RESUMO
Pretibial pruritic papular dermatitis (PPPD) is a clinical entity first described in 2006. The etiology is uncertain; however, gentle chronic rubbing is likely to be the reason for the skin reaction. Pretibial pruritic lesions may reflect many different systemic diseases and dermatoses. We present a 61-year-old patient with a 2-year history of pruritic pretibial xerosis, keratotic erythematous to brownish papules, and excoriations. Differential diagnosis excluded papular mucinosis, myxoedema, stasis dermatitis, lichen simplex chronicus, prurigo nodularis, lichen amyloidosis, and lichen planus. Regarding clinical-histological correlation, we confirmed a diagnosis of PPPD.
Assuntos
Dermatoses da Perna/diagnóstico , Dermatoses da Perna/etiologia , Prurido/diagnóstico , Prurido/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Dermatoses da Perna/terapia , Pessoa de Meia-Idade , Prurido/terapiaAssuntos
Tecido Adiposo/metabolismo , Eritema/patologia , Linfedema/patologia , Gordura Subcutânea/metabolismo , Adipogenia , Biópsia por Agulha , Terapia Combinada , Diagnóstico Diferencial , Drenagem/métodos , Eritema/diagnóstico , Terapia por Exercício/métodos , Feminino , Humanos , Imuno-Histoquímica , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/patologia , Dermatoses da Perna/terapia , Linfedema/diagnóstico , Pessoa de Meia-Idade , Recidiva , Sarcoidose Pulmonar/diagnóstico , Sarcoidose Pulmonar/tratamento farmacológico , Índice de Gravidade de Doença , Gordura Subcutânea/patologia , Resultado do TratamentoRESUMO
Erosive pustular dermatosis is a rare inflammatory skin disorder characterized by crusted erosions, sterile pustules, skin atrophy, and scarring alopecia. Cases of involvement of lower extremities, with or without scalp lesions, have been scarcely reported in the literature, and have been denominated Erosive Pustular Dermatosis of the Legs. The disorder usually affects elderly patients associated with chronic venous insufficiency and venous dermatitis. Topical corticosteroids and topical calcineurin inhibitors have been reported to be effective. On the other hand, several treatments have also failed to achieve appropriate results; hence we present a case of erosive pustular dermatosis of the leg, who was unresponsive to compression and antibacterial ointments, but successfully treated systemically with an oral retinoid and locally with the application of a bioengineered bi-layered skin substitute. This condition may be overlooked, which represents its low prevalence in literature. J Drugs Dermatol. 2019;18(3):301-302.
Assuntos
Acitretina/uso terapêutico , Procedimentos Cirúrgicos Dermatológicos/instrumentação , Dermatoses da Perna/terapia , Dermatopatias Vesiculobolhosas/terapia , Pele Artificial , Administração Oral , Idoso , Terapia Combinada/métodos , Humanos , Masculino , Resultado do TratamentoAssuntos
Dermatoses da Perna/terapia , Perna (Membro)/irrigação sanguínea , Pacotes de Assistência ao Paciente , Insuficiência Venosa/terapia , Idoso , Feminino , Humanos , Dermatoses da Perna/economia , Dermatoses da Perna/etiologia , Tempo de Internação , Masculino , Educação de Pacientes como Assunto , Readmissão do Paciente , Modalidades de Fisioterapia , Encaminhamento e Consulta , Meias de Compressão , Insuficiência Venosa/complicações , Insuficiência Venosa/economiaAssuntos
Hipotireoidismo/diagnóstico , Dermatoses da Perna/diagnóstico , Mixedema/diagnóstico , Adulto , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Dermatoses da Perna/etiologia , Dermatoses da Perna/terapia , Masculino , Mixedema/etiologia , Mixedema/terapia , Curativos Oclusivos , Tiroxina/uso terapêuticoAssuntos
Dermatoses da Perna , Pé Diabético/diagnóstico , Erisipela/diagnóstico , Erisipela/terapia , Eritema/diagnóstico , Humanos , Isquemia/diagnóstico , Perna (Membro)/irrigação sanguínea , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/etiologia , Dermatoses da Perna/terapia , Linfangite/diagnóstico , Exame Físico , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/terapiaAssuntos
Anti-Inflamatórios/administração & dosagem , Doença de Graves/terapia , Halcinonida/administração & dosagem , Lasers de Gás/uso terapêutico , Dermatoses da Perna/terapia , Mixedema/terapia , Administração Tópica , Idoso , Terapia Combinada , Doença de Graves/complicações , Doença de Graves/diagnóstico , Humanos , Dermatoses da Perna/complicações , Dermatoses da Perna/diagnóstico , Masculino , Mixedema/complicações , Mixedema/diagnóstico , Resultado do TratamentoAssuntos
Hiperaldosteronismo/complicações , Hiperaldosteronismo/diagnóstico , Ceratose/complicações , Ceratose/diagnóstico , Dermatoses da Perna/diagnóstico , Atrofia , Biópsia , Comorbidade , Derme/patologia , Epiderme/patologia , Seguimentos , Histiócitos/patologia , História do Século XVII , Humanos , Hiperaldosteronismo/patologia , Hiperaldosteronismo/terapia , Ceratose/terapia , Dermatoses da Perna/complicações , Dermatoses da Perna/patologia , Dermatoses da Perna/terapia , Linfócitos/patologia , Masculino , Pessoa de Meia-Idade , PrognósticoAssuntos
Aberrações Cromossômicas , Análise Mutacional de DNA , Dipeptidases/genética , Dermatoses da Perna/genética , Deficiência de Prolidase/genética , Úlcera Cutânea/genética , Adolescente , Adulto , Criança , Cromossomos Humanos Par 19/genética , Terapia Combinada , Dipeptídeos/urina , Facies , Feminino , Seguimentos , Humanos , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/patologia , Dermatoses da Perna/terapia , Cooperação do Paciente , Deficiência de Prolidase/diagnóstico , Deficiência de Prolidase/patologia , Deficiência de Prolidase/terapia , Recidiva , Análise de Sequência de DNA , Pele/patologia , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/patologia , Úlcera Cutânea/terapia , Adulto JovemAssuntos
Amiloidose Familiar/patologia , Dermatoses da Perna/patologia , Dermatoses do Couro Cabeludo/patologia , Dermatopatias Genéticas/patologia , Amiloidose Familiar/terapia , Feminino , Antebraço , Humanos , Dermatoses da Perna/terapia , Pessoa de Meia-Idade , Dermatoses do Couro Cabeludo/terapia , Dermatopatias Genéticas/terapiaRESUMO
BACKGROUND: Erosive pustular dermatosis of the leg (EPDL) is a poorly understood entity first described by Lanigan and Cotteril in 1987. Its clinical diagnosis is based on exclusion since the physiopathology is unknown. The primary objective of this investigation was to specify the clinical aspects and outcomes in a prospective study. The secondary objectives were to describe associated diseases, the circumstances of occurrence, and the laboratory tests used. PATIENTS AND METHODS: This was a prospective study that included 45 patients selected by members of the Angiology-Dermatology Group of the SFD (French Dermatology Society) at 13 centres between 01/09/2013 and 31/10/2014. There was a 180-day monitoring period. The records of 36 patients were analysed. Clinical and laboratory data were collected. RESULTS: Mean patient age was 79.6±9.9 years with a M/F sex ratio of 0.2. Among the patients, 16.7% had skin cancer and 91.7% had venous insufficiency. The proportion of patients wearing venous compression hose was constant between inclusion and D180. Lesions were bilateral (53%), affected the middle third of the leg, and were on the anterior aspect. Complete healing was achieved in 77.8% of cases with time to healing of 2.4±1.2 months, and under topical corticosteroids in 97.3% of cases. During follow-up, relapse occurred in 38.9% of cases after a mean time of 2.4±1.2 months. CONCLUSION: EPDL appears to be an idiopathic inflammatory dermatosis with a particular topographic expression. The physiopathology could be related to chronic inflammation associated with venous insufficiency and with certain trigger factors. Currently, there are few therapeutic alternatives to topical corticosteroids.
Assuntos
Dermatoses da Perna , Dermatopatias Vesiculobolhosas , Idoso , Feminino , Humanos , Dermatoses da Perna/patologia , Dermatoses da Perna/terapia , Masculino , Estudos Prospectivos , Dermatopatias Vesiculobolhosas/patologia , Dermatopatias Vesiculobolhosas/terapiaRESUMO
The authors report a case of pretibial myxedema (PTM) masquerading as a venous leg ulcer to alert wound care clinicians to this diagnostic possibility. Pretibial myxedema is a localized form of mucin cutaneous deposition characterized by indurated plaques most commonly on anterior legs. It is more likely to present in patients with Graves' disease, but it can be found in euthyroid patients as well. The physiopathology of PTM is complex, and there is an accumulation of highly hydrophilic glycosaminoglycans in the dermis. Minimal morbidity is associated with PTM, but the pruritus related to mucin deposition can be intense. The skin around venous leg ulcers and the skin changes related to PTM can have a similar clinical presentation, which may be a reason PTM is under-recognized.
Assuntos
Glucocorticoides/uso terapêutico , Doença de Graves/patologia , Dermatoses da Perna/patologia , Mixedema/patologia , Triancinolona Acetonida/uso terapêutico , Úlcera Varicosa/patologia , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Doença de Graves/complicações , Doença de Graves/terapia , Humanos , Dermatoses da Perna/etiologia , Dermatoses da Perna/terapia , Mucinas/análise , Mixedema/etiologia , Mixedema/terapia , Resultado do Tratamento , CicatrizaçãoRESUMO
A lot of diseases occur on the skin of elderly persons. We report four elderly cases of bullous dermatosis that did not meet various differential diagnoses. Japanese, heart failure, atrophic skin and leg edema probably due to aging, as well as flaccid or tense bullae localized in legs were the common factors to our patients. Such conditions may be increased in coming aging society. Accordingly, it is worth regarding such symptom as the new clinical entity, which may comfort patients with similar condition and attract further attention.
Assuntos
Dermatoses da Perna/diagnóstico , Dermatopatias Vesiculobolhosas/diagnóstico , Fatores Etários , Idoso de 80 Anos ou mais , Anti-Infecciosos Locais/uso terapêutico , Diagnóstico Diferencial , Etacridina/uso terapêutico , Feminino , Insuficiência Cardíaca/complicações , Humanos , Mordeduras e Picadas de Insetos/diagnóstico , Dermatoses da Perna/complicações , Dermatoses da Perna/patologia , Dermatoses da Perna/terapia , Masculino , Penfigoide Bolhoso/diagnóstico , Pênfigo/diagnóstico , Dermatopatias Vesiculobolhosas/complicações , Dermatopatias Vesiculobolhosas/patologia , Dermatopatias Vesiculobolhosas/terapia , Meias de CompressãoRESUMO
As the largest organ in the body, skin can prove the most daunting to diagnose and manage due to the large number of conditions and their uncanny ability to have similar qualities visually. Skin can reflect current trauma or infections or can be a harbinger of an underlying systemic disorder. With knowledge of the most common pediatric skin conditions, it is possible for practitioners to start a child on a basic treatment regimen and then refer to an appropriate specialist for more complex or rare disorders. This article covers the most common skin conditions seen on the lower extremity in the pediatric population.
Assuntos
Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/terapia , Fatores Etários , Criança , Dermatoses do Pé/etiologia , Humanos , Dermatoses da Perna/etiologiaRESUMO
Adverse drug reactions (ADRs) are a common cause of dermatologic consultation, involving 2 to 3 per 100 medical inpatients in the United States. Female patients are 1.3 to 1.5 times more likely to develop ADRs, except in children less than 3 years of age, among whom boys are more often affected. Certain drugs are more frequent causes, including aminopenicillins, trimethoprim-sulfamethoxazole, and nonsteroidal antiinflammatory drugs. Chemotherapeutic agents commonly cause adverse reactions to the skin and nails, with certain agents causing particular patterns of reactions. ADRs can involve any area of the skin; the appendages, including hair and nails; as well as mucosa.
Assuntos
Erupção por Droga/diagnóstico , Erupção por Droga/etiologia , Dermatoses do Pé/induzido quimicamente , Dermatoses da Perna/induzido quimicamente , Erupção por Droga/terapia , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Humanos , Dermatoses da Perna/diagnóstico , Dermatoses da Perna/terapiaRESUMO
The skin of the lower extremity can be a helpful diagnostic tool for systemic disease. Diabetes, renal disease, genetic disorders, and even cancer can have cutaneous manifestations in the legs and feet; moreover, proper diagnosis can facilitate earlier treatment of these diseases and not only clear up the skin symptoms but also bring about resolution of the systemic disease causing them. Although not comprehensive, this article discusses many of these disorders presenting with integumentary manifestations in the lower extremities. Where appropriate, it also enumerates the treatments involved, both systemic and localized.