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The British Journal of Dermatology Jan 2016Pyoderma gangrenosum (PG) is a neutrophil-predominant inflammatory disease that initially presents as a sterile pustule and may progress to ulcerations. Its root cause... (Review)
Review
Pyoderma gangrenosum (PG) is a neutrophil-predominant inflammatory disease that initially presents as a sterile pustule and may progress to ulcerations. Its root cause is unknown, but the presentation is commonly associated with systemic inflammatory conditions such as inflammatory bowel disease, arthritis and haematological abnormalities. On the other hand, pregnant women show a progressive neutrophilia during gestation, which culminates in a major inflammatory event to help drive labour. Although uncommonly, PG has been associated with pregnancy, which provides an additional link to systemic inflammation as an underlying cause of PG. We reviewed documented presentations of PG in gravid and post-partum patients, and have speculated on the possible pathogenesis based on their clinical presentations. Also, we summarize the reported treatments and their outcomes in these patients.
Topics: Adrenal Cortex Hormones; Adult; Dermatitis; Female; Gestational Age; Humans; Medical History Taking; Neutrophils; Pregnancy; Pregnancy Complications; Prenatal Care; Pyoderma Gangrenosum; Recurrence; Steroids
PubMed: 26474193
DOI: 10.1111/bjd.14230 -
Dermatology Reports Jun 2016Rosacea is a field within dermatology with new insight within immunological research and new treatment-algorithm. Patient education on rosacea and appropriate treatments... (Review)
Review
Rosacea is a field within dermatology with new insight within immunological research and new treatment-algorithm. Patient education on rosacea and appropriate treatments is an important aspect in helping patients succeed with therapy. Treatment should be tailored to each individual patient, taking into account: symptoms, trigger factors, patients' wishes, most bothersome symptoms, psychological aspect, individual needs. A combination of clinical therapies to treat different symptoms concomitantly may offer the best possible outcomes for the patient. In this review article we describe these aspects.
PubMed: 27942368
DOI: 10.4081/dr.2016.6387 -
Experimental Dermatology Aug 2023Effisayil 1 was a multicentre, randomized, double-blind, placebo-controlled study of the anti-interleukin (IL)-36 receptor monoclonal antibody, spesolimab, in patients... (Randomized Controlled Trial)
Randomized Controlled Trial
Effisayil 1 was a multicentre, randomized, double-blind, placebo-controlled study of the anti-interleukin (IL)-36 receptor monoclonal antibody, spesolimab, in patients presenting with a generalized pustular psoriasis (GPP) flare. Previously published data from this study revealed that within 1 week, rapid pustular and skin clearance were observed in patients receiving spesolimab versus placebo. In this pre-specified subgroup analysis, the efficacy of spesolimab was evaluated according to patient demographic and clinical characteristics at baseline in patients receiving spesolimab (n = 35) or placebo (n = 18) on Day 1. Efficacy was by assessed by achievement of primary endpoint (Generalized Pustular Psoriasis Physician Global Assessment [GPPGA] pustulation subscore of 0 at Week 1) and key secondary endpoint (GPPGA total score of 0 or 1 at Week 1). Safety was assessed at Week 1. Spesolimab was found to be efficacious and had a consistent and favourable safety profile in patients presenting with a GPP flare, regardless of patient demographics and clinical characteristics at baseline.
Topics: Humans; Treatment Outcome; Psoriasis; Antibodies, Monoclonal, Humanized; Skin
PubMed: 37140190
DOI: 10.1111/exd.14824 -
BMJ (Clinical Research Ed.) May 2022
Topics: Blister; Communicable Diseases; Erythema; Exanthema; Female; Humans
PubMed: 35512796
DOI: 10.1136/bmj-2022-070355 -
Clinics in Dermatology 2017Rosacea represents a common and chronic inflammatory skin disorder. Clinical features include transient and permanent erythema, inflammatory papules and pustules,...
Rosacea represents a common and chronic inflammatory skin disorder. Clinical features include transient and permanent erythema, inflammatory papules and pustules, phymatous changes, and ocular signs and symptoms. Rosacea is generally classified into four subtypes and one variant. Subtype 1, erythematotelangiectatic rosacea, includes clinical features of flushing and persistent central facial erythema with or without telangiectasia. Subtype 2, papulopustular rosacea, is characterized by persistent central facial erythema with transient papules or pustules or both on the central face. Subtype 3, phymatous rosacea, includes thickening of the skin with irregular surface nodularities and enlargement. Subtype 4, ocular rosacea, includes inflammation of different parts of the eye and eyelid. A variant, granulomatous rosacea, is noninflammatory and is characterized by hard, brown, yellow, or red cutaneous papules or nodules of uniform size. Patients may present with more than one subtype, and each individual characteristic may fluctuate. There is debate whether rosacea progresses from one subtype over time or subtypes represent discreet entities. Defining clinical presentation and improved understanding of pathophysiology has resulted in identification of novel treatment approaches. This contribution outlines a rationale for treatment, highlights an evidence-based approach with approved treatments, and considers novel developments and off-license therapy available.
Topics: Erythema; Eye Diseases; Flushing; Humans; Rosacea
PubMed: 28274361
DOI: 10.1016/j.clindermatol.2016.10.016 -
Postgraduate Medicine Apr 2021Pustular psoriasis refers to a heterogeneous group of chronic inflammatory skin disorders that are clinically, histologically, and genetically distinct from plaque... (Review)
Review
Pustular psoriasis refers to a heterogeneous group of chronic inflammatory skin disorders that are clinically, histologically, and genetically distinct from plaque psoriasis. Pustular psoriasis may present as a recurrent systemic illness (generalized pustular psoriasis [GPP]), or as localized disease affecting the palms and/or soles (palmoplantar pustulosis [PPP], also known as palmoplantar pustular psoriasis), or the digits/nail beds (acrodermatitis continua of Hallopeau [ACH]). These conditions are rare, but their possible severity and consequences should not be underestimated. GPP, especially an acute episode (flare), may be a medical emergency, with potentially life-threatening complications. PPP and ACH are often debilitating conditions. PPP is associated with impaired health-related quality of life and psychiatric morbidity, while ACH threatens irreversible nail and/or bone damage. These conditions can be difficult to diagnose; thus, primary care providers should not hesitate to contact a dermatologist for advice and/or patient referral. The role of corticosteroids in triggering and leading to flares of GPP should also be noted, and physicians should avoid the use of systemic corticosteroids in the management of any form of psoriasis.
Topics: Humans; Primary Health Care; Psoriasis; Quality of Life; Referral and Consultation; Skin
PubMed: 33118424
DOI: 10.1080/00325481.2020.1831315 -
Revista Clinica Espanola Mar 2022
Topics: Humans; Suppuration; Sweet Syndrome
PubMed: 34120878
DOI: 10.1016/j.rceng.2019.11.019 -
Clinics in Perinatology Mar 2020Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative... (Review)
Review
Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative to avoid unnecessary testing and treatment for benign eruptions, while allowing for adequate treatment of potentially fatal disorders. In this review, we highlight several rare blistering diseases of the newborn. A diagnostic approach is outlined to provide clinicians with a framework for approaching a neonate with vesicles, pustules, or ulcers.
Topics: Diagnosis, Differential; Humans; Infant, Newborn; Neonatal Screening; Rare Diseases; Skin Diseases, Vesiculobullous
PubMed: 32000929
DOI: 10.1016/j.clp.2019.09.005 -
Cutis Jul 2022Ecthyma contagiosum (orf), a worldwide cause of the hand pustule, is caused by orf virus, a member of the genus Parapoxvirus, which causes an epitheliotropic zoonotic... (Review)
Review
Ecthyma contagiosum (orf), a worldwide cause of the hand pustule, is caused by orf virus, a member of the genus Parapoxvirus, which causes an epitheliotropic zoonotic infection that spreads from ruminants (even-toed ungulate mammals such as sheep or goats) to humans. Similar members within the poxvirus family can cause a clinically identical viral pustule, which is spread to humans from the respective animal host reservoirs. These entities are impossible to clinically differentiate in the absence of social history or specific polymerase chain reaction studies, though their frequency does vary based on location across the globe.Although its 1-cm solitary hand pustule often is easily diagnosed by the experienced dermatologist, the goal of this review is to expand the understanding of the presentation, differential diagnosis, and treatment of this condition. We present 5 clinical cases of orf. Special care also has been taken to expand on our report of the unique associated cultural and social elements that the expert diagnostician should obtain to determine etiology.Early and rapid diagnosis of this classic condition are critical to prevent unnecessary biopsies or extensive testing, and determination of etiology can be important to prevent reinfection or spread to other humans by the same infected animal.
Topics: Animals; Ecthyma, Contagious; Exanthema; Goats; Humans; Orf virus; Sheep; Skin; Zoonoses
PubMed: 36179231
DOI: 10.12788/cutis.0567 -
Clinical Practice and Cases in... Nov 2020Dermatology complaints account for 3.3% of emergency department (ED) visits per year. Most rashes are benign, but there are a select few that emergency physicians must...
INTRODUCTION
Dermatology complaints account for 3.3% of emergency department (ED) visits per year. Most rashes are benign, but there are a select few that emergency physicians must be familiar with as delay in treatment could be life threatening.
CASE REPORT
A well-appearing, 76-year-old male presented to the ED with multiple coalescing pustules to his palms and soles and was transferred to the nearest tertiary care hospital for dermatology consult. He was diagnosed with palmoplantar pustulosis and discharged home with a five-day course of clobetasol propionate 0.05% cream twice daily and outpatient dermatology follow-up.
CONCLUSION
Palmoplantar pustulosis is an uncommon skin condition characterized by recurrent eruptions of sterile pustules localized to the palms and soles. Emergency physician awareness of this rare diagnosis may help prevent hospital admissions and lead to earlier initiation of treatment with outpatient dermatology follow-up.
PubMed: 33217303
DOI: 10.5811/cpcem.2020.7.48476