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Wanberg LJ, Schultz B, Goyal A. Treatment of Subcorneal Pustular Dermatosis without Dapsone: A Case Report and Review of the Literature. Case Rep Dermatol Med 2024; 2024:8140483. [PMID: 38596599 PMCID: PMC11003796 DOI: 10.1155/2024/8140483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
Subcorneal pustular dermatosis (SPD) is a rare neutrophilic dermatosis characterized by pustules on the trunk and intertriginous areas. While oral dapsone is the first-line treatment for SPD, alternative options are necessary for patients with glucose-6-phosphate dehydrogenase deficiency, drug hypersensitivity reactions, or refractory disease. To date, no consensus exists regarding next-best agents for SPD. In this report, we present a patient with significant SPD who developed dapsone hypersensitivity syndrome and then was successfully treated with colchicine and adalimumab. We propose that colchicine should be considered as a second-line treatment for SPD and present a therapeutic algorithm for clinicians to utilize when patients are not candidates for dapsone, have side effects requiring drug discontinuation, or have refractory disease.
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Affiliation(s)
- Lindsey J. Wanberg
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, USA
| | - Brittney Schultz
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, USA
- University of Minnesota, Department of Dermatology, 516 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Amrita Goyal
- University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, USA
- University of Minnesota, Department of Dermatology, 516 Delaware Street SE, Minneapolis, MN 55455, USA
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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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Montagnon CM, Fracica EA, Patel AA, Camilleri MJ, Murad MH, Dingli D, Wetter DA, Tolkachjov SN. Pyoderma gangrenosum in hematologic malignancies: A systematic review. J Am Acad Dermatol 2019; 82:1346-1359. [PMID: 31560977 DOI: 10.1016/j.jaad.2019.09.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/15/2019] [Accepted: 09/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pyoderma gangrenosum (PG) is a devastating neutrophilic dermatosis that may be associated with trauma or systemic diseases. The associations, characteristics, and temporal relationship of PG with hematologic malignancies are not well understood. OBJECTIVE We performed a systematic review of PG associated with hematologic malignancies using data from case reports, case series, and retrospective studies. METHODS We searched MEDLINE, EMBASE, Scopus, and Web of Science from each database's inception to December 12, 2018. Two reviewers independently selected studies and extracted data. RESULTS Two hundred seventy-nine publications met the inclusion criteria (340 cases). Myelodysplastic syndrome (MDS) was the most commonly reported hematologic malignancy associated with PG, followed by monoclonal gammopathy of undetermined significance and acute myeloid leukemia. The mean age of patients was 56.5 years, with males being more common. There was a predominance of the ulcerative PG subtype and multifocal distributions across all hematologic malignancies. The majority of MDS cases preceded PG, which was reversed for MGUS. LIMITATIONS The data were limited by reporting bias because PG subtypes rely on the rendered diagnosis reported. In addition, the classification for hematologic malignancies has evolved since 1978. CONCLUSION Patients with PG should be evaluated for hematologic malignancies, with MDS being the most common.
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Affiliation(s)
| | | | - Archna A Patel
- Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - M Hassan Murad
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - David Dingli
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - David A Wetter
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
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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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Ferrillo M, Villani A, Fabbrocini G, Mascolo M, Megna M, Costa C, Napolitano M. A Case of the Co-Existence of Subcorneal Pustular Dermatosis and Pyoderma Gangrenosum and a Review of the Literature. Open Access Maced J Med Sci 2018; 6:1271-1274. [PMID: 30087735 PMCID: PMC6062289 DOI: 10.3889/oamjms.2018.214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND: Subcorneal pustular dermatosis, also known as Sneddon-Wilkinson disease, can be classified as one of the neutrophilic dermatoses together with pyoderma gangrenosum. The development of both SPD and PG in the same patient has rarely been reported and may be a strong indicator of IgA dysglobulinemia CASE REPORT: We report the case of a 34-year-old woman with a 2-year history of relapsing pustular eruptions mainly affecting the abdomen, gluteus region, elbows, and the extremities. Four years after the onset of subcorneal pustular dermatosis (SPD), she developed pyoderma gangrenosum (PG) on her right hand. In literature, the coexistence of SPD and PG in the same patient has already been described. This co-occurrence might indicate a certain predisposition for immune dysregulation. CONCLUSION: Although the two NDs are often associated with systemic diseases, these patients should be followed up for any malignancy because of the strong association between these disorders.
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Affiliation(s)
- Maria Ferrillo
- Section of Dermatology, Department of Clinical Medicine and Surgery, Dermatology Unit, University of Naples Federico II, Napoli, Italy
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, Dermatology Unit, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, Dermatology Unit, University of Naples Federico II, Napoli, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Section University of Naples Federico II, Napoli, Italy
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, Dermatology Unit, University of Naples Federico II, Napoli, Italy
| | - Claudia Costa
- Section of Dermatology, Department of Clinical Medicine and Surgery, Dermatology Unit, University of Naples Federico II, Napoli, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
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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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7
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Neutrophilic dermatoses and autoinflammatory diseases with skin involvement—innate immune disorders. Semin Immunopathol 2015; 38:45-56. [DOI: 10.1007/s00281-015-0549-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 11/02/2015] [Indexed: 12/22/2022]
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Szalat R, Monsel G, Le Goff W, Battistella M, Bengouffa D, Schlageter MH, Bouaziz JD, Arnulf B, Vignon M, Lesnik P, Saussine A, Malphettes M, Lazareth A, Vignon-Pennamen MD, Bagot M, Brouet JC, Fermand JP, Rybojad M, Asli B. The spectrum of neutrophilic dermatoses associated with monoclonal gammopathy: Association with IgA isotype and inflammatory profile. J Am Acad Dermatol 2015; 73:809-20. [DOI: 10.1016/j.jaad.2015.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/21/2015] [Accepted: 07/26/2015] [Indexed: 01/31/2023]
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[Dermatological manifestations of monoclonal gammopathies: contribution of cutaneous histopathology]. Ann Pathol 2015; 35:281-93. [PMID: 26188671 DOI: 10.1016/j.annpat.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/06/2015] [Indexed: 12/19/2022]
Abstract
Skin manifestations associated with monoclonal gammapathy are common and can present with various clinical and pathological aspects. They can be the first events leading to the diagnosis of monoclonal gammapathy. They may be present either as specific lesions, including lymphoplasmacytic or pure plasma cell neoplastic infiltrates and monoclonal immunoglobulin deposits, or as non-specific dermatitis, such as leukocytoclastic vasculitis, neutrophilic dermatoses, mucinoses or xanthomatosis, giving little clues for the diagnosis of the underlying disease.
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Ajili F, Souissi A, Bougrine F, Boussetta N, Abdelhafidh NB, Sayhi S, Louzir B, Doss N, Laabidi J, Othmani S. Coexistence of pyoderma gangrenosum and sweet's syndrome in a patient with ulcerative colitis. Pan Afr Med J 2015; 21:151. [PMID: 26327988 PMCID: PMC4546795 DOI: 10.11604/pamj.2015.21.151.6364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/19/2015] [Indexed: 01/03/2023] Open
Abstract
Pyoderma gangrenosum (PG) and Sweet's Syndrome (SS) are inflammatory skin diseases caused by the accumulation of neutrophils in the skin and, rarely, in internal organs. These neutrophilic dermatosis (NDs) are distinguished by the existence of forms of transition or overlap. They are frequently associated to systemic diseases especially hematologic and gastrointestinal ones. We report a case of a patient with ulcerative colitis (UC) who successively developed two types of NDs: PG then SS. A 66 years old patient with a history of UC consulted in July 2012 for an erythematous swelling of the back of the right hand treated with antibiotics without improvement. At that time, bacteriological samples were negative. In October 2012, he was hospitalized for polyarthralgia and impaired general condition. In physical examination, he had vesiculobullous plaque of 10 cm long of the right hand and wrist, infiltrated erythematous plaque on the right leg and another topped with a large pustule at the left ankle. Skin biopsy showed at the back of the right hand an aspect of PG and at the infiltrated plaques of the ankle an aspect of SS. Prednisone was started with improvement of the skin lesions and a recovery condition. The combination of PG and SS has already been described in cases of hematologic malignancy and rarely in UC. There is also the notion of passage from a neutrophilic dermatosis to another. Indeed, a typical lesion initially of SS can evolve to a future PG. This case demonstrates that neutrophilic dermatoses form a continous spectrum of entities that may occur in UC.
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Affiliation(s)
- Faida Ajili
- Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Asmahan Souissi
- Department of Dermatology, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Fathi Bougrine
- Department of Anatomopathology, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Najah Boussetta
- Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Nadia Ben Abdelhafidh
- Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Sameh Sayhi
- Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Bassem Louzir
- Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Nejib Doss
- Department of Dermatology, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Janet Laabidi
- Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie
| | - Salah Othmani
- Department of Internal Medicine, Military Hospital of Tunis, 1008 Montleury, Tunisie
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12
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Dasanu CA, Bockorny B, Alexandrescu DT. Pyoderma gangrenosum due to lenalidomide use for multiple myeloma. J Oncol Pharm Pract 2014; 21:471-3. [PMID: 24986794 DOI: 10.1177/1078155214541975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pyoderma gangrenosum has been described in association with multiple myeloma and usually affects patients with active/untreated disease. This dermatologic condition was shown to resolve after successful anti-myeloma therapy. We report herein occurrence of pyoderma gangrenosum involving bilateral knees in a patient with multiple myeloma responding to lenalidomide therapy. Previous papers claimed usefulness of thalidomide and its newer derivatives for the therapy of this neutrophilic dermatosis. Occurrence of pyoderma gangrenosum in a myeloma patient responding to lenalidomide would argue against its effectiveness in treating this skin condition. Moreover, the clinical setting suggested that lenalidomide either induced or contributed to the occurrence of pyoderma gangrenosum in our patient. If our hypothesis is correct, we expect more reports of pyoderma gangrenosum with the use of this class of pharmaceuticals.
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Affiliation(s)
| | - Bruno Bockorny
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Doru T Alexandrescu
- Department of Dermatology, Health Care Partners Medical Group, Mission Hills, CA, USA
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Levender M, Silvers D, Grossman M. Urticaria-like neutrophilic dermatosis in association with IgA gammopathy: a new entity. Br J Dermatol 2014; 170:1189-91. [DOI: 10.1111/bjd.12771] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M.M. Levender
- Department of Dermatology; 161 Fort Washington Avenue New York NY 10032 U.S.A
| | - D.N. Silvers
- Department of Dermatology; 161 Fort Washington Avenue New York NY 10032 U.S.A
- Department of Pathology, Columbia University; 161 Fort Washington Avenue New York NY 10032 U.S.A
| | - M.E. Grossman
- Department of Dermatology; 161 Fort Washington Avenue New York NY 10032 U.S.A
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Abstract
The review provides an update on pyoderma ganrenosum, a rare chronic disease from a group of neutrophilic dermatoses. It considers its pathogenesis, its association with background visceral disease, and the specific features of skin and visceral involvement. Major and minor diagnostic criteria and differential treatment approaches are given.
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Audemard A, Verger H, Gendrot A, Jeanjean C, Auzary C, Geffray L. Association pyoderma gangrenosum, pustulose sous-cornée et abcès aseptiques spléniques : « une maladie neutrophilique ». Rev Med Interne 2012; 33:e28-30. [DOI: 10.1016/j.revmed.2011.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 08/16/2010] [Accepted: 04/16/2011] [Indexed: 12/24/2022]
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Hsiao YW, Lee HE, Kuo TT. Concurrent pyoderma gangrenosum and subcorneal pustular dermatosis in a patient with monoclonal IgA/λ gammopathy. DERMATOL SIN 2011. [DOI: 10.1016/j.dsi.2011.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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