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Dermatology and Therapy Dec 2016Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this... (Review)
Review
Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon's plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).
PubMed: 27613297
DOI: 10.1007/s13555-016-0141-6 -
American Family Physician Jan 2018Pityriasis rosea is a common self-limiting rash that usually starts with a herald patch on the trunk and progresses along the Langer lines to a generalized rash over the...
Pityriasis rosea is a common self-limiting rash that usually starts with a herald patch on the trunk and progresses along the Langer lines to a generalized rash over the trunk and limbs. The diagnosis is based on clinical and physical examination findings. The herald patch is an erythematous lesion with an elevated border and depressed center. The generalized rash usually presents two weeks after the herald patch. Patients can develop general malaise, fatigue, nausea, headaches, joint pain, enlarged lymph nodes, fever, and sore throat before or during the course of the rash. The differential diagnosis includes secondary syphilis, seborrheic dermatitis, nummular eczema, pityriasis lichenoides chronica, tinea corporis, viral exanthems, lichen planus, and pityriasis rosea-like eruption associated with certain medications. Treatment is aimed at controlling symptoms and consists of corticosteroids or antihistamines. In some cases, acyclovir can be used to treat symptoms and reduce the length of disease. Ultraviolet phototherapy can also be considered for severe cases. Pityriasis rosea during pregnancy has been linked to spontaneous abortions.
Topics: Anti-Bacterial Agents; Diagnosis, Differential; Eczema; Exanthema; Family Practice; Female; Humans; Male; Physical Examination; Pityriasis Rosea; Skin
PubMed: 29365241
DOI: No ID Found -
Dermatology and Therapy May 2022Parapsoriasis is an uncommon inflammatory skin disease characterized by chronic patches that may be resistant to therapy. It was primarily introduced and classified... (Review)
Review
Parapsoriasis is an uncommon inflammatory skin disease characterized by chronic patches that may be resistant to therapy. It was primarily introduced and classified 120 years ago, and the original classification incorporated parapsoriasis and pityriasis lichenoides under the umbrella term parapsoriasis. After a major change in classification, parapsoriasis now exclusively refers to small plaque parapsoriasis (SPP) and large plaque parapsoriasis (LPP). However, debates still frequently occur regarding various nomenclatures and classifications used by different authors. Moreover, parapsoriasis may progress to overt cutaneous lymphoma, most commonly mycosis fungoides (MF), and it is very difficult to distinguish these two conditions despite modern histologic and molecular testing techniques.As parapsoriasis is a rare disease, there is a lack of studies and clinical guidelines to assist physicians in clinical practice. In our comprehensive review, we review several aspects of parapsoriasis, from the history of nomenclature and classification, clinical characteristics, immunohistopathology, and advanced molecular techniques for the diagnosis of this condition, to the most current treatments. We also propose a scheme for distinguishing parapsoriasis from early-stage MF in this review.
PubMed: 35426607
DOI: 10.1007/s13555-022-00716-y -
Journal of the European Academy of... Nov 2019Pityriasis lichenoides (PL) represents a spectrum of inflammatory skin diseases comprising pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis...
Pityriasis lichenoides (PL) represents a spectrum of inflammatory skin diseases comprising pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). This study aimed to provide a summary of effective treatments for PL. A systematic review was performed according to PRISMA guidelines for studies investigating PL treatment including ≥3 subjects and published in English between 1 January 1970 and 15 April 2019. A total of 441 papers were screened, and 37 original manuscripts meeting the inclusion and exclusion criteria were found, including 12 case series, 18 reviews, four prospective studies, two comparative studies and a single randomized controlled study. In most studies, ultraviolet (UV) phototherapy (narrow-band UVB, broadband UVB, UVA1 or PUVA) was used. Clearance rates with the different modalities are hardly comparable between different studies, ranging approximately between 70% and 100%. Narrow-band UVB showed an efficacy similar to PUVA as such as the combination of UVA and UVB vs. PUVA. Oral erythromycin showed clearance rates ranging between 66% and 83%, whereas methotrexate up to 100% but in small and dated studies. Evidence for other treatments is scarce. There is a lack of high level of evidence studies on PL treatment. The interpretation of the results is biased by the possible auto-resolution of the disease, the sample heterogeneity between children and adults and the short follow-up period of the studies. Only some studies investigated how results were durable after cessation of therapy. Quality of life and the impact of treatment were never assessed. According to the results of this review, we suggest narrow-band UVB phototherapy as first-line treatment. Oral erythromycin with or without topical corticosteroids and low-dose methotrexate as second-line therapies. High-powered studies and randomized controlled trials are needed to establish the optimal treatment for PL.
Topics: Administration, Topical; Adrenal Cortex Hormones; Anti-Bacterial Agents; Calcineurin Inhibitors; Humans; Phototherapy; Pityriasis Lichenoides
PubMed: 31318465
DOI: 10.1111/jdv.15813 -
Journal of Clinical Medicine Feb 2023Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial... (Review)
Review
Post-inflammatory hypopigmentation is a common acquired pigmentary disorder that is more prominent in skin of color, leading to great cosmetic and psychosocial implications. Often, a diagnosis with a pigmentary disorder can negatively impact an individual's health-related quality of life and may result in stigma. Although most cases of post-inflammatory hypopigmentation resolve spontaneously over time, a systematic diagnostic approach can help with identifying the underlying etiology and informing treatment strategies. It can be due to cutaneous inflammation, sequelae of inflammatory or infectious dermatoses, or dermatologic procedures. Therefore, a thorough understanding of the epidemiology, patient history, physical exam findings, and clinical features of post-inflammatory hypopigmentation phenomenon can explain the primary cause to providers and allow for patient education. It is also important to understand the various therapeutic approaches available and the efficacy of these options, which will inform providers to choose the appropriate therapy for patients. Although algorithms exist for classifying acquired disorders of hypopigmentation, there are no established algorithms for the diagnosis and treatment of post-inflammatory hypopigmentation, which warrants further exploration and discourse.
PubMed: 36769891
DOI: 10.3390/jcm12031243 -
Expert Review of Anti-infective Therapy Jun 2016Paraviral exanthems are skin diseases suspected to be caused by viruses, with a single virus-exanthem relationship not universally accepted. Although most paraviral... (Review)
Review
INTRODUCTION
Paraviral exanthems are skin diseases suspected to be caused by viruses, with a single virus-exanthem relationship not universally accepted. Although most paraviral exanthems are self-remitting, accurate diagnoses are important as some patients might develop complications. Some of the differential diagnoses might cause serious complications, and some paraviral exanthems might lead to complications for at-risk groups such as pregnant women. Moreover, some paraviral exanthems might be symptomatic such as the development of severe pruritus, with relief of such being crucial in the plan of management. Patients and carers of patients should also be counselled regarding the aetiologies, clinical features, and prognoses of the exanthems concerned.
AREAS COVERED
We covered the clinical manifestations and managements of pityriasis rosea, pityriasis lichenoides, and Gianotti-Crosti syndrome. Expert Commentary: Most patients with pityriasis rosea do not need any active intervention. Symptomatic relief of the pruritus would be adequate. For patients with pityriasis rosea that are serious, extensive, or causing severe impacts of their quality of life, oral acyclovir could be considered. For pityriasis lichenoides, managements would be depending on the type of the exanthem such as the acute form (pityriasis lichenoides et varioliformis acuta, also known as Mucha Habermann disease) the chronic form (pityriasis lichenoides chronic Juliusberg's disease), and the febrile ulceronecrotic Mucha-Habermann disease, which is a complication of the acute form. The management of Gianotti-Crosti syndrome is mainly symptomatic. The need for long-term follow-up for chronic complications of the underlying viral infections is still controversial.
Topics: Acrodermatitis; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiviral Agents; Combined Modality Therapy; Diagnosis, Differential; Exanthema; Humans; Phototherapy; Pityriasis Lichenoides; Pityriasis Rosea; Skin Diseases, Viral
PubMed: 27144956
DOI: 10.1080/14787210.2016.1184084 -
Der Hautarzt; Zeitschrift Fur... Mar 2017Paraviral exanthems are distinct skin diseases due to infections with different viruses. Although no virus has been identified so far in some exanthems, the main age of... (Review)
Review
Paraviral exanthems are distinct skin diseases due to infections with different viruses. Although no virus has been identified so far in some exanthems, the main age of manifestation, the clinical course of the exanthem, and the extracutaneous symptoms are suggestive for a viral genesis. While many viral infections are a direct result of the infection, paraviral exanthems reflect the response of the immune system to the infectious pathogens. Viruses cannot be identified in the skin. Typical paraviral exanthems include Gianotti-Crosti syndrome, pityriasis rosea, pityriasis lichenoides, papular-purpuric gloves and sock syndrome, and asymmetrical periflexural exanthema. Unilateral mediothoracic exanthem, eruptive pseudoangiomatosis are rare and eruptive hypomelanosis has been described recently.
Topics: Diagnosis, Differential; Diagnostic Techniques, Ophthalmological; Exanthema; Humans; Skin Diseases, Viral
PubMed: 28194482
DOI: 10.1007/s00105-017-3940-5 -
Current Dermatology Reports 2023Pityriasis lichenoides (PL) is a spectrum of dermatological conditions involving polymorphous lesions. Natural history of the condition ranges from acute to chronic.... (Review)
Review
PURPOSE OF REVIEW
Pityriasis lichenoides (PL) is a spectrum of dermatological conditions involving polymorphous lesions. Natural history of the condition ranges from acute to chronic. Cases of PL following SARS-CoV-2 infection/vaccination have been reported, but not yet comprehensively reviewed. Hence, the objective of this article is to review and summarize cases of PL following SARS-CoV-2 infection/vaccination in order to guide clinicians in its diagnosis and management.
RECENT FINDINGS
PubMed, Embase, and Web of Science were searched for relevant articles. Thirteen articles, consisting of 14 cases of PL following SARS-CoV-2 infection/vaccination, were identified. Males represented 64.3% of cases, and the average age of those affected was 41.4 years. The majority of cases ( = 9, 64.3%) were following SARS-CoV-2 vaccination, the most commonly implicated being Pfizer-BioNTech ( = 8/10, 80%), while four (28.6) followed infection. The overall latency period ranged from 5 days to 1 month. Treatments varied greatly. However, at the time of follow-up, 12/14 patients (85.7%) had either marked improvement or complete resolution of lesions.
SUMMARY
This review cannot determine causality. However, a temporal association was observed with the case reports, and one case of PL followed SARS-CoV-2 infection and recurred with subsequent vaccination, suggesting an association. Nevertheless, risk of developing PL following SARS-CoV-2 infection/vaccination is likely extremely low. There is also the possibility these cases are purely coincidental. Still, clinicians should be aware of this possible etiology when diagnosing a new or exacerbated case of PL. Finally, given that the majority of patients had marked improvement or complete resolution of lesions at the time of follow-up, clinicians should provide reassurance to their affected patients.
PubMed: 36688177
DOI: 10.1007/s13671-023-00380-1 -
Actas Dermo-sifiliograficas Jun 2021Autoinflammatory keratinization disease (AiKD) is a novel clinical concept encompassing diseases with a genetic background and mixed pathogenic mechanisms of... (Review)
Review
Autoinflammatory keratinization disease (AiKD) is a novel clinical concept encompassing diseases with a genetic background and mixed pathogenic mechanisms of autoinflammation and autoimmunity, leading to an aberrant keratinization of the skin. Recent advances in medical genetics have revealed genetic causes and/or predisposing factors for a number of AiKD's, such as mutations in IL36RN related with pustular psoriasis, acrodermatitis continua and hidradenitis suppurativa, in CARD14 in pityriasis rubra pilaris type V and some forms of pustular psoriasis, and in NLRP1 related with familial keratosis lichenoides chronica (KLC). It is suspected that AiKD pathophysiology would also be involved in non-monogenic disorders. The bidirectional relationship between inflammation and keratinization should be understood in order to outline optimal management, and new drug development should take both targets into account. We assume that new inflammatory keratinization diseases may be recognized as AiKDs in the coming years.
PubMed: 34118208
DOI: 10.1016/j.ad.2021.05.015