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1.
Clin Dermatol ; 42(5): 426-433, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38914175

RESUMO

Dermatologists treating patients with autoimmune bullous dermatoses (AIBDs), as well as the patients themselves, encounter challenges at every stage of their interaction, including dermatologic and comorbidities assessment, diagnosis, prognosis evaluation, treatment, and follow-up monitoring. We summarize the current and potential future clinical applications of artificial intelligence (AI) in the field of AIBDs. Recent research and AI models have demonstrated their potential to enhance or may already be contributing to advancements in every phase of the comprehensive diagnosis and personalized treatment process in AIBDs, providing patients, clinicians, and administrators with valuable support. Image recognition AI systems might assist precise clinical diagnoses of various diseases, including AIBDs, and could offer consistent and reliable scoring of disease severity. Automated and standardized AI-assisted laboratory methods could improve the accuracy and decrease the time and cost of gold-standard tests such as direct and indirect immunofluorescence. The studies and tools discussed in this contribution, although in the early stages, might be a small precursor to a transformative shift in the way we take care of patients with chronic skin diseases, including AIBDs.


Assuntos
Inteligência Artificial , Doenças Autoimunes , Dermatopatias Vesiculobolhosas , Humanos , Dermatopatias Vesiculobolhosas/diagnóstico , Doenças Autoimunes/diagnóstico
4.
Int J Clin Pharmacol Ther ; 62(2): 89-95, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38032147

RESUMO

OBJECTIVES: Bullous pemphigoid (BP) is a rare, autoimmune, blistering disease in elderly patients that can be triggered by external factors including drugs. Drug-induced bullous pemphigoid (DIBP) does not always follow a self-limiting course after the withdrawal of the offending drug. Dipeptidyl peptidase-4 (DPP-4) inhibitors or gliptins seem to be associated with a significant risk of inducing BP. CASE PRESENTATION: We report 2 cases of BP attributed to the DPP-4 inhibitor linagliptin. In both cases, the clinical manifestation was strongly suggestive of BP. The diagnosis was verified by histology and direct immunofluorescence (DIF). Linagliptin and all other possible drug triggers of BP were discontinued after consultation with an endocrinologist and a cardiologist. Systemic treatment of BP consisted of methylprednisolone and tetracycline. During the follow-up period, one of the patients suffered a fatal brain stroke while the other was managed with reduced doses of corticosteroids. CONCLUSION: The proper management of autoimmune bullous skin disorders in elderly patients includes a scrupulous assessment of plausible drug triggers. Systemic corticosteroids for treating severe cases of DIBP can worsen concomitant diseases which often necessitates multidisciplinary care.


Assuntos
Diabetes Mellitus Tipo 2 , Inibidores da Dipeptidil Peptidase IV , Penfigoide Bolhoso , Humanos , Idoso , Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Penfigoide Bolhoso/induzido quimicamente , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/tratamento farmacológico , Linagliptina/efeitos adversos , Hipoglicemiantes/uso terapêutico , Corticosteroides/efeitos adversos , Diabetes Mellitus Tipo 2/tratamento farmacológico
5.
Clin Dermatol ; 41(5): 584-591, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37652191

RESUMO

Hidradenitis suppurativa (HS) is a clinically heterogeneous disease with a broad spectrum of clinical features. Attempts to classify HS into distinct clinical phenotypes could lead to a better understanding of the condition and the development of individualized treatment protocols. We summarize some of the existing phenotype classifications and present our experience with 250 patients and their many clinical presentations. We have emphasized the pathophysiologic and clinical overlap between HS and pyoderma gangrenosum. The more severe presentations can include erosive and ulcerative lesions, sometimes associated with vegetative changes leading to diagnostic quandaries. We propose a new phenotype of pyoderma gangrenosum-like HS in which painful ulcerative or vegetative lesions appear in sites affected by HS, their activity coincides with the flareups of classic inflammatory manifestations of HS, and they heal with cribriform or atrophic scars.


Assuntos
Hidradenite Supurativa , Pioderma Gangrenoso , Humanos , Hidradenite Supurativa/complicações , Hidradenite Supurativa/diagnóstico , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Dor
6.
BMJ Case Rep ; 16(1)2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36693704

RESUMO

A female patient in her 50s presented with blue discolouration of several toes and with single nail dystrophy affecting the little toenail. The nail changes were considered to be secondary to poor circulation and chilblains, which led to delay in the diagnosis of amelanotic subungual melanoma.


Assuntos
Pérnio , Melanoma Amelanótico , Doenças da Unha , Neoplasias Cutâneas , Humanos , Feminino , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia , Melanoma Amelanótico/diagnóstico , Melanoma Amelanótico/cirurgia , Doenças da Unha/diagnóstico , Doenças da Unha/cirurgia , Melanoma Maligno Cutâneo
7.
Clin Dermatol ; 39(1): 45-51, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33972051

RESUMO

Dermatology is a clinical and visual discipline, which makes it the quintessential medical specialty for spot diagnosis and telemedicine. The COVID-19 pandemic has led to an unprecedented worldwide renaissance of teledermatology (TD). It has helped deliver high-quality medical care, while protecting the medical personnel and vulnerable patients from potential infection. Examining a patient from a distance through digital photography has many drawbacks, including lack of physical touch, difficulties in performing full body examinations, and several legal and ethical issues. We summarize have summarized the more common pitfalls and highlight the key aspects of direct patient-to-physician TD. Basic practical advice includes the use of TD for obtaining patient history, examining patient-captured photographs for inflammatory skin disease, and skin cancer screening.


Assuntos
COVID-19/prevenção & controle , Dermatite/diagnóstico por imagem , Dermatologia/métodos , Neoplasias Cutâneas/diagnóstico por imagem , Telemedicina/métodos , COVID-19/epidemiologia , Dermatologia/ética , Dermatologia/legislação & jurisprudência , Detecção Precoce de Câncer/métodos , Humanos , Anamnese , Visita a Consultório Médico , Fotografação/normas , Telemedicina/ética , Telemedicina/legislação & jurisprudência
9.
Acta Dermatovenerol Croat ; 28(2): 109-112, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32876037

RESUMO

We present a case of a 5-year-old child with epidermolysis bullosa acquisita, clinically resembling linear IgA bullous disease. The case demonstrates that autoimmune bullous dermatoses in childhood may show a clinical overlap, which makes the diagnosis based on clinical features highly unreliable. Specific immunofluorescence and immunoserological tests are crucial for precise diagnosis - in our case circulating antibodies against collagen VII were detected using ELISA and indirect immunofluorescence on transfected cells. The disease was treated with systemic and topical steroids with excellent results.


Assuntos
Epidermólise Bolhosa Adquirida/diagnóstico , Epidermólise Bolhosa Adquirida/tratamento farmacológico , Esteroides/uso terapêutico , Pré-Escolar , Diagnóstico Diferencial , Humanos , Dermatose Linear Bolhosa por IgA/diagnóstico
10.
Clin Dermatol ; 38(1): 19-34, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32197745

RESUMO

Various infections and autoimmune and reactive skin conditions can present with blisters of varying sizes. Some of these disorders are seen in everyday practice, whereas others are rarely encountered. In many cases, the clinical picture is so typical that the diagnosis is easy and obvious; nevertheless, the significant clinical overlap between many of these diseases can cause frustration in both unexperienced and expert clinicians. We present the most typical clinical clues and offer simplified algorithms to the clinical diagnosis of skin conditions with vesicles and bullae. We focus on several aspects, when assessing a patient with blisters on the skin: age of onset, a history of comorbidities and medications intake, the general condition of the patient, and most importantly, the distribution, number, size, morphology, and evolution of the blisters, the characteristics of the peribullous skin, and the presence of mucosal involvement. Emphasis is put on differentiating between potentially life-threatening blistering eruptions and more benign self-limiting conditions. © 2020 Elsevier Inc. All rights reserved.


Assuntos
Exantema/complicações , Dermatopatias Vesiculobolhosas/etiologia , Exantema/diagnóstico , Humanos , Dermatopatias Vesiculobolhosas/diagnóstico
11.
G Ital Dermatol Venereol ; 152(5): 489-499, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28748685

RESUMO

In recent years, emphasis on the physical examination has made way for a plethora of laboratory tests and sophisticated imaging diagnostic techniques. In addition, we are witnessing an underestimation of dermatology as a specialty around the world, which is accepted as an ambulatory specialty on the border of cosmetology and beautification. However, recognizing specific cutaneous clinical signs can facilitate timely diagnosis of various systemic infections and neoplastic diseases. Thus, a skilled dermatologist can play an essential role in the multidisciplinary team, involved in the care for systemically ill patients. In this article, we will focus on some life threatening systemic infections in which the skin changes can be a major clue for the diagnosis. Recent deadly epidemics will also be focused. Classic examples of paraneoplastic skin conditions will also be provided.


Assuntos
Infecções/diagnóstico , Neoplasias/diagnóstico , Dermatopatias/diagnóstico , Dermatologia/métodos , Humanos , Infecções/complicações , Neoplasias/complicações , Equipe de Assistência ao Paciente/organização & administração , Pele/patologia , Dermatopatias/etiologia
12.
Clin Dermatol ; 32(3): 364-75, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24767184

RESUMO

Autoimmune blistering dermatoses are examples of skin-specific autoimmune disorders that can sometimes represent the cutaneous manifestation of a multiorgan disease due to potential common pathogenic mechanisms. As soon as a distinct autoimmune blistering dermatosis is diagnosed, it is imperative to consider its potential systemic involvement, as well as the autoimmune and inflammatory conditions that are frequently associated with it. In paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome, the internal organs (particularly the lungs) are affected by the autoimmune injury. Pemphigus erythematosus may manifest with overlapping serologic and immunohistologic features of lupus erythematosus. In patients with bullous pemphigoid, there is a greater prevalence of neurologic disease, possibly caused by cross-reactivity of the autoantibodies with isoforms of bullous pemphigoid antigens expressed in the skin and brain. Anti-laminin 332 pemphigoid shows an increased risk for adenocarcinomas. Patients with anti-p200 pemphigoid often suffer from psoriasis. A rare form of pemphigoid with antibodies against the α5 chain of type IV collagen is characterized by underlying nephropathia. Particularly interesting is the association of linear IgA disease or epidermolysis bullosa acquisita with inflammatory bowel disease. Dermatitis herpetiformis is currently regarded as the skin manifestation of gluten sensitivity. Bullous systemic lupus erythematosus is part of the clinical spectrum of systemic lupus erythematosus, a prototypic autoimmune disease with multisystem involvement.


Assuntos
Doenças Autoimunes/complicações , Neoplasias/complicações , Dermatopatias Vesiculobolhosas/complicações , Autoanticorpos/sangue , Doenças Autoimunes/sangue , Doenças Autoimunes/imunologia , Colágeno Tipo IV/imunologia , Dermatite Herpetiforme/complicações , Doenças do Sistema Digestório/complicações , Doenças do Sistema Endócrino/complicações , Epidermólise Bolhosa Adquirida/complicações , Humanos , Inflamação/complicações , Nefropatias/complicações , Laminina/imunologia , Dermatose Linear Bolhosa por IgA/complicações , Transtornos Mentais/complicações , Doenças do Sistema Nervoso/complicações , Síndromes Paraneoplásicas/complicações , Penfigoide Mucomembranoso Benigno/complicações , Penfigoide Bolhoso/complicações , Penfigoide Bolhoso/imunologia , Pênfigo/complicações , Pênfigo/imunologia , Dermatopatias Vesiculobolhosas/sangue , Dermatopatias Vesiculobolhosas/imunologia
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