ABSTRACT
PURPOSE OF REVIEW: This review provides updates on postinfectious skin rashes in the pediatric population from recently published literature. RECENT FINDINGS: The COVID-19 pandemic and its sequelae remain a focus of research on pediatric infectious skin rashes. Multisystem inflammatory syndrome in children (MIS-C) and reactive infectious mucocutaneous eruption (RIME) are common complications of infection with SARS-COV-2 in the pediatric population. Most cases of MIS-C show low mortality and suggest mucocutaneous symptoms do not correlate with COVID-19 disease severity. Cases of papular acrodermatitis of childhood, also known as Gianotti-Crosti, have also been reported in association with SARS-COV-2, and can present similarly in reaction to other viral infection like molluscum contagiosum, known as a Gianotti-Crosti syndrome-like reaction (GCLR). Other relevant studies on postinfectious skin rashes include updates on the management of staphylococcal scalded skin syndrome (SSSS), with newer evidence advocating for beta-lactam monotherapy without clindamycin and reduced ancillary testing. Finally, the emergence of antifungal resistance due to Trichophyton indotinae is a growing global health concern emphasizing the need for improved antifungal stewardship. SUMMARY: It is prudent for clinicians to be informed of both common and rare diagnoses that have emerged more recently in association with the COVID-19 pandemic, in addition to other diseases with newer evidence-based recommendations to guide management.
Subject(s)
COVID-19 , Humans , COVID-19/complications , Child , Exanthema/etiology , Exanthema/diagnosis , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Acrodermatitis/diagnosis , Acrodermatitis/etiologyABSTRACT
BACKGROUND: Transient symptomatic zinc deficiency (TSZD), an acquired type of zinc deficiency, is a rare, but probably underrecognized disease, extremely in breastfed premature with low birthweight infants. Its clinical manefestations are similar to Acrodermatitis enteropathica (AE), which is a genetic zinc absorption disorder caused by SLC39A4 gene mutations. This gene encodes a member of the zinc/iron-regulated transporter-like protein (ZIP) family. The encoded protein localizes to cell membranes and is required for zinc uptake in the intestine. TSZD is often misdiagnosed as AE because of their extremely similar manefestations, characterized by a typical rash. Therefore, the differention between them is still a clinical challenging. CASE PRESENTATION: Here, we present a case of TSZD in a 4 month and 23 days female Chinese Yi-ethnic premature with AE-like skin lesions, mainly presenting periorificial, perianal and perineal crusted, eroded, erythemato-squamous eruption. Laboratory examination showed the patient's blood zinc level was significantly decreased. Further sequencing of the SLC39A4 gene showed no mutation in the infant and her parents. Skin lesions significantly improved after 6 days of initial zinc supplementation (3 mg/kg/d), and maintenance treatment with 1 mg/kg/day of zinc was discontinued after 8 months without recurrence. CONCLUSIONS: The clinical manifestations of TSZD and AE are extremely similar, leading to a high rate of clinical misdiagnosis. While genetic analysis of the SLC39A4 gene is a reliable method for differentiating TSZD from AE. It is recommended that SLC39A4 gene test should be performed as far as possible in children with AE-like rash.
Subject(s)
Acrodermatitis , Zinc , Humans , Zinc/deficiency , Zinc/blood , Acrodermatitis/diagnosis , Acrodermatitis/genetics , Acrodermatitis/etiology , Female , Infant , Diagnosis, Differential , China , Cation Transport Proteins/genetics , Infant, Premature , Infant, Newborn , Infant, Premature, Diseases/diagnosis , Infant, Premature, Diseases/genetics , Infant, Premature, Diseases/blood , East Asian PeopleABSTRACT
During the past four decades the number of reported Lyme disease diagnoses in the Netherlands has increased to 27.000 a year, with a yearly incidence of Lyme disease between 111 (95% CI 106-115) to 131 (95% CI 126-136) per 100,000 person years. A large part of all Lyme disease diagnoses concern the skin; in the Netherlands, 77-89% erythema migrans, 2-3% borrelia lymfocytoom and 1-3% acrodermatitis chronica atrophicans. These skin manifestations have a variable clinical expression, reason why they can be difficult to diagnose. Early recognition and treatment is important to prevent the development of systemic manifestations.
Subject(s)
Acrodermatitis , Erythema Chronicum Migrans , Exanthema , Lyme Disease , Skin Diseases , Humans , Acrodermatitis/diagnosis , Acrodermatitis/drug therapy , Acrodermatitis/etiology , Lyme Disease/complications , Lyme Disease/diagnosis , Lyme Disease/drug therapy , Erythema Chronicum Migrans/diagnosis , Erythema Chronicum Migrans/drug therapy , Erythema Chronicum Migrans/etiology , Exanthema/diagnosis , Exanthema/etiologySubject(s)
Acrodermatitis , Deficiency Diseases , Zinc , Humans , Acrodermatitis/diagnosis , Acrodermatitis/etiology , Acrodermatitis/genetics , Acrodermatitis/therapy , Zinc/deficiency , Zinc/metabolism , Zinc/therapeutic use , Deficiency Diseases/diagnosis , Deficiency Diseases/etiology , Deficiency Diseases/genetics , Deficiency Diseases/therapySubject(s)
Acrodermatitis , COVID-19 , Humans , Acrodermatitis/diagnosis , Acrodermatitis/etiology , COVID-19/complicationsABSTRACT
We report the case of an otherwise healthy 47 year-old man who presented to the dermatology outpatient clinic with asymptomatic, one sided erythema of his leg, without edema. The diagnosis acrodermatitis chronica atrophicans was made based on positive IgG antibodies to Borrelia burgdorferi.
Subject(s)
Acrodermatitis , Borrelia burgdorferi Group , Lyme Disease , Male , Humans , Middle Aged , Leg , Acrodermatitis/diagnosis , Acrodermatitis/etiology , Lyme Disease/complications , Lyme Disease/diagnosis , Erythema/diagnosis , Erythema/etiologyABSTRACT
Acrodermatitis Enteropathica is a rare hereditary condition characterized by perioral dermatitis, diarrhoea, and alopecia. Aetiology includes autosomal recessive inheritance and acquired causes such as protein malnutrition, malabsorption syndromes, premature births, parenteral nutrition, chronic illnesses, and alcoholism. We report a rare case of a 12-year-old boy who presented with cutaneous manifestations involving the whole body, diarrhoea, and sparse hairs. A low level of plasma zinc, and alkaline phosphatase level was found, and he was started on zinc supplements. He significantly improved in a few days, and was discharged after counselling the parents about treatment compliance. This case highlights importance of early diagnosis, and the importance of treatment compliance in Acrodermatitis Enteropathica. It also stresses the need to take measures to ensure the provision of health facilities especially in remote areas.
Subject(s)
Acrodermatitis , COVID-19 , Male , Humans , Child , COVID-19/complications , Communicable Disease Control , Zinc/therapeutic use , Acrodermatitis/diagnosis , Acrodermatitis/etiology , DiarrheaABSTRACT
Acrodermatitis enteropathica (AE) is a rare disorder which can be congenital or acquired. The main features are peri-orificial dermatitis, gastrointestinal symptom in the form of diarrhoea, acral dermatitis and alopecia, among others. This report aims to highlight that AE is an important differential diagnosis to consider, when managing older patients with mucosal infections or ulcerations. Here, we present the case of a 68-year-old female with end-stage liver disease who presented with a right inter-trochanteric femoral fracture following a fall and was noted, on admission, to have non-healing mucosal ulcers.
Subject(s)
Acrodermatitis , Ulcer , Female , Humans , Aged , Ulcer/diagnosis , Ulcer/etiology , Acrodermatitis/diagnosis , Acrodermatitis/etiology , Zinc , VulvaABSTRACT
Zinc deficiency has long been known as acrodermatitis enteric dermatitis (congenital zinc deficiency). On the other hand, acquired zinc deficiency has attracted attention as a familiar disease in recent years. Epidemiological studies in Japan have shown that acquired zinc deficiency is more common than expected. It is also known that serum zinc levels fall markedly with age. In this report, several cases of acquired zinc deficiency that caused cheilitis are described. In all cases, the only symptom was cheilitis, the serum zinc level was low, and all cases were relieved by zinc supplementation. Zinc deficiency is associated with a range of pathological conditions, including mucocutaneous symptoms, delayed wound healing, dysgeusia, anemia, impaired immunity, and retarded growth development disorders. However, zinc deficiency may be overlooked even in cases of cheilitis alone. Especially in intractable cases, it is important to suspect zinc deficiency as one at the differential diagnoses.
Subject(s)
Acrodermatitis , Cheilitis , Humans , Cheilitis/etiology , Cheilitis/complications , Acrodermatitis/diagnosis , Acrodermatitis/etiology , Zinc , Intestine, Small , JapanABSTRACT
Acroangiodermatitis (AAD)[KL1] is a rare vasoproliferative disorder often involving the extremities that has been classified into two variants. Mali-type AAD is more common and associated with chronic venous stasis. Stewart-Bluefarb syndrome[KL2], the other variant, is associated with underlying arteriovenous abnormalities. Mali-type AAD is a relatively benign diagnosis but it may mimic more harmful etiologies such as Kaposi sarcoma both clinically and histologically. A 67-year-old woman with a history of varicose veins, deep vein thrombosis, stroke, and obesity presented to our outpatient clinic with verrucous red-brown papules and plaques on her right lower extremity worsening for three years. Biopsy was consistent with a diagnosis of Mali-type AAD. Providers should be aware of AAD and its variants to accurately differentiate it from more harmful entities.
Subject(s)
Acrodermatitis , Arteriovenous Malformations , Sarcoma, Kaposi , Acrodermatitis/diagnosis , Acrodermatitis/etiology , Acrodermatitis/pathology , Aged , Arteriovenous Malformations/complications , Arteriovenous Malformations/diagnosis , Arteriovenous Malformations/pathology , Female , Humans , Leg/pathology , Rare Diseases/complications , Sarcoma, Kaposi/diagnosis , SyndromeABSTRACT
BACKGROUND: Zinc is mainly absorbed in the duodenum and proximal jejunum, which are removed during pancreaticoduodenectomy (PD). Little is known about the adverse oral events and skin disorders caused by zinc deficiency after PD. Herein, we reviewed studies on the development of zinc deficiency after PD and reported about a patient with zinc deficiency after PD who required home intravenous zinc replacement. CASE PRESENTATION: A 73-year-old woman with glossitis, taste disorder, and acrodermatitis enteropathica-like eruption on her fingers presented to the Division of Dentistry and Oral Surgery 69 days after PD. Her serum zinc level markedly decreased to 30 µg/dL. Oral zinc administration was inadequate to treat hypozincemia after PD; therefore, multi-trace elements were injected intravenously during readmission. Her serum zinc levels recovered, and her lesions gradually improved. Furthermore, a central venous port was implanted to maintain normal serum zinc levels, and she continued self-injecting zinc at home. CONCLUSIONS: Zinc deficiency after PD rarely occurs. The clinical oncologist community, including dentists responsible for the oral care of cancer patients, should be aware of the oral adverse events, such as dysgeusia, glossitis, and oral pain, associated with zinc deficiency after cancer surgery and that induced by chemotherapy or head and neck radiation therapy.
Subject(s)
Acrodermatitis , Pancreaticoduodenectomy , Acrodermatitis/drug therapy , Acrodermatitis/etiology , Acrodermatitis/pathology , Aged , Dietary Supplements , Female , Humans , Pancreaticoduodenectomy/adverse effects , ZincSubject(s)
Acrodermatitis/diagnosis , Pancreaticoduodenectomy/methods , Skin Diseases/diagnosis , Zinc/deficiency , Acrodermatitis/drug therapy , Acrodermatitis/etiology , Adult , Female , Humans , Pancreas/injuries , Pancreas/surgery , Pancreaticoduodenectomy/adverse effects , Pancreatitis, Chronic/surgery , Skin Diseases/drug therapy , Skin Diseases/etiology , Steroids/therapeutic use , Zinc Sulfate/therapeutic useABSTRACT
Acroangiodermatitis (AAD) is often seen in association with various vascular anomalies such as venous insufficiency, vascular syndromes, and conditions associated with thrombosis. This is the first case reported in the literature associated with arteriovenous fistula stenosis in a patient with chronic kidney disease on hemodialysis. This case is being described for its rarity and to familiarize the clinicians with this unusual complication, especially, to prevent them from thinking of this condition as an infectious complication. It is essential to recognize the uniqueness of the pathophysiology of this disease and to do a clear distinction with that of a venous ulcer. With this work we also aim to help health practitioners with proper management of the condition. As we've seen, surgical treatment in appropriately selected cases corrects the reflux of the venous system and successfully improves the appearance of the verrucous lesion. Our patient was successfully treated by correcting the arteriovenous fistula stenosis with near-complete subsidence of the verrucous lesion within days of the procedure. Acroangiodermatitis management must be conducted with a multidisciplinary approach (dermatology, vascular surgery, and internal medicine). It is essential the comprehensive management of these patients, to ensure prompt recovery and avoid chronic effects, as well as to guarantee the quality of life in the future.