RESUMEN
In the late 1960s, palmoplantar pustulosis (PPP) with sternocostoclavicular arthropathy was first described in Japan, predominantly affecting women in the perimenopausal age. In the 1970s, the chronic non-bacterial osteomyelitis and chronic recurrent multifocal osteomyelitis were initially observed in paediatric patients with approximately 70% girls. Acne fulminans accompanied by polyarthralgia have been observed since early 1970s, which almost exclusively occurs in adolescent boys. Report on spondyloarthropathy associated with hidradenitis suppurativa can be traced back to 1982. The SAPHO syndrome was coined in 1987 to lump together synovitis, acne, pustulosis, hyperostosis and osteitis to conceptualize a group of inflammatory osteocutaneous diseases of unclear etiopathogenesis and ill-defined associations spanning disparate age and gender groups. From historical view, Sasaki syndrome is proposed to replace SAPHO syndrome to represent PPP with sternocostoclavicular arthropathy in the absence of other skin manifestations. Hidradenitis suppurativa is folliculitis in pathogenesis and no longer classified as acne. PPP accompanied by psoriasis vulgaris is more likely psoriasis pustulosa palmoplantaris in dermatological aspect, and the associated arthritis is part of psoriatic arthropathy. Pathophysiology of these disorders is incompletely understood. To echo the advancement of high-throughput sequencing, splitting but not lumping of clinical findings would be a better strategy to decipher these multigenic complex inflammatory disorders.
Asunto(s)
Síndrome de Hiperostosis Adquirido , Dermatología , Exantema , Enfermedades Cutáneas Vesiculoampollosas , Acné Vulgar/complicaciones , Acné Vulgar/patología , Síndrome de Hiperostosis Adquirido/clasificación , Síndrome de Hiperostosis Adquirido/complicaciones , Síndrome de Hiperostosis Adquirido/patología , Enfermedad Crónica , Exantema/clasificación , Exantema/complicaciones , Exantema/patología , Hidradenitis Supurativa/clasificación , Hidradenitis Supurativa/complicaciones , Hidradenitis Supurativa/patología , Humanos , Osteomielitis/complicaciones , Osteomielitis/patología , Psoriasis/complicaciones , Psoriasis/patología , Enfermedades Cutáneas Vesiculoampollosas/clasificación , Enfermedades Cutáneas Vesiculoampollosas/complicaciones , Enfermedades Cutáneas Vesiculoampollosas/patologíaAsunto(s)
Betacoronavirus/patogenicidad , Infecciones por Coronavirus/complicaciones , Exantema/clasificación , Neumonía Viral/complicaciones , Autoexamen/métodos , Algoritmos , COVID-19 , Infecciones por Coronavirus/virología , Exantema/diagnóstico , Exantema/virología , Humanos , Pandemias , Neumonía Viral/virología , SARS-CoV-2Asunto(s)
Exantema , Adulto , Niño , Exantema/clasificación , Exantema/diagnóstico , Exantema/etiología , Exantema/terapia , HumanosRESUMEN
Respiratory tract infection due to Mycoplasma pneumoniae can provoke cutaneous and mucosal rashes, which have been classified within the spectrum of erythema multiforme or Stevens-Johnson syndrome. This classification is of therapeutic and prognostic importance and has generated intense debate in the literature. A recent systematic review of 202 cases of mucocutaneous rashes associated with M. pneumoniae infection concluded that these rashes might constitute a distinct entity, for which the term Mycoplasma-induced rash and mucositis was proposed. We describe a patient with acute M pneumoniae respiratory tract infection who presented mucosal and cutaneous lesions that were difficult to classify as erythema multiforme or Stevens-Johnson syndrome; the lesions were compatible with the proposed new disease.
Asunto(s)
Eritema Multiforme/diagnóstico , Exantema/diagnóstico , Exantema/microbiología , Mucositis/diagnóstico , Mucositis/microbiología , Neumonía por Mycoplasma , Adolescente , Diagnóstico Diferencial , Eritema Multiforme/clasificación , Exantema/clasificación , Femenino , Humanos , Mucositis/clasificación , SíndromeRESUMEN
The cornerstone of adult onset Still's disease is the triad of daily fever, arthritis and rash. This syndrome remains enigmatic and most often a disease of exclusion. There are both musculoskeletal as well as systemic features. More importantly, reactive hemophagocytic syndrome may occur in patients. In this review we attempt to place this syndrome in perspective, including data on geoepidemiology, clinical and laboratory features.
Asunto(s)
Enfermedad de Still del Adulto/clasificación , Enfermedad de Still del Adulto/diagnóstico , Artritis/clasificación , Artritis/diagnóstico , Enfermedades Autoinmunes/clasificación , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/inmunología , Bacteriemia/clasificación , Bacteriemia/diagnóstico , Bacteriemia/inmunología , Diagnóstico Tardío , Diagnóstico Diferencial , Exantema/clasificación , Exantema/diagnóstico , Fiebre de Origen Desconocido/clasificación , Fiebre de Origen Desconocido/diagnóstico , Humanos , Inflamación/clasificación , Inflamación/diagnóstico , Inflamación/inmunología , Inflamación/patología , Linfohistiocitosis Hemofagocítica/clasificación , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/inmunología , Linfohistiocitosis Hemofagocítica/patología , Anomalías Musculoesqueléticas/clasificación , Anomalías Musculoesqueléticas/diagnóstico , Anomalías Musculoesqueléticas/inmunología , Anomalías Musculoesqueléticas/patología , Estudios Retrospectivos , Enfermedad de Still del Adulto/inmunología , Enfermedad de Still del Adulto/patología , Virosis/clasificación , Virosis/diagnóstico , Virosis/inmunologíaRESUMEN
BACKGROUND: Hand, foot and mouth disease (HFMD) is classically defined as a childhood fever accompanied by a rash with vesicles or erosions of the oral mucosa, hands, feet and sometimes the buttocks. Severe neurological complications are associated with enterovirus 71 outbreaks in Asia. Recently, it has been suggested that HFMD is related to coxsackie virus A6 (CV-A6) when there is an atypical rash. The objective of the study is to determine the dermatological pattern of HFMD and to identify the virus serotypes associated with a specific dermatological pattern. METHODS: A prospective, cross-sectional study was conducted in 7 pediatric dermatology units in France from March 2010 to February 2012. All children with clinically suspected diagnosis of HFMD were included. Clinical data were collected and swabs from the nasopharynx and vesicles were taken for reverse transcription polymerase chain reaction and genotyping. Only children with confirmed HFMD--defined by clinical diagnosis of HFMD and positive enterovirus polymerase chain reaction results--were included for analysis. RESULTS: One hundred and four children consulted for suspected HFMD, including 89 (mean age: 25.7 months; sex ratio M/F 1.54) with confirmed HFMD. Seventy-eight (87.6%) had skin lesions on sites other than hand, feet and mouth. Thirty-seven (41.5%) had 5 or more anatomical sites involved (hand, feet and mouth, buttocks, legs, arms and trunk) considered as widespread exanthema. Widespread vesicular exanthema was observed with both CV-A6 and CV-A16. Peri-oral rash was associated with CV-A6 (P < 0.001). CONCLUSIONS: HFMD has a clinical spectrum ranging from classical to generalized vesicular exanthema. Generalized and atypical exanthema were observed with both CV-A6 and CV-A16 infections. CV-A6 is associated with peri-oral rash.
Asunto(s)
Exantema/epidemiología , Exantema/patología , Enfermedad de Boca, Mano y Pie/epidemiología , Enfermedad de Boca, Mano y Pie/patología , Adolescente , Niño , Preescolar , Estudios Transversales , Enterovirus , Exantema/clasificación , Femenino , Francia/epidemiología , Enfermedad de Boca, Mano y Pie/clasificación , Humanos , Lactante , Masculino , Piel/patologíaAsunto(s)
Exantema/diagnóstico , Adolescente , Adulto , Diagnóstico Diferencial , Erupciones por Medicamentos/diagnóstico , Urgencias Médicas , Exantema/inducido químicamente , Exantema/clasificación , Exantema/etiología , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Humanos , Lactante , Mononucleosis Infecciosa/diagnóstico , Mordeduras y Picaduras de Insectos/diagnóstico , Masculino , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/diagnóstico , Trastornos por Fotosensibilidad/diagnóstico , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Sepsis/complicaciones , Sepsis/diagnóstico , Choque Séptico/complicaciones , Choque Séptico/diagnóstico , Sífilis Cutánea/complicaciones , Sífilis Cutánea/diagnóstico , Urticaria/diagnóstico , Virosis/complicaciones , Virosis/diagnósticoRESUMEN
BACKGROUND: Historically, skin toxicity has been assessed in prospective clinical trials using the clinician-reported National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE). The patient-reported Skindex-16 measures symptoms and perceptions of toxicity. This study was designed to compare information provided by these two measures. METHODS: Data were compiled from three placebo-controlled North Central Cancer Treatment Group studies (N06C4, N03CB, N05C4) having rash prevention as the primary objective. All used the Skindex-16 and CTCAE at baseline, weekly during treatment and during a minimum 2-week follow-up period. Statistical procedures, including Pearson correlations, were utilized to determine relationships between adverse event (AE) grades and Skindex-16 scores. RESULTS: Four hundred and twelve individual patients provided data (median age, 61; 134 male). Patients' Skindex-16 score results show a 0.9 overall mean (range 0-6 with 6 being worse symptoms), a 0.4 baseline mean (range, 0-4.3) and a 1.3 end-of-treatment mean (range, 0-5.9). Ninety-three, 142 and 177 patients experienced a grade 0, 1 and 2+ CTCAE skin toxicity, respectively. Baseline Skindex-16 scores had relatively low correlation with CTCAE grades. The correlation of rash grade with Skindex-16 scores ranged from r = 0.49 with the function subscale to r = 0.62 with the symptom subscale. The highest correlations of the maximum grade of any dermatological AE with the Skindex-16 were r = 0.48 for the total score and r = 0.55 for the symptom subscale. CONCLUSIONS: The data reported support the decision to include both measures in a clinical trial to assess the patient experience, as each measure may specifically target varying symptoms and intensities.
Asunto(s)
Antineoplásicos/efectos adversos , Exantema/inducido químicamente , Exantema/clasificación , Neoplasias/complicaciones , Neoplasias/terapia , Radiodermatitis/clasificación , Índice de Severidad de la Enfermedad , Terminología como Asunto , Algoritmos , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Neoplasias de la Mama/radioterapia , Cetuximab , Clorhidrato de Erlotinib , Femenino , Gefitinib , Humanos , Masculino , Persona de Mediana Edad , Furoato de Mometasona , Pregnadienodioles/uso terapéutico , Inhibidores de Proteínas Quinasas/efectos adversos , Inhibidores de la Síntesis de la Proteína/uso terapéutico , Quinazolinas/efectos adversos , Radiodermatitis/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Protectores Solares/uso terapéutico , Encuestas y Cuestionarios , Tetraciclina/uso terapéuticoRESUMEN
BACKGROUND: Community clinics offer potential for timelier outbreak detection and monitoring than emergency departments. However, the accuracy of syndrome definitions used in surveillance has never been evaluated in community settings. This study's objective was to assess the accuracy of syndrome definitions based on diagnostic codes in physician claims for identifying 5 syndromes (fever, gastrointestinal, neurological, rash, and respiratory including influenza-like illness) in community clinics. METHODS: We selected a random sample of 3,600 community-based primary care physicians who practiced in the fee-for-service system in the province of Quebec, Canada in 2005-2007. We randomly selected 10 visits per physician from their claims, stratifying on syndrome type and presence, diagnosis, and month. Double-blinded chart reviews were conducted by telephone with consenting physicians to obtain information on patient diagnoses for each sampled visit. The sensitivity, specificity, and positive predictive value (PPV) of physician claims were estimated by comparison to chart review. RESULTS: 1,098 (30.5%) physicians completed the chart review. A chart entry on the date of the corresponding claim was found for 10,529 (95.9%) visits. The sensitivity of syndrome definitions based on diagnostic codes in physician claims was low, ranging from 0.11 (fever) to 0.44 (respiratory), the specificity was high, and the PPV was moderate to high, ranging from 0.59 (fever) to 0.85 (respiratory). We found that rarely used diagnostic codes had a higher probability of being false-positives, and that more commonly used diagnostic codes had a higher PPV. CONCLUSIONS: Future research should identify physician, patient, and encounter characteristics associated with the accuracy of diagnostic codes in physician claims. This would enable public health to improve syndromic surveillance, either by focusing on physician claims whose diagnostic code is more likely to be accurate, or by using all physician claims and weighing each according to the likelihood that its diagnostic code is accurate.
Asunto(s)
Técnicas y Procedimientos Diagnósticos/normas , Vigilancia de la Población/métodos , Codificación Clínica/métodos , Servicios de Salud Comunitaria/estadística & datos numéricos , Recolección de Datos , Exantema/clasificación , Exantema/diagnóstico , Femenino , Fiebre/clasificación , Fiebre/diagnóstico , Humanos , Clasificación Internacional de Enfermedades , Masculino , Enfermedades del Sistema Nervioso/clasificación , Enfermedades del Sistema Nervioso/diagnóstico , Visita a Consultorio Médico/estadística & datos numéricos , Quebec , Sistema de Registros , Infecciones del Sistema Respiratorio/clasificación , Infecciones del Sistema Respiratorio/diagnóstico , Sensibilidad y EspecificidadAsunto(s)
Humanos , Masculino , Femenino , Notificación de Enfermedades , Exantema/clasificación , Exantema/diagnósticoRESUMEN
Drug rashes are a common problem occurring in patients across the whole spectrum of medical specialties. They are a source of confusion not only to the wider medical community but even among dermatologists there is lack of clarity about how to describe, classify and approach them. Common patterns of drug rash, apart from the "classical" maculo-papular eruptions (MPE), include urticarial wheals and urticaria-like rashes which it is important to distinguish, because of differences in pathogenetic mechanisms, therapeutic response and prognostic significance. The purpose of this article is to try to offer some structure both from the point of view of clinical classification and also of underlying mechanisms.
Asunto(s)
Exantema , Piel/patología , Diagnóstico Diferencial , Exantema/inducido químicamente , Exantema/clasificación , Exantema/diagnóstico , HumanosRESUMEN
PURPOSE: To describe ocular manifestations in primary varicella infection and their relationship to systemic severity and the associated eyelid rash. METHODS: One hundred consecutive children with primary varicella were examined prospectively. The cases were classified as mild, moderate, and severe according to the severity of clinical presentation. Excluding the presence of eyelid rash, children with ocular findings were assigned to group 1 (G1), and those without ocular findings were assigned to group 2 (G2). Patients in G1 were also evaluated according to the nature of ocular manifestations and the course of uveitis. RESULTS: Twenty-one percent of patients had ocular involvement (G1) and 79% had no ocular involvement (G2). While chickenpox had a mild course in 85.7% of patients in G1 and 88.6% of patients in G2, all others had a moderate course. None of the children had a severe course. A varicella eyelid rash was present in 28.6% of patients in G1 and 13.9% in G2. Among ocular findings, 38.1% of patients had conjunctivitis, 57.1% had anterior uveitis, and 4.8% had disciform keratouveitis. There was no significant association between severity of chickenpox and severity of ocular involvement (p=0.712). There was also no relationship between eyelid rash and ocular involvement (p=0.787). CONCLUSIONS: There is neither an association between the severity of chickenpox and the severity of ocular involvement nor an association between the presence of a varicella eyelid rash and the development of uveitis. As the prognosis regarding sequelae of ocular involvement in varicella infection is good, only those patients with ocular signs and symptoms need be referred by pediatricians for an ophthalmologic examination.
Asunto(s)
Varicela/complicaciones , Exantema/complicaciones , Infecciones Virales del Ojo/complicaciones , Enfermedades de los Párpados/complicaciones , Herpesvirus Humano 3/aislamiento & purificación , Adolescente , Varicela/clasificación , Niño , Preescolar , Conjuntivitis Viral/clasificación , Conjuntivitis Viral/complicaciones , Exantema/clasificación , Infecciones Virales del Ojo/clasificación , Enfermedades de los Párpados/clasificación , Femenino , Humanos , Masculino , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Uveítis Anterior/clasificación , Uveítis Anterior/complicacionesRESUMEN
Febrile exanthema (FE) is an extremely polymorphous clinical entity, frequently seen in daily clinical practice. FE is characterized by diffuse rash and fever. FE is classified in 4 types, depending on the primary skin lesion: macular, maculopapular, vesicular, and bullous exanthema. It is of infectious and non-infectious cause. Among the infectious causes the most frequent is the viral one. FE may affect all ages, but especially children and young people. Usually, FE raises important issues of differential diagnosis, because its clinical and etiological complexity. To decide the most appropriate therapeutic and prophylactic measures for FE, it is important to know the clinical criteria and the specific diagnostic methods.
Asunto(s)
Exantema/etiología , Fiebre/etiología , Diagnóstico Diferencial , Exantema/clasificación , Exantema/microbiología , Exantema/parasitología , Exantema/virología , Fiebre/clasificación , Fiebre/microbiología , Fiebre/parasitología , Fiebre/virología , HumanosRESUMEN
There is considerable evidence that epidermal growth factor receptor (EGFR) plays an important role in non-small-cell lung cancer tumor growth and proliferation. Clinical experience with EGFR inhibitors, such as erlotinib, gefitinib, and cetuximab, has suggested that there are subgroups of patients with non-small-cell lung cancer that demonstrate dramatic responses to these agents. Researchers have sought to determine whether molecular or clinical characteristics correlate with therapeutic outcomes. Rash, the most commonly reported adverse effect of anti-EGFR therapy, has also been examined as a potential marker of response. Several trials evaluating anti-EGFR therapies have reported a positive correlation between rash and response and even rash and survival. If rash is truly a predictor of outcome, it becomes imperative that clinicians identify effective methods for managing this toxicity to avoid unwanted dose reduction, therapy interruption, delay, or discontinuation in patients experiencing a therapeutic benefit. Unfortunately, because of a lack of well-defined rash etiology, variability of use, and interpretation of rash grading scales, as well as a lack of clinical trials evaluating approaches to rash management, we are left without systematic, evidence-based guidelines for treatment. Preliminary results of a prospective study evaluating a rash treatment algorithm developed at the University of Texas M. D. Anderson Cancer Center have been positive, and there is universal agreement that initiation of more prospective trials to evaluate EGFR-inhibitor rash management is needed.
Asunto(s)
Antineoplásicos/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Receptores ErbB/antagonistas & inhibidores , Exantema/inducido químicamente , Neoplasias Pulmonares/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Biomarcadores , Receptores ErbB/genética , Clorhidrato de Erlotinib , Exantema/clasificación , Exantema/terapia , Gefitinib , Genes erbB-1 , Humanos , Quinazolinas/efectos adversosAsunto(s)
Exantema/virología , Enfermedades Cutáneas Virales/clasificación , Alphaherpesvirinae/clasificación , Infecciones por Citomegalovirus/virología , Exantema/clasificación , Infecciones por Herpesviridae/virología , Humanos , Infecciones por Parvoviridae/virología , Parvovirus B19 Humano/fisiología , Activación Viral/fisiología , Latencia del Virus/fisiologíaRESUMEN
Rash is a class effect of HER1/epidermal growth factor receptor (EGFR)-targeted agents, and has occurred with high frequency and in a dose-dependent manner in clinical trials of these agents in cancer patients. Analysis of phase II trials of erlotinib (Tarceva) in non-small-cell lung cancer, head and neck cancer, and ovarian cancer shows a significant association between rash severity and objective tumor response. Rash severity was highly significantly associated with survival in patients with non-small-cell lung cancer receiving erlotinib; median survival in patients with no rash was 46.5 days, compared with 257 days in those with grade 1 rash (P < .0001) and 597 days in those with grade 2/3 rash (P < .0001). Similarly, for the combined non-small-cell lung cancer, head and neck cancer, and ovarian cancer studies, median survival in patients with no rash was 103 days, compared with 191 days in those with grade 1 rash (P = .0001) and 266 days in those with grade 2/3/4 rash (P = .0001). Similar findings have been made with cetuximab (Erbitux) and in some settings with gefitinib (Iressa). The strong association of rash severity with response/survival suggests that rash may serve as a marker of response to erlotinib treatment and may be used to guide treatment to obtain optimal response. Dosing erlotinib at the maximum tolerated dose, which is associated with more frequent and more severe rash, may improve response rates and survival durations. Further study of the potentially important association between rash and outcome of treatment with EGFR-targeted agents is needed.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Receptores ErbB/antagonistas & inhibidores , Exantema/inducido químicamente , Exantema/clasificación , Neoplasias de Cabeza y Cuello/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Ováricas/tratamiento farmacológico , Quinazolinas/efectos adversos , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Biomarcadores/análisis , Cetuximab , Ensayos Clínicos Fase II como Asunto , Relación Dosis-Respuesta a Droga , Determinación de Punto Final , Clorhidrato de Erlotinib , Femenino , Gefitinib , Humanos , Quinazolinas/farmacología , Quinazolinas/uso terapéutico , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
The differential diagnosis for febrile patients with a rash is extensive. Diseases that present with fever and rash are usually classified according to the morphology of the primary lesion. Rashes can be categorized as maculopapular (centrally and peripherally distributed), petechial, diffusely erythematous with desquamation, vesiculobullous-pustular and nodular. Potential causes include viruses, bacteria, spirochetes, rickettsiae, medications and rheumatologic diseases. A thorough history and a careful physical examination are essential to making a correct diagnosis. Although laboratory studies can be useful in confirming the diagnosis, test results often are not available immediately. Because the severity of these illnesses can vary from minor (roseola) to life-threatening (meningococcemia), the family physician must make prompt management decisions regarding empiric therapy. Hospitalization, isolation and antimicrobial therapy often must be considered when a patient presents with fever and a rash.
Asunto(s)
Exantema/diagnóstico , Exantema/etiología , Fiebre/diagnóstico , Fiebre/etiología , Diagnóstico Diferencial , Exantema/clasificación , Exantema/tratamiento farmacológico , Medicina Familiar y Comunitaria/métodos , Fiebre/clasificación , Fiebre/tratamiento farmacológico , Humanos , Control de Infecciones/métodos , Anamnesis/métodos , Examen Físico/métodosRESUMEN
Viral exanthems are common in childhood and account for a large number of patient visits to pediatric or family medicine clinics. Most exanthems are virtually harmless to the healthy child, but others can be signs of more significant systemic disease. Some exanthems that are benign or self-limited in the healthy child may propose significant risk to pregnant or immunocompromised individuals. Therefore, recognition of exanthems, which may be associated with certain viral illnesses, is important for the primary care provider. For example, prompt recognition of a viral exanthem caused by parvovirus may allow a pregnant female from exposing her fetus to a potentially fatal infection, or, if the exposure has already occurred, may indicate the need for appropriate fetal monitoring. In this manuscript, we review the recent literature pertaining to four characteristic exanthems that are thought to be viral in nature: papular purpuric gloves and socks syndrome; pityriasis rosea; unilateral lateral thoracic exanthem; and Gianotti-Crosti syndrome.