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American Family Physician Jun 2024Rosacea is a chronic inflammatory skin disease of the central face, affecting 5% of the population. The exact etiology is unknown. A diagnosis is made based on the... (Review)
Review
Rosacea is a chronic inflammatory skin disease of the central face, affecting 5% of the population. The exact etiology is unknown. A diagnosis is made based on the updated 2017 National Rosacea Society Expert Committee guidelines, including fixed erythema, phymatous changes of skin thickening due to sebaceous gland hyperplasia and fibrosis, papules, pustules, telangiectasia, and flushing. Delays in an accurate diagnosis and treatment may occur in skin of color due to difficulty visualizing erythema and telangiectasia. The daily use of sunscreen, moisturizers, and mild skin cleansers and avoidance of triggers are essential aspects of maintenance treatment. Effective topical treatment options include alpha-adrenergic receptor agonists for flushing and ivermectin, metronidazole, and azelaic acid for papules and pustules. Systemic treatments include nonselective beta blockers for flushing, low-dose doxycycline, and isotretinoin for papules and pustules. Rosacea can significantly affect a patient's emotional health and quality of life. A referral for care is recommended for fixed phymatous changes and ocular rosacea. (Am Fam Physician. 2024;109(6):533-542.
Topics: Rosacea; Humans; Dermatologic Agents; Quality of Life; Dicarboxylic Acids
PubMed: 38905551
DOI: No ID Found -
American Journal of Clinical Dermatology Jan 2022Generalized pustular psoriasis (GPP) is a rare neutrophilic skin condition characterized by episodes of widespread eruption of sterile macroscopic pustules that can be... (Review)
Review
Generalized pustular psoriasis (GPP) is a rare neutrophilic skin condition characterized by episodes of widespread eruption of sterile macroscopic pustules that can be associated with systemic inflammation. The rarity of GPP and its heterogeneous cutaneous and extracutaneous symptoms pose considerable challenges to the development and adoption of comprehensive accurate disease measures for the routine clinical assessment of disease severity and the evaluation of new treatments in clinical trials. Psoriasis disease measures remain among the most commonly used methods for evaluating patients with GPP, despite their limitations owing to a lack of assessment of pustules (a hallmark of GPP), systemic inflammation, and disease symptoms. The adaptation of psoriasis disease measures and the development of assessment tools specific for GPP severity will enable more effective and accurate monitoring of patients with GPP and enhance the clinical development of new therapies. Further clinical validation of recently developed modified assessment tools, such as the Generalized Pustular Psoriasis Physician Global Assessment and the Generalized Pustular Psoriasis Area and Severity Index, and international consensus on using quantitative tools and patient-reported outcome measures in the development of new treatments are needed to advance patient care.
Topics: Humans; Psoriasis; Severity of Illness Index; Skin Diseases, Vesiculobullous
PubMed: 35061231
DOI: 10.1007/s40257-021-00653-0 -
Cutis May 2020Acne keloidalis nuchae (AKN) is a chronic inflammatory skin disease characterized by the development of keloidlike papules, pustules, and plaques on the occipital scalp... (Review)
Review
Acne keloidalis nuchae (AKN) is a chronic inflammatory skin disease characterized by the development of keloidlike papules, pustules, and plaques on the occipital scalp and posterior neck following mechanical trauma and irritation. First-line therapy involves avoidance of aggravating factors including short and frequent haircuts. Medical treatments-from topical and intralesional steroids, oral antibiotics, and UV light to laser and surgical excision-have demonstrated varying degrees of efficacy. The active-duty military population faces unique challenges in the treatment of AKN because personal appearance and grooming standards restrict avoidance of the very factors that promote this disease process. In this population, early identification and treatment are critical to reducing overall patient morbidity and ensuring continued operational and medical readiness. This article reviews the clinical features, epidemiology, and treatments available in the management of AKN, with a special focus on the active-duty military population.
Topics: Acne Keloid; Humans; Military Personnel; Neck; Risk Factors
PubMed: 32603383
DOI: No ID Found -
Journal of Bronchology & Interventional... Oct 2023Thoracoscopic pleural biopsy is the gold standard for diagnosing tubercular pleural effusion (TPE). Various thoracoscopic appearances like sago grain nodules, caseous...
BACKGROUND
Thoracoscopic pleural biopsy is the gold standard for diagnosing tubercular pleural effusion (TPE). Various thoracoscopic appearances like sago grain nodules, caseous necrosis, and adhesions have been described in TPE. However, none of these have high specificity for diagnosing TPE. In this study we evaluate a novel finding on thoracoscopy, the " Pleural Pustule."
METHODS
This is a retrospective analysis of patients who underwent thoracoscopy for undiagnosed pleural effusion. Visual inspection of the pleura was performed to identify abnormalities. Biopsies were obtained from those areas and sent for histopathology, acid fast bacillus (AFB) smear, culture, and Xpert MTB/Rif assay. Pleural pustule was defined as a pus filled nodule on the pleural surface.
RESULTS
Of the 259 patients included, 92 were diagnosed with TPE. Pleural pustule(s) were identified in 16 patients with TPE. Presence of pleural pustule had a sensitivity, specificity, positive predictive value, and negative predictive value of 17.4%, 100%, 100% and 68.7%, respectively, for diagnosing TPE. Histopathology of pleural pustule demonstrated necrotizing granulomas in all. In patients with pleural pustule, a microbiological diagnosis of tuberculosis was achieved in 93.7% patients (AFB smear, Xpert MTB/Rif assay, and MTB culture positive in 31.3%, 93.7%, and 43.7% cases, respectively). There is a strong association between pleural pustule and positive Xpert MTB/Rif assay ( P =0.002) and microbiologic confirmation of diagnosis ( P =0.017).
CONCLUSION
The presence of pleural pustule on thoracoscopy has a high positive predictive value for TPE. In tuberculosis-endemic countries, this can be considered suggestive for TPE. When identified, a biopsy from the pleural pustule should be performed as it will likely yield a positive microbiologic diagnosis.
Topics: Humans; Tuberculosis, Pleural; Pleura; Retrospective Studies; Sensitivity and Specificity; Pleural Effusion; Mycobacterium tuberculosis
PubMed: 35968962
DOI: 10.1097/LBR.0000000000000887 -
Dermatology Research and Practice 2022Acne vulgaris, or acne, is a prevailing cutaneous predicament that customarily crops up on the face, neck, and trunk in the forms of comedones, papules, pustules, and... (Review)
Review
Acne vulgaris, or acne, is a prevailing cutaneous predicament that customarily crops up on the face, neck, and trunk in the forms of comedones, papules, pustules, and nodules. According to epidemiologic explorations, acne affects 9.4% of the global population, making it the eighth most common disease globally. Acne perturbs up to 85% of adolescents, while it is periodically misconceived as an ailment that affects teenagers only; nonetheless, it also affects myriad adults. Acne has well-documented psychosocial ramifications, including adverse effects on self-perception, mental health, and social functioning. Trifarotene is basically a novel fourth-generation locally applied retinoid approved for the first time in the regimens of both face and truncal acnes. The exclusive topical retinoid that adheres precisely to RAR-gamma, the epidermis' most frequent isoform, is trifarotene, approved in October 2019. The current review evaluates the role of trifarotene in treating acne.
PubMed: 35668721
DOI: 10.1155/2022/1504303 -
Advances in Experimental Medicine and... 2024Monkeypox (Mpox) is a zoonotic disease caused by a virus (monkeypox virus-MPV) belonging to the Poxviridae family. In humans, the disease has an incubation period of... (Review)
Review
Monkeypox (Mpox) is a zoonotic disease caused by a virus (monkeypox virus-MPV) belonging to the Poxviridae family. In humans, the disease has an incubation period of 5-21 days and then progresses in two phases, the prodromal phase and the rash phase. The prodromal phase is characterized by non-specific symptoms such as fever, muscle pain, malaise, lymphadenopathy, headache, and chills. Skin lesions appear in the rash phase of the disease. These lesions progress through different stages (macules, papules, vesicles, and pustules). In May 2022, WHO reported an outbreak of human Mpox in several countries which were previously Mpox-free. As per the CDC report of March 01, 2023, a total of 86,231 confirmed cases of Mpox and 105 deaths have been reported from 110 countries and territories across the globe. Notably, more than 90% of these countries were reporting Mpox for the first time. The phylogenetic analysis revealed that this outbreak was associated with the virus from the West African clade. However, most of the cases in this outbreak had no evidence of travel histories to MPV-endemic countries in Central or West Africa. This outbreak was primarily driven by the transmission of the virus via intimate contact in men who have sex with men (MSM). The changing epidemiology of Mpox raised concerns about the increasing spread of the disease in non-endemic countries and the urgent need to control and prevent it. In this chapter, we present all the documented cases of Mpox from 1970 to 2023 and discuss the past, present, and future of MPV.
Topics: Animals; Humans; Disease Outbreaks; Monkeypox virus; Mpox (monkeypox); Phylogeny; Zoonoses
PubMed: 38801568
DOI: 10.1007/978-3-031-57165-7_1 -
Acta Medica Indonesiana Jan 2024Mpox is caused by the Monkeypox virus, which belongs to the Orthopoxvirus genus and Poxviridae family. The Monkeypox virus was first identified as a cause of disease in...
Mpox is caused by the Monkeypox virus, which belongs to the Orthopoxvirus genus and Poxviridae family. The Monkeypox virus was first identified as a cause of disease in humans in the 1970s in the Democratic Republic of the Congo. Mpox was considered endemic in several African countries. A global outbreak of Mpox was first recognized in Europe in May 2022 and was declared a public health emergency of international concern on July 23, 2022. The first reported Mpox case in Indonesia was in October 2022 which was identified as an imported case, there were no new confirmed Mpox cases until 13 October 2023. Since then there were 72 cases of confirmed Mpox cases in Indonesia by the end of 2023, distributed across 6 provinces, mostly in the Java island.We present two different spectrums of Mpox skin lesions in patients living with HIV, with a positive polymerase chain reaction test for Mpox. The first patient is a 48-year-old male, who developed a maculopapular lesion, that was initially noticed on the face, the lesions were then spread to the back and hand. He identifies as men who have sex with men and living with HIV for the past 18 years. There were no lesions on the genitalia or mucosa. The second patient is a 28-year-old male, the initial symptom was fever, followed by skin lesions after around 1 week of fever. The lesion initially appears as pustules on the face and then spreads throughout the whole body, the lesions also grow larger and become pseudo-pustules and ulcers. There were also mucosal involvements in the mouth, making oral intake difficult. This patient also identified as men who have sex with men with multiple partners, HIV status was not known at the initial presentation. HIV screening was done with positive results.
Topics: Male; Humans; Middle Aged; Adult; Homosexuality, Male; Mpox (monkeypox); Sexual and Gender Minorities; Disease Outbreaks; HIV Infections
PubMed: 38561878
DOI: No ID Found -
Expert Review of Clinical Immunology May 2023Generalized pustular psoriasis (GPP) is a rare cutaneous and systemic inflammatory disease which is characterized by flares of widespread painful pustulation of the... (Review)
Review
INTRODUCTION
Generalized pustular psoriasis (GPP) is a rare cutaneous and systemic inflammatory disease which is characterized by flares of widespread painful pustulation of the skin, often associated with fever and elevated inflammatory markers. Although it has historically been regarded as a severe variant of plaque psoriasis, genetic and immunological developments over the past decade have revealed that it is a distinct auto-inflammatory entity, in which over-activity of the interleukin-36 signaling pathway is fundamental. Treatments targeting the IL-36 pathway are under investigation, and in 2022 spesolimab, a monoclonal antibody against the IL-36 receptor, was licensed for treating flares of GPP.
AREAS COVERED
In this review I discuss the epidemiology, clinical features, genetics, patho-mechanisms, and current treatment options for GPP. I describe the results of clinical trials that led to the licensing of spesolimab for flares of GPP.
EXPERT OPINION
The marked efficacy of spesolimab in GPP opens a new era of highly effective, scientifically-rational, and evidence-based treatment for this orphan disease, and has implications for other diseases in which interleukin 36 signaling is involved.
Topics: Humans; Antibodies, Monoclonal; Psoriasis; Antibodies, Monoclonal, Humanized; Interleukins; Acute Disease; Chronic Disease
PubMed: 36960829
DOI: 10.1080/1744666X.2023.2195165 -
Dermatology Practical & Conceptual Jan 2021mites are highly found in the skin of patients with rosacea. The diagnosis of can be made by standardized skin surface biopsy. Dermoscopy is a tool used in the...
BACKGROUND
mites are highly found in the skin of patients with rosacea. The diagnosis of can be made by standardized skin surface biopsy. Dermoscopy is a tool used in the noninvasive diagnosis of various dermatological diseases.
OBJECTIVES
To determine whether dermoscopic features of demodicosis are associated with the result of standardized skin surface biopsy in patients with rosacea and to compare dermoscopic features of rosacea in -positive and negative samples and type.
METHODS
A total of 30 patients (7 male, 23 female) were included in the study. Dermoscopic examination was performed on both the clinically most severely affected areas and adjacent healthy skin. The skin surface biopsy sample was taken from the same place from where the dermoscopic image was taken.
RESULTS
A total of 83 (lesion n = 60, non-lesion n = 23) areas were evaluated. was detected in 60.2% (n = 50) of the samples. Half of these samples revealed only , and the remaining half revealed and Of the -positive samples, 88% had tails (P =0.001) and 68% follicular openings (P = 0.002) on dermoscopy. In +-positive samples, the rate of scale and pustule was higher than positive samples (P = 0.017 and P = 0032, respectively).
CONCLUSIONS
The sensitivity and specificity of tail are higher than follicular opening and scale and pustule detection with dermoscopy and may indicate the coexistence of both and
PubMed: 33614217
DOI: 10.5826/dpc.1101a139