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Knobler R, Geroldinger-Simić M, Kreuter A, Hunzelmann N, Moinzadeh P, Rongioletti F, Denton C, Mouthon L, Cutolo M, Smith V, Gabrielli A, Bagot M, Olesen AB, Foeldvari I, Jalili A, Kähäri VM, Kárpáti S, Kofoed K, Olszewska M, Panelius J, Quaglino P, Seneschal J, Sticherling M, Sunderkötter C, Tanew A, Wolf P, Worm M, Skrok A, Rudnicka L, Krieg T. Consensus statement on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxoedema and scleroedema. J Eur Acad Dermatol Venereol 2024; 38:1281-1299. [PMID: 38456518 DOI: 10.1111/jdv.19937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
The term 'sclerosing diseases of the skin' comprises specific dermatological entities, which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present consensus provides an update to the 2017 European Dermatology Forum Guidelines, focusing on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, updated strategies for the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 2 of this consensus provides clinicians with an overview of the diagnosis and treatment of scleromyxoedema and scleroedema (of Buschke).
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Affiliation(s)
- Robert Knobler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Marija Geroldinger-Simić
- Department of Dermatology, Ordensklinikum Linz Elisabethinen, Linz, Austria
- Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Klinik Oberhausen, University Witten-Herdecke, Oberhausen, Germany
| | - Nicolas Hunzelmann
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | - Pia Moinzadeh
- Department of Dermatology and Venereology, University of Cologne, Cologne, Germany
| | | | - Christopher Denton
- Center for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Institut Cochin, Université de Paris Cité, Paris, France
| | - Maurizio Cutolo
- Laboratories for Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine DiMI, University Medical School of Genoa, IRCCS San Martino Genoa, Genova, Italy
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Armando Gabrielli
- Fondazione di Medicina Molecolare e Terapia Cellulare, Università Politecnica delle Marche, Ancona, Italy
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Anne B Olesen
- Department of Dermatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Ahmad Jalili
- Department of Dermatology, Dermatology & Skin Care Clinic, Buochs, Switzerland
| | - Veli Matti Kähäri
- Department of Dermatology and Venereology, University of Turku and Turku University Hospital, Turku, Finland
| | - Sarolta Kárpáti
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Budapest, Hungary
| | - Kristian Kofoed
- The Skin Clinic, Department of Dermato-Allergology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jaana Panelius
- Department of Dermatology and Allergology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Centre for Rare Skin Disorders, Hôpital Saint-Andre, University of Bordeaux, CNRS, Immuno CencEpT UMR 5164, Bordeaux, France
| | | | - Cord Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle, Halle (Saale), Germany
| | - Adrian Tanew
- Private Practice, Medical University of Vienna, Vienna, Austria
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venereology and Allergology, University Hospital Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Skrok
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Thomas Krieg
- Department of Dermatology and Venereology, and Translational Matrix Biology, University of Cologne, Cologne, Germany
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Linse KP, Enk A, Hoffmann J. [Dermato-neuro syndrome-an acute and life-threatening complication of scleromyxedema Arndt-Gottron]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00105-023-05159-w. [PMID: 37284981 PMCID: PMC10244840 DOI: 10.1007/s00105-023-05159-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Scleromyxedema Arndt-Gottron is the systemic variant of lichen myxedematosus in which mucin accumulation occurs in the dermis. The disease is usually chronically progressive and extracutaneous manifestations or complications are possible. The pathogenesis is unknown and the disease is usually associated with monoclonal gammopathy. High-dose intravenous immunoglobulins (IVIg) are considered to be an effective therapy. We report the case of a patient who developed dermato-neuro syndrome following an interruption of IVIg treatment and a SARS-CoV‑2 infection. A similar episode occurred 2 years earlier in association with an influenza A infection. Dermato-neuro syndrome is a potentially lethal neurological complication which is characterized by fever, delirium, convulsions, and coma.
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Affiliation(s)
- Kai-Philipp Linse
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland.
| | - Alexander Enk
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
| | - Jochen Hoffmann
- Abteilung Dermatologie, Venerologie und Allergologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 440, 69120, Heidelberg, Deutschland
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3
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Fritz M, Tinker D, Wessel AW, Morris GM, Goldenberg L, Fesler M, Rukmangadachar L, Hurley MY. SARS-CoV-2: A potential trigger of dermato-neuro syndrome in a patient with scleromyxedema. JAAD Case Rep 2021; 18:99-102. [PMID: 34778497 PMCID: PMC8571101 DOI: 10.1016/j.jdcr.2021.10.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mike Fritz
- University of Kentucky College of Medicine, Lexington, Kentucky
| | - Daniel Tinker
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
| | - Alex W Wessel
- Washington University School of Medicine, St. Louis, Missouri
| | - Gabriela M Morris
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
| | - Linda Goldenberg
- Division of Hematology, Oncology, & Cellular Therapy, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri
| | - Mark Fesler
- Division of Hematology, Oncology, & Cellular Therapy, Department of Internal Medicine, Saint Louis University, St. Louis, Missouri
| | | | - M Yadira Hurley
- Department of Dermatology, Saint Louis University, St. Louis, Missouri
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4
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Larios JM, Ciuro J, Sam Varghese T, Lyons SE. Successful treatment of dermato-neuro syndrome with plasmapheresis. BMJ Case Rep 2020; 13:13/12/e237170. [PMID: 33376089 PMCID: PMC7778741 DOI: 10.1136/bcr-2020-237170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Altered mental status can have many causes ranging from emergent intracranial pathologies to more insidious, systemic toxic aetiologies. We report a rare case of dermato-neuro syndrome in a 71-year-old man with a known history of scleromyxoedema. The patient initially presented with encephalopathy which quickly progressed to generalised tonic-clonic seizures and coma. While his presentation fits with other, although rare, cases of dermato-neuro syndrome, it is imperative to rule out lethal, more common causes of altered mentation. Due to the rarity and difficulty in diagnosis of dermato-neuro syndrome, there is a significant debate regarding the optimal management as there are no standardised treatment protocols. In our case, the patient was successfully treated with plasmapheresis resulting in improved neurologic function.
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Affiliation(s)
- Jose Maciel Larios
- Department of Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, USA
| | - Jordan Ciuro
- Department of Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, USA
| | - Thomson Sam Varghese
- Department of Internal Medicine, Providence-Providence Park Hospital, Southfield, Michigan, USA
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5
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Magira EE, Malouchou A, Karathanasi V, Mavropoulou N, Siempos II, Vourlakou C, Sykaras A, Anastasiadis G. Acute Encephalitic Syndrome Induced by Scleromyxedema. Am J Med Sci 2020; 360:192-195. [PMID: 32540147 DOI: 10.1016/j.amjms.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/20/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
Abstract
Dermato-neuro syndrome is a potentially fatal neurological complication of scleromyxedema consisting of fever, seizures, and coma. This is an overlooked scleromyxedema case of a 62-year-old female patient from 2-years ago. She was admitted to our ICU because of high fever, colloid speech, muscle ache, and nausea. Molecular methods in the cerebrospinal fluid for neurotropic viruses ruled out acute infectious encephalitis. Her thyroid hormones were within normal values while the serum protein electrophoresis confirmed the monoclonal gammopathy of immunoglobulin G lambda (IgG(λ)), known for the last 2 years. The subsequent bone-marrow biopsy excluded the development of multiple myeloma. The patient fulfilled fundamental diagnostic criteria of scleromyxedema (monoclonal gammopathy, normal thyroid function and the appearance of marked sclerosis and induration of the skin papules on the face, neck, extremities, and skin creases) presenting as dermato-neuro syndrome, which was histologically confirmed. She demonstrated a remarkable improvement after intravenous immunoglobulin treatment during the first 24 hours. Mimics of non-infectious acute encephalitis should include the clinical diagnosis of scleromyxedema, especially when patients present in the emergency department with acute fever, coma, and skin lesions of diffuse sclerodermoid and papular type.
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Affiliation(s)
- Eleni E Magira
- First Department of Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, University of Athens, Athens, Greece.
| | - Aikaterini Malouchou
- Dermatology Department, General Hospital of Athens, "Evangelismos", Athens, Greece
| | - Vasiliki Karathanasi
- Dermatology Department, General Hospital of Athens, "Evangelismos", Athens, Greece
| | - Niki Mavropoulou
- Dermatology Department, General Hospital of Athens, "Evangelismos", Athens, Greece
| | - Ilias I Siempos
- First Department of Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, University of Athens, Athens, Greece
| | - Christina Vourlakou
- Department of Pathology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Alexandros Sykaras
- Department of Pathology, General Hospital of Athens "Evangelismos", Athens, Greece
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6
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Atzori L, Ferreli C, Rongioletti F. New insights on scleromyxedema. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2019; 4:118-126. [PMID: 35382389 PMCID: PMC8922651 DOI: 10.1177/2397198318824929] [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: 12/09/2018] [Accepted: 12/24/2018] [Indexed: 10/14/2023]
Abstract
Scleromyxedema is a rare fibromucinous disorders, with several clinical and pathological overlaps with scleroderma and scleredema. Etiopathogenesis remains uncovered, and no explanation has been provided either for the origin of mucin deposition or for the paraprotein role. The disease does not show gender predilection and affects mainly middle-age adults. The course is unpredictable, and prognosis remains guarded for renal, cardiac, and neurologic complications, especially in the setting of dermato-neuro syndrome. A valuable recent progress is the consensus definition of diagnostic criteria and lines of treatment, which hold the promise to improve the early recognition and management of this rare condition worldwide. High-dose intravenous immunoglobulin has been suggested as the first-line treatment either alone or associated with systemic steroids and/or thalidomide. In very recalcitrant cases, adjunctive bortezomib and/or autologous stem cell transplant might be considered. Melphalan treatment was associated with very toxic side effects and actually is no longer recommended.
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Affiliation(s)
- Laura Atzori
- Dermatology Clinic, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Caterina Ferreli
- Dermatology Clinic, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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7
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Affiliation(s)
- Laura Atzori
- Dermatology Clinic, Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Caterina Ferreli
- Dermatology Clinic, Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Rongioletti
- Dermatology Clinic, Department Medical Science and Public Health, University of Cagliari, Cagliari, Italy
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8
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Weiner J, Marano A, Cardones A, Criscione-Schreiber L. Fever, Joint Pain, Seizures, and Rash in a 53-Year-Old Woman. Arthritis Care Res (Hoboken) 2017; 69:1437-1443. [PMID: 28376294 DOI: 10.1002/acr.23248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/03/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2022]
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9
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Bhoyrul B, Mughal AA, Paulus J, Salamat A, Howarth S. Does dermatoneuro syndrome have a viral aetiology? Clin Exp Dermatol 2015; 41:53-6. [DOI: 10.1111/ced.12698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- B. Bhoyrul
- Department of Dermatology; Singleton Hospital; Swansea UK
| | - A. A. Mughal
- Department of Dermatology; Singleton Hospital; Swansea UK
| | - J. Paulus
- Department of Dermatology; Singleton Hospital; Swansea UK
| | - A. Salamat
- Department of Haematology; Singleton Hospital; Swansea UK
| | - S. Howarth
- Department of Histopathology; Morriston Hospital; Swansea UK
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10
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Landais AF, Duchemin CM, Bourhis VM. Scleromyxedema (papular mucinosis) with dermato-neuro syndrome: A rare, potentially fatal complication. Presse Med 2015; 44:850-1. [DOI: 10.1016/j.lpm.2015.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 04/10/2015] [Indexed: 11/15/2022] Open
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11
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Shams SR, Goldstein DA, Kaufman JL, MacKelfresh J, Flowers CR, Langston AA. Dermato-Neuro Syndrome in a Patient Treated With Autologous Stem Cell Transplant for Scleromyxedema. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e213-5. [DOI: 10.1016/j.clml.2014.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 06/17/2014] [Accepted: 06/17/2014] [Indexed: 10/25/2022]
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12
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Charles S, Hainaut E, Cante V, Valette C, Levillain P, Guillet G. Dermatoneuro syndrome au cours d’un scléromyxœdème : efficacité des plasmaphérèses et des immunoglobulines intraveineuses. Ann Dermatol Venereol 2014; 141:523-7. [DOI: 10.1016/j.annder.2014.04.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/12/2014] [Accepted: 04/02/2014] [Indexed: 10/25/2022]
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13
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Long-term follow-up in a patient with the dermato-neuro syndrome treated with high-dose melphalan, thalidomide, and intravenous immunoglobulins for more than 7 years. Ann Hematol 2014; 93:1927-8. [DOI: 10.1007/s00277-014-2065-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
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Gerstner S, Kneitz H, Bröcker EB, Trautmann A. [Differential diagnose of angioedema. Acute edematous scleromyxedema]. Hautarzt 2014; 65:454-7. [PMID: 24663391 DOI: 10.1007/s00105-013-2724-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A woman presented in the emergency room with the diagnosis of angioedema refractory to treatment. She had soft, compressible periorbital edema, as well as edema of her hands and lower arms. She also complained of severe pain in her hands including sensations of numbness and tingling. The history, course and examination results eliminated several possible differential diagnostic considerations like an acute histamine- or bradykinin-mediated angioedema or superior vena cava syndrome. Histological examination confirmed the diagnosis of scleromyxedema.
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Affiliation(s)
- S Gerstner
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef Schneider Str. 2, 97080, Würzburg, Deutschland,
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15
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Macnab M, Kenny P. Successful intravenous immunoglobulin treatment of atypical lichen myxedematosus associated with hypothyroidism and central nervous system involvement: case report and discussion of the literature. J Cutan Med Surg 2013; 17:69-73. [PMID: 23364155 DOI: 10.2310/7750.2012.11125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lichen myxedematosus (LM) is a rare idiopathic disorder characterized by papules, plaques, and/or nodules in the skin secondary to mucin deposition and variable dermal fibrosis in the absence of thyroid disease. Case reports are the predominant literature on LM due to its rarity, and the data are limited regarding the disease. No standard treatment regimen exists, and the response to treatment varies. OBJECTIVE This report adds to the limited literature on atypical LM associated with thyroid dysfunction and contributes to the growing body of evidence supporting intravenous immunoglobulin (IVIg) as effective therapy for extensive cases. METHODS AND RESULTS We report an unusual case of atypical LM associated with hypothyroidism, central nervous system (CNS) disturbances, and atrial fibrillation in a 64-year-old male. The patient experienced remarkable improvement within 3 months of beginning IVIg treatment; however, he required repeat therapy due to the recurrence of CNS symptoms 3 months after treatment. CONCLUSION We agree with previous authors that thyroid dysfunction alone should not preclude a diagnosis of LM. Additionally, we contribute to the increasing evidence of IVIg being an effective treatment, particularly in the setting of systemic complications or acute worsening of LM.
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Affiliation(s)
- Magnus Macnab
- Department of Dermatology, University of British Columbia, Vancouver, BC, Canada
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Kreuter A, Stücker M, Kolios AGA, Altmeyer P, Möllenhoff K. [Scleromyxedema. A chronic progressive systemic disease]. Z Rheumatol 2012; 71:504-14. [PMID: 22806700 DOI: 10.1007/s00393-012-0997-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Scleromyxedema is a rare connective tissue disease that may affect numerous internal organs in addition to the skin. The disease is almost exclusively associated with monoclonal gammopathy. MATERIAL AND METHODS This retrospective study summarizes the clinical characteristics of four patients with scleromyxedema. In all of the patients a systematic serological and apparative check-up was performed. RESULTS The mean age of the four patients (three women and one man) was 51 years. In all cases, monoclonal gammopathy (3 cases of IgG lambda and 1 case of IgG kappa) was involved. In one patient, skin lesions were restricted to the upper part of the body and three patients had generalized disease. The internal organs of all patients were affected with fibrosis of the lungs, myositis and arthritis, peripheral polyneuropathy and hypomotility of the esophagus. The most effective forms of treatment in this patient collective were dexamethasone-pulse therapy, intravenous immunoglobulins and bortezomib. All patients had recurrences after finishing therapy. The mean observation period after the initial diagnosis of scleromyxedena was 6.25 years (range 2-11 years). CONCLUSION Scleromyxedema is a rare multisystemic disease. The heterogeneous affection of internal organs necessitates a comprehensive check-up. The response to recently published treatment strategies is low and recurrences after finishing therapy are frequent.
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Affiliation(s)
- A Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, Ruhr-Universität Bochum im St. Josef Hospital, Gudrunstr. 56, 44791, Bochum, Deutschland.
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Bielsa I, Benvenutti F, Guinovart R, Ferrándiz C. Escleromixedema y síndrome dermato-neuro: buena respuesta al tratamiento con glucocorticoides e inmunoglobulinas endovenosas. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:317-20. [DOI: 10.1016/j.ad.2011.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Revised: 04/04/2011] [Accepted: 04/12/2011] [Indexed: 11/27/2022] Open
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18
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Bielsa I, Benvenutti F, Guinovart R, Ferrándiz C. Good Response of Scleromyxedema and Dermato-Neuro Syndrome to Treatment With Intravenous Immunoglobulins. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Fleming KE, Virmani D, Sutton E, Langley R, Corbin J, Pasternak S, Walsh NM. Scleromyxedema and the dermato-neuro syndrome: case report and review of the literature. J Cutan Pathol 2012; 39:508-17. [DOI: 10.1111/j.1600-0560.2012.01882.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Tan E, Lau N, Yung A. Scleromyxoedema: a cause for unexplained encephalopathy and myositis. Clin Exp Dermatol 2010; 35:746-8. [DOI: 10.1111/j.1365-2230.2010.03807.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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21
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Rey JB, Luria RB. Treatment of scleromyxedema and the dermatoneuro syndrome with intravenous immunoglobulin. J Am Acad Dermatol 2009; 60:1037-41. [PMID: 19249127 DOI: 10.1016/j.jaad.2008.11.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 11/05/2008] [Accepted: 11/07/2008] [Indexed: 10/21/2022]
Abstract
Scleromyxedema is a rare disease characterized by extensive mucin deposition with fibrosis, and is associated with a monoclonal gammopathy. Currently there is no consensus on optimal treatment of this potentially fatal disease because of the lack of randomized controlled trials and limited number of case reports. At the time of this writing, 24 cases were published reporting clinical improvement of scleromyxedema with intravenous immunoglobulin. Herein we report a case showing dramatic improvement of scleromyxedema symptoms, both cutaneous and extracutaneous (including the dermatoneuro syndrome), and review the use of intravenous immunoglobulin in the treatment of scleromyxedema. This is a single case. The rarity of scleromyxedema, especially the dermatoneuro syndrome, precludes impedes large trials. In conclusion, increasing evidence supports intravenous immunoglobulin as an effective and relatively safe treatment for both cutaneous and extracutaneous manifestations of scleromyxedema, including the dermatoneuro syndrome.
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Affiliation(s)
- Jeanmarie B Rey
- Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA
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22
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Gholam P, Hartmann M, Enk A. Arndt–Gottron scleromyxoedema: successful therapy with intravenous immunoglobulins. Br J Dermatol 2007; 157:1058-60. [PMID: 17854360 DOI: 10.1111/j.1365-2133.2007.08169.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Scleromyxedema is a rare cutaneous mucinous disease characterized by a generalized papular sclerodermoid eruption and systemic manifestations that can lead to significant morbidity and mortality. Although its etiology remains unknown, most theories focus on a pathogenic role by paraproteins; it must be noted, however, that nonparaprotein factors have been suggested to cause fibroblast proliferation and increased mucin production. Several treatment modalities including melphalan, cyclophosphamide, interferon alfa, and plasmapheresis have been suggested; however, further research is needed to prove treatment efficacy.
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24
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Shergill B, Orteu CH, McBride SR, Rustin MHA. Dementia associated with scleromyxoedema reversed by high-dose intravenous immunoglobulin. Br J Dermatol 2005; 153:650-2. [PMID: 16120159 DOI: 10.1111/j.1365-2133.2005.06710.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Scleromyxoedema is a rare skin disease, characterized by deposition of acid mucopolysaccharides in the dermis. Although the disease primarily affects the skin, cardiovascular, renal and rheumatological manifestations have been described. In addition to these noncutaneous manifestations, about 15% of patients have central neurological symptoms such as psychosis, convulsions and encephalopathy. Successful therapy is difficult but high-dose intravenous immunoglobulin (IVIg) has been reported to be a successful treatment. We describe a patient with scleromyxoedema who presented with novel central nervous system manifestations of chronic cognitive impairment and dementia (Folstein Mini Mental State test score 8/30), which improved within a week after treatment with high-dose IVIg, with full restoration (Folstein Mini Mental State test score 27/30) at 2 months.
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Affiliation(s)
- B Shergill
- Department of Dermatology, The Royal Free Hospital, London NW3 2QG, UK.
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25
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Abstract
Scleromyxedema is a rare disease characterized by papular mucinous deposits, dermal fibroblast proliferation, and a monoclonal paraproteinemia. Its chronic course tends to be complicated by gastrointestinal, muscular, pulmonary, and neurologic disorders. We review the literature to identify the common systemic manifestations and suggest a clinical approach to this disorder. This should include: identification of the characteristic lesions, a skin biopsy, and serum protein electrophoresis. A thyroid evaluation may help differentiate this condition from others. An early neurologic, gastrointestinal, and cardiovascular evaluation should be considered.
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Affiliation(s)
- John J Pomann
- Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA
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26
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Abstract
The cutaneous mucinoses are a complex group of dermatologic diseases with local, follicular, or diffuse disease. The diffuse cutaneous mucinoses are remarkable not only for their dermal disease, but also for the numerous systemic manifestations. It is important that the clinical dermatologist be able accurately to diagnose and differentiate scleredema, scleromyxedema, REM, generalized myxedema of hypothyroidism, and pretibial myxedema of hyperthyroidism. Because of the variability of associated systemic manifestations, some with substantial morbidity and mortality, accurate diagnosis is vital for awareness and appropriate management.
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Affiliation(s)
- Elise M Jackson
- University of Virginia Health System, School of Medicine, Box 800739, Charlotesville, VA 22908, USA
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Affiliation(s)
- J R Berger
- Department of Neurology, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0284, USA
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28
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Lister RK, Jolles S, Whittaker S, Black C, Forgacs I, Cramp M, Potter M, Rustin MH. Scleromyxedema: response to high-dose intravenous immunoglobulin (hdIVIg). J Am Acad Dermatol 2000; 43:403-8. [PMID: 10901735 DOI: 10.1067/mjd.2000.104001] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report 2 patients with scleromyxedema, both associated with IgG-lambda paraproteinemia, who were treated with high-dose intravenous immunoglobulin (hdIVIg) 2g/kg per month. The response to treatment was assessed using an objective skin scoring system initially established for patients with scleroderma. This system grades the overall severity of the induration and the reduction in mobility of the skin. Both patients initially had a dramatic response to treatment which was sustained in one patient. The first patient, a 30-year-old black man, showed a reduction in skin scores from 36/60 to 11/60 over a 3-month period, during which time he had 3 infusions of hdIVIg. After an unplanned 2-month break from treatment, severe neuromuscular complications developed. These improved initially with more frequent infusions of hdIVIg but oral corticosteroids were required to treat worsening myopathy. Unfortunately, the initial response to hdIVIg has not been sustained and his skin scores at 1 year returned to baseline. The second patient, a 60-year-old white man, showed a similarly dramatic reduction in skin scores from 36/60 to 15/60 over a 3-month period after having received only 2 infusions of hdIVIg. There has been sustained improvement after 10 months of therapy and the interval between hdIVIg infusions has been increased to 10 weeks without deterioration. HdIVIg may be an effective treatment for some patients with scleromyxedema, a rare condition with few effective treatments and a poor prognosis.
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Affiliation(s)
- R K Lister
- Department of Dermatology, Royal Free Hospital, London, UK
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Gonzalez J, Palangio M, Schwartz J, Klainer AS, Bisaccia E. Scleromyxedema with dermato-neuro syndrome. J Am Acad Dermatol 2000; 42:927-8. [PMID: 10767707 DOI: 10.1016/s0190-9622(00)90274-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Scleromyxedema is a rare connective tissue disease of unknown cause characterized by a generalized papular eruption, dermal fibroblast proliferation, and monoclonal paraproteinemia. A paroxysmal triad consisting of high fever, seizures, and coma with a flu-like prodrome can rarely occur in patients with scleromyxedema and is termed "dermato-neuro syndrome." We describe a 41-year-old patient with scleromyxedema in whom the dermato-neuro syndrome developed.
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Affiliation(s)
- J Gonzalez
- Section of Photopheresis and Department of Internal Medicine, Morristown Memorial Hospital, Morristown, NJ 07962-1956, USA
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