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Chighizola CB, Suardi I, Marino A, Gattinara M, Costi S, Cattaneo A, Gerosa M, Caporali R. Belimumab-induced periungual pyogenic granulomas: A case report. Lupus 2024; 33:1017-1021. [PMID: 38860334 DOI: 10.1177/09612033241260180] [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: 06/12/2024]
Abstract
Pyogenic granuloma (PG) is a benign vascular neoformation, presenting as a painful red nodule on the skin, mucosa or nail apparatus. It is usually related to local complications such as bleedings and superinfections. The etiology of PG remains still unclear, and several triggers can lead to its formation. In case of multiple lesions, systemic conditions and drugs remain the main causes. Antineoplastic treatments, retinoids, antiretrovirals, hormones and anticonvulsants are frequently implicated in PG formation. In literature, PG has been rarely described in the course of biological treatment due to rheumatological disease. The present case report describes the development of polydactolous PGs in a 21-year-old woman with juvenile systemic lupus erythematosus (jSLE) during treatment with belimumab, a monoclonal antibody directed against BlyS. The clinical presentation, in particular the timing and the multiplicity of the lesions, and the improvement after belimumab discontinuation allowed us to consider PG as drug-induced. This case highlights the importance of considering PG as a potential complication of rheumatologic treatments.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Ilaria Suardi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Achille Marino
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Maurizio Gattinara
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Stefania Costi
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Angelo Cattaneo
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Rheumatology and Medical Sciences, Pediatric Rheumatology Unit, ASST Pini-CTO, Milan, Italy
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Pini-CTO, Milan, Italy
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Mahé E. Everolimus-induced aphthous stomatitis controlled by apremilast in a heart-transplant patient. Ann Dermatol Venereol 2023; 150:158-159. [PMID: 36739218 DOI: 10.1016/j.annder.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/28/2022] [Accepted: 11/08/2022] [Indexed: 02/05/2023]
Affiliation(s)
- E Mahé
- Service de Dermatologie, Hôpital Victor Dupouy, 69 rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France.
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3
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Abstract
Changes in nail color can provide important clues of underlying systemic and skin disease. In particular, white discoloration (leukonychia) has a high prevalence with a wide array of potential relevant causes, from simple manicure habits to life-threatening liver or kidney failure. Therefore, a reliable assessment of the patient with leukonychia is essential. In the past, two classifications for leukonychia have been presented. The morphological classifies the nail according to the distribution of the white lines: total, partial, transversal, and longitudinal leukonychia. Mees’ and Muehrcke’s lines are examples of transversal leukonychia, while Terry’s and Lindsay’s nails are examples of total and partial leukonychia. The anatomical classifies according to the structure responsible for the white color: the nail plate in true leukonychia, the nail bed in apparent leukonychia, and the surface only in pseudoleukonychia. In this review, both morphological and anatomical features have been combined in an algorithm that enables clinicians to approach leukonychia efficiently and effectively.
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Kanitakis J, Petruzzo P, Baran R, Gazarian A, Badet L, Morelon E. Nail changes in upper extremity allotransplantation: onychomadesis as the presenting sign of allograft rejection - a retrospective study. Transpl Int 2020; 33:1274-1281. [PMID: 32621769 DOI: 10.1111/tri.13689] [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: 04/21/2020] [Revised: 06/03/2020] [Accepted: 06/29/2020] [Indexed: 11/28/2022]
Abstract
Upper extremity allotransplantation (UEA) is the more common type of vascularized composite allotransplantation of which more than 80 patients have benefited worldwide. These allografts include - along with the skin - the nail unit, a specialized epithelial appendage which may be the target of graft rejection. We report an UEA recipient who developed, as an initial manifestation of graft rejection, onychomadesis, that is shedding of the nail plate starting from the proximal nail bed. On this occasion, we reviewed the nail changes we have observed in a series of eight patients with UEA who were grafted and followed in our hospital since 1998 (mean follow-up period of 9.75 years). We also reviewed the relevant literature reporting nail changes in UEA recipients. A brief discussion on the significance of these changes in the context of UEA is provided with emphasis on onychomadesis, a finding usually related to graft rejection in this specific setting.
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Affiliation(s)
- Jean Kanitakis
- Department of Dermatology, Edouard Herriot Hospital Group, Lyon cedex 03, France
| | | | | | | | - Lionel Badet
- Department of Transplantation Surgery, Edouard Herriot Hospital Group, Lyon cedex 03, France
| | - Emmanuel Morelon
- Department of Transplantation Immunology, Edouard Herriot Hospital Group, Lyon cedex 03, France
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Abstract
Drug-induced changes of hair and nails have been observed with a variety of different pharmaceutical agents, both topical and systemic. These compounds or their metabolites may interfere with hair cycling and texture, nail matrix, nail bed, nail folds, and microvasculature. Phototoxic reactions may also occur. Before initiating treatment, physicians and patients should be aware of possible adverse events to hair and nails and should be aware of the preventive measures, if available, as quality of life can be reduced, and adherence and compliance to treatment may be impaired.
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Affiliation(s)
- Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany.
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Özcan D, Seçkin D, Ada S, Haberal M. Mucocutaneous disorders in renal transplant recipients receiving sirolimus-based immunosuppressive therapy: a prospective, case-control study. Clin Transplant 2013; 27:742-8. [PMID: 23991694 DOI: 10.1111/ctr.12215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Sirolimus (SRL) has some dermatologic complications including acneiform eruptions, edema, aphthous ulceration, and onychopathy. However, controlled studies reporting the prevalence and clinical characteristics of mucocutaneous disorders are scarce. OBJECTIVE To investigate the prevalence and clinical spectrum of mucocutaneous disorders in renal transplant recipients (RTRs) receiving SRL and to compare the findings with those in RTRs not receiving SRL. METHODS Fifty RTRs (35 men, 15 women; mean age, 34.6 ± 11.6 yr) receiving SRL, 50 RTRs (36 men, 14 women; mean age, 34.4 ± 11.3 yr) not on SRL were screened for mucocutaneous disorders. RESULTS In RTRs receiving SRL, skin infection (78%) was the most common dermatologic disorder followed by facial hyperpigmentation (50%) and acneiform eruption (46%). Herpes simplex virus infections (14%) and seborrheic dermatitis (38%) were significantly more common in RTRs on SRL (p < 0.05); the frequencies of edema, aphthous ulceration, acne, and longitudinal nail ridging were similar in both groups (p > 0.05). LIMITATIONS This study had a small sample size. The investigator was not blinded to immunosuppressive treatment protocols. CONCLUSION Renal transplant recipients receiving SRL are more likely to develop seborrheic dermatitis and herpes simplex virus infections than those not taking SRL. Whereas, they are not more prone to edema, aphthous ulceration, acne, or longitudinal nail ridging.
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Affiliation(s)
- Deren Özcan
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
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Abstract
Nonneoplastic mucocutaneous lesions are frequent in organ transplant recipients. Many of them are caused by a direct toxicity of immunosuppressive drugs, in particular glucocorticoids and cyclosporine. The effects of these agents are dose- and time-dependent. Glucocorticoids can cause acne, Cushingoid appearance, irregular purpuric areas, friable skin, and wide and violaceous stripes. Cyclosporine can cause hypertrichosis, pilosebaceous lesions, and gum hypertrophy. Patients with esthetic changes may show poor adherence to treatment with these immunosuppressive agents that may lead to progressive graft dysfunction. Apart from this direct toxicity, vigorous immunosuppression may render the transplant recipients more susceptible to mucocutaneous infections. Fungal infection, viral warts, and bacterial folliculitis are the most frequent types of mucocutaneous infection. Some fungal infections, such as oral candidiasis and pityriasis versicolor, are relatively trivial, but other mycotic infections can cause severe or disfigurating lesions. Among viral infections, warts and condylomata caused by human papilloma virus are frequent and may favor the development of nonmelanoma skin cancer. Bacterial infections are usually trivial in the early period after transplantation, being represented almost exclusively by folliculitis. However, subcutaneous infections may cause a necrotizing fasciculitis which is a life-threatening disorder, usually sustained by polymicrobial pathogens.
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Affiliation(s)
- Claudio Ponticelli
- Division of Nephrology, Istituto Scientifico Humanitas, Rozzano, Milan, Italy.
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9
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Campistol JM, de Fijter JW, Flechner SM, Langone A, Morelon E, Stockfleth E. mTOR inhibitor-associated dermatologic and mucosal problems. Clin Transplant 2010; 24:149-56. [PMID: 20236129 DOI: 10.1111/j.1399-0012.2010.01232.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mammalian target of rapamycin inhibitor use is associated with numerous adverse events, including dermatologic and mucosal problems. Awareness of these complications, which clinically manifest across a severity spectrum from minor through severe and may occur at varied time points after initiation of sirolimus therapy, can be useful to clinicians in both managing these events and determining the appropriate intervention(s) for patients. This manuscript examines the dermatologic and mucosal problems associated with mammalian target of rapamycin inhibitor use, reviews the literature, and provides personal experiences regarding the management and treatment of these adverse events.
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Affiliation(s)
- Josep M Campistol
- Department of Urology and Nephrology, Hospital Clinic i Provincial, Barcelona, Spain
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Schneeberger S, Gorantla VS, van Riet RP, Lanzetta M, Vereecken P, van Holder C, Rorive S, Remmelink M, Le Moine A, Abramowicz D, Zelger B, Kaufman CL, Breidenbach WC, Margreiter R, Schuind F. Atypical acute rejection after hand transplantation. Am J Transplant 2008; 8:688-96. [PMID: 18261182 DOI: 10.1111/j.1600-6143.2007.02105.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Skin rejection after hand transplantation is characterized by a maculopapular erythematous rash that may be diffuse, patchy or focal, and distributed over forearms and dorsum of the hands. This 'classical' pattern of rejection usually spares the skin of the palm and does not affect the nails. Herein, we report the experience on four cases presenting with an 'atypical' pattern of rejection that is novel in involving the palmar skin and the nails. All patients were young and exposed to repetitive and persistent mechanical stress of the palm. Characteristic features of rejection included a desquamative rash associated with dry skin, red papules, scaling and lichenification localized to the palm. Skin lesions were associated with nail dystrophy, degeneration, deformation or loss. Histology of the skin and nail bed revealed a lymphocytic infiltrate with predominance of T cells (CD3+, CD4+ and CD8+), with small numbers of B cells (CD20+ and CD79a+) and a low number of Forkhead transcription factor 3 (FOXP3)-positive cells in one patient. The lesions persisted over weeks to months, responded poorly to steroid treatment and were managed with antithymocyte globulin (ATG; Thymoglobulin, Genzyme, Cambridge, MA), alemtuzumab and/or intensified maintenance immunosuppression.
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Affiliation(s)
- S Schneeberger
- Department of General Surgery, Innsbruck Medical University, Innsbruck, Austria
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2007. [DOI: 10.1002/pds.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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