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1.
BMC Neurol ; 20(1): 191, 2020 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-32416719

RESUMO

BACKGROUND/OBJECTIVE: Notalgia paresthetica (NP) is a sensory neuropathy characterized by localized pruritus and pain, presenting with or without a well-circumscribed hyperpigmented patch in the upper back. Abnormal sensations, such as burning, numbness, and paresthesia are often present in patients with NP. In this study, we clinically and radiologically analyzed patients with NP. The literature contains studies describing lidocaine treatments involving intravenous and topical applications for NP. We also investigated the effect of intradermal lidocaine injection on patients with NP. METHODS: A total of 80 patients (45 patients with NP and 35 suffering from dorsalgia without NP) were included in the study. The age, gender and body mass index (BMI) of the patients, and the characteristics of their symptoms were recorded. The severity of pain and pruritus was assessed by the Visual Analog Scale (VAS). Radiography and magnetic resonance imaging of the spine were performed. In this study, we intradermally administered lidocaine diluted with saline into the upper back over three sessions. 1 cc 2% lidocaine was diluted with 5 cc 0.9% saline, and a total of 6 cc lidocaine mixture was obtained. The injection was performed locally at 1-cm intervals around the hyperpigmented patch and segmentally along the C2-T6 spinous processes. These patients were called for a follow-up at the second and fourth weeks and third month. RESULTS: There was no statistically significant difference between the two groups in terms of age, BMI, VAS-pain score, and duration of symptoms (p > 0.05 for all). Forty-six cervical and/or thoracic degenerative changes or herniated nucleus pulposus (HNP) were detected in patients with NP. There was a significantly higher number of HNP at the C6-7 segment and cervical degenerative changes in the NP group (p < 0.05). The VAS-pain and VAS-pruritus scores were significantly decreased at all follow-up sessions, and improvement was sustained by lidocaine up to the third month. CONCLUSION: Cervical degenerative changes and HNP of the C6-7 segment seem to be contributing factors for NP. Local lidocaine can be effective for pain relief and pruritus in NP.


Assuntos
Anestésicos Locais/uso terapêutico , Lidocaína/uso terapêutico , Parestesia/tratamento farmacológico , Prurido/tratamento farmacológico , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Hiperpigmentação/complicações , Hiperpigmentação/tratamento farmacológico , Hiperpigmentação/patologia , Degeneração do Disco Intervertebral/epidemiologia , Deslocamento do Disco Intervertebral/epidemiologia , Masculino , Pessoa de Meia-Idade , Parestesia/complicações , Parestesia/patologia , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/patologia , Prurido/complicações , Prurido/patologia
2.
Dermatol Online J ; 26(2)2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32239890

RESUMO

Thiotepa is a common alkylating agent known to precipitate cutaneous reactions consistent with toxic erythema of chemotherapy, including erythema and hyperpigmentation. Herein, we describe an atypical case of malignant intertrigo involving preferential erythema and desquamation not only of skin folds but also of occluded areas after thiotepa-based conditioning. The diagnosis was complicated by concurrent stomatitis and oral petechiae in the setting of autologous stem cell transplant 11 days prior for diffuse large B-cell lymphoma. Histopathological examination from two cutaneous sites demonstrated epidermal dysmaturation and eccrine gland necrosis consistent with thiotepa-induced desquamation and not Stevens-Johnson syndrome or graft-versus-host-disease. Malignant intertrigo can present with extensive cutaneous involvement, as evidenced by our patient who had 25% body surface area affected. Mucosal involvement is common with most chemotherapeutic regimens and its presence should not deter the astute clinician from consideration of a diagnosis of toxic erythema of chemotherapy. No further interventions were needed and the patient healed spontaneously.


Assuntos
Antineoplásicos Alquilantes/efeitos adversos , Erros de Diagnóstico , Hiperpigmentação/induzido quimicamente , Intertrigo/diagnóstico , Síndrome de Stevens-Johnson/diagnóstico , Tiotepa/efeitos adversos , Idoso , Humanos , Hiperpigmentação/diagnóstico , Hiperpigmentação/patologia , Intertrigo/induzido quimicamente , Intertrigo/patologia , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Estomatite/induzido quimicamente
3.
Dermatol Online J ; 26(2)2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32239899

RESUMO

Prurigo pigmentosa is a rare inflammatory dermatosis that primarily affects Japanese patients. Various triggers have been identified, including the ketogenic diet. Given the current popularity of the ketogenic diet, the incidence of prurigo pigmentosa may be on the rise. Herein, to the best of our knowledge, we present the first case of prurigo pigmentosa reported in a Hispanic patient in the United States.


Assuntos
Dieta Cetogênica/efeitos adversos , Hiperpigmentação/etiologia , Prurigo/etiologia , Pele/patologia , Feminino , Humanos , Hiperpigmentação/patologia , Prurigo/patologia , Adulto Jovem
5.
An Bras Dermatol ; 95(1): 32-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31889596

RESUMO

BACKGROUND: Macular lymphocytic arteritis most commonly presents as hyperpigmented macules on the lower limbs. The pathogenesis of this disease is still unclear and there is an ongoing debate regarding whether it represents a new form of cutaneous vasculitis or an indolent form of cutaneous polyarteritis nodosa. OBJECTIVE: To describe clinical, histopathological, and laboratory findings of patients with the diagnosis of macular lymphocytic arteritis. METHODS: A retrospective search was conducted by reviewing cases followed at the Vasculitis Clinic of the Dermatology Department, School of Medicine, University of São Paulo, between 2005 and 2017. Seven patients were included. RESULTS: All cases were female, aged 9-46 years, and had hyperpigmented macules mainly on the legs. Three patients reported symptoms. Skin biopsies evidencing a predominantly lymphocytic infiltrate affecting arterioles at the dermal subcutaneous junction were found, as well as a typical luminal fibrin ring. None of the patients developed necrotic ulcers, neurological damage, or systemic manifestations. The follow-up ranged from 18 to 151 months, with a mean duration of 79 months. STUDY LIMITATIONS: This study is subject to a number of limitations: small sample of patients, besides having a retrospective and uncontrolled study design. CONCLUSIONS: To the best of the authors' knowledge, this series presents the longest duration of follow-up reported to date. During this period, none of the patients showed resolution of the lesions despite treatment, nor did any progress to systemic vasculitis. Similarities between clinical and skin biopsy findings support the hypothesis that macular lymphocytic arteritis is a benign, incomplete, and less aggressive form of cutaneous polyarteritis nodosa.


Assuntos
Arterite/patologia , Dermatopatias Vasculares/patologia , Adolescente , Adulto , Biópsia , Criança , Feminino , Seguimentos , Humanos , Hiperpigmentação/patologia , Imuno-Histoquímica , Linfócitos/patologia , Pessoa de Meia-Idade , Poliarterite Nodosa/patologia , Estudos Retrospectivos , Adulto Jovem
8.
J Dermatolog Treat ; 31(2): 160-167, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30935257

RESUMO

Background: Topical tretinoin's role in acne has been established through evidence-based guidelines. Cutaneous irritation and potential to cause or exacerbate postinflammatory hyperpigmentation (PIH) may limit use.Objective: Evaluate safety and tolerability of novel polymeric formulation of tretinoin 0.05% lotion in moderate-to-severe acne.Methods: One thousand six hundred and forty patients randomized to tretinoin 0.05% lotion or vehicle in two double-blind placebo-controlled 12-week studies. Investigator-evaluated cutaneous safety (erythema and scaling) and patient-reported tolerability (itching, burning/stinging) assessed using a scale of 0 (none) to 3 (severe). Hyper- and hypo-pigmentation evaluated at each study visit. A number of subpopulations were investigated.Results: Tretinoin 0.05% lotion was considered safe and very well tolerated. Only application site pain (3.1%), dryness (3.7%) and erythema (1.4%) were reported by >1% or patients. Treatment-related adverse events were particularly rare (≤2%) in Hispanic and male subpopulations, and lower in adult females. The severity of cutaneous safety and tolerability scores remained <0.5 (where 1 = mild) and were generally lower than baseline severity. Tretinoin 0.05% lotion did not appear to cause or exacerbate PIH.Conclusions: A novel polymeric formulation of tretinoin 0.05% lotion provides a highly favorable safety and tolerability profile, with an incidence of erythema, dryness, and skin burning lower than that previously reported with other formulations of tretinoin.


Assuntos
Acne Vulgar/tratamento farmacológico , Ceratolíticos/uso terapêutico , Tretinoína/uso terapêutico , Acne Vulgar/patologia , Adolescente , Adulto , Criança , Método Duplo-Cego , Esquema de Medicação , Tolerância a Medicamentos , Feminino , Humanos , Hiperpigmentação/patologia , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Efeito Placebo , Prurido/patologia , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
9.
Phytother Res ; 34(6): 1320-1328, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31840901

RESUMO

Ultraviolet (UV) radiation elicits melanogenesis and pigmentation in the skin. Apigenin (4',5,7-trihydroxyflavone [AGN]) is a plant flavone contained in various herbs, fruits, and vegetables. We herein investigated antimelanogenic properties of AGN and the molecular mechanisms of the action of AGN. In UVB-treated mice, AGN inhibited cutaneous hyperpigmentation and macrophage migration inhibitory factor (MIF) expression as a melanogenesis-related key factor. In mouse keratinocytes, AGN inhibited the expression of MIF and also the related factors (e.g., stem cell factor and proteinase-activated receptor 2) induced by MIF. In addition to ellagic acid as a casein kinase II (CK2) inhibitor, AGN suppressed CK2 enzymatic activity and UVB-induced CK2 expression and subsequent phosphorylation of IκB and MIF expression. These results suggest that AGN inhibits UVB-induced hyperpigmentation through the regulation of CK2-mediated MIF expression in keratinocytes.


Assuntos
Apigenina/fisiologia , Apigenina/uso terapêutico , Caseína Quinase II/efeitos dos fármacos , Hiperpigmentação/tratamento farmacológico , Fatores Inibidores da Migração de Macrófagos/efeitos dos fármacos , Raios Ultravioleta/efeitos adversos , Animais , Apigenina/farmacologia , Humanos , Hiperpigmentação/patologia , Camundongos
10.
Ann Saudi Med ; 39(6): 444-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31804142

RESUMO

Prurigo pigmentosa is a rare pruritic inflammatory dermatosis with a unique staged clinicopathological presentation. It was first reported by Nagashima in 1971, and recently, more cases have been reported We introduce a case of a young Saudi female who developed biopsy proved prurigo pigmentosa after she followed strict ketogenic diet. Her condition resolved after she resumed a regular diet.


Assuntos
Dorso , Dieta Cetogênica/efeitos adversos , Hiperpigmentação/etiologia , Prurigo/etiologia , Tórax , Adulto , Feminino , Humanos , Hiperpigmentação/patologia , Prurigo/patologia , Pele/patologia
11.
Asian Pac J Cancer Prev ; 20(12): 3723-3728, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31870114

RESUMO

BACKGROUND: Skin hyperpigmentation usually results from an increased number, or activity, of melanocytes. The degree of pigmentation of skin depends on the amount and type of melanin, degree of skin vascularity, presence of carotene, and thickness of the stratum corneum. Common causes of hyperpigmentation include post-inflammatory hyperpigmentation, melasma, solar lentigines, ephelides (freckles), and café-au-lait macules. Some skin tumors can be hyperpigmented as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM). Stem cell factor (SCF) is a growth factor and its interaction with its receptor, c-kit, is well known to be critical to the survival of melanocytes. METHODS: This study was carried out on 60 patients complaining of hyperpigmented skin lesions (20 melasma, 20 solar lentigines, and 20 freckles) and 36 patients with skin tumors (14 BCC, 12 SCC, and 10 MM). Punch skin biopsies were taken from the previous lesions. Immunohistochemical staining of these samples was done using the stem cell factor (SCF). RESULTS: There was positive expression of SCF in all cases of melasma, solar lentigines and freckles with significant increase in the intensity of expression in the lesional areas than the non-lesional ones (P=0.004). There was also a statistically significant increase in the expression of SCF in BCC and melanoma tumor cells. CONCLUSION: SCF has a great role in skin hyperpigmented disorders and this can be used as a target for the developing of new antipigmentary lines of treatment by inhibiting SCF. SCF can also be involved in the emergence of some skin tumors.


Assuntos
Biomarcadores Tumorais/metabolismo , Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Hiperpigmentação/patologia , Melanoma/patologia , Neoplasias Cutâneas/patologia , Fator de Células-Tronco/metabolismo , Adulto , Idoso , Carcinoma Basocelular/metabolismo , Carcinoma de Células Escamosas/metabolismo , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Hiperpigmentação/metabolismo , Masculino , Melanoma/metabolismo , Pessoa de Meia-Idade , Prognóstico , Neoplasias Cutâneas/metabolismo
13.
Biomed Res Int ; 2019: 5829185, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31781623

RESUMO

Background: Ashy dermatosis (AD) and lichen planus pigmentosus (LPP) are both acquired macular pigmentation of uncertain aetiology. Despite the controversy surrounding their entities, recent global consensus has concluded that they are 2 different diseases with distinct clinical presentations. Nevertheless, there are limited data on their histopathological comparisons. Objective: To evaluate the differences in histopathological findings between AD and LPP. Methods: Electronic records and photographs of patients with the diagnosis of AD or LPP from January 2008 to December 2018 were retrospectively reviewed by a dermatologist. Patients were then classified into groups with AD and LPP, based on the clinical descriptions from the recent consensus. Those with history/clinical presentations suggestive of other causes of macular pigmentation were excluded. The histopathological diagnosis of AD and LPP was then reevaluated by a blinded dermatopathologist. Results: One hundred and twenty-four patients with acquired macular pigmentation were identified; 24 were excluded due to clinical history or photographs being inconsistent with AD or LPP. Of the remaining 100 patients, 71 had clinical findings consistent with LPP while 29 had AD. The prevalence of epidermal hyperkeratosis was significantly higher in LPP when compared to AD (33.8% vs. 0%, p < 0.001), as well as epidermal hypergranulosis (35.2% vs. 0%, p < 0.001), lichenoid dermatitis (49.3% vs. 7.1%, p < 0.001), perifollicular infiltration (47.9% vs.10.3%, p < 0.001), and perifollicular fibrosis (35.2% vs. 10.3%, p=0.01). In addition, the degree of pigmentary incontinence was more severe in LPP (21.1% vs. 3.5%, p=0.015). For AD, vacuolization of the epidermal basal cell layer was more common (96.4% vs. 77.5%, p=0.02). Conclusions: Although most cases of AD and LPP can be diagnosed clinically, in doubtful cases, histopathological findings of lichenoid dermatitis, epidermal hyperkeratosis/hypergranulosis, and moderate to severe pigmentary incontinence can help distinguish LPP from AD.


Assuntos
Líquen Plano/diagnóstico , Líquen Plano/patologia , Dermatopatias/diagnóstico , Dermatopatias/patologia , Adulto , Consenso , Diagnóstico Diferencial , Epiderme/patologia , Feminino , Humanos , Hiperpigmentação/diagnóstico , Hiperpigmentação/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tailândia , Resultado do Tratamento
14.
Dermatol Online J ; 25(9)2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31738846

RESUMO

A 28-year-old man with a history of mycosis fungoides presented for evaluation of multiple dark-brown macules and hyperpigmented dome-shaped papules on the distal tongue. A shave biopsy of the tongue revealed melanin pigment in the basal keratinocytes and melanophages in the lamina propria, consistent with pigmented fungiform papillae of the tongue. Relevant clinical and histologic features of this diagnosis are reviewed.


Assuntos
Hiperpigmentação/patologia , Melaninas , Papilas Gustativas/patologia , Doenças da Língua/patologia , Adulto , Humanos , Hiperpigmentação/etiologia , Masculino , Melaninas/análise , Micose Fungoide/complicações , Neoplasias Cutâneas/complicações , Doenças da Língua/etiologia
15.
Dermatol Online J ; 25(10)2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31735009

RESUMO

Hydroxyurea is a chemotherapeutic agent that is used in the treatment of various hematological diseases including chronic myelogenous leukemia, polycythemia vera, and sickle cell anemia. Hydroxyurea is also used to treat psoriasis. Drug-induced hyperpigmentation is a known cutaneous side effect of hydroxyurea along with xerosis, dermal ulcers, and dermatomyositis-like eruptions. Hyperpigmentation has been observed in the oral mucosa, nails, and in a generalized or a diffuse pattern. The mechanism of hyperpigmentation related to hydroxyurea is believed to be correlated with increased melanin. Classically, clinical types of diffuse hyperpigmentation owing to iron deposition in the dermis have been associated with minocycline and not with hydroxyurea. We report a novel case in which hydroxyurea hyperpigmentation is associated with iron deposition.


Assuntos
Hidroxiureia/efeitos adversos , Hiperpigmentação/induzido quimicamente , Ferro/análise , Inibidores da Síntese de Ácido Nucleico/efeitos adversos , Pele/patologia , Idoso , Humanos , Hiperpigmentação/patologia , Masculino , Microscopia Eletroquímica de Varredura , Pele/química
19.
Pediatr Dermatol ; 36(6): 864-868, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31576600

RESUMO

BACKGROUND AND OBJECTIVES: Melanonychia striata is common in children of darker-skinned Asian races, while subungual melanoma is extremely rare and it is difficult to make a diagnosis clinically. However, performing nail unit biopsies in children is particularly challenging and can result in permanent nail dystrophy. The aim of this study was to review the clinical and histologic characteristics of melanonychia striata in pediatric patients of Asian descent to aid in the clinical decision regarding nail biopsy. METHODS: Sixty-two pediatric patients presenting with melanonychia striata involving single or multiple nails at two tertiary pediatric dermatology clinics in Singapore between 2005 and 2015 were reviewed. Clinical and histopathological data were analyzed, including age at onset, age at presentation, location, color, width, presence of Hutchinson's sign, pseudo-Hutchinson's sign, nail dystrophy, length of follow-up, and clinical evolution. Histopathological assessment was performed by three senior dermatopathologists independently for cases that underwent a nail biopsy. RESULTS: No cases of subungual melanoma were detected in our series. Solitary melanonychia of the thumbnail with a single uniform color was the most common presentation. Pseudo-Hutchinson's sign was commonly observed. Consensus in histological diagnosis emerged amongst all three dermatopathologists in only half of the cases biopsied. CONCLUSION: The occurrence of melanoma in Asian children presenting with melanonychia is extremely rare. We recommend clinical follow-up and anticipatory guidance for these patients and nail unit biopsy only in the presence of high-risk clinical features.


Assuntos
Hiperpigmentação/patologia , Melanoma/patologia , Doenças da Unha/patologia , Neoplasias Cutâneas/patologia , Adolescente , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Hiperpigmentação/etnologia , Lactente , Recém-Nascido , Masculino , Melanoma/etnologia , Doenças da Unha/etnologia , Estudos Retrospectivos , Singapura , Neoplasias Cutâneas/etnologia
20.
ABCS health sci ; 44(2): 147-150, 11 out 2019. tab, ilus
Artigo em Português | LILACS | ID: biblio-1022408

RESUMO

INTRODUÇÃO: O processo de hiperpigmentação cutânea envolve mecanismos bioquímicos e imunológicos que estimulam a melanogênese e apesar da nefrotoxicidade consistir na reação adversa mais relevante da polimixina B, o antimicrobiano também está associado a esta alteração. RELATO DE CASO: Caso 1: paciente masculino diagnosticado com Linfoma de Hodgkin, que desenvolveu hiperpigmentação cutânea após iniciar tratamento com meropenem, anidulafungina e polimixina B devido a um quadro de choque séptico. Caso 2: paciente masculino admitido na UTI por rebaixamento do nível de consciência e suspeita de IAMCSST, diagnosticado com endocardite e pericardite, que também apresentou hiperpigmentação cutânea durante terapia com anfotericina B e polimixina B. CONCLUSÃO: Após criteriosa avaliação da ordem cronológica e medicamentos utilizados pelos pacientes, concluímos que a polimixina B desencadeou a hiperpigmentação em ambos. Por fim, baseado ao mecanismo desta reação e aos achados científicos, estudos clínicos que possam evidenciar um provável efeito farmacológico com o uso de antagonistas H2 são necessários.


INTRODUCTION: The skin hyperpigmentation process involves biochemical and immunological mechanisms that stimulate melanogenesis and although nephrotoxicity consists of the most relevant adverse reaction of polymyxin B, it is also associated with this changes. CASE REPORT: Case 1: male patient, diagnosed with Hodgkin's Lymphoma, who developed skin hyperpigmentation after starting treatment with meropenem, anidulafungin and polymyxin B due to a septic shock. Case 2: male patient, admitted to the ICU for decreased level of consciousness and suspected STEMI, diagnosed with endocarditis and pericarditis, who also presented skin hyperpigmentation during therapy with amphotericin B and polymyxin B. CONCLUSION: After careful evaluation of chronological order and drugs used by patients, we conclude that polymyxin B caused hyperpigmentation in both patients. Finally, based on the mechanism of this reaction and the scientific findings, clinical studies that may evidence a probable pharmacological effect with the use of H2 antagonists are required.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Polimixina B/administração & dosagem , Polimixina B/efeitos adversos , Polimixina B/uso terapêutico , Hiperpigmentação/patologia , Hiperpigmentação/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos
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