RESUMEN
This case report describes tofacitinib treatment for 2 patients with pretibial myxedema.
Asunto(s)
Mixedema , Piperidinas , Pirimidinas , Humanos , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/patología , Mixedema/tratamiento farmacológico , Mixedema/diagnóstico , Piperidinas/uso terapéutico , Piperidinas/administración & dosificación , Inhibidores de Proteínas Quinasas/uso terapéutico , Inhibidores de Proteínas Quinasas/administración & dosificación , Pirimidinas/uso terapéutico , Pirimidinas/administración & dosificación , Pirroles/administración & dosificación , Pirroles/uso terapéutico , Resultado del TratamientoRESUMEN
INTRODUCTION: Pretibial myxedema is a rare manifestation of Graves' disease, and pseudotumoral forms may be confused with lower limb lymphedema. OBSERVATIONS: We reported 3 cases of pretibial myxedema in 2 women and 1 man, aged 72, 66, and 49 years, treated for Graves' disease 3, 25 and 32 years previously. Two patients were active smokers. Lymphedema diagnosis of the lower limbs was suspected in the presence of bilateral pseudotumoral lesions of the feet, toes and ankles and the presence of a Stemmer's sign (skin thickening at the base of the 2nd toe, pathognomonic of lymphedema). Lymphoscintigraphy in one case was normal, not confirming lymphedema. CONCLUSION: Pretibial pseudotumoral myxedema is a differential diagnosis of lower limb lymphedema. This diagnosis is confirmed by questioning the patient about preexisting Graves' disease, the underlying etiology, to decide the appropriate treatment and to encourage cessation of smoking, which is a risk factor for pretibial myxedema.
Asunto(s)
Enfermedad de Graves , Dermatosis de la Pierna , Mixedema , Masculino , Humanos , Femenino , Mixedema/diagnóstico , Mixedema/etiología , Mixedema/patología , Diagnóstico Diferencial , Enfermedad de Graves/complicaciones , Enfermedad de Graves/diagnóstico , Extremidad Inferior/patología , Dedos del Pie/patología , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/etiología , Dermatosis de la Pierna/patologíaRESUMEN
Stasis dermatitis is a chronic inflammatory skin disease of the lower extremities. It typically occurs in older individuals and is the cutaneous manifestation of venous hypertension caused by venous reflux. Such retrograde venous blood flow is the result of incompetent venous valves, valve destruction, or venous obstruction. Stasis dermatitis is eczematous. The associated impairment of venous valves may cause swelling of the legs, leading to serious conditions including venous ulcerations. Diagnosis can be challenging because of its clinical resemblance to other skin conditions and poor clinical recognition by physicians. The cornerstones of stasis dermatitis treatment are compression therapy to ameliorate pain and swelling, topical treatments to alleviate secondary skin changes, and interventional treatment options to correct the underlying causes of venous reflux. Given the central role of inflammation of the lower extremities in driving the cutaneous changes characteristic of stasis dermatitis, new therapeutic approaches that target the inflammation are under clinical evaluation in patients with stasis dermatitis.
Stasis dermatitis is a skin disease that can affect a person for a long time. It affects the legs of older people who have a disease called chronic venous insufficiency. This is when a person's veins have difficulty sending blood from their limbs back to their heart. Stasis dermatitis is caused by increased pressure inside a person's veins. Its signs and symptoms are skin discoloration, itch, dryness, and scaling and can be similar to the signs and symptoms of cellulitis and allergic contact dermatitis. Cellulitis is a common skin infection caused by bacteria. Cellulitis causes redness, swelling, and pain. Allergic contact dermatitis is an itchy skin rash caused by contact with something that irritates the skin. Stasis dermatitis is usually diagnosed after a healthcare provider has looked at person's skin and their medical history. Treatment for stasis dermatitis should treat the chronic venous insufficiency that causes the disease. It should also treat the skin lesions caused by stasis dermatitis. One way to treat stasis dermatitis is to reduce pain and swelling. This is done by applying pressure with compression stockings or bandages. Minor surgery can treat the venous insufficiency that causes stasis dermatitis. No treatments have been approved for the skin symptoms associated with stasis dermatitis. New ways to treat such symptoms need to be developed.
Asunto(s)
Eccema , Dermatosis de la Pierna , Úlcera Varicosa , Várices , Insuficiencia Venosa , Humanos , Anciano , Insuficiencia Venosa/complicaciones , Várices/complicaciones , Úlcera Varicosa/complicaciones , Úlcera Varicosa/diagnóstico , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/etiología , Dermatosis de la Pierna/patología , InflamaciónRESUMEN
Pretibial myxedema (PTM), characterized by the accumulation of glycosaminoglycans in dermis is an autoimmune skin disorder, which is almost always associated with Graves' disease (GD). Although fibroblast stimulated by thyroid-stimulating hormone receptor (TSHR) antibody, cytokines and growth factors have been postulated as target of the autoimmune process in the dermopathy, the pathogenesis of PTM remains unclear. We hypothesize that the local immune microenvironment of the skin including the antigens and antibodies, T cells, B cells, plasma cells and fibroblasts may play an important role in the development of PTM. Results obtained on PTM patients indicate increased thyroid-stimulating hormone receptor antibodies (TRAb) in the blood positively correlate with the dermal thickness of the lesions. Further analysis shows that there were more CD3+ T cells and CD20+ B cells in the skin lesions. These T and B cells are in close contact, indicating that inducible skin-associated lymphoid tissue (iSALT) may be formed in the area. In addition, we found that the infiltrating plasma cells can secrete TRAb, proving that B cells in the skin other than the thyroid are an additional source of TSHR antibodies. Meanwhile, the T and B cells in the skin or skin homogenate of patients can promote the proliferation of pretibial fibroblasts. In conclusion, our results provide evidence that the local immune microenvironment of the skin may play an important role in the development of PTM.
Asunto(s)
Microambiente Celular , Enfermedad de Graves , Dermatosis de la Pierna/inmunología , Mixedema/inmunología , Estudios de Casos y Controles , Fibroblastos/metabolismo , Humanos , Dermatosis de la Pierna/patología , Mixedema/patologíaRESUMEN
Pyoderma gangrenosum (PG) is a rare, debilitating, inflammatory skin disease associated with a variety of systemic diseases. Because of its rarity, PG is treated with miscellaneous immunosuppressive agents as there is no US Food and Drug Administration-approved standardized treatment approach. We present four patients with PG treated with tofacitinib in the context of the six existing cases in the literature. Tofacitinib appeared to be beneficial in the small sample of patients (n = 10) who failed an average of four other systemic therapies. The majority of patients had classic PG located on the legs (80%, 8/10), while 20% of cases (2/10) were peristomal. The most common comorbidity was inflammatory bowel disease (78%, 7/9). There were no negative treatment results and 40% (4/10) of patients had complete healing of their ulcers, while the other 60% (6/10) had marked clinical improvement. From our observation, tofacitinib appears to be a promising steroid-sparing adjuvant treatment in patients with refractory PG who have failed on other systemic therapies.
Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Piperidinas/uso terapéutico , Inhibidores de Proteínas Quinasas/uso terapéutico , Piodermia Gangrenosa/tratamiento farmacológico , Pirimidinas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Inflamatorias del Intestino/complicaciones , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/patología , Masculino , Persona de Mediana Edad , Piodermia Gangrenosa/complicaciones , Piodermia Gangrenosa/patología , Estomas Quirúrgicos/patología , Resultado del TratamientoRESUMEN
Dermatomyositis (DM) is an autoimmune connective tissue disease that is included in the idiopathic inflammatory myopathies. Cutaneous manifestations are a prominent part of the condition: some skin signs in DM are common to most patients, while other signs are encountered infrequently. A number of features are pathognomic for DM. The demonstration of myositis-specific antibodies (MSAs) in DM has extended the ability to define phenotypic subgroups. It appears that the presence of certain MSAs confers susceptibility to specific clinical features, an association which reveals a serotype-phenotype relationship. In this review article we have provided a detailed summary of common and under-recognized cutaneous manifestations of DM.
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Dermatomiositis/patología , Exantema/patología , Calcinosis/etiología , Dermatomiositis/complicaciones , Dermatosis Facial/patología , Dermatosis de la Mano/patología , Humanos , Dermatosis de la Pierna/patología , Paniculitis/etiología , Dermatosis del Cuero Cabelludo/patología , Torso/patologíaRESUMEN
Cutaneous tuberculosis occurs in 1-2% of world cases of tuberculosis and more common in tropical countries. It presents with different clinical forms. Unusual clinical presentations are not uncommon and awareness of these will help in suspecting and managing these patients successfully. Lupus pernio like lupus vulgaris, tuberculosis of glans penis and lichen scrofulosorum on the distal parts of limbs are presented here because of their unusual clinical presentation.
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Dermatosis Facial/patología , Dermatosis de la Pierna/patología , Lupus Vulgar/patología , Enfermedades del Pene/patología , Tuberculosis Cutánea/patología , Tuberculosis de los Genitales Masculinos/patología , Adulto , Antituberculosos/uso terapéutico , Dermatosis Facial/diagnóstico , Dermatosis Facial/tratamiento farmacológico , Antebrazo/patología , Humanos , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/tratamiento farmacológico , Lupus Vulgar/diagnóstico , Lupus Vulgar/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Enfermedades del Pene/diagnóstico , Enfermedades del Pene/tratamiento farmacológico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Tuberculosis de los Genitales Masculinos/diagnóstico , Tuberculosis de los Genitales Masculinos/tratamiento farmacológicoAsunto(s)
Sporothrix , Esporotricosis , Animales , Antifúngicos/uso terapéutico , Glicosaminoglicanos/análisis , Humanos , Itraconazol/uso terapéutico , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/microbiología , Dermatosis de la Pierna/patología , Masculino , Persona de Mediana Edad , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Micosis/patología , Patología Molecular , Sporothrix/efectos de los fármacos , Sporothrix/aislamiento & purificación , Esporotricosis/diagnóstico , Esporotricosis/tratamiento farmacológico , Esporotricosis/patologíaAsunto(s)
Trastornos de la Coagulación Sanguínea/tratamiento farmacológico , Trastornos de la Coagulación Sanguínea/patología , Infecciones por Coronavirus/patología , Dermatosis de la Pierna/patología , Neumonía Viral/patología , Anciano , Anticoagulantes/administración & dosificación , Biopsia con Aguja , Trastornos de la Coagulación Sanguínea/diagnóstico , COVID-19 , Prueba de COVID-19 , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Femenino , Técnica del Anticuerpo Fluorescente Directa , Humanos , Inmunohistoquímica , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/tratamiento farmacológico , Pandemias , Neumonía Viral/diagnóstico , Púrpura/diagnóstico , Púrpura/patología , Medición de Riesgo , Resultado del TratamientoRESUMEN
Abstract We report a 74-year-old male presented to an outpatient dermatology clinic in Manaus, Amazonas, with a one-year history of pruritic, keloidal lesions on his left lower extremity. Histopathology showed round structures in reticular dermis. Grocott methenamine silver stain revealed numerous round yeasts with thick double walls, occurring singly or in chains connected by tubular projections. The diagnosis was lobomycosis. Although the keloidal lesions presented by this patient are typical of lobomycosis, their linear distribution along the left lower limb is unusual.
Asunto(s)
Humanos , Masculino , Anciano , Lobomicosis/diagnóstico , Lobomicosis/patología , Queloide/diagnóstico , Queloide/patología , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/patología , Biopsia , Dermis/microbiología , Dermis/patologíaRESUMEN
BACKGROUND: Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. It has a characteristic rash described as palpable purpura that most frequently affects the distal lower extremities and buttocks. HSP rarely presents with bullous rash nor pulmonary nodules. CASE PRESENTATION: We present a novel case of a 12-years-old female with recurrent pediatric HSP with a combination of the rare manifestations of bullous rash and pulmonary nodules. She initially presented with the bullous rash, chest pain, cough, and abdominal pain. Patient was successfully treated with intravenous pulse corticosteroids followed by a high dose oral corticosteroid taper, with resolution of the bullous rash and pulmonary nodules. CONCLUSION: The rare manifestations of scarring bullous rash and pulmonary nodules can be presenting features of pediatric HSP, the combination of which has not been previously reported. The treatment of intravenous corticosteroid resolved patient's abdominal symptoms, rash and pulmonary nodules.
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Vasculitis por IgA/fisiopatología , Nódulos Pulmonares Múltiples/fisiopatología , Enfermedades Cutáneas Vesiculoampollosas/fisiopatología , Biopsia con Aguja Fina , Líquido del Lavado Bronquioalveolar , Dolor en el Pecho/tratamiento farmacológico , Dolor en el Pecho/fisiopatología , Niño , Complemento C3 , Tos , Femenino , Técnica del Anticuerpo Fluorescente Directa , Gabapentina/uso terapéutico , Glucocorticoides/uso terapéutico , Humanos , Vasculitis por IgA/diagnóstico por imagen , Vasculitis por IgA/tratamiento farmacológico , Vasculitis por IgA/patología , Biopsia Guiada por Imagen , Inmunoglobulina A , Dermatosis de la Pierna/tratamiento farmacológico , Dermatosis de la Pierna/patología , Dermatosis de la Pierna/fisiopatología , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/tratamiento farmacológico , Neuralgia/tratamiento farmacológico , Neuralgia/fisiopatología , Recurrencia , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Enfermedades Cutáneas Vesiculoampollosas/patología , Tomografía Computarizada por Rayos XRESUMEN
We report a 74-year-old male presented to an outpatient dermatology clinic in Manaus, Amazonas, with a one-year history of pruritic, keloidal lesions on his left lower extremity. Histopathology showed round structures in reticular dermis. Grocott methenamine silver stain revealed numerous round yeasts with thick double walls, occurring singly or in chains connected by tubular projections. The diagnosis was lobomycosis. Although the keloidal lesions presented by this patient are typical of lobomycosis, their linear distribution along the left lower limb is unusual.
Asunto(s)
Queloide/diagnóstico , Queloide/patología , Dermatosis de la Pierna/diagnóstico , Dermatosis de la Pierna/patología , Lobomicosis/diagnóstico , Lobomicosis/patología , Anciano , Biopsia , Dermis/microbiología , Dermis/patología , Humanos , MasculinoAsunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Enfermedad de Graves/complicaciones , Dermatosis de la Pierna/patología , Mixedema/patología , Anciano , Enfermedad de Graves/radioterapia , Terapia de Reemplazo de Hormonas , Humanos , Radioisótopos de Yodo/uso terapéutico , Dermatosis de la Pierna/complicaciones , Masculino , Mixedema/complicaciones , Tiroxina/uso terapéuticoAsunto(s)
Dermatosis de la Pierna/patología , Úlcera de la Pierna/patología , Neoplasias/patología , Humanos , Pierna , DolorAsunto(s)
Calcifilaxia/complicaciones , Dermopatía Fibrosante Nefrogénica/complicaciones , Diálisis Renal , Pared Abdominal/patología , Adulto , Calcifilaxia/patología , Femenino , Humanos , Fallo Renal Crónico/terapia , Dermatosis de la Pierna/complicaciones , Dermatosis de la Pierna/patología , Dermopatía Fibrosante Nefrogénica/patologíaRESUMEN
INTRODUCTION: Stasis mucinosis and obesity-associated lymphedematous mucinosis (OALM) have been described as 2 discrete diagnostic entities. CASE REPORT: A morbidly obese African American man in his late 60s presented to the emergency room with a 3-month history of swelling of both lower extremities and secondary changes suggestive of lymphedema and venous dermatitis. On physical examination, the patient had severe edema with multiple raised areas of verruciform skin changes and varicosities, diffuse induration, erythema, and scaling. He also had an open wound in his left hallux. The skin biopsy found mucinosis. A diagnosis of stasis mucinosis was rendered. He had normal thyroid function test laboratory results. CONCLUSIONS: The authors suggest stasis mucinosis and OALM represent the spectrum of euthyroid mucin depositional disease in varying clinical settings.