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Fijałkowska A, Kądziela M, Żebrowska A. The Spectrum of Cutaneous Manifestations in Lupus Erythematosus: A Comprehensive Review. J Clin Med 2024; 13:2419. [PMID: 38673692 PMCID: PMC11050979 DOI: 10.3390/jcm13082419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Lupus erythematosus (LE) is an autoimmune inflammatory disease with complex etiology. LE may present as a systemic disorder affecting multiple organs or be limited solely to the skin. Cutaneous LE (CLE) manifests with a wide range of skin lesions divided into acute, subacute and chronic subtypes. Despite classic forms of CLE, such as malar rash or discoid LE, little-known variants may occur, for instance hypertrophic LE, chilblain LE and lupus panniculitis. There are also numerous non-specific manifestations including vascular abnormalities, alopecia, pigmentation and nail abnormalities or rheumatoid nodules. Particular cutaneous manifestations correlate with disease activity and thus have great diagnostic value. However, diversity of the clinical picture and resemblance to certain entities delay making an accurate diagnosis The aim of this review is to discuss the variety of cutaneous manifestations and indicate the clinical features of particular CLE types which facilitate differential diagnosis with other dermatoses. Although in diagnostically difficult cases histopathological examination plays a key role in the differential diagnosis of LE, quick and accurate diagnosis ensures adequate therapy implementation and high quality of life for patients. Cooperation between physicians of various specialties is therefore crucial in the management of patients with uncommon and photosensitive skin lesions.
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Affiliation(s)
| | | | - Agnieszka Żebrowska
- Department of Dermatology and Venereology, Medical University of Lodz, Haller sq. 1, 90-647 Lodz, Poland; (A.F.); (M.K.)
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Caro-Chang LA, Fung MA. The role of eosinophils in the differential diagnosis of inflammatory skin diseases. Hum Pathol 2023; 140:101-128. [PMID: 37003367 DOI: 10.1016/j.humpath.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
Eosinophils are known to be present in inflammatory skin diseases, but their diagnostic utility is not well established. Upon review of the published status of lesional eosinophils, several categories were identified. 1) Lesional eosinophils highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses. 2) Lesional eosinophils rare or absent, such that, in their presence, the pathologist may question the diagnosis. These include pityriasis lichenoides, graft versus host disease, and connective tissue disorders. 3) Lesional eosinophils variable and, while in some cases expected, are not required for diagnosis. These include drug reactions, atopic dermatitis and allergic contact dermatitis. 4) Lesional eosinophils variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.
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Population Characteristics, Symptoms, and Risk Factors of Idiopathic Chilblains: A Systematic Review, Meta-Analysis, and Meta-Regression. BIOLOGY 2022; 11:biology11111651. [DOI: 10.3390/biology11111651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Background: Chilblains/perniosis is a non-freezing cold injury causing painful inflammatory skin lesions. Its pathogenesis remains poorly understood because it is often studied as secondary to other underlying conditions. Methods: We systematically investigated the population characteristics, symptoms, and predisposing factors of chilblains in healthy adults exposed to cool/cold environments. We screened PubMed, Embase, and Cochrane Library, and we adopted PRISMA reporting guidelines (PROSPERO: CRD42021245307). The risk of bias was assessed by two independent reviewers (RTI item bank). Random-effects model meta-analyses were performed to calculate the pooled prevalence of histopathological features. Mixed-effects meta-regressions were used to assess other sources of between-study heterogeneity. Results: Thirteen studies (477 patients) were included. Chilblains affect more women than men, up to 12% of the body skin surface, and most frequently, the hands and fingers. Meta-analyses of nine studies (303 patients) showed a frequent presence of perivascular lymphocytic infiltrate (81%), basal epidermal-cell layer vacuolation (67%), papillary dermal edema (66%), and perieccrine lymphocytic infiltrate (57%). Meta-regressions (p ≤ 0.05) showed that smoking and frequent occupational exposure to water increase the likelihood of histopathological features. Conclusions: The population characteristics, symptoms, and predisposing factors of chilblains revealed in this analysis should be incorporated in medical care to improve the condition’s diagnosis and management.
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Relvas M, Xará J, Azevedo J, Cardoso JC, Ramos L. Multiple annular plaques on the thighs of an 8‐year‐old girl. Int J Dermatol 2022; 62:747-748. [PMID: 36326194 DOI: 10.1111/ijd.16482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Maria Relvas
- Department of Dermatology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Joana Xará
- Department of Dermatology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Joana Azevedo
- Clinical Hematology Department Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - José C. Cardoso
- Department of Dermatology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Leonor Ramos
- Department of Dermatology Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
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5
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Painful Nodules on the Thighs. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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6
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Conejero R, Rivera-Rodríguez Á, Ara M. Painful Nodules on the Thighs. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:357-358. [PMID: 33127421 DOI: 10.1016/j.ad.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 10/23/2022] Open
Affiliation(s)
- R Conejero
- Departamento de Dermatología, Hospital Royo Villanova, Zaragoza, España.
| | | | - M Ara
- Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Iijima S, Miyamoto H, Tsunoda T, Otoyama K. Two cases of cold‐associated perniosis of the thighs in stable workers successfully treated with diaminodiphenylsulfone. J Dermatol 2020; 47:e404-e406. [DOI: 10.1111/1346-8138.15554] [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)
| | | | - Takahiko Tsunoda
- Department of Dermatology Yamagata City Hospital Saiseikan Yamagata Japan
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Stewart JR, Swanson LA, Drage LA, Comfere NI. Ice-pack dermatosis of the buttocks. Int J Dermatol 2020; 59:e418-e419. [PMID: 32436222 DOI: 10.1111/ijd.14942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Leah A Swanson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lisa A Drage
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, USA
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Abstract
Idiopathic chilblain is a relatively common yet poorly recognized acrosyndrome. This literature review aims to better understand and draw attention to this disorder. Chilblain is a localized inflammation of the skin that occurs on exposure to cold but non-freezing wet weather. It usually resolves spontaneously. The etiology is uncertain, but vasospasm seems to play a role in this abnormal reaction to cold. Diagnosis is most often based on clinical presentation, but a skin biopsy can be useful in dubious cases. In histology, dermal edema and an inflammatory infiltrate are usually present. A distribution of the infiltrate particularly around the eccrine gland is typical. Systemic symptoms and underlying autoimmune disease should be screened. Avoiding cold and keeping extremities warm is the first recommendation for management, as well as smoking cessation. Calcium channel blockers (in particular nifedipine) seems to be the treatment that has been most evaluated in chilblains. However, their effectiveness is not confirmed by all studies. Topical betamethasone is often used but its effect has not been confirmed by randomized clinical trials. Other treatments, such as pentoxifylline, hydrochloroquine and topical nitroglycerin have shown positive effects only in a reduced number of patients. Acupuncture seems to bring a benefit.
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Affiliation(s)
- Astrid Nyssen
- Department of Cardiology, CHR Verviers East Belgium Verviers, Belgium.,Department of Vascular Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Magnée
- Department of Cardiology, CHR Verviers East Belgium Verviers, Belgium
| | - Josette André
- Department of Dermatology and Dermatopathology, Hôpital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Koopmansch
- Department of Dermatology and Dermatopathology, Hôpital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Claude Wautrecht
- Department of Vascular Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Syringotropic Lichen Planus: A Potential Histopathologic Mimicker of Syringotropic Mycosis Fungoides. Am J Dermatopathol 2019; 41:e50-e53. [PMID: 30371514 DOI: 10.1097/dad.0000000000001295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Perieccrine inflammation may be observed in several different dermatoses, but true permeation of the secretory coil by lymphocytes (lymphocytic syringotropism) is a rather uncommon finding, usually observed in mycosis fungoides (MF-syringotropic MF). Rare cases of syringotropic lichen striatus and lymphocytic autoimmune hidradenitis showing a similar pattern have been described as well. We describe an exceptional case of lichen planus (LP) characterized by marked lymphocytic syringotropism with focal hyperplasia of the eccrine epithelium. Histopathology was characterized by the combination of features of conventional LP, prominent permeation of the secretory portion of the eccrine glands by reactive lymphocytes, and focal involvement of a hair follicle. Syringotropic LP may be regarded as a histologic mimicker of syringotropic MF, thus representing a potential diagnostic pitfall.
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Semkova K, Ong ELH, Jullie M, Beteta V, Santos-Bris A, Bernardis C, Calonje E. Two cases of perniosis in a free flap and a graft site of the hands. Clin Exp Dermatol 2019; 44:824-826. [PMID: 30628107 DOI: 10.1111/ced.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 12/01/2022]
Affiliation(s)
- K Semkova
- Dermatopathology Department, St. John's Institute of Dermatology, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - E L H Ong
- Dermatopathology Department, St. John's Institute of Dermatology, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - M Jullie
- Histopathology Department, University Hospital of Bordeaux, France
| | - V Beteta
- Hospital Universitario de Salamaca, Salamanca, Spain
| | - A Santos-Bris
- Hospital Universitario de Salamaca, Salamanca, Spain
| | - C Bernardis
- Plastic Surgery Department, St Thomas' Hospital, London, UK
| | - E Calonje
- Dermatopathology Department, St. John's Institute of Dermatology, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Adachi A, Masaki S, Akiyama M. Equestrian cold panniculitis in a cold-storage-room worker. J Dermatol 2019; 46:e245-e246. [PMID: 30628122 DOI: 10.1111/1346-8138.14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Akiko Adachi
- Division of Dermatology, Inazawa Municipal Hospital, Inazawa, Japan
| | - Sadao Masaki
- Division of Dermatology, Inazawa Municipal Hospital, Inazawa, Japan
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Wang ML, Chan MP. Comparative Analysis of Chilblain Lupus Erythematosus and Idiopathic Perniosis: Histopathologic Features and Immunohistochemistry for CD123 and CD30. Am J Dermatopathol 2018; 40:265-271. [DOI: 10.1097/dad.0000000000000945] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Karkouche R, Bernigaud C, Fontugne J, Zehou O, Bellaud G, N'Diaye M, Cherif K, Wolkenstein P, Chosidow O, Ortonne N, Ingen-Housz-Oro S. Cold-associated perniosis of the thighs histopathologically mimicking lupus. Six observations. J Eur Acad Dermatol Venereol 2016; 31:1029-1032. [DOI: 10.1111/jdv.13969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- R. Karkouche
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - C. Bernigaud
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - J. Fontugne
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - O. Zehou
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - G. Bellaud
- Service de maladies infectieuses; Hôpital Tenon; Assistance Publique-Hôpitaux de Paris; Paris France
| | - M. N'Diaye
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - K. Cherif
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
| | - P. Wolkenstein
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
- Université Paris-Est Créteil Val de Marne (UPEC); Créteil France
| | - O. Chosidow
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
- Université Paris-Est Créteil Val de Marne (UPEC); Créteil France
- Centre d'Investigation Clinique 1430, AP-HP; Créteil France
| | - N. Ortonne
- Département de pathologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
- Université Paris-Est Créteil Val de Marne (UPEC); Créteil France
| | - S. Ingen-Housz-Oro
- Service de dermatologie; Hôpital Henri Mondor; Assistance Publique-Hôpitaux de Paris; Créteil France
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