1
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Erduran F, Adışen E, Hayran Y, Aksoy GG, Alpsoy E, Selçuk LB, Günaydın SD, Yazıcı AC, Öktem A, Güngör M, Afacan E, Kuşçu DD, Elmas L, Aydoğan K, Bayramgürler D, Demirsoy EO, Akyol M, Güner RY, Erdoğan HK, Acer E, Ergun T, Yaylı S, Bulut F, Saraç E, Aktaş A. Analysis of clinical characteristics and factors affecting treatment responses in patients with pyoderma gangrenosum: a multicenter study of 239 patients ☆. An Bras Dermatol 2024:S0365-0596(24)00079-5. [PMID: 38735817 DOI: 10.1016/j.abd.2024.02.002] [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: 10/30/2023] [Revised: 02/08/2024] [Accepted: 02/17/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Pyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers. OBJECTIVE We aimed to evaluate the demographic, clinical characteristics, treatments and factors affecting the treatment responses of patients with PG. METHODS We performed a multicenter study of 12 tertiary care centers. We analyzed the data of the patients who were followed up with a diagnosis of PG between the years 2012‒2022 retrospectively. RESULTS We included a total of 239 patients of whom 143 were female and 96 were male, with an average age of 54.2 ± 17.4 years. The most common treatment was systemic steroids (n = 181, 75.7%). Among these patients, 50.8% (n = 92) used systemic steroids as the sole systemic agent, while 49.2% (n = 89) used at least one adjuvant immunosuppressive agent. The independent factors determined in regression analysis to influence response to systemic steroids positively were disease onset age ≥ 30-years, negative pathergy, absence of leukocytosis, negative wound culture, presence of a single lesion, and absence of upper extremity involvement. Biological agents were used in 18.4% (n = 44) of the patients in the present study. We also analyzed pathergy positive PG and early onset (onset age < 30) PG separately due to their distinct clinical features which were revealed during statistical analysis. STUDY LIMITATIONS Retrospective nature of the present study. CONCLUSIONS Analyses of the factors influencing treatment responses are addressed in this study. Also, we concluded that investigation for accompanying autoinflammatory diseases of pathergy positive PG and early onset PG is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments.
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Affiliation(s)
- Funda Erduran
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey.
| | - Esra Adışen
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Yıldız Hayran
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Güneş Gür Aksoy
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Erkan Alpsoy
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Leyla Baykal Selçuk
- Department of Dermatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Sibel Doğan Günaydın
- Department of Dermatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayça Cordan Yazıcı
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Ayşe Öktem
- Ankara University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
| | - Malik Güngör
- Department of Dermatology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Elif Afacan
- Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deniz Devrim Kuşçu
- Ankara University Faculty of Medicine, Department of Dermatology, Ankara, Turkey
| | - Leyla Elmas
- Department of Dermatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kübra Aydoğan
- Department of Dermatology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Dilek Bayramgürler
- Department of Dermatology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | | | - Melih Akyol
- Department of Dermatology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Rukiye Yasak Güner
- Department of Dermatology, Sivas Cumhuriyet University Faculty of Medicine, Sivas, Turkey
| | - Hilal Kaya Erdoğan
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Ersoy Acer
- Department of Dermatology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Tulin Ergun
- Marmara University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey
| | - Savaş Yaylı
- Department of Dermatology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Ferhan Bulut
- Marmara University Faculty of Medicine, Department of Dermatology, İstanbul, Turkey
| | - Esra Saraç
- Department of Dermatology, Koç University Faculty of Medicine, İstanbul, Turkey
| | - Akın Aktaş
- Department of Dermatology, Ankara Bilkent City Hospital, Ankara, Turkey
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Wallach D. The Neutrophilic Dermatoses, or the Cutaneous Expressions of Neutrophilic Inflammation. Dermatol Clin 2024; 42:139-146. [PMID: 38423676 DOI: 10.1016/j.det.2023.08.001] [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] [Indexed: 03/02/2024]
Abstract
Acute febrile neutrophilic dermatosis, or Sweet syndrome, has been described in 1964 and is now considered as a prototypical condition of the group of the neutrophilic dermatoses. Since this time, many clinical conditions have been included in this group and a clinical-pathological classification in 3 subgroups has been proposed. Neutrophilic infiltrates can localize in all internal organs. This defines the neutrophilic disease, which induces difficult diagnostic and therapeutic problems. Autoinflammation is the main pathophysiological mechanism of the neutrophilic dermatoses. There is a special link between myeloid malignancies (leukemia and myelodysplasia) and the neutrophilic dermatoses.
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3
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Kipers T, Tolkachjov SN. Postoperative and Peristomal Pyoderma Gangrenosum: Subtypes of Pyoderma Gangrenosum. Dermatol Clin 2024; 42:171-181. [PMID: 38423679 DOI: 10.1016/j.det.2023.12.001] [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] [Indexed: 03/02/2024]
Abstract
Postoperative pyoderma gangrenosum and peristomal pyoderma gangrenosum are 2 subtypes of pyoderma gangrenosum. The diagnosis is made as a clinicopathologic correlation when assessing a rapidly progressing ulcer with irregular and undermined borders following a surgical procedure, trauma, or the creation of a stoma. Familiarity with the associated risk factors and distinguishing features of these disorders can facilitate prompt recognition, proper diagnosis, and the initiation of treatment. Management usually involves the use of corticosteroids and steroid-sparing agents as immunomodulators to shift the inflammatory neutrophilic dermatoses to chronic noninflammatory wounds and eventual healing.
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Affiliation(s)
- Théodora Kipers
- School of Medicine, Texas A&M University School of Medicine, 5536 Tremont Street, Dallas, TX 75214, USA
| | - Stanislav N Tolkachjov
- Mohs Micrographic & Reconstructive Surgery, Epiphany Dermatology; Department of Dermatology, Baylor University Medical Center; University of Texas at Southwestern; Texas A&M University School of Medicine, 1640 FM 544, Suite 100, TX 75056, USA.
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4
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Kreyberg I, Schrumpf E, Fredrik von Krogh C, Lilleng R, Tjønnfjord GE. Successful treatment of subcorneal pustular dermatosis targeting an underlying monoclonal IgA gammopathy. JAAD Case Rep 2023; 41:33-36. [PMID: 37842157 PMCID: PMC10568226 DOI: 10.1016/j.jdcr.2023.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- Ina Kreyberg
- Department of Dermatology and Venereology, Oslo University Hospital, Oslo, Norway
| | - Elisabeth Schrumpf
- Department of Dermatology and Venereology, Oslo University Hospital, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Rune Lilleng
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Geir E. Tjønnfjord
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Centre for B-cell malignancies, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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5
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Cutaneous manifestations of monoclonal gammopathy. Blood Cancer J 2022; 12:58. [PMID: 35411042 PMCID: PMC9001632 DOI: 10.1038/s41408-022-00661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/23/2022] [Indexed: 12/29/2022] Open
Abstract
Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.
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6
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Xing F, Chiu KHY, Yang J, Ye H, Zhang L, Liu C, Yuen KY. Pyoderma gangrenosum with pulmonary involvement: a pulmonary special report and literature review. Expert Rev Respir Med 2022; 16:149-159. [PMID: 35034556 DOI: 10.1080/17476348.2022.2027756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pyoderma gangrenosum (PG) is the prototypical neutrophilic dermatosis, commonly associated with inflammatory bowel disease, with pulmonary involvement being the commonest extracutaneous manifestation. PG with tracheobronchial involvement may present as upper airway obstruction and can be life-threatening. AREAS COVERED To evaluate the clinical characteristics and predictors of PG with pulmonary involvement, we reported a case of PG with tracheobronchial involvement in China, and performed a literature retrieval on PG with pulmonary involvement. Demographic data, clinical presentations, underlying diseases, radiological and histopathological findings, treatments, and clinical outcomes were collected and subjected to statistical analysis. Forty-seven cases (including ours) were identified. Diseases associated with PG with pulmonary involvement were similar. Clinical presentation of PG with pulmonary involvement was non-specific, with cough and dyspnea being the most common clinical symptoms, and pulmonary infiltrates and cavitation being the most common radiological signs. Further univariate analysis suggested stridor and young age (p < 0.01) may be predictors of tracheobronchial involvement in PG. EXPERT OPINION PG with tracheobronchial involvement can be life-threatening, with young age and stridor being possible predictors. Therefore, prompt airway assessment and management are required in younger patients with PG with pulmonary involvement presenting with stridor.
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Affiliation(s)
- Fanfan Xing
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kelvin Hei-Yeung Chiu
- Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - Jin Yang
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Haiyan Ye
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lijun Zhang
- Department of Rheumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chenjing Liu
- Department of Pediatrics, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kwok-Yung Yuen
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Microbiology, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China.,State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.,The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
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7
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Nedley A, Ramos O, Zuppan C, Wongworawat YC, Danisa O. Synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome presenting with a cervical vertebral fracture: A case report. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 5:100050. [PMID: 35141616 PMCID: PMC8820063 DOI: 10.1016/j.xnsj.2021.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Allen Nedley
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
| | - Omar Ramos
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
- Corresponding author.
| | - Craig Zuppan
- Department of Pathology, Loma Linda University, Loma Linda, CA, United States
| | - Yan C. Wongworawat
- Department of Pathology, Loma Linda University, Loma Linda, CA, United States
| | - Olumide Danisa
- Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA, United States
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8
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Passet M, Lepelletier C, Vignon-Pennamen MD, Chasset F, Hirsch P, Battistella M, Duriez P, Sicre de Fontbrune F, Boissel N, Legrand O, Raffoux E, Bagot M, Adès L, Clappier E, Bouaziz JD. Next-Generation Sequencing in Myeloid Neoplasm-Associated Sweet's Syndrome Demonstrates Clonal Relation between Malignant Cells and Skin-Infiltrating Neutrophils. J Invest Dermatol 2020; 140:1873-1876.e5. [PMID: 32081610 DOI: 10.1016/j.jid.2019.12.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/27/2019] [Accepted: 12/14/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Marie Passet
- Hematology Laboratory, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U944/CNRS UMR7212, Institut de Recherche Saint-Louis, Paris, France; Université de Paris, Paris, France
| | - Clémence Lepelletier
- Université de Paris, Paris, France; INSERM UMR976, Centre de Recherche sur la Peau, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - François Chasset
- Dermatology Department, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Hirsch
- Hematology Laboratory, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Université, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| | - Maxime Battistella
- Université de Paris, Paris, France; INSERM UMR976, Centre de Recherche sur la Peau, Paris, France; Pathology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Paul Duriez
- Pathology Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Flore Sicre de Fontbrune
- Bone Marrow Transplant Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Boissel
- Université de Paris, Paris, France; Hematology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ollivier Legrand
- Sorbonne Université, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France; Hematology Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Raffoux
- Hematology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martine Bagot
- Université de Paris, Paris, France; INSERM UMR976, Centre de Recherche sur la Peau, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lionel Adès
- INSERM U944/CNRS UMR7212, Institut de Recherche Saint-Louis, Paris, France; Université de Paris, Paris, France; Bone Marrow Transplant Unit, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Clappier
- Hematology Laboratory, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM U944/CNRS UMR7212, Institut de Recherche Saint-Louis, Paris, France; Université de Paris, Paris, France
| | - Jean-David Bouaziz
- Université de Paris, Paris, France; INSERM UMR976, Centre de Recherche sur la Peau, Paris, France; Dermatology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.
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9
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[Drug-induced Sweet's syndrome related to hydroxychloroquine: About 2 cases]. Rev Med Interne 2019; 41:289-292. [PMID: 31540835 DOI: 10.1016/j.revmed.2019.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Hydroxychloroquine is widely prescribed in systemic lupus erythematosus. Dermatologic adverse drug reactions are rare but can mimic a disease specific manifestation of lupus. Exceptionally, Sweet's syndrome, or acute febrile neutrophilic dermatosis, may be drug-induced. CASE REPORTS Two patients aged 31 and 42 years were treated with hydroxychloroquine for systemic lupus and Sjogren's syndrome, respectively. Three weeks after starting treatment, they had a febrile, purple and erythematous papular rash of the trunk and limbs. There was a biological inflammatory syndrome and skin biopsy disclosed an infiltrate of the dermis rich in neutrophils. Lesions regressed after stopping hydroxychloroquine and introducing systemic corticosteroid therapy. Allergologic tests discussed the differential diagnosis with a delayed-type hypersensitivity reaction. CONCLUSION We report two exceptional cases of drug-induced Sweet's syndrome related to hydroxychloroquine treatment in autoimmune rheumatic diseases.
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10
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Bucchia M, Barbarot S, Reumaux H, Piram M, Mahe E, Mallet S, Balguerie X, Phan A, Lacour JP, Decramer S, Hatchuel Y, Jean S, Begon E, Joubert A, Merlin E, Wallach D, Meinzer U, Bourrat E. Age-specific characteristics of neutrophilic dermatoses and neutrophilic diseases in children. J Eur Acad Dermatol Venereol 2019; 33:2179-2187. [PMID: 31166045 DOI: 10.1111/jdv.15730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Our suggested 'modern' concepts of 'neutrophilic dermatoses' (ND) and 'neutrophilic disease' were based on observations in adult patients and have not been studied in paediatric patients. Only a minority of ND occurs in children, and little is known about age-specific characteristics. OBJECTIVES To describe age-specific characteristics of ND in children and to study whether our suggested 'modern' classification of ND may be applied to children. METHODS We conducted a retrospective multicentre study in a French cohort of 27 paediatric patients diagnosed with pyoderma gangrenosum (PG) or Sweet's syndrome (SS). RESULTS Demographics and distribution of typical/atypical forms were similar in patients diagnosed with PG and SS. Atypical ND were more frequent in infants (90%), when compared to young children (60%) and adolescents (33%). Neutrophilic disease was observed in 17/27 patients and was most frequent in infants. Neutrophilic disease of the upper respiratory tract, as well as cardiac neutrophilic disease, was only observed in infants, whereas other locations were similarly found in infants, young children and adolescents. In infants and young children, ND were associated with a large spectrum of general diseases, whereas in adolescents associations were limited to inflammatory bowel disease and Behçet's disease. CONCLUSIONS Our study describes the concept of ND in paediatric patients and shows that they have some characteristics different from ND occurring in adults. ND occurring in infants can be associated with a large spectrum of general diseases. Occurrence of neutrophilic disease is frequent in children. Thus, ND occurring in young paediatric patients should incite clinicians to schedule complementary explorations in order to search for involvement of other organs and to rule out monogenetic autoinflammatory syndromes.
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Affiliation(s)
- M Bucchia
- Centre Hospitalier Le Mans, Service Urgences pédiatriques, Le Mans, France.,Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France
| | - S Barbarot
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - H Reumaux
- Service de Pédiatrie et médecine générale, CHRU de Lille, Hôpital Jeanne de Flandre, Lille, France
| | - M Piram
- CHU de Bicêtre, Service de Rhumatologue Pédiatrique, CEREMAIA, Le Kremlin-Bicêtre, France.,CESP, U1018 Inserm, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - E Mahe
- Service de Dermatologie, Unité de Soutien à la Recherche Clinique, Argenteuil, France
| | - S Mallet
- Service de Dermatologie de l'hôpital de la Timone, Aix-Marseille Université, Marseille, France
| | - X Balguerie
- Clinique Dermatologique, CHU de Rouen, Rouen, France
| | - A Phan
- Service de Néphro-Rhumato-Dermatologie Pédiatrique, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - J-P Lacour
- Service de Dermatologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - S Decramer
- Centre Hospitalier Universitaire de Toulouse, Service de Néphrologie Médecine Interne Pédiatrique, Hôpital des Enfants, Centre De Référence des Maladies Rénales Rares du Sud Ouest, Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Y Hatchuel
- Service de Pédiatrie, Centre Hospitalier Universitaire de Martinique, Fort de France, France
| | - S Jean
- Service de pédiatrie Centre Hospitalier universitaire de Rennes, Rennes, France
| | - E Begon
- Service de Médecine, Centre Hospitalier René-Dubois, Cergy Pontoise, France
| | - A Joubert
- Service de Dermatologie, CHU de Nantes - Hôtel Dieu, Nantes, France
| | - E Merlin
- CHU Clermont-Ferrand, Pédiatrie Générale Multidisciplinaire, CIC INSERM 1405, Clermont-Ferrand, France
| | - D Wallach
- Médecin (honoraire) des Hôpitaux de Paris, Paris, France
| | - U Meinzer
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,INSERM UMR1149, Université Paris Diderot, Paris, France.,Institut Pasteur, Unité Biologie et génétique de la paroi bactérienne, Paris, France
| | - E Bourrat
- Centre de référence des rhumatismes inflammatoires et maladies auto-immunes systémiques rares de l'enfant (RAISE), Service de pédiatrie générale, Maladies Infectieuses et Médecine Interne, Hôpital Robert Debré, Paris, France.,Service de Dermatologie, Centre Hospitalier Universitaire Saint-Louis, Paris, France
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11
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Monari P, Moro R, Motolese A, Misciali C, Baraldi C, Fanti PA, Caccavale S, Puviani M, Olezzi D, Zampieri P, Trevisan G, Nan K, Fiorentini C, Pellacani G, Gualdi G. Epidemiology of pyoderma gangrenosum: Results from an Italian prospective multicentre study. Int Wound J 2018; 15:875-879. [PMID: 29877043 DOI: 10.1111/iwj.12939] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 12/20/2022] Open
Abstract
Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by painful, necrotic ulcerations. PG is described as a rare disease: the world-wide incidence is estimated to be around 3 to 10 cases per million population per year. These estimations are based mostly on case reports and retrospective case series; there are no prospective, multicentre studies on the matter. The apparent rarity of PG is in contrast with our clinical perception as dermatologists: in our opinion, PG is not so uncommon. Therefore, we decide to investigate the epidemiology of PG in the Italian population and confirm our clinical suspicions that it is not an orphan disease. We enrolled all patients diagnosed with PG in 8 Italian Dermatological Departments from 1st October 2014 to 1st November 2015, and we recorded their features. Our data, collected from 64 patients, are in accordance with those of the published literature regarding the epidemiology and features of PG. In an Italian population of roughly 8 million inhabitants of 7 provinces, we found an incidence of 5.17 new cases per million population per year. Unlike our predictions before the study, we confirmed the world-wide incidence of PG. To our knowledge, this is the first observational, multicentre study on PG. We hope that it provides a stimulus for further researches on PG and for the creation of an Italian register.
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Affiliation(s)
- Paola Monari
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili di Brescia, Brescia, Italy
| | - Ruggero Moro
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili di Brescia, Brescia, Italy
| | - Alberico Motolese
- Department of Dermatology, ASST dei Sette Laghi, Ospedale di Circolo e Fondazione Macchi di Varese, Varese, Italy
| | - Cosimo Misciali
- Division of Dermatology, Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Azienda Ospedaliera Sant'Orsola-Malpighi, Bologna, Italy
| | - Carlotta Baraldi
- Division of Dermatology, Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Azienda Ospedaliera Sant'Orsola-Malpighi, Bologna, Italy
| | - Pier Alessandro Fanti
- Division of Dermatology, Department of Specialized, Experimental, and Diagnostic Medicine, University of Bologna, Azienda Ospedaliera Sant'Orsola-Malpighi, Bologna, Italy
| | - Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Mario Puviani
- Department of Dermatology and Dermatologic Surgery, Ospedale di Sassuolo, Italy
| | - Daniela Olezzi
- Department of Dermatology and Dermatologic Surgery, Ospedale di Sassuolo, Italy
| | - Pierfrancesco Zampieri
- Department of Dermatology, Azienda Sanitaria dell'Alto Adige-Comprensorio Sanitario di Merano, Ospedale "F. Tappeiner", Merano, Italy
| | - Giusto Trevisan
- Department of Dermatology, University of Trieste, Trieste, Italy
| | - Katiuscia Nan
- Department of Dermatology, University of Trieste, Trieste, Italy
| | | | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio-Emilia, Modena, Italy
| | - Giulio Gualdi
- Department of Dermatology, ASST degli Spedali Civili, Spedali Civili di Brescia, Brescia, Italy
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Marzano AV, Borghi A, Wallach D, Cugno M. A Comprehensive Review of Neutrophilic Diseases. Clin Rev Allergy Immunol 2017; 54:114-130. [DOI: 10.1007/s12016-017-8621-8] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Schissler C, Velter C, Lipsker D. Amicrobial pustulosis of the folds: Where have we gone 25 years after its original description? Ann Dermatol Venereol 2017; 144:169-175. [DOI: 10.1016/j.annder.2016.10.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/07/2016] [Accepted: 10/28/2016] [Indexed: 12/13/2022]
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Satoh TK, Mellett M, Contassot E, French LE. Are neutrophilic dermatoses autoinflammatory disorders? Br J Dermatol 2016; 178:603-613. [PMID: 27905098 DOI: 10.1111/bjd.15105] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 12/14/2022]
Abstract
Neutrophils constitute essential players in inflammatory responses and are the first line of defence against harmful stimuli. However, dysregulation of neutrophil homeostasis can result in excessive inflammation and subsequent tissue damage. Neutrophilic dermatoses are a spectrum of inflammatory disorders characterized by skin lesions resulting from a neutrophil-rich inflammatory infiltrate in the absence of infection. The exact molecular pathophysiology of neutrophilic dermatoses has long been poorly understood. Interestingly, neutrophil-rich cutaneous inflammation is also a cardinal feature of several autoinflammatory diseases with skin involvement, the latter being caused by aberrant innate immune responses. Overactivation of the innate immune system leading to increased production of interleukin-1 family members and 'sterile' neutrophil-rich cutaneous inflammation are features of both inherited autoinflammatory syndromes with skin involvement and an increasing number of neutrophilic dermatoses. Therefore, we propose that autoinflammation may be a cause of neutrophilic dermatoses.
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Affiliation(s)
- T K Satoh
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
| | - M Mellett
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
| | - E Contassot
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
| | - L E French
- Department of Dermatology, University Hospital Zurich, Gloriastraße 31, Zurich, 8091, Switzerland
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Marzano AV, Tavecchio S, Berti E, Gelmetti C, Cugno M. Paradoxical Autoinflammatory Skin Reaction to Tumor Necrosis Factor Alpha Blockers Manifesting as Amicrobial Pustulosis of the Folds in Patients With Inflammatory Bowel Diseases. Medicine (Baltimore) 2015; 94:e1818. [PMID: 26559252 PMCID: PMC4912246 DOI: 10.1097/md.0000000000001818] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The therapy of inflammatory bowel disease, particularly with tumor necrosis factor (TNF) blockers, may be associated with a number of cutaneous adverse effects, including psoriasis-like, eczema-like, and lichenoid eruptions. Other rare skin complications are neutrophilic dermatoses such as amicrobial pustulosis of the folds (APF), which is a chronic relapsing pustular disorder classified in this spectrum.The authors analyzed clinical, histopathologic, and cytokine expression profiles of 3 inflammatory bowel disease patients with APF triggered by adalimumab (patient 1) and infliximab (patients 2 and 3).All 3 patients presented with sterile pustules involving the cutaneous folds, genital regions, and scalp 6 months after starting adalimumab (patient 1) and 9 months after starting infliximab (patients 2 and 3). Histology was characterized by epidermal spongiform pustules with a dermal neutrophilic and lymphocytic infiltrate. Tumor necrosis factor blocker withdrawal associated with topical and systemic corticosteroids induced complete remission of APF in all 3 patients. The expressions of interleukin (IL)-1 beta and its receptors as well as TNF alpha and its receptors were significantly higher in APF than in controls. Also IL-17, leukocyte selectin, and chemokines, such as IL-8, [C-X-C motif] chemokine ligand 1/2/3 (C = cysteine, X = any amino acid), [C-X-C motif] chemokine ligand 16 (C = cysteine, X = any amino acid), and RANTES (regulated on activation, normal T cell expressed and secreted) were significantly overexpressed. Finally, the authors found significant overexpression of both metalloproteinases 2/9 and their inhibitors 1/2.The observation of 3 patients with APF following anti-TNF therapy expands not only the clinical context of APF but also the spectrum of anti-TNF side effects. Overexpression of cytokines/chemokines and molecules amplifying the inflammatory network supports the view that APF is autoinflammatory in origin.
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Affiliation(s)
- Angelo V Marzano
- From the Dermatology Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (AVM, ST, EB, CG) and Internal Medicine Unit, Department of Pathophysiology and Transplantation, University of Milan, IRCCS Cà Granda Foundation, Milan, Italy (MC)
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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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Postoperative pyoderma gangrenosum (PG): The Mayo Clinic experience of 20 years from 1994 through 2014. J Am Acad Dermatol 2015. [DOI: 10.1016/j.jaad.2015.06.054] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Wallach D, Vignon-Pennamen MD. Pyoderma gangrenosum and Sweet syndrome: the prototypic neutrophilic dermatoses. Br J Dermatol 2015. [PMID: 26202386 DOI: 10.1111/bjd.13955] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pyoderma gangrenosum, a dramatic ulcerative skin disease, and Sweet syndrome, a papular dermatosis, were described independently. It was subsequently shown that they share many characteristics, including clinical overlap and the frequent association with multisystemic disorders. The group of the neutrophilic dermatoses encompasses these two dermatoses, as well as other conditions having in common an aseptic neutrophilic infiltrate predominating in the epidermis and/or the dermis and/or the subcutis. Some patients also experience neutrophilic infiltrates in other organs, defining the neutrophilic disease. Recent research suggests that the neutrophilic dermatoses could be considered as the cutaneous expression of the autoinflammation, an aberrant hyperproduction of interleukin-1. Autoinflammation is responsible for monogenic diseases, and is also involved in the mechanism of many polygenic conditions, including the neutrophilic dermatoses.
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Affiliation(s)
- D Wallach
- Médecin (hon). des Hôpitaux, Paris, France
| | - M-D Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, F-75010, Paris, France.,INSERM, U1165, F-75010, Paris, France.,Laboratoire de Pathologie, Hôpital Saint-Louis, AP-HP, F-75010, Paris, France
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Gade M, Studstrup F, Andersen AK, Hilberg O, Fogh C, Bendstrup E. Pulmonary manifestations of pyoderma gangrenosum: 2 cases and a review of the literature. Respir Med 2015; 109:443-50. [PMID: 25622759 DOI: 10.1016/j.rmed.2014.12.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 12/25/2014] [Accepted: 12/29/2014] [Indexed: 11/28/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare ulcerative neutrophilic dermatologic disease that occasionally is accompanied by extracutaneous manifestations, amongst these is pulmonary involvement. The etiology is unknown. More than 50% of PG cases are associated with an underlying systemic disease such as inflammatory bowel disease, rheumatoid arthritis, hematological disorder or malignancy. Extracutaneous manifestations are rare and only 29 cases of pulmonary involvement have been reported previously in the literature. Pyoderma gangrenosum is usually diagnosed in the third to sixth decade, but early debut in childhood is also described. Skin manifestations are usually evident before pulmonary involvement, although primary lung affection is seen. Pulmonary involvement is diagnosed simultaneously or from a few weeks up to several years after the diagnosis of cutaneous PG. The most important differential diagnoses are lung cancer, lung abscess and Wegener's granulomatosis. Histological specimens will exclude these diagnoses. The treatment of PG is immune modulation, but due to the rarity of the disease, only one randomized treatment trials exists [1] and the long term course of PG with pulmonary involvement is unknown. We present two cases of pulmonary manifestations of pyoderma gangrenosum and a review of the literature.
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Affiliation(s)
- Melina Gade
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Denmark.
| | - Frej Studstrup
- Department of Dermatology, Aarhus University Hospital, Denmark
| | | | - Ole Hilberg
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Denmark
| | - Carsten Fogh
- Department of Dermatology, Aarhus University Hospital, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Medicine and Allergology, Aarhus University Hospital, Denmark
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Méndez-Flores S, Charli-Joseph Y, Saeb-Lima M, Orozco-Topete R, Fernández Sánchez M. Amicrobial Pustulosis of the Folds Associated with Autoimmune Disorders: Systemic Lupus Erythematosus Case Series and First Report on the Association with Autoimmune Hepatitis. Dermatology 2013; 226:1-4. [DOI: 10.1159/000343595] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/15/2012] [Indexed: 11/19/2022] Open
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Sujobert P, Cuccuini W, Vignon-Pennamen D, Martin-Garcia N, Albertini AF, Uzunov M, Redjoul R, Dombret H, Raffoux E. Evidence of differentiation in myeloid malignancies associated neutrophilic dermatosis: a fluorescent in situ hybridization study of 14 patients. J Invest Dermatol 2012. [PMID: 23190893 DOI: 10.1038/jid.2012.408] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ahronowitz I, Harp J, Shinkai K. Etiology and management of pyoderma gangrenosum: a comprehensive review. Am J Clin Dermatol 2012; 13:191-211. [PMID: 22356259 DOI: 10.2165/11595240-000000000-00000] [Citation(s) in RCA: 265] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis characterized by painful, necrotic ulceration. It typically affects patients in the third to sixth decades of life, with almost equal incidence in men and women. PG occurs most frequently on the lower extremities. Five clinical variants are currently recognized: classic, bullous, pustular, vegetative, and peristomal types. Half of PG cases are seen in association with systemic disease. Mimickers include infection, vascular insufficiency ulcers, systemic vasculitides, autoimmune disease, cancer, and exogenous tissue injury, among others. PG is often a diagnosis of exclusion, as there are no specific laboratory or histopathologic findings to confirm the diagnosis. PG thus presents many clinical challenges: it is difficult to diagnose, is frequently misdiagnosed, and often requires a work-up for underlying systemic disease. Successful management of PG typically requires multiple modalities to reduce inflammation and optimize wound healing, in addition to treatment of any underlying diseases. Prednisone and cyclosporine have been mainstays of systemic treatment for PG, although increasing evidence supports the use of biologic therapies, such as tumor necrosis factor-α inhibitors, for refractory cases of PG. Here, we review the clinical presentation and pathophysiology of PG, as well as its associated conditions, diagnostic work-up, and management.
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Affiliation(s)
- Iris Ahronowitz
- Department of Dermatology, University of California, San Francisco, 94115, USA
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Brajon D, Cuny JF, Barbaud A, Schmutz JL. Dermatose neutrophilique des mains. Ann Dermatol Venereol 2011; 138:673-6. [DOI: 10.1016/j.annder.2011.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 02/19/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
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25
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Marzano AV, Cugno M, Trevisan V, Lazzari R, Fanoni D, Berti E, Crosti C. Inflammatory cells, cytokines and matrix metalloproteinases in amicrobial pustulosis of the folds and other neutrophilic dermatoses. Int J Immunopathol Pharmacol 2011; 24:451-60. [PMID: 21658319 DOI: 10.1177/039463201102400218] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Amicrobial pustulosis of the folds (APF) is a rare cutaneous disease characterized by relapsing sterile pustules frequently associated with autoimmune disorders. Although APF pathophysiology is still undefined, scattered reports suggest involvement of neutrophils. The aim of the present study is to evaluate the role of the skin inflammatory infiltrate, selected multifunctional cytokines and effectors of tissue damage in APF and other neutrophilic dermatoses. We studied, by immunohistochemical methods, inflammatory cell markers (CD3, CD163, myeloperoxidase), cytokines (TNF-alpha, IL-8, IL-17), metalloproteinases (MMP-2, MMP-9) and vascular-endothelial-growth-factor (VEGF) in lesional skin from six patients with APF, 11 with pyoderma gangrenosum (PG), 7 with Sweet's syndrome, and in 20 normal skin samples. Immunoreactivities of CD3, CD163, myeloperoxidase, TNF-alpha, IL-8, IL-17, MMP-2, MMP-9 and VEGF were significantly higher in APF, PG and Sweet's syndrome than in controls (p=0.0001). IL-8 was more expressed in PG than in APF (P=0.002) and Sweet's syndrome (p=0.001). In APF, MMP-9 reactivity was higher than in Sweet's syndrome (p=0.035), but less intense than in PG (p=0.020). Our study supports the role of proinflammatory cytokines/chemokines and MMPs as important effectors for the tissue damage in APF similarly to classic neutrophilic dermatoses.
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Affiliation(s)
- A V Marzano
- Unità Operativa di Dermatologia, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi di Milano, Italy
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Sobol UA, Sherman KL, Smith J, Nagda SN, Micetich K, Nickoloff BJ, Shoup MC. Sweet's syndrome with neurologic manifestations in a patient with esophageal adenocarcinoma: case report and review of the literature. Int J Dermatol 2009; 48:1062-5. [DOI: 10.1111/j.1365-4632.2009.04138.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Tlougan BE, Podjasek JO, O'Haver J, Cordova KB, Nguyen XH, Tee R, Pinckard-Hansen KC, Hansen RC. Chronic recurrent multifocal osteomyelitis (CRMO) and synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome with associated neutrophilic dermatoses: a report of seven cases and review of the literature. Pediatr Dermatol 2009; 26:497-505. [PMID: 19840301 DOI: 10.1111/j.1525-1470.2009.00984.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A growing body of literature has identified the association between neutrophilic dermatoses and multifocal, aseptic bone lesions in children, termed chronic recurrent multifocal osteomyelitis (CRMO). Classically, patients present with swelling, pain, and impaired mobility of the affected area, with skin lesions developing concurrently or in the future. Bone biopsy reveals inflammatory changes consistent with infectious osteomyelitis, but cultures and histologic staining invariably fail to identify an infectious source. Patients are refractory to antibiotic therapy, but dramatically respond to systemic steroids and may need to be maintained on low-dose steroids to prevent relapse. Numerous authors have suggested that CRMO and synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome lie along the same clinical spectrum. In fact some believe that CRMO is the pediatric presentation of SAPHO. The two syndromes share numerous characteristics, including osteitis, a unifocal or multifocal presentation, hyperostosis, and pustulosis, which all occur in a generally healthy individual. Our seven patients, five of whom were diagnosed with CRMO, and two of whom were diagnosed with SAPHO syndrome further strengthen the idea that CRMO and SAPHO syndrome do indeed lie along the same clinical spectrum. In addition, we include two rare cases of pediatric Sweet's syndrome with evidence of pathergy.
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Affiliation(s)
- Brook E Tlougan
- Department of Dermatology, New York University Langone Medical Center, New York, New York 10016, USA.
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PORNEUF M, DUTERQUE M, SOTTO A, JOURDAN J. Unusual erythema elevatum diutinum with fibrohistiocytic proliferation. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1996.d01-917.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Ocular Involvement in Acute Febrile Neutrophilic Dermatosis (Sweet Syndrome): New Cases and Review of the Literature. Surv Ophthalmol 2008; 53:219-26. [DOI: 10.1016/j.survophthal.2008.02.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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31
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Marzano AV, Ramoni S, Caputo R. Amicrobial Pustulosis of the Folds. Dermatology 2008; 216:305-11. [DOI: 10.1159/000113942] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 06/20/2007] [Indexed: 11/19/2022] Open
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Cañibano-Domínguez C, Fernández-Casado J, López-Quintana A, Acín F. Embolismo aortoilíaco de etiología multicausal en un paciente joven. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)06009-4] [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]
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Cohen PR. Sweet's syndrome--a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis 2007; 2:34. [PMID: 17655751 PMCID: PMC1963326 DOI: 10.1186/1750-1172-2-34] [Citation(s) in RCA: 490] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 07/26/2007] [Indexed: 01/19/2023] Open
Abstract
Sweet's syndrome (the eponym for acute febrile neutrophilic dermatosis) is characterized by a constellation of clinical symptoms, physical features, and pathologic findings which include fever, neutrophilia, tender erythematous skin lesions (papules, nodules, and plaques), and a diffuse infiltrate consisting predominantly of mature neutrophils that are typically located in the upper dermis. Several hundreds cases of Sweet's syndrome have been published. Sweet's syndrome presents in three clinical settings: classical (or idiopathic), malignancy-associated, and drug-induced. Classical Sweet's syndrome (CSS) usually presents in women between the age of 30 to 50 years, it is often preceded by an upper respiratory tract infection and may be associated with inflammatory bowel disease and pregnancy. Approximately one-third of patients with CSS experience recurrence of the dermatosis. The malignancy-associated Sweet's syndrome (MASS) can occur as a paraneoplastic syndrome in patients with an established cancer or individuals whose Sweet's syndrome-related hematologic dyscrasia or solid tumor was previously undiscovered; MASS is most commonly related to acute myelogenous leukemia. The dermatosis can precede, follow, or appear concurrent with the diagnosis of the patient's cancer. Hence, MASS can be the cutaneous harbinger of either an undiagnosed visceral malignancy in a previously cancer-free individual or an unsuspected cancer recurrence in an oncology patient. Drug-induced Sweet's syndrome (DISS) most commonly occurs in patients who have been treated with granulocyte-colony stimulating factor, however, other medications may also be associated with DISS. The pathogenesis of Sweet's syndrome may be multifactorial and still remains to be definitively established. Clinical and laboratory evidence suggests that cytokines have an etiologic role. Systemic corticosteroids are the therapeutic gold standard for Sweet's syndrome. After initiation of treatment with systemic corticosteroids, there is a prompt response consisting of dramatic improvement of both the dermatosis-related symptoms and skin lesions. Topical application of high potency corticosteroids or intralesional corticosteroids may be efficacious for treating localized lesions. Other first-line oral systemic agents are potassium iodide and colchicine. Second-line oral systemic agents include indomethacin, clofazimine, cyclosporine, and dapsone. The symptoms and lesions of Sweet's syndrome may resolved spontaneously, without any therapeutic intervention; however, recurrence may follow either spontaneous remission or therapy-induced clinical resolution.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Houston, Texas, USA.
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Affiliation(s)
- Philip R Cohen
- Dermatologic Surgery Center of Houston, Department of Dermatology, University of Texas-Houston Medical School, Houston, TX, USA.
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Masmoudi A, Chaaben H, Hamdouni K, Boudaya S, Bouassida S, Turki H, Zahaf A. [Sweet syndrome: retrospective study of 54 cases]. Presse Med 2007; 36:419-24. [PMID: 17321363 DOI: 10.1016/j.lpm.2006.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2006] [Accepted: 07/20/2006] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Sweet syndrome is the most common neutrophilic dermatosis. We studied its natural history and epidemiologic, clinical, and therapeutic characteristics from a series of 54 cases. MATERIALS AND METHODS This retrospective study examines 54 cases collected over a 10-year-period. Diagnosis was based on clinical and histological criteria. RESULTS Patients' mean age was 47 years. The sex ratio was 8 women for every man. Disease developed most often in autumn and onset was sudden in all patients. Untypical aspects were found in 20 patients. Lesions were located mainly on the arms (43 cases) and legs (33 cases). No mucous membrane involvement was observed. Histological testing found leukocytoclastic vasculitis in 8 cases. Sweet syndrome was idiopathic for 38 patients. Lesions began at the site of previous trauma for 9 patients, occurred during pregnancy for 2, and were associated with cancer for 3. First-line treatment was colchicine for 23 patients and oral steroids for 12. Six patients had recurrences and 2 patients had relapses. COMMENTARY This large series of patients with Sweet syndrome differs from other reports by the frequency of untypical aspects and post-traumatic forms, as well as the rarity of association with cancer. Histological findings of vasculitis do not rule out a diagnosis of Sweet syndrome.
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Ruhl AP, Ganz JE, Bickston SJ. Neutrophilic folliculitis and the spectrum of pyoderma gangrenosum in inflammatory bowel disease. Dig Dis Sci 2007; 52:18-24. [PMID: 17160479 DOI: 10.1007/s10620-006-9361-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 03/28/2006] [Indexed: 01/06/2023]
Affiliation(s)
- A P Ruhl
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Guerre-Schmidt AR, Pelletier F, Carbonnel F, Humbert P, Aubin F. Syndrome arthrocutané associé à une maladie de Crohn chez une adolescente. Rev Med Interne 2006; 27:874-7. [PMID: 16997433 DOI: 10.1016/j.revmed.2006.07.017] [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] [Received: 02/10/2006] [Revised: 07/21/2006] [Accepted: 07/21/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pustulosis, erythema nodosum, arthritis and systemic manifestations are associated in the dermatosis-arthritis syndrome. It is a well recognized complication of the bowel ileo-jejunal bypass but it is also associated with inflammatory bowel diseases. EXEGESE We report the case of an adolescent who presented with a dermatosis-arthritis syndrome associated to a Crohn's disease during a referring for pustulosis, erythema nodosum and fever. The evolution is complicated by proctorragia. Colonoscopy and intestinal biopsy found a Crohn's disease. Cutaneous and intestinal symptoms quickly improved with systemic corticosteroids. CONCLUSION The dermatosis-arthritis syndrome can be associated with bowel bypass and with inflammatory bowel disease, more frequently with ulcerative colitis than with Crohn's disease. It consists in a vesiculo-pustular eruption, erythema nodosum, fever, arthritis and ocular manifestations. Histopathology bears a strong resemblance with Sweet's syndrome. Physiopathology implicates microbial proliferation, formation of immune complex against skin and activation and migration of neutrophils and increasing factors. The treatment is based on corticosteroids and non steroid anti-inflammatory drugs or dapsone.
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Affiliation(s)
- A-R Guerre-Schmidt
- Département de dermatologie, CHU Saint-Jacques, 2, place Saint-Jacques, 25030 Besancon cedex, France
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Wallach D, Vignon-Pennamen MD. From acute febrile neutrophilic dermatosis to neutrophilic disease: forty years of clinical research. J Am Acad Dermatol 2006; 55:1066-71. [PMID: 17097401 DOI: 10.1016/j.jaad.2006.07.016] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 06/22/2006] [Accepted: 07/22/2006] [Indexed: 11/16/2022]
Abstract
In 1964, Sweet described an acute febrile neutrophilic dermatosis. It is now widely accepted that Sweet's syndrome belongs to a group of associated neutrophilic dermatoses. Although clinically dissimilar, Sweet's syndrome, pyoderma gangrenosum, subcorneal pustular dermatosis, erythema elevatum diutinum, and a few other conditions can be considered a part of this same pathologic spectrum of inflammatory disorders because of (1) the existence of transitional and overlap forms; (2) the similar histopathologic feature of an infiltrate by normal polymorphonuclear leukocytes; (3) the possible occurrence of extracutaneous neutrophilic infiltrates, defining the neutrophilic disease; and (4) the frequent association with systemic diseases. According to the localization of the neutrophilic infiltrate, we describe neutrophilic dermatoses en plaques (dermal), superficial (epidermal), and deep (dermal and hypodermal). Almost every organ of the body may be involved by a neutrophilic aseptic inflammation. The main systemic diseases associated with neutrophlic dermatoses are hematologic, gastrointestinal, and rheumatologic diseases. Although the pathophysiology of these conditions is still poorly understood, treatment with systemic anti-inflammatory agents is usually efficacious.
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Affiliation(s)
- Daniel Wallach
- Department of Dermatology, Hôpital Cochin-Tarnier, Paris, France.
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Sellier S, Levesque H, Courville P, Joly P. Dermatose neutrophilique, au décours d’une lymphadénopathie angio-immunoblastique, avec dysmyélopoïèse induite par le cyclophosphamide. Ann Dermatol Venereol 2006; 133:459-62. [PMID: 16760835 DOI: 10.1016/s0151-9638(06)70940-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cutaneous involvement in patients with angioimmunoblastic lymphadenopathy is often poorly specific for maculopapular eruptions. We report an atypical case of neutrophilic disorder associating subcorneal pustules and hypodermal nodules in a male patient with angioimmunoblastic lymphadenopathy. CASE REPORT A 62 year-old man with angioimmunoblastic lymphadenopathy was treated with oral prednisone (15 mg/day) and cyclophosphamide. Pustules and deep nodules occurred simultaneously on the arms and trunk, the abdomen and the back respectively. Biopsy of these lesions showed an infiltration of neutrophil polymorphonuclears in the median and superficial dermis with a subcorneal pustule and nodular infiltration of neutrophil polymorphonuclears in the deep dermis and hypodermis respectively. Increasing the dose of prednisone to 30 mg/day led to rapid and complete healing of the cutaneous lesions. DISCUSSION This atypical case of neutrophilic disorder associating acute subcorneal pustules and deep dermal-hypodermal nodules seems to correspond to a unique type of neutrophilic disorder that differs from those previously reported in the literature. Neutrophilic disorders have been reported only rarely in patients with angioimmunoblastic lymphadenopathy. This case illustrates the wide range of clinical and histological lesions found in neutrophilic disorders, a number of which may coexist in a single patient.
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Affiliation(s)
- S Sellier
- Clinique Dermatologique, CHU de Rouen, Rouen
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CHO KH, HAN KH, KIM SW, YOUN SW, YOUN JI, KIM BK. Neutrophilic dermatoses associated with myeloid malignancy. Clin Exp Dermatol 2006. [DOI: 10.1111/j.1365-2230.1997.tb01093.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Pyoderma gangrenosum (PG) is a rare, inflammatory, noninfective, nonneoplastic skin disorder, which is often associated with systemic diseases. These include inflammatory bowel disease, rheumatoid arthritis, paraproteinaemia, or hematologic malignancy, which can be found in up to 50% of patients with some variants of PG. Brunsting et al (Arch Dermatol 1930;22:655-80) first described PG as a disease entity in 5 patients who had painful, enlarging necrotic ulcers with bluish undermined borders surrounded by advancing zones of erythema. Four of these patients had chronic ulcerative colitis. They felt that the condition might be associated with bacterial infection (pyoderma) and considered it as linked to the underlying bowel disease. Although the cause of PG remains obscure, bacterial infection seems to be unrelated to its causation, rendering the term pyoderma redundant. In addition, the number of conditions reported in association with PG has markedly expanded in recent years, showing clearly that this is not solely a cutaneous manifestation of inflammatory bowel disease. The clinical concept of PG has also been broadened, and certain clinical variants of PG have been linked with different types of associated disease seen in these patients.
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Affiliation(s)
- Sharareh Ahmadi
- Regional Dermatology Centre, Mater Misericordiae Hospital, Dublin, Ireland
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Sapadin AN, Fleischmajer R. Tetracyclines: nonantibiotic properties and their clinical implications. J Am Acad Dermatol 2006; 54:258-65. [PMID: 16443056 DOI: 10.1016/j.jaad.2005.10.004] [Citation(s) in RCA: 470] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Revised: 08/16/2005] [Accepted: 10/05/2005] [Indexed: 10/25/2022]
Abstract
Tetracyclines are broad-spectrum antibiotics that act as such at the ribosomal level where they interfere with protein synthesis. They were first widely prescribed by dermatologists in the early 1950s when it was discovered that they were effective as a treatment for acne. More recently, biologic actions affecting inflammation, proteolysis, angiogenesis, apoptosis, metal chelation, ionophoresis, and bone metabolism have been researched. The therapeutic effects of tetracycline and its analogues in various diseases have also been investigated. These include rosacea, bullous dermatoses, neutrophilic diseases, pyoderma gangrenosum, sarcoidosis, aortic aneurysms, cancer metastasis, periodontitis, and autoimmune disorders such as rheumatoid arthritis and scleroderma. We review the nonantibiotic properties of tetracycline and its analogues and their potential for clinical application.
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Affiliation(s)
- Allen N Sapadin
- Department of Dermatology, Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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Boms S, Gambichler T. Review of literature on amicrobial pustulosis of the folds associated with autoimmune disorders. Am J Clin Dermatol 2006; 7:369-74. [PMID: 17173471 DOI: 10.2165/00128071-200607060-00005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Amicrobial pustulosis of the folds (APF) is characterized by relapsing, primary aseptic, pustular eruptions mainly affecting the cutaneous folds, scalp, and periorificial regions such as the mouth, external ear canal, and nostrils. APF is a rare condition that has previously been reported in 25 women exhibiting a wide spectrum of autoimmune abnormalities, particularly systemic lupus erythematosus. Histology of the skin lesions usually shows spongiform pustulation in the upper layer of the epidermis and a polymorphonuclear infiltrate in the dermis. APF must be differentiated from other noninfectious pustular diseases such as subcorneal pustulosis (Sneddon-Wilkinson disease) and pustular forms of psoriasis. APF should be included in the spectrum of reactive neutrophilic dermatoses, even though the exact pathomechanisms remain obscure. However, the striking female predominance may be of pathogenetic significance. Based on the small number of previously reported patients, the most effective therapy seems to be medium-dose systemic corticosteroids.
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Affiliation(s)
- Stefanie Boms
- Department of Dermatology, University of Heidelberg, Heidelberg, Germany
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Wallach D. Les dermatoses neutrophiliques. Rev Med Interne 2005; 26:41-53. [DOI: 10.1016/j.revmed.2004.06.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2004] [Accepted: 06/17/2004] [Indexed: 11/24/2022]
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Abstract
Sweet's syndrome, also referred to as acute febrile neutrophilic dermatosis, is characterized by a constellation of symptoms and findings: fever, neutrophilia, erythematous and tender skin lesions that typically show an upper dermal infiltrate of mature neutrophils, and prompt improvement of both symptoms and lesions after the initiation of treatment with systemic corticosteroids. Hundreds of patients with this dermatosis have been reported. The manifestations of Sweet's syndrome in these individuals have not only confirmed those originally described by Dr Robert Douglas Sweet in 1964, but have also introduced new features that have expanded the clinical and pathologic concepts of this condition. The history, clinical characteristics, laboratory findings, associated diseases, pathology, and treatment options of Sweet's syndrome are reviewed. The evolving and new concepts of this dermatosis that are discussed include: (i) Sweet's syndrome occurring in the clinical setting of a disease-related malignancy, or medication, or both; (ii) detection of additional sites of extracutaneous Sweet's syndrome manifestations; (iii) discovery of additional Sweet's syndrome-associated diseases; (iv) variability of the composition and/or location of the cutaneous inflammatory infiltrate in Sweet's syndrome lesions; and (v) additional efficacious treatments for Sweet's syndrome.
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Affiliation(s)
- Philip R Cohen
- University of Houston Health Center, Department of Dermatology, The University of Texas-Houston Medical School, Houston, Texas, USA.
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Abstract
Neutrophilic (lobular) panniculitis (NP) is a very rare condition that belongs to the group of neutrophilic dermatoses. We report the case of a patient with NP and review the relevant literature. NP appears as a subcutaneous nodular eruption. Histology shows a lobular neutrophilic infiltrate. NP must be differentiated from other types of panniculitis, and also from the subcutaneous septal involvement that may occur in some cases of Sweet's syndrome and from erythema nodosum. NP is significantly associated with myelodysplasia. It is highly sensitive to oral steroid therapy.
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Rodríguez Díaz E, Cuesta CÁ, Blanco Barrios S, Galache Osuna C, Requena Caballero C. Dermatosis eosinofílicas (I). ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)79228-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Rodríguez-Díaz E, Álvarez-Cuesta C, Blanco S, Galache C, Requena C. Dermatosis eosinofílicas (y II). ACTAS DERMO-SIFILIOGRAFICAS 2003. [DOI: 10.1016/s0001-7310(03)76659-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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