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1.
Isr Med Assoc J ; 22(4): 227-231, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32286025

RESUMO

BACKGROUND: Solar urticaria (SU) is a rare and disabling photodermatosis. SU typically manifests as urticarial wheals and erythema appearing shortly after sun exposure. SU is often initially diagnosed clinically with subsequent confirmation through photoprovocation tests. Early diagnosis is important for correct management of patients. OBJECTIVES: To present the clinical features of three cases of atypical presentation of SU and to discuss possible underlying mechanisms. METHODS: We report a series of three patients who presented with transient pruritic erythema without wheals after sun exposure. All patients had photoprovocation tests conducted to confirm SU diagnosis and to determine their action spectra. Treatment outcomes were recorded. RESULTS: All three patients developed classical manifestations of SU during photoprovocation tests within the UVA1 spectrum. Two patients required high-dose irradiation to provoke urticaria. CONCLUSIONS: Erythema without urticaria can be the primary manifestation of SU, especially in countries with sunny climates where natural skin hardening is common. Such cases require a high index of suspicion for SU and highlight the importance of photoprovocation testing to confirm the diagnosis.


Assuntos
Omalizumab/uso terapêutico , Transtornos de Fotossensibilidade/diagnóstico , Prurido/etiologia , Luz Solar/efeitos adversos , Urticária/etiologia , Adulto , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/etiologia , Feminino , Seguimentos , Humanos , Masculino , Transtornos de Fotossensibilidade/tratamento farmacológico , Prurido/diagnóstico , Prurido/tratamento farmacológico , Medição de Risco , Amostragem , Testes Cutâneos/métodos , Fatores de Tempo , Resultado do Tratamento , Urticária/diagnóstico , Urticária/tratamento farmacológico
5.
An Bras Dermatol ; 94(4): 388-398, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644609

RESUMO

Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.


Assuntos
Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/terapia , Pênfigo/patologia , Pênfigo/terapia , Autoanticorpos/imunologia , Eritema/diagnóstico , Eritema/patologia , Humanos , Doenças da Boca/diagnóstico , Doenças da Boca/patologia , Síndromes Paraneoplásicas/diagnóstico , Síndromes Paraneoplásicas/imunologia , Pênfigo/diagnóstico , Pênfigo/imunologia , Pele/patologia
6.
Rev. clín. med. fam ; 12(3): 160-162, oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186808

RESUMO

Presentamos un caso de liquen aureus en una mujer joven de 22 años, rara lesión cutánea que pertenece al grupo de las dermatosis purpúricas pigmentadas, diagnosticada por biopsia, que no precisó otro tratamiento que la exéresis de la lesión y que ha tenido una evolución favorable. Es una lesión eritematosa de la piel, con aspecto de su fondo dorado, de etiología desconocida y que, por su escasa sintomatología y pronóstico benigno, muchas veces es infradiagnosticada, por lo que debe ser conocida para hacer un diagnóstico diferencial eficiente


We present the case of a 22-year-old young woman with lichen aureus, a rare skin lesion that belongs to the group of pigmented purpuric dermatosis. It was diagnosed by biopsy and did not require any other treatment than the excision of the lesion, with a favorable evolution. Lichen aureus is an erythematous skin lesion with a golden background of unknown etiology. It is often underdiagnosed because it presents few symptoms and has a benign prognosis, so it should be known to make an effective differential diagnosis


Assuntos
Humanos , Feminino , Adulto Jovem , Erupções Liquenoides/diagnóstico , Púrpura/diagnóstico , Eritema/diagnóstico , Dermatopatias Eczematosas/diagnóstico , Diagnóstico Diferencial , Transtornos da Pigmentação/etiologia , Biópsia
7.
Ned Tijdschr Geneeskd ; 1632019 08 29.
Artigo em Holandês | MEDLINE | ID: mdl-31483587

RESUMO

A 74-year-old woman was referred to the dermatologist because of erythema on the chest which had not improved with topical corticosteroids. She had a medical history of papillary thyroid carcinoma. Pathologic assessment of two skin biopsies revealed cutaneous metastases from thyroid carcinoma.


Assuntos
Eritema/diagnóstico , Neoplasias Cutâneas/diagnóstico , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Idoso , Eritema/etiologia , Feminino , Humanos , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/secundário
8.
Cutis ; 104(1): 38-41, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487335

RESUMO

Rosacea is a chronic inflammatory cutaneous disorder that may be underreported and underrecognized in skin of color (SOC) patients. There are several skin disorders that can present with the classic features of rosacea, such as erythema, papules, and pustules, which can confound the diagnosis. To promote accurate and timely diagnosis of rosacea, we review possible rosacea mimickers in SOC patients.


Assuntos
Rosácea/diagnóstico , Dermatopatias/diagnóstico , Pigmentação da Pele , Doença Crônica , Eritema/diagnóstico , Eritema/patologia , Humanos , Rosácea/patologia , Dermatopatias/patologia
9.
Korean J Gastroenterol ; 74(3): 175-182, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554034

RESUMO

Pancreatitis, panniculitis, and polyarthritis (PPP) syndrome is a rare but critical disease with a high mortality rate. The diagnostic dilemma of PPP syndrome is the fact that symptoms occur unexpectedly. A 48-year-old man presented with fever and painful swelling of the left foot that was initially mistaken for cellulitis and gouty arthritis. The diagnosis of PPP syndrome was made based on the abdominal CT findings and elevated pancreatic enzyme levels, lobular panniculitis with ghost cells on a skin biopsy, and polyarthritis on a bone scan. The pancreatitis and panniculitis disappeared spontaneously over time, but the polyarthritis followed its own course despite the use of anti-inflammatory agents. In addition to this case, 30 cases of PPP syndrome in the English literature were reviewed. Most of the patients had initial symptoms other than abdominal pain, leading to misdiagnosis. About one-third of them were finally diagnosed with a pancreatic tumor, of which pancreatic acinar cell carcinoma was the most dominant. They showed a mortality rate of 32.3%, associated mainly with the pancreatic malignancy. Therefore, PPP syndrome should be considered when cutaneous or osteoarticular manifestations occur in patients with pancreatitis. Active investigation and continued observations are needed for patients suspected of PPP syndrome.


Assuntos
Artrite/diagnóstico , Pancreatite/diagnóstico , Paniculite/diagnóstico , Artrite/tratamento farmacológico , Artrite/patologia , Artrite Gotosa/diagnóstico , Osso e Ossos/diagnóstico por imagem , Celulite (Flegmão)/diagnóstico , Diagnóstico Diferencial , Eritema/diagnóstico , Eritema/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Octreotida/uso terapêutico , Pancreatite/tratamento farmacológico , Pancreatite/patologia , Paniculite/tratamento farmacológico , Paniculite/patologia , Tomografia Computadorizada por Raios X
13.
An. bras. dermatol ; 94(4): 388-398, July-Aug. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1038294

RESUMO

Abstract: Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.


Assuntos
Humanos , Síndromes Paraneoplásicas/patologia , Síndromes Paraneoplásicas/terapia , Pênfigo/imunologia , Pênfigo/patologia , Pênfigo/terapia , Síndromes Paraneoplásicas/imunologia , Pele/patologia , Autoanticorpos/imunologia , Pênfigo/diagnóstico , Eritema/diagnóstico , Eritema/patologia , Doenças da Boca/diagnóstico , Doenças da Boca/patologia
14.
Cutis ; 103(6): 357-360, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31348450

RESUMO

Erythema gyratum repens (EGR) is a rare and poorly understood dermatosis. The relationship of superficial dermatophytic infection to EGR-like eruptions in mycosis fungoides (MF) is unclear. We present a case of an EGR-like eruption in a patient with Sézary syndrome (SS). Histopathologic examination revealed both a superficial dermatophyte (Trichophyton rubrum) and cutaneous T-cell lymphoma (CTCL) in biopsies of the skin, regardless of whether those biopsies showed EGR-like lesions or erythroderma clinically. On 2 occasions, treatment of the superficial dermatophytic infection led to resolution of the EGR-like eruption and associated pruritus but not to resolution of the erythroderma. This case supports a role for dermatophytic superinfection in an EGR-like eruption in SS. Further investigation is necessary to fully understand the impact of dermatophytic infection in this clinical setting.


Assuntos
Eritema/diagnóstico , Linfoma Cutâneo de Células T/diagnóstico , Síndrome de Sézary/patologia , Neoplasias Cutâneas/diagnóstico , Tinha/diagnóstico , Idoso , Biópsia , Eritema/etiologia , Feminino , Humanos , Linfoma Cutâneo de Células T/patologia , Neoplasias Cutâneas/patologia , Tinha/patologia , Trichophyton/isolamento & purificação
16.
J Drugs Dermatol ; 18(6): 522, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31251544

RESUMO

Background: Anecdotal reports indicate the use of microfocused ultrasound with visualization (MFU-V) improves facial redness. Objective: The purpose of this pilot study was to assess the safety and effectiveness of MFU-V for improving the signs and symptoms of erythematotelangiectatic rosacea. Methods & Materials: Healthy adults with a clinical diagnosis of erythematotelangiectatic rosacea were enrolled (N=91). Eligible subjects had baseline Clinician Erythema Assessment (CEA) scores ≥3 and Patient Self-Assessment (PSA) of erythema scores ≥2. Subjects were randomized to receive one or two low-density MFU-V treatments or one or two high-density MFU-V treatments. Subjects were evaluated at 90, 180, and 365 days after treatment. The primary effectiveness endpoint was treatment success, defined as a 1-point change in CEA scores at 90 days post-treatment. Results: Across groups, 75 to 91.3% of subjects achieved treatment success at 90 days post-treatment. Notable adverse events include bruising (44%), tenderness/soreness (43%), and redness (35%). Treatment results were sustained, lasting up to 1 year. Subject satisfaction was high based on self-assessment questionnaires. Conclusion: The results of this study demonstrated that a single, high-density MFU-V treatment may be effective for treating erythematotelangiectatic rosacea. Based on these results, a large, randomized controlled study of single, high-density MFU-V treatment for erythematotelangiectatic rosacea is warranted. J Drugs Dermatol. 2019;18(6):522-531.


Assuntos
Eritema/terapia , Satisfação do Paciente , Rosácea/terapia , Terapia por Ultrassom/métodos , Adulto , Idoso , Eritema/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Rosácea/diagnóstico , Índice de Gravidade de Doença , Inquéritos e Questionários/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
18.
J Fam Pract ; 68(3): 175-177, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31039216

RESUMO

A 9-day-old boy was brought to the emergency department by his mother. The infant had been doing well until his most recent diaper change when his mother noticed a rash around the umbilicus, genitalia, and anus. The infant was born at term via spontaneous vaginal delivery. The pregnancy was uncomplicated; the infant's mother was group B strep negative. Following a routine postpartum course, the infant underwent an elective circumcision before hospital discharge on his second day of life. There were no interval reports of irritability, poor feeding, fevers, vomiting, or changes in urine or stool output.


Assuntos
Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Antibacterianos/uso terapêutico , Eritema/diagnóstico , Eritema/etiologia , Exantema/diagnóstico , Exantema/etiologia , Humanos , Recém-Nascido , Masculino , Doenças Raras , Medição de Risco , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Resultado do Tratamento
19.
JAMA Facial Plast Surg ; 21(4): 278-285, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-30998810

RESUMO

Importance: Acute rejection is one of the most frequent complications in facial transplantation, with potentially severe consequences for the recipient if overlooked. Clinical signs, such as erythema or edema, are helpful to diagnose acute rejection in the early follow-up stage; however, it is not well known whether these clinical signs remain reliable markers of acute rejection beyond the second posttransplant year. Objective: To determine the diagnostic value of clinical signs of acute rejection after facial transplantation over time. Design, Setting, and Participants: A retrospective, single-center cohort study was conducted of patients who underwent facial transplantation at Brigham and Women's Hospital between April 2009 and October 2014, with up to an 8-year follow-up. Medical records were reviewed until September 30, 2017. The medical records from 104 encounters with 7 patients who underwent partial or full facial transplantation were analyzed for symptoms of rejection, immunosuppressive therapy, and histopathologic findings. Main Outcomes and Measures: The occurrence of 5 clinical signs of acute rejection were evaluated: erythema, edema, exanthema, suture line erythema, and mucosal lesions. Odds ratios (ORs) were calculated to determine the statistically significant association of these signs with the histopathologic diagnosis of rejection. In addition, tacrolimus blood levels, as a surrogate marker of immunosuppressive therapy, were evaluated. Results: Of the 7 patients included in the study, 5 were men. The mean follow-up was 66 months (range, 35-101). Of 104 clinical encounters, 46 encounters (44.2%) represented rejection episodes and 58 encounters (55.8%) represented no-rejection episodes. Beyond 2 years posttransplantation, only erythema (OR, 6.53; 95% CI, 1.84-20.11; P = .004) and exanthema (OR, ∞; 95% CI, 2.2-∞; P = .004) were demonstrated to be reliable clinical signs of acute rejection in facial transplantation. There was also a statistically significant association of subtherapeutic tacrolimus levels with late rejection episodes (OR, 3.79; 95% CI, 1.25-12.88; P = .03). In addition, the occurrence of subclinical rejection was more frequent during later follow-up times (7 [24.1%] late rejections vs 1 [5.9%] early rejection). Five of 8 subclinical rejections (62.5%) were associated with subtherapeutic tacrolimus levels. Conclusions and Relevance: Clinical signs of acute rejection in facial transplantation appear to be of limited diagnostic value, particularly after the second postoperative year. Until alternative biomarkers for rejection are identified, protocol skin biopsies will remain necessary for guiding assessments of allograft rejection. Level of Evidence: 3.


Assuntos
Transplante de Face , Rejeição de Enxerto/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Eritema/diagnóstico , Exantema/diagnóstico , Feminino , Seguimentos , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade
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