RESUMO
This case describes a patient with known mantle cell lymphoma without cutaneous involvement presenting with a diffuse morbilliform rash during an inpatient admission for bacterial pneumonia. The patient was thought to have a hypersensitivity to antibiotics but failed to improve after the offending agents were stopped. A skin biopsy revealed metastatic cutaneous mantle cell lymphoma. Treatment with high-dose corticosteroids and chemotherapy was initiated resulting in the resolution of the rash.
RESUMO
Dermatomyositis (DM) is an autoimmune disease that affects the skin, lungs, and muscle. Although the pathogenesis of DM is not completely understood, several environmental triggers have been linked to DM onset or flare. This article specifically examines the effects of herbal supplements, drugs, infections, ultraviolet (UV) radiation, and environmental pollutants on the onset or exacerbation of DM. Herbal supplements such as Spirulina platensis, Aphanizomenon flos-aquae, Chlorella, Echinacea, and Alfalfa have been implicated and are frequently used in health foods. Medications such as hydroxyurea, TNF-α inhibitors, immune checkpoint inhibitors (ICI), and penicillamine, as well as certain viral infections, such as parvovirus B19, coxsackie virus, polyomavirus, Epstein-Barr virus (EBV), hepatitis, influenza, and human immunodeficiency viruses (HIV) have been associated with DM onset. Bacterial infections and vaccinations have also been linked to the development of DM. Additional environmental factors, including UV radiation and air pollutants, such as silica, biological/mineral dust, and particulate air matter from vehicle and industrial emissions, may also play a role in DM pathogenesis. Overall, there is general agreement that an autoimmune attack of the skin, muscle, and lungs in DM can be triggered by various environmental factors and warrants further investigation.
RESUMO
Systemic sclerosis is an uncommon autoimmune connective tissue disease with multiorgan system involvement and significant associated morbidity and mortality. Cutaneous signs and clinical manifestations are of particular importance, as they may be recognized before systemic manifestations, allowing earlier risk stratification into the limited and diffuse cutaneous subtypes, as well as earlier initiation of treatment. Important cutaneous manifestations include Raynaud's phenomenon, digital ulcers, cutaneous sclerosis, calcinosis cutis, telangiectasias, pruritus, and dyspigmentation. Despite investigation of a wide variety of treatments, no FDA-approved pharmacologic therapies exist for systemic sclerosis, and data from high-quality studies are limited. In the following review, we will discuss skin-directed therapies. Although there is evidence to support specific treatments for Raynaud's phenomenon, digital ulcers, and cutaneous sclerosis, there are limited rigorous studies evaluating the treatment of other cutaneous signs and clinical manifestations. Additional randomized-controlled trials and large observational studies are necessary to develop future evidence-based treatment options.
Assuntos
Esclerodermia Localizada/terapia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/terapia , Autoanticorpos/sangue , Calcinose/etiologia , Calcinose/terapia , Dedos , Humanos , Transtornos da Pigmentação/tratamento farmacológico , Transtornos da Pigmentação/etiologia , Prurido/tratamento farmacológico , Prurido/etiologia , Doença de Raynaud/etiologia , Doença de Raynaud/terapia , Esclerodermia Localizada/etiologia , Escleroderma Sistêmico/classificação , Úlcera Cutânea/etiologia , Úlcera Cutânea/terapia , Telangiectasia/etiologia , Telangiectasia/terapia , Terminologia como AssuntoAssuntos
Antifúngicos/efeitos adversos , Toxidermias/etiologia , Uso de Medicamentos , Neoplasias Cutâneas/induzido quimicamente , Voriconazol/efeitos adversos , Antifúngicos/uso terapêutico , Atitude do Pessoal de Saúde , Estudos Transversais , Toxidermias/epidemiologia , Toxidermias/prevenção & controle , Feminino , Humanos , Incidência , Masculino , Padrões de Prática Médica , Prognóstico , Medição de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/fisiopatologia , Voriconazol/uso terapêuticoRESUMO
Port-wine stains (PWSs), or capillary malformations, are common congenital lesions, but acquired lesions rarely present in the setting of trauma. We present the case of an 18-year-old man who developed a PWS and associated localized eczema following penetrating trauma to the left abdomen. The diagnoses were confirmed on biopsy. The patient's eczema improved with topical steroids. Magnetic resonance imaging of PWSs is recommended in order to rule out deeper arteriovenous malformations. More research is needed to elucidate the connection between PWS pathophysiology and the development of eczema.