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Rani S, Sardana K, Dhiman A, Singh S, Malhotra P, Bhat F. Recurrent amicrobial pustulosis responded well to dapsone. Indian J Dermatol 2021; 66:681-682. [PMID: 35283506 PMCID: PMC8906294 DOI: 10.4103/ijd.ijd_817_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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2
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Fernandez-Flores A, Hermosa-Gelbard A, Pérez A, Bello JA, Cabo F. Scarring alopecia in chronic cutaneous lupus erythematosus with neutrophils: A new scenario with therapeutic connotations. J Cutan Pathol 2020; 47:976-982. [PMID: 32483922 DOI: 10.1111/cup.13764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
The relationship between autoinflammatory and autoimmune conditions has been demonstrated in recent decades. Several autoimmune conditions exhibit an autoinflammatory component, which can manifest in various ways. Neutrophilic dermatosis in the context of lupus erythematosus (LE) is one example. Otherwise, neutrophils are rare in LE, except for the bullous variant and nonbullous neutrophilic LE. In this paper, we describe a case of scarring alopecia due to LE that stopped responding to a treatment that had been effective for years. The biopsy specimen demonstrated the presence of neutrophils in the inflammatory infiltrate. A treatment with dapsone was prescribed and yielded rapid improvement. This first case of scarring alopecia in the context of nonbullous neutrophilic LE emphasizes the importance of the infiltrate in determining the optimal therapeutic choice.
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Affiliation(s)
- Angel Fernandez-Flores
- Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain.,Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain.,Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC) A Coruña, Spain
| | - Angela Hermosa-Gelbard
- Dermatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain.,Dermatology Department, Hospital Universitario Quirón San José, Madrid, Spain.,Dermatology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Alberto Pérez
- Department of Anatomic Pathology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - José Antonio Bello
- Department of Anatomic Pathology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Fernando Cabo
- Department of Dermatology, Complexo Hospitalario Universitario de Ourense, Ourense, Spain
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3
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Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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4
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Schissler C, Velter C, Lipsker D. Amicrobial pustulosis of the folds: Where have we gone 25 years after its original description? Ann Dermatol Venereol 2017; 144:169-175. [DOI: 10.1016/j.annder.2016.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/07/2016] [Accepted: 10/28/2016] [Indexed: 12/13/2022]
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5
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Wang MZ, Camilleri MJ, Guo R, Wieland CN. Amicrobial pustulosis of the folds: Report of 4 cases. J Cutan Pathol 2017; 44:367-372. [DOI: 10.1111/cup.12873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/22/2016] [Accepted: 12/13/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Michael J. Camilleri
- Department of DermatologyMayo Clinic Rochester Minnesota
- Division of Anatomic PathologyMayo Clinic Rochester Minnesota
| | - Ruifeng Guo
- Department of DermatologyMayo Clinic Rochester Minnesota
| | - Carilyn N. Wieland
- Department of DermatologyMayo Clinic Rochester Minnesota
- Division of Anatomic PathologyMayo Clinic Rochester Minnesota
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6
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Marzano AV, Tavecchio S, Berti E, Gelmetti C, Cugno M. Cytokine and Chemokine Profile in Amicrobial Pustulosis of the Folds: Evidence for Autoinflammation. Medicine (Baltimore) 2015; 94:e2301. [PMID: 26683967 PMCID: PMC5058939 DOI: 10.1097/md.0000000000002301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Autoinflammation has recently been suggested in the pathogenesis of neutrophilic dermatoses but systematic studies on their cytokine profile are lacking. Notably, amicrobial pustulosis of the folds (APF), classified among neutrophilic dermatoses, has been studied only in small case series. In our University Hospital, we conducted an observational study on 15 APF patients, analyzing their clinical and laboratory features with a follow-up of 9 months to 20 years. Skin cytokine pattern of 9 of them was compared to that of 6 normal controls. In all patients, primary lesions were pustules symmetrically involving the skin folds and anogenital region with a chronic-relapsing course and responding to corticosteroids. Dapsone, cyclosporine, and tumor necrosis factor blockers were effective in refractory cases. In skin samples, the expressions of interleukin (IL)-1β, pivotal cytokine in autoinflammation, and its receptors I and II were significantly higher in APF (P = 0.005, 0.018, and 0.034, respectively) than in controls. Chemokines responsible for neutrophil recruitment such as IL-8 (P = 0.003), CXCL 1/2/3 (C-X-C motif ligand 1/2/3) (P = 0.010), CXCL 16 (P = 0.045), and RANTES (regulated on activation, normal T cell expressed and secreted) (P = 0.034) were overexpressed. Molecules involved in tissue damage like matrix metalloproteinase-2 (MMP-2) (P = 0.010) and MMP-9 (P = 0.003) were increased. APF is a pustular neutrophilic dermatosis with a typical distribution in all patients. The disorder may coexist with an underlying autoimmune/dysimmune disease but is often associated only with a few autoantibodies without a clear autoimmunity. The overexpression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that APF has an important autoinflammatory component.
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Affiliation(s)
- Angelo V Marzano
- From the Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Unità Operativa di Dermatologia, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy (AVM, ST, EB, CG) and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Medicina Interna, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy (MC)
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7
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Marzano AV, Tavecchio S, Berti E, Gelmetti C, Cugno M. Paradoxical Autoinflammatory Skin Reaction to Tumor Necrosis Factor Alpha Blockers Manifesting as Amicrobial Pustulosis of the Folds in Patients With Inflammatory Bowel Diseases. Medicine (Baltimore) 2015; 94:e1818. [PMID: 26559252 PMCID: PMC4912246 DOI: 10.1097/md.0000000000001818] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The therapy of inflammatory bowel disease, particularly with tumor necrosis factor (TNF) blockers, may be associated with a number of cutaneous adverse effects, including psoriasis-like, eczema-like, and lichenoid eruptions. Other rare skin complications are neutrophilic dermatoses such as amicrobial pustulosis of the folds (APF), which is a chronic relapsing pustular disorder classified in this spectrum.The authors analyzed clinical, histopathologic, and cytokine expression profiles of 3 inflammatory bowel disease patients with APF triggered by adalimumab (patient 1) and infliximab (patients 2 and 3).All 3 patients presented with sterile pustules involving the cutaneous folds, genital regions, and scalp 6 months after starting adalimumab (patient 1) and 9 months after starting infliximab (patients 2 and 3). Histology was characterized by epidermal spongiform pustules with a dermal neutrophilic and lymphocytic infiltrate. Tumor necrosis factor blocker withdrawal associated with topical and systemic corticosteroids induced complete remission of APF in all 3 patients. The expressions of interleukin (IL)-1 beta and its receptors as well as TNF alpha and its receptors were significantly higher in APF than in controls. Also IL-17, leukocyte selectin, and chemokines, such as IL-8, [C-X-C motif] chemokine ligand 1/2/3 (C = cysteine, X = any amino acid), [C-X-C motif] chemokine ligand 16 (C = cysteine, X = any amino acid), and RANTES (regulated on activation, normal T cell expressed and secreted) were significantly overexpressed. Finally, the authors found significant overexpression of both metalloproteinases 2/9 and their inhibitors 1/2.The observation of 3 patients with APF following anti-TNF therapy expands not only the clinical context of APF but also the spectrum of anti-TNF side effects. Overexpression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that APF is autoinflammatory in origin.
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Affiliation(s)
- Angelo V Marzano
- From the Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (AVM, ST, EB, CG) and Internal Medicine Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (MC)
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Méndez-Flores S, Charli-Joseph Y, Saeb-Lima M, Orozco-Topete R, Fernández Sánchez M. Amicrobial Pustulosis of the Folds Associated with Autoimmune Disorders: Systemic Lupus Erythematosus Case Series and First Report on the Association with Autoimmune Hepatitis. Dermatology 2013; 226:1-4. [DOI: 10.1159/000343595] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/15/2012] [Indexed: 11/19/2022] Open
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Lim YL, Ng SK, Lian TY. Amicrobial pustulosis associated with autoimmune disease in a patient with Sjögren syndrome and IgA nephropathy. Clin Exp Dermatol 2012; 37:374-8. [PMID: 22300247 DOI: 10.1111/j.1365-2230.2011.04262.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Amicrobial pustulosis associated with autoimmune disease (APAD) is a rare clinical condition, characterized by relapsing pustular eruption, affecting mainly the skin folds. Almost all previously described cases were young women with varying underlying autoimmune diseases. We report a 36-year-old woman with the interesting triad of APAD, Sjögren syndrome and IgA nephropathy. Her rashes responded to oral prednisolone and cyclophosphamide.
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Affiliation(s)
- Y L Lim
- National Skin Centre, Singapore.
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10
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Saint-Jean M, Gagey-Caron V, Jossic F, Barbarot S, Hamidou M, Stalder JF. [Amicrobial pustulosis of the skin folds and autoimmune erythroblastopenia]. Ann Dermatol Venereol 2011; 138:399-404. [PMID: 21570565 DOI: 10.1016/j.annder.2010.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 11/09/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Amicrobial pustulosis of the skin folds represents a new entity within the spectrum of neutrophilic dermatoses. This disease is characterized by acute onset of pustular lesions in the skin folds, association with an autoimmune disorder, and improvement under systemic corticosteroids. OBSERVATION A 24-year-old woman had been presenting pustular dermatosis for several months involving the inguinal folds and the scalp. The pustules coalesced to form oozing and crusting plaques. Eczematous lesions were located on the trunk. She also presented macrocytic anemia related to autoimmune erythroblastopenia. Bacteriological culture was negative. Antinuclear antibodies were found with anti-SSA specificity. Histopathological examination of a skin biopsy specimen showed pustules in the epidermis together with an inflammatory dermal infiltrate. Cutaneous direct immunofluorescence testing was negative. The patient responded to systemic corticosteroids. DISCUSSION Thirty-six cases of amicrobial pustulosis of the skin folds have been reported in the literature. All but two previously reported patients were females with an autoimmune disorder (chiefly systemic lupus erythematosus). The clinical picture is characterized by aseptic pustular lesions of the major and minor skin folds of the scalp and the anogenital area associated with eczematous lesions. Diagnostic criteria have recently been proposed. This disease responds to systemic corticosteroids. We report a new case of amicrobial pustulosis of the skin folds associated with autoimmune erythroblastopenia, which to the best of our knowledge has been described only once in the literature.
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Affiliation(s)
- M Saint-Jean
- Service de dermatologie, CHU Hôtel-Dieu, 1 place A.-Ricordeau, Nantes cedex 01, France
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Lee HY, Pelivani N, Beltraminelli H, Hegyi I, Yawalkar N, Borradori L. Amicrobial Pustulosis-Like Rash in a Patient with Crohn’s Disease under Anti-TNF-Alpha Blocker. Dermatology 2011; 222:304-10. [DOI: 10.1159/000329428] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 04/16/2011] [Indexed: 11/19/2022] Open
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12
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López-Navarro N, Alcaide A, Gallego E, Herrera-Acosta E, Gallardo M, Bosch RJ, Herrera E. Amicrobial pustulosis of the folds associated with Hashimotoâs thyroiditis. Clin Exp Dermatol 2009; 34:e561-3. [DOI: 10.1111/j.1365-2230.2009.03370.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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13
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Frigerio E, Ramoni S, Franchi C, Garutti C, Garavaglia M, Splnelli M, Capsoni F, Altomare G. Successful Cyclosporine Treatment in a Case of Amicrobial Pustulosis Associated with Immunological Abnormalities. Int J Immunopathol Pharmacol 2009; 22:243-6. [DOI: 10.1177/039463200902200128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Amicrobial pustulosis associated with autoimmune diseases (APAD) is a clinical entity which was described only recently and few cases are reported in the literature. This condition is characterized by recurrent acute onset with pustular lesions predominantly involving skin folds, genitals, scalp and external auditory canals of young women. The etiopathogenesis of APAD is unknown and the most effective therapeutic treatment seems to be systemic corticosteroids. We describe the case of a 16-year old female patient suffering from APAD successfully treated with cyclosporine A.
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Affiliation(s)
| | | | | | | | | | | | - F. Capsoni
- Rheumatology Division, Institute O. Galeazzi, IRCCS, University of Milan, Italy
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Satta R, Bolognini S, Montesu MA, Cottoni F. Amicrobial pustular dermatosis of the folds and Dapsone syndrome on treatment: a case report. J Eur Acad Dermatol Venereol 2008; 22:501-2. [DOI: 10.1111/j.1468-3083.2007.02363.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Antille C, Frei M, Sorg O, Tran C, Kaya G, Masouyé I, Fontao L, Prins C, Saurat JH. Amicrobial Pustulosis of the Folds Associated with Auto-Immune Disorders. Dermatology 2008; 216:324-9. [DOI: 10.1159/000113946] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 09/23/2007] [Indexed: 11/19/2022] Open
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Marzano AV, Ramoni S, Caputo R. Amicrobial Pustulosis of the Folds. Dermatology 2008; 216:305-11. [DOI: 10.1159/000113942] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 06/20/2007] [Indexed: 11/19/2022] Open
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Natsuga K, Sawamura D, Homma E, Nomura T, Abe M, Muramatsu R, Mochizuki T, Koike T, Shimizu H. Amicrobial pustulosis associated with IgA nephropathy and Sjögren's syndrome. J Am Acad Dermatol 2007; 57:523-6. [PMID: 17599665 DOI: 10.1016/j.jaad.2007.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 04/23/2007] [Accepted: 05/11/2007] [Indexed: 10/23/2022]
Abstract
Amicrobial pustulosis is a rare clinical entity characterized by a relapsing pustular eruption, primarily involving the skin folds. We describe a case of amicrobial pustulosis associated with autoimmune diseases (APAD). The patient suffered from IgA nephropathy and Sjögren's syndrome. Skin symptoms were alleviated dramatically after corticosteroid pulse therapy and tonsillectomy.
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Affiliation(s)
- Ken Natsuga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
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Gambichler T, Boms S, Hochdorfer B, Altmeyer P, Kreuter A. Immunohistology of amicrobial pustulosis of the folds. Clin Exp Dermatol 2007; 32:155-8. [PMID: 17244342 DOI: 10.1111/j.1365-2230.2006.02329.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Amicrobial pustulosis of the folds (APF), is a rare pustular eruption, predominantly involving the cutaneous folds, the external auditory canals and the scalp, occurring in patients who exhibit a wide spectrum of autoimmune abnormalities. There is a lack of data on the immunohistology of APF. We report a new case of APF associated with features of systemic lupus erythematosus (LE). Extensive immunohistological examinations of lesional and nonlesional skin were performed. The results of our immunohistological studies indicate that immunostaining with p53, Bcl-2, and CD8 antigens could be useful in differentiating APF from closely related inflammatory conditions such as psoriasis and cutaneous LE. However, studies on a larger sample size including controls are needed to substantiate our findings.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Gudrunstr. 56, D-44791 Bochum, Germany.
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Boms S, Gambichler T. Review of literature on amicrobial pustulosis of the folds associated with autoimmune disorders. Am J Clin Dermatol 2006; 7:369-74. [PMID: 17173471 DOI: 10.2165/00128071-200607060-00005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Amicrobial pustulosis of the folds (APF) is characterized by relapsing, primary aseptic, pustular eruptions mainly affecting the cutaneous folds, scalp, and periorificial regions such as the mouth, external ear canal, and nostrils. APF is a rare condition that has previously been reported in 25 women exhibiting a wide spectrum of autoimmune abnormalities, particularly systemic lupus erythematosus. Histology of the skin lesions usually shows spongiform pustulation in the upper layer of the epidermis and a polymorphonuclear infiltrate in the dermis. APF must be differentiated from other noninfectious pustular diseases such as subcorneal pustulosis (Sneddon-Wilkinson disease) and pustular forms of psoriasis. APF should be included in the spectrum of reactive neutrophilic dermatoses, even though the exact pathomechanisms remain obscure. However, the striking female predominance may be of pathogenetic significance. Based on the small number of previously reported patients, the most effective therapy seems to be medium-dose systemic corticosteroids.
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Affiliation(s)
- Stefanie Boms
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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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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