Prevention and treatment of radiation-induced acute dermatitis in head and neck cancer patients: a systematic review.

Acute dermatitis is the most common radio-induced side effect during treatment for head and neck cancer. The use of a wide variety of agents is reported to handle skin toxicity. Our aim was to review the literature and synthesize current available evidence. A comprehensive search was performed on multiple electronic databases until February 2017 and a systematic approach was carried out according to PRISMA guidelines. A total of 17 papers (950 patients on the whole) met the inclusion/exclusion criteria, with 12 randomized controlled trials and five nonrandomized observational and prospective studies. Generally speaking, there was no strong evidence to support the superiority of any specific intervention neither in prevention nor in therapeutic settings. Well-designed randomized studies including quality of life measurements are needed.

Autoimmune progesterone dermatitis.

Autoimmune progesterone dermatitis (APD) is an exceptional condition affecting young women of childbearing age with a high prevalence during the third decade of life. The diagnosis should be confirmed using an intradermal skin test to progesterone, during the follicular phase of the menstrual cycle. APD represents an early manifestation of autoimmune disease. A case of APD is presented who after curative treatment did not develop other autoimmune diseases during a 6-year follow-up. Dermatologists, gynecologists and obstetricians should be aware of this rare but highly invalidating entity.

Stratum Corneum Abnormalities and Disease-Affected Skin: Strategies for Successful Outcomes in Inflammatory Acne.

Stratum corneum (SC) abnormalities are associated with disease-affected skin conditions such as inflammatory acne. Current topical acne treatment options including benzoyl peroxide and retinoids can worsen the barrier dysfunctions by increasing transepidermal water loss, depleting SC vitamin E levels, and relatively decreasing SC thickness. However, strategies exist to employ these treatments in a more effective manner and lessen barrier function disruption including use of less irritating vehicles or concomitant application of moisturizers. Patients also play a role in the outcome of their skin barrier function based on their compliance and administration technique. By increasing patient compliance and proper application of treatments, patient skin barrier function can improve. Additionally, future treatments are on the horizon that may customize acne therapy at a molecular level.

J Drugs Dermatol. 2016;15(10):1170-1173.

Dermatitis Artefacta: A Practical Guide for Diagnosis and Management.

Dermatitis artefacta (DA) is a psycho-dermatologic condition based on patients' behavioral patterns, characterized by an intentional production of cutaneous lesions on their own skin. The clinical presentation can be highly variable. Patients with DA seldom seek psychological support or psychiatric consultation. More often, they seek help from their primary care physician or dermatologist. This review article aims to provide a practical guide for the diagnosis and management of AD and affected patients. A broad literature search was performed using the PubMed and Google Scholar electronic online databases, using key words "dermatitis artefacta", "diagnosis", "management", and "psychodermatology". The search was limited to English and Spanish language articles and was supplemented with themed books and book chapters. DA can occur in a variety of clinical presentations, and physicians should suspect DA in patients with a history of psychiatric disorders or extensive use of healthcare services. The ultimate goal of DA treatment may be a proper referral to mental health services. However, the prognosis is poor even when successful mental health referrals are achieved, with low recovery rates. A useful approach may include the suggestion that a mental health provider can help with the anxiety and the distress generated by the lesions: in this case in this case it will be crucial to discuss this with the mental health provider after obtaining informed consent from the patient. Considering the difficulty in promoting patients' adherence to treatment, the ideal setting for DA treatment is a psycho-dermatologic clinic, where both dermatologic and psychological interventions can be seamlessly integrated.

[Cutaneous and pulmonary sarcoidosis. Successful therapy with fumaric acid esters]. / Kutane und pulmonale Sarkoidose. Erfolgreiche Therapie mit Fumarsäureestern.

A 43-year-old man with cutaneous and pulmonary sarcoidosis was treated with fumaric acid esters (Fumaderm®) for 11 months because of the cutaneous lesions. During the treatment the cutaneous lesions and pulmonary changes vanished completely. In addition, serum angiotensin converting enzyme (ACE) levels normalized after end of therapy. This case report is one of a few examples of the successful treatment of cutaneous and pulmonary sarcoidosis with fumaric acid esters (Fumaderm®).

Gray hair and acrodermatitis enteropathica-like dermatitis: an unexpected presentation of cystic fibrosis.

Presentation of cystic fibrosis (CF) with an acrodermatitis enteropathica-like skin rash, anemia, and hypoproteinemia without pulmonary disease is rarely reported before. We describe an 11-month-old boy with rash and edema as the presenting signs of cystic fibrosis. The interesting additional finding in our patient was the graying hair after 3 months of age. A reversal of the gray hair was observed by pancreatic enzyme replacement therapy. In conclusion, acrodermatitis-like eruption and hypoproteinemia can be a presenting sign of CF. Graying hair has not been noticed so far as a sign of CF in these patients.

Chondrodermatitis nodularis chronica helicis - a conservative therapeutic approach by decompression.

BACKGROUND: Chondrodermatitis nodularis chronica helicis is a rather common condition which substantially affects quality of life causing pain and sleeping disturbances. Surgical treatment is connected with a tendency to recurrence. Mechanical pressure is probably the main etiological factor. PATIENTS AND METHODS: A prospective study was performed with 18 patients that were offered a non-surgical treatment using a self-made bandage of foam plastic which they applied during the night. Of these, 12 performed the treatment including follow-up; 6 patients initially also consented, but they did not return after the initial visit. RESULTS: 11 patients reported substantial reduction of pain within the first month; after an average of 1.75 months they were free of pain. All 8 patients with initial sleeping problems caused by pain reported undisturbed sleep after only one month. In 11 patients the lesions receded satisfactorily, in 9 patients completely, in 2 patients leaving small asymptomatic residual lesions. Recurrences appeared in 3 patients with 2 of them having been surgically pretreated at the same location. CONCLUSIONS: We recommend conservative treatment using protective padding as first line treatment for chondrodermatitis nodularis chronica helicis. The successful outcome achieved only by relief of pressure supports pressure as the main etiological factor in the development of the disease.

[Erythema annulare centrifugum. A clinical reaction pattern]. / Erythema anulare centrifugum. Ein klinisches Reaktionsmuster.

Erythema annulare centrifugum (EAC) is a clinical reaction pattern and not a specific clinicohistologic entity. The clinical and histologic differential diagnosis of EAC should take at least three main disease groups into consideration, which are often classified under this disorder: (tumid) lupus erythematosus, spongiotic dermatitides, and pseudolymphomas.

[Inflammatory stage of disseminated superficial porokeratosis in a 71-year old patient]. / Eruptive inflammatorische disseminierte Porokeratose bei einer 71-jährigen Patientin.

The inflammatory stage of disseminated superficial porokeratosis is a rare disease, which has only been described in case reports, primarily affecting Japanese patients. After having asymptomatic disseminated superficial porokeratosis for years, a typical patient then experiences a sudden exacerbation with distinct pruritus. Histologically, the lesions may show eosinophilic spongiosis in addition to the characteristic cornoid lamella. We describe a 71-year old patient with clinically and histologically diagnosed inflammatory stage of disseminated superficial porokeratosis.

Wrong diagnosis erysipelas: hypodermitis - case series and review of literature.

BACKGROUND: Patients with an advanced chronic venous insufficiency (CVI) often show inflammatory changes of their legs. Often erysipelas is diagnosed and systemic antibiotic therapy initiated. Frequently this approach is not successful. PATIENTS AND METHODS: During the last 6 months 5 patients with an outside diagnosis of erysipelas presented to our clinic. All had a painful erythema of the medial part of one or both calves and all failed numerous antibiotic regimens. RESULTS: In all patients a sharply demarcated, tender indurated erythema of the medial part of one or both calves was seen. Inguinal lymphadenopathy, fever and other systemic signs and symptoms were absent. In 4 of 5 patients normal laboratory inflammatory parameters were normal. We diagnosed hypodermitis in all. They were treated with compression therapy and topical corticosteroids. In addition, their underlying CVI was addressed. CONCLUSIONS: Dermatosclerosis is often seen in patients with advanced CVI. An acute inflammatory phase (hypodermitis) and a chronic phase of the disease can be differentiated. The acute hypodermitis can imitate erysipelas clinically, with systemic signs and symptoms, as well as laboratory evidence of inflammation generally being absent.

Dapsone Hypersensitivity Syndrome (DHS): A Detrimental Effect of Dapsone? A Case Report.

BACKGROUND: Dapsone is a sulfone derived drug used in the treatment of leprosy and several chronic inflammatory dermatological diseases. Dapsone Hypersensitivity Syndrome (DHS) is characterized by fever, hepatitis, generalized exfoliative dermatitis and lymphadenopathy. It is rare and potentially fatal. CASE REPORT: We present a case report of a 52 years old female with a recent history of antecedent dapsone exposure of 100 mg daily for 2 weeks. She developed fever 10 days after exposure to dapsone therapy and was treated in various primary and tertiary centers for features of sepsis. When she presented to us, clinical features of multi-organ dysfunction and intractable sepsis was evident. She was successfully managed with intravenous corticosteroids and other supportive therapy. This case of DHS is unique due to pulmonary, hepatic and colonic involvement in addition to secondary bacterial and fungal infection, which is associated with an increased risk of mortality. CONCLUSION: As dapsone is mainstay in the treatment several infections and inflammatory conditions, further research is needed to characterize markers to diagnose DHS and to develop screening policies prior to initiation of dapsone therapy.

Unravelling the NERDS syndrome.

A 22-year-old man presented with symmetric polyarthritis, pruritus and deviation of angle of mouth to the right side since the last 7 years. His symptoms were persistent despite receiving ayurvedic medications and symptomatic therapy. Examination revealed dry skin, cutaneous nodules, xanthelasma, periarticular non-tender swellings, pitting oedema of hands and feet and lower motor neuron type right facial palsy. Haematological investigations revealed eosinophilia and skin biopsy had cutaneous eosinophilic infiltration. The constellation of above findings comprises the nodules, eosinophilia, rheumatism, dermatitis and swelling syndrome. It a rare syndrome with few reported cases in literature. The patient was started on oral corticosteroids which was subsequently tapered and methotrexate therapy. His polyarthritis and skin rashes resolved with therapy. He has been followed-up for 2 years and is presently asymptomatic for the last 1 year.

Common Skin Conditions in Children: Neonatal Skin Lesions.

Skin findings during the initial month of life are ubiquitous. One study estimated that more than 95% of newborns have cutaneous findings, which often are distressing to parents but frequently are benign and self-limited. Among them are milia, cutis marmorata, congenital dermal melanocytosis, and the benign neonatal pustular eruptions (eg, benign cephalic pustulosis, erythema toxicum neonatorum, transient neonatal pustular melanosis). Clinicians need to recognize these benign skin conditions and differentiate them from more serious conditions, such as infectious pustular eruptions from bacterial, viral, and fungal causes, and inflammatory conditions, such as Langerhans cell histiocytosis. Notable bacterial pustular eruptions are bullous impetigo and congenital syphilis. Viral pustular dermatoses include neonatal herpes simplex virus infection and varicella zoster virus infection, which consists of congenital varicella syndrome, perinatal varicella, and infantile zoster. Fungal pustular eruptions include congenital and neonatal candidiasis. Seborrheic dermatitis is a self-limited condition that occurs with varying severity; symptomatic treatment is reserved for the more severe forms. Diaper dermatitis encompasses a broad clinical diagnosis, including allergic and irritant contact dermatitis, atopic dermatitis, infections, psoriasis, and other dermatologic conditions. Critical components of newborn skin care are immersion bathing, umbilical cord care, and use of emollients to augment skin barrier function.

An Unusual Presentation of Deep Tissue Injury, Do We Really Understand It? A Case Report and Literature Review

Deep tissue injury (DTI) is an injury to the soft tissue under the skin due to pressure and is usually over boney prominence. This injury is commonly seen in bedridden patients in hospitals and nursing homes. Although many efforts were made to elucidate the precise mechanism and clinical presentation, the pathogenesis and the final clinical outcome are yet to be determined. Although the current agreed upon presentation describes DTI as purple- or maroon-colored skin with ulceration, presented herein is an unusual case where DTI presented with only erythema and induration over the sacrum and right gluteal area.

Comportamiento clínico-epidemiológico del eritema nudoso en el Hospital Provincial Docente Clínico Quirúrgico León Cuervo Rubio / Epidemiological clinical behavior of erythema nodosum at the Provincial Teaching Clinical Surgical Hospital Leon Cuervo Rubio

RESUMEN Introducción: el eritema nudoso es la variante clínico-patológica más frecuente de la paniculitis. Es una reacción cutánea inmunológica en respuesta a un amplio espectro de agentes etiológicos. Objetivo: caracterizar el comportamiento clínico-epidemiológico del eritema nudoso. Materiales y métodos: se realizó un estudio descriptivo, prospectivo y longitudinal en pacientes con diagnóstico de eritema nudoso, ingresados en el Hospital Provincial Docente Clínico Quirúrgico León Cuervo Rubio, de Pinar del Río, en el período de enero de 2017 a diciembre de 2018. El universo estuvo constituido por 34 pacientes con diagnóstico clínico de eritema nudoso, hospitalizados en los servicios de Medicina Interna y Dermatología. Para la recogida de la información se utilizaron la historia clínica, el examen físico y los exámenes de laboratorio. Se utilizaron métodos teóricos, empíricos y estadísticos; de los últimos se empleó la estadística descriptiva a través de frecuencias absolutas y porcentaje. Resultados: el mayor grupo de pacientes estuvo entre 30 y 39 años, y fue del sexo femenino. Las lesiones fueron más frecuentes en los meses de invierno. El tipo de eritema nudoso idiopático prevaleció. Predominó el tiempo de evolución de 1 a 3 meses. Como causa secundaria predominaron las infecciones, y los tratamientos más usado fueron los antiinflamatorios no esteroideos. Conclusiones: se trata de una importante enfermedad de salud, cuyo un diagnóstico etiológico temprano permite un tratamiento adecuado. Resulta difícil su identificación y manejo tanto en la atención primaria como en la secundaria (AU).

ABSTRACT Introduction: erythema nodosum is the most common clinical-pathological variant of panniculitis. It is an immunological skin reaction in response to a wide spectrum of etiologic agents. Objective: to characterize the clinical-epidemiological behavior of erythema nodosum. Materials and methods: a descriptive, prospective and longitudinal study was carried out in patients with diagnosis of erythema nodosum, admitted to the Provincial Teaching Clinical Surgical Hospital León Cuervo Rubio, of Pinar del Río, in the period January 2017 to December 2018. The universe was formed by 34 patients with clinical diagnosis of erythema nodosum, hospitalized in the services of Internal Medicine and Dermatology. Medical records, physical examination and laboratory tests were used for the collection of information. Theoretical, empirical and statistical methods were used; descriptive statistics was used through absolute frequencies and percentage. Results: the largest group of patients was between 30 and 39 years, and they were female. Injuries were more frequent in the winter months. The type of idiopathic erythema nodosum prevailed. The time of evolution prevailed from 1 to 3 months. Infections predominated as a secondary cause, and the most commonly used treatments were non-steroidal anti-inflammatory drugs. Conclusions: it is an important health condition, whose early etiological diagnosis allows the proper treatment. Its identification and management in both primary and secondary care is difficult (AU).