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Kreyberg I, Schrumpf E, Fredrik von Krogh C, Lilleng R, Tjønnfjord GE. Successful treatment of subcorneal pustular dermatosis targeting an underlying monoclonal IgA gammopathy. JAAD Case Rep 2023; 41:33-36. [PMID: 37842157 PMCID: PMC10568226 DOI: 10.1016/j.jdcr.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- Ina Kreyberg
- Department of Dermatology and Venereology, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Schrumpf
- Department of Dermatology and Venereology, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Rune Lilleng
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Geir E. Tjønnfjord
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Centre for B-cell malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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2
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Kishimoto M, Komine M, Okada H, Sato A, Kamiya K, Maekawa T, Murata S, Ohtsuki M. Three cases of subcorneal pustular dermatosis with immunohistochemical examinations. J Dermatol 2023; 50:1150-1155. [PMID: 37288510 DOI: 10.1111/1346-8138.16850] [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: 01/14/2023] [Revised: 04/25/2023] [Accepted: 05/12/2023] [Indexed: 06/09/2023]
Abstract
Subcorneal pustular dermatosis, a rare, benign skin disease, is a type of neutrophilic dermatosis. The authors reported three cases of subcorneal pustular dermatosis. In case 1, a 9-year-old girl developed a skin rash with blisters following a mycoplasma infection and had a flare-up due to a common cold. She was successfully treated with a topical corticosteroid. In case 2, a 70-year-old woman who had been treated for rheumatoid arthritis with adalimumab, salazosulfapyridine, and leflunomide developed 3- to 5-mm pustules on her trunk and thighs 4 days after flu vaccination. The rash disappeared with drug withdrawal and treatment with diaminodiphenyl sulfone. In case 3, an 81-year-old man, who was diagnosed with pyoderma gangrenosum at 61 years old, developed multiple small flaccid pustules on his trunk and extremities due to an infection in the arteriovenous shunt area on the forearm. The pustule disappeared with intravenous antibiotic therapy; however, the pustules subsequently flared up along with ulcers typical of pyoderma gangrenosum. He was given oral prednisolone therapy, which was effective for the small pustules and some ulcers. Immunohistochemical examination of the three cases revealed neutrophilic infiltration in the subcorneal layer of the epidermis. The pustules contained neutrophils as well as some CD68+ and a few CD1a+ cells. The epidermis and dermis were more predominantly infiltrated by CD4+ cells than by CD8+ cells. Positive stainings for interleukin 8, interleukin 36γ, and phospho-extracellular signal-regulated kinases 1 and 2 were observed in the upper layers of the epidermis below the pustules. Although the pathogenesis of subcorneal pustular dermatosis has not been clarified, the current results suggest that a variety of inflammatory cells, including those responsible for both innate and acquired immunity, are involved in the accumulation of neutrophils in subcorneal pustular dermatosis.
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Affiliation(s)
- Megumi Kishimoto
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Hirofumi Okada
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Atsuko Sato
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Koji Kamiya
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Takeo Maekawa
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Satoru Murata
- Murata Dermatology Clinic, Shimotsuke, Tochigi, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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3
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Parisi R, Shah H, Navarini AA, Muehleisen B, Ziv M, Shear NH, Dodiuk-Gad RP. Acute Generalized Exanthematous Pustulosis: Clinical Features, Differential Diagnosis, and Management. Am J Clin Dermatol 2023:10.1007/s40257-023-00779-3. [PMID: 37156992 PMCID: PMC10166469 DOI: 10.1007/s40257-023-00779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 05/10/2023]
Abstract
Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.
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Affiliation(s)
- Rose Parisi
- Albany Medical College, Albany, New York, NY, USA
| | - Hemali Shah
- Albany Medical College, Albany, New York, NY, USA
| | - Alexander A Navarini
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Beda Muehleisen
- Department of Dermatology and Allergy, University Hospital of Basel, Basel, Switzerland
| | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Roni P Dodiuk-Gad
- Department of Dermatology, Emek Medical Center, Afula, Israel.
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, M5S 1A1, Canada.
- Department of Dermatology, Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, 3525433, Israel.
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4
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Alhafi MA, Janahi MI, Almossalli ZN. Subcorneal Pustular Dermatosis in Paediatrics: A Case Report and Review of the Literature. Cureus 2021; 13:e20221. [PMID: 35004040 PMCID: PMC8729309 DOI: 10.7759/cureus.20221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 11/30/2022] Open
Abstract
Subcorneal pustular dermatosis (SPD) is a rare chronic condition rarely seen in adolescence and childhood. The exact etiology of the disease remains unknown. In this paper, we report the case of a 14-year-old girl who came with a history of itchy skin lesions confined to the upper and lower extremities, thighs and pubic area for two months. Physical examination showed well-demarcated annular brownish plaques, ranging in size from 5cm to 7cm, in addition to a scaly and elevated border with few pustules noted over the upper and lower extremities, thighs and pubic area. Some lesions also showed central clearing. New annular vesicular lesions were also noted on the lower extremity and inner thigh. She was diagnosed with SPD based on the characteristic clinical and histological features. The patient was treated with Dapsone and showed good clinical response.
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5
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Lamberti A, Miracco C, Cinotti E, Trovato E, Vispi M, Fimiani M, Rubegni P. An unusual triple association: Superficial granulomatous pyoderma, subcorneal pustular dermatosis, IgA multiple myeloma. J Cutan Pathol 2020; 48:461-463. [PMID: 33245568 DOI: 10.1111/cup.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/08/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Arianna Lamberti
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Clelia Miracco
- Department of Human Pathology and Oncology, Pathological Anatomy Section, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Emanuele Trovato
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Martina Vispi
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Michele Fimiani
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy
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6
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Doolan BJ, Cranwell WC, Nicolopoulos J, Dolianitis C. Topical dapsone gel for treatment of axillary subcorneal pustular dermatosis. J Dermatol 2019; 46:e437-e438. [DOI: 10.1111/1346-8138.14953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Brent J. Doolan
- Department of Dermatology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - William C. Cranwell
- Department of Dermatology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Jenny Nicolopoulos
- Department of Dermatology The Royal Melbourne Hospital Melbourne Victoria Australia
| | - Con Dolianitis
- Department of Dermatology The Royal Melbourne Hospital Melbourne Victoria Australia
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7
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Khosravi-Hafshejani T, Dutz JP. Chronic annular pustular psoriasis resembling subcorneal pustular dermatosis: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19857392. [PMID: 31258906 PMCID: PMC6587379 DOI: 10.1177/2050313x19857392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Generalized pustular psoriasis and subcorneal pustular dermatosis are generalized pustular dermatoses that are characterized by the subcorneal accumulation of neutrophils. Careful examination is important in distinguishing these diseases for appropriate management. Patients with acute generalized pustular psoriasis are systemically unwell with discrete pustules as opposed to the chronicity and associated hypopyon lesions in subcorneal pustular dermatosis. Generalized pustular psoriasis lesions demonstrate psoriasiform changes on histology and the increased expression of Th17 cytokines. We describe a middle-aged woman presenting with chronic annular generalized pustular psoriasis, initially mistaken for subcorneal pustular dermatosis due to their clinical and histological semblance. The patient had recurrent skin disease for 6 years despite conventional therapy of oral retinoid, immunosuppressant and biologic therapy. Complete and persistent clearance of her skin lesions was achieved with secukinumab, an interleukin 17A inhibitor.
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Affiliation(s)
| | - Jan P Dutz
- Department of Dermatology and Skin Science, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
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8
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Mayba J, Hawkins CN. First presentation of Sneddon-Wilkinson disease with unexpected immunoglobulin A gammopathy: A case report and review of the literature. SAGE Open Med Case Rep 2019; 7:2050313X19826432. [PMID: 30728980 PMCID: PMC6354295 DOI: 10.1177/2050313x19826432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of Sneddon-Wilkinson disease in a 52-year-old female at her first presentation to dermatology. Outlined in the case are various investigations undertaken at this initial presentation, including rheumatologic and hematologic malignancy markers, which identified immunoglobulin A gammopathy. The systemic and topical therapies used to treat the patient’s condition are described, as well as her response to these treatments. In this discussion, we explain the epidemiology, pathophysiology, and clinical presentation of Sneddon-Wilkinson disease. Various medical conditions having known association with Sneddon-Wilkinson disease are discussed, including immunoglobulin A or immunoglobulin G monoclonal gammopathies and lymphoproliferative disorders. A comprehensive differential diagnosis for Sneddon-Wilkinson disease is provided, including immunoglobulin A pemphigus, acute generalized exanthematous pustulosis and pustular psoriasis, among others. We describe the systemic and topical therapy options for the treatment of Sneddon-Wilkinson disease, of which first line treatment is systemic dapsone. This patient serves as an excellent case of Sneddon-Wilkinson disease with unexpected immunoglobulin A gammopathy.
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Affiliation(s)
- Julia Mayba
- University of Saskatchewan, Saskatoon, SK, Canada
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9
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Jardim MML, Diniz TACB, Cunha TAC, Valente NYS. Subcorneal pustular dermatosis in the pediatric age. An Bras Dermatol 2018; 93:116-118. [PMID: 29641711 PMCID: PMC5871376 DOI: 10.1590/abd1806-4841.20186576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/31/2017] [Indexed: 11/22/2022] Open
Abstract
Subcorneal pustular dermatosis is a rare pustular eruption which occurs mainly in middle-aged women and rarely during childhood. We report a case of a 15-year-old female with a 4-year history of pustular lesions on the proximal region of the upper limbs with subsequent impairment of the trunk. Physical examination revealed small pustules distributed on the trunk and proximal region of the limbs. Histopathology showed a subcorneal pustule and direct immunofluorescence for IgA, IgM, IgG and fibrinogen was negative, confirming the diagnosis of subcorneal pustular dermatosis. The patient was treated with dapsone with good clinical response after one month. Subcorneal pustular dermatosis is a rare condition and there are only isolated cases reported in the literature in pediatric patients. Thus, we discuss the main clinical aspects and treatment response of this condition during childhood.
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10
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Kretschmer L, Maul JT, Hofer T, Navarini AA. Interruption of Sneddon-Wilkinson Subcorneal Pustulation with Infliximab. Case Rep Dermatol 2017; 9:140-144. [PMID: 28559813 PMCID: PMC5437431 DOI: 10.1159/000468917] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/05/2017] [Indexed: 01/17/2023] Open
Abstract
Subcorneal pustular dermatosis (SCPD, Sneddon-Wilkinson disease) is a rare chronic-relapsing skin disorder that typically manifests as flaccid sterile pustules without systemic symptoms. Although the accumulation of neutrophils is acknowledged to be a hallmark of SCPD, its exact pathomechanism is still not known. Several chemotactic factors have been implicated in neutrophil recruitment and invasion, including the proinflammatory cytokine TNF-α. These findings correspond well with clinical reports of successful off-label use of TNF blocking agents in cases that were refractory to first-line therapy, mostly with dapsone. We report the case of a 29-year-old male with atypical and severe manifestation of SCPD that resolved after a single dose of infliximab. Consolidation was observed 1 day after treatment and regression of skin lesions occurred after a few days. Residual scarring and postlesional hyperpigmentation was seen at a 2-month follow-up appointment. The patient was initiated on a daily maintenance therapy with dapsone, which led to a drop in hemoglobin and had to be stopped. Upon development of small, scaly lesions, a maintenance therapy with infliximab was started and the patient has had no recurrence to date. Anti-TNF agents present a promising option for patients affected by severe SCPD. We review the reports of similar cases in the literature to date.
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Affiliation(s)
- Lorenz Kretschmer
- aDepartment of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Julia-Tatjana Maul
- aDepartment of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Thomas Hofer
- bPraxisgemeinschaft Winkelried, Wettingen, Switzerland
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Pradhan S, Madke B, Kabra P, Singh AL. Anti-inflammatory and Immunomodulatory Effects of Antibiotics and Their Use in Dermatology. Indian J Dermatol 2016; 61:469-81. [PMID: 27688434 PMCID: PMC5029230 DOI: 10.4103/0019-5154.190105] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Antibiotics (antibacterial, antiviral, and antiparasitic) are class of drugs which result in either killing or inhibiting growth and multiplication of infectious organisms. Antibiotics are commonly prescribed by all specialties for treatment of infections. However, antibiotics have hitherto immunomodulatory and anti-inflammatory properties and can be exploited for various noninfectious dermatoses. Dermatologists routinely prescribe antibiotics in treatment of various noninfectious disorders. This study will review anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology.
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Affiliation(s)
- Swetalina Pradhan
- Department of Dermatology, STD and Leprosy, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
| | - Poonam Kabra
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
| | - Adarsh Lata Singh
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College and AVBR Hospital, Wardha, Maharashtra, India
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12
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Bou-Dargham MJ, Khamis ZI, Cognetta AB, Sang QXA. The Role of Interleukin-1 in Inflammatory and Malignant Human Skin Diseases and the Rationale for Targeting Interleukin-1 Alpha. Med Res Rev 2016; 37:180-216. [PMID: 27604144 DOI: 10.1002/med.21406] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 12/11/2022]
Abstract
Inflammation plays a major role in the induction and progression of several skin diseases. Overexpression of the major epidermal proinflammatory cytokines interleukin (IL) 1 alpha (IL-1α) and 1 beta (IL-1β) is positively correlated with symptom exacerbation and disease progression in psoriasis, atopic dermatitis, neutrophilic dermatoses, skin phototoxicity, and skin cancer. IL-1β and the interleukin-1 receptor I (IL-1RI) have been used as a therapeutic target for some autoinflammatory skin diseases; yet, their system-wide effects limit their clinical usage. Based on the local effects of extracellular IL-1α and its precursor, pro-IL-1α, we hypothesize that this isoform is a promising drug target for the treatment and prevention of many skin diseases. This review provides an overview on IL-1α and IL-β functions, and their contribution to inflammatory and malignant skin diseases. We also discuss the current treatment regimens, and ongoing clinical trials, demonstrating the potential of targeting IL-1α, and not IL-1β, as a more effective strategy to prevent or treat the onset and progression of various skin diseases.
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Affiliation(s)
- Mayassa J Bou-Dargham
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL, 32306.,Institute of Molecular Biophysics, Florida State University, Tallahassee, FL, 32306
| | - Zahraa I Khamis
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL, 32306.,Institute of Molecular Biophysics, Florida State University, Tallahassee, FL, 32306.,Department of Chemistry and Biochemistry, Lebanese University, Faculty of Sciences, Hadath-Beirut, Lebanon
| | - Armand B Cognetta
- Dermatology Associates of Tallahassee and Division of Dermatology, Florida State University College of Medicine, Tallahassee, FL, 32308
| | - Qing-Xiang Amy Sang
- Department of Chemistry and Biochemistry, Florida State University, Tallahassee, FL, 32306.,Institute of Molecular Biophysics, Florida State University, Tallahassee, FL, 32306
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13
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Kurtzman D, Vleugels RA, Callen J. Approach to and Management of the Neutrophilic Dermatoses. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0129-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Morgan M, Cooke A, Rogers L, Adams-Huet B, Khan DA. Double-blind placebo-controlled trial of dapsone in antihistamine refractory chronic idiopathic urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2014; 2:601-6. [PMID: 25213055 PMCID: PMC4165520 DOI: 10.1016/j.jaip.2014.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 05/18/2014] [Accepted: 06/11/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Management of antihistamine refractory chronic idiopathic urticaria (CIU) has poorly defined therapeutic options. OBJECTIVE To evaluate the efficacy of dapsone (4,4'-diaminodiphenylsulfone) in antihistamine refractory CIU compared with placebo. METHODS Twenty-two patients with antihistamine refractory CIU were randomly assigned to 100 mg of dapsone daily or placebo for 6 weeks in a 14-week double-blind, placebo-controlled crossover trial. End points were measured from a daily diary that reflected the weekly hive score, the weekly itch score, and a visual analog scale (VAS) score. Secondary to a carryover effect, the first period results were analyzed as a parallel design that compared placebo with dapsone directly by using repeated-measures analysis. RESULTS After 6 weeks, the patients in the dapsone arm showed mean improvement over baseline in VAS (2.3 [95% CI, 0.6-4.1], P = .01), urticaria score (-3.5 [95% CI, -6.2 to -0.9], P = .01), and itch score (-4.8 [95% CI, -7.6 to -2.1], P = .001), whereas the placebo arm showed no improvement over baseline for VAS, urticaria, or itch scores. Dapsone showed greater improvement compared with placebo for itch (P = .047) and VAS (P = .04). Of the 22 patients, 3 showed complete resolution of hives and itch with dapsone, whereas 31% and 41% had ≥ 50% resolution of hives and itch, respectively. No serious adverse effects were observed with dapsone. CONCLUSION To our knowledge, this is the first double-blind, placebo controlled study of dapsone in CIU and indicates that dapsone has efficacy in patients with antihistamine refractory CIU.
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Affiliation(s)
- Matt Morgan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Allergy, Asthma, and Immunology of North Texas, McKinney, Texas
| | - Andrew Cooke
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Laura Rogers
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Chicago Lake Shore Allergy and Asthma, Chicago, Ill
| | - Beverley Adams-Huet
- Division of Biostatistics, Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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15
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Prat L, Bouaziz JD, Wallach D, Vignon-Pennamen MD, Bagot M. Neutrophilic dermatoses as systemic diseases. Clin Dermatol 2013; 32:376-88. [PMID: 24767185 DOI: 10.1016/j.clindermatol.2013.11.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neutrophilic dermatoses (ND) are inflammatory skin conditions characterized by a sterile infiltrate of normal polymorphonuclear leukocytes. The main clinical forms of ND include Sweet syndrome, pyoderma gangrenosum, erythema elevatum diutinum, subcorneal pustular dermatosis, and their atypical or transitional forms. ND are often idiopathic, but they may be associated with myeloid hematologic malignancies (Sweet syndrome), inflammatory bowel disease or rheumatoid arthritis (pyoderma gangrenosum), and monoclonal gammopathies (erythema elevatum diutinum, subcorneal pustular dermatosis). The possible infiltration of internal organs with neutrophils during the setting of ND underlies the concept of a neutrophilic systemic disease. ND may be seen as a polygenic autoinflammatory syndrome due to their frequent association with other autoinflammatory disorders (monogenic or polygenic) and the recent published efficacy of interleukin-1 blocking therapies in their management.
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Affiliation(s)
- Lola Prat
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Jean-David Bouaziz
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France.
| | - Daniel Wallach
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Marie-Dominique Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
| | - Martine Bagot
- Université Paris Diderot, Sorbonne Paris Cité; AP-HP, Paris, France; Service de Dermatologie et Service d'Anatomo-Pathologie, Hôpital Saint Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
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Abstract
This article provides a new categorization of inflammatory pustular dermatoses in the context of recent genetic and biological insights. Monogenic diseases with pustular phenotypes are discussed, including deficiency of interleukin 1 receptor antagonist, deficiency of the interleukin 36 receptor antagonist, CARD14-associated pustular psoriasis, and pyogenic arthritis, pyoderma gangrenosum, and acne. How these new genetic advancements may inform how previously described pustular diseases are viewed, including pustular psoriasis and its clinical variants, with a focus on historical classification by clinical phenotype, is also discussed.
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Affiliation(s)
- Haley B Naik
- Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 12N238, 10 Center Drive, MSC 1908, Bethesda, MD 20892-1908, USA
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17
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Sauder MB, Glassman SJ. Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis. Int J Dermatol 2013; 52:624-8. [DOI: 10.1111/j.1365-4632.2012.05707.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maxwell B. Sauder
- Division of Dermatology; Department of Medicine; University of Ottawa; Ottawa; Ontario; Canada
| | - Steven J. Glassman
- Division of Dermatology; Department of Medicine; University of Ottawa; Ottawa; Ontario; Canada
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18
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Weishaupt J, Schön MP, Bröcker EB, Kerstan A. Multiple large flaccid purulent blisters in a patient with metastatic breast cancer. J Dtsch Dermatol Ges 2012. [PMID: 23190553 DOI: 10.1111/j.1610-0387.2012.08056.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Weishaupt
- Clinic and Polyclinic for Dermatology, Venereology, and Allergology, Würzburg University Hospital, Germany
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19
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Gordon RA, Mays R, Sambrano B, Mayo T, Lapolla W. Antibiotics used in nonbacterial dermatologic conditions. Dermatol Ther 2012; 25:38-54. [PMID: 22591498 DOI: 10.1111/j.1529-8019.2012.01496.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The majority of nonbacterial dermatological conditions treated with antibiotics benefit from the anti-inflammatory properties of these medications, usually dapsone or tetracycline. Many other antimicrobials are used to treat noninfectious conditions. The following chapter is an overview of select noninfectious dermatological conditions for which antibiotics are used, with a focus on the most common antibiotics used for their nonantimicrobial properties.
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20
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Abstract
Many cutaneous conditions can mimic infection. If these lesions are not accurately recognized, they may be treated with antimicrobial agents, which adds cost, potential risk, and inconvenience to the patient and the healthcare system. The presenting signs and symptoms of many ulcerating, pustular, morbilliform, bullous, neoplastic, granulomatous, autoimmune, and neutrophilic conditions, as well as clinical vasculitis, cellulitis, folliculitis, and panniculitis, have been mistaken for infection. This review emphasizes the clinical presentation, physical exam, and diagnostic workup of many of these conditions to assist the clinician in ascertaining the correct diagnosis. In addition, general treatment options are provided for each disease category.
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Affiliation(s)
- Janelle R Ricketts
- Dermatology Department, University of CT Health Center, Farmington, CT 06030, USA.
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21
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Razera F, Olm GS, Bonamigo RR. Dermatoses neutrofílicas: parte II. An Bras Dermatol 2011; 86:195-209; quiz 210-1. [DOI: 10.1590/s0365-05962011000200001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Indexed: 11/22/2022] Open
Abstract
Neste artigo são abordadas as dermatoses neutrofílicas, complementando o artigo anterior (parte I). São apresentadas e comentadas as seguintes dermatoses: pustulose subcórnea de Sneddon-Wilkinson, dermatite crural pustulosa e atrófica, pustulose exantemática generalizada aguda, acroder matite contínua de Hallopeau, pustulose palmoplantar, acropustulose infantil, bacteride pustular de Andrews e foliculite pustulosa eosinofílica. Uma breve revisão das dermatoses neutrofílicas em pacientes pediátricos também é realizada.
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Affiliation(s)
- Fernanda Razera
- Universidade Federal de Ciências da Saúde de Porto Alegre; Universidade Federal de Ciências da Saúde de Porto Alegre; Hospital Mãe de Deus, Brasil
| | - Gislaine Silveira Olm
- Hospital Mãe de Deus, Brasil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil
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22
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Abstract
Autoimmune mucocutaneous blistering diseases (AMBD) are a rare group of dermatoses that can be potentially fatal. There are many subtypes and their clinical presentation can vary from being localized to general involvement. It is crucial that a diagnosis be made as early as possible and appropriate treatments are implemented. This article will discuss the diagnosis and available treatments of the major AMBDs. There are very few case-controlled studies regarding the treatments of these diseases. Most of the treatments used for these diseases are based on anecdotal reports. Hence, a synopsis of the conventional treatments and some brief recommendations will also be discussed. A brief discussion regarding "rescue" therapies that have been used for those patients with more recalcitrant cases of AMBD will also be presented.
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Affiliation(s)
- Naveed Sami
- Department of Dermatology, University of Alabama, 1720 University Blvd., Birmingham, AL 35294, USA.
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23
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Naretto C, Baldovino S, Rossi E, Spriano M, Roccatello D. The case of SLE associated Sneddon-Wilkinson pustular disease successfully and safely treated with infliximab. Lupus 2009; 18:856-7. [PMID: 19578113 DOI: 10.1177/0961203309103053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Abstract
Sweet syndrome, pyoderma gangrenosum, and subcorneal pustular dermatosis are neutrophilic dermatoses - conditions that have an inflammatory infiltrate consisting of mature polymorphonuclear leukocytes. The neutrophils are usually located within the dermis in Sweet syndrome and pyoderma gangrenosum; however, in subcorneal pustular dermatosis, they are found in the upper layers of the epidermis. Sweet syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by pyrexia, elevated neutrophil count, painful erythematous cutaneous lesions that have an infiltrate of mature neutrophils typically located in the upper dermis, and prompt clinical improvement following the initiation of systemic corticosteroid therapy. Classical, malignancy-associated, and drug-induced variants of Sweet syndrome exist. Pyoderma gangrenosum is characterized by painful, enlarging necrotic ulcers with bluish undermined borders surrounded by advancing zones of erythema; its clinical variants include: ulcerative or classic, pustular, bullous or atypical, vegetative, peristomal, and drug-induced. Subcorneal pustular dermatosis is an uncommon relapsing symmetric pustular eruption that involves flexural and intertriginous areas; it can be idiopathic or associated with cancer, infections, medications, and systemic diseases. Since Sweet syndrome, pyoderma gangrenosum, and subcorneal pustular dermatosis share not only the same inflammatory cell but also similar associated systemic diseases, it is not surprising that the concurrent or sequential development of these neutrophilic dermatoses has been observed in the same individual. Also, it is not unexpected that several of the effective therapeutic interventions - including systemic drugs, topical agents, and other treatment modalities - for the management of these dermatoses are the same. The treatment of choice for Sweet syndrome and idiopathic pyoderma gangrenosum is systemic corticosteroids; however, for subcorneal pustular dermatosis, dapsone is the drug of choice. Yet, tumor necrosis factor-alpha antagonists are becoming the preferred choice when pyoderma gangrenosum is accompanied by inflammatory bowel disease or rheumatoid arthritis. Potassium iodide and colchicine are alternative first-line therapies for Sweet syndrome and indomethacin (indometacin), clofazimine, cyclosporine (ciclosporin), and dapsone are second-line treatments. Cyclosporine is effective in the acute management of pyoderma gangrenosum; however, when tapering the drug, additional systemic agents are necessary for maintaining the clinical response. In some patients with subcorneal pustular dermatosis, systemic corticosteroids may be effective; yet, systemic retinoids (such as etretinate and acitretin) have effectively been used for treating this neutrophilic dermatosis - either as monotherapy or in combination with dapsone or as a component of phototherapy with psoralen and UVA radiation. Topical agents can have an adjuvant role in the management of these neutrophilic dermatoses; however, high-potency topical corticosteroids may successfully treat localized manifestations of Sweet syndrome, pyoderma gangrenosum, and subcorneal pustular dermatosis. Intralesional corticosteroid therapy for patients with Sweet syndrome and pyoderma gangrenosum, hyperbaric oxygen and plasmapheresis for patients with pyoderma grangrenosum, and phototherapy for patients with subcorneal pustular dermatosis are other modalities that have been used effectively for treating individuals with these neutrophilic dermatoses.
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Affiliation(s)
- Philip R Cohen
- The University of Houston Health Center, University of Houston, Houston, Texas, USA.
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25
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Ranieri P, Bianchetti A, Trabucchi M. Sneddon-Wilkinson Disease: A Case Report of a Rare Disease in a Nonagenarian. J Am Geriatr Soc 2009; 57:1322-3. [DOI: 10.1111/j.1532-5415.2009.02337.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Mühlhoff C, Megahed M. [Therapy of subcorneal pustulosis (Sneddon-Wilkinson disease) with tacalcitol]. Hautarzt 2009; 60:369-70. [PMID: 19367371 DOI: 10.1007/s00105-009-1749-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Subcorneal pustular dermatosis is a rare, chronic recurrent disease with disseminated pustules involving trunk and proximal extremities. We report on a patient in whom topical treatment with tacalcitol induced a complete remission.
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Affiliation(s)
- C Mühlhoff
- Klinik für Allergologie und Dermatologie, Universitätsklinikum der RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Deutschland.
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27
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Abstract
The neutrophilic dermatoses are rare disorders, especially in children, and are characterized by neutrophilic infiltrates in the skin and less commonly in extracutaneous tissue. The neutrophilic dermatoses share similar clinical appearances and associated conditions, including inflammatory bowel disease, malignancies, and medications. Overlap forms of disease demonstrating features of multiple neutrophilic dermatoses may be seen. The manuscript attempts to provide an up-to-date review of (i) classical neutrophilic dermatoses, focusing on distinctive features in children and (ii) neutrophilic dermatoses which may largely be pediatric or genodermatosis-associated (Majeed, SAPHO [synovitis, severe acne, sterile palmoplantar pustulosis, hyperostosis, and osteitis] syndrome, PAPA (pyogenic sterile arthritis, pyoderma gangrenosum, and acne), PFAPA (periodic fever with aphthous stomatitis, pharyngitis, and cervical adenopathy), and other periodic fever syndromes, and congenital erosive and vesicular dermatosis healing with reticulated supple scarring).
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Affiliation(s)
- David R Berk
- Department of Internal Medicine, Division of Dermatology, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri, USA.
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28
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Berk DR, Hurt MA, Mann C, Sheinbein D. Sneddon-Wilkinson disease treated with etanercept: report of two cases. Clin Exp Dermatol 2008; 34:347-51. [PMID: 18699836 DOI: 10.1111/j.1365-2230.2008.02905.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sneddon-Wilkinson disease (SWD), also known as subcorneal pustular dermatosis, is a rare, chronic eruption that is often difficult to treat, particularly in patients who do not respond to or cannot tolerate dapsone. Few case reports exist of patients with SWD treated with antitumour necrosis factor-alpha therapy. We report two patients with SWD refractory to numerous treatments, who responded to etanercept (in combination with low-dose acitretin in one case).
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Affiliation(s)
- D R Berk
- Department of Internal Medicine, Division of Dermatology, Washington University School of Medicine, St Louis, MO 63110, USA.
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29
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Bordignon M, Zattra E, Montesco MC, Alaibac M. Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) with absence of desmoglein 1 and 3 antibodies: case report and literature review. Am J Clin Dermatol 2008; 9:51-5. [PMID: 18092844 DOI: 10.2165/00128071-200809010-00006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Subcorneal pustular dermatosis (SPD) [Sneddon-Wilkinson disease] is a benign and uncommon disorder characterized by a chronic, relapsing vesiculopustular eruption of unknown etiology. We present a case of SPD in a young Black woman in whom ELISA was performed to test for desmoglein 1 and 3 antigens (the first reported case of evaluation for these antigens in a patient with SPD). The test revealed the absence of both antibodies. The patient was successfully treated with topical corticosteroids and narrow-band UVB phototherapy. In this report, we review both the pathophysiology of SPD, which has yet to be clarified, and its treatment. Data obtained from our case report add further support to the hypothesis that a non-antibody-mediated mechanism is operative in SPD. The treatment of choice for SPD is dapsone. However, the combination of corticosteroids and UVB phototherapy should be considered a valid therapeutic option in patients who are not appropriate candidates for dapsone therapy.
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30
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Bedi MK. Successful treatment of long-standing, recalcitrant subcorneal pustular dermatosis with etanercept. Skinmed 2007; 6:245-7. [PMID: 17786105 DOI: 10.1111/j.1540-9740.2007.888109.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Monica K Bedi
- Dermatology Associates of Sarasota, 3830 Bee Ridge Road, Sarasota, FL 34233, USA.
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31
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Karadoğan SK, Aydoğan K, Başkan EB, Tunali S. A case of subcorneal pustular dermatosis treated successfully with a combination of cyclosporin and prednisolone. J Eur Acad Dermatol Venereol 2007; 21:536-7. [PMID: 17373984 DOI: 10.1111/j.1468-3083.2006.01929.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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32
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Kerl K, Masouyé I, Lesavre P, Saurat JH, Borradori L. A Case of Amicrobial Pustulosis of the Folds Associated with Neutrophilic Gastrointestinal Involvement in Systemic Lupus Erythematosus. Dermatology 2005; 211:356-9. [PMID: 16286747 DOI: 10.1159/000088508] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Accepted: 02/12/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Amicrobial pustulosis of the folds is a recently described entity characterized by relapsing pustular lesions involving predominantly the cutaneous folds and the scalp. The disease typically occurs in the context of an autoimmune or systemic disease and should be included within the spectrum of neutrophilic dermatoses. OBSERVATION We describe a patient with a history of systemic lupus erythematosus, who developed amicrobial pustulosis of the folds. Strikingly, the patient also exhibited recurrent oral and gastrointestinal manifestations that paralleled the course of the cutaneous signs. CONCLUSIONS Our observation indicates that, in analogy to the other neutrophilic dermatoses, amicrobial pustulosis of the folds can also be complicated by the development of extracutaneous neutrophilic involvement, knowledge of which is critical for its diagnosis and proper management.
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Affiliation(s)
- K Kerl
- Department of Dermatology, University Medical School, Geneva, Switzerland
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33
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Abstract
The differential diagnosis for pustular skin disorders is extensive. The distribution of the lesions and the age of the patient are characteristics that may provide strong clues to the etiology of cutaneous pustular eruptions. In adults, generalized pustular dermatoses include pustular psoriasis, Reiter's disease and subcorneal pustular dermatosis. Medications can cause generalized pustular eruptions, such as in the case of acute generalized exanthematous pustulosis; or more localized reactions, such as acneiform drug eruptions, which usually involve the face, chest and back. Localized pustular eruptions are seen on the hands and feet in adults with pustulosis palmaris et plantaris and acrodermatitis continua (both of which may be variants of psoriasis); on the face in patients with acne vulgaris, rosacea, and perioral dermatitis; and on the trunk and/or extremities in patients with folliculitis. A separate condition known as eosinophilic folliculitis occurs in individuals with advanced human immunodeficiency disease. Severely pruritic, sterile, eosinophilic pustules are found on the chest, proximal extremities, head and neck. Elevated serum immunoglobulin E and eosinophilia are often concurrently found. In neonates, it is especially important to make the correct diagnosis with respect to pustular skin disorders, since pustules can be a manifestation of sepsis or other serious infectious diseases. Generalized pustular eruptions in neonates include erythema toxicum neonatorum and transient neonatal pustular melanosis, both of which are non-infectious. Pustules are seen in infants with congenital cutaneous candidiasis, which may or may not involve disseminated disease. Ofuji's syndrome is an uncommon generalized pustular dermatosis of infancy with associated eosinophilia. As in adults, neonates and infants may develop acne or scabies infestations. In this article, we review the most common pustular dermatoses and offer a systematic approach to making a diagnosis. We also report the most up-to-date information on the treatment of these various cutaneous pustular conditions.
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Affiliation(s)
- Yebabe M Mengesha
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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