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Ali FM, Zhou J, Wang M, Wang Q, Sun L, Mshenga MM, Lu H. Epidermolysis Bullosa: Two rare case reports of COL7A1 and EBS-GEN SEV KRT14 variants with review of literature. BMC Pediatr 2024; 24:242. [PMID: 38580989 PMCID: PMC10996244 DOI: 10.1186/s12887-024-04715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/20/2024] [Indexed: 04/07/2024] Open
Abstract
EPIDERMOLYSIS Bullosa is a rare hereditary skin condition that causes blisters. Genes encoding structural proteins at or near the dermal-epidermal junction are mutated recessively or dominantly, and this is the primary cause of EB. Herein, two Chinese boys were diagnosed with the condition, each with a different variant in a gene that serves as a reference for EB genetic counseling. Skincare significantly impacted their prognosis and quality of life. CASE PRESENTATION Two Chinese boys, with phenotypically normal parents, have been diagnosed with distinct blister symptoms, one with Dominant Dystrophic Epidermolysis Bullosa and the other with a severe form of Epidermolysis Bullosa Simplex. The first patient had a G-to-A variant in the COL7A1 allele, at nucleotide position 6163 which was named "G2055A". The proband is heterozygous for Dystrophic Epidermolysis Bullosa due to a COL7A1 allele with a glycine substitution at the triple helix domain. A similar variant has been discovered in his mother, indicating its potential transmission to future generations. Another patient had severe Epidermolysis Bullosa Simplex with a rare c.377T > A variant resulting in substitution of amino acid p.Leu126Arg (NM_000526.5 (c.377T > G, p.Leu126Arg) in the Keratin 14 gene. In prior literature, Keratin 14 has been associated with an excellent prognosis. However, our patient with this infrequent variant tragically died from sepsis at 21 days old. There has been a reported occurrence of the variant only once. CONCLUSION Our study reveals that Epidermolysis Bullosa patients with COL7A1 c.6163G > A and KRT14 c.377T>A variants have different clinical presentations, with dominant forms of Dystrophic EB having milder phenotypes than recessive ones. Thus, the better prognosis in the c.6163G > A patient. Furthermore, c.377T>A patient was more prone to infection than the patient with c.6163G>A gene variant. Genetic testing is crucial for identifying the specific variant responsible and improving treatment options.
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Affiliation(s)
- Fatma Mabrouk Ali
- Department of Pediatrics, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jieyu Zhou
- Department of Pediatrics, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Mingyan Wang
- Department of Pediatrics, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Qiuxia Wang
- Department of Pediatrics, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Lulu Sun
- Department of Pediatrics, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China
| | | | - Hongyan Lu
- Department of Pediatrics, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
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Noble CA, Bhate C, Duong BT, Cruse AR, Brodell RT, Hanus RC. Clinical-pathologic correlation: The impact of grossing at the bedside. Semin Diagn Pathol 2024:S0740-2570(24)00006-6. [PMID: 38336505 DOI: 10.1053/j.semdp.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/02/2024] [Indexed: 02/12/2024]
Abstract
The unenlightened clinician may submit a skin specimen to the lab and expect an "answer." The experienced clinician knows that in performing skin biopsies, it is critical to select the most appropriate: 1) anatomic location for the biopsy1,2; 2) type of biopsy1,2; 3) depth and breadth of the biopsy; and 4) medium for hematoxylin and eosin staining (formalin) or direct immunofluorescence (Michel's Transport Medium or normal saline).2 Demographic information, anatomic location, clinical context, and differential diagnosis are all critical components of a properly completed requisition form.3-5 Proper biopsy design and appropriate grossing of the tissue at the bedside should be added to this list. In this article, we review the basics of gross pathologic examination and then provide four examples to demonstrate that optimal clinical-pathologic correlation requires the clinician consider the needs of the pathologist when tissue is presented to the lab.
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Affiliation(s)
- C Alexis Noble
- PGY-3, Department of Dermatology, University of Mississippi Medical Center, Jackson, MS, United States.
| | - Chinmoy Bhate
- Clinical Assistant Professor, Dermatology, Pathology & Laboratory Medicine Rutgers New Jersey Medical School Newark, New Jersey, United States
| | - Buu T Duong
- University of Mississippi Medical Center Jackson, Mississippi, United States
| | - Allison R Cruse
- Assistant Professor, Department of Dermatology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Robert T Brodell
- Professor and Chair, Department of Dermatology, Professor, Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Riley C Hanus
- Department of Mechanical Engineering, Georgia Institute of Technology Atlanta, GA, United States
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Saal RC, Edwards JF, Whitlock SM, Byrd RC. Dermatologic conditions in dancers: a statewide survey. Arch Dermatol Res 2023; 316:54. [PMID: 38112897 DOI: 10.1007/s00403-023-02787-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/03/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
Performing artists, such as dancers, singers, actors and musicians, rely on their physical bodies to successfully execute their artforms. However, literature regarding dermatologic conditions that impact dancers is lacking. An anonymous REDCap® secure survey was distributed by email to Dance Majors, Dance Minors, and Dance Instructors/Professors at five Virginia undergraduate institutions. Responses regarding demographics, style of dance, and dermatological diseases were recorded over a 2 month period. When asked about developing skin disease, 57 (59%) of survey participants reported experiencing skin diseases, such as acne, eczema, hyperhidrosis, and plantar warts. When asked about skin diseases exacerbated or believed to be caused from dancing, 56 (59%) reported blisters, callouses, skin splitting, nail/foot infection, ingrown nails, and floor burns. This study demonstrates two main findings: dancing may exacerbate current skin disorders and some skin conditions may be caused by dancing. Additionally, the common practice of dancing barefoot likely contributes to the development of certain skin conditions. Limitations include sample size, response bias, and lack of validation of the survey.
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Affiliation(s)
- Ryan C Saal
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, 23508, USA.
| | - Joshua F Edwards
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, 23508, USA
| | - Scott M Whitlock
- Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA, 23508, USA
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Fakhar M, Alian S, Zakariaei A, Nourzad F, Zakariaei Z. Massive dermal ulcerative lesions because of brown recluse spider bite: a rare case report and review of literature. J Surg Case Rep 2023; 2023:rjad357. [PMID: 37360745 PMCID: PMC10284676 DOI: 10.1093/jscr/rjad357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
A brown recluse spider (BRS) bite is challenging to confirm, but can be clinically diagnosed by considering the location, the season of the year and the clinical manifestations. We described a 26-year-old male who presented after a BRS bite with a skin lesion, bruising, severe swelling and diffuse blisters on the right lower extremity after 3 days. This case should be considered in the differential diagnosis of necrotizing fasciitis. Although spider bite poisoning is rare, proper diagnosis and management are important because, in some cases, it can have devastating outcomes.
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Affiliation(s)
- Mahdi Fakhar
- Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahriar Alian
- Antimicrobial Resistance Research Center, Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ashkan Zakariaei
- Student Research Committee, Babol Branch, Islamic Azad University, Babol, Iran
| | - Fatemeh Nourzad
- Toxicology Ward, Qaemshahr Razi Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Correspondence address. Toxicology and Forensic Medicine Division, Mazandaran Registry Center for Opioids Poisoning, Antimicrobial Resistance Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, PO Box 48166-33131, Sari, Iran. Tel/Fax: 981133357916; E-mail:
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de Azevedo BLR, Roni GM, Dettogni RS, Torrelio RMF, Leal LF, da Gama-de-Souza LN. Epidermolysis bullosa in oral health: clinical manifestations and salivary alterations. Clin Oral Investig 2023:10.1007/s00784-023-04917-3. [PMID: 36781477 DOI: 10.1007/s00784-023-04917-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
Epidermolysis bullosa (EB) is an inherited disease characterized by the fragility of the skin and mucous membranes. All types/subtypes of EB can lead to alterations in the mouth and glands. OBJECTIVE To evaluate clinical manifestations of EB on the oral mucosa and alterations in salivary flow. MATERIALS AND METHODS Sociodemographic and clinical data were obtained from EB individuals. The salivary flow analysis was performed in EB and in non-EB patients. Fischer's exact test was applied to the qualitative variables, and the Mann-Whitney test was applied to the quantitative data. RESULTS A total of 11 cases of EB were evaluated, and 3 types of EB were diagnosed (recessive dystrophic-RDEB; junctional-JEB; and simplex-EBS). Only individuals with RDEB or JEB showed the oral manifestation of the disease. The most affected sites were the lips (54%), hard palate (36%), and oral mucosa (27%). Ulcer and ankyloglossia were diagnosed in all RDEB cases. Regarding salivary flow, an intragroup comparison revealed an increase in stimulated versus unstimulated collection in the control sample (p = 0.0064). The EB group showed no difference (p = 0.6086). We also observed no differences in salivary volume between the control and EB groups (p = 0.7117 and p = 0.5557, unstimulated and stimulated flows, respectively). CONCLUSIONS No oral manifestations were observed in EBS subjects. It is unclear whether individuals with EB are predisposed to manifest hyposalivation. CLINICAL RELEVANCE Severe cases of EB show broad alterations in the oral mucosa, whereas the saliva needs to be better evaluated.
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Affiliation(s)
| | - Gabriel Marim Roni
- Medical School, Morphology Department, Health Science Center, Federal University of Espírito Santo, Vitória, Brazil
| | - Raquel Spinassé Dettogni
- Morphology Department, Health Science Center, Federal University of Espírito Santo, Vitória, ES, Brazil
| | | | | | - Letícia Nogueira da Gama-de-Souza
- Graduate Program in Dental Science, Morphology Department, Health Science Center, Federal University of Espírito Santo, Avenue Marechal Campos, 1468, Maruípe, 29.040-090, Vitória, ES, Brazil.
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Ismail A, Saahath A, Ismail Y, Ismail MF, Zubair Z, Subbaram K. 'Tomato flu' a new epidemic in India: Virology, epidemiology, and clinical features. New Microbes New Infect 2022; 51:101070. [PMID: 36582550 PMCID: PMC9792351 DOI: 10.1016/j.nmni.2022.101070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
This article aims to highlight the current update on the 'tomato flu' outbreak in India. Recently there was an outbreak of a new illness in some parts of India. The disease was very contagious and it manifested with a rash mainly noticed in children younger than nine years. The rash was very painful and blisters were the size of small tomatoes, hence it was termed 'tomato flu'. A detailed literature review was performed on the virology, replication, epidemiology, and clinical features of this disease. The current outbreak was compared with similar other diseases of the past. The affected children exhibited severe rash in the palms, soles, oral cavity, and other body parts. They developed febrile illness with a sore throat, and myalgia followed by blisters on the tongue, gums, and cheeks. The affected children did not develop any complications leading to death. The therapy involved mainly symptomatic, supportive treatment with isolation and maintaining hygienic practices. The causative agent was identified to be Coxsackievirus A16, an RNA virus belonging to the family, Picornaviridae. We conclude that the recent Indian epidemic of this disease might be due to a new variant of Coxsackievirus A16 actually causing HFMD.
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Affiliation(s)
| | | | | | | | | | - Kannan Subbaram
- Corresponding author. School of Medicine, The Maldives National University, Male’, Maldives.
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Gorelik S, Leos A, Kuah A, Desai S, Namous A, Onica A, Vlahovic TC. Cutaneous Manifestations of the Diabetic Foot. Clin Podiatr Med Surg 2021; 38:569-76. [PMID: 34538435 DOI: 10.1016/j.cpm.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diabetes mellitus is one of the most common conditions that affects the US population and burdens the health care system. Knowledge of the skin conditions that may occur before diagnosis of diabetes mellitus is made or after the diagnosis is made is pertinent for the practitioner. This article reviews skin disorders found on the lower extremity that are associated with diabetes mellitus.
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Martin MU, Lambert A, Miremont G, Gaiffe A, Agier MS, Studer M, Mahé A, Tebacher M, Cribier B. Bullous haemorrhagic dermatitis induced by heparins and other anticoagulants: 94 cases from French pharmacovigilance centres and a literature review. Ann Dermatol Venereol 2021; 149:45-50. [PMID: 34175142 DOI: 10.1016/j.annder.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/17/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Bullous haemorrhagic dermatitis (BHD) is an uncommon and highly particular side effect of various forms of heparins. METHODS To better characterise the disease, we collected all cases from French Pharmacovigilance centres recorded over a 20-year period (37 cases) and performed a Medline literature search up to June 2020 (57 cases). RESULTS In all, 94 patients were identified (male/female ratio: 2.2) of mean age 73.5±12.1 years (31-94). Patients were treated with enoxaparin (n=66), unfractionated heparin (n=11), fondaparinux (n=10), tinzaparin (n=4), bemiparin (n=1), reviparin (n=1), dalteparin (n=1), and 4 with other anticoagulants: warfarin (n=3) and rivaroxaban (n=1). All cases presented with 1 to more than 100 haemorrhagic vesicles and bullae, distant from the injection sites, located mainly on the lower (75%) or upper limbs (69%). The lesions were asymptomatic, except in 5 patients who had pruritic or painful lesions. The interval between treatment initiation and BHD ranged from 6 hours to 30 days (mean: 8.4±7 days). Biopsy (n=53) showed intraepidermal or subcorneal cavity with red cells (n=39) or junctional blisters (n=10), with eosinophilic infiltrate only rarely. Direct immuno-fluorescence was negative in 19/20 cases and indirect immunofluorescence was negative in 8/8. The outcome was favourable in all cases, including in 12 patients for whom heparin was maintained. A 93-year-old patient died of compressive haematomas unrelated to BHD. We found 5 cases similar to BHD due to other anticoagulants. DISCUSSION This is the largest comprehensive series of this adverse effect due to heparins or, more rarely, to other anticoagulants. Dermatologists must be aware of BHD, since this benign side effect does not necessarily require interruption of treatment. It is rare, considering the large-scale prescription of heparins, and occurs mainly in male patients aged over 70. Although the presentation is highly typical, the physiopathology is difficult to understand, as coagulation parameters are usually normal. Aging, skin fragility or mechanical factors might play a role.
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Affiliation(s)
- M-U Martin
- Centre régional de pharmacovigilance de Strasbourg, HUS, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - A Lambert
- Centre régional de pharmacovigilance de Strasbourg, HUS, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - G Miremont
- Pôle de santé publique, pharmacologie médicale, centre de pharmacovigilance de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - A Gaiffe
- Centre régional de pharmacovigilance de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - M-S Agier
- Centre régional de pharmacovigilance de Tours, 2, boulevard Tonnellé, 37000 Tours, France
| | - M Studer
- Service de dermatologie, centre hospitalier de Colmar, 39, avenue de la Liberté, 68000 Colmar, France
| | - A Mahé
- Service de dermatologie, centre hospitalier de Colmar, 39, avenue de la Liberté, 68000 Colmar, France
| | - M Tebacher
- Centre régional de pharmacovigilance de Strasbourg, HUS, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - B Cribier
- Clinique dermatologique, hôpitaux universitaires et université de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Abstract
Open fractures are considered an orthopaedic emergency due to the severe soft tissue disruption that might potentially lead to devastating complications. On the other hand, closed fractures, and especially those resulting from high-energy mechanisms, are also often accompanied by severe soft tissue trauma. Soft tissue envelope compromise can have a detrimental effect on the final outcome of the patients. Fracture blisters in particular, develop as a sign of significant local tissue trauma and appear in a time period between 6 to 72 hours post-injury. They can delay the definitive fracture treatment for a considerable amount of time and at the same time they also increase the risk for post-operative wound complications. Awareness of fracture blisters pathophysiology and their management options are crucial for orthopaedic surgeons, in order to achieve a favorable clinical outcome. In the herein study we present a concise synopsis of the pathophysiology pathways and management options of fracture blisters.
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Affiliation(s)
- Theodoros H Tosounidis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Crete. PC 71110, Heraklion, Greece.
| | - Ioannis I Daskalakis
- Department of Orthopaedic Surgery, University Hospital of Heraklion, Crete. PC 71110, Heraklion, Greece
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Floor D, Clarendon Wing, Leeds General Infirmary, Great George Street, Leeds, West Yorkshire, LS1 3EX, United Kingdom; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
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10
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Knapik JJ, Farina EK, Ramirez CB, Pasiakos SM, McClung JP, Lieberman HR. Medical Encounters During the United States Army Special Forces Assessment and Selection Course. Mil Med 2020; 184:e337-e343. [PMID: 30941425 PMCID: PMC6614812 DOI: 10.1093/milmed/usz056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/24/2018] [Accepted: 03/08/2019] [Indexed: 01/24/2023] Open
Abstract
Introduction The Special Forces Assessment and Selection (SFAS) is an extremely physically and mentally demanding 19- to 20-day course designed to determine whether Soldiers are qualified to enter the Special Forces Qualification Course. As a first step to understand medical problems during SFAS, this study examined injuries, illnesses, and activities associated with injuries during the course. Materials and Methods Medical events during the SFAS course were compiled from Sick Call Trackers (a log of medical encounters maintained by medical personnel in the field) and Chronology of Medical Care (Standard Form 600). Descriptive statistics were calculated for each injury and illness and injuries were compiled by the activities performed when the injuries occurred. Results Of the 800 Soldiers who volunteered for the study, 38% (n = 307/800) and 12% (n = 97/800) experienced one or more injuries and/or illnesses, respectively. The most common injuries were blisters and abrasions/lacerations with incidences of 20% (n = 158/800) and 13% (104/800), respectively. The most common illnesses were respiratory infections, other infections, contact dermatitis, and allergies with incidences of 7% (n = 57/800), 2% (n = 14/800), 2% (n = 14/800), and 2% (n = 13/800), respectively. Among all injuries recorded (n = 573), the most common were blisters (46%), abrasions/lacerations (24%), pain (not otherwise specified) (19%), tendonitis (3%), and sprains (3%). Among all illnesses recorded (n = 133), the most common were respiratory infections (56%), allergies (11%), contact dermatitis (11%), and other infections (11%). Most injuries were experienced during land navigation (44%), team events (20%), and foot marching (11%), running (6%), and the obstacle course (5%), but when the estimated time involved for each event was considered, activities with the highest injury rates were the obstacle course (65 injuries/hr), running (27 injuries/hr), the Combat Readiness Assessment (activity involving combat-related tasks) (20 injuries/hr), and foot marching (16 injuries/hr). Conclusion The major limitations of this investigation were: 1) the low specificity with regard to many of the diagnoses/complaints; and 2) the fact that the medical problems reported here are only those seen by medical care providers and are likely an underestimate of the total morbidity in the SFAS course. Soldiers often self-treat and some may be reluctant to see medical personnel because of how it might affect their rating in the course. Nonetheless, this investigation alerts medical personnel to the injuries and illnesses to expect, and public health workers and leadership with activities to target for injury prevention measures during SFAS.
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Affiliation(s)
- Joseph J Knapik
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA.,Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Emily K Farina
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | | | - Stefan M Pasiakos
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - James P McClung
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA
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Abstract
We report two cases of patients with diabetes mellitus who developed bullae measuring 2 cm in diameter on the fingers or toes, which could be classified as bullosis diabeticorum after excluding several differential diagnoses that are discussed. Bullosis diabeticorum is a rare blister formation located on the palmoplantar region, which is mainly observed in the case of diabetic patients. The clinical picture is characterized by tense bullae measuring up to 10 cm in diameter, containing clear to hemorrhagic fluid. Generally, lesions heal without residual scarring, less frequently with residual postinflammatory pigmentation or tender scars. On histopathological examination, both intraepidermal and subepidermal bullae are found without any significant inflammatory infiltrate. The etiopathogenesis of bullosis diabeticorum has not yet been clarified.
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Butler DC. An 81-Year-Old Woman with Recalcitrant Blisters. Dermatopathology (Basel) 2018; 5:1-5. [PMID: 29719822 PMCID: PMC5920955 DOI: 10.1159/000481529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Epidermolysis bullosa acquisita (EBA) is a rare mucocutaneous blistering disorder with typical onset in adulthood. Diagnosis and management can be difficult owing to the variability in presentation and clinical manifestation. In this case, we explore a case of EBA as well as provide a general overview of the condition and its variants.
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Affiliation(s)
- Daniel C Butler
- Harvard Combined Dermatology Residency Program, and Departments of Pathology and Dermatology, Massachusetts General Hospital, Boston, MA, USA
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13
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Leung AKC, Barankin B, Leong KF. Staphylococcal-scalded skin syndrome: evaluation, diagnosis, and management. World J Pediatr 2018; 14:116-20. [PMID: 29508362 DOI: 10.1007/s12519-018-0150-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 10/17/2022]
Abstract
BACKGROUND Staphylococcal-scalded skin syndrome (SSSS), also known as Ritter disease, is a potentially life-threatening disorder and a pediatric emergency. Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition. The purpose of this article is to familiarize physicians with the evaluation, diagnosis, and treatment of SSSS. DATA SOURCES A PubMed search was completed in Clinical Queries using the key terms "Staphylococcal scalded skin syndrome" and "Ritter disease". RESULTS SSSS is caused by toxigenic strains of Staphylococcus aureus. Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation. The diagnosis is mainly clinical, based on the findings of tender erythroderma, bullae, and desquamation with a scalded appearance especially in friction zones, periorificial scabs/crusting, positive Nikolsky sign, and absence of mucosal involvement. Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin, oxacillin, or flucloxacillin is essential until cultures are available to guide therapy. Clarithromycin or cefuroxime may be used should the patient have penicillin allergy. If the patient is not improving, critically ill, or in communities where the prevalence of methicillin-resistant S. aureus is high, vancomycin should be used. CONCLUSION A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.
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Abstract
Patch-clamp electrophysiology is the standard technique used for the high-resolution functional measurements on ion channels. While studies using patch clamp are commonly carried out following ion channel expression in a heterologous system such as Xenopus oocytes or tissue culture cells, these studies can also be carried out using ion channels reconstituted into lipid vesicles. In this chapter, we describe the methodology for reconstituting ion channels into liposomes and the procedure for the generation of unilamellar blisters from these liposomes that are suitable for patch clamp. Here, we focus on the bacterial K+ channel KcsA, although the methodologies described in this chapter should be applicable for the functional analysis of other ion channels.
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Affiliation(s)
- Kimberly Matulef
- Program in Chemical Biology, Department of Physiology and Pharmacology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L334, Portland, OR, 97239, USA
| | - Francis I Valiyaveetil
- Department of Physiology and Pharmacology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L334, Portland, OR, 97239, USA.
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Ott H, Eich C, Schriek K, Ludwikowski B. [Hereditary epidermolysis bullosa in school children and adolescents. Clinical picture and interdisciplinary management]. Hautarzt 2016; 67:279-86. [PMID: 26943360 DOI: 10.1007/s00105-016-3774-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hereditary epidermolysis bullosa (EB) represents a clinically heterogeneous group of congenital blistering disorders requiring multiprofessional care. EB is associated with a broad spectrum of potentially severe complications often reaching their full extent during school age and adolescence. This review aims at summarizing cutaneous manifestations of EB as well as extracutaneous complications of this complex disease and their interdisciplinary management.
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Affiliation(s)
- H Ott
- Fachbereich Pädiatrische Dermatologie und Allergologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Janusz-Korczak-Allee 12, 30173, Hannover, Deutschland. .,Epidermolysis bullosa-Zentrum Hannover, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland.
| | - C Eich
- Abt. Anästhesie, Kinderintensiv- und Notfallmedizin, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
| | - K Schriek
- Epidermolysis bullosa-Zentrum Hannover, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland.,Abt. Kinderchirurgie und Kinderurologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
| | - B Ludwikowski
- Epidermolysis bullosa-Zentrum Hannover, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland.,Abt. Kinderchirurgie und Kinderurologie, Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Deutschland
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Abstract
Some blistering eruptions are self-limited, but others are life threatening, and prompt diagnosis and management are critical. The clinical presentation of vesicles and bullae suggests a broad differential and this article (1) highlights some common diagnoses that may be encountered by primary care physicians and subspecialists; (2) provides a possible systematic diagnostic approach to such patients, including history, physical examination, and relevant work-up.
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Affiliation(s)
- Tarannum Jaleel
- Department of Dermatology, University of Alabama at Birmingham, 1520 3rd Avenue South, EFH 414, Birmingham, AL 35294-0009, USA
| | - Young Kwak
- Department of Dermatology, University of Alabama at Birmingham, 1520 3rd Avenue South, EFH 414, Birmingham, AL 35294-0009, USA
| | - Naveed Sami
- Department of Dermatology, University of Alabama at Birmingham, 1520 3rd Avenue South, EFH 414, Birmingham, AL 35294-0009, USA.
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Sridhar S, Benkouiten S, Belhouchat K, Drali T, Memish ZA, Parola P, Brouqui P, Gautret P. Foot ailments during Hajj: A short report. J Epidemiol Glob Health 2015; 5:291-4. [PMID: 25659945 PMCID: PMC7320529 DOI: 10.1016/j.jegh.2014.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 12/08/2014] [Accepted: 12/10/2014] [Indexed: 11/18/2022] Open
Abstract
A study of ailments of the feet in pilgrims of Hajj revealed that 31% of them suffered from blisters, and the prevalence was five times higher in females. The presence of comorbidity (diabetes, obesity and advanced age) warrants immediate attention to them to avoid serious complications.
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Affiliation(s)
- Shruti Sridhar
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, 27 bd Jean Moulin, 13005 Marseille, France
| | - Samir Benkouiten
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, 27 bd Jean Moulin, 13005 Marseille, France
| | - Khadidja Belhouchat
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France
| | - Tassadit Drali
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France
| | - Ziad A Memish
- Public Health Directorate, Saudi Ministry of Health, WHO Collaborating Center for Mass Gathering Medicine, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Philippe Parola
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, 27 bd Jean Moulin, 13005 Marseille, France
| | - Philippe Brouqui
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, 27 bd Jean Moulin, 13005 Marseille, France
| | - Philippe Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, 13015 Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, Faculté de Médecine, 27 bd Jean Moulin, 13005 Marseille, France.
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Villaverde Doménech ME, Simón Sanz E, Pujol Marco C, Pérez del Caz MD, Blanco Cerdá O, Safont Albert J. Pellagra. A challenging differential diagnosis in burn injuries. J Tissue Viability 2013; 23:37-41. [PMID: 24405724 DOI: 10.1016/j.jtv.2013.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
With this case report we want to emphasize the importance of performing a thorough physical examination of the burn and detailed review of the patient's history. This is a challenging case because it deals with an uncommon disease nowadays, pellagra, which presents lesions with an appearance very similar to burns; on the other hand the management of pellagra is different to the management of the common burns we are used to handling day-to-day. With this case report we will be able to revise the broad list of different injuries that can bring up an issue related to a correct diagnosis, caused by a large diversity of different etiologies with cutaneous expression. We will look over the diagnostic process of pellagra, management, treatment and results in this patient.
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Affiliation(s)
- M E Villaverde Doménech
- Department of Plastic and Reconstructive Surgery, La Fe Hospital, Bulevar Sur s/n, Valencia, Spain.
| | - E Simón Sanz
- Department of Plastic and Reconstructive Surgery, La Fe Hospital, Bulevar Sur s/n, Valencia, Spain
| | - C Pujol Marco
- Department of Dermatology, La Fe Hospital, Bulevar Sur, s/n, Valencia, Spain
| | - M D Pérez del Caz
- Department of Plastic and Reconstructive Surgery, La Fe Hospital, Bulevar Sur s/n, Valencia, Spain
| | - O Blanco Cerdá
- Department of Plastic and Reconstructive Surgery, La Fe Hospital, Bulevar Sur s/n, Valencia, Spain
| | - J Safont Albert
- Department of Plastic and Reconstructive Surgery, La Fe Hospital, Bulevar Sur s/n, Valencia, Spain
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Qayoom S, Masood Q, Sultan J, Hassan I, Jehangir M, Bhat YJ, Bhat T, Chisti M. Epidermolysis bullosa: a series of 12 patients in kashmir valley. Indian J Dermatol 2010; 55:229-32. [PMID: 21063512 PMCID: PMC2965906 DOI: 10.4103/0019-5154.70668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Epidermolysis Bullosa (EB) is a genetically determined mechano-bullous disorder of the skin encompassing a group of conditions that share skin fragility as a common feature. Materials and Methods: Twele patients with Epidermolysis Bullosa from Kashmir valley are reported. Results: Our series included 12 patients, 5 males and 7 females. Features were consistent with EB simplex in 8 patients, EB pruriginosa in 2 patients, generalized atrophic benign EB in one patient and EB acquista in one patient. Conclusion: EB is a rare, genetically determined, blistering disorder affecting both males and females with predominant involvement of hands and feet. In the absence of specific therapy, treatment mainly involves avoidance of provoking factors, prevention and treatment of complications.
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Affiliation(s)
- Seema Qayoom
- Department of Dermatology, STD & Leprosy, SKIMS Medical College, Bemina, India
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