RESUMO
Mycosis fungoides palmaris et plantaris (MFPP) is a rare variant of mycosis fungoides (MF), a type of cutaneous T-cell lymphoma. MFPP primarily affects the palms and soles of the feet and is often misdiagnosed as dyshidrotic eczema due to its similar clinical presentation. This case report presents a middle-aged woman with MFPP whose initial presentation was mistaken for dyshidrotic eczema. Despite treatment with topical corticosteroids, the patient's lesions persisted, prompting further investigations that led to the diagnosis of MFPP. The patient was initiated on betamethasone dipropionate ointment and hydroxyzine for pruritus management, with a pivotal referral to oncology for comprehensive evaluation. This case highlights the importance of considering MFPP in the differential diagnosis of persistent eczematous lesions on the palms and soles, especially when treatment with topical corticosteroids is ineffective. J Drugs Dermatol. 2024;23(7):569-570. doi:10.36849/JDD.8474.
Assuntos
Eczema Disidrótico , Micose Fungoide , Neoplasias Cutâneas , Humanos , Feminino , Micose Fungoide/diagnóstico , Micose Fungoide/tratamento farmacológico , Micose Fungoide/patologia , Diagnóstico Diferencial , Pessoa de Meia-Idade , Eczema Disidrótico/diagnóstico , Eczema Disidrótico/tratamento farmacológico , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/tratamento farmacológico , Betametasona/administração & dosagem , Betametasona/análogos & derivadosAssuntos
Eczema Disidrótico/diagnóstico , Linfoma Cutâneo de Células T/diagnóstico , Linfoma de Células T Periférico/diagnóstico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Biópsia , Ciclofosfamida , Diagnóstico Diferencial , Doxorrubicina , Eczema Disidrótico/tratamento farmacológico , Humanos , Imuno-Histoquímica , Linfoma Cutâneo de Células T/tratamento farmacológico , Linfoma de Células T Periférico/tratamento farmacológico , Masculino , Prednisona , Tomografia Computadorizada por Raios X , VincristinaAssuntos
Eczema Disidrótico/induzido quimicamente , Imunoglobulinas Intravenosas/efeitos adversos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Triancinolona/uso terapêutico , Administração Tópica , Biópsia por Agulha , Eczema Disidrótico/tratamento farmacológico , Eczema Disidrótico/patologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
BACKGROUND: Numerous studies have confirmed the short-term effectiveness of 8-methoxypsoralen bath PUVA therapy in patients with chronic palmoplantar dermatoses; however, little is known about long-term results. PATIENTS AND METHODS: In this retrospective study we examined the long-term results in 79 patients (mean age: 48 years) with chronic palmoplantar dermatoses who were treated with bath PUVA three times a week over an 8-year period. A good clinical response (a reduction of more than 50% of the skin lesions) occurred after a mean of 23 treatments and a mean cumulative UVA dose of 39 J/cm(2) in 51 patients (65%). In 2007 a questionnaire was sent to these 51 patients to assess the long-term outcome. RESULTS: With bath PUVA treatment, the best results were found in patients with hyperkeratotic eczema (17/22; 77% good clinical response) followed by patients with palmoplantar psoriasis (26/41; 63%) and patients with dyshidrotic eczema (8/16; 50%). Thirty-four patients (67%) answered the questionnaire after a mean follow-up interval of 4.3 years (10-87 months). Among these patients, 36% reported an improved course of disease after PUVA therapy with reduced frequency and/or intensity of the skin rash, and 29% of patients reported continued complete clearance. 79% of our patients reported a long-term reduction in the use of topical corticosteroids during the follow-up period (mean: 4.3 years). In addition, 67% of patients reported a lasting improvement in quality of life. CONCLUSIONS: These data show that bath PUVA may have a long-term, beneficial influence on the course of disease in a majority of patients with recalcitrant chronic palmoplantar dermatoses.
Assuntos
Banhos/estatística & dados numéricos , Eczema Disidrótico/tratamento farmacológico , Eczema Disidrótico/epidemiologia , Ceratodermia Palmar e Plantar/tratamento farmacológico , Ceratodermia Palmar e Plantar/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Terapia Combinada/estatística & dados numéricos , Eczema Disidrótico/patologia , Feminino , Seguimentos , Furocumarinas/uso terapêutico , Alemanha/epidemiologia , Humanos , Ceratodermia Palmar e Plantar/patologia , Masculino , Pessoa de Meia-Idade , Terapia PUVA , Prevalência , Radiossensibilizantes/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Hand dermatitis is common, with lymphoedema of the hand and forearm a rare complication. The mechanism of lymphoedema in such cases is poorly understood, hence management can be challenging. To investigate the underlying mechanism of lymphoedema associated with hand dermatitis and outline recommendations for management, we identified all patients with lymphoedema associated with hand dermatitis referred to our lymphoedema service, a tertiary referral centre. Treatment outcome was assessed by telephone interview and through correspondence with primary physicians and therapists. In total, nine patients, six with bilateral and three with unilateral lymphoedema associated with hand dermatitis, attended our service over a 4-year period. Most had long-standing bilateral pompholyx eczema. Three patients reported no signs of infection prior to the onset of swelling. All patients had recurrent episodes of infection after the onset of swelling. Lymphoscintigraphy, when used, revealed a failure of small initial lymphatics of the hand to absorb and drain lymph to regional nodes. Prophylactic antibiotics together with aggressive management of the dermatitis, often with systemic therapy, were required to reduce swelling. Possible mechanisms for lymphoedema associated with hand dermatitis include obliterative lymphangitis from infection, an inflammatory effect of the dermatitis on local lymphatics or a constitutive weakness of lymph drainage exposed to chronic inflammation, or any combination of the three. Treatment is only successful once both infection and inflammation from the dermatitis are controlled.
Assuntos
Dermatoses da Mão/etiologia , Linfedema/complicações , Adulto , Antibioticoprofilaxia , Azatioprina/uso terapêutico , Eczema Disidrótico/tratamento farmacológico , Eczema Disidrótico/patologia , Feminino , Dermatoses da Mão/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Linfedema/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Penicilina V/uso terapêutico , Prednisolona/uso terapêutico , Resultado do TratamentoAssuntos
Dermatopatias/tratamento farmacológico , Acne Queloide/tratamento farmacológico , Acne Queloide/patologia , Acne Vulgar/tratamento farmacológico , Acne Vulgar/patologia , Adulto , Condiloma Acuminado/patologia , Síndrome do Nevo Displásico/patologia , Síndrome do Nevo Displásico/cirurgia , Eczema Disidrótico/tratamento farmacológico , Eczema Disidrótico/patologia , Feminino , Humanos , Lúpus Eritematoso Discoide/tratamento farmacológico , Lúpus Eritematoso Discoide/patologia , Masculino , Melanose/tratamento farmacológico , Melanose/radioterapia , Dermatopatias/patologiaAssuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Eczema Disidrótico/tratamento farmacológico , Dermatoses da Mão/tratamento farmacológico , Hiperidrose/tratamento farmacológico , Fármacos Neuromusculares/uso terapêutico , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Eczema Disidrótico/complicações , Eczema Disidrótico/patologia , Dermatoses da Mão/patologia , Humanos , Hiperidrose/complicações , Hiperidrose/patologia , Injeções Subcutâneas , Masculino , Fármacos Neuromusculares/administração & dosagem , RecidivaAssuntos
Fármacos Dermatológicos/administração & dosagem , Eczema Disidrótico/tratamento farmacológico , Curativos Oclusivos , Tacrolimo/análogos & derivados , Administração Tópica , Idoso , Biópsia , Fármacos Dermatológicos/uso terapêutico , Eczema Disidrótico/patologia , Seguimentos , Pé , Mãos , Humanos , Masculino , Peptidilprolil Isomerase/antagonistas & inibidores , Índice de Gravidade de Doença , Tacrolimo/administração & dosagem , Tacrolimo/uso terapêutico , Fatores de TempoAssuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Eczema Disidrótico/tratamento farmacológico , Imunoglobulina G/administração & dosagem , Receptores do Fator de Necrose Tumoral/administração & dosagem , Adulto , Esquema de Medicação , Etanercepte , Feminino , Humanos , Injeções Subcutâneas , Recidiva , Resultado do TratamentoRESUMO
A Japanese woman had bullous eruptions on her palms and soles for two months, histopathologic examination, immunofluorescence microscopy, and ELISA for BP180 antigen led to the definitive diagnosis of dyshidrosiform pemphigoid (DP). This paper also includes a study of 15 other cases of DP.
Assuntos
Eczema Disidrótico/patologia , Penfigoide Bolhoso/patologia , Idoso , Autoantígenos/imunologia , Biópsia por Agulha , Eczema Disidrótico/tratamento farmacológico , Ensaio de Imunoadsorção Enzimática , Feminino , Mãos , Humanos , Imuno-Histoquímica , Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/imunologia , Prednisona/administração & dosagem , Prognóstico , Medição de Risco , Índice de Gravidade de DoençaRESUMO
BACKGROUND: We describe two severe cases of polymorphic eruption of pregnancy associated with dyshidrosis and purpuric lesions. CASE-REPORT: Two patients, primigravida at 35 and 34 weeks of amenorrhea, were admitted in our department for a severe and itchy eruption. In the first case, some papular lesions were particularly concentrated on the abdominal striae, associated with vesicles on the limbs. There were plantar dyshidrosis and purpuric macules on the toes. In the second case, there were a maculopapular eruption on the abdomen and limbs, some vesicles and bullae of palms and soles, and a purpura of heels. In both cases, the skin biopsy showed dermic inflammatory, direct immunofluorescence and Pemphigoide Gestationis Factor research were negatives. The two patients were treated with betamethasone dipropionate (Diprosone(R)), and hydroxyzine (Atarax(R)). They gave birth to healthy babies. DISCUSSION: Dyshidrosis is not exceptional in polymorphic eruption of pregnancy. Indeed, in the several series of polymorphic eruption of pregnancy we checked, a pompholyx distribution was observed in 5 p. 100 of the cases. It is not necessary a sign of pemphigoid gestationis, even if this localization is commonly observed. The purpuric lesions are unusual because, according to our knowledge, there is no description of purpura associated with palmoplantar lesions in polymorphic eruption of pregnancy. The purpuric lesions may be secondary to high capillary permeability, increased by severe dermic inflammation of the polymorphic eruption of pregnancy and, possibly, high level of circulating estrogens.
Assuntos
Betametasona/análogos & derivados , Eczema Disidrótico/complicações , Eczema Disidrótico/patologia , Complicações na Gravidez/patologia , Prurido/complicações , Prurido/patologia , Púrpura/complicações , Púrpura/patologia , Administração Tópica , Adulto , Anti-Inflamatórios/uso terapêutico , Antipruriginosos/uso terapêutico , Betametasona/uso terapêutico , Biópsia , Quimioterapia Combinada , Eczema Disidrótico/tratamento farmacológico , Feminino , Glucocorticoides , Humanos , Hidroxizina/uso terapêutico , Paridade , Gravidez , Complicações na Gravidez/tratamento farmacológico , Prurido/tratamento farmacológico , Púrpura/tratamento farmacológicoRESUMO
The beneficial effects of ultraviolet (UV) radiation on atopic dermatitis has been appreciated for many years. While broadband UVB and psoralen UVA have been the mainstay of phototherapy for some time, the past 5 years have seen the introduction of phototherapeutic modalities, including UVA-1 and 311nm UVB. The best modality and mode of usage is dependent on the type of atopic dermatitis, severity and body site. T lymphocytes play an important role in disease pathogenesis and UV radiation has profound effects on skin and systemic immune responses.
Assuntos
Dermatite Atópica/tratamento farmacológico , Terapia PUVA/métodos , Eczema Disidrótico/tratamento farmacológico , Feminino , Humanos , Terapia PUVA/normas , Fotoferese/métodos , Fotoferese/normas , Terapia Ultravioleta/métodos , Terapia Ultravioleta/normasRESUMO
Bath-PUVA therapy has been described as successful treatment for palmoplantar eczema. However, our own observations showed that patients with palmoplantar eczema of the dyshidrotic or hyperkeratotic type responded only partially to bath-PUVA therapy. In order to evaluate environmental influences possibly having an impact on the efficacy of this therapy, smokers and non-smokers suffering from palmoplantar eczema treated with bath-PUVA therapy were compared. A retrospective study was conducted involving 62 patients, 39 non-smokers and 23 smokers, with palmar and/or plantar eczema resistant to local corticosteroids. Bath-PUVA therapy was performed according to the European standard regimen for oral PUVA therapy. The total number of treatments and the cumulative UVA-dose were similar in smokers and non-smokers (smokers 24+/-17.7 (mean+/-SD) and 67.6+/-51.3 J/cm2 vs. non-smokers 25.7+/-16.3 and 68.5+/-49.3 J/cm2). In the group of non-smokers, 31% showed complete remission (CR; 100% clearance), 33% partial remission (PR; more than 50% clearance) and 36% no change after treatment (NC; less than 50% clearance). In contrast, the group of smokers showed only 13% CR and 22% PR, whereas 65% exhibited NC. The differences regarding complete or partial remission between the groups were statistically significant (Student t-test for paired samples; P<0.05). Regarding the different type of eczema, bath-PUVA proved to be more successful in the dyshidrotic type of eczema as compared to the hyperkeratotic type in non-smokers (P<0.05). In the group of smokers no CR was achieved in patients suffering from the dyshidrotic form of eczema. Smoking is likely to be a reason for the failure of bath-PUVA therapy in the treatment of chronic palmoplantar eczema, in particular regarding smokers with eczema of the dyshidrotic type where no complete remission was achieved.
Assuntos
Banhos , Eczema Disidrótico/tratamento farmacológico , Eczema/tratamento farmacológico , Terapia PUVA , Fumar , Adulto , Idoso , Doença Crônica , Feminino , Humanos , Ceratose/tratamento farmacológico , Masculino , Metoxaleno/administração & dosagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Clinical expression of pemphigoid can sometimes be misleading. Localized dyshidrosis is rarely reported in the literature. CASE REPORT: We observed 4 cases of pemphigoid with unusual dyshidrosis lesions. Skin biopsy was unspecific in both cases. Immunofluorescence gave the diagnosis in both. One case responded to low-dose general corticosteroids associated with local applications of corticosteroids. The other patients required high-dose oral corticosteroids. CONCLUSION: Our cases illustrated the misleading dyshidrosis nature of certain pemphigoids and the need for repeated skin biopsies with immunofluorescence in case of recent development of dyshidrosis in elderly subjects. As in the literature, and despite the localized nature of the lesions, general corticosteroid treatment appears necessary in many cases.
Assuntos
Eczema Disidrótico/diagnóstico , Penfigoide Bolhoso/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Eczema Disidrótico/tratamento farmacológico , Feminino , Imunofluorescência , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/tratamento farmacológico , Glucocorticoides/uso terapêutico , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/tratamento farmacológico , Humanos , Masculino , Penfigoide Bolhoso/tratamento farmacológicoRESUMO
Topical PUVA was compared with UVA for the treatment of chronic vesicular hand eczema in a double-blind randomized within-patient trial. Twelve of 15 patients completed 8 weeks' treatment and were followed up for 8 weeks. Both sides improved over the 8-week treatment period (p less than 0.05) and both remained substantially better objectively and subjectively at 8 weeks' follow-up. There was no statistical difference between assessments of the treated hands at any stage. Nine of the patients who completed the study answered a questionnaire up to 18 months later. In 4, eczema was healed, 3 were better on the PUVA-treated hand and 1 on the UVA-treated hand. It is possible that UVA alone is beneficial for chronic hand eczema.
Assuntos
Eczema Disidrótico/radioterapia , Dermatoses da Mão/radioterapia , Terapia PUVA , Terapia Ultravioleta , Adulto , Idoso , Doença Crônica , Método Duplo-Cego , Eczema Disidrótico/tratamento farmacológico , Feminino , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Terapia PUVA/efeitos adversos , Terapia Ultravioleta/efeitos adversosRESUMO
In some cases that have been diagnosed as contact allergy to nickel, there are repeated cutaneous eruptions of pompholyx, even in areas with no direct contact with the metal. The possible alimentary origin of dyshidrotic eczema should be considered when deciding on therapy. We have collected the clinical data for 24 patients with dyshidrotic eczema caused by nickel, to evaluate the benefit of a low-nickel diet versus treatment with oral disodium cromoglycate, comparing both objective and subjective symptoms. A low-nickel diet does not improve these patients but those treated with DSCG reacted better, from both objective and subjective point of view, than either the controls or the patients treated by diet. We next did intestinal permeability tests before therapy and after 15 days of treatment. We found that nickel uptake diminishes simultaneously with the reduction of absorption through the smaller aqueous "pores". This phenomenon was greatest after DSCG. We suggest that DSCG can help selected cases of pompholyx.
Assuntos
Cromolina Sódica/uso terapêutico , Eczema Disidrótico/terapia , Níquel/efeitos adversos , Adulto , Eczema Disidrótico/induzido quimicamente , Eczema Disidrótico/dietoterapia , Eczema Disidrótico/tratamento farmacológico , Feminino , Humanos , Absorção Intestinal/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Níquel/urina , Distribuição AleatóriaRESUMO
Ingestion of nickel is important for the chronicity of hand eczema in nickel-sensitive patients. We have tried the effect of chelating agents. Diethyldithiocarbamate (DDC) and tetraethyl thiuramdisulfide (TETD) have proved effective in the treatment of nickel carbonyl poisoning. A 66-year-old woman suffering from severe nickel dermatitis has been treated in three periods, first with DDC 100 mg Q. I. D. for 20 days, and later with TETD 100 mg T. I. D. for two periods. An improvement has been observed in all three experiments.