RESUMO
Folliculosebaceous cystic hamartoma (FSCH) is a rare and benign form of cutaneous hamartomas. These skin lesions often lead to clinical and histopathological misdiagnosis due to their similarities to cutaneous lesions with overproduction of clustered sebaceous glands. Clinically, the lesions often present as solitary, skin-colored, pedunculated warts to cauliflower-like, exophytic papules and nodules, usually with a diameter ranging 0.5-1.5 cm that rarely exceed 2 cm in size. Only a small number of giant variants are reported in the literature with a diameter in the range of 5-23 cm. The vast majority of the lesions appear in the central face and show a striking predilection for the nose, ears, and scalp, but also emerge on the nipples, extremities, and genitals. Histologically, the epithelial components of folliculosebaceous cystic hamartoma comprise dilated infundibular cystic proliferation with surrounding mesenchymal components, which commonly include fibroplasia and vascular and adipose tissue proliferation. These histological characteristics were coined by Kimura and colleagues (1991). To the best of our knowledge, our case represents the biggest variant of giant folliculosebaceous cystic hamartoma.
RESUMO
It is a general goal to improve wound healing, especially of chronic wounds. As light therapy has gained increasing attention, the positive influence on healing progression of water-filtered infrared A (wIRA), a special form of thermal radiation, has been investigated and compared to the detrimental effects of UV-B irradiation on wound closure in vitro. Models of keratinocyte and fibroblast scratches help to elucidate effects on epithelial and dermal healing. This study further used the simulation of non-optimal settings such as S. aureus infection, chronic inflammation, and anti-inflammatory conditions to determine how these affect scratch wound progression and whether wIRA treatment can improve healing. Gene expression analysis for cytokines (IL1A, IL6, CXCL8), growth (TGFB1, PDGFC) and transcription factors (NFKB1, TP53), heat shock proteins (HSP90AA1, HSPA1A, HSPD1), keratinocyte desmogleins (DSG1, DSG3), and fibroblast collagen (COL1A1, COL3A1) was performed. Keratinocyte and fibroblast wound healing under non-optimal conditions was found to be distinctly reduced in vitro. wIRA treatment could counteract the inflammatory response in infected keratinocytes as well as under chronic inflammatory conditions by decreasing pro-inflammatory cytokine gene expression and improve wound healing. In contrast, in the anti-inflammatory setting, wIRA radiation could re-initiate the acute inflammatory response necessary after injury to stimulate the regenerative processes and advance scratch closure.
RESUMO
HISTORY: A female patient aged 57 presented at the emergency room with painful skin lesions after repeated gardening days. Bullae and striate erythema were ovserved in light exposed areas. The patient was transferred to the Dermatology Department at the University hospital Jena, Germany. FINDINGS AND DIAGNOSIS: Blood test showed raised levels of inflammation parameters. The general body examination showed no abnormalities. Dermatits bullosa pratensis (grass dermatitis), was diagnosed, based on the patient case history, the examination results and the typical skin lesions. THERAPY AND COURSE: Treatment with intravenous corticosteroids, followed by topical steroids and sterile punctures of blisters was prescribed. CONCLUSIONS: Dermatits bullosa pratensis, is a skin condition appearing during the summer season in Germany. It belongs to the photo phytotoxic dermatitis types and is induced by phytochemicals in combination with UV-light. It is therefore important to take appropriate skin protective safety measures when touching plant containing phytochemicals in sunlight. In this way dermatitis bullosa pratensis can be easily avoided.
Assuntos
Vesícula , Dermatite , Eritema , Compostos Fitoquímicos/toxicidade , Raios Ultravioleta/efeitos adversos , Corticosteroides/uso terapêutico , Idoso , Vesícula/diagnóstico , Vesícula/tratamento farmacológico , Vesícula/etiologia , Vesícula/patologia , Dermatite/diagnóstico , Dermatite/tratamento farmacológico , Dermatite/etiologia , Dermatite/patologia , Eritema/diagnóstico , Eritema/tratamento farmacológico , Eritema/etiologia , Eritema/patologia , Extremidades/patologia , Feminino , Humanos , Pele/patologiaRESUMO
Eosinophilic dermatoses are a heterogeneous group of diseases, characterized by an eosinophil-rich infiltrate and/or degranulation of eosinophils. Blood eosinophilia may be an associated feature. Typical, albeit not specific histological findings include 'flame figures', which are caused by the accumulation of cationic proteins released by eosinophils and subsequent collagen denaturation. "Classic" eosinophilic dermatoses include eosinophilic cellulitis (Wells syndrome), granuloma faciale, eosinophilic fasciitis (Shulman syndrome) and eosinophilic folliculitis (Ofuji disease). In addition, there is a multitude of skin diseases that present with varying degrees of eosinophilic infiltration. These include atopic dermatitis, bullous pemphigoid, urticaria, allergic contact dermatitis, prurigo nodularis, arthropod bite reaction, parasitic infections, and drug hypersensitivity. Even though these disorders share a common characteristic (tissue eosinophilia), they differ greatly in their clinical presentation.
Assuntos
Colágeno/metabolismo , Proteína Catiônica de Eosinófilo/metabolismo , Eosinófilos/imunologia , Dermatopatias/imunologia , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/imunologia , Celulite (Flegmão)/patologia , Dermatite Alérgica de Contato/tratamento farmacológico , Dermatite Alérgica de Contato/imunologia , Dermatite Alérgica de Contato/patologia , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/imunologia , Dermatite Atópica/patologia , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/patologia , Eosinofilia/tratamento farmacológico , Eosinofilia/imunologia , Eosinofilia/patologia , Eosinófilos/patologia , Eosinófilos/ultraestrutura , Fasciite/tratamento farmacológico , Fasciite/imunologia , Fasciite/patologia , Foliculite/tratamento farmacológico , Foliculite/imunologia , Foliculite/patologia , Granuloma/tratamento farmacológico , Granuloma/imunologia , Granuloma/patologia , Humanos , Mordeduras e Picadas de Insetos/tratamento farmacológico , Mordeduras e Picadas de Insetos/imunologia , Mordeduras e Picadas de Insetos/patologia , Doenças Parasitárias/tratamento farmacológico , Doenças Parasitárias/imunologia , Doenças Parasitárias/patologia , Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/imunologia , Penfigoide Bolhoso/patologia , Prurigo/tratamento farmacológico , Prurigo/imunologia , Prurigo/patologia , Dermatopatias/classificação , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Dermatopatias Vesiculobolhosas/imunologia , Dermatopatias Vesiculobolhosas/patologia , Urticária/tratamento farmacológico , Urticária/imunologia , Urticária/patologiaAssuntos
Acne Conglobata/tratamento farmacológico , Adalimumab/administração & dosagem , Minociclina/administração & dosagem , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Acne Conglobata/patologia , Adolescente , Anti-Inflamatórios/administração & dosagem , Quimioterapia Combinada , Humanos , Injeções Subcutâneas , MasculinoAssuntos
Sífilis/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Biópsia/métodos , Etilenodiaminas/uso terapêutico , Exantema/etiologia , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Humanos , Masculino , Penicilina G/uso terapêutico , Sífilis/diagnóstico por imagem , Treponema pallidum/patogenicidadeRESUMO
Teledermatology is the use of telecommunication technologies to exchange medical information for diagnosis, consultation, treatment and teaching in dermatology. While its use has been evaluated in a wide range of dermatological diagnoses, only few studies exist on its validity, diagnostic precision, feasibility, and cost-effectiveness in occupational dermatology. However, these studies show a considerable potential for diagnosis, prevention, treatment support and follow-up of patients with occupational skin diseases. Asynchronous (store and forward; SAF) or synchronous dermatology teleconsults could assist occupational medicine specialists not only in occupational preventive care, but also in the context of skin cancer screening in outdoor workers. Thus, teledermatology might contribute to earlier prevention and notification of occupational skin diseases. Modern smartphone apps with artificial intelligence technologies may also facilitate self-monitoring in employees working in high-risk jobs.
Assuntos
Dermatologia , Telemedicina , Humanos , Dermatopatias/diagnóstico , Neoplasias Cutâneas/diagnósticoAssuntos
Indústria da Construção , Dermatite Ocupacional/diagnóstico , Dermatoses Faciais/diagnóstico , Dermatoses da Mão/diagnóstico , Lúpus Eritematoso Cutâneo/diagnóstico , Exposição Ocupacional , Raios Ultravioleta/efeitos adversos , Biópsia , Dermatite Ocupacional/etiologia , Dermatite Ocupacional/patologia , Diagnóstico Diferencial , Dermatoses Faciais/etiologia , Dermatoses Faciais/patologia , Dermatoses da Mão/etiologia , Dermatoses da Mão/patologia , Humanos , Lúpus Eritematoso Cutâneo/etiologia , Lúpus Eritematoso Cutâneo/patologia , Masculino , Pessoa de Meia-Idade , Pescoço , Pele/patologiaAssuntos
Imunocompetência , Dermatoses da Perna/etiologia , Linfedema/complicações , Infecções por Mycobacterium não Tuberculosas/etiologia , Biópsia , Doença Crônica , Claritromicina/uso terapêutico , Derme/patologia , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Quimioterapia Combinada , Epiderme/patologia , Feminino , Humanos , Dermatoses da Perna/patologia , Linfedema/patologia , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/patologia , Rifampina/uso terapêuticoAssuntos
Acrodermatite/diagnóstico , Eritema/diagnóstico , Dermatoses da Mão/diagnóstico , Zinco/deficiência , Acrodermatite/patologia , Biópsia , Colecistectomia , Diagnóstico Diferencial , Eritema/patologia , Feminino , Derivação Gástrica , Dermatoses da Mão/patologia , Humanos , Pessoa de Meia-Idade , Pancreatectomia , Pancreatite Crônica/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Pele/patologiaAssuntos
Vesícula/patologia , Antebraço/patologia , Dermatoses da Mão/patologia , Naproxeno/efeitos adversos , Porfiria Cutânea Tardia/induzido quimicamente , Úlcera Cutânea/patologia , Pele/patologia , Anti-Inflamatórios não Esteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/farmacologia , Anti-Inflamatórios não Esteroides/uso terapêutico , Biópsia , Vesícula/induzido quimicamente , Feminino , Dermatoses da Mão/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Naproxeno/farmacologia , Naproxeno/uso terapêutico , Porfiria Cutânea Tardia/patologia , Pele/efeitos dos fármacos , Úlcera Cutânea/induzido quimicamente , Raios Ultravioleta/efeitos adversosAssuntos
Técnicas Cosméticas/efeitos adversos , Reação a Corpo Estranho/tratamento farmacológico , Glucocorticoides/administração & dosagem , Granuloma de Corpo Estranho/tratamento farmacológico , Sarcoidose/tratamento farmacológico , Pele/efeitos dos fármacos , Tatuagem/efeitos adversos , Triancinolona/administração & dosagem , Adulto , Biópsia , Feminino , Reação a Corpo Estranho/diagnóstico , Reação a Corpo Estranho/etiologia , Granuloma de Corpo Estranho/induzido quimicamente , Granuloma de Corpo Estranho/diagnóstico , Humanos , Injeções Intralesionais , Sarcoidose/induzido quimicamente , Sarcoidose/diagnóstico , Pele/patologia , Resultado do TratamentoAssuntos
Dermatoses do Couro Cabeludo/diagnóstico , Couro Cabeludo/irrigação sanguínea , Couro Cabeludo/patologia , Artérias Temporais/patologia , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Diferencial , Testa/irrigação sanguínea , Testa/patologia , Cefaleia/etiologia , Cefaleia/patologia , Humanos , Masculino , Necrose , Dermatoses do Couro Cabeludo/patologia , Trombose/diagnóstico , Trombose/patologiaRESUMO
TNF-alpha-Inhibitoren werden seit Anfang der 1990er Jahre erfolgreich zur Behandlung diverser immunvermittelter entzündlicher Erkrankungen eingesetzt. Inzwischen gibt es eine umfangreiche Datenlage bezüglich ihrer Sicherheit. Nebenwirkungen sind bezogen auf die Häufigkeit der Anwendung selten und meist nicht schwerwiegend. Zu den Nebenwirkungen am Hautorgan zählen lokale injektionsassoziierte Reaktionen, Infektionen, immunvermittelte Reaktionen sowie Neoplasien. Die häufigsten schwerwiegenden Nebenwirkungen sind infektiöser Natur. Mykobakterielle Infektionen, aber auch non-mykobakterielle Erreger, Viren und Pilze können potenziell letale, systemische Infektionen auslösen. Im Folgenden wird eine Übersicht über das gegenwärtige Wissen bezüglich der Nebenwirkungen von TNFα-Inhibitoren am Hautorgan gegeben.
RESUMO
Since the early 1990s, tumor necrosis factor alpha (TNF-alpha) inhibitors have been successfully used in the treatment of various immune-mediated inflammatory diseases. By now, comprehensive safety data has been compiled. While adverse reactions do occur, they are - in relation to the frequent use of these agents - rare and usually not serious. Cutaneous side effects include local injection site reactions, infections, immune-mediated reactions, and neoplasms. The most common serious adverse events are of an infectious nature. Mycobacteria but also non-mycobacterial pathogens, such as viruses and fungi, may cause serious, even lethal, systemic infections. The present article is meant to review current knowledge with respect to cutaneous side effects of TNF-alpha inhibitors.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Toxidermias/etiologia , Imunossupressores/efeitos adversos , Psoríase/induzido quimicamente , Dermatopatias Infecciosas/induzido quimicamente , Neoplasias Cutâneas/induzido quimicamente , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Relação Dose-Resposta a Droga , Toxidermias/diagnóstico , Toxidermias/prevenção & controle , Medicina Baseada em Evidências , Humanos , Psoríase/diagnóstico , Psoríase/prevenção & controle , Fatores de Risco , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/prevenção & controle , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/prevenção & controle , Resultado do TratamentoRESUMO
Die Necrobiosis lipoidica ist eine seltene granulomatöse Erkrankung von bisher unzureichend geklärter Ätiologie. Häufig stellt die bei Diabetikern gehäuft zu beobachtende und zur Ulzeration neigende Dermatose eine starke Belastung für die Patienten dar. Bezüglich der Therapie existieren aktuell keine deutschen oder europäischen Leitlinien. Gleichzeitig lässt sich unter der aktuellen Standardtherapie, der lokalen oder intraläsionalen Anwendung von Glukokortikoiden, nicht immer ein zufriedenstellendes Ansprechen beobachten. Daher wurde untersucht, ob seit dem Jahr 2000 publizierte Therapiemodalitäten das Therapiespektrum relevant und erfolgversprechend erweitern. Es erfolgte eine Betrachtung aller Arbeiten im oben genannten Zeitraum, bei denen mehr als ein Einzelfallbericht je Therapiemodalität publiziert wurde. Insgesamt wurden in einem systematischen Review die Daten von 16 verschiedenen, seit 2000 publizierten Therapieverfahren in 49 Publikationen analysiert. Im Ergebnis zeigte sich, dass die meisten Erfahrungen bezüglich der topischen PUVA-Therapie, der photodynamischen Therapie (PDT) und der systemischen Therapie mit Fumarsäureestern vorliegen. Allerdings ist auffällig, dass mit steigender Zahl der pro Behandlungsmodalität behandelten Patienten der Anteil der Patienten, bei denen eine Abheilung bzw. eine teilweise Abheilung berichtet wurde, sinkt. Wir interpretieren diese Beobachtung als Publikationsbias. Daher kann für keines der besprochenen Verfahren eine klare Empfehlung als Therapie der zweiten Wahl nach Versagen der lokalen bzw. intraläsionalen Steroidtherapie gegeben werden.
RESUMO
Necrobiosis lipoidica (NL) is a rare granulomatous disease of hitherto unclear etiology frequently seen in patients with diabetes. Characterized by its potential for ulcerations, it often presents a serious burden for those affected. There are currently neither German nor European guidelines for the treatment of NL. At the same time, standard treatment with topical or intralesional corticosteroids does not always show satisfactory results. We therefore set out to evaluate whether the various treatment regimens published since 2000 have actually expanded the therapeutic armamentarium in a relevant manner. Included were all publications that described more than one patient being treated with any given therapeutic modality. Overall, we analyzed data for 16 different treatment regimens reported in 49 publications. The largest amount of data exists for topical PUVA therapy, photodynamic therapy (PDT), and systemic treatment with fumaric acid esters. Remarkably, our analysis showed that with an increase in the number of documented patients treated with a given therapeutic modality, the proportion of those achieving a complete or partial response actually decreased. This was interpreted as publication bias. Thus, no clear recommendation can be given for second-line therapy in case topical or intralesional corticosteroids fail.
Assuntos
Corticosteroides/administração & dosagem , Fumaratos/administração & dosagem , Necrobiose Lipoídica/diagnóstico , Necrobiose Lipoídica/terapia , Terapia PUVA/métodos , Fotoquimioterapia/métodos , Administração Cutânea , Terapia Combinada , Medicina Baseada em Evidências , Humanos , Resultado do TratamentoRESUMO
HISTORY AND CLINICAL FINDINGS: A 44-year-old man presented at a dermatologist with a 2 months history of a blue-brown reticular macule on the right thigh that had appeared spontaneously. It was neither painful nor itching and showed no growth or further colour change. INVESTIGATIONS: Punch biopsy, antinuclear antibodies, CrP, immune electrophoresis, hepatitis serology, urine diagnostics showed normal results. DIAGNOSIS: On specific inquiry the patient, a long-distance truck driver, reported to rest his laptop during driving breaks always on the right thigh. We diagnosed a "laptop dermatitis". CONCLUSION: Consider external mechanical or thermal triggers if skin changes are unilateral. Thermal isolation from permanent heat exposure prevents an erythema ab igne reliably.