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IMPORTANCE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous adverse reaction occurring 2 to 8 weeks after medication initiation. Diagnosis is clinical; RegiSCAR scoring includes biopsy "suggestive of DRESS," undefined in the literature. OBJECTIVE: This study correlates DRESS dermatopathology, culprit drugs, disease course, and outcome severity compared with maculopapular drug reactions (MDR). METHODS: Between 2014 and 2023, a retrospective cohort study at a tertiary care institute reviewed 55 patients with DRESS, assessing demographics, culprit drug, illness course, and histopathology. Biopsies of 15 patients with DRESS and 15 MDR patients were graded by a predefined histopathological scoring system. Statistical analysis (significant P -value<0.05) included the Fisher exact probability, ANOVA, and correlation tests. RESULTS: Among 55 patients with DRESS (mean age 50.13, 28 female/27 male), 15 (mean age 50.4, 7 female/8 male) had diagnostic biopsies. Compared with MDR patients, patients with DRESS exhibited significantly more interface dermatitis ( P = 0.04), lichenoid dermatitis ( P = 0.0007), pigment incontinence ( P = 0.04), and periadnexal interface dermatitis ( P = 0.002). MDR biopsies displayed perivascular inflammation and higher eosinophils than DRESS, trending toward significance. CONCLUSIONS: Key histopathologic features are interface dermatitis, periadnexal interface dermatitis, lichenoid dermatitis, pigment incontinence, and neutrophils dominance over eosinophils indicate DRESS clinically.
Assuntos
Síndrome de Hipersensibilidade a Medicamentos , Humanos , Feminino , Masculino , Síndrome de Hipersensibilidade a Medicamentos/patologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Adulto , Idoso , BiópsiaRESUMO
BACKGROUND: Previous studies have found familial aggregation of melanoma and keratinocyte cancers (KCs). OBJECTIVE: We sought to determine the risk of melanoma and KCs in those with a positive family history of melanoma while controlling for pigmentary and environmental risk factors. METHODS: We prospectively followed 216,115 participants from the Nurses' Health Study, Nurse's Health Study 2, and Health Professionals Follow-up Study for more than 20 years. Cox proportional hazards regression controlling for known risk factors for skin cancer was used to estimate association between family history of melanoma and melanoma and KCs. RESULTS: Compared with those without a family history of melanoma, individuals with a family history of melanoma had a 74% increased risk of melanoma (hazard ratio [HR], 1.74; 95% confidence interval [CI], 1.45-2.09), a 22% increased risk of squamous cell carcinoma (HR, 1.22; 95% CI, 1.06-1.40), and a 27% increased risk of basal cell carcinoma (HR, 1.27; 95% CI, 1.12-1.44). Family history of melanoma increased the risk of development of truncal melanoma in both sexes, extremity melanoma in women, and extremity squamous cell carcinoma in women. LIMITATIONS: Limitations of this study include self-reported family history and detection bias. CONCLUSION: Individuals with a family history of melanoma are at an increased risk of melanoma and KCs.
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Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Melanoma/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adulto , Extremidades , Saúde da Família , Feminino , Inquéritos Epidemiológicos , Humanos , Incidência , Masculino , Melanoma/genética , Pessoa de Meia-Idade , Linhagem , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Sexuais , Neoplasias Cutâneas/genética , Tronco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The presence of nevi portends an increased risk for melanoma. OBJECTIVE: We sought to examine the association between extremity nevus count and the risk of melanoma and keratinocyte cancers. METHODS: We evaluated prospective cohorts of 176,317 women (the Nurses' Health Study, 1986-2012 and the Nurses' Health Study 2, 1989-2013) and 32,383 men (Health Professionals Follow-up Study, 1986-2012). Information on nevus count (none, 1-5, 6-14, ≥15) on the extremity was collected at baseline. RESULTS: There were 1704 incident cases of melanoma, 2296 incident cases of squamous cell carcinoma, and 30,457 incident cases of basal cell carcinoma, with a total of 4,655,043 person-years for melanoma and 4,267,708 person-years for keratinocyte cancers. The presence of an extremity nevus was associated with an increased risk of melanoma in all anatomic areas and increased risk of basal cell carcinoma (BCC). Individuals with ≥15 nevi had the highest risk of melanoma and BCC compared to those without any extremity nevi (melanoma hazard ratio 2.79 [95% confidence interval 2.04-3.83]; BCC HR 1.40 [95% confidence interval 1.32-1.49]). No significant association was observed for squamous cell carcinoma. LIMITATIONS: Limitations of our study included self-reported nevus count and detection bias. CONCLUSIONS: Extremity nevus count is a helpful clinical marker in risk-stratifying individuals for BCC and melanoma on all body sites.
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Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Melanoma/epidemiologia , Nevo Pigmentado/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Carga Tumoral , Feminino , Antebraço , Humanos , Incidência , Perna (Membro) , Masculino , Estudos Prospectivos , Fatores de Risco , Estados UnidosAssuntos
Melanoma , Humanos , Estados Unidos , Estudos Retrospectivos , Melanoma/cirurgia , Etnicidade , Grupos RaciaisAssuntos
Estado Civil , Estadiamento de Neoplasias , Programa de SEER , Neoplasias das Glândulas Sebáceas , Humanos , Programa de SEER/estatística & dados numéricos , Masculino , Feminino , Neoplasias das Glândulas Sebáceas/mortalidade , Neoplasias das Glândulas Sebáceas/patologia , Neoplasias das Glândulas Sebáceas/epidemiologia , Pessoa de Meia-Idade , Estado Civil/estatística & dados numéricos , Idoso , Estados Unidos/epidemiologia , Adulto , Adenocarcinoma Sebáceo/patologia , Adenocarcinoma Sebáceo/mortalidade , Adenocarcinoma Sebáceo/epidemiologia , Taxa de Sobrevida , Idoso de 80 Anos ou maisRESUMO
Nevus sebaceus of Jadassohn, a congenital cutaneous hamartoma, has the potential to develop into various epidermal adnexal-origin neoplasms. While the most common neoplasms are trichoblastoma or syringocystadenoma, proliferating trichilemmal cysts are exceptionally rare. We report a case of a 63-year-old Cuban male with a giant proliferating trichilemmal cyst arising from a nevus sebaceus on the right shoulder which had been growing for 30 years. Proliferating trichilemmal cysts arising from nevus sebaceus cases are difficult to diagnose clinically and histologically as they are very rare and have not been defined by exact diagnostic criteria. Our case creates awareness of this particular tumor in nevus sebaceus and shares clinical and histological diagnostic information that can be used to make a proper diagnosis.
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Clinical trials are critical for the development of new therapies in dermatology, and their results help determine US Food and Drug Administration (FDA) approval and guide care. Of special relevance is the clinical trial efficacy end point, the metric from which statistically significant outcome is derived. Clinicians' understanding of a clinical trial's end point is necessary for critical analysis of the trial results and for applying those results to daily practice. This review provides practical knowledge and critical evaluation of end points used in treatment approvals by the FDA. The end points for actinic keratosis, acne vulgaris, atopic dermatitis, onychomycosis, and cutaneous ulcer serve as examples.
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Ensaios Clínicos como Assunto , Aprovação de Drogas , Determinação de Ponto Final , Dermatopatias/tratamento farmacológico , Acne Vulgar/tratamento farmacológico , Dermatite Atópica/tratamento farmacológico , Humanos , Ceratose Actínica/tratamento farmacológico , Onicomicose/tratamento farmacológico , Úlcera Cutânea/tratamento farmacológico , Resultado do Tratamento , Estados Unidos , United States Food and Drug AdministrationRESUMO
BACKGROUND: The incidence of melanoma in situ (MIS) is increasing, but little is known about its clinical and epidemiologic features. OBJECTIVE: We sought to determine trends in diagnosis and clinical features of MIS. METHODS: Incident cases of melanoma were collected prospectively from the Nurses' Health Study (1976-2010) and Health Professionals Follow-up Study (1986-2010). RESULTS: MIS incidence increased from 2 to 42 per 100,000 person-year among women, and from 11 to 73 per 100,000 person-year among men, exceeding the rate of increase of invasive melanomas. Melanoma mortality initially increased during the follow-up period then plateaued. Men were more likely than women to develop in situ melanomas on the upper half of the body (P < .001). Invasive melanomas were diagnosed at a younger age than MIS (P < .001), and were more likely to be found on the lower extremities than MIS (P < .001). LIMITATIONS: This is a strictly descriptive study without examination into mechanisms. CONCLUSION: We found epidemiologic and clinical differences for in situ and invasive melanomas, which support further examination into the variations in etiologic pathways. The lack of improvement in mortality despite the increase in detection of in situ relative to invasive lesions further highlights the need to improve invasive melanoma-specific clinical screening features.
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Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Melanoma/epidemiologia , Melanoma/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Adulto , Distribuição por Idade , Idoso , Carcinoma in Situ/diagnóstico , Feminino , Humanos , Sarda Melanótica de Hutchinson/epidemiologia , Sarda Melanótica de Hutchinson/patologia , Incidência , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Medição de Risco , Distribuição por Sexo , Neoplasias Cutâneas/diagnóstico , Estados Unidos/epidemiologia , Melanoma Maligno CutâneoAssuntos
Antibacterianos/efeitos adversos , Diuréticos/efeitos adversos , Toxidermias/imunologia , Tolerância Imunológica/efeitos dos fármacos , Penfigoide Bolhoso/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Biópsia , Diagnóstico Tardio , Toxidermias/diagnóstico , Toxidermias/patologia , Feminino , Humanos , Masculino , Diagnóstico Ausente , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/imunologia , Penfigoide Bolhoso/patologia , Polimedicação , Estudos Retrospectivos , Pele/imunologia , Pele/patologia , Fatores de TempoRESUMO
Although basal cell carcinomas (BCC) are relatively common, particularly in older individuals, the development of multiple BCCs at a young age can indicate an associated genetic disorder. Several cases of unilateral or segmental BCCs have been described in the literature. Some cases have demonstrated concomitant syndromic findings while others had unilateral BCCs as the only finding. Herein we present a non-syndromic case of multiple unilateral nodular and pigmented BCCs in a 61-year-old Hispanic man.