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Di Ludovico A, Rinaldi M, Lauriola F, Ciarelli F, La Bella S, Gualdi G, Chiarelli F, Bailey K, Breda L. The Diagnostic Role of Skin Manifestations in Rheumatic Diseases in Children: A Critical Review of Paediatric Vasculitis. Int J Mol Sci 2024; 25:7323. [PMID: 39000430 PMCID: PMC11242831 DOI: 10.3390/ijms25137323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/16/2024] Open
Abstract
Skin lesions are frequently observed in children with rheumatic diseases, particularly in conditions such as IgA vasculitis (IgAV) and Kawasaki disease (KD). In paediatric vasculitis, the presence of skin lesions serves as an early indicator, emphasising the importance of timely diagnosis to prevent complications, such as cardiac or renal involvement. Conversely, autoinflammatory disorders like juvenile systemic lupus erythematosus (SLE) and juvenile dermatomyositis (DM) may manifest with cutaneous manifestations either at the onset of disease or during its progression. Identifying these skin lesions prior to the appearance of systemic symptoms offers an opportunity for early diagnosis and treatment, which has a positive influence on the outcomes. Additionally, it is noteworthy that specific rheumatological conditions, such as acute rheumatic fever (ARF) or oligoarticular or polyarticular forms of juvenile idiopathic arthritis (JIA), may exhibit occasional, but significant skin involvement, which is strongly correlated with an unfavourable prognosis. The assessment of skin is important in the holist approach to assessing patients for potentially systemic/multisystem disorder and helps distinguish discrete conditions.
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Affiliation(s)
- Armando Di Ludovico
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Marta Rinaldi
- Paediatric Department, Buckinghamshire Healthcare NHS Trust, Aylesbury-Thames Valley Deanery, Oxford HP21 8AL, UK
| | - Federico Lauriola
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Francesca Ciarelli
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Saverio La Bella
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Giulio Gualdi
- Dermatology Clinic, Department of Medicine and Aging Science, University G D’Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Chiarelli
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
| | - Kathryn Bailey
- Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Luciana Breda
- Paediatric Department, University of Chieti “G. D’Annunzio”, 66100 Chieti, Italy; (A.D.L.)
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Yamashita A, Fukui T, Akasaka E, Nakajima K, Nakano H, Sawamura D, Hamaya T. Acquired cutis laxa secondary to acute generalized exanthematous pustulosis: A case report and mini-review of literature. J Dermatol 2024; 51:287-293. [PMID: 37334758 DOI: 10.1111/1346-8138.16860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/20/2023]
Abstract
Cutis laxa presents as loose redundant skin folds and loss of dermal elastic tissue. Acquired cutis laxa (ACL) is characterized by later onset. It has been reported in association with various kinds of neutrophilic dermatoses, drugs, metabolic disorders, and autoimmune disorders. Acute generalized exanthematous pustulosis (AGEP) is usually classified as a severe cutaneous adverse reaction characterized by T cell-mediated neutrophilic inflammation. We previously reported a mild case of AGEP caused by gemcitabine in a 76-year-old man. Here, we report a case of ACL secondary to AGEP in this patient. He developed AGEP 8 days after gemcitabine administration. Four weeks after beginning chemotherapy, his skin had become atrophic, loose, and darkly pigmented in areas previously affected by AGEP. Histopathological examination revealed edema and perivascular lymphocytic infiltration but no neutrophilic infiltration in the upper dermis. Elastica van Gieson staining showed that the elastic fibers in all layers of the dermis were sparse and shortened. Electron microscopy showed elevated numbers of fibroblasts and altered elastic fibers with irregular surfaces. Finally, he was diagnosed with ACL secondary to AGEP. He was treated with topical corticosteroids and oral antihistamines. Skin atrophy decreased over 3 months. We summarize 36 cases (including our case) with ACL secondary to neutrophilic dermatosis. We discuss these clinical manifestations, causative neutrophilic disorders, treatments, and outcomes. The mean age of patients was 3.5 years. Five patients had an aortic lesion as systemic involvement. The most common causative neutrophilic disorders were Sweet syndrome (24 cases), followed by urticaria-like neutrophilic dermatosis (11 cases). There were no cases of AGEP except for our case. Although treatment for ACL secondary to neutrophilic dermatosis, such as dapsone, oral prednisolone, adalimumab, and plastic surgery were reported, ACL is generally refractory and irreversible. Our patient was considered reversibly cured due to the absence of continuous neutrophil-mediated elastolysis.
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Affiliation(s)
- Aya Yamashita
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomohisa Fukui
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eijiro Akasaka
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koji Nakajima
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hajime Nakano
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Daisuke Sawamura
- Department of Dermatology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tomoko Hamaya
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Stappers S, Swinnen I, Siozopoulou V, Bastin J, De Smet A, Dubois M, Loeys B, Aerts O. Neutrophilic dermatoses and aneurysms: An overlooked association? J Eur Acad Dermatol Venereol 2023; 37:e1461-e1464. [PMID: 37471474 DOI: 10.1111/jdv.19365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Sofie Stappers
- Department of Dermatology, University Hospital Antwerp (UZA), Antwerp, Belgium
| | - Inge Swinnen
- Department of Dermatology, Heilig Hart Ziekenhuis Lier, Antwerp, Belgium
| | | | - Julie Bastin
- Department of General Medical Oncology, Heilig Hart Ziekenhuis Lier, Antwerp, Belgium
| | - Anthony De Smet
- Department of Vascular Surgery, Heilig Hart Ziekenhuis Lier, Antwerp, Belgium
| | - Marc Dubois
- Department of Vascular Surgery, Heilig Hart Ziekenhuis Lier, Antwerp, Belgium
| | - Bart Loeys
- Center of Medical Genetics, University of Antwerp/Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Olivier Aerts
- Department of Dermatology, University Hospital Antwerp (UZA), Antwerp, Belgium
- Research Group Immunology, Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
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Michl C, Hühn R, Sunderkötter C. [Sweet syndrome of childhood with acquired cutis laxa (Marshall syndrome) as primary manifestation of Takayasu arteritis]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2022; 73:884-890. [PMID: 35925217 PMCID: PMC9592653 DOI: 10.1007/s00105-022-04999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/15/2023]
Abstract
A special form of the rare infantile Sweet syndrome (acute febrile neutrophilic dermatosis) is facultative healing in the form of postinflammatory elastolysis with acquired cutis laxa, named "Marshall" syndrome after the authors who first described it. We report the case of a 3-year-old child in whom the cutaneous manifestation led to diagnosis of Takayasu arteritis. Postinflammatory elastolysis with acquired cutis laxa is a clinically relevant cutaneous indicator of life-threatening cardiovascular complications such as aortitis, aortic aneurysm, coronary stenosis and heart failure in children with Sweet's syndrome. Cutis laxa usually precedes cardiac complications or, as in our case, occurs simultaneously; thus, immediate cardiac and rheumatologic examinations are important to initiate systemic therapy with anti-inflammatory and immunomodulatory agents early to prevent complications.
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Affiliation(s)
- Christiane Michl
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle/Saale, Halle/Saale, Deutschland.
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Ernst-Grube-Str. 40, 06120, Halle, Deutschland.
| | - Regina Hühn
- Universitätsklinik und Poliklinik für Pädiatrie I, Universitätsklinikum Halle/Saale, Halle/Saale, Deutschland
| | - Cord Sunderkötter
- Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Universitätsklinikum Halle/Saale, Halle/Saale, Deutschland
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Knöpfel N, Theiler M, Luchsinger I, Hafner B, Brunner C, Kolm I, Weibel L. Infliximab for the treatment of recalcitrant bullous Sweet syndrome in a 10-year-old girl. Pediatr Dermatol 2020; 37:1183-1184. [PMID: 32901971 DOI: 10.1111/pde.14356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We report the case of a 10-year-old girl with bullous Sweet syndrome, recalcitrant to high-dose systemic corticosteroids. Subsequent treatment with infliximab resulted in a rapid improvement in cutaneous lesions and systemic symptoms. Cutis laxa was noted in the healed skin. We propose early second-line treatment with infliximab in children with steroid-refractory Sweet syndrome.
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Affiliation(s)
- Nicole Knöpfel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Theiler
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Isabelle Luchsinger
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bettina Hafner
- Pediatric Skin Center, Skin- and Wound Management, University Children's Hospital Zurich, Zurich, Switzerland
| | - Corinne Brunner
- Pediatric Skin Center, Skin- and Wound Management, University Children's Hospital Zurich, Zurich, Switzerland
| | - Isabel Kolm
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Lisa Weibel
- Pediatric Skin Center, Department of Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
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Abdelmaksoud A. Comment on ‘Progressive erythematous papules and plaques in an infant’: Sweet that is not so sweet! Clin Exp Dermatol 2019; 44:950-951. [DOI: 10.1111/ced.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 11/27/2022]
Affiliation(s)
- A. Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital Mansoura Egypt
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Heath MS, Ortega-Loayza AG. Insights Into the Pathogenesis of Sweet's Syndrome. Front Immunol 2019; 10:414. [PMID: 30930894 PMCID: PMC6424218 DOI: 10.3389/fimmu.2019.00414] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
Sweet's syndrome, also known as Acute Febrile Neutrophilic Dermatosis, is a rare inflammatory condition. It is considered to be the prototype disease of neutrophilic dermatoses, and presents with acute onset dermal neutrophilic lesions, leukocytosis, and pyrexia. Several variants have been described both clinically and histopathologically. Classifications include classic Sweet's syndrome, malignancy associated, and drug induced. The cellular and molecular mechanisms involved in Sweet's syndrome have been difficult to elucidate due to the large variety of conditions leading to a common clinical presentation. The exact pathogenesis of Sweet's syndrome is unclear; however, new discoveries have shed light on the role of inflammatory signaling, disease induction, and relationship with malignancy. These findings include an improved understanding of inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic contributions. Continued investigations into effective treatments and targeted therapy will benefit patients and improve our molecular understanding of inflammatory diseases, including Sweet's syndrome.
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Affiliation(s)
- Michael S Heath
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
| | - Alex G Ortega-Loayza
- Oregon Health and Science University, Department of Dermatology, Portland, OR, United States
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Chasset F, Francès C. Cutaneous Manifestations of Medium- and Large-Vessel Vasculitis. Clin Rev Allergy Immunol 2017; 53:452-468. [DOI: 10.1007/s12016-017-8612-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Webb K, Hlela C, Jordaan HF, Suliman S, Scriba T, Lipsker D, Scott C. A Review and Proposed Approach to the Neutrophilic Dermatoses of Childhood. Pediatr Dermatol 2015; 32:437-46. [PMID: 25727235 DOI: 10.1111/pde.12502] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neutrophilic dermatoses (NDs) are inflammatory skin conditions that are not associated with infection. The classification and clinical approach to these conditions in children is poorly described. This review classifies these conditions into five nosological subtypes: Sweet's syndrome, pyoderma gangrenosum, aseptic pustules, neutrophilic urticarial dermatoses, and Marshall's syndrome. In addition, we review the various secondary diseases that need to be excluded in the clinical management of the NDs of childhood, with a focus on the autoinflammatory conditions that the reader may not be familiar with. We propose a practical clinical approach to these disorders.
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Affiliation(s)
- Kate Webb
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa.,Department of Dermatology, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - H Francois Jordaan
- Division of Dermatology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South Africa
| | - Sara Suliman
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Thomas Scriba
- South African TB Vaccine Initiative, University of Cape Town, Cape Town, South Africa
| | - Dan Lipsker
- Faculté de Médecine, Université de Strasbourg and Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Chris Scott
- Department of Rheumatology, University of Cape Town, Cape Town, South Africa
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Çalışkan E, Açıkgöz G, Yeniay Y, Özmen İ, Gamsızkan M, Akar A. A case of Marshall's syndrome and review of the literature. Int J Dermatol 2014; 54:e217-21. [DOI: 10.1111/ijd.12471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/22/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Ercan Çalışkan
- Department of Dermatology; Gülhane School of Medicine; Gülhane Military Medical Academy; Ankara Turkey
| | - Gürol Açıkgöz
- Department of Dermatology; Gülhane School of Medicine; Gülhane Military Medical Academy; Ankara Turkey
| | - Yıldıray Yeniay
- Department of Dermatology; Gülhane School of Medicine; Gülhane Military Medical Academy; Ankara Turkey
| | - İbrahim Özmen
- Department of Dermatology; Çorlu Military Hospital; Çorlu Turkey
| | - Mehmet Gamsızkan
- Department of Pathology; Gülhane School of Medicine; Gülhane Military Medical Academy; Ankara Turkey
| | - Ahmet Akar
- Department of Dermatology; Gülhane School of Medicine; Gülhane Military Medical Academy; Ankara Turkey
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Abstract
PURPOSE OF REVIEW To highlight the recent observations regarding not only research but also the clinical features and management of Sweet's syndrome. RECENT FINDINGS Some of the new insights concerning Sweet's syndrome include: (1) bortezomib-induced Sweet's syndrome (some of which are the histiocytoid variant), (2) a rare extracutaneous manifestation of Sweet's syndrome with cardiovascular involvement including coronary artery occlusion, and (3) the possibility that photosensitivity may have a role in the pathogenesis of Sweet's syndrome. SUMMARY Animal models of Sweet's syndrome and new associated medication have been observed. The definitive mechanism of pathogenesis still remains to be elucidated. Recent observations in paediatric patients suggest evaluation of dermatosis-related cardiac involvement in patients with post-Sweet's syndrome cutis laxa. Treatment advances include antitumour necrosis factor- alpha drugs; however, these medications have also been associated with inducing Sweet's syndrome. Nearly 50 years after the initial description of an acute febrile neutrophilic dermatosis by Dr Robert Douglas Sweet, the dermatosis remains a fascinating condition with regard to laboratory investigation, clinical manifestations and treatment.
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