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Gutiérrez-Cerrajero C, Sprecher E, Paller AS, Akiyama M, Mazereeuw-Hautier J, Hernández-Martín A, González-Sarmiento R. Ichthyosis. Nat Rev Dis Primers 2023; 9:2. [PMID: 36658199 DOI: 10.1038/s41572-022-00412-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2022] [Indexed: 01/20/2023]
Abstract
The ichthyoses are a large, heterogeneous group of skin cornification disorders. They can be inherited or acquired, and result in defective keratinocyte differentiation and abnormal epidermal barrier formation. The resultant skin barrier dysfunction leads to increased transepidermal water loss and inflammation. Disordered cornification is clinically characterized by skin scaling with various degrees of thickening, desquamation (peeling) and erythema (redness). Regardless of the type of ichthyosis, many patients suffer from itching, recurrent infections, sweating impairment (hypohidrosis) with heat intolerance, and diverse ocular, hearing and nutritional complications that should be monitored periodically. The characteristic clinical features are considered to be a homeostatic attempt to repair the skin barrier, but heterogeneous clinical presentation and imperfect phenotype-genotype correlation hinder diagnosis. An accurate molecular diagnosis is, however, crucial for predicting prognosis and providing appropriate genetic counselling. Most ichthyoses severely affect patient quality of life and, in severe forms, may cause considerable disability and even death. So far, treatment provides only symptomatic relief. It is lifelong, expensive, time-consuming, and often provides disappointing results. A better understanding of the molecular mechanisms that underlie these conditions is essential for designing pathogenesis-driven and patient-tailored innovative therapeutic solutions.
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Affiliation(s)
- Carlos Gutiérrez-Cerrajero
- Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amy S Paller
- Departments of Dermatology and Paediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Masashi Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | | | - Rogelio González-Sarmiento
- Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca (IBSAL), Salamanca, Spain
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Wetzel M, Owen CE, Callen JP. Paraneoplastic Syndromes for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-00277-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
A variety of cutaneous abnormalities can be seen in patients with malignant diseases, some of which are infectious, with others representing direct involvement of the skin by the underlying disorder. Yet another group of lesions can be regarded as associated markers of the malignant process, and, as such, are termed "paraneoplastic." This review considers the latter collection of conditions, grouping them by the generic type of malignancy that is usually linked to the paraneoplasia. Some of the processes show a predominant association with alimentary tract malignancies (acanthosis nigricans, acrodermatitis paraneoplastica, florid cutaneous papillomatosis, necrolytic migratory erythema, palmoplantar keratoderma, pancreatic fat necrosis, and pityriasis rotunda). Others are usually linked to a hematolymphoid malignancy (acquired ichthyosis, exfoliative erythroderma, necrobiotic xanthogranuloma, pemphigus paraneoplastica, plane xanthoma, pyoderma gangrenosum, scleromyxedema, Sweet syndrome, and leukocytoclastic vasculitis). Finally, yet another collection of paraneoplastic skin disorders can associate themselves with anatomically-diverse malignancies (Leser-Trelat syndrome, Trousseau syndrome, dermatomyositis, erythema gyratum repens, hypertrichosis lanuginosa acquisita, papuloerythroderma of Ofuji, tripe palms, and multicentric reticulohistiocytosis). Recognition of these processes by the pathologist can be a valuable step in the characterization of underlying malignant diseases.
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Affiliation(s)
- Mark R Wick
- PRW Laboratories, Charlottesville, VA, United State.
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Al-Khazraji A. Cutaneous manifestations of hepatocellular cancer (HCC). Expert Rev Gastroenterol Hepatol 2016; 10:1075-1077. [PMID: 27558446 DOI: 10.1080/17474124.2016.1229182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ahmed Al-Khazraji
- a Department of Medicine , Icahn School of Medicine at Mount Sinai (Elmhurst) , Elmhurst , NY , USA
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5
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Attwa MH, El-Etreby SA. Guide for diagnosis and treatment of hepatocellular carcinoma. World J Hepatol 2015; 7:1632-1651. [PMID: 26140083 PMCID: PMC4483545 DOI: 10.4254/wjh.v7.i12.1632] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/31/2014] [Accepted: 05/27/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is ranked as the 5th common type of cancer worldwide and is considered as the 3rd common reason for cancer-related deaths. HCC often occurs on top of a cirrhotic liver. The prognosis is determined by several factors; tumour extension, alpha-fetoprotein (AFP) concentration, histologic subtype of the tumour, degree of liver dysfunction, and the patient’s performance status. HCC prognosis is strongly correlated with diagnostic delay. To date, no ideal screening modality has been developed. Analysis of recent studies showed that AFP assessment lacks adequate sensitivity and specificity for effective surveillance and diagnosis. Many tumour markers have been tested in clinical trials without progressing to routine use in clinical practice. Thus, surveillance is still based on ultrasound (US) examination every 6 mo. Imaging studies for diagnosis of HCC can fall into one of two main categories: routine non-invasive studies such as US, computed tomography (CT), and magnetic resonance imaging, and more specialized invasive techniques including CT during hepatic arteriography and CT arterial portography in addition to the conventional hepatic angiography. This article provides an overview and spotlight on the different diagnostic modalities and treatment options of HCC.
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van Heerden T, Webb MJ, Barrett CL. Pityriasis rotunda as an incidental paraneoplastic finding in two patients with multiple myeloma. Clin Exp Dermatol 2014; 39:734-7. [DOI: 10.1111/ced.12396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2014] [Indexed: 02/06/2023]
Affiliation(s)
- T. van Heerden
- Department of Internal Medicine; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - M. J. Webb
- Division of Clinical Haematology; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
| | - C. L. Barrett
- Department of Internal Medicine; Faculty of Health Sciences; University of the Free State; Bloemfontein South Africa
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Dogra S, Jindal R. Cutaneous manifestations of common liver diseases. J Clin Exp Hepatol 2011; 1:177-84. [PMID: 25755383 PMCID: PMC3940632 DOI: 10.1016/s0973-6883(11)60235-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 11/25/2011] [Indexed: 02/06/2023] Open
Abstract
Skin functions as a window to our overall health and a number of systemic diseases result in various cutaneous changes. Knowledge of these manifestations helps in suspecting an underlying systemic illness. Cutaneous abnormalities are quite common in patients with liver diseases and this article aims to focus on these dermatoses. Cutaneous manifestations seen in patients with liver disease though common are nonspecific. They can also be seen in patients without liver diseases and generally do not indicate about a specific underlying hepatic disorder. The presence of a constellation of signs and symptoms is more useful in pointing toward an underlying hepatobiliary condition. The commonest symptom in patients with liver disease is pruritus which is often protracted and disabling. Other common features include spider angiomas, palmar erythema, paper money skin, xanthelasmas, pigmentary changes, and nutritional deficiencies. In this article, first the common cutaneous manifestations that may be associated with liver disorders are discussed and then common liver diseases with their specific cutaneous findings are discussed. Cutaneous abnormalities may be the first clue to the underlying liver disease. Identifying them is crucial for early diagnosis and better management.
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Affiliation(s)
- Sunil Dogra
- Address for correspondence: Sunil Dogra, Associate Professor, Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India
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Abstract
The skin plays a critical role in the detection of internal malignances. Cutaneous signs of these disorders afford clinicians opportunities for early diagnosis and treatment. We aim to succinctly review the recognition, diagnosis, and treatment of selected cutaneous paraneoplastic diseases. Skin disorders that may be associated with paraneoplastic syndromes include: cutaneous metastases, tripe palms, Sweet's syndrome, glucagonoma, Paget's disease and extramammary Paget's disease, acanthosis nigricans, Birt-Hogg-Dube syndrome, basal cell nevus syndrome, Bazex syndrome (acrokeratosis paraneoplastica), carcinoid syndrome, Cowden's disease(multiple hamartoma syndrome), dermatomyositis, erythema gyratum repens, ichthyosis aquisita, von Recklinghausen's disease, pityriasis rotunda, pyoderma gangrenosum, Quincke's edema (angioedema and paraneoplastic uricaria), paraneoplastic pemphigus, Degos' disease, superior vena cava syndrome, Werner's syndrome, diffuse normolipemic plane xanthomas, and yellow nail syndrome. Treatment for these disorders depends on the nature and anatomic distribution of the primary neoplastic process.
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Ramirez CC, Berman B. Cutaneous signs and syndromes associated with internal malignancies. Skinmed 2005; 4:84-90; quiz 91-2. [PMID: 15785135 DOI: 10.1111/j.1540-9740.2005.03379.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cutaneous changes may indicate the presence of or herald the incipient development of internal malignancies. The authors review 24 cutaneous signs, symptoms, diseases, and syndromes associated with internal malignancies. Early recognition of these cutaneous changes may allow for vigilance for, and prompt detection and management of, the underlying neoplasm.
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Affiliation(s)
- Claudia C Ramirez
- Department of Dermatology and Cutaneous Surgery, University of Miami, Rosenstiel Medical Sciences Building, Room 2023 A (R250), 1600 Northwest 10th Avenue, Miami, FL 33136, USA
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Abstract
Pityriasis rotunda is a rare disease characterized by perfectly round to oval, sharply defined, scaly, hypo/hyperpigmented patches of variable number and size located mainly over the trunk and proximal extremities. More than 95% of the reported cases in medical literature are from three countries/ethnic populations, namely Japan, South Africa (Bantu), and Italy (Sardinian islanders). To the best of my knowledge, no patient with the characteristic clinico-pathologic features has been reported from the Indian subcontinent. I report a 44-year-old man with eighteen pityriasis rotunda patches, persistent for nearly 20 years. The lesions in the groin and axillae closely resembled erythrasma and tinea, and he had received treatment for these conditions several times in the past. Histopathology of the skin biopsy showed thinning of the epidermis with a thinned-out granular layer and a sparse lymphomononuclear infiltrate in the dermis. A review of literature suggests that there are two subsets of the disease. The type I subset is comprised of pityriasis rotunda associated with systemic illness and is seen in Black or Oriental patients with no family history of the disease. The lesions tend to subside on treatment of the underlying illness. The type II subset patients are Caucasians as well as Blacks and Orientals with no underlying systemic illness. Familial occurrence is possible; lesions tend to be persistent and unresponsive to therapy.
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Affiliation(s)
- S Gupta
- Department of Dermatology, Venerology & Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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12
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 2-1996. A 32-year-old woman with subcostal pain and a left hepatic mass. N Engl J Med 1996; 334:176-82. [PMID: 8531975 DOI: 10.1056/nejm199601183340309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
OBJECTIVE To provide an overview of the clinical manifestations, pathophysiology, and oncologic implications of the cutaneous paraneoplastic syndromes that occur predominantly in patients with solid tumors. METHODS A review was performed of the literature identified by a comprehensive MEDLINE search. RESULTS Diverse cutaneous paraneoplastic syndromes may be associated with underlying tumors. They include musculoskeletal disorders (clubbing, hypertrophic osteoarthropathy, dermatomyositis, and multicentric reticulohistiocytosis), reactive erythemas (erythema gyratum repens and necrolytic migratory erythema), vascular dermatoses (Trousseau's syndrome), papulosquamous disorders (acanthosis nigricans, tripe palms, palmar hyperkeratosis, acquired ichthyosis, pityriasis rotunda, Bazex's syndrome, florid cutaneous papillomatosis, the sign of Leser-Trélat, and extramammary Paget's disease), and disorders of hair growth (hypertrichosis lanuginosa acquisita). The clinical manifestations of these dermatoses may precede, coincide with, or follow the diagnosis of cancer. The presence of a cutaneous paraneoplastic syndrome is often associated with a poor prognosis. CONCLUSIONS Cutaneous paraneoplastic syndromes are specific constellations of mucous membrane and/or skin abnormalities that are caused by an underlying tumor. Since they may be the presenting sign of an occult cancer, cognizance of their features and clinical implications are of considerable importance. Individuals with these syndromes should have a thorough workup for an associated malignancy.
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Affiliation(s)
- R Kurzrock
- Department of Clinical Investigation, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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Grimalt R, Gelmetti C, Brusasco A, Tadini G, Caputo R. Pityriasis rotunda: report of a familial occurrence and review of the literature. J Am Acad Dermatol 1994; 31:866-71. [PMID: 7962738 DOI: 10.1016/s0190-9622(94)70248-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Pityriasis rotunda is an uncommon dermatosis characterized by multiple, widely distributed, strikingly circular hypopigmented or hyperpigmented patches that are slightly scaly. It has been described in Oriental and black patients, usually in association with certain infective or malignant systemic diseases. Pityriasis rotunda is rare in white patients and does not act as a marker of malignancy. Our ultrastructural and histologic findings demonstrated that pityriasis rotunda is more closely related to congenital ichthyoses than ichthyosis vulgaris, contrary to previous reports. On the basis of our studies and a review of the literature, it seems that two types of pityriasis rotunda exist with significant prognostic differences.
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Affiliation(s)
- R Grimalt
- First Department of Dermatology and Pediatric Dermatology, University of Milan, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Maggiore
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Poole S, Fenske NA. Cutaneous markers of internal malignancy. II. Paraneoplastic dermatoses and environmental carcinogens. J Am Acad Dermatol 1993; 28:147-64. [PMID: 8432911 DOI: 10.1016/0190-9622(93)70022-l] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A variety of cutaneous disorders may reflect the presence of an internal disease. The ability to recognize those that may indicate an underlying malignancy is of particular importance. In part I of this series malignant involvement of the skin, either direct or metastatic, and the genodermatoses with malignant potential were reviewed. In this portion, we describe the paraneoplastic dermatoses as well as the cutaneous effects of some environmental carcinogens associated with internal malignancy. In addition, several uncommon and controversial associations between benign dermatoses and internal malignant disease will be discussed.
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Affiliation(s)
- S Poole
- Division of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine, Tampa 33612
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Affiliation(s)
- T Etoh
- Department of Dermatology, Faculty of Medicine, University of Tokyo, Japan
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