RESUMEN
Patch tests are highly recommended in eczema patients with eyelid involvement. Sunscreen constitutes a potential cause of eyelid or facial allergic contact dermatitis, and should be considered in patients with refractory eczema on these locations. We report a patient sensitized to several emerging allergens such as bis-ethylhexyloxyphenol methoxyphenyl triazine (Tinosorb S), Scutellaria baicalensis extract, and propylene glycol with an eyelid dermatitis. Patch tests to the combined ingredients propylene carbonate, cyclopentasiloxane, and disteardimonium hectorite; and talc, Cl 77 491, and dimethicone/methicone copolymer were also positive. We highlight the importance of systematically patch testing with the cosmetics brought in by our patients, as well as with the individual ingredients whenever positive. The identification of emerging allergies to new compounds in cosmetics mainly depends on this practice.
Asunto(s)
Dermatitis Alérgica por Contacto/etiología , Enfermedades de los Párpados/inducido químicamente , Fenoles/efectos adversos , Extractos Vegetales/efectos adversos , Propilenglicol/efectos adversos , Triazinas/efectos adversos , Adulto , Femenino , Humanos , Pruebas del Parche , Scutellaria baicalensisAsunto(s)
Alopecia Areata , Dermatitis Alérgica por Contacto , Tinturas para el Cabello , Tatuaje , Humanos , Tinturas para el Cabello/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Alopecia Areata/etiología , Pruebas del Parche , Fenilendiaminas , ColorantesRESUMEN
Epidermolysis bullosa (EB) is a heterogeneous group of rare, chronic, inherited skin disorders characterized by marked mechanical fragility of epithelial tissues, with blistering and erosions after minor trauma. We present the first report of a nails-only phenotype in two patients with epidermolysis bullosa simplex (EBS) and a heterozygous pGlu170Lys mutation and the second reported case of EBS associated with a homozygous p.Glu170Lys mutation in the KRT5 gene. Our findings may be relevant for genetic counseling and for understanding the inheritance pattern of EBS.
Asunto(s)
Epidermólisis Ampollosa Simple/genética , Queratina-5/genética , Uñas/patología , Adulto , Niño , Femenino , Humanos , Masculino , Mutación , FenotipoAsunto(s)
Dermatitis Alérgica por Contacto/etiología , Dermatitis Exfoliativa/inducido químicamente , Psoriasis/tratamiento farmacológico , Quinolinas/efectos adversos , Corticoesteroides/uso terapéutico , Dermatitis Alérgica por Contacto/tratamiento farmacológico , Dermatitis Exfoliativa/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Pruebas del Parche , Aceites de Plantas/efectos adversos , Psoriasis/complicacionesAsunto(s)
Linfadenopatía/diagnóstico por imagen , Linfadenopatía/etiología , Pruebas del Parche/efectos adversos , Pruebas del Parche/métodos , Tiazoles/efectos adversos , Adulto , Axila/diagnóstico por imagen , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Femenino , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/etiología , Humanos , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/etiología , UltrasonografíaAsunto(s)
Aterosclerosis/complicaciones , Aterosclerosis/diagnóstico por imagen , Arteria Femoral/diagnóstico por imagen , Psoriasis/complicaciones , Adulto , Grosor Intima-Media Carotídeo , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Ultrasonografía DopplerAsunto(s)
Antiinfecciosos/efectos adversos , Aceite de Ricino/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Dermatosis Facial/inducido químicamente , Nitrofurazona/efectos adversos , Sulfadiazina de Plata/efectos adversos , Pustulosis Exantematosa Generalizada Aguda/diagnóstico , Anciano , Quemaduras/terapia , Dermatitis Alérgica por Contacto/diagnóstico , Diagnóstico Diferencial , Humanos , MasculinoAsunto(s)
Enfermedades Asintomáticas/epidemiología , Aterosclerosis/epidemiología , Aterosclerosis/patología , Grosor Intima-Media Carotídeo , Psoriasis/epidemiología , Psoriasis/patología , Adulto , Pueblo Asiatico/estadística & datos numéricos , Aterosclerosis/fisiopatología , Estudios de Cohortes , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Psoriasis/fisiopatología , Medición de RiesgoAsunto(s)
Dedos/patología , Sarcoidosis , Adulto , Humanos , Masculino , Sarcoidosis/diagnóstico , Sarcoidosis/patologíaRESUMEN
AIMS: We aimed to evaluate whether traditional risk scores [short-term, 'psoriasis-modified' (multiplied by 1.5) and lifetime] were able to capture high cardiovascular disease (CVD) risk as defined by the presence of atherosclerotic plaques in coronary, femoral, or carotid arteries in psoriasis. METHODS AND RESULTS: We used two prospectives obseravational cohorts. European cohort: femoral and carotid atherosclerotic plaques were evaluated by ultrasound in 73 psoriasis patients. Lifetime CVD risk (LTCVR) was evaluated with QRISK-LT; short-term CVD risk was evaluated with SCORE and psoriasis-modified SCORE. American cohort: 165 patients underwent coronary computed tomography angiography to assess presence of coronary plaques. LTCVR was evaluated with atherosclerotic cardiovascular disease (ASCVD-LT) lifetime; short-term CVD risk was evaluated with ASCVD and psoriasis-modified ASCVD. European cohort: subclinical atherosclerosis was present in 51% of patients. QRISK-LT identified 64% of patients with atherosclerosis missing a high proportion (35%) with atheroma plaque (P < 0.05). The percentage of patients with atherosclerosis identified by QRISK-LT was significantly higher than those detected by SCORE (0%) and modified SCORE (10%). American cohort: subclinical atherosclerosis was present in 54% of patients. ASCVD-LT captured 54% of patients with coronary plaques missing a high proportion (46%) with coronary plaque (P < 0.05). The percentage of patients with atheroma plaques detected with ASCVD and modified ASCVD were only 20% and 45%, respectively. CONCLUSIONS: Application of lifetime, short-term and 'psoriasis-modified' risk scores did not accurately capture psoriasis patients at high CVD risk.
Asunto(s)
Enfermedades Cardiovasculares , Placa Aterosclerótica , Psoriasis , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/epidemiología , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Psoriasis/complicaciones , Psoriasis/epidemiología , Medición de Riesgo/métodos , Factores de RiesgoRESUMEN
Psoriasis is associated with a higher risk of liver diseases. We investigated the impact of hepatic steatosis (European cohort) and hepatic inflammation (United States cohort) on subclinical atherosclerosis. In the European cohort (n = 76 psoriasis participants and 76 controls), nonalcoholic fatty liver disease, assessed by the sonographic hepatorenal index, was more prevalent in psoriasis than in controls (61% vs. 45%; P = 0.04). Participants with psoriasis with nonalcoholic fatty liver disease had a higher prevalence of subclinical atherosclerosis (ultrasonographic presence of plaque in femoral or carotid arteries) than participants with psoriasis without nonalcoholic fatty liver disease (61% vs. 23%; P = 0.006) and controls with nonalcoholic fatty liver disease (61% vs. 32%; P < 0.05). Sonographic hepatorenal index was a determinant of subclinical atherosclerosis in psoriasis (OR = 3.5; P = 0.01). In the United States cohort (n = 162 participants with psoriasis who underwent positron emission tomography and coronary computed tomography angiography), those with high hepatic 2-[fluorine-18]fluoro-2-deoxy-D-glucose uptake had higher noncalcified (1.3 [0.49 mm2] vs. 1.0 [0.40 mm2]), fibrofatty (0.23 [0.15 mm2] vs. 0.11 [0.087 mm2]), and lipid-rich necrotic core (4.3 [2.3 mm2] vs. 3.0 [1.7 mm2]) coronary burden (all P < 0.001). Hepatic 2-[fluorine-18]fluoro-2-deoxy-D-glucose uptake associated with noncalcified (ß = 0.28; P < 0.001), fibrofatty (ß = 0.49; P < 0.001), and lipid-rich necrotic core (ß = 0.28; P = 0.003) burden. These results show the downstream cardiovascular effects of subclinical liver disease in psoriasis.
Asunto(s)
Aterosclerosis/epidemiología , Arterias Carótidas/diagnóstico por imagen , Hígado Graso/epidemiología , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Psoriasis/epidemiología , Adulto , Arterias Carótidas/patología , Estudios de Cohortes , Angiografía por Tomografía Computarizada , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Prevalencia , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Mastocytosis is a heterogeneous group of diseases characterized by abnormal proliferation of neoplastic mast cells in the skin and/or other extracutaneous tissues. Most patients with skin involvement can be subclassified into one of the three subtypes of cutaneous mastocytosis currently recognized by the World Health Organization (i.e., mastocytoma, maculopapular cutaneous mastocytosis and diffuse cutaneous mastocytosis); however, some patients may occasionally present with atypical skin lesions that cannot be ascribed to any of these disease subtypes. Here, we report three patients diagnosed with mastocytosis and an unusual cutaneous involvement mimicking Kaposi's sarcoma. Skin biopsies showed neoplastic mast cell infiltrates together with features commonly seen in acroangiodermatitis, and immunohistochemistry for human herpesvirus 8 was negative. One patient fulfilled the criteria for aggressive systemic mastocytosis, showed no response to cytoreductive therapy, and died because of disease progression. The remaining two patients had indolent and smoldering systemic mastocytosis, respectively, but they showed several features associated with an unfavorable prognosis such as extensive involvement of the hematopoiesis by the KIT D816V mutation, increased serum ß2-microglobulin, and decreased serum lactate dehydrogenase. The presence of pseudo-Kaposi's sarcoma skin lesions is an uncommon finding in mastocytosis which may alert physicians to the possible existence of underlying features indicative of a poor prognosis.
Asunto(s)
Mastocitosis Cutánea , Mastocitosis Sistémica , Mastocitosis , Sarcoma de Kaposi , Humanos , Mastocitos , Mastocitosis Cutánea/complicaciones , Mastocitosis Cutánea/diagnóstico , Mastocitosis Sistémica/complicaciones , Mastocitosis Sistémica/diagnóstico , Proteínas Proto-Oncogénicas c-kit/genéticaRESUMEN
BACKGROUND: Psoriasis is associated with an increased risk of cardiovascular disease (CVD) at younger ages that is not identifiable by traditional risk factors. Screening for subclinical atherosclerosis with ultrasound has only been investigated in carotid arteries. Femoral artery ultrasound has never been considered for this purpose. The link between psoriasis and accelerated atherosclerosis has not yet been established. OBJECTIVE: To study the usefulness of femoral artery ultrasound for the detection of subclinical atherosclerosis in psoriasis. We also investigated its possible relationship with changes in insulin resistance. METHODS: We conducted a cross-sectional study in 140 participants, 70 patients with moderate-to-severe psoriasis and 70 healthy controls, matched 1:1 for age, sex, and BMI. Femoral and carotid atherosclerotic plaques were evaluated by ultrasonography. Insulin resistance was assessed by the homeostasis model assessment method (HOMA-IR). RESULTS: Femoral atherosclerotic plaque prevalence was significantly higher in patients with psoriasis (44.64%) than in controls (19.07%) (p<0.005), but no significant difference was found in carotid plaque prevalence (p<0.3). Femoral plaques were significantly more prevalent than carotid plaques (21.42%) among patients with psoriasis (p<0.001). In the regression analysis, insulin resistance was the most influential determinant of atherosclerosis in psoriasis and C-reactive protein the most significant predictor of insulin resistance. CONCLUSIONS: Ultrasound screening for femoral atherosclerotic plaques improves the detection of subclinical atherosclerosis in patients with psoriasis, whereas the study of carotid arteries is not sufficiently accurate. Insulin resistance appears to play a greater role in the development of atherosclerosis in these patients in comparison to other classical CVD risk factors.