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JAMA Dermatology Aug 2014
Topics: Hand Dermatoses; Humans; Male; Middle Aged; Neutrophils; Remission, Spontaneous; Skin Ulcer
PubMed: 24964734
DOI: 10.1001/jamadermatol.2014.202 -
Infection and Drug Resistance 2015Lymphogranuloma venereum is a sexually transmitted disease caused by L1, L2, and L3 serovars of Chlamydia trachomatis. In the last 10 years outbreaks have appeared in... (Review)
Review
Lymphogranuloma venereum is a sexually transmitted disease caused by L1, L2, and L3 serovars of Chlamydia trachomatis. In the last 10 years outbreaks have appeared in North America, Europe, and Australia in the form of proctitis among men who have sex with men. Three stages of disease have been described. The disease in primary stage may go undetected when only a painless papule, pustule, or ulceration appears. The diagnosis is difficult to establish on clinical grounds alone and frequently relies upon either serologic testing, culture, or more recently, nucleic acid amplification testing of direct specimens. A proper treatment regimen cures the infection and prevents further damage to tissues. Lymphogranuloma venereum causes potentially severe infections with possibly irreversible sequels if adequate treatment is not begun promptly. Early and accurate diagnosis is essential. Doxycycline is the drug of choice. Pregnant and lactating women should be treated with erythromycin or azithromycin. Patient must be followed up during the treatment, until disease signs and symptoms have resolved. Repeated testing for syphilis, hepatitis B and C, and HIV to detect early infection should be performed.
PubMed: 25870512
DOI: 10.2147/IDR.S57540 -
Skinmed 2017The pathergy test produces a nonspecific hyperreactive lesion in Behçet's disease (BD), a finding that has been known since 1937. Pathergy refers to the development of... (Review)
Review
The pathergy test produces a nonspecific hyperreactive lesion in Behçet's disease (BD), a finding that has been known since 1937. Pathergy refers to the development of new skin lesions or the aggravation of existing ones after trivial trauma. In clinical practice, the pathergy test induces a skin response by needleprick, with positive reactions manifesting as a papule or pustule developing by 48 hours. The pathergy test is one of the major features and diagnostic criteria of the disease. It is very similar to the erythematous papules or pustules that appear spontaneously in patients with BD. There is no standardized method for conducting the pathergy test. Intradermal, intravenous, and subcutaneous applications are used. There is no generally accepted opinion on which form of the test yields a higher positivity rate. The pathergy reaction is also reported in pyoderma gangrenosum, and has been noted in other neutrophilic dermatoses such as Sweet syndrome. The overall objective of this contribution is to provide a review of the available information, literature, and research relating to the pathergy test.
Topics: Behcet Syndrome; Disease Progression; Female; Humans; Hypersensitivity; Immunization; Male; Sensitivity and Specificity; Skin; Skin Tests
PubMed: 28528602
DOI: No ID Found -
Dermatologie (Heidelberg, Germany) Sep 2023Rosacea is a common chronic inflammatory dermatosis of the face, clinically characterized by erythema, telangiectasia, papules, pustules, and rhinophyma. In January...
Rosacea is a common chronic inflammatory dermatosis of the face, clinically characterized by erythema, telangiectasia, papules, pustules, and rhinophyma. In January 2022, the updated guideline on rosacea was published. Groundbreaking innovations include the new clinical classification according to phenotypes, extended diagnostic and therapeutic recommendations for ocular rosacea and implications of the gut microbiome on rosacea. Furthermore, the guideline encompasses a new chapter on the psychosocial aspects of rosacea and detailed recommendations for approved and off-label therapies.
Topics: Animals; Rosacea; Rhinophyma; Dermatitis; Hydrozoa; Blister
PubMed: 37594512
DOI: 10.1007/s00105-023-05197-4 -
Journal of the European Academy of... Aug 2022Pustules are among the most common lesions produced in human skin. Infections by pathogens and drug-induced reactions are frequent causes of pustule formation. In recent...
Pustules are among the most common lesions produced in human skin. Infections by pathogens and drug-induced reactions are frequent causes of pustule formation. In recent years immune-mediated pustular diseases have drawn attention. It is proposed to classify pustular diseases according to the initiating events and sites: purely epidermal pustules, follicular pustules or pustules noted in autoinflammatory syndromes. The unifying pathology in all of the three categories is a microinvasion of activated neutrophils into epidermal or adnexal epithelia. Formation of pustules involves established IL-17 / IL-23, IL-36 / IL-36RN driven pathology, or IL-1 /caspase-activated autoinflammation. Pathophysiology demonstrates an intriguing synergy of keratinocytes with neutrophils. This is called keratinocyte-myeloid synergy (KMS). Non-infectious pustules are formed by IFNα controlling the production of chemoattractants (IL-8, LTB4) or induced by IL-1-regulated inflammasomes and caspase/ IFNβ-induced chemotaxins. The presence of physical barriers, for example, cornified cell layers (str. corneum), is instrumental in establishing chemotactic gradients and blocking migrating neutrophils. In follicular KMS-driven pustular disorders, in contrast to epidermal pustules, neutrophil-mediated toxicity propagates lasting and expanding ulcerating diseases with increased levels of circulating immunoglobulin A (IgA). Complexed IgA is suggested to propagate ongoing pustular diseases. These are prerequisites essential for developing pustules in burdensome human skin diseases.
Topics: Caspases; Exanthema; Humans; Immunoglobulin A; Interleukin-1; Keratinocytes; Neutrophils; Psoriasis
PubMed: 35848143
DOI: 10.1111/jdv.18279 -
Journal of Cutaneous Medicine and... 2023
PubMed: 37602706
DOI: 10.1177/12034754231194255 -
Boletin Medico Del Hospital Infantil de... 2022Acute generalized exanthematous pustulosis is a rare disease. Although it is usually related to drug intake, it is occasionally associated with infections, especially in...
BACKGROUND
Acute generalized exanthematous pustulosis is a rare disease. Although it is usually related to drug intake, it is occasionally associated with infections, especially in the pediatric age. It is characterized by the sudden onset of sterile non-follicular pustules on an erythematous fundus, fever, and leukocytosis, with frequent and prompt spontaneous resolution. It mainly affects adults and is uncommon in childhood. Complications have been reported in approximately 20% of cases.
CASE REPORT
We report the case of a 10-year-old female patient with a 5-day history of fever and dermatosis characterized by countless non-follicular pustules, predominantly on the trunk, inguinal folds, and proximal thighs but not involving palms, soles, and mucous membranes. The patient reported an incident of upper respiratory tract infection that occurred 7 days earlier. Histopathological examination confirmed the diagnosis of acute generalized exanthematous pustulosis. Spontaneous resolution occurred within 2 weeks.
CONCLUSIONS
This disease is one of the severe cutaneous adverse reactions that usually have a self-limited and benign course within a few weeks. We propose that a previous respiratory infection triggered the acute generalized exanthematous pustulosis in this pediatric case. Knowledge of this pathology by the medical professionals, in general, and the pediatricians, in particular, will prevent an aggressive and inappropriate approach and management.
Topics: Acute Generalized Exanthematous Pustulosis; Adult; Child; Female; Humans
PubMed: 36100209
DOI: 10.24875/BMHIM.21000125 -
European Journal of Dermatology : EJD Oct 2021Generalized pustular psoriasis (GPP) is a chronic disease characterized by non-bacterial pustules. Variants in several genes, such as IL36RN, AP1S3, and CARD14, are... (Review)
Review
Generalized pustular psoriasis (GPP) is a chronic disease characterized by non-bacterial pustules. Variants in several genes, such as IL36RN, AP1S3, and CARD14, are involved in the pathogenesis of GPP. The prevalence of different gene variants varies among ethnicities, and some variants are related to concurrent psoriasis vulgaris or age at onset. Flares can be triggered by medications (most commonly corticosteroids), infections (possibly due to Toll-like receptor [TLR] and antimicrobial peptides), pregnancy (the onset of GPP has been attributed to endocrine abnormalities such as hypoparathyroidism and hypocalcaemia), hypocalcaemia (presumably due to low levels of calcium and vitamin D regulating the proliferation and differentiation of keratinocytes), and other factors including stress and sun exposure. The mechanisms of pustule formation involve: 1) the LL37/TLR pathway, in which LL37 acts as an alarmin, interacting with TLR and activating the NF-κB and MAPK pathways; 2) the balance between calcium and 1,25(OH)2D levels, and 3) neutrophils and the complement system.
Topics: Cathelicidins; Female; Genetic Variation; Glucocorticoids; Humans; Hypocalcemia; Pregnancy; Pregnancy Complications; Psoriasis; Respiratory Tract Infections; Toll-Like Receptors; Vitamin D Deficiency; Withholding Treatment
PubMed: 34903506
DOI: 10.1684/ejd.2021.4047 -
Clinical and Experimental Dermatology May 2022We report the case of a 61-year-old woman presenting with a subacute eruption of a florid, circinate eruption with peripheral pustules. Histological findings included a...
We report the case of a 61-year-old woman presenting with a subacute eruption of a florid, circinate eruption with peripheral pustules. Histological findings included a neutrophilic intraepidermal pustule with associated acantholysis, and a mixed inflammatory cell infiltrate within the dermis.
Topics: Diagnosis, Differential; Exanthema; Female; Humans; Middle Aged
PubMed: 35106790
DOI: 10.1111/ced.15077 -
Dermatology Online Journal Jan 2017Sexually transmitted infections, includingurogenital gonorrheal infection, are a growing healthconcern in the United States. Nearly 50% of cervicalinfections are... (Review)
Review
BACKGROUND
Sexually transmitted infections, includingurogenital gonorrheal infection, are a growing healthconcern in the United States. Nearly 50% of cervicalinfections are asymptomatic. If left undiagnosedand untreated, there is a risk of disseminatedinfection.
PURPOSE
To describe an 18-year-old womanpresenting with disseminated gonococcal infectionconfirmed by blood cultures, skin biopsy, and urinegonococcal probe. We also describe the presentation,diagnosis, and treatment of disseminated gonococcalinfection, including discussion of the variousmorphologies of cutaneous lesions that have beenreported in the literature.
MATERIALS AND METHODS
Thefeatures of a woman with disseminated gonococcalinfection are presented. Using PubMed, the termscutaneous, disseminated, gonococcal, gonorrhea,infection, lesions, manifestations, pustules, skin, andsystemic were searched. Relevant citations wereutilized and discussed.
RESULTS
Hemorrhagic pustules,petechiae, and purpuric lesions developed in a youngwoman with fever and joint pain. Blood cultures grewbeta lactamase negative Neisseria gonorrhoeae andthe Neisseria gonorrhoeae/Chlamydia trachomatisprobe was positive for both N. gonorrhoeae and C.trachomatis. Biopsy revealed bulla with neutrophils,extravasated erythrocytes, fibrin deposits in the vesselwalls, and leukocytoclasia.
CONCLUSION
Cutaneouslesions of disseminated gonococcal infection caninclude abscesses, cellulitis, petechiae, purpuricmacules, necrotizing fasciitis, and vasculitis. It isimportant for the clinician to recognize the clinicalsigns and symptoms of disseminated gonococcalinfection, particularly the various cutaneousmanifestations.
Topics: Adolescent; Anti-Bacterial Agents; Arthritis, Infectious; Bacteremia; Ceftriaxone; Dermatitis; Female; Gonorrhea; Humans; Neisseria gonorrhoeae
PubMed: 28329470
DOI: No ID Found