Paraviral cutaneous manifestations associated to SARS-CoV-2 Omicron variant.

BACKGROUND: The spreading of the SARS-CoV-2 Omicron variant is probably due to its increased transmissibility and ability to escape from neutralising antibodies. Cutaneous manifestations have been reported after infection with the Omicron strain, consisting mainly of generalised urticarial eruption and prickly heat rash, also known as miliaria, that can persist for several days. Here the impact of Omicron SARS-CoV-2 on skin was investigated. METHODS: The case series of 10 patients with SARS-CoV-2 Omicron variant-related cutaneous manifestations were described; moreover, skin derived cells were challenged in vitro with SARS-CoV-2 Omicron variant. RESULTS: The main clinical cutaneous features observed were urticarial lesions lasting more than 24 h, mainly involving the trunk and sometimes extending to the extremities, and miliaria presenting with clusters of small sweat-filled vesicles, sometimes surrounded by slight erythema. HaCaT keratinocytes, BJ fibroblast cell lines and outer root sheath (ORS) keratinocytes were not susceptible to SARS-CoV-2 Omicron variant infection; they also did not present any evident cytopathic effect or modification of cells viability. CONCLUSION: Our findings suggests that, despite the high number of nucleotide mutations in the spike protein of SARS-CoV-2 Omicron variant, responsible to the higher transmissibility of this virus, and the increased reports of cutaneous manifestation in COVID-19 affected patients, the virus is not able to directly infect and damage the keratinocytes and fibroblasts, thus suggesting an indirect virus-induced activation of the immune system as the major pathogenetic driver.

[A newborn with blisters]. / Een neonaat met blaasjes.

This case concerns a newborn with many small transparent vesicles on the forehead, trunk and face. Miliaria crystallina was diagnosed based on the typical presentation. Miliaria crystalline is a transient obstruction of sweat glands resulting in non-inflammatory vesicles. The treatment is simple: cool down.

Miliaria crystallina induced by idarubicin and all-trans-retinoic acid: Two case reports.

Miliaria crystallina is a benign, self-limiting disorder of the eccrine sweat glands characterized by the obstruction of the sweat ducts, which leads to secondary sweat retention into stratum corneum. We present two patients with MC during treatment with idarubicin and all-trans-retinoic acid (ATRA) for acute promyelocytic leukaemia (APL). Anthracyclines can be excreted through sweat and induce MC through exfoliation. The use of idarubicin in combination with ATRA would favour the process of producing a peeling effect. Reports of MC associated with idarubicin and ATRA are scarce. Recognizing this benign entity and its triggers will help to differentiate it from other skin reactions, improving the management of patients by avoiding unnecessary studies and treatments.

Miliaria Scarlatinosa, A Peculiar and Rare Form of Scarlet Fever - A Case Report.

Scarlet fever typically presents with distinctive erythematous papular rash following pharyngitis. Atypical forms may develop, making the diagnosis difficult. We present the case of a girl with fever, and unusual vesicular skin eruption (miliaria scarlatinosa) preceded by a skin infection, without mucosal changes. Leukocyte count, C-reactive protein, and antistreptolysin O-titer were elevated. Bacteriological swabs of the skin injury revealed Streptococcus pyogenes. Histopathology was compatible with scarlet fever exanthema. Intramuscular penicillin and topical wound care induced complete remission. It is of great importance to be aware of uncommon clinical presentations of scarlet fever in order to establish a timely diagnosis and prevent potential complications.

Miliaria crystallina secondary to herbal remedies-induced toxic epidermal necrolysis: A case report.

Miliaria crystallina is a skin disorder that often erupts in the process of febrile diseases or under hot and humid climatic conditions. Toxic epidermal necrolysis (TEN) is a rare, acute, and life-threatening mucocutaneous disease with a mortality rate of 25-35%. There has been no inevitable connection between the two diseases among previously reported cases, but we observed a case of secondary miliaria crystallina a woman with herbal remedies-induced TEN during the therapeutic process.

Heat-related skin disease

Skin disease can be caused by high temperature, and it is related to the temperature regulation mechanism of human body, adaptation reaction to temperature change, and health problems due to the recent problematic climate change. In hyperthermia, hot and dry skin is typical manifestation, and sometimes the skin color turns red. On the other hand, the skin color can become pale in severe febrile convulsion. Burn is a skin damage caused by heat, and not only the skin but also the underlying tissues can be destroyed in severe case. It is important to determine the degree and extent of the burn to treat adequately. In the case of severe burns, systemic treatment and prevention of infection or shock should be needed. Miliaria, also called “sweat rash,” occurs when the sweat is accumulated as the sweat gland is closed and sweat cannot be secreted to the surface of the skin. The basis of treating miliaria is to keep the patient in a cool environment. Erythema ab igne is defined as a network of hyperpigmentation that occurs after prolonged exposure to heat that is not enough to cause burn. It may disappear when exposure to heat is interrupted, but it may remain permanently. The extent and mechanism of heat-induced skin disease very diverse and it should be carefully assessed for the severity of each disease, the treatment method and prognosis.

[Widespread miliaria crystallina: about a case]. / La miliaire cristalline généralisée: à propos d'un cas.

Prickly heat is a benign cutaneous manifestation due to the obstruction of the sweat ducts following excessive exposure to heat, humidity or hyperthermia. We report the case of a 70-year old diabetic female patient treated with insulin, hospitalized in the Intensive Care Unit due to acidocetosic coma secondary to pyelonephritis. The patient had diffuse clear vesicular lesions spread all over the body,(a) firm to palpation, on a healthy skin, suggesting miliaria crystallina. Miliaria crystallina is a benign cutaneous manifestation due to sweat retention secondary to obstruction of the sweat ducts. It is possible to distinguish between miliaria crystallina due to the obstruction in the stratum corneum, miliaria rubra due to the obstruction within the malpighian stratum and miliaria profunda due to an obstrusction in or below the dermoepidermal junction, depending on the level of obstruction. Miliaria crystallina heals spontaneously in a few hours giving rise to a desquamation, as occurred in our patient after regression of febrile syndrome.

Segunda opinião formativa: o que é e como orientar o cuidado de uma criança com brotoeja?

Brotoeja é o nome popular da miliária, uma dermatite inflamatória causada pela obstrução das glândulas sudoríparas, que impede a saída do suor. As bolhas podem ser pequenas, transparentes e sem sinal de inflamação. Quando observamos pus, provavelmente, está ocorrendo uma infecção bacteriana secundária. O tratamento da brotoeja leva em conta as características das lesões, o local onde se instalaram e a idade do paciente.

Benign skin disease with pustules in the newborn.

The neonatal period comprises the first four weeks of life. It is a period of adaptation where the skin often presents several changes: transient lesions, resulting from a physiological response, others as a consequence of transient diseases and some as markers of severe disorders. The presence of pustules in the skin of the newborn is always a reason for the family and for the assisting doctor to be worried, since the newborn is especially vulnerable to bacterial, viral or fungal infection. However, the majority of neonatal skin pustules is not infectious, comprising the benign neonatal pustulosis. Benign neonatal pustuloses are a group of clinical disease characterized by pustular eruptions in which a contagious agent is not responsible for its etiology. The most common ones are erythema toxicum neonatorum, the transient neonatal pustular melanosis and the benign cephalic pustulosis. These dermatoses are usually benign, asymptomatic and self-limited. It is important that the dermatologist and the neonatologist can identify benign and transient lesions, those caused by genodermatoses, and especially differentiate between neonates with systemic involvement from those with benign skin lesions, avoiding unnecessary diagnostic tests and worries.

Benign skin disease with pustules in the newborn

Abstract: The neonatal period comprises the first four weeks of life. It is a period of adaptation where the skin often presents several changes: transient lesions, resulting from a physiological response, others as a consequence of transient diseases and some as markers of severe disorders. The presence of pustules in the skin of the newborn is always a reason for the family and for the assisting doctor to be worried, since the newborn is especially vulnerable to bacterial, viral or fungal infection. However, the majority of neonatal skin pustules is not infectious, comprising the benign neonatal pustulosis. Benign neonatal pustuloses are a group of clinical disease characterized by pustular eruptions in which a contagious agent is not responsible for its etiology. The most common ones are erythema toxicum neonatorum, the transient neonatal pustular melanosis and the benign cephalic pustulosis. These dermatoses are usually benign, asymptomatic and self-limited. It is important that the dermatologist and the neonatologist can identify benign and transient lesions, those caused by genodermatoses, and especially differentiate between neonates with systemic involvement from those with benign skin lesions, avoiding unnecessary diagnostic tests and worries.

Milia En Plaque as a Distinct Follicular Hamartoma With Cystic Trichoepitheliomatous Features.

Milia en plaque (MEP) is an uncommon disorder characterized by an erythematous plaque containing numerous milia. The pathogenesis of MEP is not clear. The authors report a man with an erythematous plaque on the right retroauricular area, containing numerous white-yellow cysts varying in size. Histological examination showed that multiple cystic structures at various levels of the dermis that were lined by stratified squamous epithelium and contained keratinous material-these findings were consistent with the diagnosis of multiple milia. In addition to epidermal cysts, however, the lesion consisted of a branched proliferation of pale-staining keratinocytes lined with basal keratinocytes budding from the overlying epidermis. Moreover, some cysts were formed within the branched epithelial proliferation, had thicker cyst walls than the ordinary milium, or had irregular or branched projections toward the surrounding dermis. From these findings, the authors conclude that MEP is a distinct follicular hamartoma with cystic trichoepitheliomatous features.