RESUMO
We describe a case of mpox characterized by a circularly distributed facial rash but no identified risk factors. Fomite transmission of monkeypox virus from contaminated linen at a massage spa was suspected. Clinicians should consider mpox in patients with consistent clinical syndromes, even in the absence of epidemiologic risk factors.
Assuntos
Roupas de Cama, Mesa e Banho , Mpox , Feminino , Humanos , Fatores de Risco , Massachusetts , Monkeypox virus , SíndromeRESUMO
Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction (SCAR) characterized by sterile nonfollicular pustules on an erythematous base that form rapidly after drug exposure. AGEP is mediated by numerous cytokines produced by drug-specific T cells that mediate neutrophilic intracorneal, subcorneal, or intraepidermal pustule development. Though genetic susceptibility is not fully understood, individuals with mutations in IL-36RN may be at increased risk of AGEP development. AGEP commonly presents with leukocytosis and fever in the acute pustular phase and follows a self-limited desquamative recovery phase upon removal of offending drug. Severe cases of AGEP may have multisystem organ involvement. Atypical presentations of AGEP include localized eruptions and cases with overlapping clinical and histopathologic features associated with Stevens-Johnson syndrome/toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, and generalized pustular psoriasis. Most cases of AGEP clear rapidly with systemic corticosteroids, but severe or recalcitrant cases may require other systemic therapies, such as cyclosporine, and intravenous immunoglobulin.
Assuntos
Pustulose Exantematosa Aguda Generalizada , Exantema , Síndrome de Stevens-Johnson , Pustulose Exantematosa Aguda Generalizada/diagnóstico , Pustulose Exantematosa Aguda Generalizada/etiologia , Pustulose Exantematosa Aguda Generalizada/patologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Pele/patologia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/tratamento farmacológico , Síndrome de Stevens-Johnson/etiologiaRESUMO
Dermatologists play a critical role in diagnosing and managing nutritional deficiencies as they often present with cutaneous findings. Traditionally, nutritional dermatoses are taught in the context of developing countries, famine, population displacement, and poor health care access; however, in the United States, common risk factors include chronic liver disease, alcoholism, psychiatric disease, bariatric surgery, inflammatory bowel disease, and hemodialysis. Additionally, nutritional dermatoses may be underdiagnosed in the United States and result in increased morbidity and utilization of hospital resources. There is a need for providers in developed nations to identify these deficiencies, and this review aims to meet that practice gap and provide relevant context to these diseases for dermatologists. This 2-part review series will focus on the epidemiology, impact, appearance, and diagnostic modalities for micronutrient deficiencies, including zinc, selenium, copper, and vitamins A and C in part 1. The companion review will focus on the B-complex vitamins.
Assuntos
Desnutrição , Selênio , Dermatopatias , Ácido Ascórbico , Cobre , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Micronutrientes , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/etiologia , Vitamina A , Vitaminas , ZincoRESUMO
Nutritional dermatoses are traditionally taught in the context of developing countries, famine, population displacement, and limited access to health care. In the United States, nutritional dermatoses may be underdiagnosed, leading to increased morbidity and utilization of hospital resources. These findings underscore the need for providers in developed nations to be able to identify these deficiencies. Dermatologists play a critical role in the diagnosis and management of patients with nutritional deficiencies, as they often present with cutaneous findings. Part 2 of this review series will focus on the epidemiology, impact, manifestations, and diagnosis of B-complex vitamins, which can present with cutaneous findings, including thiamine, riboflavin, niacin, pyridoxine, and biotin.
Assuntos
Dermatopatias , Complexo Vitamínico B , Ácido Fólico , Humanos , Micronutrientes , Ácido Pantotênico , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Complexo Vitamínico B/uso terapêutico , Vitamina KRESUMO
In industrialized countries, nutritional dermatoses are likely underdiagnosed and result in increased disease morbidity and utilization of hospital resources. These findings underscore the need for physicians to be able to correctly identify these deficiencies. Nutritional dermatoses may be split into micronutrient deficiencies and macronutrient deficiencies. This article is intended to serve as a supplement to a 2-part review of micronutrient deficiency dermatoses and highlights cutaneous findings in patients with protein-energy malnutrition and essential fatty acid deficiency. This article reviews the evaluation, cutaneous manifestations, and management of macronutrient deficiencies.
Assuntos
Desnutrição , Dermatopatias , Suplementos Nutricionais , Humanos , Desnutrição/diagnóstico , Desnutrição/etiologia , Desnutrição/terapia , Micronutrientes , Nutrientes , Dermatopatias/diagnóstico , Dermatopatias/etiologia , Dermatopatias/terapiaRESUMO
BACKGROUND: Hidradenitis suppurativa disproportionately affects women, minorities, and skin of color. Botulinum toxin is a potential therapy; however, literature regarding its utility is sparse. OBJECTIVE: We analyzed evidence surrounding botulinum toxin in the treatment of hidradenitis suppurativa. METHODS: We conducted a database search of PubMed, Embase, and Cochrane library for studies addressing botulinum toxin therapy for hidradenitis suppurativa through June 10, 2020. Review articles, meta-analyses, and studies without published results were excluded. RESULTS: Seven studies met criteria for inclusion and review. Botulinum toxin administration resulted in either clinical improvement or improved quality of life in 96.8% (n = 30/31) of patients. Level of evidence was moderate. LIMITATIONS: Results are limited by the quantity and evidence level of reviewed studies. CONCLUSION: Botulinum toxin is a safe and potentially effective alternative for hidradenitis suppurativa patients resistant to standard of care therapies. Dermatologists can address this health disparity by strengthening recommendations with high-quality investigations regarding its therapeutic potential. J Drugs Dermatol. 2022;21(4):408-412. doi:10.36849/JDD.5747.
Assuntos
Toxinas Botulínicas , Hidradenite Supurativa , Feminino , Humanos , Toxinas Botulínicas/efeitos adversos , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/tratamento farmacológico , Hidradenite Supurativa/etnologia , Qualidade de Vida , PeleRESUMO
Despite the expansion of available in vitro laboratory tests at a rate far exceeding that of dermatologic pharmaceuticals, the existing literature is dominated by discussion of the latter. With the advent of numerous new tests, it can be difficult for practicing dermatologists to stay up-to-date on the available options, methodologies, and recommendations for when to order one test over another. Understanding the inherent strengths and weaknesses of these options is necessary to inform appropriate ordering and proper interpretation of the results. The first article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of undifferentiated patients suspected of having dermatologic autoimmune diseases and it provides a general guide to ordering these tests.
Assuntos
Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico , Dermatopatias/sangue , Dermatopatias/diagnóstico , Técnicas de Laboratório Clínico , Humanos , Dermatopatias/imunologiaRESUMO
The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.
Assuntos
Dermatopatias/sangue , Dermatopatias/diagnóstico , Trombofilia/sangue , Trombofilia/diagnóstico , Técnicas de Laboratório Clínico , Humanos , Dermatopatias/etiologia , Trombofilia/complicaçõesRESUMO
BACKGROUND: Insurance, racial, and socioeconomic health disparities continue to pose significant challenges for access to dermatologic care. Studies applying teledermatology to increase access to underinsured individuals and ethnic minorities are limited. OBJECTIVE: To determine how the implementation of a teledermatology program affects access to health care and patient outcomes. METHODS: A cross-sectional evaluation was performed of all ambulatory dermatology referrals and electronic dermatology consultations (eConsults) at Ohio State University within a 25-month period. RESULTS: Compared with ambulatory referrals, eConsults served more nonwhite patients (612 of 1698 [36.0%] vs 4040 of 16,073 [25.1%]; P < .001) and more Medicaid enrollees (459 of 1698 patients [27.0%] vs 3266 of 16,073 [20.3%]; P < .001). In addition, ambulatory referral patients were significantly less likely to attend their scheduled appointment compared with eConsult patients, as either "no-shows" (246 of 2526 [9.7%] vs 3 of 62 [4.8%]) or cancellations (742 of 2526 [29.4%] vs 8 of 62 [12.9%]; P = .003). There were fewer median days to extirpation for eConsult patients compared with ambulatory referral patients (interquartile range; 80.7 ± 79.8 vs 116.9 ± 86.6 days; P = .004). CONCLUSION: Integrating dermatologic care through a telemedicine system can result in improved access for underserved patients through improved efficiency outcomes.
Assuntos
Dermatologia/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Dermatopatias/diagnóstico , Adulto , Agendamento de Consultas , Estudos Transversais , Dermatologia/métodos , Dermatologia/organização & administração , Feminino , Implementação de Plano de Saúde , Acessibilidade aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitais Universitários/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , Avaliação de Programas e Projetos de Saúde , Consulta Remota/organização & administração , Estudos Retrospectivos , Dermatopatias/terapia , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricosRESUMO
Filiform warts are commonly treated with surgical removal or cryotherapy, yet such treatment modalities may result in complications for darker skin types. We report a man successfully treated for more than 50 filiform facial warts using a combination of 5-fluorouracil 5% and salicylic acid 20%.
Assuntos
Ácido Salicílico , Verrugas , Administração Tópica , Crioterapia , Fluoruracila/uso terapêutico , Humanos , Masculino , Ácido Salicílico/uso terapêutico , Verrugas/tratamento farmacológicoRESUMO
Lesbian, gay, bisexual, and transgender (LGBT) patients face unique health disparities.1 Routine collection of sexual orientation and gender identity (SOGI) data can optimize patient-provider interactions.2 Gender-neutral bathrooms promote inclusivity for LGBT patients.3 There is limited data on the extent to which dermatology practices make use of such features to deliver culturally competent care to LGBT patients.
Assuntos
Assistência à Saúde Culturalmente Competente , Dermatologia , Padrões de Prática Médica , Minorias Sexuais e de Gênero , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
Crusted scabies is a highly contagious variant of classic scabies. Affected individuals are often elderly or immunocompromised and disease is associated with significant morbidity and mortality. Herein, we report an elderly woman residing in an assisted living facility who presented with diffuse sand-on-skin scale on her trunk, proximal extremities, scalp, hands, and feet. She was diagnosed with crusted scabies, isolated from other patients, and subsequently treated with permethrin 5% lotion and ivermectin. She died two weeks after initial presentation owing to sepsis.
Assuntos
Escabiose/patologia , Pele/patologia , Idoso , Bacteriemia/complicações , Evolução Fatal , Feminino , Humanos , Ivermectina/uso terapêutico , Permetrina/uso terapêutico , Escabiose/complicações , Escabiose/diagnóstico , Sepse/etiologia , Pele/parasitologiaRESUMO
Cryptococcosis is a rare opportunistic infection with morphologically diverse cutaneous presentations. Primary infection typically occurs in the lungs with subsequent hematogenous dissemination to other organ systems, especially in immunocompromised patients. Herein, we report a woman in her 70's who presented with pruritic, umbilicated papulonodules of the bilateral upper and lower extremities present for many weeks. She was diagnosed with disseminated Cryptococcus and subsequently evaluated for potential pulmonary and meningeal disease involvement. She died as a result of multiple medical comorbidities.
Assuntos
Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Extremidades/microbiologia , Idoso , Candida albicans/isolamento & purificação , Criptococose/etiologia , Criptococose/microbiologia , Dermatomicoses , Diabetes Mellitus Tipo 2/complicações , Doença Hepática Terminal/complicações , Extremidades/patologia , Evolução Fatal , Feminino , Virilha/microbiologia , Humanos , Falência Renal Crônica/complicações , Infecções Oportunistas , Fatores de RiscoRESUMO
Dermatomyositis is a clinically heterogenous inflammatory myopathy with unique cutaneous features. Myositis-specific antibodies can aid in diagnosis and anticipation of patient prognosis. Herein, we report a 22-year-old man who presented with multifocal erythematous plaques with violaceous papules on his bilateral elbows, neck, and face. He was diagnosed with biopsy-proven dermatomyositis and determined to be seropositive for nuclear matrix protein 2 antibody (NXP-2). He was treated with systemic corticosteroids, then intravenous methylprednisolone and azathioprine, and ultimately achieved greatest treatment response with intravenous immune globulin therapy.
Assuntos
Corticosteroides/uso terapêutico , Autoanticorpos/sangue , Proteínas de Ligação a DNA/imunologia , Dermatomiosite/imunologia , Dermatomiosite/terapia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores de Transcrição/imunologia , Algoritmos , Biópsia , Dermatomiosite/diagnóstico , Dermatomiosite/patologia , Diagnóstico Diferencial , Humanos , Masculino , Adulto JovemRESUMO
BACKGROUND: Transgender patients have many unique dermatologic needs, yet the literature concerning dermatologic care of transgender individuals is lacking. OBJECTIVE: We aimed to provide a systematic review of the literature on dermatology care in transgender individuals to provide a foundation for future research and education. METHODS: We systematically reviewed peer-reviewed published studies that examined dermatologic treatment of transgender patients. RESULTS: A total of 110 articles met the inclusion criteria for systematic review. LIMITATIONS: Because of a lack of quantitative research in transgender dermatology, much of the available literature included in this review relies on case reports and expert opinions. CONCLUSION: Dermatologists have the ability to greatly affect the care of transgender patients, and there are ample opportunities for dermatologists to expand the literature pertaining to this population.
Assuntos
Dermatologia , Hormônios Gonadais/farmacologia , Serviços de Saúde para Pessoas Transgênero , Papel do Médico , Competência Cultural , Preenchedores Dérmicos/efeitos adversos , Dermatologia/ética , Feminino , Hormônios Gonadais/efeitos adversos , Cabelo/efeitos dos fármacos , Humanos , Masculino , Relações Médico-Paciente , Procedimentos de Readequação Sexual , Dermatopatias/induzido quimicamente , Dermatopatias/diagnósticoRESUMO
BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions that may present with similar findings to other severe dermatologic diseases. OBJECTIVE: The primary objective of this exploratory study was to explore factors associated with SJS/TEN and develop a model that provides the predicted probability of SJS/TEN for patients for whom the diagnosis of SJS/TEN is considered. METHODS: Retrospective review of consultations for patients with suspected SJS, TEN, or overlap at 4 academic dermatology consultation services. RESULTS: Overall, 208 patients were included; 59 (28.4%) had a final diagnosis of SJS/TEN, and 149 (71.6%) were given a different diagnosis. The most common mimickers were drug hypersensitivity syndrome (n = 21, 10.1%), morbilliform drug eruption (n = 18, 8.7%), erythema multiforme (n = 15, 7.2%), and acute generalized exanthematous pustulosis (n = 13, 6.2%). Nikolsky sign, atypical targets, fever, and lymphopenia were included in a model for predicting the probability of SJS/TEN. LIMITATIONS: All cases were obtained from academic centers, which may limit the generalization of findings to community-based settings. This was an exploratory study with a small number of cases, and external validation of the model performance is needed. CONCLUSION: Early dermatologic evaluation of patients with suspected SJS/TEN is key to separating patients with this condition from those who ultimately receive diagnoses of other serious skin diseases.
Assuntos
Modelos Biológicos , Encaminhamento e Consulta , Síndrome de Stevens-Johnson/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodosAssuntos
Necrose , Úlcera Cutânea , Abuso de Substâncias por Via Intravenosa , Xilazina , Humanos , Abuso de Substâncias por Via Intravenosa/complicações , Necrose/induzido quimicamente , Úlcera Cutânea/induzido quimicamente , Úlcera Cutânea/patologia , Masculino , Xilazina/efeitos adversos , Xilazina/administração & dosagem , Adulto , Feminino , Pessoa de Meia-IdadeRESUMO
Numerous studies have suggested a correlation between oral health, the oral microbiome, and various dermatologic conditions, particularly psoriasis. In this study, we utilize a specially designed questionnaire administered to 265 patients at The Ohio State University's dermatology clinics to explore the relationship between psoriasis and a combination of factors that included dietary habits, oral health, and oral hygiene practices. Age, family history of psoriasis, previous diagnosis of strep throat or rheumatoid arthritis, and oral pain or discomfort experienced within the last 12 months were all found to be significant predictors of psoriasis. Additionally, higher body mass index scores, poor gum health, and speech difficulties related to dental problems were all correlated with more severe psoriasis symptoms. Conversely, patients who reported consuming fresh fruit at least once a day experienced milder symptoms. Our goal is to develop a better understanding of how and why psoriasis incidence is correlated with some of the oral health factors under review.
Assuntos
Dieta/efeitos adversos , Higiene , Saúde Bucal , Psoríase/etiologia , Adulto , Fatores Etários , Artrite Reumatoide/complicações , Estudos de Casos e Controles , Progressão da Doença , Humanos , Modelos Lineares , Modelos Logísticos , Pessoa de Meia-Idade , Gravidade do Paciente , Faringite/complicações , Faringite/microbiologia , Psoríase/genética , Estudos Retrospectivos , Fatores de Risco , Infecções Estreptocócicas/complicações , Inquéritos e QuestionáriosRESUMO
Accurate and prompt diagnosis of skin ulcers is critical to optimise management; however, studies in hospitalised patients are limited. This retrospective review of dermatologic consultations included 272 inpatients with skin ulcers between July 2015 and July 2018 in four U.S. academic hospitals. The median age was 54 years and 45% were male. In 49.3% of the patients, skin ulcers were considered the primary reason for admission. Ulcers of 62% were chronic and 49.6% were located on the lower extremities. Pyoderma gangrenosum (17.3%), infection (12.5%), and exogenous causes (11.8%) were the leading aetiologies; 12% remained diagnostically inconclusive after consultation. Diagnostic agreements pre-dermatology and post-dermatology consult ranged from 0.104 (n = 77, 95% CI 0.051-0.194) to 0.553 (n = 76, 95% CI 0.440-0.659), indicating poor-modest agreement. This study highlights the diagnostic complexity and relative incidences of skin ulcers in the inpatient setting.