RESUMO
Neutrophilic eccrine hidradenitis (NEH) is a rare neutrophilic dermatosis involving the eccrine glands. It is commonly associated with haematological malignancy and administration of chemotherapy. An infective aetiology for NEH is termed infectious eccrine hidradenitis (IEH). Pathogens that have been associated with IEH include Nocardia, Serratia, Enterobacter sp., Staphylococcus aureus and Mycobacterium chelonae We describe a case of IEH in a patient with prolonged use of a compression sleeve for their upper limb lymphoedema. The histopathological findings of NEH and IEH are almost identical. Skin tissue culture and rapid clinical improvement with antibiotic therapy are keys in delineating the two subtypes.
Assuntos
Hidradenite , Mycobacterium chelonae , Nocardia , Celulite (Flegmão)/complicações , Celulite (Flegmão)/tratamento farmacológico , Hidradenite/tratamento farmacológico , Hidradenite/etiologia , Hidradenite/patologia , Humanos , Glândulas Sudoríparas/patologiaAssuntos
Neoplasias das Glândulas Suprarrenais/complicações , Hidradenite/diagnóstico , Hiperidrose/complicações , Miliária/diagnóstico , Neuroblastoma/complicações , Neoplasias das Glândulas Suprarrenais/cirurgia , Pré-Escolar , Feminino , Hidradenite/etiologia , Hidradenite/patologia , Humanos , Miliária/etiologia , Miliária/patologia , Neuroblastoma/cirurgia , Pele/patologiaRESUMO
Neutrophilic dermatoses are a heterogeneous group of inflammatory skin disorders that present with unique clinical features but are unified by the presence of a sterile, predominantly neutrophilic infiltrate on histopathology. The morphology of cutaneous lesions associated with these disorders is heterogeneous, which renders diagnosis challenging. Moreover, a thorough evaluation is required to exclude diseases that mimic these disorders and to diagnose potential associated infectious, inflammatory, and neoplastic processes. While some neutrophilic dermatoses may resolve spontaneously, most require treatment to achieve remission. Delays in diagnosis and treatment can lead to significant patient morbidity and even mortality. Therapeutic modalities range from systemic corticosteroids to novel biologic agents, and the treatment literature is rapidly expanding. The first article in this continuing medical education series explores the pathogenesis of neutrophilic dermatoses and reviews the epidemiology, clinical and histopathologic features, diagnosis, and management of Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease.
Assuntos
Síndrome de Behçet , Hidradenite , Síndrome de Sweet , Corticosteroides/uso terapêutico , Antineoplásicos/efeitos adversos , Doenças Autoimunes/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/epidemiologia , Síndrome de Behçet/etiologia , Síndrome de Behçet/patologia , Quimiotaxia de Leucócito , Citocinas/fisiologia , Derme/imunologia , Derme/patologia , Diagnóstico Diferencial , Toxidermias/etiologia , Epiderme/imunologia , Epiderme/patologia , Etnicidade/genética , Predisposição Genética para Doença , Hidradenite/diagnóstico , Hidradenite/epidemiologia , Hidradenite/etiologia , Hidradenite/patologia , Humanos , Imunidade Inata , Imunossupressores/uso terapêutico , Inflamação , Neoplasias/complicações , Neutrófilos/imunologia , Neutrófilos/patologia , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/epidemiologia , Síndrome de Sweet/etiologia , Síndrome de Sweet/patologia , Vasculite/etiologiaRESUMO
Neutrophilic dermatoses are a group of inflammatory skin disorders characterized by an overactive innate immune system with dysregulation of neutrophils without underlying infectious etiology. The major representative conditions discussed are Sweet syndrome; pyoderma gangrenosum; neutrophilic eccrine hidradenitis; palmoplantar eccrine hidradenitis; subcorneal pustular dermatoses; bowel-associated dermatosis arthritis syndrome; and synovitis, acne, pustulosis, hyperostosis, and osteitis. We will also discuss other neutrophilic conditions present almost exclusively in the pediatric population, including congenital erosive and vesicular dermatosis with reticulated supple scarring and the recently described group of autoinflammatory diseases. The clinical characteristics, diagnostic approach, and treatment management in the pediatric and adult population are discussed.
Assuntos
Síndrome de Hiperostose Adquirida , Hidradenite , Pioderma Gangrenoso , Dermatopatias Vesiculobolhosas , Síndrome de Sweet/diagnóstico , Síndrome de Hiperostose Adquirida/diagnóstico , Adolescente , Adulto , Antineoplásicos/efeitos adversos , Criança , Pré-Escolar , Cicatriz/etiologia , Hidradenite/diagnóstico , Hidradenite/tratamento farmacológico , Hidradenite/etiologia , Humanos , Lactente , Recém-Nascido , Prognóstico , Pioderma Gangrenoso/diagnóstico , Pioderma Gangrenoso/tratamento farmacológico , Dermatopatias Vesiculobolhosas/complicações , Dermatopatias Vesiculobolhosas/congênito , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/terapia , Síndrome de Sweet/tratamento farmacológicoRESUMO
A 14-year-old boy who had undergone a matched sibling bone marrow transplant for acute lymphoblastic leukemia presented with painful nodules on his palms after prolonged gaming on his computer and mobile phone. Histology showed a neutrophilic inflammatory infiltrate surrounding the acrosyringium and eccrine sweat coils in the deep dermis. The lesions resolved spontaneously with conservative management.
Assuntos
Glândulas Écrinas/patologia , Hidradenite/diagnóstico , Jogos de Vídeo/efeitos adversos , Ferimentos e Lesões/complicações , Adolescente , Transplante de Medula Óssea , Mãos/patologia , Hidradenite/etiologia , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Pele/patologia , Ferimentos e Lesões/etiologiaRESUMO
BACKGROUND: Hand, foot, and mouth disease is a contagious viral infection usually affecting children. A resurgence of cases in adults, mainly caused by coxsackievirus A6 and with an atypical and more severe presentation, has taken place. OBJECTIVE: The goal was to examine the clinical, histologic, and immunohistochemical features of this disease in adults. METHODS: This is a retrospective study on documented cases of adult hand, foot, and mouth disease from France's Dermatology Department of Strasbourg University Hospital and Bel-Air Hospital in Thionville. RESULTS: Six patients with severe and atypical presentation were included, 4 caused by coxsackievirus A6. The histologic features were: spongiosis, neutrophilic exocytosis, massive keratinocyte necrosis, shadow cells in the upper epidermis, vacuolization of basal cells, necrotic cells in follicles and sweat glands, dense superficial dermal infiltrate of CD3+ lymphocytes, and strong granulysin expression. LIMITATIONS: This is a retrospective case series. CONCLUSION: In adult patients presenting with atypical hand, foot, and mouth disease caused by coxsackievirus A6, biopsy specimens show distinctive changes in the epidermis but also in adnexal structures. The inflammatory infiltrate is made of T cells with a cytotoxic profile, with numerous granulysin-positive cells, as observed in severe drug-induced eruption with necrosis of keratinocytes.
Assuntos
Doença de Mão, Pé e Boca/patologia , Adulto , Antígenos de Diferenciação de Linfócitos T/análise , Enterovirus Humano A/isolamento & purificação , Feminino , Foliculite/etiologia , Foliculite/patologia , Granzimas/análise , Folículo Piloso/patologia , Doença de Mão, Pé e Boca/complicações , Doença de Mão, Pé e Boca/virologia , Hidradenite/etiologia , Hidradenite/patologia , Humanos , Queratinócitos/patologia , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/patologia , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos , Pele/química , Pele/patologia , Avaliação de Sintomas , Linfócitos T Citotóxicos/imunologiaRESUMO
: The modern conveniences and enjoyment brought about by electronic devices bring with them some health concerns. In particular, personal electronic devices are responsible for rising cases of several skin disorders, including pressure, friction, contact dermatitis, and other physical dermatitis. The universal use of such devices, either for work or recreational purposes, will probably increase the occurrence of polymorphous skin manifestations over time. It is important for clinicians to consider electronics as potential sources of dermatological ailments, for proper patient management. We performed a literature review on skin disorders associated with the personal use of modern technology, including personal computers and laptops, personal computer accessories, mobile phones, tablets, video games, and consoles.
Assuntos
Telefone Celular , Computadores de Mão , Computadores , Dermatite Alérgica de Contato/etiologia , Ceratose/etiologia , Jogos de Vídeo , Periféricos de Computador , Dermatite/etiologia , Dermatite de Contato/etiologia , Fricção , Hidradenite/etiologia , HumanosRESUMO
Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic inflammatory disease characterized by painful nodules, abscesses, fistulas, sinus tracts and scarring, which may lead to severe functional and psychological impairment. Patients often suffer for many years before the right diagnosis is finally made. HS/AI is still a therapeutic challenge. Conservative therapies play a role in mild stages of the disease; however they do not result in healing. Therapy of choice associated with the lowest recurrence rate is a radical wide excision of involved skin.
Assuntos
Doenças do Ânus/diagnóstico , Doenças do Ânus/terapia , Hidradenite Supurativa/diagnóstico , Hidradenite/diagnóstico , Hidradenite/terapia , Doenças do Ânus/etiologia , Hidradenite/etiologia , Hidradenite Supurativa/terapia , Humanos , Recidiva , Fatores de Risco , Resultado do TratamentoRESUMO
Infectious eccrine hidradenitis (IEH), which usually manifests as singular or multiple erythematous papules or plaques, is a rare dermatosis involving an infectious agent and histologic findings identical to that of neutrophilic eccrine hidradenitis (NEH). We report a case of IEH in a 24-year-old woman who developed a pruritic, erythematous, papular rash after a sunburn. A culture of a pustule revealed methicillin-sensitive Staphylococcus aureus. Our patient had complete resolution of her rash within 2 weeks of starting amoxicillin and clavulanate. This case of IEH and NEH related to both intense sun exposure and infection supports the hypothesis that NEH is a response to nonspecific stimuli and may occur in many different clinical settings.
Assuntos
Hidradenite/etiologia , Infecções Cutâneas Estafilocócicas/etiologia , Luz Solar/efeitos adversos , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Feminino , Hidradenite/microbiologia , Hidradenite/patologia , Humanos , Infecções Cutâneas Estafilocócicas/microbiologia , Infecções Cutâneas Estafilocócicas/patologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Adulto JovemRESUMO
We present a case of hidradenitis occurring in a patient after chemotherapy for acute myeloid leukemia (AML) in the setting of profound neutropenia. Neutrophilic eccrine hidradenitis (NEH) presents as tender erythematous papules and plaques and is often associated with chemotherapy for AML. NEH is postulated to be due to toxic injury to the sweat glands followed by neutrophilic inflammation. Alternatively, some hypothesize that NEH represents a primary neutrophilic process. Our patient's clinical presentation was similar to previously reported cases of NEH; however, degenerative changes of the sweat ducts were noted on microscopy without neutrophilic inflammation. She had fewer than 0.01 thousand neutrophils per microliter for 4 days preceding the biopsy. At the same time, a separate area of superficial skin infection developed because of Staphylococcus epidermidis and also lacked neutrophilic inflammation. The similar clinical course and shared histopathologic features between our case and NEH argue that neutrophils are a secondary response to a toxic effect rather than the primary effector in NEH. Neutrophil-poor variants of hidradenitis, both infectious and due to drug toxicity, should be considered diagnostically in neutropenic patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Glândulas Écrinas/patologia , Hidradenite/patologia , Leucemia Mieloide Aguda/tratamento farmacológico , Neutrófilos/patologia , Citarabina/efeitos adversos , Daunorrubicina/efeitos adversos , Glândulas Écrinas/efeitos dos fármacos , Feminino , Hidradenite/etiologia , Humanos , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/patologia , Pessoa de Meia-Idade , Neutropenia/complicações , Neutropenia/patologia , Infecções Cutâneas Estafilocócicas/etiologia , Infecções Cutâneas Estafilocócicas/patologia , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/fisiologiaRESUMO
Idiopathic palmoplantar eccrine hidradenitis is characterised by painful erythematous plantar and/or palmar nodules and is triggered by exposure to wet and cold conditions. The course is benign and self-limiting with a tendency for recurrence. We describe two cases in otherwise healthy children after physical activity in a swimming bath. They were hospitalised for one and three days, respectively. Diagnostic considerations are briefly reviewed. Sufficient attention to the characteristic clinical appearance could prevent unnecessary diagnostic procedures and hospitalisation.
Assuntos
Dermatoses do Pé/diagnóstico , Hidradenite/diagnóstico , Criança , Diagnóstico Diferencial , Dermatoses do Pé/etiologia , Dermatoses do Pé/patologia , Hidradenite/etiologia , Hidradenite/patologia , Humanos , Masculino , PiscinasRESUMO
A 13-month-old girl presented a reticulated eruption of 2 months duration located on her buttocks. Histologically, a mononuclear cell inflammatory infiltration was found within and around the eccrine sweat glands, with epithelial cell damage. The lesions were related to several traumatic mechanisms involving the buttocks, such as crawling and repeated trauma with a bathmat carpet.
Assuntos
Nádegas/lesões , Hidradenite/etiologia , Hidradenite/patologia , Banhos , Biópsia , Nádegas/patologia , Células Epiteliais/patologia , Feminino , Pisos e Cobertura de Pisos , Humanos , Umidade , Lactente , Leucócitos Mononucleares/patologiaAssuntos
Hidradenite/etiologia , Leucemia Mieloide/complicações , Síndromes Paraneoplásicas/etiologia , Doença Aguda , Antineoplásicos/uso terapêutico , Hidradenite/patologia , Humanos , Leucemia Mieloide/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/patologia , RecidivaAssuntos
Eritema/etiologia , Hidradenite/etiologia , Doença de Hodgkin/complicações , Leucemia Neutrofílica Crônica/complicações , Síndromes Paraneoplásicas/complicações , Corticosteroides/uso terapêutico , Idoso , Feminino , Humanos , Neoplasias Cutâneas/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Neutrophilic eccrine hidradenitis occurs mostly in patients receiving chemotherapy for acute myeloblastic leukemia, rarely in healthy patients. Histopathologic pattern is characteristic and includes selective necrosis of the eccrine glands with a local neutrophilic infiltrate. CASE REPORT: We report the case of a 41 year-old woman with no medical past-history who developed during 2 years successive papulous skin eruptions. The latter always resolved spontaneously. Skin biopsy led to the diagnosis showing typical features of neutrophilic eccrine hidradenitis. DISCUSSION: Our case is original because the neutrophilic eccrine hidradenitis had occurred in a healthy woman. Neither malignant hematologic disease nor visceral cancer was disclosed in this patient in the following 31 months.
Assuntos
Hidradenite/etiologia , Hidradenite/patologia , Adulto , Feminino , Humanos , Remissão EspontâneaRESUMO
INTRODUCTION: We report the case of a Pseudomonas (P.) aeruginosa eccrine hidradenitis in a child, or a "Pseudomonas Hot Foot Syndrome", revealing an acute lymphoblastic leukemia. OBSERVATION: A 10 year-old girl consulted for the sudden onset of painful and necrotic palmoplantar nodules in a context of fever and shivering. Histology of a cutaneous biopsy found necrosis of the eccrine glands and, on culture, P. aeruginosa. The blood count revealed pancytopenia and the myelogram acute lymphoblastic leukemia. All the hemocultures and other microbiological samples were negative. The cutaneous signs had appeared 48 hours after bathing in an aquatic amusement park. Diagnosis of Pseudomonas eccrine hidradenitis, or "Pseudomonas Hot Foot Syndrome" was retained, although the local sanitary authorities were not able to demonstrate P. aeruginosa contamination of the water in the park. COMMENTS: Lesions evoking juvenile Pseudomonas aeruginosa eccrine hidradenitis without obvious traumatic factor must lead to the search for P. aeruginosa contamination from water and the subsequent sanitary and epidemiological consequences. Furthermore, severe P. aeruginosa cutaneous infections in children must also lead to the search for an underlying immunosuppression and notably an acute leukemic process.