Erosive Pustular Dermatosis of the Leg Successfully Treated With an Oral Retinoid and a Bi-layered Skin Substitute

Erosive pustular dermatosis is a rare inflammatory skin disorder characterized by crusted erosions, sterile pustules, skin atrophy, and scarring alopecia. Cases of involvement of lower extremities, with or without scalp lesions, have been scarcely reported in the literature, and have been denominated Erosive Pustular Dermatosis of the Legs. The disorder usually affects elderly patients associated with chronic venous insufficiency and venous dermatitis. Topical corticosteroids and topical calcineurin inhibitors have been reported to be effective. On the other hand, several treatments have also failed to achieve appropriate results; hence we present a case of erosive pustular dermatosis of the leg, who was unresponsive to compression and antibacterial ointments, but successfully treated systemically with an oral retinoid and locally with the application of a bioengineered bi-layered skin substitute. This condition may be overlooked, which represents its low prevalence in literature. J Drugs Dermatol. 2019;18(3):301-302.

Erosive pustular dermatosis of the leg: A prospective, multicentre, observational study of 36 cases.

BACKGROUND: Erosive pustular dermatosis of the leg (EPDL) is a poorly understood entity first described by Lanigan and Cotteril in 1987. Its clinical diagnosis is based on exclusion since the physiopathology is unknown. The primary objective of this investigation was to specify the clinical aspects and outcomes in a prospective study. The secondary objectives were to describe associated diseases, the circumstances of occurrence, and the laboratory tests used. PATIENTS AND METHODS: This was a prospective study that included 45 patients selected by members of the Angiology-Dermatology Group of the SFD (French Dermatology Society) at 13 centres between 01/09/2013 and 31/10/2014. There was a 180-day monitoring period. The records of 36 patients were analysed. Clinical and laboratory data were collected. RESULTS: Mean patient age was 79.6±9.9 years with a M/F sex ratio of 0.2. Among the patients, 16.7% had skin cancer and 91.7% had venous insufficiency. The proportion of patients wearing venous compression hose was constant between inclusion and D180. Lesions were bilateral (53%), affected the middle third of the leg, and were on the anterior aspect. Complete healing was achieved in 77.8% of cases with time to healing of 2.4±1.2 months, and under topical corticosteroids in 97.3% of cases. During follow-up, relapse occurred in 38.9% of cases after a mean time of 2.4±1.2 months. CONCLUSION: EPDL appears to be an idiopathic inflammatory dermatosis with a particular topographic expression. The physiopathology could be related to chronic inflammation associated with venous insufficiency and with certain trigger factors. Currently, there are few therapeutic alternatives to topical corticosteroids.

Clinical and epidemiological assessment of patients hospitalized for primary and recurrent erysipelas / Ocena kliniczna i epidemiologiczna pacjentów hospitalizowanych z powodu rózy pierwotnej i nawrotowej

INTRODUCTION: Erysipelas is a bacterial infection, caused by group A ß-hemolytic streptococci (Streptococcus pyogenes), rarely other bacteria. It is characterized by sudden onset and rapid course, with the presence of systemic symptoms. OBJECTIVE: A retrospective analysis of patients hospitalized for primary and recurrent erysipelas with particular consideration of clinical profile of patients, causes, complications and risk factors of the recurrence. MATERIAL AND METHODS: We have analyzed the medical records of patients hospitalized for erysipelas at the Dermatology and Venereology Department of the Medical University of Bialystok from 2011 to 2015. RESULTS: One hundred twenty female (53,8%) and 103 male (46,2%) were included in the study. The median age was 61. The first episode of clinical symptoms was observed in 78% patients, while 22% of them were diagnosed as recurrent erysipelas. Skin lesions in both cases were located in the lower extremities most often. Mechanical trauma was statistically more frequently cause of the disease in men, while venous insufficiency and ulcers in women. Complications such as abscess, ulceration, phlegmon and thrombosis were observed in 22% of patients, significantly more common in men. Patients who were hospitalized more than 10 days were more likely to have higher body mass index and higher indicators of inflammation than patients who required a shorter hospital stay. Recurrent erysipelas was more often diagnosed in patients with co-morbidities, including hypertension, overweight, venous insufficiency and diabetes. CONCLUSIONS: Erysipelas located in the lower extremities, high temperature on admission, higher indicators of the inflammation, complications and coexistence of obesity and diabetes are the risk factors of the prolonged hospital stay. Primary and recurrent erysipelas have a similar course, severity of the disease and duration of hospitalization.

[Pancreatic panniculitis with multiple osteolytic lesions]. / Pankreatische Pannikulitis mit multiplen osteolytischen Läsionen.

A 62-year-old man with a history of chronic alcohol abuse presented with severe pancreatic panniculitis associated with an acute exacerbation of chronic pancreatitis.

Venous eczema and lipodermatosclerosis.

Cutaneous changes are a common feature of chronic venous insufficiency and include venous eczema and lipodermatosclerosis. This review will address the presumed pathophysiology of these conditions, their clinical findings, and important management strategies.

[Skin problems in a swollen lower limb]. / Alaraajaturvotus ja iho-ongelmat.

Swollen lower limb is a diagnostic challenge for a physician. Common conditions causing swelling of lower extremities are chronic venous insufficiency and abnormalities in lymph drainage. Stasis dermatitis and lymphedema are manifestations of these defects. The most important therapy of both stasis dermatitis and lymphedema is adequate compression therapy. Patient education is important in order to achieve good compliance with compression therapy. The mainstay therapies of skin eczema are corticosteroids and tacrolimus ointment. Patients with stasis dermatitis have a higher risk for contact sensitization, which is important to remember when prescribing topical treatments.

Treatment-resistant elephantiasic thyroid dermopathy responding to rituximab and plasmapheresis.

A 44-year-old woman was diagnosed with Graves' disease in 1995 and over the following 12 months developed thyroid dermopathy (pretibial myxoedema). Despite being trialled on multiple recognized therapies over the course of 11 years, the patient's dermopathy progressively worsened. She developed ocular proptosis, elephantiasic thyroid dermopathy and acropachy in both hands. In mid 2006, the patient was started on rituximab and plasmapheresis, with rapid response. The patient's condition stabilized and in October 2009 at the age of 58 years she was able to cease therapy.

Myiasis after study trip to French Guiana.

Cutaneous myiasis is usually a harmless tropical disease caused by infestation with larvae from a variety of flies. Because of its rare occurrence in Europe, it is often misdiagnosed. Increased travel to tropical regions has correspondingly increased the number of cases observed in Europe. The furuncular type of cutaneous myiasis in a 31-year-old biology student was diagnosed upon his return from French Guiana. The student cultured one of the larvae to obtain a botfly. This case is discussed in the light of the current literature on pathogenesis, incidence and therapy of cutaneous myiasis.

A case report and differential diagnosis of pruritic pretibial skin lesions.

Pretibial pruritic papular dermatitis (PPPD) is a clinical entity first described in 2006. The etiology is uncertain; however, gentle chronic rubbing is likely to be the reason for the skin reaction. Pretibial pruritic lesions may reflect many different systemic diseases and dermatoses. We present a 61-year-old patient with a 2-year history of pruritic pretibial xerosis, keratotic erythematous to brownish papules, and excoriations. Differential diagnosis excluded papular mucinosis, myxoedema, stasis dermatitis, lichen simplex chronicus, prurigo nodularis, lichen amyloidosis, and lichen planus. Regarding clinical-histological correlation, we confirmed a diagnosis of PPPD.