RESUMO
The skin often reflects the presence of internal diseases. Acrokeratosis neoplastica (Bazex syndrome) is a unique skin manifestation characterized by its erythematous hyperkeratosis with yellowish, adherent scales on the palm, sole, or other acral locations. There is a potentially high association between Bazex syndrome and malignant pathology, especially squamous cell carcinomas (SCC). To date, various skin conditions have been recognized as diagnostic indicators of insidious malignancies. The recognition of paraneoplastic dermatoses has a strong potential for prompt cancer detection and early therapeutic intervention. Here we describe clinical and forensic cases of Bazex syndrome that are associated with SCC of the glottis and lung. Bazex syndrome has been reported to be associated with a variety of cancers in addition to SCC. We review the clinical manifestations of Bazex syndrome and include updated knowledge on disease pathogenesis.
RESUMO
The skin microbiome at lesion sites in patients with atopic dermatitis (AD) is characterized by dysbiosis. Although the administration of dupilumab, an IL-4Rα inhibitor, improves dysbiosis in the bacterial microbiome, information regarding the fungal microbiome remains limited. This study administered dupilumab to 30 patients with moderate-to-severe AD and analyzed changes in both fungal and bacterial skin microbiomes over a 12-week period. Malassezia restricta and M. globosa dominated the fungal microbiome, whereas non-Malassezia yeast species increased in abundance, leading to greater microbial diversity. A qPCR analysis revealed a decrease in Malassezia colonization following administration, with a higher reduction rate observed where the pretreatment degree of colonization was higher. A correlation was found between the group classified by the Eczema Area and Severity Index, the group categorized by the concentration of Thymus and activation-regulated chemokine, and the degree of skin colonization by Malassezia. Furthermore, an analysis of the bacterial microbiome also confirmed a decrease in the degree of skin colonization by the exacerbating factor Staphylococcus aureus and an increase in the microbial diversity of the bacterial microbiome. Our study is the first to show that dupilumab changes the community structure of the bacterial microbiome and affects the fungal microbiome in patients with AD.
RESUMO
Skin reflects the presence of systemic diseases, leading to an unexpected diagnosis of insidious diseases. Deck-chair sign is a unique skin eruption characterized by widespread erythematous papules that become erythrodermic with spare skin folds. An association between the deck-chair sign and malignancies, especially hematological neoplasms, has been suggested. We report a forensic case of mycosis fungoides unexpectedly diagnosed in the presence of a deck-chair sign. Mycosis fungoides is representative of cutaneous T-cell lymphomas. Here, we successfully demonstrated the feasibility of analyzing mycosis fungoides in a forensic autopsy case using basic histopathology and serology. We emphasize that the underlying malignancy should be primarily considered in cadavers with a positive deck-chair sign and review current reports about this characteristic skin manifestation.
Assuntos
Micose Fungoide , Neoplasias Cutâneas , Humanos , Autopsia , Micose Fungoide/diagnóstico , Micose Fungoide/patologia , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologiaRESUMO
A man in his thirties was suspected of committing a sexual offense against a young girl. A video on his mobile telephone provided the only evidence. Photographs obtained from the video showed male genitalia in two views, with the penis in both views exhibiting unique pigmentation. We appraised this case with the cooperation of dermatologists, who diagnosed the pigmentation as male genital melanosis, a relatively rare disease, which matched that on the suspected perpetrator's penis. Photographs obtained from the video were thus decisive evidence of sexual offense and identified the perpetrator.
Assuntos
Criminosos , Melanose , Delitos Sexuais , Feminino , Humanos , Masculino , PênisRESUMO
The association of Panton-Valentine leukocidin (PVL) toxin with necrotizing soft tissue infection (NSTI) caused by Staphylococcus aureus remains controversial. Here, we report the complete genome sequence of the PVL-negative S. aureus strain JMUB1273, isolated from a patient with pervasive NSTI.
Assuntos
Autoantígenos/imunologia , Distonina/imunologia , Imunoglobulina A/metabolismo , Imunoglobulina G/metabolismo , Dermatose Linear Bolhosa por IgA/tratamento farmacológico , Colágenos não Fibrilares/imunologia , Idoso de 80 Anos ou mais , Dermatite Esfoliativa/complicações , Humanos , Dermatose Linear Bolhosa por IgA/complicações , Dermatose Linear Bolhosa por IgA/metabolismo , Masculino , Colágeno Tipo XVIIAssuntos
Calcitriol/análogos & derivados , Fármacos Dermatológicos/administração & dosagem , Paraceratose/tratamento farmacológico , Doenças das Glândulas Sudoríparas/tratamento farmacológico , Administração Cutânea , Adulto , Axila , Calcitriol/administração & dosagem , Desodorantes/efeitos adversos , Feminino , Humanos , Paraceratose/diagnóstico , Paraceratose/etiologia , Paraceratose/patologia , Doenças das Glândulas Sudoríparas/diagnóstico , Doenças das Glândulas Sudoríparas/etiologia , Doenças das Glândulas Sudoríparas/patologia , Glândulas Sudoríparas/efeitos dos fármacos , Glândulas Sudoríparas/patologia , Resultado do Tratamento , Adulto JovemAssuntos
Antifúngicos/administração & dosagem , Dermatomicoses/microbiologia , Microsporum/isolamento & purificação , Administração Cutânea , Idoso , Animais , Biópsia , Gatos , Dermatomicoses/diagnóstico , Dermatomicoses/tratamento farmacológico , Dermatomicoses/transmissão , Feminino , Humanos , Imidazóis/administração & dosagem , Animais de Estimação/microbiologia , Pele/microbiologia , Pele/patologia , Microbiologia do Solo , Resultado do TratamentoAssuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Mucosite/tratamento farmacológico , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/tratamento farmacológico , Estomatite/tratamento farmacológico , Adulto , Testes de Aglutinação , Diagnóstico Diferencial , Feminino , Humanos , Infusões Intravenosas , Mucosite/diagnóstico , Mucosite/microbiologia , Pneumonia por Mycoplasma/diagnóstico , Pneumonia por Mycoplasma/microbiologia , Síndrome de Stevens-Johnson/diagnóstico , Estomatite/diagnóstico , Estomatite/microbiologia , Resultado do TratamentoAssuntos
Colite Ulcerativa/complicações , Pioderma Gangrenoso/diagnóstico , Sporothrix , Esporotricose/complicações , Esporotricose/diagnóstico , Diagnóstico Diferencial , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Iodeto de Potássio/administração & dosagem , Iodeto de Potássio/uso terapêutico , Pioderma Gangrenoso/genética , Análise de Sequência , Esporotricose/genética , Resultado do TratamentoRESUMO
Bullous pemphigoid (BP) is a common autoimmune blistering disorder with unknown etiology. Recently, increasing numbers of BP cases which developed under the medication with dipeptidyl peptidase-4 inhibitors (DPP4i), widely used antihyperglycemic drugs, have been reported in published works. Here, we report a case of DPP4i (teneligliptin)-associated BP that developed in a 70-year-old Japanese man. Interestingly, the patient had acquired reactive perforating collagenosis (ARPC), which is also known to be associated with the onset of BP. In the present case, clinical, histopathological and immunological findings suggested that DPP4i rather than ARPC was associated with the onset of BP.
Assuntos
Doenças do Colágeno/etiologia , Diabetes Mellitus/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Penfigoide Bolhoso/complicações , Idoso , Autoantígenos/imunologia , Biópsia , Doenças do Colágeno/diagnóstico , Doenças do Colágeno/patologia , Substituição de Medicamentos/métodos , Ensaio de Imunoadsorção Enzimática , Inibidores de Glicosídeo Hidrolases/uso terapêutico , Humanos , Inositol/análogos & derivados , Inositol/uso terapêutico , Masculino , Colágenos não Fibrilares/imunologia , Penfigoide Bolhoso/induzido quimicamente , Penfigoide Bolhoso/imunologia , Penfigoide Bolhoso/patologia , Pirazóis/efeitos adversos , Pele/imunologia , Pele/patologia , Tiazolidinas/efeitos adversos , Colágeno Tipo XVIIRESUMO
A 61-year-old Japanese man developed bullous skin lesions during topical therapy for psoriasis vulgaris. Physical examination demonstrated numerous tense bullae and scaly erythemas on the trunk and extremities. Histopathology of the skin biopsy demonstrated subepidermal bullae and lymphocytic infiltration with eosinophils in the dermis. Direct immunofluorescence revealed linear deposits of immunoglobulin (Ig)G, IgA and C3 along the basement membrane zone. Indirect immunofluorescence of 1 mol/L NaCl-split skin showed IgG reactivity with both epidermal and the dermal sides. IgM reactivity with both the epidermal and dermal sides was also detected. Enzyme-linked immunosorbent assays showed negative results for both BP180 and BP230. Immunoelectrophoresis of serum and bone marrow aspiration revealed underlying primary macroglobulinemia with M-proteinemia of IgM-κ type. Immunoblot analysis revealed IgG, but not IgM, antibodies to recombinant protein of BP180 C-terminal domain. We diagnosed the present case as bullous pemphigoid with IgG anti-BP180 C-terminal domain autoantibodies associated with primary macroglobulinemia and psoriasis vulgaris. Systemic administration of prednisolone 30 mg/day resulted in dramatic improvement of both bullous and psoriatic skin lesions. When the bullous and psoriatic lesions relapsed, DRC chemotherapy (dexamethasone, rituximab and cyclophosphamide) for macroglobulinemia was performed. Then, the psoriatic lesions improved and the bullous lesions disappeared. We suggested that the present case may be paraneoplastic syndrome of bullous pemphigoid associated with primary macroglobulinemia and psoriasis vulgaris.
Assuntos
Autoantígenos/imunologia , Colágenos não Fibrilares/imunologia , Síndromes Paraneoplásicas/etiologia , Penfigoide Bolhoso/etiologia , Psoríase/complicações , Macroglobulinemia de Waldenstrom/complicações , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Autoanticorpos/metabolismo , Biópsia , Ensaio de Imunoadsorção Enzimática , Técnica Direta de Fluorescência para Anticorpo , Técnica Indireta de Fluorescência para Anticorpo , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulina G/metabolismo , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/tratamento farmacológico , Síndromes Paraneoplásicas/patologia , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/patologia , Prednisolona/uso terapêutico , Psoríase/tratamento farmacológico , Pele/patologia , Macroglobulinemia de Waldenstrom/tratamento farmacológico , Colágeno Tipo XVIIRESUMO
BACKGROUND: Rosacea is a common skin disease and predominantly affects on the face of middle-aged women. It exceptionally occurs on the extrafacial areas such as ear, neck, axilla, and upper extremities, and has been reported as disseminated rosacea. MAIN OBSERVATION: A 40-year-old Japanese female presented with one-month history of erythematous skin eruption with burning sensation on the face, neck, and upper limbs. Physical examination showed rosacea-like eruption on the face as well as multiple papules disseminated on the neck, forearms, and hands. These extrafacial lesions demonstrated papulonecrotic appearance. Bilateral conjunctiva showed marked hyperemic which was consistent with ocular rosacea. Corneal opacity was also seen. Histology of the umbilicated papule on the neck revealed necrobiotic granulomas around the hair follicle with transepidermal elimination. Another tiny solid papule on the forearm suggesting early lesion also demonstrated necrobiosis with palisading granuloma but no transepidermal elimination. Systemic administration of minocycline and topical tacrolimus therapy promptly improved the skin lesions. Topical application of fluorometholone in temporary addition with levofloxacin improved ocular involvement 12 weeks after her 1st visit. The clinical course of the skin lesion and ocular symptoms mostly correlated. Then, the skin lesion and ocular symptoms often relapsed. Rosacea uncommonly associates with the extrafacial involvement as disseminated rosacea. The present case is characterized by the disseminated papulonecrotic lesions of the extrafacial areas histologically showing transepidermal elimination of necrobiotic granulomas. CONCLUSIONS: Dermatologists should recognize that papulonecrotic lesions of the neck and upper extremities might be extrafacial rosacea when the patient has rosacea on the face.