RESUMEN
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.
Asunto(s)
Eccema Dishidrótico , Micosis Fungoide , Neoplasias Cutáneas , Humanos , Femenino , Micosis Fungoide/diagnóstico , Micosis Fungoide/tratamiento farmacológico , Micosis Fungoide/patología , Diagnóstico Diferencial , Persona de Mediana Edad , Eccema Dishidrótico/diagnóstico , Eccema Dishidrótico/tratamiento farmacológico , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/tratamiento farmacológico , Betametasona/administración & dosificación , Betametasona/análogos & derivadosRESUMEN
BACKGROUND: Palmoplantar pustulosis (PPP) and pompholyx are chronic diseases characterized by pustules and vesicles on the palms and soles. These disorders often have similar clinicopathological features, which lead to diagnostic difficulties. We aimed to investigate the expression patterns of keratins and involucrin in PPP and pompholyx using immunohistochemical staining. METHODS: Skin biopsies from patients with PPP (n = 40) and pompholyx (n = 22) were immunohistochemically analyzed for Keratin 5, 9, 14, and involucrin expression. RESULTS: K5 expression was higher in PPP than in pompholyx, with diffusely positive expression in the basal, spinous, and granular layers. K14 expression did not differ between groups. K9 expression was observed near the pompholyx vesicle (P = 0.014) and stratum spinosum (P < 0.001) but was almost absent around PPP pustules. Involucrin expression was diffused around the PPP pustules and partially around the pompholyx vesicles, but without statistical significance (P = 0.123). Involucrin expression was elevated in the basal layer of the PPP compared with that in the pompholyx (P = 0.023). CONCLUSION: PPP and pompholyx exhibited distinctive differentiation in the expression of K5, K9, and involucrin.
Asunto(s)
Inmunohistoquímica , Queratinas , Precursores de Proteínas , Psoriasis , Humanos , Precursores de Proteínas/metabolismo , Precursores de Proteínas/análisis , Psoriasis/metabolismo , Psoriasis/patología , Psoriasis/diagnóstico , Masculino , Femenino , Queratinas/metabolismo , Queratinas/análisis , Persona de Mediana Edad , Adulto , Diagnóstico Diferencial , Anciano , Adulto Joven , Eccema Dishidrótico/diagnóstico , Eccema Dishidrótico/metabolismo , Eccema Dishidrótico/patología , Biopsia , Adolescente , Piel/patología , Piel/metabolismo , Queratina-9/metabolismo , Queratina-9/análisis , Queratina-14/metabolismo , Queratina-14/análisisAsunto(s)
Eccema Dishidrótico , Humanos , Eccema Dishidrótico/diagnóstico , Piel , Diagnóstico DiferencialRESUMEN
Intravenous immunoglobulin (IVIg) is increasingly used for the treatment of inflammatory and autoimmune diseases. Although skin reactions to IVIg therapy are usually minor, rare, and not life-threatening, dermatologists need to recognize the nature of these adverse reactions. We describe a 33-year-old man suffering from demyelinating polyneuropathy who developed dyshidrotic eczema on the palms and flaky grayish-white scales on an erythematous base on his face after the administration of IVIg.
Asunto(s)
Dermatitis Seborreica , Eccema Dishidrótico , Eccema , Exantema , Adulto , Eccema/inducido químicamente , Eccema/diagnóstico , Eccema/terapia , Eccema Dishidrótico/inducido químicamente , Eccema Dishidrótico/diagnóstico , Humanos , Inmunoglobulinas Intravenosas/efectos adversos , MasculinoRESUMEN
INTRODUCTION: Bullous pemphigoid is an autoimmune bullous disease characterized by subepidermal separation. We encountered cases of bullous pemphigoid confirmed by direct immunofluorescence study but demonstrating spongiotic dermatitis without subepidermal clefting. Many of them occurred in volar sites, mimicking dyshidrotic dermatitis. METHODS: We retrospectively collected patients who were pathologically and/or immunopathologically diagnosed with bullous pemphigoid from 2002 to 2017. Patients who presented with prominent spongiosis without subepidermal clefting were included and compared with patients who were diagnosed with dyshidrotic dermatitis. RESULTS: A total of nine cases of spongiform pemphigoid out of 385 bullous pemphigoid patients (2.3%) were identified and compared with 15 patients with dyshidrotic dermatitis. Average age of spongiform pemphigoid patients (76 years) was much older than that of the control group (34 years). Microvesicles in the mid- to lower epidermis (P < 0.001), eosinophils exocytosis (P < 0.001), and eosinophils microabscess (P < 0.001) in both the epidermis and papillary dermis were more common in spongiform pemphigoid. CONCLUSION: Spongiform pemphigoid mimics spongiotic dermatitis may result in a pathological diagnostic pitfall. The presence of eosinophil microabscess and exocytosis in the epidermis and papillary dermis were important clues. Immunofluorescence studies should be conducted to confirm the diagnosis of bullous pemphigoid.
Asunto(s)
Enfermedades Autoinmunes , Penfigoide Ampolloso , Anciano , Anciano de 80 o más Años , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/inmunología , Enfermedades Autoinmunes/metabolismo , Enfermedades Autoinmunes/patología , Eccema Dishidrótico/diagnóstico , Eccema Dishidrótico/inmunología , Eccema Dishidrótico/metabolismo , Eccema Dishidrótico/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Penfigoide Ampolloso/diagnóstico , Penfigoide Ampolloso/inmunología , Penfigoide Ampolloso/metabolismo , Penfigoide Ampolloso/patología , Estudios RetrospectivosRESUMEN
Palmoplantar pustulosis (PPP) and pompholyx are both chronic and relapsing diseases occurring on the palms and soles. Although these two diseases have been considered completely different from each other, it is sometimes very difficult even for dermatologists to differentiate them from each other because of their similarities in clinical presentation. In this study, we aimed to analyze the histopathological features of PPP and pompholyx and find out "clues" to differentiate between PPP and pompholyx by their histopathological features. The histopathology of 11 PPP and six pompholyx patients, who were diagnosed with typical clinical history and histopathology, were carefully observed. PPP cases were divided into three phases (vesicle, pustulovesicule and pustule) and pompholyx cases were divided into two phases (vesicle and pustule), and histopathological findings and a 4-point checklist to distinguish between PPP and pompholyx were preliminarily established. To confirm whether the checklist establishes the clues for diagnosis, biopsy samples from 43 patients (32 PPP and 11 pompholyx) who had been already diagnosed at five hospitals were examined according to our checklist without any additional clinical information. According to our 4-point checklist, 31 of 32 PPP patients and all 11 pompholyx patients were diagnosed histopathologically consistent with their clinical diagnosis. In conclusion, histopathological findings of "vesicles without spongiosis" and "microabscess on the edges of vesicles" would be impact points for the differential diagnosis between PPP and pompholyx. The 4-point checklist was trustworthy to distinguish between PPP and pompholyx.
Asunto(s)
Lista de Verificación/métodos , Eccema Dishidrótico/diagnóstico , Psoriasis/diagnóstico , Piel/patología , Adulto , Anciano , Biopsia , Diagnóstico Diferencial , Eccema Dishidrótico/patología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psoriasis/patologíaRESUMEN
A 44-year-old woman with a history of asthma, hypercholesterolemia, and impaired glucose tolerance presented with severely painful and intensely pruritic plantar dermatitis for more than two years that impaired her ability to walk.
Asunto(s)
Antiasmáticos/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Eccema Dishidrótico/diagnóstico , Eccema Dishidrótico/tratamiento farmacológico , Pie/patología , Índice de Severidad de la Enfermedad , Adulto , Anticuerpos Monoclonales Humanizados , Femenino , Humanos , Inducción de Remisión/métodosAsunto(s)
Eccema Dishidrótico/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Pie , Mano , HumanosRESUMEN
Dupilumab (Dupixent, Regeneron Pharmaceuticals and Sanofi Genzyme) is a novel biologic medication recently approved by the FDA for the treatment of moderate-to-severe atopic dermatitis in adults who have not achieved adequate control with topical medications. Dyshidrotic eczema is a distinct entity, often considered on the spectrum of atopic dermatitis, that primarily effects the palms and soles; it is often associated with considerable morbidity yet is frequently challenging to treat. We report two cases of recalcitrant dyshidrotic eczema treated successfully with dupilumab at standard dosing. Further studies to establish the efficacy of dupilumab in the treatment of dyshidrosis are warranted.
J Drugs Dermatol. 2018;17(3):355-356.
.Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Eccema Dishidrótico/diagnóstico , Eccema Dishidrótico/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Eccema Dishidrótico/diagnóstico , Linfoma Cutáneo de Células T/diagnóstico , Linfoma de Células T Periférico/diagnóstico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica , Biopsia , Ciclofosfamida , Diagnóstico Diferencial , Doxorrubicina , Eccema Dishidrótico/tratamiento farmacológico , Humanos , Inmunohistoquímica , Linfoma Cutáneo de Células T/tratamiento farmacológico , Linfoma de Células T Periférico/tratamiento farmacológico , Masculino , Prednisona , Tomografía Computarizada por Rayos X , VincristinaRESUMEN
La hidradenitis palmoplantar idiopática (HPPI) es una dermatosis neutrofílica que cursa con placas eritematoso-edematosas en las plantas de los pies y, en ocasiones, en las palmas de las manos. Estas lesiones se presentan en niños sin antecedentes de medicación ni manifestaciones sistémicas. Se postula que determinados factores mecánicos afectarían a las glándulas ecrinas inmaduras. El tratamiento es controvertido, aunque se ha observado que se puede manejar de forma conservadora. Por otro lado, el diagnóstico histológico, que presenta hallazgos típicos, no sería necesario realizarlo en todos los casos, puesto que la mayoría presenta una clínica característica con resolución espontánea en menos de 3 semanas. Presentamos dos casos de HPPI en niños (AU)
Idiopathic palmoplantar hidradenitis (IPPH) is a neutrophilic dermatosis that causes erythematous plaques in plants and sometimes in palms. These injuries occur in children with no history of medication or systemic manifestations. It is postulated that mechanical factors affect immature eccrine glands. The treatment is controversial, although we know that it can be conservatively managed. On the other hand, histological diagnosis, which presents typical findings, would not be necessary in all cases, since most of them present characteristic symptoms and spontaneous remission in less than three weeks. We present two cases of IPPH in children (AU)
Asunto(s)
Humanos , Masculino , Preescolar , Niño , Hidradenitis/complicaciones , Hidradenitis/diagnóstico , Glándulas Sudoríparas/anatomía & histología , Eritema/complicaciones , Diagnóstico Diferencial , Descanso , Analgésicos/uso terapéutico , Eccema Dishidrótico/complicaciones , Eccema Dishidrótico/diagnóstico , Sudoración , Traumatismos de los Pies/complicacionesRESUMEN
Background: Pompholyx is a type of hand eczema which is characterized by recurrent vesicles and bullae.It is seen commonly in the age group 20 -40 years, affects all races and has an equal sex distribution. It is commonly associated with contact allergic dermatitis and contact irritant dermatitis and atopy. Other associated factors include emotional stress, chronic illness such as HIV and physiological states like pregnancy. Pompholyx is said to be common in warm climate. In which the study area can be classified as such being a tropical climate in the Sub Saharan Africa. Pompholyx is a disease that reduces the quality of living of affected individuals and can bea cause of social stigmatization, often mistaken for a contagious infection such as scabies. It can also be a cause great discomfort to the body and mind leading to work and school absenteeism. Methodology:It was a retrospective cross sectional study of new pompholyx cases within the period of January 2006 to December 2015 from the new patient clinical register. Folders were retrieved and data was extracted using a semi-structured questionnaire developed from standard written medical literature on pompholyx. Data was analyzed using Statistical Package for Social Sciences version 20.Results:Thirty six new cases of pompholyx were seen within the period with an average incidence of 0.59% over the ten year period consisting of 22 females and 14 males with age range of 2- 65years.There was no statistical significant relationship between age categories and sex. The majority of cases were seen amongst students. The age 20-45 group constituted the highest number. 61% had a history of contact dermatitis with the major triggers being detergents, chemicals and metals. All patients were counseled and improved after receiving treatment from at least two of the five major classes of drugs- corticosteroids, antifungal, antibiotics, antihistamines and astringents. Conclusion:Pompholyx is a recurrent hand dermatitis characterized by vesicles and bullae though not common as the study reflects; it can be a source of mental and physical discomfort leading to a poor quality of life in affected individuals
Asunto(s)
Dermatitis Alérgica por Contacto/epidemiología , Eccema Dishidrótico/diagnóstico , Eccema Dishidrótico/epidemiología , NigeriaAsunto(s)
Fibrilación Atrial/tratamiento farmacológico , Dabigatrán/efectos adversos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Eccema Dishidrótico/diagnóstico , Psoriasis/diagnóstico , Enfermedades Cutáneas Eccematosas , Anciano , Antitrombinas/administración & dosificación , Antitrombinas/efectos adversos , Fibrilación Atrial/complicaciones , Biopsia/métodos , Dabigatrán/administración & dosificación , Diagnóstico Diferencial , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/patología , Femenino , Humanos , Piel/patología , Enfermedades Cutáneas Eccematosas/inducido químicamente , Enfermedades Cutáneas Eccematosas/diagnóstico , Enfermedades Cutáneas Eccematosas/patología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & controlRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anciano , Eccema Dishidrótico/inducido químicamente , Eccema Dishidrótico/diagnóstico , Eccema Dishidrótico/patología , Inmunoglobulinas Intravenosas/efectos adversos , Inmunoglobulinas Intravenosas/análisis , Inmunoglobulinas Intravenosas/inmunología , Examen Físico/instrumentación , Examen Físico/métodos , Examen Físico , Diagnóstico , Corticoesteroides/farmacología , Corticoesteroides/uso terapéutico , Pruebas Serológicas/instrumentación , Pruebas Serológicas/métodos , Pruebas Serológicas , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/patología , Enfermedades de la Piel/terapiaRESUMEN
BACKGROUND: Classification of hand eczema (HE) is mandatory in epidemiological and clinical studies, and also important in clinical work. OBJECTIVES: The aim was to test a recently proposed classification system of HE in clinical practice in a prospective multicentre study. METHODS: Patients were recruited from nine different tertiary referral centres. All patients underwent examination by specialists in dermatology and were checked using relevant allergy testing. Patients were classified into one of the six diagnostic subgroups of HE: allergic contact dermatitis, irritant contact dermatitis, atopic HE, protein contact dermatitis/contact urticaria, hyperkeratotic endogenous eczema and vesicular endogenous eczema, respectively. An additional diagnosis was given if symptoms indicated that factors additional to the main diagnosis were of importance for the disease. RESULTS: Four hundred and twenty-seven patients were included, 379 (89%) of the patients could be classified directly into one of the six diagnostic subgroups, with irritant and allergic contact dermatitis comprising 249 patients (58%). For 32 (7%) more than one of the six diagnostic subgroups had been formulated as a main diagnosis, and 16 (4%) could not be classified. 38% had one additional diagnosis and 26% had two or more additional diagnoses. Eczema on feet was found in 30% of the patients, statistically significantly more frequently associated with hyperkeratotic and vesicular endogenous eczema. CONCLUSION: We find that the classification system investigated in the present study was useful, being able to give an appropriate main diagnosis for 89% of HE patients, and for another 7% when using two main diagnoses. The fact that more than half of the patients had one or more additional diagnoses illustrates that HE is a multifactorial disease.