RESUMO
BACKGROUND/OBJECTIVES: Epidermal necrolysis (Stevens-Johnson syndrome and toxic epidermal necrolysis) includes immune-mediated, life-threatening inflammatory blistering disorders that can affect children. The Score of Toxic Epidermal Necrosis (SCORTEN) tool has accurately predicted the outcome of these disorders in adults but has not been tested in children. METHODS: We performed a retrospective chart review to compare the accuracy of the adult SCORTEN tool with that of two modifications tailored to children in predicting disease outcome. RESULTS: The longer the patient's median length of hospital stay was, the higher the adult and two proposed pediatric SCORTENs were. In addition, all patients who died had SCORTENs greater than 4. CONCLUSION: The pediatric-modified tools were not superior to the adult SCORTEN, which accurately predicted outcome.
Assuntos
Síndrome de Stevens-Johnson/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de DoençaRESUMO
We report an HIV-negative, 55-year-old manwith recurrent Kaposi's sarcoma (KS) of the lowerextremities, who does not fit into any of thefour previously described variants of KS: classicKS, AIDS-related KS, iatrogenic KS, and AfricanendemicKS. There are reports in the literature ofchildhood-onset KS, which is thought to be dueto an inherited immune deficiency that confers ahigher susceptibility to human Herpesvirus-8 (HHV-8), which is the virus that is known to cause KS. Ourpatient may be affected with an inherited immunedeficiency that has predisposed him to KS, and thismutation also may account for his prostate andbladder cancer.
Assuntos
Perna (Membro) , Recidiva Local de Neoplasia/diagnóstico , Sarcoma de Kaposi/diagnóstico , Neoplasias Cutâneas/diagnóstico , Antineoplásicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Neoplasias da Próstata/complicações , Neoplasias da Próstata/cirurgia , Radioterapia , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/patologia , Sarcoma de Kaposi/terapia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapia , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
We report a 48 -year-old woman witherythrokeratoderma variabilis, which is a rarehereditary disorder of keratinization, who developednew, painful, blisters within her skin lesions. Thediagnosis of herpes simplex virus infection was madebased on the clinical history and histopathologicfeatures. She was successfully treated withprophylactic valacyclovir, and her herpetic outbreakshave halted. This case serves as a reminder thateven among the most rare skin disorders, commonsecondary complications may be easily overlooked.
Assuntos
Eritroceratodermia Variável/complicações , Dermatoses Faciais/complicações , Herpes Simples/complicações , Abdome , Aciclovir/análogos & derivados , Aciclovir/uso terapêutico , Antivirais/uso terapêutico , Braço , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/tratamento farmacológico , Dermatoses Faciais/patologia , Feminino , Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Herpes Simples/patologia , Humanos , Perna (Membro) , Pessoa de Meia-Idade , Simplexvirus , Parede Torácica , Valaciclovir , Valina/análogos & derivados , Valina/uso terapêuticoRESUMO
Frontal fibrosing alopecia is a scarring alopecia thatis characterized by recession of the frontotemporalhairline with the frequent loss of eyebrows. Itpredominantly affects postmenopausal womenand only rarely affects men. We report the caseof a 46-year-old man with a ten-year history of anerythematous patch with perifollicular erythemaat the superior aspect of the forehead andfrontotemporal hairline. A skin biopsy specimenshowed a perivascular, lymphocytic infiltrate withperiinfundibular fibrosis. These findings establisheda diagnosis of frontal fibrosing alopecia. Thepathogenesis of this condition is poorly understoodbut may be hormonally-mediated.
Assuntos
Alopecia/diagnóstico , Dermatoses do Couro Cabeludo/diagnóstico , Couro Cabeludo/patologia , Alopecia/patologia , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Dermatoses do Couro Cabeludo/patologiaRESUMO
We report a 68-year-old woman with chroniclymphocytic leukemia, who developed numerous,pruritic, edematous, and vesicobullous skin lesionsof the face and extremities over the course of severalmonths. The diagnosis of eosinophilic dermatosis ofhematologic malignancy (EDHM) was made basedon the clinical history and histopathologic features.Owing to the possible link between EDHM and amore aggressive underlying CLL, she was startedagain on chemotherapy. This case serves as areminder that, although the precise pathogenesis ofEDHM remains unclear, the paraneoplastic disorderis the result of immune dysregulation. Patientswho develop EDHM should undergo prompthematologic/oncologic evaluation.
Assuntos
Eosinofilia/diagnóstico , Leucemia Linfocítica Crônica de Células B/complicações , Síndromes Paraneoplásicas/diagnóstico , Dermatopatias/diagnóstico , Idoso , Eosinofilia/complicações , Eosinofilia/patologia , Dermatoses Faciais/complicações , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/patologia , Feminino , Humanos , Dermatoses da Perna/complicações , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/patologia , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/patologia , Dermatopatias/complicações , Dermatopatias/patologiaRESUMO
Cutis verticis gyrata that involves only the face isa rare presentation of this even rarer cutaneousanomaly. We present a 61-year-old man, whodeveloped primary essential progressive cutis verticisgyrata of the face.
Assuntos
Dermatoses Faciais/diagnóstico , Dermatoses Faciais/patologia , Testa , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report a 34 year-old woman with psoriasis, systemic lupus erythematosus (SLE), and recent anti-TNFa therapy, who presented with multiple, eruptive dermatofibromas (MEDF). Although the pathogenesis of MEDF remains unknown, there is substantial evidence that this phenomenon represents an aberrant immune response. Like the more common presentation of solitary dermatofibromas, these lesions are benign, and no treatment is required. However, MEDF is increasingly recognized as a sign of immune dysregulation and an appropriate work-up should be initiated to identify an underlying cause in patients without a known trigger.
Assuntos
Histiocitoma Fibroso Benigno/patologia , Neoplasias Cutâneas/patologia , Pele/patologia , Adulto , Biópsia , Feminino , HumanosAssuntos
Ciclosporina/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Prurigo/tratamento farmacológico , Prurigo/patologia , Centros Médicos Acadêmicos , Adulto , Idoso , Estudos de Coortes , Ciclosporina/efeitos adversos , Fármacos Dermatológicos/efeitos adversos , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Approximately one in four patients undergoing dermatologic surgery takes an antithrombotic medication. When approaching the management of antithrombotic agents, procedural dermatologists must balance surgical outcomes, bleeding risks, and cardiovascular protection. Continuing antithrombotics during surgery increases the risk hemorrhage, but discontinuation of these agents may increase the risk of thrombotic events. Despite increasing evidence for continuation of antithrombotics during dermatologic surgery, few official guidelines exist, and clinicians have been slow to integrate new evidence into clinical practice. A study in 2007 reported that more than 40% of dermatologic surgeons sometimes discontinue warfarin for surgery. OBJECTIVE: This article reviews antithrombotic agents in the United States and summarize perioperative management recommendations of antithrombotic agents in skin surgery. MATERIALS AND METHODS: A review of the literature was performed focused on antithrombotic medications commercially available in the United States, including the two newest agents, dabigatran and rivaroxaban. CONCLUSION: Although there are concerns regarding bleeding, there are no reports of life-threatening hemorrhage from continued antithrombotic therapy in dermatologic surgery. Furthermore, potentially fatal cardiovascular events after cessation of medically indicated antithrombotic medications are increasingly recognized, leading to the growing acceptance that the risk of stopping most antithrombotics may outweigh the risks of bleeding incurred by continuing antithrombotic therapy.