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Anais Brasileiros de Dermatologia 2016Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes.... (Review)
Review
Ultrasonography is a method of imaging that classically is used in dermatology to study changes in the hypoderma, as nodules and infectious and inflammatory processes. The introduction of high frequency and resolution equipments enabled the observation of superficial structures, allowing differentiation between skin layers and providing details for the analysis of the skin and its appendages. This paper aims to review the basic principles of high frequency ultrasound and its applications in different areas of dermatology.
Topics: Dermatology; Humans; Inflammation; Skin; Skin Diseases, Infectious; Skin Neoplasms; Transducers; Ultrasonography, Doppler
PubMed: 27438191
DOI: 10.1590/abd1806-4841.20164446 -
The American Journal of Tropical... Jun 2015Histoid leprosy is rare type of lepromatous leprosy characterized by unique clinical, histopathological, and microbiological features. It is characterized by cutaneous...
Histoid leprosy is rare type of lepromatous leprosy characterized by unique clinical, histopathological, and microbiological features. It is characterized by cutaneous and subcutaneous nodules. Histoid leprosy cases represent probable resistant bacilli and a highly active lepromatous process. These cases may act as reservoirs of the disease and lead to further spread of leprosy. Continual occurrence of these cases does not bode well for eradication of leprosy.
Topics: Extremities; Humans; Leprosy, Lepromatous; Male; Skin; Thorax; Young Adult
PubMed: 26041788
DOI: 10.4269/ajtmh.14-0658 -
BMJ Case Reports May 2018A 22-year-old man presented with symmetric polyarthritis, pruritus and deviation of angle of mouth to the right side since the last 7 years. His symptoms were...
A 22-year-old man presented with symmetric polyarthritis, pruritus and deviation of angle of mouth to the right side since the last 7 years. His symptoms were persistent despite receiving ayurvedic medications and symptomatic therapy. Examination revealed dry skin, cutaneous nodules, xanthelasma, periarticular non-tender swellings, pitting oedema of hands and feet and lower motor neuron type right facial palsy. Haematological investigations revealed eosinophilia and skin biopsy had cutaneous eosinophilic infiltration. The constellation of above findings comprises the nodules, eosinophilia, rheumatism, dermatitis and swelling syndrome. It a rare syndrome with few reported cases in literature. The patient was started on oral corticosteroids which was subsequently tapered and methotrexate therapy. His polyarthritis and skin rashes resolved with therapy. He has been followed-up for 2 years and is presently asymptomatic for the last 1 year.
Topics: Adrenal Cortex Hormones; Dermatitis; Edema; Eosinophilia; Facial Paralysis; Finger Joint; Humans; Male; Methotrexate; Rheumatic Diseases; Rheumatoid Nodule; Syndrome; Treatment Outcome; Young Adult
PubMed: 29754136
DOI: 10.1136/bcr-2017-223506 -
Medical Archives (Sarajevo, Bosnia and... Jun 2020Calciphylaxis is a rare, but serious, kidney complication. Calciphylaxia is a vasculopathy of small blood vessels characterized by the deposition of calcium deposits in...
INTRODUCTION
Calciphylaxis is a rare, but serious, kidney complication. Calciphylaxia is a vasculopathy of small blood vessels characterized by the deposition of calcium deposits in intimal arterioles with the consequent proliferation of intima, fibrosis and thrombosis.
AIM
The aim was to show the significance of recognition of calciphylaxis relies on heightened clinical awareness of the presence of atypical skin nodules or ulcers that occur in patients with hemodialysis dependence and to characterize features of calciphylaxis or components of treatment that may lead to improved outcome.
CASE REPORT
We present the case of 84-year-old woman with chronic kidney disease and diabetes mellitus as well as severely painful, firm, indurated plaques on the lower extremities. The plaques progressed to involve larger areas with associated local ulceration and necrosis. Laboratory testing revealed hyperparathyroidism and incisional skin biopsy confirmed calciphylaxis. Wound microbiology confirmed Staphylococcus aureus.
CONCLUSION
The diagnosis can be based on clinical grounds, supported by histological analysis if possible. The laboratory workout must cover all the possible implications of chronic kidney disease with special attention to Ca+ and P+ values and evidence of skin or systemic infection. Calciphylaxis must be known by dermatologist as early diagnosis and proper management can be decisive for better prognosis.
Topics: Aged, 80 and over; Calciphylaxis; Diabetes Mellitus, Type 2; Female; Humans; Leg Ulcer; Necrosis; Renal Dialysis; Renal Insufficiency, Chronic; Skin
PubMed: 32801442
DOI: 10.5455/medarh.2020.74.233-235 -
The Journal of Investigative Dermatology Apr 2021Aging results from intrinsic changes (chronologic) and damage from external exposures (extrinsic) on the human body. The skin is ideal to visually differentiate their... (Review)
Review
Aging results from intrinsic changes (chronologic) and damage from external exposures (extrinsic) on the human body. The skin is ideal to visually differentiate their unique features. Inherited diseases of DNA repair, such as xeroderma pigmentosum (XP), provide an excellent model for human aging due to the accelerated accumulation of DNA damage. Poikiloderma, atypical lentigines, and skin cancers, the primary cutaneous features of XP, occur in the general population but at a much older age. Patients with XP also exhibit ocular changes secondary to premature photoaging, including ocular surface tumors and pterygium. Internal manifestations of premature aging, including peripheral neuropathy, progressive sensorineural hearing loss, and neurodegeneration, are reported in 25% of patients with XP. Internal malignancies, such as lung cancer, CNS tumors, and leukemia and/or lymphoma, occur at a younger age in patients with XP, as do thyroid nodules. Premature ovarian failure is overrepresented among females with XP, occurring 20 years earlier than in the general population. Taken together, these clinical findings highlight the importance of DNA repair in maintaining genomic integrity. XP is a unique model of human premature aging, which is revealing new insights into aging mechanisms.
Topics: Aging; Aging, Premature; DNA Damage; DNA Repair; Humans; Mucous Membrane; Skin; Xeroderma Pigmentosum
PubMed: 33436302
DOI: 10.1016/j.jid.2020.11.012 -
International Journal of Molecular... Aug 2023Neurofibromatosis type 1 (NF1) is a rare inherited neurocutaneous disorder with a major impact on the skin, nervous system and eyes. The ocular diagnostic hallmarks of... (Review)
Review
Neurofibromatosis type 1 (NF1) is a rare inherited neurocutaneous disorder with a major impact on the skin, nervous system and eyes. The ocular diagnostic hallmarks of this disease include iris Lisch nodules, ocular and eyelid neurofibromas, eyelid café-au-lait spots and optic pathway gliomas (OPGs). In the last years, new manifestations have been identified in the ocular district in NF1 including choroidal abnormalities (CAs), hyperpigmented spots (HSs) and retinal vascular abnormalities (RVAs). Recent advances in multi-modality imaging in ophthalmology have allowed for the improved characterization of these clinical signs. Accordingly, CAs, easily detectable as bright patchy nodules on near-infrared imaging, have recently been added to the revised diagnostic criteria for NF1 due to their high specificity and sensitivity. Furthermore, subclinical alterations of the visual pathways, regardless of the presence of OPGs, have been recently described in NF1, with a primary role of neurofibromin in the myelination process. In this paper, we reviewed the latest progress in the understanding of choroidal and retinal abnormalities in NF1 patients. The clinical significance of the recently revised diagnostic criteria for NF1 is discussed along with new updates in molecular diagnosis. New insights into NF1-related neuro-ophthalmic manifestations are also provided based on electrophysiological and optical coherence tomography (OCT) studies.
Topics: Humans; Neurofibromatosis 1; Choroid; Neurofibromatoses; Skin; Eyelids
PubMed: 37686284
DOI: 10.3390/ijms241713481 -
International Journal of Molecular... Aug 2022Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disease characterized by painful skin lesions that occur in the axillary,... (Review)
Review
Hidradenitis suppurativa (HS; also designated as acne inversa) is a chronic inflammatory disease characterized by painful skin lesions that occur in the axillary, inguinal, gluteal and perianal areas of the body. These lesions contain recurring deep-seated, inflamed nodules and pus-discharging abscesses and fistulas. Affecting about 1% of the population, this common disease has gained appropriate clinical attention in the last years. Associated with numerous comorbidities including metabolic syndrome, HS is considered a systemic disease that severely impairs the quality of life and shortens life expectancy. Therapeutic options for HS are limited, comprising long-term antibiotic treatment, the surgical removal of affected skin areas, and neutralization of TNF-α, the only approved systemic treatment. Novel treatment options are needed to close the therapeutic gap. HS pathogenesis is increasingly better understood. In fact, neutrophilic granulocytes (neutrophils) seem to be decisive for the development of the purulent destructive skin inflammation in HS. Recent findings suggest a key role of the immune mediators IL-1β, IL-17A and G-CSF in the migration into and activation of neutrophils in the skin. Although phytomedical drugs display potent immunoregulatory properties and have been suggested as complementary therapy in several chronic disorders, their application in HS has not been considered so far. In this review, we describe the IL-1/IL-17/G-CSF axis and evaluate it as potential target for an integrated phytomedical treatment of HS.
Topics: Granulocyte Colony-Stimulating Factor; Hidradenitis Suppurativa; Humans; Interleukin-17; Phytotherapy; Plant Preparations; Quality of Life; Skin
PubMed: 36012322
DOI: 10.3390/ijms23169057 -
International Journal of Molecular... May 2023Hidradenitis suppurativa (HS) is an immune-mediated inflammatory disorder characterized by deep-seated nodules, abscesses, sinus tracts and scars localized in the... (Review)
Review
Hidradenitis suppurativa (HS) is an immune-mediated inflammatory disorder characterized by deep-seated nodules, abscesses, sinus tracts and scars localized in the intertriginous areas. It is accompanied by pain, malodourous secretion and a dramatically decreased quality of life. Although the pathogenesis has not been entirely elucidated, the primary event is follicular hyperkeratosis of the pilosebaceous apocrine unit. Since the registration of the tumor necrosis factor-alpha inhibitor Adalimumab in 2015, several cytokines have been implicated in the pathomechanism of HS and the research of novel therapeutic targets has been intensified. We provide an update on the inflammatory cytokines with a central role in HS pathogenesis and the most promising target molecules of future HS management.
Topics: Humans; Hidradenitis Suppurativa; Quality of Life; Adalimumab; Skin; Cytokines
PubMed: 37176138
DOI: 10.3390/ijms24098428 -
American Journal of Ophthalmology Aug 2021To determine classification criteria for tubercular uveitis. (Comparative Study)
Comparative Study
PURPOSE
To determine classification criteria for tubercular uveitis.
DESIGN
Machine learning of cases with tubercular uveitis and 14 other uveitides.
METHODS
Cases of noninfectious posterior uveitis or panuveitis, and of infectious posterior uveitis or panuveitis, were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were analyzed by anatomic class, and each class was split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the intermediate uveitides. The resulting criteria were evaluated on the validation sets.
RESULTS
Two hundred seventy-seven cases of tubercular uveitis were evaluated by machine learning against other uveitides. Key criteria for tubercular uveitis were a compatible uveitic syndrome, including (1) anterior uveitis with iris nodules, (2) serpiginous-like tubercular choroiditis, (3) choroidal nodule (tuberculoma), (4) occlusive retinal vasculitis, and (5) in hosts with evidence of active systemic tuberculosis, multifocal choroiditis; and evidence of tuberculosis, including histologically or microbiologically confirmed infection, positive interferon-γ release assay test, or positive tuberculin skin test. The overall accuracy of the diagnosis of tubercular uveitis vs other uveitides in the validation set was 98.2% (95% confidence interval 96.5, 99.1). The misclassification rates for tubercular uveitis were training set, 3.4%; and validation set, 3.6%.
CONCLUSIONS
The criteria for tubercular uveitis had a low misclassification rate and seemed to perform sufficiently well for use in clinical and translational research.
Topics: Adult; Female; Humans; Machine Learning; Male; Middle Aged; Retrospective Studies; Tuberculin Test; Tuberculosis, Ocular; Uveitis; Young Adult
PubMed: 33845014
DOI: 10.1016/j.ajo.2021.03.040 -
The Journal of Hand Surgery, European... Jul 2016Whether the palmar skin has a role in the development, propagation or recurrence of Dupuytren's disease remains unclear. Clinical assessment for skin involvement is...
UNLABELLED
Whether the palmar skin has a role in the development, propagation or recurrence of Dupuytren's disease remains unclear. Clinical assessment for skin involvement is difficult and its correlation with histology uncertain. We prospectively biopsied the palmar skin of consecutive patients undergoing single digit fasciectomy (for primary Dupuytren's disease without clinically involved skin) and dermofasciectomy (for clinically involved skin or recurrence) in order to investigate this relationship. We found dermal fibromatosis in 22 of 44 patients (50%) undergoing fasciectomy and 41 of 59 patients (70%) undergoing dermofasciectomy. Dermal fibromatosis appeared to be associated with greater preoperative angular deformity, presence of palmar nodules and occupations involving manual labour. Dermal fibromatosis exists in the absence of clinical features of skin involvement and we hypothesize that the skin may have a greater role in the development and propagation of Dupuytren's disease than previously thought.
LEVEL OF EVIDENCE
III.
Topics: Aged; Cohort Studies; Dupuytren Contracture; Fasciotomy; Female; Humans; Male; Middle Aged; Recurrence; Skin
PubMed: 26353945
DOI: 10.1177/1753193415601353