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Zha S, Yu X, Wang X, Gu Y, Tan Y, Lu Y, Yao Z. Topical Simvastatin Improves Lesions of Diffuse Normolipemic Plane Xanthoma by Inhibiting Foam Cell Pyroptosis. Front Immunol 2022; 13:865704. [PMID: 35619689 PMCID: PMC9128406 DOI: 10.3389/fimmu.2022.865704] [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] [Received: 01/30/2022] [Accepted: 04/15/2022] [Indexed: 12/02/2022] Open
Abstract
Xanthoma pathogenesis is speculated to be associated with oxidized low-density lipoprotein (ox-LDL) deposition, although this remains unclear. Most patients with diffuse plane xanthomas present elevated blood lipid levels, and they benefit from treatment with oral lipid-lowering agents. However, there is no available treatment for diffuse normolipemic plane xanthoma (DNPX). In this study, for the first time, we used a topical simvastatin ointment to treat DNPX in three pediatric patients and observed favorable results. Immunofluorescence staining showed that the pyroptotic pathway was significantly attenuated after topical simvastatin application on the skin lesions of the patients. As ox-LDL deposition was observed in the lesions, we used ox-LDL to build a foam cell model in vitro. In the ox-LDL-induced foam cell formation, simvastatin consistently inhibited pyroptotic activation and inflammation in the macrophages. Additionally, the overexpression of nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3) or 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase (HMGCR), the known target of statins, reversed the effects of simvastatin. Moreover, gasdermin D (GSDMD) or HMGCR knockdown inhibited ox-LDL-induced pyroptosis. Furthermore, the immunoprecipitation results confirmed the interaction between NLRP3 and HMGCR, and this interaction was inhibited by simvastatin. In conclusion, we demonstrated that topical application of simvastatin ointment might be a promising treatment for DNPX skin lesions and that this therapeutic effect may be related to pyroptosis inhibition via HMGCR inhibition in foam cells. Moreover, xanthoma pathogenesis might be associated with ox-LDL deposition and inflammation.
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Affiliation(s)
- Siyuan Zha
- Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Yu
- Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxiao Wang
- Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Gu
- Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yidong Tan
- Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Lu
- Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhirong Yao
- Department of Dermatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Institute of Dermatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kutkienė S, Petrulionienė Ž, Laucevičius A, Čerkauskienė R, Samuilis A, Augaitienė V, Gedminaitė A, Bieliauskienė G, Šaulytė-Mikulskienė A, Staigytė J, Petrulionytė E, Gargalskaitė U, Skiauterytė E, Matuzevičienė G, Kovaitė M, Nedzelskienė I. Achilles tendon ultrasonography - A useful screening tool for cardiovascular risk estimation in patients with severe hypercholesterolemia. ATHEROSCLEROSIS SUPP 2019; 36:6-11. [PMID: 30876532 DOI: 10.1016/j.atherosclerosissup.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Achilles tendon lesions have long been associated with genetic defects in lipid metabolism and increased risk of cardiovascular diseases (CVD). With this study we aimed to evaluate the usefulness of Achilles tendon ultrasonography in identifying people at greater risk among subjects with severe hypercholesterolemia (SH) in a high-risk population. METHODS During the period of 2016-2017 a total of 213 participants were enrolled in this case-control study. Data of 110 patients with SH and 103 age and sex matched controls without dyslipidaeplemia and established CVD was collected. RESULTS Achilles tendinopathy (AT) was present in 42.7% of subjects with SH and in 29.1% of controls (p = 0.039). Stronger association between SH and AT was seen in women - 24.1% vs 2.0% (p = 0.001). SH increased odds of AT by 1.815 (95% CI, 1.028-3.206). Prevalence of AT was higher in males despite presence (SH+) or absence (SH-) of severe hypercholesterolemia (SH+ 60.7% vs 24.1%, SH- 55.8% vs 2.0%, p < 0.001). AT was associated with higher proportion of subjects exceeding normal mean values of TC (80.5% vs 52.9%, p = 0.001), LDL-C (76.6% vs 52.2%), TG (54.5% vs. 22.1%), ApoB (57.1% vs 22.2%), ApoE (44.0% vs 22.4%) levels and ApoB/ApoA ratio (46.1% vs 21.5%) (p = 0.001) and family history of premature coronary heart disease (CHD). CONCLUSIONS AT is more prevalent among subjects with SH and is associated with higher levels of TC, TG, LDL-C, ApoB, ApoE, ApoB/ApoA ratio, family history of premature CHD. SH increases the odds of developing AT.
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Affiliation(s)
- Sandra Kutkienė
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania.
| | - Žaneta Petrulionienė
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Aleksandras Laucevičius
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Rimantė Čerkauskienė
- Children's Hospital, Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Faculty of Medicine, Lithuania
| | - Artūras Samuilis
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Institute of Biomechanical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Lithuania
| | - Virginija Augaitienė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Institute of Biomechanical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Lithuania
| | - Aurelija Gedminaitė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Institute of Biomechanical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Lithuania
| | - Gintarė Bieliauskienė
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Akvilė Šaulytė-Mikulskienė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Justina Staigytė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | | | | | - Eglė Skiauterytė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Gabija Matuzevičienė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Milda Kovaitė
- Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Irena Nedzelskienė
- Children's Hospital, Vilnius University Hospital Santaros Klinikos, Lithuania
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Elkin VD, Sedova TG, Plotnikova EV, Kuznetsov ID, Novoselova MU. DIFFUSION NORMOLIPIDEMIC FLAT XANTHOMA, ASSOCIATED WITH HYPOCHROMIC ANEMIA. DESCRIPTION OF THE CASES. VESTNIK DERMATOLOGII I VENEROLOGII 2017. [DOI: 10.25208/0042-4609-2017-93-4-62-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The diffuse plane xanthoma (DPX) belongs to the class II of histiocytosis arising from the dermal dendritic cells (Histiocyte Society). The dominate role in the formation of the disease in the skin plays an accumulation of phagocytic immune complexes of macrophages. The clinical picture of the DPX is very specific and characterized by the appearance of periorbital xanthelasma and planar xanthomas on the skin of the trunk and extremities. The disease is often associated with hematological and lymphoproliferative diseases. The diagnosis is confirmed by histological examination.
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Abstract
Xanthomas are a common manifestation of lipid metabolism disorders. They include hyperlipemic xanthoma, normolipemic xanthoma, and a related condition, necrobiotic xanthogranuloma (NXG). All 3 forms can be associated with monoclonal immunoglobulin (MIg). In an attempt to improve diagnosis, understanding, and treatment of this association, we retrospectively analyzed a personal series of 24 patients (2 hyperlipemic xanthoma, 11 normolipemic xanthoma, and 11 NXG) and 230 well-documented reports from the literature. With the exception of the nodules and plaques featured in NXG, the clinical presentation of xanthomatous lesions usually resembled that seen in common hyperlipidemic forms and could not be used to suspect MIg-associated xanthomas. Extracutaneous sites were not rare. The MIg was an IgG in 80% of cases. Myeloma was diagnosed in 35%. Hypocomplementemia with low C4 fraction was present in 80% of studied patients. Low C1 inhibitor serum levels were found in 53%. Cryoglobulinemia was detected in 27%. These abnormalities suggest immune complex formation because of interactions between the MIg and lipoproteins and argue in favor of a causal link between MIg and xanthomas. Monoclonal gammopathy therapy could thus be an option. Indeed, among the patients who received chemotherapy, hematologic remission was accompanied by improvement in xanthoma lesions in several cases.
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Abstract
Palmoplantar keratodermas (PPKs) are a diverse entity of disorders that are characterized by abnormal thickening of the skin on the palms and soles. Traditionally they have been classified as either hereditary or acquired and are distinguished from each other on the basis of mode of inheritance, presence of transgrediens (defined as contiguous extension of hyperkeratosis beyond the palmar and/or plantar skin), co-morbidities with other symptoms, and extent of epidermal involvement, namely diffuse, focal, and punctate. As the terms hyperkeratosis and keratoderma have been used interchangeably throughout the literature, we define acquired keratoderma as a non-hereditary, non-frictional hyperkeratosis of the palms and/or soles that involves >/=50% of the surface of involved acral areas and that may or may not be associated with clinical and histologic inflammation. Given the numerous possible underlying causes for acquired PPKs, evaluation of patients presenting with acquired PPK can be a perplexing task. To facilitate such evaluations, this review categorizes the acquired PPKs as: keratoderma climactericum, drug related, malnutrition associated, chemically induced, systemic disease related, malignancy associated, dermatoses related, infectious, and idiopathic. In order to avoid the possibility of overlooking an underlying etiology and to eliminate excessive testing, we present an algorithm for assessing patients presenting with acquired PPK. The first step should include a comprehensive history and a physical examination, including a complete skin examination. If findings are consistent with a hereditary keratoderma, then a genetics consultation should be considered. Any findings suggestive of underlying conditions should be aggressively evaluated and treated. If no pertinent findings are identified after a history and a physical examination, laboratory and radiology studies should be undertaken in a systematic, logical fashion. In terms of treatment, the most successful results occur when the underlying etiology is diagnosed and treated. If no such etiology is evident, then conservative treatment options include topical keratolytics (urea, salicylic acid, lactic acid), repeated physical debridement, topical retinoids, topical psoralen plus UVA, and topical corticosteroids. Etretinate and acitretin have also shown some success as alternative treatments in recalcitrant cases.
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Affiliation(s)
- Shaily Patel
- Department of Dermatology, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Kleyn CE, Lai-Cheong JE, Bell HK. Cutaneous manifestations of internal malignancy: diagnosis and management. Am J Clin Dermatol 2006; 7:71-84. [PMID: 16605288 DOI: 10.2165/00128071-200607020-00001] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
An association between systemic malignancy and cutaneous manifestations has long been recognized. The cutaneous features that can occur are numerous and heterogeneous, and many different etiologic mechanisms are represented - from direct tumor invasion of skin or distant metastases to a wide variety of inflammatory dermatoses that may occur as paraneoplastic phenomena. In addition, there are a number of inherited syndromes that carry an increased risk of cutaneous as well as internal malignancies. While some of these inherited syndromes and paraneoplastic phenomena are exceedingly rare, all clinicians will be aware of the common cutaneous manifestations of advanced malignant disease such as generalized xerosis and pruritus. This review classifies these wide-ranging cutaneous manifestations of internal malignancy into five basic groups and provides practical advice regarding diagnosis and screening of patients who initially present with a cutaneous complaint. Also included is up-to-date information on two rapidly expanding and exciting areas of research that are likely to have far-reaching clinical implications: (i) clarification of underlying humoral mechanisms, for example, in the malignant carcinoid syndrome; and (ii) identification of an increasing number of specific genetic defects that confer a susceptibility to malignancy.Increased clinician awareness regarding the associations between these lesions and internal malignancy or inherited syndromes will facilitate screening and early diagnosis.
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Affiliation(s)
- C Elise Kleyn
- Department of Dermatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
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Kourou K, Suga Y, Muramatsu S, Yaguchi H, Ogawa H. A case of diffuse plane normolipemic xanthomatosis associated with pancytopenia and monoclonal gammopathy. J Dermatol 2006; 33:64-7. [PMID: 16469089 DOI: 10.1111/j.1346-8138.2006.00013.x] [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] [Indexed: 11/29/2022]
Abstract
We report a case of diffuse plane normolipemic xanthomatosis (DPNX) which showed poorly demarcated, uncommon, yellow macules symmetrically distributed on the nape, axillae and inguinal folds accompanied by severe, persistent itching. Histopathological and ultrastructural studies of skin biopsy specimens revealed the existence of some foamy cells and the deposition of neutral fat in the upper papillary dermis. Laboratory investigations and bone marrow aspirate smears showed that our patient had myelodysplastic syndrome (MDS) associated with pancytopenia and monoclonal gammopathy of undetermined significance. Because our patient had neither a malignant hematological disorder nor a severe systemic disease, monoclonal gammopathy might explain the pathogenesis of DPNX in the present case.
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Affiliation(s)
- Kazuhiro Kourou
- Department of Dermatology, Juntendo University School of Medicine, Tokyo, Japan
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Tsouli SG, Kiortsis DN, Argyropoulou MI, Mikhailidis DP, Elisaf MS. Pathogenesis, detection and treatment of Achilles tendon xanthomas. Eur J Clin Invest 2005; 35:236-44. [PMID: 15816992 DOI: 10.1111/j.1365-2362.2005.01484.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Tendon xanthomatosis often accompanies familial hypercholesterolaemia, but it can also occur in other pathologic states. Achilles tendons are the most common sites of tendon xanthomas. Low-density lipoprotein (LDL) derived from the circulation accumulates into tendons. The next steps leading to the formation of Achilles tendon xanthomas (ATX) are the transformation of LDL into oxidized LDL (oxLDL) and the active uptake of oxLDL by macrophages within the tendons. Although physical examination may reveal Achilles tendon xanthomas (ATX), there are several imaging methods for their detection. It is worth mentioning that ultrasonography is the method of choice in everyday clinical practice. Although several treatments for Achilles tendon xanthomas (ATX) have been proposed (LDL apheresis, statins, etc.), they target mostly in the treatment of the basic metabolic disorder of lipid metabolism, which is the main cause of these lesions. In this review we describe the formation, detection, differential diagnosis and treatment of ATX as well as the relationship between tendon xanthomas and atheroma.
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Urbańska-Ryś H, Robak E, Kordek R, Bartkowiak J, Rieske P, Woźniacka A, Smolewski P, Robak T. Multiple myeloma in a patient with systemic lupus erythematosus, myasthenia gravis and non-familial diffuse palmoplantar keratoderma. Leuk Lymphoma 2005; 45:1913-8. [PMID: 15223654 DOI: 10.1080/10428190410001663581] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The coexistence of autoimmune diseases and malignancies including lymphoproliferative diseases is often reported in the literature. Here we report an unusual case with two autoimmune diseases--myasthenia gravis (MG) and systemic lupus erythematosus (SLE) associated with unique palmoplantar keratoderma (PK) which preceded the development of multiple myeloma (MM) for twenty and seven years respectively. MG associated with non-malignant thymoma developed in 1981 and was successfully treated with thymectomy and physostigmine. Thirteen years later SLE was diagnosed and until now it is also accompanied by skin lesions corresponding to non-familial, diffuse palmoplantar keratoderma which is resistant to treatment. In 2001 the patient revealed inguinal and abdominal lymphadenopathy first diagnosed as extramedullary plasmacytoma and then as multiple myeloma on the basis of bone marrow infiltration and monoclonal gammopathy. Therapy with VAD regimen achieved complete remission of the MM and significant improvement of the skin changes lasting for six months. We failed to collect sufficient numbers of CD 34+ cells for peripheral blood stem cell transplantation. Now the malignancy is in partial remission after CHOP therapy and the skin lesions have returned to their initial status. To our knowledge, this is the first case to be reported with coexistence of these four diseases.
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Affiliation(s)
- Halina Urbańska-Ryś
- Department of Haematology, Medical University of Łódź, Copernicus Memorial Hospital, 93-513 Łódź Pabianicka st. 62, Poland
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Akhyani M, Daneshpazhooh M, Seirafi H, Naraghi ZS. Diffuse plane xanthoma in an otherwise healthy woman. Clin Exp Dermatol 2001; 26:405-7. [PMID: 11488827 DOI: 10.1046/j.1365-2230.2001.00846.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of diffuse plane xanthoma in a 40-year-old otherwise healthy woman. Her disease began 18 years ago as xanthelasma and progressed to involve large areas of her face, neck and trunk. No associated diseases were detected on repeated laboratory testing.
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Affiliation(s)
- M Akhyani
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Gómez Centeno P, García Costa A, Rodríguez López J, Álvarez López J, Cabo Gómez F, Peón Currás G, Fonseca Moretón A, Veiga Codesido C, Gómez Domínguez J. Xantoma plano difuso asociado a gammapatía monoclonal, crioglobulinemia e hipocomplementemia. ACTAS DERMO-SIFILIOGRAFICAS 2001. [DOI: 10.1016/s0001-7310(01)76440-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Daoud MS, Lust JA, Kyle RA, Pittelkow MR. Monoclonal gammopathies and associated skin disorders. J Am Acad Dermatol 1999; 40:507-35; quiz 536-8. [PMID: 10188670 DOI: 10.1016/s0190-9622(99)70434-2] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The monoclonal gammopathies are characterized by clonal proliferation of plasma cells and other clonally related cells in the B-cell lineage. These disorders include monoclonal gammopathy of undetermined significance, multiple myeloma, Waldenström macroglobulinemia, heavy chain diseases, plasmacytoma, and primary amyloidosis. Many skin disorders have been described in association with monoclonal gammopathies. This article provides an introduction to the definition, detection, natural course, and spectrum of monoclonal gammopathies and a brief discussion of pathogenesis. The article also reviews the skin disorders associated with monoclonal gammopathies, categorizes the association, and evaluates the strength of the association.
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Affiliation(s)
- M S Daoud
- Department of Dermatology, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA
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