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Abstract
Raynaud's phenomenon, which is characterized by episodic digital pallor, cyanosis and rubor upon exposure to cold environment or to stress, is relatively common, although the prevalence depends on the climate. Still, it is under-diagnosed, under-treated, and often confused with other conditions. Primary Raynaud's phenomenon (i.e., Raynaud disease) must be distinguished from secondary Raynaud's phenomenon (i.e., Raynaud syndrome) as long-term morbidity and outcomes differ vastly between the two conditions. Additionally, the practitioner must differentiate between Raynaud's phenomenon and related vascular disorders, such as acrocyanosis, pernio, and livedo reticularis. In this article, we review differences between the conditions and suggest an approach to diagnosis and treatment strategy for these disorders.
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Affiliation(s)
- Eunjung Choi
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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2
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Miulescu R, Balaban DV, Sandru F, Jinga M. Cutaneous Manifestations in Pancreatic Diseases-A Review. J Clin Med 2020; 9:E2611. [PMID: 32806580 PMCID: PMC7464368 DOI: 10.3390/jcm9082611] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.
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Affiliation(s)
- Raluca Miulescu
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
| | - Daniel Vasile Balaban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Florica Sandru
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
| | - Mariana Jinga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
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3
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Mitri F, Enk A, Bersano A, Kraemer M. Livedo racemosa in neurological diseases: an update on the differential diagnoses. Eur J Neurol 2020; 27:1832-1843. [DOI: 10.1111/ene.14390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- F. Mitri
- Department of Dermatology University Hospital Heidelberg Heidelberg Germany
| | - A. Enk
- Department of Dermatology University Hospital Heidelberg Heidelberg Germany
| | - A. Bersano
- Cerebrovascular Unit Fondazione IRCCS Istituto Neurologico ‘Carlo Besta’ Milan Italy
| | - M. Kraemer
- Department of Neurology Alfried Krupp von Bohlen und Halbach Hospital Essen Germany
- Department of Neurology Heinrich Heine University Hospital Düsseldorf Germany
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4
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Savell AS, Morris B, Heaphy MR. Cutaneous metastasis of urothelial carcinoma resulting in vascular occlusion and livedo racemosa. JAAD Case Rep 2020; 6:574-576. [PMID: 32514424 PMCID: PMC7267676 DOI: 10.1016/j.jdcr.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
| | - Bryn Morris
- University of Nevada Reno School of Medicine, Reno, Nevada
| | - Michael R. Heaphy
- University of Nevada Reno School of Medicine, Reno, Nevada
- Skin Cancer and Dermatology Institute, Reno, Nevada
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Quaresma MV, Gomes ACD, Serruya A, Vendramini DL, Braga L, Buçard AM. Amantadine-induced livedo reticularis--Case report. An Bras Dermatol 2016; 90:745-7. [PMID: 26560223 PMCID: PMC4631243 DOI: 10.1590/abd1806-4841.20153394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/18/2014] [Indexed: 12/05/2022] Open
Abstract
Livedo reticularis is a spastic-anatomical condition of the small vessels which
translates morphologically by a reticular pattern, interspersing cyanosis, pallor and
erythema. The same can be congenital or acquired. Among the acquired, we highlight
the physiological livedo reticularis and the idiopathic livedo by vasospasm; the
latter configures the most common cause. The drug-induced type is less common. The
drugs amantadine and norepinephrine are often implicated. Cyanosis is usually
reversible if the causative factor is removed, however, with chronicity, the vessels
may become permanently dilated and telangiectatic. We report a case of a patient
diagnosed with Parkinson’s disease with chronic livedo reticularis associated with
the use of amantadine and improvement after discontinuation of the drug.
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Affiliation(s)
| | | | - Aline Serruya
- Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Lara Braga
- Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alice Mota Buçard
- Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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6
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Abstract
Life-threatening and benign drug reactions occur frequently in the skin, affecting 8 % of the general population and 2-3 % of all hospitalized patients, emphasizing the need for physicians to effectively recognize and manage patients with drug-induced eruptions. Neurologic medications represent a vast array of drug classes with cutaneous side effects. Approximately 7 % of the United States (US) adult population is affected by adult-onset neurological disorders, reflecting a large number of patients on neurologic drug therapies. This review elucidates the cutaneous reactions associated with medications approved by the US Food and Drug Administration (FDA) to treat the following neurologic pathologies: Alzheimer disease, amyotrophic lateral sclerosis, epilepsy, Huntington disease, migraine, multiple sclerosis, Parkinson disease, and pseudobulbar affect. A search of the literature was performed using the specific FDA-approved drug or drug classes in combination with the terms 'dermatologic,' 'cutaneous,' 'skin,' or 'rash.' Both PubMed and the Cochrane Database of Systematic Reviews were utilized, with side effects ranging from those cited in randomized controlled trials to case reports. It behooves neurologists, dermatologists, and primary care physicians to be aware of the recorded cutaneous adverse reactions and their severity for proper management and potential need to withdraw the offending medication.
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Affiliation(s)
| | | | - Sylvia Hsu
- Department of Dermatology, Baylor College of Medicine, Houston, TX, USA
| | - Joseph S Kass
- Department of Neurology, Baylor College of Medicine, 7200 Cambridge St., 9th Floor, Houston, TX, 77030, USA.
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Huang H, Hohler AD. The Dermatological Manifestations of Postural Tachycardia Syndrome: A Review with Illustrated Cases. Am J Clin Dermatol 2015; 16:425-30. [PMID: 26242228 DOI: 10.1007/s40257-015-0144-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Postural tachycardia syndrome (POTS) is a syndrome of excessive tachycardia with orthostatic challenge, and relief of such symptoms with recumbence. There are several proposed subtypes of the syndrome, each with unique pathophysiology. Numerous symptoms such as excessive tachycardia, lightheadedness, blurry vision, weakness, fatigue, palpitations, chest pain, and tremulousness are associated with orthostatic intolerance. Other co-morbid conditions associated with POTS are not clearly attributable to orthostatic intolerance. These include chronic headache, fibromyalgia, functional gastrointestinal or bladder disorders, cognitive impairment, and sleep disturbances. Dermatological manifestations of POTS are also common and wide ranging, from livedo reticularis to Raynaud's phenomenon, from cutaneous flushing to erythromelalgia. Here, we provide three illustrative cases of POTS with dermatological manifestations. We discuss the potential pathophysiology underlying such dermatological manifestations, and how such mechanisms could in turn help guide development of management.
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Affiliation(s)
- Hao Huang
- Department of Neurology, Boston University Medical Campus, 72 East Concord St, A-302, Boston, MA, 02118, USA.
| | - Anna DePold Hohler
- Department of Neurology, Boston University Medical Campus, 72 East Concord St, A-302, Boston, MA, 02118, USA
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8
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Zemtsov A, Omueti-Ayoade K, Zemtsov R, Yang M. Livedo reticularis as an initial clinical manifestation of gemcitabine-induced hemolytic uremic syndrome. J Dermatol 2011; 39:487-9. [PMID: 21906135 DOI: 10.1111/j.1346-8138.2011.01353.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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9
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Abstract
OPINION STATEMENT Livedo reticularis is a violaceous mottling of the skin with a "fishnet" reticular appearance. Primary and secondary etiologies exist, including a pathologic variant termed livedo racemosa. No evidence-based medicine exists to guide therapy for this disorder, but most patients with primary and secondary livedo reticularis are asymptomatic and do not require treatment. In the rare instance that a patient with primary livedo reticularis experiences mild symptoms such as episodic numbness and tingling, avoidance of cold and vasoconstricting substances should be encouraged. Lastly, judicious dosing of a vasodilator such as a calcium channel blocker can be prescribed. Patients with secondary livedo reticularis or livedo racemosa may benefit from these same therapeutic suggestions; however, treating the proximate cause of livedo with a systemic association is encouraged and is most likely to yield cutaneous improvement. Although antiplatelet and/or anticoagulant therapy is often required when treating a patient with the antiphospholipid antibody syndrome or Sneddon's syndrome, the attendant livedo racemosa typically remains unchanged or progresses despite this treatment.
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Affiliation(s)
- Steven M Dean
- Division of Cardiovascular Medicine, 200 Davis Heart Lung Institute, The Ohio State University College of Medicine, 473W. 12th Avenue, Columbus, OH, 43210, USA,
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10
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Abstract
Internal diseases can manifest in a myriad of skin dermatoses ranging from single disorders such as calciphylaxis, cryoglobulinemia, amyopathic dermatomyositis, and Raynaud phenomenon, to spectrum disorders such as the neutrophilic dermatoses and morphea. In this article the underlying causes, triggering events, constitutional symptoms, clinical features and presentations, appearance at various stages, and pathogenesis are described. The course of the diseases and probable healing outcomes are outlined. Finally, examination and diagnostic methods, and therapies and treatments are provided.
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Affiliation(s)
- Andrew G Franks
- Department of Dermatology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
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11
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Hirschmann JV, Raugi GJ. Blue (or purple) toe syndrome. J Am Acad Dermatol 2009; 60:1-20; quiz 21-2. [DOI: 10.1016/j.jaad.2008.09.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 08/26/2008] [Accepted: 09/03/2008] [Indexed: 01/19/2023]
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Affiliation(s)
- Juan C Salgado
- Geisinger Medical Center, Department of General Internal Medicine, Danville, Pennsylvania 17822, USA
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13
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Abstract
Livedo reticularis (LR) is a well-known, relatively common physical finding consisting of macular, violaceous, connecting rings that form a netlike pattern (Fig 1). In most cases, it is a completely benign finding related to cold exposure. However, there are many potential causes (Table I), and this can make the evaluation of a patient presenting with this finding very difficult. An excellent review of the topic by Fleischer and Resnick was published in 1990. We have endeavored to update the literature and provide clinicians with guidance regarding the evaluation and treatment of patients presenting with LR.
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Affiliation(s)
- Mark B Gibbs
- Department of Dermatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Shrestha NK, Gordon SM, Isada CM. Livedo reticularis associated with the use of a midline catheter. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2003; 34:845-6. [PMID: 12578157 DOI: 10.1080/0036554021000026942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of livedo reticularis as an unusual complication of a midline catheter in a patient being treated for pyelonephritis with intravenous antibiotics. The rash resolved completely after catheter removal. The constellation of symptoms suggested an aberrant autonomic response as the cause of the illness.
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Affiliation(s)
- Nabin K Shrestha
- Department of Infectious Diseases, The Cleveland Clinic Foundation, Cleveland, OH, USA.
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Gould JW, Helms SE, Schulz SM, Stevens SR. Relapsing livedo reticularis in the setting of chronic pancreatitis. J Am Acad Dermatol 1998; 39:1035-6. [PMID: 9843029 DOI: 10.1016/s0190-9622(98)70290-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J W Gould
- Department of Dermatology, University Hospitals of Cleveland/Case Western Reserve University, OH 44106-5028, USA
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 30-1995. A 69-year-old woman with lupus erythematosus and painful skin lesions of the feet. N Engl J Med 1995; 333:862-8. [PMID: 7651478 DOI: 10.1056/nejm199509283331308] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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