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Oddenino GA, Cozzani EC, Capurro N, Parodi A. Atypical Dermatitis of the Hand: A Quiz. Acta Derm Venereol 2022; 102:adv00828. [PMID: 36472365 PMCID: PMC9811298 DOI: 10.2340/actadv.v102.4521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract is missing (Quiz)
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Affiliation(s)
- Giorgio Alberto Oddenino
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San Martino, IRCCS, Università di Genova, IT-16132 Genova, Italy.
| | - Emanuele C Cozzani
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San Martino, IRCCS, Università di Genova, IT-16132 Genova, Italy
| | - Niccolò Capurro
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San Martino, IRCCS, Università di Genova, IT-16132 Genova, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health and Science (DissaL), Polyclinic Hospital San Martino, IRCCS, Università di Genova, IT-16132 Genova, Italy
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Lowy DB, Makker PGS, Moalem-Taylor G. Cutaneous Neuroimmune Interactions in Peripheral Neuropathic Pain States. Front Immunol 2021; 12:660203. [PMID: 33912189 PMCID: PMC8071857 DOI: 10.3389/fimmu.2021.660203] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022] Open
Abstract
Bidirectional interplay between the peripheral immune and nervous systems plays a crucial role in maintaining homeostasis and responding to noxious stimuli. This crosstalk is facilitated by a variety of cytokines, inflammatory mediators and neuropeptides. Dysregulation of this delicate physiological balance is implicated in the pathological mechanisms of various skin disorders and peripheral neuropathies. The skin is a highly complex biological structure within which peripheral sensory nerve terminals and immune cells colocalise. Herein, we provide an overview of the sensory innervation of the skin and immune cells resident to the skin. We discuss modulation of cutaneous immune response by sensory neurons and their mediators (e.g., nociceptor-derived neuropeptides), and sensory neuron regulation by cutaneous immune cells (e.g., nociceptor sensitization by immune-derived mediators). In particular, we discuss recent findings concerning neuroimmune communication in skin infections, psoriasis, allergic contact dermatitis and atopic dermatitis. We then summarize evidence of neuroimmune mechanisms in the skin in the context of peripheral neuropathic pain states, including chemotherapy-induced peripheral neuropathy, diabetic polyneuropathy, post-herpetic neuralgia, HIV-induced neuropathy, as well as entrapment and traumatic neuropathies. Finally, we highlight the future promise of emerging therapies associated with skin neuroimmune crosstalk in neuropathic pain.
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Affiliation(s)
- Daniel B Lowy
- School of Medical Sciences, The University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
| | - Preet G S Makker
- School of Medical Sciences, The University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
| | - Gila Moalem-Taylor
- School of Medical Sciences, The University of New South Wales, UNSW Sydney, Sydney, NSW, Australia
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Egger A, Tosti A. Carpal tunnel syndrome and associated nail changes: Review and examples from the author's practice. J Am Acad Dermatol 2020; 83:1724-1729. [PMID: 32199899 DOI: 10.1016/j.jaad.2020.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 01/17/2023]
Abstract
Carpal tunnel syndrome (CTS) is commonly seen by general practitioners and often presents with neurologic symptoms of nocturnal pain and paresthesia along the median nerve distribution. Approximately 20% of patients also present with cutaneous findings (ulcerations, blistering, sclerodactyly, nail dystrophy) characterizing a severe form called necrotic CTS. Necrotic CTS can also be associated with bone changes (acro-osteolysis). In the author's practice, combined nail and skin findings are not an uncommon presentation of CTS, although this form remains overlooked and underreported in the dermatological textbooks and studies. This manuscript aims to review the literature on CTS cases, with a specific focus on using associated nail findings as diagnostic clues. The literature review along with a few additional recent cases from the author's practice demonstrate that CTS is frequently accompanied by a variety of nail changes including koilonychia, longitudinal fissuring, Beau's lines, onychomadesis, melanonychia, nail thickening, hyperkeratosis, and ischemic ulcerations with paronychia. Furthermore, when these changes are limited to the second and third fingernails, they should prompt the diagnosis of CTS. Once suspected, diagnostic evaluation is not difficult and surgical management can resolve cutaneous findings and prevent irreversible changes such as acro-osteolysis.
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Affiliation(s)
- Andjela Egger
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida.
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Cevik B, Tekcan A, Inanir A, Kurt SG, Yigit S. The investigation of association between IL-1Ra and ACE I/D polymorphisms in carpal tunnel syndrome. J Clin Lab Anal 2017; 32. [PMID: 28370589 DOI: 10.1002/jcla.22204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 02/22/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Carpal tunnel syndrome (CTS) is a common neurologic impairment caused by injury on the median nerve in the wrist, characterized by pain and loss of sensory. CTS usually occurs through three factors, such as a mechanical pressure on median nerve, immunologic changes, and oxidative stress. The aim of this study was to evaluate the influence of interleukin-1 receptor antagonist (IL-1Ra) and angiotensin-converting enzyme (ACE) I/D polymorphisms on the susceptibility of patients to the CTS. METHODS One hundred fifty-eight patients with CTS and 151 healthy controls were enrolled in this study. Each patient was analyzed according to diseases symptoms, such as gender, a positive Tinel's sign, a positive Phalen maneuver, disease sides, EMG findings, and clinical stage. We applied the polymerase chain reaction (PCR) to determine the polymorphisms of IL-1Ra and ACE I/D. RESULTS The statistically significant relation was not found between IL-1Ra, ACE I/D polymorphisms and CTS (respectively, P>.05; P>.05, OR: 1.51, CI: 0.82-1.61). Additionally, in the result of the statistical analysis compared with gene polymorphisms and clinical characteristics, we did not find any correlation (P>.05). CONCLUSIONS Our findings showed that there are no associations of IL-1Ra and ACE I/D polymorphisms with susceptibility of a person for the development of CTS. So, it means that these polymorphisms do not create a risk for the development of CTS. Further studies with larger populations will be required to confirm these findings in different study populations.
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Affiliation(s)
- Betul Cevik
- Faculty of Medicine, Department of Neurology, Gaziosmanpasa University, Tokat, Turkey
| | - Akin Tekcan
- Faculty of Medicine, Department of Medical Biology, Ahi Evran University, Kirsehir, Turkey
| | - Ahmet Inanir
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Gaziosmanpasa University, Tokat, Turkey.,Academic Pain-Hernia Center, Samsun, Turkey
| | - Semiha Gulsum Kurt
- Faculty of Medicine, Department of Neurology, Gaziosmanpasa University, Tokat, Turkey
| | - Serbulent Yigit
- Faculty of Medicine, Department of Medical Biology, Gaziosmanpasa University, Tokat, Turkey
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Romeo EL, Previti M, Giandalia A, Russo GT, Cucinotta D. Ulcero-osteolytic lesions in a woman with type 2 diabetes and carpal tunnel syndrome: A case report and literature review. Diabetes Res Clin Pract 2016; 113:204-7. [PMID: 26830858 DOI: 10.1016/j.diabres.2016.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Abstract
We describe the case of a 73-year-old woman with type 2 diabetes presenting with ulcers and ostelytic lesions on distal phalanges of left hand, who was diagnosed with the rare "ulcero-mutilating" variant of carpal tunnel syndrome. A review of literature on cutaneous manifestations associated with the syndrome is also presented.
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Affiliation(s)
- Elisabetta L Romeo
- Department of Clinical and Experimental Medicine, University of Messina, Italy.
| | - Marcello Previti
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Annalisa Giandalia
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Giuseppina T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Domenico Cucinotta
- Department of Clinical and Experimental Medicine, University of Messina, Italy
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Şalçini C, Sunter G, Gumustas SA, Evrensel A. Cervical dermatomal zona misdiagnosed as ulnar nerve entrapment. BMJ Case Rep 2015; 2015:bcr-2015-209669. [PMID: 26032704 DOI: 10.1136/bcr-2015-209669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Herpes zoster is a secondary reactivation of primary contagious varicella-zoster virus in the dorsal root ganglia. While thoracic zona is common, cervical dermatomal zona is a rare segmental complication of herpes zoster and can be easily misdiagnosed as other diseases. This article describes a patient with initial neuralgia without dermatomal lesions that was treated as ulnar nerve entrapment syndrome until manifestation of herpetiform cutaneous lesions appeared. It is important that clinicians should be aware of the possibility of zoster infection when evaluating the onset of neuralgia in a dermatomal distribution in the upper limb, especially without rash.
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Affiliation(s)
- Celal Şalçini
- Department of Neurology, Uskudar University, NPIstanbul Neuropsychiatry Hospital, İstanbul, Turkey
| | - Gülin Sunter
- Department of Neurology, Ümraniye Eğitim ve Araştırma Hastanesi, İstanbul, Turkey
| | - Seyit Ali Gumustas
- Department of Orthopedics, Yavuz Selim Kemik Hastalıkları ve Rehabilitasyon Hastanesi, Trabzon, Turkey
| | - Alper Evrensel
- Department of Psychiatry, Uskudar University, İstanbul, Turkey
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Piccolo V, Russo T, Bove D, Baroni A. Segmental immune disorders resulting from neurologic injuries. Clin Dermatol 2015; 32:628-32. [PMID: 25160104 DOI: 10.1016/j.clindermatol.2014.04.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The immunocompromised cutaneous district (ICD) is a novel pathogenic concept that refers to the occurrence of opportunistic skin disorders (such as infections, malignancies, and immune diseases) at a cutaneous site previously marked by a damaging event, usually involving the local lymph network or peripheral sensory nerves. In addition to herpetic infections, which are notoriously harmful for sensory nerve fibers and therefore already included among the potential causes of ICD, there are a large and variegate group of further neurologic diseases, both peripheral (carpal tunnel syndrome, facial nerve palsy, and trigeminal trophic syndrome) and central (poliomyelitis and brain stroke), which may be added to the wide and expanding spectrum of injuring events resulting in an ICD. The neural compartment of skin immunity plays a key role in immune homeostasis, and this assertion is confirmed by the fact that any neurologic injury, whatever the origin (peripheral or central) or the cause (infection, trauma, ischemia), can give rise to immune destabilization of the innervated area, which becomes a site prone to the occurrence of opportunistic skin disorders. A neural-driven process may be responsible for the cutaneous immune dysregulation ensuing from some neurologic diseases.
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Affiliation(s)
- Vincenzo Piccolo
- Department of Dermatology, Second University of Naples, Naples, Italy.
| | - Teresa Russo
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Domenico Bove
- FUSIS Association for Scientific Research in Neurology and Psychiatry of Childhood and Adolescence, Alvignano (Caserta), Italy
| | - Adone Baroni
- Department of Dermatology, Second University of Naples, Naples, Italy
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Maldonado García C, Valente Duarte de Sousa IC, López Cepeda L. Necrotic carpal tunnel syndrome in a child. Pediatr Dermatol 2014; 31:500-3. [PMID: 23360428 DOI: 10.1111/pde.12066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Median nerve entrapment at the wrist level causes carpal tunnel syndrome (CTS). Although frequent in adults, CTS is a rare entity in children. Bouvier described an exceptional necrotic variant in 1979 in which skin, nail, and bone lesions are typical. We report the case of a 10-year-old child with necrotic CTS secondary to trauma. To our knowledge, this is the first case reported in a child.
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Bove D, Lupoli A, Caccavale S, Piccolo V, Ruocco E. Dermatological and immunological conditions due to nerve lesions. FUNCTIONAL NEUROLOGY 2014; 28:83-91. [PMID: 24125557 DOI: 10.11138/fneur/2013.28.2.083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Some syndromes are of interest to both neurologists and dermatologists, because cutaneous involvement may harbinger symptoms of a neurological disease. The aim of this review is to clarify this aspect. The skin, because of its relationships with the peripheral sensory nervous system, autonomic nervous system and central nervous system, constitutes a neuroimmunoendocrine organ. The skin contains numerous neuropeptides released from sensory nerves. Neuropeptides play a precise role in cutaneous physiology and pathophysiology, and in certain skin diseases. A complex dysregulation of neuropeptides is a feature of some diseases of both dermatological and neurological interest (e.g. cutaneous and nerve lesions following herpes zoster infection, cutaneous manifestations of carpal tunnel syndrome, trigeminal trophic syndrome). Dermatologists need to know when a patient should be referred to a neurologist and should consider this option in those presenting with syndromes of unclear etiology.
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