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Grover A, Choi F, Wang SP. Early Cutaneous Manifestations of COVID-19: A Systematic Review and Public Health Implications. WMJ 2023; 122:349-356. [PMID: 38180923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Cutaneous manifestations before other symptoms have great potential for early COVID-19 diagnosis to prevent surge. METHODS We conducted a search of PubMed and Embase databases through April 11, 2021 to include 39 studies reporting skin manifestations occurring prior to any other COVID-19 symptoms in laboratory-confirmed cases. RESULTS Ninety-seven patients were included. Urticarial (24.7%) and maculopapular (22.7%) lesions were most common, followed by pernio (17.5%), vesicular (14.4%), papulosquamous (8.2%), and purpuric (5.1%) lesions. Cutaneous to systemic symptom latency ranged from 2 to 20 days in cases that reported it (26%), while skin lesions were the only presentation in 23 cases (23.7%). Skin lesions were the only COVID-19 manifestation in 58.8% of pernio, 40% of vesicular, 16.6% of urticarial, 18.2% of maculopapular, and 12.5% of papulosquamous presymptomatic cases. Although sample size is limited, all purpuric cases developed other symptom(s) later. CONCLUSIONS Pernio and purpuric lesions have been well-associated with COVID-19, but papulosquamous, vesicular, mild maculopapular, and urticarial lesions can easily be dismissed as unrelated to COVID-19. Pernio lesions are thought to be related to strong immune response and low contagiousness, while purpuric and vesicular cases are speculated to be related to higher SARS-CoV2 viral load, severity, and contagiousness. All rashes, even without other symptoms, should necessitate high level of suspicion for isolation or contact tracing.
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Affiliation(s)
- Abhinav Grover
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin,
| | - Franchesca Choi
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- DermAI, Taipei, Taiwan
| | - Sheng-Pei Wang
- DermAI, Taipei, Taiwan
- National Cheng Kung University International Research Center of Wound Repair and Regeneration, Tainan, Taiwan
- University of Southern California Department of Pathology, Los Angeles, California
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McClelland P, Gray BH. Cilostazol as a Treatment for COVID Toes: A Case Report. Ann Vasc Surg 2023; 91:76-80. [PMID: 36442709 PMCID: PMC9691508 DOI: 10.1016/j.avsg.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022]
Abstract
During the Coronavirus Disease 2019 (COVID-19) pandemic, skin lesions resembling those seen in pernio (chilblains) have been observed in patients with COVID-19 infection. The term "COVID toes" has been used when there is toe involvement. We describe the case of a fully vaccinated, 56-year-old woman with no prior diagnosis of COVID-19 who developed pernio-like lesions many months after being vaccinated. Her skin lesions resolved after treatment with cilostazol, suggesting that this medication may be a viable treatment for pernio in the setting of COVID-19 infection.
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Affiliation(s)
- Patton McClelland
- University of South Carolina School of Medicine Greenville, Greenville, SC
| | - Bruce H Gray
- Department of Medicine, Division of Surgery/Vascular Medicine, Prisma Health-Upstate, Greenville, SC.
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Mungmunpuntipantip R, Wiwanitkit V. Post SARS-CoV-2 Vaccine Chilblains-like Lesions. J Rheumatol 2022; 49:859. [PMID: 35428717 DOI: 10.3899/jrheum.210996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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4
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Yin H, Lu L. Chilblain-like acral lesions. Eur J Intern Med 2022; 100:119-120. [PMID: 35331594 DOI: 10.1016/j.ejim.2022.03.019] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022]
Affiliation(s)
- Hanlin Yin
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liangjing Lu
- Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Affiliation(s)
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Science (DISSAL), University of Genoa, IT-16132 Genoa, Italy.
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Tammaro A, Alexander S, Adebanjo GAR, Parisella FR, Rello J, Ramirez-Estrada S. Coexisting Purpuric and Pseudo-Chilblain Lesions in COVID-19 Patients. Skinmed 2022; 20:155-158. [PMID: 35532774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Antonella Tammaro
- Dermatology Department, NESMOS, Sapienza University of Rome, Rome, Italy;
| | - Shehani Alexander
- Dermatology Department, NESMOS, Sapienza University of Rome, Rome, Italy
| | | | | | - Jordi Rello
- Critical Care Department, Clínica Corachan, Barcelona, Spain
- Centro de Investigación Biomedica en Red de Enfermedades Respirorias (CIBERES), Instituto Salud Carlos III, Madrid, Spain
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
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Sachdeva M, Mufti A, Maliyar K, Lara-Corrales I, Salcido R, Sibbald C. A Review of COVID-19 Chilblains-like Lesions and Their Differential Diagnoses. Adv Skin Wound Care 2021; 34:348-354. [PMID: 34125725 DOI: 10.1097/01.asw.0000752692.72055.74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
GENERAL PURPOSE To familiarize wound care practitioners with the differential diagnoses of chilblains-like lesions that could be associated with the complications of COVID-19. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify the population most often affected by COVID toes.2. Select the assessments that help differentiate the various conditions that cause chilblains-like lesions.3. Choose appropriate treatment options for the various conditions that cause chilblains-like lesions.
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Discepolo V, Catzola A, Pierri L, Mascolo M, Della Casa F, Vastarella M, Smith G, Travaglino A, Punziano A, Nappa P, Staibano S, Bruzzese E, Fabbrocini G, Guarino A, Alessio M. Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2111369. [PMID: 34110396 PMCID: PMC8193438 DOI: 10.1001/jamanetworkopen.2021.11369] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive. OBJECTIVE To examine the association of chilblain-like lesions with SARS-CoV-2 infection. DESIGN, SETTING, AND PARTICIPANTS This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy. MAIN OUTCOMES AND MEASURES Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy. RESULTS Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions. CONCLUSIONS AND RELEVANCE This study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis. These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection. Ongoing studies will help clarify the etiopathogenic mechanisms.
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Affiliation(s)
- Valentina Discepolo
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Andrea Catzola
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Luca Pierri
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Massimo Mascolo
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Francesca Della Casa
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Maria Vastarella
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Grace Smith
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Antonio Travaglino
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Paola Nappa
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Stefania Staibano
- Department of Advanced Biomedical Sciences, Pathology Unit, University of Naples Federico II, Naples, Italy
| | - Eugenia Bruzzese
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Alfredo Guarino
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Maria Alessio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy
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Abstract
ABSTRACT Biopsies were taken from 4 patients who presented to their dermatologist with violaceous papules and plaques of the dorsal toes (COVID Toes) associated with varying degrees of severe acute respiratory syndrome coronavirus 2 exposure and COVID-19 testing. Major histopathologic findings were lymphocytic eccrine inflammation and a spectrum of vasculopathic findings to include superficial and deep angiocentric-perivascular lymphocytic inflammation, lymphocytes in vessel walls (lymphocytic vasculitis), endothelial swelling, red blood cell extravasation, and focal deposits of fibrin in both vessel lumina, and vessel walls. Interface changes were observed to include vacuolopathy and apoptotic keratinocytes at the basement membrane. Immunostains showed a dominant T-cell lineage (positive for T-cell receptor beta, CD2, CD3, CD5, and CD7). B-cells were rare and clusters of CD123-positive dermal plasmacytoid dendritic cells were observed surrounding eccrine clusters and some perivascular zones. The consistent perieccrine and vasculopathic features represent important pathologic findings in the diagnosis of COVID toes and are suggestive of pathogenetic mechanisms. Clinicopathologic correlation, the epidemiological backdrop, and the current worldwide COVID-19 pandemic favor a viral causation and should alert the physician to initiate a workup and the appropriate use of COVID-19 testing.
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Affiliation(s)
- Thomas G Olsen
- Department of Pathology, Wright State University Boonshoft School of Medicine, Fairborn, OH
- Dermatopathology Laboratory of Central States, Dayton, OH
| | - M Atef Shrit
- Department of Pathology, Wright State University Boonshoft School of Medicine, Fairborn, OH
- Compunet Clinical Laboratories, Moraine, OH; and
| | | | - Jeffrey J Wargo
- Department of Pathology, Wright State University Boonshoft School of Medicine, Fairborn, OH
- Division of Dermatology, Ohio State University College of Medicine, Gahanna, OH
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Abstract
BACKGROUND Numerous of cases of chilblains have been observed, mainly in young subjects with no or mild symptoms compatible with COVID-19. The pathophysiology of these lesions is still widely debated and an association with SARS-CoV-2 infection remains unconfirmed. OBJECTIVES This paper focus on the unresolved issues about these COVID toes and in particular whether or not they are associated with COVID-19. ARGUMENTS The temporal link between the outbreak of chilblains and the COVID-19 pandemic is a first suggests a link between the two events. Positive anti-SARS-CoV/SARS-CoV-2 immunostaining on skin biopsy of chilblains seem to confirm the presence of the virus in the lesions, but lack specificity and must be interpreted with caution. Conversely, RT-PCR and anti-SARS-CoV-2 serology were negative in the majority of patients with chilblains. Therefore, SARS-CoV-2 infection can be excluded, with relative certainty, even after accounting for possible lower immunization in mild/asymptomatic patients and for some differences in sensitivity/specificity between the tests used. Some authors hypothesize that chilblains could be the cutaneous expression of a strong type I interferon (IFN-I) response. High production of IFN-I is suggested to be associated with early viral control and may suppress antibody response. However, the absence of other cutaneous or extracutaneous symptoms as observed in other interferonopathies raises unanswered questions. To date, a direct link between chilblains and COVID-19 still seems impossible to confirm. A more indirect association due to lifestyle changes induced by lockdown is a possible explanation. Improvement of chilblains when protective measures were adopted and after lifting of lockdown, support this hypothesis. CONCLUSION Conflicting current evidence highlights the need for systematic and repeated testing of larger numbers of patients and the need for valid follow-up data that take into consideration epidemic curves and evolution of lockdown measures.
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Affiliation(s)
- Marie Baeck
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
| | - Anne Herman
- Department of Dermatology, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCLouvain), Avenue Hippocrate 10, 1200, Brussels, Belgium.
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Rongioletti F, Ferreli C, Sena P, Caputo V, Atzori L. Clinicopathologic correlations of COVID-19-related cutaneous manifestations with special emphasis on histopathologic patterns. Clin Dermatol 2021; 39:149-162. [PMID: 33972045 PMCID: PMC7832768 DOI: 10.1016/j.clindermatol.2020.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Skin is one of target organs affected by the novel coronavirus SARS-CoV-2, and in response to the current COVID-19 pandemic, a fast body of literature has emerged on related cutaneous manifestations. Current perspective is that the skin is not only a bystander of the general cytokines storm with thrombophilic multiorgan injury, but it is directly affected by the epithelial tropism of the virus, as confirmed by the detection of SARS-CoV-2 in endothelial cells and epithelial cells of epidermis and eccrine glands. In contrast with the abundance of epidemiologic and clinical reports, histopathologic characterization of skin manifestations is limited. Without an adequate clinicopathologic correlation, nosology of clinically similar conditions is confusing, and effective association with COVID-19 remains presumptive. Several patients with different types of skin lesions, including the most specific acral chilblains-like lesions, showed negative results at SARS-CoV-2 nasopharyngeal and serologic sampling. The aim of this review is to provide an overview of what has currently been reported worldwide, with a particular emphasis on microscopic patterns of the skin manifestations in patients exposed to or affected by COVID-19. Substantial breakthroughs may occur in the near future from more skin biopsies, improvement of immunohistochemistry studies, RNA detection of SARS-CoV-2 strain by real-time polymerase chain reaction-based assay, and electron microscopic studies.
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Affiliation(s)
- Franco Rongioletti
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; IRCCS San Raffaele Hospital and Dental School, Vita Salute University, 20132 Milan, Italy
| | - Caterina Ferreli
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Paolo Sena
- Unit of Dermatology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Caputo
- Unit of Pathology, Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Atzori
- Unit of Dermatology, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Aleshin M, Martin S, Palla B, Holland V, Young L. Chilblain lupus erythematosus presenting with bilateral hemorrhagic bullae of distal halluces. Cutis 2018; 101:E16-E18. [PMID: 30063789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Maria Aleshin
- David Geffen School of Medicine, University of California, Los Angeles, USA
| | - Stephanie Martin
- Department of Medicine, Division of Dermatology, University of California, Los Angeles, USA
| | - Beth Palla
- Division of Pathology and Laboratory Medicine, University of California, Los Angeles, USA
| | - Vanessa Holland
- Department of Medicine, Division of Dermatology, University of California, Los Angeles, USA
| | - Lorraine Young
- Department of Medicine, Division of Dermatology, University of California, Los Angeles, USA
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Mu EW, Terushkin V, Meehan SA, Leger M, Femia A. A case of perniosis. Dermatol Online J 2016; 22:13030/qt9m573346. [PMID: 28329550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 06/06/2023] Open
Abstract
Perniosis is a localized, inflammatory reaction that ischaracterized by erythematous papules and nodulesthat often are located on the acral surfaces in youngwomen. The lesions of perniosis are thought to bedue to cold-induced vasoconstriction that leadsto hypoxemia and inflammation of the vessel wall.Histopathologic and laboratory studies are indicatedfor patients with suspected perniosis to distinguishbetween idiopathic perniosis and secondaryperniosis. Treatment includes adequate heating andclothing, proper food intake, nifedipine, ultravioletA1 phototherapy, topical glucocorticoids, andvasodilators.
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Affiliation(s)
- Euphemia W Mu
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, NYU Langone Medical Center
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Guinan K. Photoguide: Ganglion or myxoid cyst? Practitioner 2011; 255:31; author reply 31. [PMID: 21513046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Vano-Galvan S, Moreno C, Fernández-Lorente M, Jaén P. Classic Kaposi sarcoma mimicking chilblains. Dermatol Online J 2011; 17:16. [PMID: 21382299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Kaposi Sarcoma (KS) is a low-grade vascular tumor associated with human herpes virus-8 infection. It usually presents in elderly patients as violaceous plaques of the lower limbs. However, KS may present in a wide spectrum of atypical clinical forms, leading to misdiagnoses. We report a case of classic KS mimicking chilblains.
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Stollery N. Fingers and toes. Practitioner 2010; 254:35-37. [PMID: 21166298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Stollery N. Foot problems. Practitioner 2010; 254:33-34. [PMID: 20198935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Parra SL, Wisco OJ. What is your diagnosis? Perniosis (Chilblain). Cutis 2009; 84:15-29. [PMID: 19743718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Sylvia L Parra
- Department of Dermatology, Mike O'Callaghan Federal Hospital, Nellis Air Force Base, Nevada, USA
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Piga M, Vacca A, Cauli A, Porru G, Mathieu A. Familial chilblain and late contractural arachnodactyly: a novel association? Joint Bone Spine 2009; 76:205-8. [PMID: 19124263 DOI: 10.1016/j.jbspin.2008.08.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 08/21/2008] [Indexed: 11/17/2022]
Abstract
We report an Italian family suffering from chilblain. Seven members over three generations affected, two of them presenting association with late contractural arachnodactyly. Inflammatory cutaneous lesions following exposure to cold or drop in temperature are called chilblain. Arachnodactyly is an hallmark of hereditary connective tissue disorders such as Marfan's syndrome and Beals' syndrome. The latter, showing joint congenital contractures, is called indeed congenital contractural arachnodactyly. We speculate that an underlying alteration in connective tissue could lead to the association between chilblain lesions and contractural arachnodactyly.
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Affiliation(s)
- Matteo Piga
- Department of Medical Sciences, University of Cagliari and AOU of Cagliari, Italy
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Brănişteanu DE, Molodoi AD, Stătescu L, Petrescu Z, Vasiluţ D, Anisiei E, Ferariu D, Brănişteanu D. [Chilblain lupus in an adolescent]. Rev Med Chir Soc Med Nat Iasi 2008; 112:646-651. [PMID: 20201246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chilblain lupus or lupus pernio is a particular clinical type of cutaneous chronic lupus erythematosus, more frequently met in adults and difficult do diagnose without specific lesions at the level of the face and/or the scalp. The patient B.A., female, aged 16 is hospitalized in the Dermatological Clinic Iasi for some red-to-violaceous plaques, infiltrated, slightly scaling located around the nails and on the hands and legs finger sides. The lesions come up at the age of 13 become even more serious and painful in cold weather, getting better in the warm season when they become slightly pruriginous and are accompanied by a discrete facial erythema in "vespertilio", completely neglected by the patient. The general status was very good during this time, without general manifestations or visceral touches. The clinical diagnosis that was initially suggested, pernio, was afterwards denied by a detailed anamnesis, by laboratory testes (positive antinuclear antibodies, positive anti-double-stranded DNA antibodies) and by the histopathological examination of the biopsy from cutaneous lesions. The introduction of the antimalarial drugs (Plaquenil 200 mg/ day) associated with photoprotective creams, led to cure of cutaneous lesions.
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Affiliation(s)
- Daciana Elena Brănişteanu
- Facultatea de Medicină, Clinica Dermatologie, Universitatea de Medicină si Farmacie "Gr.T. Popa" Iaşi
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Rice G, Patrick T, Parmar R, Taylor CF, Aeby A, Aicardi J, Artuch R, Montalto SA, Bacino CA, Barroso B, Baxter P, Benko WS, Bergmann C, Bertini E, Biancheri R, Blair EM, Blau N, Bonthron DT, Briggs T, Brueton LA, Brunner HG, Burke CJ, Carr IM, Carvalho DR, Chandler KE, Christen HJ, Corry PC, Cowan FM, Cox H, D'Arrigo S, Dean J, De Laet C, De Praeter C, Dery C, Ferrie CD, Flintoff K, Frints SGM, Garcia-Cazorla A, Gener B, Goizet C, Goutieres F, Green AJ, Guet A, Hamel BCJ, Hayward BE, Heiberg A, Hennekam RC, Husson M, Jackson AP, Jayatunga R, Jiang YH, Kant SG, Kao A, King MD, Kingston HM, Klepper J, van der Knaap MS, Kornberg AJ, Kotzot D, Kratzer W, Lacombe D, Lagae L, Landrieu PG, Lanzi G, Leitch A, Lim MJ, Livingston JH, Lourenco CM, Lyall EGH, Lynch SA, Lyons MJ, Marom D, McClure JP, McWilliam R, Melancon SB, Mewasingh LD, Moutard ML, Nischal KK, Ostergaard JR, Prendiville J, Rasmussen M, Rogers RC, Roland D, Rosser EM, Rostasy K, Roubertie A, Sanchis A, Schiffmann R, Scholl-Burgi S, Seal S, Shalev SA, Corcoles CS, Sinha GP, Soler D, Spiegel R, Stephenson JBP, Tacke U, Tan TY, Till M, Tolmie JL, Tomlin P, Vagnarelli F, Valente EM, Van Coster RNA, Van der Aa N, Vanderver A, Vles JSH, Voit T, Wassmer E, Weschke B, Whiteford ML, Willemsen MAA, Zankl A, Zuberi SM, Orcesi S, Fazzi E, Lebon P, Crow YJ. Clinical and molecular phenotype of Aicardi-Goutieres syndrome. Am J Hum Genet 2007; 81:713-25. [PMID: 17846997 PMCID: PMC2227922 DOI: 10.1086/521373] [Citation(s) in RCA: 311] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Accepted: 06/14/2007] [Indexed: 11/03/2022] Open
Abstract
Aicardi-Goutieres syndrome (AGS) is a genetic encephalopathy whose clinical features mimic those of acquired in utero viral infection. AGS exhibits locus heterogeneity, with mutations identified in genes encoding the 3'-->5' exonuclease TREX1 and the three subunits of the RNASEH2 endonuclease complex. To define the molecular spectrum of AGS, we performed mutation screening in patients, from 127 pedigrees, with a clinical diagnosis of the disease. Biallelic mutations in TREX1, RNASEH2A, RNASEH2B, and RNASEH2C were observed in 31, 3, 47, and 18 families, respectively. In five families, we identified an RNASEH2A or RNASEH2B mutation on one allele only. In one child, the disease occurred because of a de novo heterozygous TREX1 mutation. In 22 families, no mutations were found. Null mutations were common in TREX1, although a specific missense mutation was observed frequently in patients from northern Europe. Almost all mutations in RNASEH2A, RNASEH2B, and RNASEH2C were missense. We identified an RNASEH2C founder mutation in 13 Pakistani families. We also collected clinical data from 123 mutation-positive patients. Two clinical presentations could be delineated: an early-onset neonatal form, highly reminiscent of congenital infection seen particularly with TREX1 mutations, and a later-onset presentation, sometimes occurring after several months of normal development and occasionally associated with remarkably preserved neurological function, most frequently due to RNASEH2B mutations. Mortality was correlated with genotype; 34.3% of patients with TREX1, RNASEH2A, and RNASEH2C mutations versus 8.0% RNASEH2B mutation-positive patients were known to have died (P=.001). Our analysis defines the phenotypic spectrum of AGS and suggests a coherent mutation-screening strategy in this heterogeneous disorder. Additionally, our data indicate that at least one further AGS-causing gene remains to be identified.
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Affiliation(s)
- Gillian Rice
- Leeds Institute of Molecular Medicine, St James's University Hospital, Leeds, LS9 7TF, UK
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Pfurtscheller K, Kerbl R, Hanzer M, Muntean W. [Pernio as cause of a blue toe syndrome]. Klin Padiatr 2006; 219:240-2. [PMID: 16878289 DOI: 10.1055/s-2006-933456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The evaluation of a blue toe syndrome in children is a diagnostic challenge. The differential diagnosis includes pernio (chilblains) if all diagnostic tests are negative and a corresponding anamnesis is presented. In this report we illustrate the case of a 7 1/2- year-old girl who presented with two blue toes and discuss differential-diagnostic considerations.
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Affiliation(s)
- K Pfurtscheller
- Univ.-Klinik für Kinder- und Jugendheilkunde, Klinische Abteilung für Allgemeinpädiatrie, Graz, Osterreich.
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Richez C, Dumoulin C, Schaeverbeke T. Infliximab induced chilblain lupus in a patient with rheumatoid arthritis. J Rheumatol 2005; 32:760-1. [PMID: 15801042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Yazawa H, Saga K, Omori F, Jimbow K, Sasagawa Y. The chilblain-like eruption as a diagnostic clue to the blast crisis of chronic myelocytic leukemia. J Am Acad Dermatol 2004; 50:S42-4. [PMID: 14726865 DOI: 10.1016/s0190-9622(03)02114-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 70-year-old Japanese man visited our clinic with the chief complaint of chilblain-like eruptions on the toes of both feet. His toes were bluish, erythematous, and swollen. Neither oral administration of vitamin E for 2 weeks nor wearing insulated socks improved the clinical manifestations. Peripheral blood examination revealed the presence of a large number of monocytic atypical cells and myeloblasts, anemia, and thrombocytopenia. In the bone marrow, monocytic cells were elevated, and myelocytic atypical cells were observed. Chromosomal analysis demonstrated Philadelphia chromosome. We diagnosed him as having a blast crisis of chronic myelocytic leukemia (CML). A biopsy specimen of the skin from the chilblain-like eruption showed infiltration of large, atypical, mononuclear cells; most of them were positive for CD68, and some of them were positive for CD14. Therefore, we concluded that the chilblain-like eruptions on his toes were specific skin lesions of a blast crisis in CML.
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Affiliation(s)
- Hitoshi Yazawa
- Department of Dermatology, Sapporo Medical University School of Medicine, Minami 1 Nishi 16, Chyuo-ku, 060-8543 Sapporo, Japan
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Helm TN, Jones CM. Chilblain lupus erythematosus lesions precipitated by the cold. Cutis 2002; 69:183-4, 190. [PMID: 11926337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Lupus erythematosus (LE) may exhibit a broad array of clinical presentations. Cutaneous manifestations include malar rash, discoid lesions, alopecia, and panniculitis. Cold-induced lesions are uncommon. To illustrate this unusual presentation, we describe a case of typical chilblain LE.
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Abstract
Perniosis, or chilblains, are skin lesions that occur as an abnormal reaction to cold, damp environments. We describe five cases of perniosis affecting the thighs. Four of the five cases occurred after wading across mountain rivers. Histological changes of deep perniosis and panniculitis were seen in a skin biopsy from one of the cases. In each case there was marked pain and discomfort, and lesions resolved over more than 1 week.
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Affiliation(s)
- R D Price
- General Practitioner, Highfield Medical Centre, Timaru, New Zealand
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Affiliation(s)
- John B P Stephenson
- Fraser of Allander Neurosciences Unit, Royal Hospital for Sick Children, Glasgow, Scotland, UK.
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Abstract
BACKGROUND The histopathologic diagnosis of chilblains is controversial and the histologic changes are often considered nonspecific, mainly because they are poorly documented. Although a dermal inflammation in chilblains has been noticed, the infiltrate has not yet been characterized. OBJECTIVE Our purpose was to analyze microscopic and immunohistochemical findings in a large series of chilblains and to compare the results with those of lupus erythematosus (LE). METHODS We included 36 cases of clinically typical chilblains of the hands, of which 17 were thoroughly investigated to rule out cryopathy or LE. Ten biopsy specimens of hand lesions from patients with proven LE were included as controls. All slides were analyzed by conventional microscopy and by immunohistochemistry with anti-CD3, anti-CD20, and anti-CD68 antibodies. RESULTS The most characteristic finding in chilblains (47% of cases) was the association of edema and reticular dermis infiltrate that showed a perieccrine reinforcement. Such a combination of changes was not observed in LE. Epidermal changes in chilblains consisted mainly in necrotic keratinocytes in 52% of cases. The comparison of 17 idiopathic chilblains with LE showed significant differences in spongiosis (58% vs 0% respectively), vacuolation of basal layer (6% vs 60%), edema of the dermis (70% vs 20%), and deep perieccrine inflammation (76% vs 0%). Immunohistochemistry showed that the infiltrate was composed of a majority of T cells associated with macrophages and a few B lymphocytes. The same pattern was observed in both chilblains and LE. CONCLUSION Our results show that a predominantly T-cell papillary and deep infiltrate with a perieccrine reinforcement, associated with dermal edema and necrotic keratinocytes, are the hallmarks of chilblains of the hands. These changes can help differentiate idiopathic perniosis from LE; immunohistochemistry is of no use in differentiation.
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Affiliation(s)
- B Cribier
- Laboratoire d'Histopathologie Cutanée, Clinique Dermatologique des Hôpitaux Universitaires, Strasbourg, France.
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Abstract
A 45-year-old woman had symmetrical livid plaques with yellowish hyperkeratoses for 5 years, which progressed on to the fingers and toes and on the soles of the feet. Two years later creamy, whitish areas and maceration appeared on the buccal mucosa and the lips. A skin biopsy revealed massive collagen hyaline degeneration in the perivascular area, hyperkeratosis and hypergranulosis, small lymphocyte infiltrates with several melanophages and extravasates of erythrocytes in the upper corium in perivascular areas and hydropic degeneration of basal keratinocytes. The findings using direct immunofluorescence were compatible with lupus erythematosus (LE). Laboratory investigation showed a slight leucopenia and thrombopenia, a slightly elevated erythrocyte sedimentation rate, hypocomplementaemia C3 and C4, a high titre of rheumatoid factor and antinuclear antibodies positivity of extractable nuclear antigen. The results reflected probably the development of a systemic form of the disease. The patient was successfully managed by methylprednisolone and hydroxychloroquine. After 1 year of therapy, a new skin biopsy revealed a substantial reduction of hyperkeratosis and hyaline degeneration of collagen tissue in the perivascular areas. The combination of the extensive hyperkeratosis and hyalinization thus seems to be features of the long-lasting, untreated lesions in chilblain LE.
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Affiliation(s)
- L Pock
- Dermatohistopathological laboratory, Prague, Czech Republic.
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Cribier B. [Chilblain]. Ann Dermatol Venereol 2001; 128:557-60. [PMID: 11395660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- B Cribier
- Clinique Dermatologique des Hôpitaux Universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg Cedex
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Boehm I, Bieber T. Chilblain lupus erythematosus Hutchinson: successful treatment with mycophenolate mofetil. Arch Dermatol 2001; 137:235-6. [PMID: 11176709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Lavigne C, Maillot F, Machet L, Lorette G, Vaillant L. Lethal pancytopenia associated with chilblain lupus erythematosus. Acta Derm Venereol 2000; 80:393. [PMID: 11200851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Affiliation(s)
- P Wessagowit
- Division of Dermatology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
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Affiliation(s)
- R Giusti
- Department of Pediatrics, Long Island College Hospital, Brooklyn, NY, USA
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Abstract
Perniosis is a term applied to cold-induced painful or pruritic erythematous or violaceous acral papular or nodular lesions. We examined 39 skin biopsies from 38 patients who presented with acral purpuric lesions, suggesting a diagnosis of perniosis clinically or pathologically. The presence of a systemic or extracutaneous disease was established in 17 patients, including 5 with systemic lupus erythematosus (SLE), 3 with antiphospholipid antibodies, in 1 in whom there was underlying HIV disease, 2 with viral hepatitis, 2 with rheumatoid arthritis (RA), 2 with cryofibrinogenemia, 1 with hypergammaglobulinemia, 1 with iritis, and 1 with Crohn's disease. In the other 21 patients, the clinical presentations prompted further studies in 12, which showed a positive antinuclear antibody (ANA) in 10. A diagnosis of idiopathic perniosis (IP) was rendered in all 21 of these patients including those in whom a positive ANA was discovered, based on the absence of any other serological markers, signs, or symptoms indicative of a specific systemic disease complex; many had Raynaud's phenomenon, small joint arthralgias, atopy, or a family history of either connective tissue disease or Raynaud's disease. The histopathology of IP comprised a superficial and deep angiocentric lymphocytic infiltrate with papillary dermal edema and lymphocytic exocytosis directed to retia and acrosyringia. A few cases showed a mild vacuolopathic or lichenoid interface dermatitis, adventitial dermal mucinosis, lymphocytic eccrine hidradenitis, vascular ectasia, and thrombosis confined to dermal papillae capillaries. The biopsies from patients with iritis, RA, and Crohn's disease showed a granulomatous vasculitis and a granuloma annulare-like tissue reaction. The biopsies from the patients with SLE, cryofibrinogenemia, primary antiphospholipid antibody syndrome, and hypergammaglobulinemia shared a similar histopathology comprising an interface dermatitis, superficial and deep angiocentric and eccrinotropic lymphocytic infiltrates, vascular ectasia, and dermal mucinosis with prominent involvement of the eccrine coil. Many cases did not show features of IP, namely papillary dermal edema, thrombosis of dermal papillary capillaries, and lymphocytic exocytosis into the retia and acrosyringia. There was frequent vascular fibrin deposition involving reticular dermal vessels. The latter two variables were statistically significant discriminators between IP and in perniotic lesions observed in the setting of underlying systemic disease. With respect to the latter, some cases occurred in the setting of cold exposure and were designated by us as "secondary perniosis" (SP), whereas others showed no specific association with cold exposure and were designated as perniotic mimics (PMs) based exclusively on the gross and microscopic morphology of the lesions.
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Affiliation(s)
- A N Crowson
- Department of Laboratories, Misericordia General Hospital, Winnipeg, Manitoba, Canada
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Affiliation(s)
- B B Tan
- Department of Dermatology, North Staffordshire Hospital, Stoke-on-Trent ST4 7PA, England
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Vayssairat M, Abuaf N, Deschamps A, Baudot N, Gaitz JP, Chakkour K, Nussaume O. Nailfold capillary microscopy in patients with anticardiolipin antibodies: a case-control study. Dermatology 1997; 194:36-40. [PMID: 9031789 DOI: 10.1159/000246054] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND DESIGN This case-control study was undertaken to determine whether anticardiolipin antibodies (ACA) are responsible for particular abnormalities in nailfold capillary microscopy (NCM). Cases comprised 33 consecutive patients positive for ACA (24 women and 7 men). Controls comprised the same number of ACA-negative patients, with the same sex ratio, the same diagnosis and the most similar duration of disease possible. Clinical data, serum samples and NCM recordings were obtained from all patients and controls. RESULTS In each group, 22 patients had connective-tissue-related disorders and 11 various other diseases. In ACA-positive patients, the mean IgG ACA titre was 39 +/- 58 IgG phospholipid units. Cases and controls displayed various cutaneous manifestations. In ACA-positive patients, there were Raynaud's phenomenon (54%), cutaneous vasculitis (24%), scleroderma changes (18%), photosensitivity (9%), a history of digital gangrene (6%), malar rash (6%), acrocyanosis (6%), chilblains (3%), livedo reticularis (3%) and purpura (3%). Cases and controls exhibited numerous NCM abnormalities. In ACA-positive patients, they included haemorrhages (54%), oedema (24%), bushy capillaries (21%), disordered capillaries (18%), capillary bed disorganization (12%), capillary rarefaction (9%), giant capillaries (6%) and 'desert areas' (3%). There were no correlations between the ACA titres on the one hand and the number of cutaneous manifestations or NCM abnormalities on the other. CONCLUSIONS ACA-positive patients frequently exhibit clinical skin lesions and abnormal NCM. In this study, these lesions and NCM abnormalities resembled those of the matched ACA-negative controls.
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Affiliation(s)
- M Vayssairat
- Laboratory for Research in Microcirculation, Tenon Hospital, Paris, France
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Affiliation(s)
- D A Fisher
- University of California Medical Center, San Francisco, USA
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Su WP, Perniciaro C, Rogers RS, White JW. Chilblain lupus erythematosus (lupus pernio): clinical review of the Mayo Clinic experience and proposal of diagnostic criteria. Cutis 1994; 54:395-9. [PMID: 7867381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Five cases of chilblain lupus erythematosus were retrospectively reviewed regarding their clinical, histopathologic, serologic, and immunofluorescence findings. Ages at onset of chilblain lupus erythematosus varied from 26 to 73 years, with a female-to-male ratio of 3:2. Since other entities can be confused with this disorder, we propose the following diagnostic criteria. The two major criteria are skin lesions in acral locations induced by exposure to cold or a drop in temperature, and evidence of lupus erythematosus in the skin lesions by results of histopathologic examination or direct immunofluorescence study. The three minor criteria are coexistence of systemic lupus erythematosus or other skin lesions of discoid lupus erythematosus, response to anti-lupus erythematosus therapy, and negative results of cryoglobulin and cold agglutinin studies. We conclude that chilblain lupus erythematosus can be diagnosed and treated. Discoid lupus erythematosus lesions respond more quickly to treatment than chilblain lupus erythematosus lesions. Treatment with antimalarial agents, prednisone, pentoxifylline, or dapsone was of benefit to our patients.
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Affiliation(s)
- W P Su
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905
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Affiliation(s)
- T R Wade
- Atlanta Dermatopathology Associates, GA
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Brado B, Keilholz U, Tilgen W, Pezzutto A, Gissler M, Hunstein W. [Chilblain lupus erythematosus. A case report]. Internist (Berl) 1992; 33:701-3. [PMID: 1428687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- B Brado
- Medizinische Klinik und Poliklinik V, Universität Heidelberg
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Abstract
A patient with recurrent pernio of the right ankle for 21 years after surgery had a leukocytoclastic vasculitis localized in the area. We suggest that the various histologic descriptions of pernio in the literature and in this case represent different levels of severity of the disease.
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Affiliation(s)
- M H Klapman
- Dermatology Department, Kaiser Permanente Los Angeles Medical Center, CA 90027
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Abstract
Unfamiliarity of physicians with chilblains (perniosis) gives rise to unnecessary hospital admissions with expensive laboratory and radiologic evaluations and, at times, hazardous therapy. Seven cases of chilblains were seen in San Francisco from November 1986 through January 1987. The patients presented with pruritic, at times painful, purple acral patches or plaques on the fingers, toes, and nose after exposure to a cool or a cold, damp environment. Histologic examination in two cases revealed a perivascular lymphocytic infiltrate with endothelial swelling of the subcutaneous fat and of the upper and lower dermal plexus.
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Affiliation(s)
- D K Goette
- Department of Medicine, Letterman Army Medical Center, Presidio of San Francisco, CA 94129-6700
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Goodfield M. Cold-induced skin disorders. Practitioner 1989; 233:1616, 1618-20. [PMID: 2622853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Skin conditions caused by cold temperatures are not uncommon. Recognition is generally easy at a clinical level, but awareness of the much less common underlying disorders is important. Treatment, both physical and pharmacological, is aimed at keeping the body warm and maintaining vasodilation.
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Brazzelli V, Borroni G. [Erythema pernio of the face: clinical and histopathological aspects]. GIORN ITAL DERMAT V 1989; 124:345-9. [PMID: 2628279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A case of chilblains on the face of a man is described. An acute episode of chilblains occurred after a long period of exposure to cold. The unusual site and unusual clinical aspect raised problems of differential clinical diagnosis. Moreover histological diagnosis is easy to perform only after a correct clinical diagnosis has been carried out. For these reasons the literature on chilblains needs to be updated, even though, thanks to impaired living and working conditions, this disease is becoming uncommon.
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