RESUMO
This cohort study investigated the association between treatment of dermatomyositis with intravenous immunoglobulin and thromboembolic events.
Assuntos
Dermatomiosite , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/etiologia , Imunoglobulinas Intravenosas/uso terapêutico , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Fatores de Risco , Medição de RiscoRESUMO
This case series examines the efficacy of anifrolumab as a therapeutic option for patients with lupus erythematosus.
Assuntos
Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Humanos , Anticorpos Monoclonais Humanizados/uso terapêutico , Lúpus Eritematoso Discoide/diagnóstico , Lúpus Eritematoso Discoide/tratamento farmacológicoRESUMO
Raynaud's phenomenon describes symptoms caused by digital vascular spasm and is classically induced by cold exposure. Severe cases can result in ulceration, necrosis, and digital autoamputation. When standard and adjunctive medical therapies fail or are contraindicated, botulinum toxin A (BTX-A) is an effective treatment option that can be added to existing regimens and should be considered before utilizing rescue therapies associated with higher risk and often higher cost. This report describes our technique, highlights considerations relevant to pediatric patients, and provides photos and videos of the procedure performed on a 16-year-old girl.
Assuntos
Toxinas Botulínicas Tipo A , Doença de Raynaud , Úlcera Cutânea , Feminino , Humanos , Criança , Adolescente , Toxinas Botulínicas Tipo A/uso terapêutico , Resultado do Tratamento , Úlcera Cutânea/etiologia , Doença de Raynaud/tratamento farmacológico , Doença de Raynaud/diagnóstico , NecroseRESUMO
BACKGROUND: Facial skin is characterized by high density of follicles. Facial neoplasms may present overlapping clinical and dermoscopic findings. Our goal was to evaluate and compare, via reflectance confocal microscopy (RCM), follicular involvement in facial neoplasms. METHODS: We retrospectively searched our image database, between January 2008 and December 2020, for all facial lesions with (1) a standardized set of clinical, dermoscopic, and RCM images, and (2) a biopsy-proven diagnosis of lentigo maligna/lentigo maligna melanoma (LM/LMM, n = 39), basal cell carcinoma (BCC, n = 51), squamous cell carcinoma in situ (SCCIS, n = 5), actinic keratosis (AK, n = 11), and lichen-planus-like keratosis (LPLK, n = 18). Two readers jointly evaluated the RCM images for a set of predefined features of follicular involvement. RESULTS: Diffuse obliteration of follicles was frequent in BCC (88%), while follicular infiltration by refractile dendritic cells and/or by bright round nucleated cells was common in melanoma (90% and 44%, respectively). Extension of atypical keratinocytes down follicles was more prominent among SCCIS than AK (80% vs. 45%, p = 0.01). In most LPLK (89%), there was follicular sparing. CONCLUSIONS: Evaluation of RCM criteria centering on the follicles can be useful in the differential diagnosis between common facial neoplasms.
Assuntos
Neoplasias Faciais , Sarda Melanótica de Hutchinson , Ceratose Actínica , Melanoma , Neoplasias Cutâneas , Humanos , Sarda Melanótica de Hutchinson/diagnóstico , Sarda Melanótica de Hutchinson/patologia , Neoplasias Cutâneas/patologia , Estudos Retrospectivos , Melanoma/diagnóstico , Melanoma/patologia , Ceratose Actínica/diagnóstico , Neoplasias Faciais/patologia , Diagnóstico Diferencial , Dermoscopia/métodos , Microscopia Confocal/métodosRESUMO
The management of connective tissue diseases is dramatically evolving with the advent of biologics and novel oral systemic therapeutics. Despite involvement in the care of these complex patients, there is a knowledge gap in the field of dermatology regarding these emerging agents. The first article in this continuing medical education series discusses new and emerging therapeutics for lupus erythematosus and Sjögren syndrome that target cells, intracellular signaling pathways, and cytokines.
Assuntos
Produtos Biológicos , Doenças do Tecido Conjuntivo , Lúpus Eritematoso Sistêmico , Síndrome de Sjogren , Doenças do Tecido Conjuntivo/terapia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Síndrome de Sjogren/complicações , Síndrome de Sjogren/tratamento farmacológicoRESUMO
The management of connective tissue diseases is dramatically evolving with the advent of biologics and novel oral systemic therapeutics. Despite involvement in the care of these complex patients, there is a knowledge gap in the field of dermatology regarding these emerging agents. The second article in this continuing medical education series discusses new and emerging therapeutics for dermatomyositis and scleroderma that target cells, intracellular signaling pathways, and cytokines.
Assuntos
Doenças do Tecido Conjuntivo , Dermatomiosite , Esclerodermia Localizada , Escleroderma Sistêmico , Doenças do Tecido Conjuntivo/terapia , Dermatomiosite/tratamento farmacológico , Humanos , Esclerodermia Localizada/tratamento farmacológico , Escleroderma Sistêmico/terapiaRESUMO
This study used the crowdsourcing platform GoFundMe to analyze the financial hardships associated with treatment of juvenile dermatomyositis. Uncovered medical expenses, travel costs, and loss of income were all commonly cited reasons for fundraising, demonstrating high out-of-pocket costs and significant economic hardship associated with this disease, even among families with health insurance.
Assuntos
Crowdsourcing , Dermatomiosite , Dermatomiosite/diagnóstico , Dermatomiosite/terapia , Gastos em Saúde , Humanos , Renda , Seguro SaúdeRESUMO
There has been considerable research in recent years on dietary factors and/or nutritional elements that might impact melanoma risk. A wide variety of dietary compounds have been studied, but only a selected group will be discussed in this review. Many have promising in vitro evidence supporting their potential, and some have been associated with decreased melanoma risk in epidemiologic studies; however, data from randomized controlled trials in humans are lacking. Future studies may be able to clarify the potential role of dietary components in melanoma risk reduction.
Assuntos
Dieta , Melanoma , Humanos , Melanoma/etiologia , Melanoma/prevenção & controleRESUMO
Despite an incomplete overall understanding, nutrition plays an important role in connective tissue disease. Assessment of patients with connective tissue disease for nutritional status and metabolic disturbances may significantly contribute to patient outcomes. Several studies have indicated the multifactorial role of macronutrients, micronutrients, and supplements in the setting of connective tissue disease. There is additional evidence regarding the roles of weight, obesity, and malnutrition. This contribution reviews a growing body of data regarding nutrition in the development and treatment of various connective tissue diseases, including systemic lupus erythematosus, dermatomyositis, and systemic sclerosis.
Assuntos
Doenças do Tecido Conjuntivo , Dermatomiosite , Lúpus Eritematoso Sistêmico , Escleroderma Sistêmico , Doenças do Tecido Conjuntivo/complicações , Humanos , Lúpus Eritematoso Sistêmico/complicações , Estado Nutricional , Escleroderma Sistêmico/terapiaRESUMO
Nonmelanoma skin cancer (NMSC), the most widely diagnosed cancer in the United States, is rising in incidence despite public health and educational campaigns that highlight the importance of sun avoidance. It is,therefore, important to establish other modifiable risk factors that may be contributing to this increase. There is a growing body of evidence in the literature suggesting certain nutrients may have protective or harmful effects on NMSC. We review the current literature on nutrition and its effect on NMSC with a focus on dietary fat, vitamin A, nicotinamide, folate, vitamin C, vitamin D, vitamin E, polyphenols, and selenium.
Assuntos
Carcinoma Basocelular , Neoplasias Cutâneas , Carcinoma Basocelular/etiologia , Carcinoma Basocelular/prevenção & controle , Humanos , Incidência , Fatores de Risco , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/prevenção & controle , Estados Unidos/epidemiologia , Vitamina A , Vitamina D/uso terapêuticoRESUMO
Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that has the potential to revolutionize dermatology. Extensive research in this area in conjunction with the recent assignment of reimbursement codes has made the clinical use of this technology a practical reality. Though there is awareness and use of this technology at large academic centers, a knowledge gap still remains in interpreting RCM images among the dermatology community. We review the key RCM features of melanocytic and nonmelanocytic lesions to provide guidance in distinguishing benign entities from malignant dermatologic neoplasms.
Assuntos
Melanócitos , Neoplasias Cutâneas , Dermoscopia , Humanos , Microscopia Confocal , Neoplasias Cutâneas/diagnóstico por imagemRESUMO
Aim: To evaluate whether the presence of a history of depression hinders psoriasis response to systemic therapies and to delineate baseline characteristics of patients whose depressive symptoms improved on systemic treatment. Methods: We studied patients within the Corrona® Psoriasis Registry, a prospective, multicenter observational disease-based registry, that were enrolled through September 2018, comparing changes from enrollment to 12-month visit. Results: There was a statistically significant improvement in all disease characteristics and most patient-reported outcomes in patients reporting a history of depression and in those that did not while there was no statistically significant difference in the degree of change comparing these two cohorts. Patients who noted improvement in depressive symptoms had more severe baseline disease characteristics and reported overall worse baseline patient-reported outcomes. Conclusions: History of depression does not portend a differential response to systemic treatment. Patients with improvement in depressive symptoms had worse baseline characteristics.