245. [PMID: 37374026 DOI: 10.3390/life13061245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Annular dermatoses are a heterogeneous and extremely diverse group of skin diseases, which share in common annular, ring-like patterns with centrifugal spreading. Numerous skin diseases can sometimes display annular lesions, but some specific skin conditions are originally annular. We take the opportunity to review here mainly the causes of primary annular erythemas and their differential diagnoses, but also the rare causes of annular purpuras.
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Affiliation(s)
- Nicolas Kluger
- Department of Dermatology, Allergology and Venereology, Helsinki University Hospital & University of Helsinki, 00250 Helsinki, Finland
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Hoffman C, Benyamine A, Granel B. [Erythema on the back of the hands]. Rev Med Interne 2021; 42:893-894. [PMID: 34736800 DOI: 10.1016/j.revmed.2021.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/19/2021] [Accepted: 08/29/2021] [Indexed: 11/17/2022]
Affiliation(s)
- C Hoffman
- Service de médecine interne, hôpital Nord, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille Université (AMU), Marseille, France.
| | - A Benyamine
- Service de médecine interne, hôpital Nord, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille Université (AMU), Marseille, France
| | - B Granel
- Service de médecine interne, hôpital Nord, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille Université (AMU), Marseille, France.
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[An erythema of the thighs]. Rev Med Interne 2021; 43:125-127. [PMID: 34863598 DOI: 10.1016/j.revmed.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/29/2021] [Indexed: 11/21/2022]
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[Drug-induced Sweet's syndrome related to hydroxychloroquine: About 2 cases]. Rev Med Interne 2019; 41:289-292. [PMID: 31540835 DOI: 10.1016/j.revmed.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hydroxychloroquine is widely prescribed in systemic lupus erythematosus. Dermatologic adverse drug reactions are rare but can mimic a disease specific manifestation of lupus. Exceptionally, Sweet's syndrome, or acute febrile neutrophilic dermatosis, may be drug-induced. CASE REPORTS Two patients aged 31 and 42 years were treated with hydroxychloroquine for systemic lupus and Sjogren's syndrome, respectively. Three weeks after starting treatment, they had a febrile, purple and erythematous papular rash of the trunk and limbs. There was a biological inflammatory syndrome and skin biopsy disclosed an infiltrate of the dermis rich in neutrophils. Lesions regressed after stopping hydroxychloroquine and introducing systemic corticosteroid therapy. Allergologic tests discussed the differential diagnosis with a delayed-type hypersensitivity reaction. CONCLUSION We report two exceptional cases of drug-induced Sweet's syndrome related to hydroxychloroquine treatment in autoimmune rheumatic diseases.
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Principales manifestations dermatologiques du lupus érythémateux disséminé. ACTUALITES PHARMACEUTIQUES 2017. [DOI: 10.1016/j.actpha.2017.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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7
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Lupus cutané subaigu induit par la capécitabine : un cas. Ann Dermatol Venereol 2014; 141:593-7. [DOI: 10.1016/j.annder.2014.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/08/2014] [Accepted: 06/19/2014] [Indexed: 11/23/2022]
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Étude de trois cas de lupus érythémateux bulleux. Ann Dermatol Venereol 2013; 140:778-83. [DOI: 10.1016/j.annder.2013.04.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 02/13/2013] [Accepted: 04/08/2013] [Indexed: 11/19/2022]
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Pehr K. Mycophenolate Mofetil and Erythromycin for Bullous Lupus Erythematosus of Childhood. J Cutan Med Surg 2012; 16:50-3. [DOI: 10.1177/120347541201600110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Bullous lupus erythematosus is a rare disease that is extremely rare in childhood (with only seven previous reports) and difficult to control. Objective: Herein is presented the youngest patient reported with this condition, and a novel, safe, and effective treatment regimen is described. Methods: Through study, perseverance, serendipity, and creativity, a safe and effective regimen was developed. Results: The combination of mycophenolate mofetil and erythromycin (plus sun protection) was found to be efficacious. Conclusion: It is proposed that the two medications act synergistically, with the “antibiotic” acting as a antiinflammatory agent, but at a different point in the inflammatory cascade than mycophenolate mofetil. This suggests the approach of using common, inexpensive, and benign antibiotics to potentiate, and perhaps decrease the use of, immunomodulatory agents in autoimmune and autoinflammatory diseases.
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Affiliation(s)
- Kevin Pehr
- Division of Dermatology, McGill University-SMBD Jewish General Hospital, Montreal, QC
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Abstract
There is no definition or guidelines for refractory disease (RD) in Systemic Lupus Erythematosus (SLE). However, new therapies have been tested mainly in refractory patients. The concept, like the disease, is complex and implies deeper knowledge on the disease pathogenesis and patients' subsets. RD is not included in current activity indices of the disease, what raises the question of how are we monitoring its response to new drugs. In this paper, we analyse some concepts considered important for the global definition of RD in SLE and in some specific organ involvements, excluding lupus nephritis. Management issues will be addressed also. Finally, we review therapeutic options in particular subsets of the disease, namely, cutaneous, articular, haematological and neuropsychiatric lupus. Crucial to the management of a patient suspected to be refractory is an accurate diagnosis, assuring that the persistent clinical manifestations are derived primarily from SLE and not from a concomitant or alternative process. Likewise, certainty about the patient compliance with the therapy prescribed is a frequent unrecognized problem that erroneously might lead to a classification of RD. Therapy of RD for SLE, in general and in most particular involvements, is currently based mainly on the clinician's own experience and judgement, with few randomized trials effectively addressing the issue. In such a heterogeneous disease, consideration of approval of drugs for single-organ indications may pave the way for new therapies. Better biomarkers are needed to add accuracy to the currently used activity indices in order to monitor RD and consolidate its definition. Prospective studies directed to RD in the main SLE involvements are needed to improve our understanding on the management of the disease and foster the development of targeted new drugs.
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Affiliation(s)
- Ana Campar
- Santo António Hospital, Internal Medicine Department, Porto, Portugal.
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Biver-Dalle C, Gil H, Méaux-Ruault N, Mermet-Ginet I, Aubin F, Humbert P, Magy-Bertrand N. [Acquired ichthyosis and livedoid palmoplantar keratoderma: two unusual skin manifestations of systemic lupus erythematosus]. Rev Med Interne 2011; 33:e14-6. [PMID: 21429634 DOI: 10.1016/j.revmed.2011.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 02/04/2011] [Accepted: 02/13/2011] [Indexed: 02/06/2023]
Abstract
Acquired ichthyosis and livedoid palmoplantar keratoderma have rarely been described in systemic lupus erythematosus (SLE). In the first case, a 51-year-old man presented with generalized acquired ichthyosis associated with renal glomurelosclerosis and neurolupus. rituximab allowed total resolution of the acquired ichthyosis. A livedoid palmoplantar keratoderma was observed in a 45-year-old woman as the initial clinical manifestation of a systemic lupus erythematosus associated with Raynaud's phenomenon, photosensitivity and inflammatory polyarthralgia. Although the pathophysiology is not well-defined, these unusual cutaneous manifestations should be considered by physicians when diagnosis of SLE is suspected.
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Affiliation(s)
- C Biver-Dalle
- Service de dermatologie, hôpital Saint-Jacques, 2 place Saint-Jacques, Besançon cedex, France
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Elqatni M, Fatihi J, Sekkach Y, Hammi S, Ameziane T, Abouzahir A, Ghafir D, Ohayon V. [Bullous lesions]. Rev Med Interne 2010; 31:863-4. [PMID: 20828893 DOI: 10.1016/j.revmed.2010.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2010] [Accepted: 07/17/2010] [Indexed: 11/28/2022]
Affiliation(s)
- M Elqatni
- Service de médecine interne B, hôpital militaire d'instruction Mohammed V, Rabat, Maroc.
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Leblanc C, Lahaxe L, Girszyn N, Levesque H, Marie I. Des ulcérations buccales…. Presse Med 2010; 39:736-7. [DOI: 10.1016/j.lpm.2009.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 09/14/2009] [Accepted: 09/15/2009] [Indexed: 11/29/2022] Open
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Mastite lupique associée à un lupus érythémateux systémique sévère. Rev Med Interne 2009; 30:540-2. [DOI: 10.1016/j.revmed.2008.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 07/31/2008] [Accepted: 08/04/2008] [Indexed: 11/19/2022]
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Bens G. [Photosensitivity in lupus erythematosus]. Rev Med Interne 2009; 30:857-65. [PMID: 19304357 DOI: 10.1016/j.revmed.2009.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2008] [Accepted: 01/24/2009] [Indexed: 11/24/2022]
Abstract
Photosensitivity is one of the ARA diagnostic criteria of systemic lupus erythematosus. Sun exposure can also induce extracutaneous manifestations of the disease. Photosensitivity may be difficult to prove by history taking in lupus patients, as the delay between sun exposure and the onset of specific skin lesions is rather long. Photo-induction of lupus can occur by ultraviolet A (UVA) radiation in the shadow or behind window glass, so that the relationship between radiation exposure and exacerbation of the disease may not seem obvious to the patient. Phototesting procedures for lupus erythematosus have been described, but they are not used in routine practice. Both UVB and UVA play a role in the pathogenesis of lupus erythematosus: in the epidermis they induce DNA damage, they expose nuclear antigens and photo-induced neo-antigens at the cell surface, they lead to an accumulation of apoptotic material, and they induce several pro-inflammatory cytokines. In the dermis, UV radiation triggers skin infiltration by inflammatory cells by modulation of microvascular flow rates and by upregulation of white blood cell migration from dermal capillaries to the skin. Photodistribution of skin lesions and a delay of their onset of more than 48 hours after sun exposure are clinical hallmarks of cutaneous lupus erythematosus that are usually completed by histological confirmation. Photoprotection is essential in the treatment of lupus patients: it comprises sun avoidance suitable for both UVB and UVA radiation, protective clothing, and topical broad-spectrum filters.
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Affiliation(s)
- G Bens
- Service de dermatologie, centre hospitalier régional d'Orléans, hôpital Porte-Madeleine, BP 2439, Orléans cedex 1, France.
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