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Al-Showbaki L, Toubasi AA, Jaber DZ, Shdifat MA, Al-Maani N, Qudah O, Fararjeh F, Amir E. Paraneoplastic Cutaneous Manifestations of Hepatocellular Carcinoma. A Systematic Review and Meta-analysis. J Cancer 2024; 15:1021-1029. [PMID: 38230223 PMCID: PMC10788718 DOI: 10.7150/jca.88931] [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: 08/08/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
Background: There remains a scarcity of published data on the clinical significance of paraneoplastic cutaneous manifestations in hepatocellular carcinoma (HCC). Method: A systematic search of MEDLINE was performed in December 2022. Inclusion criteria comprised studies reporting on patients with HCC, who had paraneoplastic cutaneous manifestations. Outcomes of interests comprise survival and response to cancer-directed and/or skin directed therapy. Results: A total of 48 studies comprising 60 HCC patients were included in the analysis. The most frequent reported skin abnormalities were dermatomyositis, pityriasis rotunda, and porphyria. Most patients presented with dermatomyositis had underlying viral hepatitis, while all reported porphyria and acanthosis cases were associated with metabolic causes of HCC, such as steatosis. Paraneoplastic skin changes were more common in patients with metastatic disease. Pityriasis Rotunda was associated with the lowest risk of death, (OR: 0.05, 95% CI: 0.003 to 0.89; p = 0.04), while dermatomyositis had a statistically significant higher risk of death (OR: 3.37, 95% CI: 1.01-12.1; p = 0.03). Most patients showed an improvement in their cutaneous abnormalities, following cancer-directed therapy. Conclusion: Paraneoplastic cutaneous manifestations are reported more frequently in patients with a higher burden of disease, especially presence of metastases. Certain cutaneous manifestations have prognostic implication.
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Affiliation(s)
- Laith Al-Showbaki
- Division of Hematology and Medical Oncology, Department of Medicine, Jordan University Hospital and School of Medicine, the University of Jordan, Amman, Jordan
| | | | - Dunia Z. Jaber
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Noor Al-Maani
- Division of Dermatology, Department of Medicine, Jordan university Hospital and school of Medicine, The University of Jordan, Amman, Jordan
| | - Omar Qudah
- Division of Hepatology and gastroenterology, Department of Medicine, Jordan university Hospital and school of Medicine, The University of Jordan, Amman, Jordan
| | - Feras Fararjeh
- Division of Hematology and Medical Oncology, Department of Medicine, Jordan University Hospital and School of Medicine, the University of Jordan, Amman, Jordan
| | - Eitan Amir
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON. Canada
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2
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Byard RW. Manifestations and etiology of cutaneous findings in cases of morbid obesity. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00721-3. [PMID: 37889417 DOI: 10.1007/s12024-023-00721-3] [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] [Accepted: 09/15/2023] [Indexed: 10/28/2023]
Abstract
Morbid obesity is associated with a wide range of metabolic, infective, and organic disorders related to adipose tissue overload. While careful documentation of internal autopsy findings is usual, skin manifestations may be overlooked. Skin manifestations are quite diverse and include striae distensae, skin tags, plantar hyperkeratosis, acanthosis nigricans, the sequelae of hyperandrogenism, lymphedema, panniculus morbidus, chronic venous insufficiency, stasis dermatitis, leg ulceration, intertrigo, cellulitis, pressure ulcers and 'buried penis'. Obesity has also been associated with hidradenitis suppurativa, psoriasis, atopic dermatitis, melanoma, systemic lupus erythematosus, lichen planus and acne vulgaris. Evaluating these findings at the time of autopsy may give a more complete assessment of a particular case and may also identify conditions that may have contributed to, or caused, death.
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Affiliation(s)
- Roger W Byard
- Forensic Science SA and the School of Biomedicine, The University of Adelaide, Level 2, Room N237, Helen Mayo North, Frome Road, Adelaide, SA, 5000, Australia.
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3
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Sleiman J, Patel M, Khan MZ, Falloon K, Cohen B, Click B, Khanna U, Fernandez AP, Rieder F. Sweet Syndrome Associated with Active Inflammatory Bowel Disease: A Case Series of a Rare Extra-intestinal Manifestation. Dig Dis Sci 2023; 68:3562-3568. [PMID: 37402983 PMCID: PMC10921822 DOI: 10.1007/s10620-023-07983-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Cutaneous extra-intestinal manifestations (EIM) occur in up to 20% of patients with IBD. Information about Sweet syndrome (SS)'s clinical course as a rare cutaneous EIM in IBD is limited to case reports. We present the largest retrospective cohort on the occurrence and management of SS in IBD. STUDY Electronic medical records and paper charts since 1980 were retrospectively reviewed at a large quaternary medical center to identify all adult IBD patients with histopathology-proven SS. Patient characteristics and clinical outcomes were evaluated. RESULTS 25 IBD patients with SS were identified; 3 patients were assessed to have AZA-induced SS. The majority of SS patients were female. Median age at diagnosis was 47 years (IQR 33-54 years) and SS appeared at a median of 6.4 years after IBD diagnosis. IBD patients with SS had a high rate of complicated IBD phenotypes (75% extensive colitis in UC and 73% stricturing or penetrating disease in CD, with 100% colonic involvement), as well as frequent co-occurring EIMs (60%). SS correlated with global IBD disease activity. Corticosteroids were an effective therapy for SS in IBD. Recurrence rate of SS was 36%. CONCLUSION Contrary to previous case reports, SS was a cutaneous EIM occurring late after diagnosis of IBD in our cohort, with occurrences paralleling global IBD disease activity. Although AZA-induced and IBD-associated SS were both effectively treated with corticosteroids, distinguishing them is relevant for future IBD treatment strategies.
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Affiliation(s)
- Joseph Sleiman
- Department of Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
- Division of Gastroenterology, Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mihir Patel
- Department of Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
| | - Muhammad Zarrar Khan
- Department of Internal Medicine, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine Falloon
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Benjamin Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Benjamin Click
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Colorado University Anschutz Medical Campus, Aurora, CO, USA
| | - Urmi Khanna
- Department of Dermatology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Anthony P Fernandez
- Departments of Pathology, Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Dermatology, Dermatology & Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
- Center for Global Translational Inflammatory Bowel Diseases, Cleveland Clinic Foundation, Cleveland, OH, USA.
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4
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Pinto-Pulido EL, Fernández-Parrado M, Rodríguez-Cuadrado FJ. RF - Monkeypox: Key Concepts. Actas Dermosifiliogr 2023; 114:627-628. [PMID: 35777458 DOI: 10.1016/j.ad.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- E L Pinto-Pulido
- Servicio de Dermatología, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, España.
| | - M Fernández-Parrado
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
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5
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Pinto-Pulido EL, Parrado MF, Rodríguez-Cuadrado FJ. FR - Viruela símica: conceptos clave: Key Concepts. Actas Dermosifiliogr 2023:S0001-7310(23)00471-4. [PMID: 37302487 DOI: 10.1016/j.ad.2022.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/13/2023] Open
Affiliation(s)
- E Lucía Pinto-Pulido
- Servicio de Dermatología, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Madrid, España.
| | - M Fernández Parrado
- Servicio de Dermatología, Hospital Universitario de Navarra, Pamplona, España
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6
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Rao SK, Srinivas RT, Reddy M, Ashraf A. Study of Cutaneous Manifestations in Alcohol Dependence Syndrome Patients in a Rural Tertiary Care Center in India. Addict Health 2023; 15:45-52. [PMID: 37560076 PMCID: PMC10408745 DOI: 10.34172/ahj.2023.1340] [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] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 10/29/2022] [Indexed: 08/11/2023]
Abstract
BACKGROUND Chronic alcoholism is a multifactorial condition predisposed by environmental, social, and psychological factors. Alcohol dependence syndrome (ADS) can present with varied cutaneous and systemic manifestations. The effects of alcohol use include cutaneous infections, infestations, features of malnutrition, exacerbation of pre-existing dermatoses, and alcohol-related dermatoses. This study aimed to analyze and document cutaneous manifestations secondary to infections, infestations, malnutrition, and modifications of pre-existing dermatoses in ADS patients and investigate the correlation between the presence of cutaneous manifestations and duration and quantity of alcohol intake. METHODS The present observational study was carried out in the Department of Dermatology for a period of one year. A total of 172 male patients with ADS presenting with skin manifestations were included in the study. Detailed analysis of history, clinical examination, and relevant investigations were conducted. FINDINGS Out of 172 male patients with ADS, the most common dermatoses noted were infections (166, 96.5%) and features of malnutrition (161, 93.6%). Exacerbation of pre-existing dermatoses (101, 58.7%) and alcohol-related dermatoses (85, 49.4%) were also observed. CONCLUSION Most of the dermatoses were significantly correlated with the quantity of alcohol intake than with its duration, implying that higher quantity of alcohol intake has more impact on cutaneous and systemic manifestations. Identifying the cutaneous manifestations in ADS patients plays an important role in recognizing the underlying systemic disorders which in turn facilitates early intervention and thereby prevents complications.
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Affiliation(s)
- Sneha Krishnoji Rao
- Senior Resident, Department of Dermatology, Venereology & Leprosy, Sri Devaraj Urs Medical College, Kolar, Karnataka
| | - Rajashekar Talari Srinivas
- Head of Department, Department of Dermatology, Venereology & Leprosy, Sri Devaraj Urs Medical College, Kolar, Karnataka
| | - Mohan Reddy
- Head of Department, Department of Psychiatry, Sri Devaraj Urs Medical College, Kolar, Karnataka
| | - Ashna Ashraf
- Resident, Department of Dermatology, Venereology & Leprosy, Sri Devaraj Urs Medical College, Kolar, Karnataka
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7
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Sivaz O, Ozkur E, Altunay IK, Oncul A, Sevgi DY. Muco cutaneous Manifestations of People Living with HIV in Current Antiretroviral Therapy Era. Curr HIV Res 2022; 20:120-128. [PMID: 35236269 DOI: 10.2174/1570162x20666220302141504] [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: 11/07/2021] [Revised: 01/04/2022] [Accepted: 01/25/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE It has been reported that approximately 90% of patients who are infected with human immunodeficiency virus (HIV) have various cutaneous symptoms that are related to the virus. This study aims to describe the cutaneous disorders that have developed in HIV-infected patients and to investigate the factors that may be related, such as relationships to drug use and CD4 counts. METHODS This cross-sectional study included people who were living with HIV and being followed by our hospital's infectious diseases clinic after they had been referred to the dermatology clinic because of skin lesions. These patients had been diagnosed with HIV by enzyme-linked immunosorbent assay tests and were included in the study if they were older than 18 years and had agreed to participate. Findings from detailed dermatological examinations were recorded, along with the patients' CD4 counts, the durations of their illnesses, and the treatments they received. RESULTS 144 patients were included in the study. The most common mucocutaneous manifestation was seborrheic dermatitis, at 28.5% (n = 41). The mean CD4 count was 607.1 (min-max = 10.6-1982).The CD4 counts were divided into three groups in the study as follows: 22 (15.3%) patients with <200, 35 (24.3%) patients between 200 and 500, and 87 (60.4%) patients with >500. There were no statistical differences between these groups in terms of dermatological findings. Nevertheless, the highest rate of patients with three or more dermatological conditions was found among those with CD4 counts <200 (n = 11.50%). CONCLUSION Skin manifestations are common in patients who are HIV-positive; however, many skin disorders can be seen in HIV/acquired immunodeficiency syndrome (AIDS) patients whatever CD4 cell counts of these patients are.
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Affiliation(s)
- Onur Sivaz
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Ezgi Ozkur
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Ilknur Kivanc Altunay
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Dermatology, Istanbul, Turkey
| | - Ahsen Oncul
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
| | - Dilek Yıldız Sevgi
- Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
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8
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Sodeifian F, Mushtaq S, Rezaei N. Cutaneous manifestation of COVID-19: What have we learned an year into the pandemic? Actas Dermosifiliogr 2022; 113:157-65. [PMID: 35244561 DOI: 10.1016/j.ad.2022.01.023] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) is an emerging health situation caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The ongoing COVID-19 pandemic which emerged from the Chinese city of Wuhan in December 2019 has spread to over 188 countries and infected over 100 million people across the globe in over one year. Most common symptoms of COVID-19 include fever and respiratory illness. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported from different geographical regions. The exact incidence or prevalence of COVID-19 associated skin manifestation remains largely unknown and the pathophysiological mechanisms are still unclear. In this article, we have attempted to give a comprehensive overview of what has been learned an year into the pandemic on the epidemiology, clinical and histopathological features, pathophysiological mechanisms and clinical management of COVID-19 associated cutaneous manifestations.
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9
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Jabri M, El Houda Lamaasab N, Daoudi C, Jabrouni F, Benzekri H, Bouchlarhem A, Oulali N. Purpura as a late complication of covid-19 infection that should not be ignored: Case report and brief review. Ann Med Surg (Lond) 2022; 73:103216. [PMID: 35003729 PMCID: PMC8719914 DOI: 10.1016/j.amsu.2021.103216] [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: 11/26/2021] [Revised: 12/25/2021] [Accepted: 12/26/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction and importance The SARS COV2 infection is a challenging pandemic that has affected millions of people with a very high mortality rate. In addition to the typical respiratory symptoms, it can also cause variable skin lesions, such as vascular purpura in some exceptional cases. Case presentation We report the case of a 60-year-old woman who was admitted for a SARS COV2 infection, the evolution was marked by the appearance of a vascular purpura at D20 after the beginning of the symptoms. Discussion The cutaneous manifestations associated with the SARS COV2 infection are polymorphic. Vascular purpura is one of them. Its diagnosis is retained in the light of a combination of arguments, which makes it a real challenge for the physician to diagnose it. The management of the disease is based on a symptomatic treatment. The clinical evolution is, in general, favorable. Conclusion Although rare and still not fully explained, skin involvement during SARS COV2 infection has been described. It should not be neglected and it should be diagnosed early and treated appropriately, especially in asymptomatic patients. Infection with the COVID-19 virus can be manifested by clinical signs of varying severity, sometimes fatal. Being a systemic disease, SARS COV2 infection may be revealed, in addition to respiratory symptoms, by skin lesions including vascular purpura We report a case of vascular purpura occurring post-infection
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Affiliation(s)
- Meryem Jabri
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.,Department of Emergency, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Nour El Houda Lamaasab
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.,Department of Emergency, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Chaimae Daoudi
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.,Department of Emergency, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Fadoua Jabrouni
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.,Department of Emergency, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Hajar Benzekri
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.,Department of Emergency, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Amine Bouchlarhem
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.,Department of Emergency, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
| | - Nourdinne Oulali
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco.,Department of Emergency, Mohammed VI University Hospital Mohammed I University Oujda, Morocco
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10
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Fernández-Figueras MT. Dermatopathology of COVID-19 infection and vaccination. Pathologie (Heidelb) 2022; 43:114-118. [PMID: 36197514 PMCID: PMC9533285 DOI: 10.1007/s00292-022-01126-9] [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] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Many peculiar skin changes have been described in relation to both coronavirus disease 2019 (COVID-19) infection and vaccination. OBJECTIVE This paper provides an overview of these dermatologic manifestations, focusing on their dermatopathological appearances. RESULTS Most COVID-19 patients develop variegated maculopapular eruptions with a combination of histological patterns commonly including keratinocyte apoptosis and eosinophilia. Urticaria-like lesions often show a combination of spongiotic and lichenoid patterns and are more frequent in individuals with severe disease. Vesicular lesions can be disseminated; in some cases, they become pustular and in others show dyskeratosis and a peculiar form of ballooning. Some patients develop vesicular Grover disease on the trunk. Young patients with a strong immunological response can eliminate the virus easily but may develop chilblains as a consequence of the high interferon response. Conversely, older individuals with immunosenescence and a tendency toward hypercoagulability can present livedoid and ischemic areas. Regarding COVID-19 vaccination, hypersensitivity reactions are most frequent, including "COVID-arm." Nonetheless, a combination of local and systemic cutaneous manifestations (reactogenicity) is commonly seen. Histopathologically, lichenoid and spongiotic changes and a variable number of eosinophils are typical of rashes characterized by papules and plaques. Other dermatological side effects of COVID-19 vaccination include lesions mimicking well-defined dermatoses such as lichen planus or bullous pemphigoid and triggering of collagenous diseases. CONCLUSION Well-characterized skin manifestations of coronavirus disease 2019 (COVID-19) include chilblains, livedo necrotic lesions, vesicular eruptions, urticarial lesions, and maculopapular eruptions. Hypersensitivity reactions are common after SARS-CoV‑2 mRNA vaccination. Vaccine reactions may also mimic other dermatosis such as bullous pemphigoid or lichen planus, stimulate herpes reactivation, or trigger the development of autoimmune diseases.
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Affiliation(s)
- María-Teresa Fernández-Figueras
- grid.440254.30000 0004 1793 6999Dept Anatomic pathology., Hospital Universitari General de Catalunya. Grupo Quironsalud, Carrer Pedro i Pons, 1, 08195 Sant Cugat del Vallès (Barcelona), Spain
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11
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Sodeifian F, Mushtaq S, Rezaei N. Cutaneous manifestation of COVID-19: What have we learned an year into the pandemic? Actas Dermosifiliogr 2021:S1578-2190(21)00339-5. [PMID: 34866636 PMCID: PMC8626141 DOI: 10.1016/j.adengl.2021.11.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease-19 (COVID-19) is an emerging health situation caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The ongoing COVID-19 pandemic which emerged from the Chinese city of Wuhan in December 2019 has spread to over 188 countries and infected over 100 million people across the globe in over one year. Most common symptoms of COVID-19 include fever and respiratory illness. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported from different geographical regions. The exact incidence or prevalence of COVID-19 associated skin manifestation remains largely unknown and the pathophysiological mechanisms are still unclear. In this article, we have attempted to give a comprehensive overview of what has been learned an year into the pandemic on the epidemiology, clinical and histopathological features, pathophysiological mechanisms and clinical management of COVID-19 associated cutaneous manifestations.
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Affiliation(s)
- F Sodeifian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - S Mushtaq
- Department of Dermatology, Venereology and Leprology Government Medical College & Associated Hospitals, University of Jammu, J&K, India
| | - N Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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12
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López C, Cardona R. [Urticaria associated with COVID-19 in allergic patients. A case series]. Rev Alerg Mex 2021; 68:214-217. [PMID: 34634853 DOI: 10.29262/ram.v68i3.869] [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] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In December 2019, a new coronavirus was identified as the causal agent of the 2019 coronavirus disease (COVID-19) with a wide clinical spectrum that goes from asymptomatic cases to critical and fatal cases. Its usual manifestations are fever, cough, and fatigue; although some cases present skin lesions. CASES REPORT The first case was a 30-year-old woman with a history of controlled solar urticaria who presented erythematous and pruritic wheals in malar and cervical regions and extremities; associated with general malaise, headaches, and nausea, in whom the presence of COVID-19 was confirmed; her condition improved with a quadruple dose of antihistamines. The second case was a 47-year-old woman with a history of wasp sting anaphylaxis, without mastocytosis, who presented nasal congestion, headaches, and hypogeusia associated with generalized, erythematous, and pruritic wheals, with confirmation of COVID-19; her condition improved with quadruple doses of antihistamines. CONCLUSIONS Cutaneous manifestations associated with COVID-19 are frequent and can be classified as inflammatory and vascular. Among them, urticarial lesions occupy the fourth place, and although there could be some predominance of these in patients with a history of allergies, more studies are required to define an association.
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Affiliation(s)
- Catalina López
- Universidad de Antioquia, Facultad de Medicina, Grupo de Alergología Clínica y Experimental, Medellín, Colombia.
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13
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Starling CT, Nguyen QBD, Butler IJ, Numan MT, Hebert AA. Cutaneous manifestations of orthostatic intolerance syndromes. Int J Womens Dermatol 2021; 7:471-477. [PMID: 34621961 PMCID: PMC8484984 DOI: 10.1016/j.ijwd.2021.03.003] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/05/2021] [Accepted: 03/05/2021] [Indexed: 11/27/2022] Open
Abstract
Dysautonomia refers to a group of autonomic nervous system disorders that affect nearly 70 million people worldwide. One subset of dysautonomia includes syndromes of orthostatic intolerance (OI), which primarily affect adolescents and women of childbearing age. Due to the variability in disease presentation, the average time from symptom onset to diagnosis of dysautonomia is 6 years. In general, there is a paucity of dermatological research articles describing patients with dysautonomia. The objective of this review is to summarize the existing literature on cutaneous manifestations in dysautonomia, with an emphasis on syndromes of OI. A PubMed database of the English-language literature (1970–2020) was searched using the terms “dysautonomia”, “orthostatic intolerance”, “cutaneous”, “skin”, “hyperhidrosis”, “hypohidrosis”, “sweat”, and other synonyms. Results showed that cutaneous manifestations of orthostatic intolerance are common and varied, with one paper citing up to 85% of patients with OI having at least one cutaneous symptom. Recognition of dermatological complaints may lead to an earlier diagnosis of orthostatic intolerance, as well as other comorbid conditions.
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Affiliation(s)
| | - Quoc-Bao D Nguyen
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Ian J Butler
- Department of Pediatrics, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Mohammed T Numan
- Department of Pediatrics, UTHealth McGovern Medical School at Houston, Houston, Texas
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, Texas.,Department of Pediatrics, UTHealth McGovern Medical School at Houston, Houston, Texas
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Sestan M, Srsen S, Kifer N, Sapina M, Batnozic Varga M, Ovuka A, Held M, Kozmar A, Frkovic M, Laskarin G, Gagro A, Jelusic M. Persistence and Severity of Cutaneous Manifestations in IgA Vasculitis Is Associated with Development of IgA Vasculitis Nephritis in Children. Dermatology 2021; 238:340-346. [PMID: 34098552 DOI: 10.1159/000516765] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/25/2021] [Accepted: 04/21/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVE The purpose of this study was to evaluate the prevalence and severity of skin involvement in children with IgA vasculitis (IgAV) and its relationship with clinical and biochemical parameters and the risk of developing IgA vasculitis nephritis (IgAVN), the only cause of long-term morbidity and the main prognostic factor in IgAV patients. METHODS This national multicenter retrospective study included 611 patients under the age of 18 years with IgAV referred to five Croatian tertiary hospitals between 2009 and 2019. Patient data were collected from a database with systematic analysis of IgAV patients in the Croatian population. RESULTS Among the 611 children, 205 (33.55%) had purpura on the lower extremities, in 207 (33.88%) the rash extended on the trunk, in 149 (24.39%) it extended to the upper extremities, in 32 (5.24%) the rash was generalized, while 15 (2.47%) had the most severe skin symptoms: bullae, ulcerations, and necroses. IgAVN developed in 130 (21.28%) and persistent IgAVN (present for >3 months) in 48 (7.86%) children. Multivariate logistic regression found that presence of ulcerations and necroses (OR 3.20 [95% CI 1.03-9.91]), persistent purpura (OR 2.89 [95% CI 1.71-4.88]), and higher age (OR 1.16 [95% CI 1.09-1.23]) were significant predictors of IgAVN, whereas persistent purpura (OR 20.11 [95% CI 1.09-372.52]), male sex (OR 3.32 [95% CI 1.13-9.80]), and higher age (OR 1.15 [95% CI 1.00-1.30]) were predictors of persistent IgAVN. Among the laboratory parameters, higher serum urea (OR 1.43 [95% CI 1.03-2.00]) and reduction in activated partial thromboplastin time (OR 0.83 [95% CI 0.74-0.93]) were shown to have a significant impact on increasing the risk of persistent IgAVN. CONCLUSION With increasing severity and duration of cutaneous manifestations in IgAV, the risk of developing IgAVN increases, making the prognosis worse, with a greater likelihood to need more aggressive treatment.
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Affiliation(s)
- Mario Sestan
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sasa Srsen
- Department of Paediatrics, University of Split School of Medicine, University Hospital Centre Split, Split, Croatia
| | - Nastasia Kifer
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Matej Sapina
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty and Faculty of Dental Medicine and Health Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Mateja Batnozic Varga
- Department of Paediatrics, Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, University Hospital Centre Osijek, Osijek, Croatia
| | - Aleksandar Ovuka
- Department of Paediatrics, University of Rijeka, Faculty of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
| | - Martina Held
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Kozmar
- Clinical Department of Laboratory Diagnostics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Frkovic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Alenka Gagro
- Department of Paediatrics, Children's Hospital Zagreb, Zagreb, Croatia.,Josip Juraj Strossmayer University of Osijek, Medical Faculty Osijek, Osijek, Croatia
| | - Marija Jelusic
- Department of Paediatrics, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
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15
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Birlutiu V, Feiereisz AI, Oprinca G, Dobritoiu S, Rotaru M, Birlutiu RM, Iancu GM. Cutaneous manifestations associated with anosmia, ageusia and enteritis in SARS-CoV-2 infection - A possible pattern? Observational study and review of the literature. Int J Infect Dis 2021; 107:72-77. [PMID: 33887455 PMCID: PMC8054550 DOI: 10.1016/j.ijid.2021.04.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 01/12/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background The cutaneous manifestations of coronavirus disease 2019 (COVID-19) have been covered insufficiently in the literature. Methods Thirty-nine patients admitted to the study hospital with confirmed COVID-19 who experienced various skin manifestations during hospitalization or in the convalescence period, were analysed retrospectively. Results Thirty-nine patients with COVID-19, admitted to the study hospital between 23 March and 12 September 2020, had intra-infectious rash or lesions of cutaneous vasculitis during convalescence. The most common cutaneous manifestations of COVID-19 were erythematous and erythematous papular rash. Twenty-seven of the 39 patients had anosmia (69.2%), 26 patients had ageusia (66.7%), 34 patients had pneumonia (87.2%) and 24 patients had intra-infectious enterocolitis (61.5%). Skin biopsies were rarely performed in these patients. This article reports the results of biopsies performed in two patients, showing histopathological and immunohistochemical changes in erythematous rash and erythema multiforme-like lesions. Both skin biopsies revealed early fibrous remodelling of the dermis, suggesting similarity with changes that occur in the lungs and other tissues in patients with COVID-19. Conclusions Correlations between skin lesions and anosmia, ageusia and enteritis in patients with COVID-19 do not seem to be accidental, but are associated with a similar response to ACE2 receptor expression in these tissues.
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Affiliation(s)
- Victoria Birlutiu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Infectious Diseases Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | | | - George Oprinca
- Department of Pathology, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | - Simona Dobritoiu
- Infectious Diseases Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | - Maria Rotaru
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Dermatology Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
| | - Rares Mircea Birlutiu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; FOISOR Clinical Hospital of Orthopaedics, Traumatology and Osteoarticular TB, Bucharest, Romania.
| | - Gabriela Mariana Iancu
- Faculty of Medicine, Lucian Blaga University of Sibiu, Sibiu, Romania; Dermatology Clinic, Academic Emergency Hospital Sibiu, Sibiu, Romania
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16
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López-Quintero W, Cleves D, Gomez-Vasco JD, Pérez P, Patiño J, Medina-Valencia D, Pachajoa H, Torres-Canchala L, Vidal A, Olaya M. Skin manifestations in pediatric patients with primary immunodeficiency diseases (PIDs) in a tertiary care hospital in Colombia. World Allergy Organ J 2021; 14:100527. [PMID: 33747343 DOI: 10.1016/j.waojou.2021.100527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background The current literature describes the characteristics of some skin manifestations in the context of primary immunodeficiency diseases (PIDs), also known as inborn errors of the immune system. However, there are hardly any data on the epidemiological trends of skin manifestations and PIDs in Latin America (LA). We aimed to describe the characteristics of patients with skin manifestations and the diagnosis of a PID treated at a tertiary hospital in Colombia. Methods This was a retrospective observational study. Data were taken from the institutional database of pediatric PIDs, which includes 306 patients under 18 years of age who attended a tertiary care center in Cali, Colombia for inpatient or outpatient services between December 2013 and December 2018. A trained third-year dermatology resident reviewed the electronic clinical records of all the patients in the database and double-checked patients who presented with cutaneous signs and symptoms. Results A total of 83 patients out of the original 306 patients (27.1%) presented with some type of cutaneous manifestation. Of these patients, 56.6% had atopic dermatitis, 56.6% reported at least one episode of skin infection, and some of the patients had both of these manifestations. Infections were more frequent in the PID group of combined immunodeficiency associated with well-defined syndromes and atopic dermatitis in the group of antibody deficiencies. Conclusions It is important to recognize dermatological clinical characteristics in patients with PIDs. More studies are necessary to establish recommendations regarding the approach of diagnosis and management of these patients.
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17
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Fattori A, Cribier B, Chenard MP, Mitcov M, Mayeur S, Weingertner N. Cutaneous manifestations in patients with coronavirus disease 2019: clinical and histological findings. Hum Pathol 2021; 107:39-45. [PMID: 33161030 PMCID: PMC7834212 DOI: 10.1016/j.humpath.2020.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022]
Abstract
The clinical spectrum of coronavirus disease 2019 is getting wider with the exponential increase of patients worldwide. Initially described with flu-like symptoms, variable cutaneous manifestations have been reported, with only few histopathological descriptions. Detection of the virus in cutaneous samples has been assessed in very few cases until now, and the causative role of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been proven for every type of cutaneous manifestations yet. We aimed to describe histological features of cutaneous eruptions occurring concomitantly to SARS-CoV-2 infection and assess by immunochemistry and in situ hybridization using RNAscope validation techniques the presence of the virus in skin lesions. We retrieved all skin biopsies received in the departments of pathology and dermatopathology, University Hospital of Strasbourg, performed in hospitalized SARS-CoV-2-infected patients presenting concomitant cutaneous manifestations since March 2020. In situ hybridization and immunostaining using a polyclonal SARS nucleocapsid protein antibody were performed on each sample. Skin biopsies from six patients presenting morbilliform eruption concomitant to SARS-CoV-2 infection were available for evaluation. All six samples showed varying degrees of spongiosis, perivascular inflammatory infiltrates of the dermis, and, for some of them, discrete interface dermatitis. In situ hybridization and immunohistochemistry were negative in all cutaneous samples. Morbilliform rash concomitant to SARS-CoV-2 infection is characterized by mild and unspecific histopathological features with no detectable viral RNA and protein and appears then not to be directly caused by the virus. Even if, at least for a few cases, the differential diagnosis with drug hypersensitivity reaction can be difficult, these cutaneous eruptions seem to rather correspond to paraviral rashes.
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Affiliation(s)
- Antonin Fattori
- Department of Pathology, Strasbourg University Hospital, 67200, France.
| | - Bernard Cribier
- Department of Dermatology, Strasbourg University Hospital, 67200, France
| | | | - Mona Mitcov
- Department of Dermatology, Strasbourg University Hospital, 67200, France
| | - Sylvain Mayeur
- Department of Pathology, Strasbourg University Hospital, 67200, France
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18
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Miraglia E, Moliterni E, Iacovino C, Roberti V, Laghi A, Moramarco A, Giustini S. Cutaneous manifestations in neurofibromatosis type 1. Clin Ter 2020; 171:e371-e377. [PMID: 32901776 DOI: 10.7417/ct.2020.2242] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To better understand the real prevalence of cutaneous manifestations, in Neurofibromatosis type 1. MATERIALS AND METHODS We reviewed all clinical charts of 1102 NF1 patients followed by February 1983 to February 2020 at the "Sapienza" University of Rome, Italy. NF1 patients are seen usually every year by a dermatologist. RESULT Café-au-lait macules were shown in 1063 patients (96.5%), axillary and inguinal freckling in 991 (90%) and neurofibromas in 861 (78.1%). Other skin manifestations included: lipoma (6.2%), nevus anemicus (3.9%), psoriasis (3.4%), spilus nevus (3.2%), juvenile xanthogranuloma (3.2%), vitiligo (2.3%), Becker's nevus (1.9%), melanoma (0.7%) and poliosis (0.5%). CONCLUSION Neurofibromatosis type 1 is a multisystem disorder primarily involving the skin and nervous system. The clinical manifestations are extremely variable even within a family. This study was performed to delineate the prevalence of cutaneous manifestations in NF1.
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Affiliation(s)
- E Miraglia
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - E Moliterni
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - C Iacovino
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - V Roberti
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - A Laghi
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - A Moramarco
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| | - S Giustini
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
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19
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Genovese G, Moltrasio C, Berti E, Marzano AV. Skin Manifestations Associated with COVID-19: Current Knowledge and Future Perspectives. Dermatology 2020; 237:1-12. [PMID: 33232965 PMCID: PMC7801998 DOI: 10.1159/000512932] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [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: 09/01/2020] [Accepted: 11/10/2020] [Indexed: 11/28/2022] Open
Abstract
Background Coronavirus disease-19 (COVID-19) is an ongoing global pandemic caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2), which was isolated for the first time in Wuhan (China) in December 2019. Common symptoms include fever, cough, fatigue, dyspnea and hypogeusia/hyposmia. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported in the last few months. Summary The polymorphic nature of COVID-19-associated cutaneous manifestations led our group to propose a classification, which distinguishes the following six main clinical patterns: (i) urticarial rash, (ii) confluent erythematous/maculopapular/morbilliform rash, (iii) papulovesicular exanthem, (iv) chilblain-like acral pattern, (v) livedo reticularis/racemosa-like pattern, (vi) purpuric “vasculitic” pattern. This review summarizes the current knowledge on COVID-19-associated cutaneous manifestations, focusing on clinical features and therapeutic management of each category and attempting to give an overview of the hypothesized pathophysiological mechanisms of these conditions.
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Affiliation(s)
- Giovanni Genovese
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Moltrasio
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Emilio Berti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy, .,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy,
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20
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Garduño-Soto M, Choreño-Parra JA, Cazarin-Barrientos J. Dermatological aspects of SARS-CoV-2 infection: mechanisms and manifestations. Arch Dermatol Res 2020; 313:611-622. [PMID: 33159236 PMCID: PMC7646711 DOI: 10.1007/s00403-020-02156-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/02/2020] [Revised: 10/11/2020] [Accepted: 10/17/2020] [Indexed: 02/08/2023]
Abstract
The human infection caused by the novel SARS-CoV-2 is a public health emergency of international concern. Although the disease associated to this virus, named COVID-19, mainly affects the lungs, the infection can spread to extrapulmonary tissues, causing multiorgan involvement in severely ill patients. The broad infective capacity of SARS-CoV-2 is related to the pattern of expression of the viral entry factors ACE2 and TMPRSS2 in human tissues. As such, the respiratory and gastrointestinal tracts are at high risk for SARS-CoV-2 infection due to their high expression of ACE2 and TMPRSS2, which explains the clinical phenotype described in the vast majority of infected patients that includes pneumonia and diarrhea. Recently, preoccupation about the potential of the virus to infect the skin has been raised by dermatologists due to the increasing observations of cutaneous manifestations in patients with SARS-CoV-2 infection. Although there is little evidence of the expression of ACE2 and TMPRSS2 in the normal skin, the dermatological findings observed among COVID-19 patients warrants further investigation to delineate the mechanisms of skin affection after SARS-CoV-2 infection. Here, we provide a summary of the dermatological findings observed among patients with laboratory-confirmed SARS-CoV-2 infection based on recent reports. In addition, we analyze possible mechanisms of skin injury in COVID-19 patients and discuss about the risk of individuals with chronic skin conditions for SARS-CoV-2 infection. The present review constitutes a useful informative tool to improve our understanding of the pathophysiological mechanisms of COVID-19 and the possible implications of the current pandemic in dermatology.
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Affiliation(s)
- Myriam Garduño-Soto
- Department of Dermatology, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico.
| | | | - Jorge Cazarin-Barrientos
- Department of Dermatology, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, Cuauhtémoc, 06720, Mexico City, Mexico
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21
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Kassas ME, Hegazy OMO, Salah EM. Effect of treating chronic hepatitis C with direct-acting antivirals on extrahepatic cutaneous manifestations. World J Hepatol 2020; 12:841-849. [PMID: 33200021 PMCID: PMC7643207 DOI: 10.4254/wjh.v12.i10.841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/25/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) is a disease with a significant global impact, affecting approximately 2%-2.5% of the world’s population. New direct-acting antivirals (DAAs) have been introduced over the past few years with great success in viral eradication. The association of chronic HCV infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature.
AIM To assess the effect of treating HCV with DAAs on the extrahepatic cutaneous manifestations of HCV.
METHODS This prospective observational study included 1039 HCV positive Egyptian patients who were eligible to receive DAAs. A total of 30 patients were diagnosed with extrahepatic cutaneous manifestations and fulfilled the inclusion criteria of the study. Of these patients, 6 had classic lichen planus, 8 were diagnosed with psoriasis vulgaris and 16 had pruritus. All patients received DAAs from October 2018 to July 2019 in the form of a three-month course of sofosbuvir/daclatasvir combination. Patients with lichen planus or psoriasis were dermoscopically evaluated before treatment and 6 mo after treatment, while patients with hepatic pruritus were assessed using the 12-Item Pruritus Severity Scale over the same period.
RESULTS All patients with psoriasis showed significant improvement in all psoriatic plaques, and all patients with hepatic pruritus scored 0 on the 12-Item Pruritus Severity Scale indicating total improvement of pruritus. In addition, four of six patients with lichen planus showed complete improvement.
CONCLUSION Treatment of HCV with DAAs was significantly effective in improving virus-related extrahepatic cutaneous manifestations.
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Affiliation(s)
- Mohamed El Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Osama MO Hegazy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
| | - Eman M Salah
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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22
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Sani H, Abubakar AB, Bakari AG. Prevalence and pattern of skin diseases in patients with diabetes mellitus at a tertiary hospital in Northern Nigeria. Niger J Clin Pract 2020; 23:970-974. [PMID: 32620727 DOI: 10.4103/njcp.njcp_95_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/04/2022]
Abstract
Background Diabetes mellitus is one of the most common metabolic disorders with a rising prevalence. It cuts across all ages and socioeconomic status. Various skin lesions are frequently observed in diabetic patients. Aims This study was carried out to determine the prevalence, pattern, and determinants of skin diseases in diabetic patients at the Barau Dikko Teaching Hospital, Kaduna, North West Nigeria. Materials and Methods One hundred consecutive diabetic patients attending the clinic were included in the study. Results Many of the patients had more than one skin condition at a time. The most prevalent skin diseases were idiopathic guttate hypomelanosis which was seen in 61% of patients, infections from fungal, bacterial, and viral causes occurred in 30% of patients, other skin disorders were diabetic dermopathy seen in 17% of patients, palmoplantar hyperpigmentation was seen in 13% of patients, while pruritus occurred in 12% of patients and xerosis was seen in 10% of patients. Conclusion Skin disorders are common among diabetic patients at Barau Dikko Teaching Hospital, Kaduna, North West Nigeria.
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Affiliation(s)
- H Sani
- Department of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
| | - A B Abubakar
- Department of Medicine, Barau Dikko Teaching Hospital, Kaduna State University, Kaduna, Nigeria
| | - A G Bakari
- Department of Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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23
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Mawhirt SL, Frankel D, Diaz AM. Cutaneous Manifestations in Adult Patients with COVID-19 and Dermatologic Conditions Related to the COVID-19 Pandemic in Health Care Workers. Curr Allergy Asthma Rep 2020; 20:75. [PMID: 33047260 PMCID: PMC7549735 DOI: 10.1007/s11882-020-00974-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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] [Accepted: 09/30/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW COVID-19 (coronavirus viral disease 2019), due to the novel SARS-CoV-2, may present with different types of cutaneous manifestations of varying pathophysiology. During the ongoing pandemic, publications reporting dermatologic findings in COVID-19 continue to emerge. RECENT FINDINGS Cutaneous vasculopathy and microthrombus-related changes including acral and sacral lesions, retiform purpura, livedo reticularis, and cutaneous vasculitis are notable findings in adult patients. Other exanthems include urticaria or angioedema, morbilliform/maculopapular exanthems, erythema multiforme, and vesicular eruptions. Increased recognition of these findings, especially those consistent with cutaneous microthrombi or vasculitis, is of particular importance. Additionally, occupational dermatologic disease related to extended personal protective equipment (PPE) use, such as skin damage and irritant or allergic contact dermatitis (ACD), represents another emerging problem amidst the pandemic. In this review, we highlight the various cutaneous manifestations associated with COVID-19 in adult patients and occupational dermatitis in health care workers (HCWs) caring for this patient population.
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Affiliation(s)
- Stephanie L Mawhirt
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA.
| | - David Frankel
- Division of Allergy and Immunology, Department of Medicine, NYU Winthrop Hospital, 120 Mineola Blvd Suite 410, Mineola, New York, USA
| | - Althea Marie Diaz
- Department of Medicine, 222 Station Plaza North, Suite 509, Mineola, New York, USA
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the COVID-19 global pandemic, is notable for an expanding list of atypical manifestations including but not limited to coagulopathies, renal dysfunction, cardiac injury and a multisystem inflammatory syndrome in children. In addition, SARS-CoV-2 has been purportedly linked to multiple cutaneous manifestations, among them chilblain-like skin lesions, also known as "COVID toes." Driven in large part by social media, dermatologists around the world reported a dramatic increase in the frequency of chilblain-like diagnoses early in the COVID-19 pandemic, often in members of the same family. This phenomenon has been captured in a rapidly expanding medical literature. As of this writing, the chilblain-like presentation has been reported to occur predominantly in younger, minimally symptomatic patients and to emerge late in the COVID-19 disease course. Evidence of SARS-CoV-2 infection is not consistently found when these patients are evaluated by polymerase chain reaction. A robust antiviral immune response in young patients that induces microangiopathic changes has been posited as a mechanism. Herein we review the rapid evolution of the literature regarding chilblain-like skin lesions early in the COVID-19 global pandemic.
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Affiliation(s)
- Paul R Massey
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Krystal M Jones
- Dermatology Program, Boston Children's Hospital, Harvard Medical School, Boston, MA.
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25
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Chaabane I, Loukil M, Amri R, Badri I, Baha H, Lajmi M, Bouzaidi K, Ghrairi H. Cutaneous manifestations of COVID-19: report of three cases. Arch Dermatol Res 2020. [PMID: 32895763 DOI: 10.1007/s00403-020-02112-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/01/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) shows rapid spread around the world. Its classic presentation is a respiratory illness. However, cutaneous manifestations have rarely been described as the first clinical manifestation in patients with this infection. The aim of this article is to describe cutaneous manifestations in patients with COVID-19 through three case reports.
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Abstract
Given the visibility of cutaneous findings, skin manifestations are often a presenting symptom of underlying systemic disease, including chronic liver disease. Many cutaneous signs and symptoms that correlate with chronic liver disease are common physical examination findings in patients with no history of liver disease. It is nonetheless important to be aware that these cutaneous findings may be an indication of underlying liver disease and often occur in the setting of such hepatic dysfunction. This article covers general cutaneous signs that may correlate with various liver diseases and describes specific cutaneous signs as they relate to more specific liver diseases.
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Affiliation(s)
- Ashaki D Patel
- Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Kimberly Katz
- Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Kenneth B Gordon
- Department of Dermatology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, Veraldi S, Ziv M, Leshem E, Dodiuk-Gad RP. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci 2020; 98:75-81. [PMID: 32381430 PMCID: PMC7189855 DOI: 10.1016/j.jdermsci.2020.04.011] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [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: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Various cutaneous manifestations have been observed in patients with COVID-19 infection. However, overall similarities in the clinical presentation of these dermatological manifestations have not yet been summarized. OBJECTIVE This review aims to provide an overview of various cutaneous manifestations in patients with COVID-19 through three case reports and a literature review. METHODS A literature search was conducted using PubMed, OVID, and Google search engines for original and review articles. Studies written in the English language that mentioned cutaneous symptoms and COVID-19 were included. RESULTS Eighteen articles and three additional cases reported in this paper were included in this review. Of these studies, 6 are case series and 12 are case report studies. The most common cutaneous manifestation of COVID-19 was found to be maculopapular exanthem (morbilliform), presenting in 36.1% (26/72) patients. The other cutaneous manifestations included: a papulovesicular rash (34.7%, 25/72), urticaria (9.7%, 7/72), painful acral red purple papules (15.3%, 11/72) of patients, livedo reticularis lesions (2.8%, 2/72) and petechiae (1.4%, 1/72). Majority of lesions were localized on the trunk (66.7%, 50/72), however, 19.4% (14/72) of patients experienced cutaneous manifestations in the hands and feet. Skin lesion development occurred before the onset of respiratory symptoms or COVID-19 diagnosis in 12.5% (9/72) of the patients, and lesions spontaneously healed in all patients within 10 days. Majority of the studies reported no correlation between COVID-19 severity and skin lesions. CONCLUSION Infection with COVID-19 may result in dermatological manifestations with various clinical presentations, which may aid in the timely diagnosis of this infection.
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Affiliation(s)
- Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raffaele Gianotti
- Institute of Dermatological Sciences, University of Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Shah
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lucia Bradanini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
| | - Diego Tosi
- Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael Ziv
- Dermatology Department, Emek Medical Center, Israel
| | - Eyal Leshem
- Institute for Travel and Tropical Medicine, Sheba Medical Centre, Israel; School of Medicine, Tel Aviv University, Israel
| | - Roni P Dodiuk-Gad
- Dermatology Department, Emek Medical Center, Israel; Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Israel; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Ashwini PK, Betkerur J, Shastry V. Study of muco cutaneous manifestations of HIV and its relation to total lymphocyte count. Indian J Sex Transm Dis AIDS 2020; 41:47-52. [PMID: 33062982 PMCID: PMC7529186 DOI: 10.4103/ijstd.ijstd_58_16] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/14/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION HIV is associated with various mucocutaneous manifestations which may be the first pointers toward HIV and can also be prognostic markers for disease progression. This study was done to note the different mucocutaneous lesions present in HIV and their relation to total lymphocyte count (TLC). METHODOLOGY Three hundred and seventy-nine HIV patients attending the Department of Dermatology, Venereology, and Leprosy were included in the study. They were screened for the presence of any mucocutaneous lesions. TLC in patients presenting with mucocutaneous lesions was done and also CD4 count was done wherever possible. RESULTS Among 379 patients, 53.8% developed mucocutaneous manifestations. Male: female ratio was 2.2:1. Majority of patients belonged to 20-39 years age group. Among mucocutaneous manifestations, oral candidiasis was the most common, followed by herpes zoster and dermatophytoses. Adverse drug reactions were noted in few. The majority of patients had TLC <1500/mm3 and CD4 <200. CONCLUSION Mucocutaneous manifestations are common and have varied presentation in HIV/AIDS. Patients with mucocutaneous manifestations were clustered at lower TLC and CD4 count. Like CD4 count, TLC can be considered as a marker for disease progression.
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Affiliation(s)
- P. K. Ashwini
- Department of Dermatology, JSS Hospital, Mysore, Karnataka, India,Address for correspondence: Dr. P. K. Ashwini, Department of Dermatology, JSS Hospital, MG Road, Mysore - 570 004, Karnataka, India. E-mail:
| | - Jayadev Betkerur
- Department of Dermatology, JSS Hospital, Mysore, Karnataka, India
| | - Veeranna Shastry
- Department of Dermatology, JSS Hospital, Mysore, Karnataka, India
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Abstract
Dermatologists worldwide are engaged in the struggle against Covid-19. They limited their daily activity to priority cases, intending to reduce the exposure of patients in the waiting room. Teledermatology was recommended as an efficient alternative to assure patients' needs and safety. At the same time, dermatologists had to manage the skin injuries of frontline healthcare workers; to characterize the cutaneous manifestations of Covid-19; to assess the optimal treatment of patients with skin diseases, especially those taking immunomodulating and immunosuppressant molecules; and finally to promote balanced precautions in healthy persons.
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Affiliation(s)
- Boutros Soutou
- Dermatology Department, School of Medicine, Université Saint-Joseph, Beirut, Lebanon ,Hôtel-Dieu de France Hospital, Achrafieh, Bvd Alfred Naccache, Beirut, 16-6830 Lebanon
| | - Roland Tomb
- Dermatology Department, School of Medicine, Université Saint-Joseph, Beirut, Lebanon
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Kostopoulos N, Platsidaki E, Tzanetakou V, Petraki K, Lekarakou M, Bafaloukos D, Potouridou I. Nodular Lesions on the Upper Trunk: An Uncommon Anatomical Site of Renal Tumor Metastases. Indian J Dermatol 2019; 64:251. [PMID: 31148873 PMCID: PMC6537680 DOI: 10.4103/ijd.ijd_634_16] [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] [Indexed: 11/17/2022] Open
Abstract
Renal cell carcinoma (RCC) is the most frequent cancer of the kidney and it accounts for 3% of all solid malignancies. Although rare, cutaneous metastases can be an important manifestation of RCC. We present a case of a 56-year-old male with a history of RCC, followed by the development of cutaneous metastases 4 years later with an uncommon clinical presentation. RCC is the most common genitourinary cancer to metastasize to the skin and accounts for 6.8% of cutaneous metastases. These patients have a poor prognosis. It is essential for these patients to perform a complete periodic dermatologic examination for proper restaging and treatment.
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Affiliation(s)
| | | | | | | | - Maria Lekarakou
- Department of Pathology, Metropolitan Hospital, Piraeus, Greece
| | | | - Irini Potouridou
- Department of Dermatology, Andreas Syggros Hospital, Athens, Greece
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Shehu E, Harxhi A, Simaku A. Cutaneous Manifestations of Human Immunodeficiency Virus/AIDS Patients in Albania. Int J Appl Basic Med Res 2019; 9:197-200. [PMID: 31681542 PMCID: PMC6822325 DOI: 10.4103/ijabmr.ijabmr_287_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/25/2018] [Revised: 03/03/2019] [Accepted: 08/16/2019] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Dermatologic diseases are common in the human immunodeficiency virus (HIV)-infected population. Cutaneous manifestations of HIV disease may result from HIV infection itself or from opportunistic disorders secondary to the declined immunocompetence due to the disease. AIMS The aim of this study is to determine the pattern of c0utaneous manifestations in HIV in an adult HIV Clinic in Tirana. SUBJECTS AND METHODS This is a retrospective study including 355 HIV-positive patients with cutaneous manifestations who referred to the Ambulatory Clinic for HIV/AIDS, at the Infective Service and Dermatology Service of University Hospital Centre "Mother Theresa," Tirana, Albania over the period 2008-2015. RESULTS The mean age of patients was 43.08 (±11.8) years, with a range 15-79 years. Two hundred and forty-seven (69.6%) of patients were male and 108 (30.4%) female. Male-to-female ratio is 2.3:1. The study found a significant trend of increasing incidence of dermatological pathologies with increasing stage of the disease. Fifty-five (15.5%) of patients with cutaneous lesions were in Stage 1, 132 (37.2%) in Stage 2, and 168 (47.4%) in Stage 3 (P < 0.001). As for the HIV transmission method, the majority of patients (71%) were infected through heterosexual contact, followed by homosexual contact (16.3%), blood transfusion (3.4%), injecting drug user (2.3%), while for 7% of patients the mode of transmission was unknown. CONCLUSIONS Early recognition of the cutaneous manifestation can help in better management of HIV infection in resource-poor setting, as it can indicate the progression of the disease and underlying immune status.
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Affiliation(s)
- Erjona Shehu
- University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Arjan Harxhi
- University Hospital Centre “Mother Theresa”, Tirana, Albania
| | - Artan Simaku
- Department of Epidemiology, Institute of Public Health, Tirana, Albania,Address for correspondence: Dr. Artan Simaku, Institute of Public Health, Tirana, Albania. E-mail:
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Dhouib NG, Ben Khaled M, Ouederni M, Ben-Mustapha I, Kouki R, Besbes H, Barbouche MR, Mellouli F, Bejaoui M. Cutaneous Manifestations of Primary Immunodeficiency Diseases in Tunisian Children. Mediterr J Hematol Infect Dis 2018; 10:e2018065. [PMID: 30416697 DOI: 10.4084/MJHID.2018.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/15/2018] [Indexed: 12/01/2022] Open
Abstract
Skin manifestations are frequent among patients with primary immunodeficiency diseases (PIDs). Their prevalence varies according to the type of immunodeficiency. This review provides the reader with an up-to-date summary of the common dermatologic manifestations of PIDs among Tunisian children. We conducted a prospective study on two hundred and ninety children with immune deficiency. Demographic details (including age, sex, and consanguinity) with personal and family history were recorded. Special attention was paid to cutaneous manifestations. Dermatological involvements were grouped according to the etiology of their most prominent sign. Cutaneous manifestations were found in 164 patients (56.5%). They revealed the diagnosis of PIDs in 71 patients (24.5 %). The mean age at presentation was 21 months. Overall the most prominent cutaneous alterations were infectious. They accounted for 106 cases (36.55%). The most prevalent causes of cutaneous infections were bacterial: 93 cases (32.06%). Immuno-allergic skin diseases were among the common findings in our study. These include eczematous dermatitis found in 62 cases (21.38%). Malignancy related PIDs was seen in a boy with Wiskott Aldrich syndrome. He developed Kaposi’s sarcoma at the age of 14 months. Cutaneous changes are common among children with PIDs. In pediatric patients with failure to thrive, chronic refractory systemic manifestations often present in other family members, recurrent cutaneous infections unresponsive to adequate therapy, atypical forms of eczematous dermatitis or unusual features should arouse the suspicion of PIDs and prompt specialized immunologic consultation should be made.
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Abstract
PURPOSE OF REVIEW The hyper IgE syndromes (HIES) comprise a group of rare primary immunodeficiency disorders (PIDDs), which are characterized by extremely high serum IgE levels, eczema, recurrent skin and pulmonary infections. Both autosomal dominant (AD) HIES due to STAT3 mutations and autosomal recessive (AR) HIES due to PGM3, SPINK5, DOCK8 and TKY2 mutations have been reported. Here, we aim to summarize and compare the major clinical manifestations of different subtypes of HIES. We will also discuss otitis media, which usually do not get enough attention in HIES. Update and familiarity with these clinical features will help to make a better diagnose, assessment and treatment of HIES. RECENT FINDINGS Although hyper serum IgE levels have been identified in PGM3 deficiency and Comel-Netherton syndrome, PGM3 and SPINK5 genes were not included in the list of genetic etiologies of AR-HIES by the Expert Committee of the International Union of Immunological Societies until 2015. The identification of these HIES-causing genes greatly promoted the pathogenic mechanism studies of HIES. Also, in recent years, more clinical manifestations, which were often not of concern in HIES patients, have been shown to be highly related to HIES. For example, a significantly high frequency of vascular and gastrointestinal abnormities has been reported in STAT3-deficient AD-HIES patients. These new findings might help to provide new clues to the functional study of these HIES-related genes. This review summarizes and compares the major clinical manifestations of different subtypes of HIES, and we suggest that the incidence and severity of otitis media should not be underestimated in HIES patients.
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Affiliation(s)
- Jing Wu
- Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China
- Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Li Hong
- Allergy and Immunology Multidisciplinary Specialty Clinic, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
| | - Tong-Xin Chen
- Department of Allergy and Immunology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
- Division of Immunology, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Allergy and Immunology Multidisciplinary Specialty Clinic, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dongfang Road, Shanghai, 200127, China.
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Rashpa RS, Mahajan VK, Kumar P, Mehta KS, Chauhan PS, Rawat R, Sharma V. Muco cutaneous Manifestations in Patients with Chronic Kidney Disease: A Cross-sectional Study. Indian Dermatol Online J 2018; 9:20-26. [PMID: 29441293 PMCID: PMC5803936 DOI: 10.4103/idoj.idoj_160_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Chronic kidney disease (CKD)-associated mucocutaneous manifestations significantly impair the quality of life but often remain understudied. They may also vary across regions, socioeconomic and nutritional status, and racial differences. Objectives: To study the patterns of mucocutaneous disorders and their prevalence in CKD patients irrespective of clinical stage or dialysis status. Materials and Methods: 122 (M:F = 77:45) patients aged 21‒85 (Mean ± SD = 57.5 ± 14.0) years having CKD for 3 month to 5 years were studied for mucocutaneous manifestations. Fifty (41%) patients were on hemodialysis for 1‒42 months. Detailed medical history, clinical and mucocutaneous examination, and lab investigations were performed. KOH mounts, skin biopsy, Gram's and Giemsa staining, bacterial or fungal cultures were performed as required. Results: Xerosis in 93 (76.2%), skin pallor in 61 (50%), pruritus in 57 (46.7%), pigmentation in 47 (38.5%), and purpura in 18 (14.8%) patients were the major dermatoses. Bullous lesions and perforating folliculitis occurred in 3 (2.5%) patients each. Major nail abnormalities were pallor (in 35.2%), absent lunula (in 23.8%), nail discoloration (in 18%), and “half-and-half nails” in 16.4% patients, respectively. Hair abnormalities included sparse scalp and body hairs (in 35.2% and 13.1%, respectively) and lusterless hair in 12.3% patients. Coated tongue (in 14.8%), xerostomia (in 12.3%), and macroglossia with teeth indention (in 7.4%) patients were the mucosal manifestations. Conclusions: Xerosis, pruritus, skin pallor/pigmentary changes, nail pallor, absent lunula, nail discoloration, sparse hairs, coated tongue, xerostomia, macroglossia, and infections were the most common mucocutaneous manifestations in the studied patients irrespective of hemodialysis status. Cold and dry climates might be additional aggravators for xerosis/pruritus. Lifelong follow-up may be needed to reduce the morbidity associated with CKD/hemodialysis specific dermatoses appearing over a period.
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Affiliation(s)
- Rattan S Rashpa
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Vikram K Mahajan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Pankaj Kumar
- Department of Internal Medicine, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Ritu Rawat
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
| | - Vikas Sharma
- Department of Dermatology, Venereology and Leprosy, Dr. R. P. Govt. Medical College, Kangra, Himachal Pradesh, India
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Abstract
Drug hypersensitivity reactions may manifest with either organ-specific or systemic symptoms, but cutaneous eruptions are the most common manifestations. Different medications may cause identical skin symptoms, whereas hypersensitivity to a single drug may manifest with various patterns of symptoms depending on the pathomechanism of hypersensitivity. Drug reactions should be also taken into account in the differential diagnosis of numerous skin rashes. Analysis of morphology of drug-induced lesions, about potential immunologic or nonimmunological mechanisms, is important for the final diagnosis. Thus, here the authors present a morphologic approach to the diagnosis of cutaneous drug-induced eruptions.
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Affiliation(s)
- Anna Zalewska-Janowska
- Department of Psychodermatology, Medical University of Lodz, 251 Pomorska Street, Lodz 92-213, Poland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of Pharmacy, Jagiellonian University Medical College, 9 Medyczna Street, Krakow 30-688, Poland
| | - Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, 251 Pomorska Street, Lodz 92-213, Poland.
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Abstract
Skin manifestations are a reflection of many of the internal diseases. Sometimes, skin disease may be the only manifestation of the internal disease. Internal malignancies may give rise to a number of cutaneous manifestations through their immunological, metabolic, and metastatic consequences. Curth proposed criteria to establish a causal relationship between a dermatosis and a malignant internal disease. Malignancy can present with a plethora of cutaneous manifestations. Here, we describe in brief about various skin manifestations of internal malignancies.
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Affiliation(s)
- Rita V Vora
- Department of Dermatology, Shree Krishna Hospital, Pramukh Swami Medical College, Karamsad, Gujarat, India
| | - RahulKrishna S Kota
- Department of Dermatology, Shree Krishna Hospital, Pramukh Swami Medical College, Karamsad, Gujarat, India
| | - Nilofar G Diwan
- Department of Dermatology, Shree Krishna Hospital, Pramukh Swami Medical College, Karamsad, Gujarat, India
| | - Nidhi B Jivani
- Department of Dermatology, Shree Krishna Hospital, Pramukh Swami Medical College, Karamsad, Gujarat, India
| | - Shailee S Gandhi
- Department of Dermatology, Shree Krishna Hospital, Pramukh Swami Medical College, Karamsad, Gujarat, India
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Diyabalanage S, Fonseka S, Dasanayake DMSNB, Chandrajith R. Environmental exposures of trace elements assessed using keratinized matrices from patients with chronic kidney diseases of uncertain etiology (CKDu) in Sri Lanka. J Trace Elem Med Biol 2017; 39:62-70. [PMID: 27908426 DOI: 10.1016/j.jtemb.2016.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 05/30/2016] [Revised: 07/21/2016] [Accepted: 08/02/2016] [Indexed: 01/29/2023]
Abstract
An alarming increase in chronic kidney disease with unknown etiology (CKDu) has recently been reported in several provinces in Sri Lanka and chronic exposures to toxic trace elements were blamed for the etiology of this disease. Keratinized matrices such as hair and nails were investigated to determine the possible link between CKDu and toxic element exposures. Elements Li, B, Al, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Sr, Mo, Cd, Ba, Hg and Pb of hair and nails of patients and age that matched healthy controls were determined with Inductively Coupled Plasma Mass Spectrometry (ICP-MS). The results showed that trace element contents in the hair of patients varies in the order of Zn>Fe>Al>Mn>Cu>Ba>Sr>Ni>Pb>Cr>B>Hg>Se>Mo>Co>As>Li>Cd while Fe>Al>Zn>Ni>Cu>Mn>Cr>Ba>Sr>B>Pb>Se>Mo>Co>Hg>Li>As>Cd in nail samples. The hair As levels of 0.007-0.165μgg-1 were found in CKDu subjects. However, no significant difference was observed between cases and controls. The total Se content in hair of CKDu subjects ranged from 0.043 to 0.513μgg-1 while it was varied from 0.031 to 1.15μgg-1 in controls. Selenium in nail samples varied from 0.037μgg-1 to 4.10μgg-1 in CKDu subjects and from 0.042μgg-1 to 2.19μgg-1 in controls. This study implies that substantial proportions of Sri Lankan population are Se deficient irrespective of gender, age and occupational exposure. Although some cutaneous manifestations were observed in patient subjects, chemical analyses of hair and nails indicated that patients were not exposed to toxic levels of arsenic or the other studied toxic elements. Therefore the early suggested causative factors such as exposure to environmental As and Cd, can be ruled out.
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Affiliation(s)
- Saranga Diyabalanage
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka; Postgraduate Institute of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sanjeewani Fonseka
- Department of Pharmacology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - D M S N B Dasanayake
- Department of Pharmacology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka.
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Abstract
The skin of the lower extremity can be a helpful diagnostic tool for systemic disease. Diabetes, renal disease, genetic disorders, and even cancer can have cutaneous manifestations in the legs and feet; moreover, proper diagnosis can facilitate earlier treatment of these diseases and not only clear up the skin symptoms but also bring about resolution of the systemic disease causing them. Although not comprehensive, this article discusses many of these disorders presenting with integumentary manifestations in the lower extremities. Where appropriate, it also enumerates the treatments involved, both systemic and localized.
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Affiliation(s)
- Joseph Vella
- Private Practice, Impression Foot & Ankle, 5656 South Power Road, Suite 124, Gilbert, AZ 85295, USA.
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Garcia NG, de Carli ML, Oliveira DT, Soares CT, Ribeiro Júnior NV, Sperandio FF, Hanemann JA. Tuberous Sclerosis with Severe Cutaneous Manifestation and Multiples Facial Angiofibromas. Head Neck Pathol 2016; 10:542-6. [PMID: 27140177 DOI: 10.1007/s12105-016-0723-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/21/2016] [Accepted: 04/27/2016] [Indexed: 12/15/2022]
Abstract
Tuberous sclerosis is an extremely variable disease that can affect virtually any organ in the body. The most common findings are cutaneous manifestations, that are critical features in helping to establish diagnosis. We present a case of young man with diagnosis of tuberous sclerosis presenting multiple shagreen patches around the trunk, in the neck and genital region; large plaques with uneven surfaces on the right side of the lower back; and multiple papular lesions in his face, particularly around the nasolabial region, eyebrows and forehead. Considering that tuberous sclerosis is a disease with a highly variable clinical presentation, thus dentists and doctors should be aware of the different manifestations that may be found.
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Carlesimo M, Abruzzese C, Narcisi A, Margagnoni G, Zerboni G, Purchiaroni F, Pagnini C, Di Giulio E, Corleto VD. Cutaneous manifestations and gastrointestinal disorders: Report of two emblematic cases. Clin Ter 2015; 166:e269-72. [PMID: 26378761 DOI: 10.7417/t.2015.1872] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Gastrointestinal (GI) diseases, such as inflammatory bowel diseases (IBD), can manifest themselves with intestinal and extra-intestinal symptoms. Among the latter, cutaneous manifestations, such as pyoderma gangraenosum (PG) and metastatic Crohn's disease (MCD), represent a possible onset of IBD, with or without simultaneous bowel alterations. In such cases, intestinal and skin lesions are supported by the same immune-mediated mechanism. We hereby report two cases of patients with skin manifestations together with signs and symptoms suggestive of IBD. IBD and some skin lesions arise from the same immune-mediated mechanism. A multidisciplinary approach to these immune-mediated diseases is needed for an early and correct diagnosis, which in turn may lead to the use of the right drug avoiding useless treatment.
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Affiliation(s)
- M Carlesimo
- NESMOS, U.O.C. Dermatology, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - C Abruzzese
- NESMOS, U.O.C. Dermatology, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - A Narcisi
- NESMOS, U.O.C. Dermatology, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - G Margagnoni
- NESMOS, Department of Digestive Endoscopy, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - G Zerboni
- NESMOS, Department of Digestive Endoscopy, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - F Purchiaroni
- NESMOS, Department of Digestive Endoscopy, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - C Pagnini
- NESMOS, Department of Digestive Endoscopy, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - E Di Giulio
- NESMOS, Department of Digestive Endoscopy, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - V D Corleto
- NESMOS, Department of Digestive Endoscopy, School of Medicine and Psychology, University Sapienza, Sant'Andrea Hospital, Rome, Italy
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Gowri BV, Chandravathi PL, Sindhu PS, Naidu KS. Correlation of Skin Changes with Hormonal Changes in Polycystic Ovarian Syndrome: A Cross-sectional Study Clinical Study. Indian J Dermatol 2015; 60:419. [PMID: 26288423 PMCID: PMC4533553 DOI: 10.4103/0019-5154.160505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 01/19/2023] Open
Abstract
Background: Polycystic ovarian syndrome (PCOS) is a heterogenous collection of signs and symptoms that when gathered, form a spectrum of disorder with disturbance of reproductive, endocrine and metabolic functions. Aim: The aim of this study is to correlate the skin manifestations with hormonal changes and to know the incidence and prevalence of skin manifestations in patients with PCOS. Materials and Methods: A total of 40 patients with PCOS were examined during 1 year time period from May 2008 P to May 2009. Detailed clinical history was taken from each patient. PCOS was diagnosed on the basis of ultrasonography. Hormonal assays included fasting blood sugar, postprandial blood sugar, follicle-stimulating hormone, luteinizing hormone, thyroid stimulating hormone, dehydroepiandrostenedione, prolactin, free testosterone, fasting lipid profile and sex hormone binding globulin. The results obtained were statistically correlated. Results: In our study, the prevalence of cutaneous manifestations was 90%. Of all the cutaneous manifestations acne was seen in highest percentage (67.5%), followed by hirsutism (62.5%), seborrhea (52.5%), androgenetic alopecia (AGA) (30%), acanthosis nigricans (22.5%) and acrochordons (10%). Fasting insulin levels was the most common hormonal abnormality seen in both acne and hirsutism, whereas AGA was associated with high testosterone levels. Conclusion: The prevalence of cutaneous manifestations in PCOS was 90%. Hirsutism, acne, seborrhea, acanthosis nigricans and acrochordons were associated with increased levels of fasting insulin, whereas AGA showed higher levels of serum testosterone.
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Affiliation(s)
- B Vijaya Gowri
- Department of Dermatology, Care Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - P L Chandravathi
- Department of Dermatology, Care Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - P S Sindhu
- Department of Dermatology, Care Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
| | - K Shanthi Naidu
- Department of Lab Medicine, Care Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
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Afzali A, Wheat CL, Hu JK, Olerud JE, Lee SD. The association of psoriasiform rash with anti-tumor necrosis factor (anti-TNF) therapy in inflammatory bowel disease: a single academic center case series. J Crohns Colitis 2014; 8:480-8. [PMID: 24268978 DOI: 10.1016/j.crohns.2013.10.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 09/08/2013] [Revised: 10/14/2013] [Accepted: 10/29/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Anti-tumor necrosis factors (anti-TNF) including infliximab, adalimumab and certolizumab pegol are used to treat Crohn's disease (CD) and ulcerative colitis (UC). Paradoxically, while also indicated for the treatment of psoriasis, anti-TNF therapy has been associated with development of psoriasiform lesions in IBD patients and can compel discontinuation of therapy. We aim to investigate IBD patient, clinical characteristics, and frequency for the development of and outcomes associated with anti-TNF induced psoriasiform rash. METHODS We identify IBD patients on anti-TNFs with an onset of a psoriasiform rash. Patient characteristics, duration of anti-TNF, concomitant immunosuppressants, lesion distribution, and outcomes of rash are described. RESULTS Of 1004 IBD patients with exposure to anti-TNF therapy, 27 patients (2.7%) developed psoriasiform lesions. Psoriasiform rash cases stratified by biologic use were 1.3% for infliximab, 4.1% for adalimumab, and 6.4% for certolizumab. Average time on treatment (206.3weeks) and time on treatment until onset of psoriasiform lesions (126.9weeks) was significantly higher in the infliximab group. The adalimumab group had the highest need for treatment discontinuation (60%). The majority (59.3%) of patients were able to maintain on anti-TNFs despite rash onset. Among patients that required discontinuation (40.7%), the majority experienced improvement with a subsequent anti-TNF (66.7%). CONCLUSION 27 cases of anti-TNF associated psoriasiform lesions are reported. Discontinuation of anti-TNF treatment is unnecessary in the majority. Dermatologic improvement was achieved in the majority with a subsequent anti-TNF, suggesting anti-TNF induced psoriasiform rash is not necessarily a class effect.
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Affiliation(s)
- Anita Afzali
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, United States; Inflammatory Bowel Disease Program, University of Washington Medical Center, Seattle, WA, United States.
| | - Chelle L Wheat
- Inflammatory Bowel Disease Program, University of Washington Medical Center, Seattle, WA, United States
| | - Jie Kate Hu
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - John E Olerud
- Division of Dermatology, Department of Medicine, University of Washington, Seattle, WA, United States
| | - Scott D Lee
- Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA, United States; Inflammatory Bowel Disease Program, University of Washington Medical Center, Seattle, WA, United States
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Dahbi N, Hocar O, Akhdari N, Amal S, Bassit N, Fadili W, Laouad I. [ Cutaneous manifestations in hemodialysis patients]. Nephrol Ther 2014; 10:101-5. [PMID: 24508001 DOI: 10.1016/j.nephro.2013.10.008] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 09/21/2013] [Accepted: 10/13/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hemodialysis patients have frequent and various cutaneous manifestations of often hypothetical pathogenesis. Chronic renal failure (CRF) presents with an array of cutaneous manifestations. The objective was to evaluate the prevalence and nature of cutaneous lesions associated with CRF patients on hemodialysis patients. PATIENTS AND METHODS Transversal and observational study of 53 patients with CRF on regular hemodialysis. RESULTS There were 28 women and 25 men. Their mean age was 44 year-old. All patients had cutaneous manifestations and 64% complained of dermatological signs. Cutaneous xerosis and pigmentation disorders were found in 96 and 94% of patients, respectively. Other manifestations were pallor (41%), pruritus (20.7%), a diffuse hair loss (35.8%) and nails changes (66%). COMMENTS Cutaneous manifestations in hemodialysis patients are frequent polymorphous. Their incidence varies from 50 to 100% of the series. Their knowledge deserves a proper management by both dermatologists and nephrologists to improve the life quality of hemodialysis patients.
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Affiliation(s)
- Noama Dahbi
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc.
| | - Ouafa Hocar
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Nadia Akhdari
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Said Amal
- Service de dermatologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Nora Bassit
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Wafaa Fadili
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
| | - Inas Laouad
- Service de néphrologie, faculté de médecine et de pharmacie, université Cadi Ayyad, centre hospitalier universitaire Mohammed VI, Marrakech, Maroc
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Yuste Chaves M, Unamuno Pérez P. Cutaneous manifestations of systemic malignancies: part 2. Actas Dermosifiliogr 2013; 104:543-53. [PMID: 23891448 DOI: 10.1016/j.adengl.2012.05.026] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/07/2012] [Indexed: 12/12/2022] Open
Abstract
The skin can be key to early diagnosis of systemic malignancies. In the second part of this review, we present various skin conditions that can, in certain contexts, reveal the presence of malignancy. The skin conditions are presented in groups based on a diverse range of morphological characteristics. Specifically, the following groups are analyzed: erosive and blistering lesions; inflammatory papules and nodules; xerosis, ichthyosis, and generalized exfoliative dermatitis; symptoms such as pruritus; abnormal hair distribution patterns; sweating disorders; benign tumors that can form part of hereditary syndromes associated with a risk of visceral cancer; and finally, oral and nail abnormalities. This review highlights the importance of the skin in the study of systemic malignancies.
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Affiliation(s)
- M Yuste Chaves
- Servicio de Dermatología, Hospital Universitario de Salamanca, Salamanca, Spain.
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Abstract
Dermatomyositis (DM) is a chronic inflammatory disorder of the skin and muscles. Evidence supports that DM is an immune-mediated disease and 50–70% of patients have circulating myositis-specific auto-antibodies. Gene expression microarrays have demonstrated upregulation of interferon signaling in the muscle, blood, and skin of DM patients. Patients with classic DM typically present with symmetric, proximal muscle weakness, and skin lesions that demonstrate interface dermatitis on histopathology. Evaluation for muscle inflammation can include muscle enzymes, electromyogram, magnetic resonance imaging, and/or muscle biopsy. Classic skin manifestations of DM include the heliotrope rash, Gottron's papules, Gottron's sign, the V-sign, and shawl sign. Additional cutaneous lesions frequently observed in DM patients include periungual telangiectasias, cuticular overgrowth, “mechanic's hands”, palmar papules overlying joint creases, poikiloderma, and calcinosis. Clinically amyopathic DM is a term used to describe patients who have classic cutaneous manifestations for more than 6 months, but no muscle weakness or elevation in muscle enzymes. Interstitial lung disease can affect 35–40% of patients with inflammatory myopathies and is often associated with the presence of an antisynthetase antibody. Other clinical manifestations that can occur in patients with DM include dysphagia, dysphonia, myalgias, Raynaud phenomenon, fevers, weight loss, fatigue, and a nonerosive inflammatory polyarthritis. Patients with DM have a three to eight times increased risk for developing an associated malignancy compared with the general population, and therefore all patients with DM should be evaluated at the time of diagnosis for the presence of an associated malignancy. This review summarizes the immunopathogenesis, clinical manifestations, and evaluation of patients with DM.
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Affiliation(s)
- Umaima Marvi
- Division of Immunology and Rheumatology, Stanford University, USA
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Abstract
Background: The metabolic complications and pathologic changes that occur in diabetes mellitus (DM) influence the occurrence of various dermatoses. Aim: To study the impact of control of diabetes on the pattern of cutaneous disorders. Materials and Methods: A cross-sectional descriptive study of patients attending diabetic clinic in a tertiary care hospital. A total of 500 consecutive patients were studied. Detailed history, clinical examination and relevant investigations were done to diagnose diabetic complications and cutaneous disorders. Dermatoses with or without known pathogenesis were correlated with age, gender, fasting plasma glucose (FPG), duration of diabetes, and complications of DM. Statistical analysis was carried out using Student “t” test and Chi-square test with 5% confidence interval (P value 0.05). Results: Majority of patients had well-controlled (FPG<130 mg/ml, 60%) type 2 DM (98.8%). No statistically significant difference (P>0.05) between the patients with or without DM specific cutaneous disorders was noticed with reference to age and gender distribution, duration of DM and FPG. Signs of insulin resistance, acrochordon (26.2%), and acanthosis nigricans (5%) were common, followed by fungal (13.8%) and bacterial (6.8%) infections. Eruptive xanthoma (0.6%), diabetic foot (0.2%), diabetic bulla (0.4%), diabetic dermopathy (0.2%), generalized granuloma annulare (0.2%), and insulin reactions (6.2%) and lipodystrophy (14%) were also seen. Conclusion: Well-controlled diabetes decreases the prevalence of DM-specific cutaneous disorders associated with chronic hyperglycemia. It is necessary to have a dermatologist in the diabetic clinic for early detection of potentially grave or predisposing conditions.
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Affiliation(s)
- Shivanna Ragunatha
- Department of Dermatology, Venereology and Leprosy, and Diabetic Clinic, Shri B.M. Patil Medical College Hospital and Research Center, Bijapur - 586 103, Karnataka, India
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Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is an autoimmune disease with multiorgan involvement. The skin is the second most commonly affected organ. SLE with skin lesions can produce considerable morbidity resulting from painful skin lesions, alopecia, disfigurement, etc. Skin lesions in patients with lupus may be specific (LE specific) or may be non specific (LE non specific). Acute cutaneous LE (Lupus specific) has a strong association with systemic disease and non-specific skin lesions always indicate disease activity for which patients present to rheumatologists and internists. Therefore, a thorough understanding of the cutaneous manifestations of SLE is essential for most efficient management. AIMS The aims of this study were to evaluate the patterns and prevalence of skin lesions in patients with SLE and to assess the relationship between skin lesions and other systemic involvement. MATERIALS AND METHODS At the Department of Rheumatology and Clinical Immunology, IPGME&R in Kolkata, 150 patients with SLE fulfilling the clinical and laboratory criteria of the American Rheumatology Association (updated 1982) were examined and followed-up for cutaneous manifestations between January 2002 and January 2007. RESULTS Skin lesions were important clinical features. About 45 patients (30%) presented with skin lesions although all patients had skin lesions during the follow-up period. Skin changes noted were as follows: Lupus specific lesions: malar rash in 120 patients (80%), photosensitive dermatitis in 75 patients (50%), generalized maculopapular rash in 40 patients (26.67%), discoid rash in 30 patients (20%), subacute cutaneous lupus erythematosus (SCLE) in 5 patients (3.34%), lupus profundus in 5 patients (3.34%). The lupus non-specific lesions were non-scarring alopecia in 130 patients (86.67%), oral ulcers in 85 patients (56.67%), vasculitic lesions in 50 patients (33.34%), bullous lesions in 15 patients (10%), Raynaud's phenomenon in 10 patients (6.67%), pyoderma gangrenosum in 2 patients (1.34%), erythema multiforme in 10 patients (6.67%), and nail fold infarcts in 2 patients (1.34%); however, mucosal discoid lupus, lichenoid discoid lupus, livedo reticularis, sclerodactyly, etc. were not detected. Patients having lupus-specific skin lesions e.g., malar rash were associated with systemic involvement, whereas those having lupus non-specific skin lesions were associated with disease flare. CONCLUSIONS Skin lesions in patients with SLE are important disease manifestations and proper understanding is essential for diagnosis and efficient management.
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Affiliation(s)
- Alakes Kumar Kole
- From the Institute of Post Graduate Medical Education and Research, Department of Rheumatology and Clinical Immunology
| | - Alakendu Ghosh
- From the Institute of Post Graduate Medical Education and Research, Department of Rheumatology and Clinical Immunology
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