RESUMO
Angioimmunoblastic T-cell lymphoma (AITL) is a rare form of non-Hodgkin lymphoma often accompanied by autoimmune and paraneoplastic phenomena. Up to 50% of patients with AITL present with skin manifestations. This case series highlights two cases of AITL presenting with unusual cutaneous findings: one with a medium-vessel vasculitis and another with a chronic urticarial eruption. Clinicians should consider AITL in the differential diagnosis of vasculitis or urticaria refractory to standard treatment.
Assuntos
Linfoma Cutâneo de Células T/complicações , Síndromes Paraneoplásicas/patologia , Neoplasias Cutâneas/complicações , Pele/patologia , Urticária/etiologia , Vasculite/etiologia , Evolução Fatal , Feminino , Humanos , Linfadenopatia Imunoblástica/patologia , Linfoma Cutâneo de Células T/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Urticária/patologia , Vasculite/patologiaRESUMO
Introduction: We define rogue hairs as unusually long hairs on the face outside of the typical hormone-driven hair-bearing areas. These represent a common and previously undocumented phenomenon. This mixed-method study describes the frequency and clinical features of rogue hairs using a case series, patient survey, and social media analysis. Methods: Clinical cases were identified by dermatologists, and social media platforms were searched for additional cases. Social media comments were reviewed using qualitative thematic analysis. Surveys were administered to patients at an academic dermatology clinic. Results: The case series revealed these hairs are seen in children and adults, men and women, and across races. Of the surveyed patients, 18% reported rogue hairs. Social media analysis highlighted common experiences of sudden appearance, frequent removal attempts, and minimal interaction with dermatologists. Conclusion: This mixed-method study defines rogue hairs on the face, underscoring their prevalence despite their benign nature. While the biological explanation for these hairs remains unknown, the study highlights the potential of social media as a tool for clinical inquiry and enhanced understanding of the patient experience. The study provides evidence-based information for individuals experiencing rogue hairs and prompts future research into the biologic mechanisms underlying this common phenomenon.
This research defines a new term called "rogue hairs" which are unusually long hairs on the face outside of the places where long hairs typically grow. These hairs are common but were not previously reported in medical literature. This study describes how often these hairs occur, where they occur, and other details about the people who have them. People with rogue hairs were identified by dermatologists, and social media platforms were searched to find additional people with these hairs. This study also used surveys and social media websites to learn about people with these hairs. The results showed that these hairs are seen in children and adults, men and women, and across races. Eighteen percent of the surveyed patients reported rogue hairs. Social media analysis showed common experiences of sudden appearance, frequent attempts to remove the hairs, and minimal interaction with dermatologists. The cause for these hairs is not known. This study highlights the potential of social media as a tool for answering clinical questions and better understanding the patient experience. The study provides evidence-based information for individuals experiencing rogue hairs and prompts future research into the causes of this common phenomenon.
RESUMO
BACKGROUND: The increase in popularity of tattoos has coincided with an increase in reports of cutaneous inoculation of nontuberculous (atypical) mycobacteria (NTM) during the tattooing process. We report 3 NTM infections in otherwise healthy persons who received tattoos, which prompted a multiagency epidemiologic investigation. METHODS: Tattoo artists involved were contacted and interviewed regarding practices, ink procurement and use, and other symptomatic clients. Additional patients were identified from their client lists with an Internet survey. RESULTS: Thirty-one cases of suspected or confirmed NTM inoculation from professional tattooing were uncovered, including 5 confirmed and 26 suspected cases. Clinical biopsy specimens from 3 confirmed infections grew Mycobacterium abscessus strains that were indistinguishable by pulsed-field gel electrophoresis testing. Another 2 skin specimens grew Mycobacterium chelonae, which also grew from a bottle of graywash ink obtained from the tattoo artist. CONCLUSIONS: The pathogenicity and antibiotic resistance patterns of certain NTM isolates highlight the importance of correct diagnosis and potential difficulty in treating infections. Enforcement of new standards for the regulation and use of tattoo inks should be considered.
Assuntos
Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções por Mycobacterium não Tuberculosas/transmissão , Micobactérias não Tuberculosas/isolamento & purificação , Dermatopatias Bacterianas/etiologia , Tatuagem/efeitos adversos , Antituberculosos/uso terapêutico , Farmacorresistência Bacteriana , Humanos , Tinta , Infecções por Mycobacterium não Tuberculosas/epidemiologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/efeitos dos fármacos , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/microbiologia , Washington/epidemiologiaRESUMO
OBJECTIVE: Continuous subcutaneous insulin infusion (CSII) for type 1 diabetes is increasing in use. Pump site failures are common, but little is known about skin changes from pump use. Using noninvasive optical coherence tomography (OCT), OCT angiography (OCTA), and skin biopsies, we evaluated skin changes from chronic insulin infusion. RESEARCH DESIGN AND METHODS: In this cross-sectional study, OCT operating at a 1,310-nm central wavelength with a bandwidth of 100 nm was performed immediately before skin punch biopsies were collected at three sites: the current site, with the infusion set removed at time of OCT and biopsy; the recovery site, with the infusion set removed 3 days before biopsy; and the control site, which was never used for any insulin infusion or injection. RESULTS: OCT and OCTA identified characteristics of increased inflammation and vessel density at pump sites compared with control sites. Histologic analysis of pump sites showed differences in skin architecture, including fibrosis, inflammation (including increased tissue eosinophils), and fat necrosis. Immunohistochemical staining showed differences between infusion and control sites regarding staining of ILGF-I and transforming growth factor-ß3. CONCLUSIONS: These findings support allergic sensitization as a potentially common reaction at CSII sites. The leading candidates causing this include insulin preservatives, plastic materials, and adhesive glue used in device manufacturing. The inflammatory response caused by these common allergic responses may result in tissue changes responsible for the infusion site failures seen frequently in clinical practice.
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Diabetes Mellitus Tipo 1 , Humanos , Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Estudos Transversais , Insulina/uso terapêutico , Inflamação , Derme , Sistemas de Infusão de InsulinaRESUMO
Most systemic lupus erythematosus (SLE) patients are photosensitive and ultraviolet B light (UVB) exposure worsens cutaneous disease and precipitates systemic flares of disease. The pathogenic link between skin disease and systemic exacerbations in SLE remains elusive. In an acute model of UVB-triggered inflammation, we observed that a single UV exposure triggered a striking IFN-I signature not only in the skin, but also in the blood and kidneys. The early IFN-I signature was significantly higher in female compared to male mice. The early IFN-I response in the skin was almost entirely, and in the blood partly, dependent on the presence of cGAS, as was skin inflammatory cell infiltration. Inhibition of cGAMP hydrolysis augmented the UVB-triggered IFN-I response. UVB skin exposure leads to cGAS-activation and both local and systemic IFN-I signature and could contribute to acute flares of disease in susceptible subjects such as patients with SLE.
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Exposição Ambiental , Interferon Tipo I/biossíntese , Nucleotidiltransferases/metabolismo , Raios Ultravioleta/efeitos adversos , Animais , Citocinas/metabolismo , Dermatite/etiologia , Dermatite/metabolismo , Dermatite/patologia , Modelos Animais de Doenças , Suscetibilidade a Doenças , Feminino , Humanos , Mediadores da Inflamação/metabolismo , Masculino , Camundongos , Camundongos Knockout , Nucleotidiltransferases/genética , Fatores Sexuais , Pele/metabolismo , Pele/patologia , Pele/efeitos da radiaçãoRESUMO
BACKGROUND: Human beta-defensins (hBDs) are antimicrobial peptides with a role in innate immune defense. Our laboratory previously showed that a single nucleotide polymorphism (SNP) in the 5' untranslated region of the hBD1 gene (DEFB1), denoted -44 (rs1800972), is correlated with protection from oral Candida. Because this SNP alters the putative mRNA structure, we hypothesized that it alters hBD1 expression. METHODS: Transfection of reporter constructs and evaluation of antimicrobial activity and mRNA expression levels in keratinocytes from multiple donors were used to evaluate the effect of this SNP on constitutive and induced levels of expression. RESULTS: Transfection of CAT reporter constructs containing the 5' untranslated region showed that the -44 G allele yielded a 2-fold increase in CAT protein compared to other common haplotypes suggesting a cis effect on transcription or translation. The constitutive hBD1 mRNA level in human oral keratinocytes was significantly greater in cells from donors with the -44 GG genotype compared to those with the common CC genotype. Surprisingly, the hBD3 mRNA level as well as antimicrobial activity of keratinocyte extracts also correlated with the -44 G allele. Induced levels of hBD1, hBD2, and hBD3 mRNA were evaluated in keratinocytes challenged with Toll-like receptor 2 and 4 ligands, interleukin-1beta, TNFalpha, and interferon-gamma (IFNgamma). In contrast to constitutive expression levels, IFNgamma-induced keratinocyte hBD1 and hBD3 mRNA expression was significantly greater in cells with the common CC genotype, but there was no clear correlation of genotype with hBD2 expression. CONCLUSION: The DEFB1 -44 G allele is associated with an increase in overall constitutive antimicrobial activity and expression of hBD1 and hBD3 in a manner that is consistent with protection from candidiasis, while the more common C allele is associated with IFNgamma inducibility of these beta-defensins and is likely to be more protective in conditions that enhance IFNgamma expression such as chronic periodontitis. These results suggest a complex relationship between genetics and defensin expression that may influence periodontal health and innate immune responses.
RESUMO
Delusional infestation is a psychiatric condition defined by a fixed belief of infestation despite contrary evidence. Diagnosis includes exclusion of organic etiologies. Treatment with antipsychotics is effective and safe in the majority of patients. Patients are characteristically reluctant to pursue psychiatric evaluation and may resist discussing their disease in psychiatric terms. Strategies to strengthen the provider-patient therapeutic alliance facilitate communication around appropriate treatment. Without antipsychotic medications, patients can become heavy utilizers of care and practice self-destructive behaviors in attempts to clear their perceived infestation.
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Antipsicóticos/uso terapêutico , Delírio de Parasitose/tratamento farmacológico , Delírio de Parasitose/epidemiologia , Compreensão , Delírio de Parasitose/diagnóstico , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Prevalência , Prognóstico , Medição de RiscoRESUMO
CD4+/CD56+ hematodermic neoplasm (HN), formerly known as a blastic natural killer (NK) cell lymphoma, is a rare subtype of a cutaneous dendritic cell neoplasm notable for highly aggressive behavior. The characteristic features are: expression of the T-helper/inducer cell marker CD4 and the NK-cell marker CD56 in the absence of other T cell or NK-cell specific markers. In particular, CD3 (surface or cytoplasmic) and CD2 are not expressed. Although T-cell receptor (TCR) genes are generally reported to be in a germline configuration, we present an unusual variant of a CD4+/CD56+ HN with a clonal rearrangement of TCR genes. This feature of a CD4+/CD56+ HN has been only rarely reported. Recognition of the presence of clonal TCR gene rearrangements in a small subset of CD4+/CD56+ HN is important to avoid misdiagnosis of this entity as an unusual variant of a cutaneous T-cell lymphoma.
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Antígenos CD4/análise , Antígeno CD56/análise , Rearranjo Gênico da Cadeia gama dos Receptores de Antígenos dos Linfócitos T/genética , Linfoma Cutâneo de Células T/patologia , Neoplasias Cutâneas/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Ciclofosfamida/uso terapêutico , DNA de Neoplasias/genética , Dexametasona/uso terapêutico , Doxorrubicina/uso terapêutico , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Linfoma Cutâneo de Células T/química , Linfoma Cutâneo de Células T/tratamento farmacológico , Linfoma Cutâneo de Células T/genética , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/química , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/genética , Vincristina/uso terapêuticoRESUMO
This case report describes significant longitudinal ridging and nail plate crumbling on several of a patient's fingernails.
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Doenças da Unha , Sarcoidose , Humanos , Unhas , Doenças da Unha/diagnóstico , Doenças da Unha/etiologia , Sarcoidose/diagnósticoRESUMO
In common rheumatologic diseases skin findings are an important diagnostic clue for astute clinicians. Skin manifestations can help identify systemic disease or may require therapy uniquely targeted at the cutaneous problem. This article discusses 3 common rheumatologic conditions seen in adults by dermatologists: cutaneous lupus, dermatomyositis, and morphea. The focus is on the cutaneous findings and clinical presentation. Some approaches to treatment are explored. Clues to help identify systemic disease are also highlighted.
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Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Tecido Conjuntivo/terapia , Anticorpos/sangue , Antirreumáticos/uso terapêutico , Inibidores de Calcineurina/uso terapêutico , Diagnóstico Diferencial , Glucocorticoides/uso terapêutico , Humanos , Anamnese , Síndromes Paraneoplásicas/diagnóstico , Fototerapia , Exame FísicoRESUMO
We report an immunocompetent woman with multisystem organ failure following herpes simplex virus type 2 (HSV-2) hepatitis. After she initially responded to intravenous acyclovir, she was switched to oral valacyclovir. She developed respiratory failure and opportunistic infections and died. Autopsy confirmed disseminated HSV infection, and lung tissue grew acyclovir-resistant HSV-2.