Subject(s)
COVID-19 , Dermatology , Motivation , Skin Diseases , Telemedicine/trends , France , Humans , PandemicsSubject(s)
Acute Generalized Exanthematous Pustulosis/etiology , Antifungal Agents/adverse effects , Candidiasis, Oral/drug therapy , Drug Hypersensitivity Syndrome/etiology , Miconazole/adverse effects , Administration, Oral , Antifungal Agents/administration & dosage , Female , Humans , Miconazole/administration & dosage , Middle AgedABSTRACT
Mucous membrane pemphigoid is a rare autoimmune blistering disease characterized by post-bullous erosion of mucous membranes. Herein, we present a case of a nonagenarian man who was referred to our department of dermatology presenting with painful erosion of the buccal mucosa. Physical examination revealed palate erosion associated with erosion of the buccal mucosa. A diagnosis of mucous membrane pemphigoid was confirmed, and the patient was successfully treated with topical corticosteroids.
ABSTRACT
Eccrine syringofibroadenoma (ESFA) is a rare adnexal tumor deriving from the acrosyringeal portion of the eccrine duct. Five subtypes of ESFA were described including a reactive form. Reactive ESFAs are associated with inflammatory and neoplastic dermatoses. In this article, we report the case of a 90-year-old woman presenting with 3 leg ulcers evolving for 2 years surrounded by large verrucous and eczematous lesions. Multiple skin biopsies showed anastomosing epithelial cords connected to the epidermis consistent with ESFA. We identified 8 cases of ESFA associated with chronic leg ulcers in the literature and reviewed their main clinical and histological features.
Subject(s)
Adenoma, Sweat Gland , Leg Ulcer , Skin Neoplasms , Sweat Gland Neoplasms , Varicose Ulcer , Female , Humans , Aged, 80 and over , Adenoma, Sweat Gland/complications , Adenoma, Sweat Gland/pathology , Sweat Gland Neoplasms/complications , Sweat Gland Neoplasms/diagnosis , Sweat Gland Neoplasms/pathology , Skin/pathology , Skin Neoplasms/complications , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Varicose Ulcer/pathology , Leg Ulcer/pathology , Eccrine Glands/pathologyABSTRACT
Immune checkpoint inhibitors (ICIs) have become the standard treatment for many types of cancer. After several years of using these therapies, many adverse events related to ICIs have been observed. Dermatologic toxicities such as nonspecific morbilliform rash, vitiligo, Stevens-Johnson syndrome/toxic epidermal necrolysis, and more rarely, lichenoid eruptions have been described in the literature. We report 2 cases of pustular lichenoid eruptions, 1 in a patient with nonsmall cell lung carcinoma and 1 in a patient with metastatic melanoma, induced by pembrolizumab and nivolumab, respectively. The 2 patients were treated with topical corticosteroids, and complete healing of lesions was slowly obtained. Due to the severity of the cutaneous eruptions, pembrolizumab and nivolumab were discontinued. We identified 6 cases of pustular lichenoid eruptions induced by ICIs in the published literature and in the French Pharmacovigilance Database and reviewed their main clinical features and courses.
Subject(s)
Exanthema , Lichenoid Eruptions , Lung Neoplasms , Melanoma , Humans , Nivolumab/adverse effects , Immune Checkpoint Inhibitors/adverse effects , Melanoma/drug therapy , Lichenoid Eruptions/etiology , Lichenoid Eruptions/chemically induced , Exanthema/chemically induced , Lung Neoplasms/drug therapyABSTRACT
Calcific uremic arteriolopathy (CUA) is a severely morbid disease, affecting mostly dialyzed end-stage renal disease (ESRD) patients, associated with calcium deposits in the skin. Calcifications have been identified in ESRD patients without CUA, indicating that their presence is not specific to the disease. The objective of this retrospective multicenter study was to compare elastic fiber structure and skin calcifications in ESRD patients with CUA to those without CUA using innovative structural techniques. Fourteen ESRD patients with CUA were compared to 12 ESRD patients without CUA. Analyses of elastic fiber structure and skin calcifications using multiphoton microscopy followed by machine-learning analysis and field-emission scanning electron microscopy coupled with energy dispersive X-ray were performed. Elastic fibers specifically appeared fragmented in CUA. Quantitative analyses of multiphoton images showed that they were significantly straighter in ESRD patients with CUA than without CUA. Interstitial and vascular calcifications were observed in both groups of ESRD patients, but vascular calcifications specifically appeared massive and circumferential in CUA. Unlike interstitial calcifications, massive circumferential vascular calcifications and elastic fibers straightening appeared specific to CUA. The origins of such specific elastic fiber's alteration are still to be explored and may involve relationships with ischemic vascular or inflammatory processes.
Subject(s)
Calciphylaxis , Kidney Failure, Chronic , Vascular Calcification , Humans , Elastic Tissue , Kidney Failure, Chronic/complications , Margins of Excision , Microscopy, Electron, ScanningABSTRACT
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disease characterized by aberrant immune hyperactivation of T CD8 lymphocytes and macrophages driven by cytokine dysfunction. We report a 64-year-old man, with advanced BRAF-mutant melanoma treated by combined targeted therapies who had a recalcitrant and cortico-dependent Epstein-Barr virus (EBV)-induced HLH. One rituximab cycle led to a rapid and prolonged HLH remission which allowed to switch the targeted therapy for immunotherapy rituximab thus makes it possible to limit the use of corticosteroids, which limits the effectiveness of immunotherapy. The patient finally died of a cerebral tumoral progression 2 years later. Despite secondary hypogammaglobulinemia, we did not observe any severe infections during this period. This case suggests that rituximab can be a valuable option for EBV-induced HLH to avoid the T-suppressive effects of high-dose of corticosteroids in immunotherapy-treated patients.
Subject(s)
Epstein-Barr Virus Infections , Lymphohistiocytosis, Hemophagocytic , Melanoma , Skin Neoplasms , Male , Humans , Middle Aged , Lymphohistiocytosis, Hemophagocytic/drug therapy , Rituximab/pharmacology , Rituximab/therapeutic use , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/drug therapy , Herpesvirus 4, Human , Melanoma/complications , Melanoma/drug therapy , Skin Neoplasms/drug therapyABSTRACT
Hard-to-heal wounds are a problem for both patients and caregivers. The biofi lm is one of the local factors of delayed healing. Wound hygiene carried out in 4 steps (cleansing, debridement, refashion - care of the edges, and dressing) constitutes the basis of proactive and curative anti-biofi lm strategies.
Subject(s)
Bandages , Wound Healing , HumansABSTRACT
HHV-6B is the subtype most often involved in the systemic manifestations of the DRESS, but also in myelosuppression in bone marrow transplant. We report a new observation of its myelosuppressive effect: a case of DRESS complicated by agranulocytosis with detectable HHV-6 RNA in bone marrow.
ABSTRACT
Primary cutaneous EBV-positive diffuse large B-cell lymphoma is an exceptional and aggressive neoplasia with a poorer prognosis than other cutaneous lymphoma. Our observation points out the rarity of the presentation and the dismal clinical course.
ABSTRACT
Mycobacterium ulcerans is the causal agent of Buruli ulcer, a neglected tropical disease with cutaneous tropism. We report a case of Buruli ulcer in a patient who travelled in Senegal, a country not identified by the World Health Organization as being endemic for this disease. This case is the third case of Buruli ulcer reported as having been contracted in Senegal, showing the urgent need to develop data collection in this country by having an active community-based surveillance-response system.
Subject(s)
Buruli Ulcer/microbiology , Aged , Buruli Ulcer/diagnosis , Buruli Ulcer/epidemiology , Humans , Male , Mycobacterium ulcerans/genetics , Mycobacterium ulcerans/isolation & purification , Mycobacterium ulcerans/physiology , Senegal/epidemiologyABSTRACT
Importance: Calcific uremic arteriolopathy (CUA), a rare, potentially fatal, disease with calcium deposits in skin, mostly affects patients with end-stage renal disease who are receiving dialysis. Chemical composition and structure of CUA calcifications have been poorly described. Objectives: To describe the localization and morphologic features and determine the precise chemical composition of CUA-related calcium deposits in skin, and identify any mortality-associated factors. Design, Setting, and Participants: A retrospective, multicenter cohort study was conducted at 7 French hospitals including consecutive adults diagnosed with CUA between January 1, 2006, and January 1, 2017, confirmed according to Hayashi clinical and histologic criteria. Patients with normal renal function were excluded. For comparison, 5 skin samples from patients with arteriolosclerosis and 5 others from the negative margins of skin-carcinoma resection specimens were also analyzed. Main Outcomes and Measures: Localization and morphologic features of the CUA-related cutaneous calcium deposits were assessed with optical microscopy and field-emission-scanning electron microscopy, and the chemical compositions of those deposits were evaluated with µ Fourier transform infrared spectroscopy, Raman spectroscopy, and energy dispersive radiographs. Results: Thirty-six patients (median [range] age, 64 [33-89] years; 26 [72%] female) were included, and 29 cutaneous biopsies were analyzed. Calcific uremic arteriolopathy and arteriolosclerosis skin calcifications were composed of pure calcium-phosphate apatite. Calcific uremic arteriolopathy vascular calcifications were always circumferential, found in small to medium-sized vessels, with interstitial deposits in 22 (76%) of the samples. A thrombosis, most often in noncalcified capillary lumens in the superficial dermis, was seen in 5 samples from patients with CUA. Except for calcium deposits, the vessel structure of patients with CUA appeared normal, unlike thickened arteriolosclerotic vessel walls. Twelve (33%) patients died of CUA. Conclusions and Relevance: Calcific uremic arteriolopathy-related skin calcifications were exclusively composed of pure calcium-phosphate apatite, localized circumferentially in small to medium-sized vessels and often associated with interstitial deposits, suggesting its pathogenesis differs from that of arteriolosclerosis. Although the chemical compositions of CUA and arteriolosclerosis calcifications were similar, the vessels' appearances and deposit localizations differed, suggesting different pathogenetic mechanisms.