Review

Authors: Rose Parisi, Hemali Shah, Alexander A Navarini...

Acute generalized exanthematous pustulosis (AGEP) is a rare, acute, severe cutaneous adverse reaction mainly attributed to drugs, although other triggers, including infections, vaccinations, ingestion of various substances, and spider bites, have also been described. AGEP is characterized by the development of edema and erythema followed by the eruption of multiple punctate, non-follicular, sterile pustules and subsequent desquamation. AGEP typically has a rapid onset and prompt resolution within a few weeks. The differential diagnoses for AGEP are broad and include infectious, inflammatory, and drug-induced etiologies. Diagnosis of AGEP depends on both clinical and histologic criteria, as cases of overlap with other disease processes have been reported. Management includes removal of the offending drug or treatment of the underlying cause, if necessary, and supportive care, as AGEP is a self-limited disease. This review aims to provide an overview and update on the epidemiology, pathogenesis, reported precipitating factors, differentials, diagnosis, and management of AGEP.

Topics: Humans; Acute Generalized Exanthematous Pustulosis; Diagnosis, Differential; Skin; Exanthema; Erythema

PubMed: 37156992
DOI: 10.1007/s40257-023-00779-3

Review

Authors: Irene Roberts, Nicholas J Fordham, Anupama Rao...

Neonatal leukaemia is defined as occurring within the first 28 days of life and most, if not all, cases are congenital. With the exception of Down syndrome-associated transient abnormal myelopoiesis, which is not considered here, neonatal leukaemias are rare. In two-thirds of patients the disease manifests as an acute myeloid leukaemia, frequently with monocytic/monoblastic characteristics. Most other cases are acute lymphoblastic leukaemia, particularly B lineage, but some are mixed phenotype or blastic plasmacytoid dendritic cell neoplasms. The most frequently observed cytogenetic/molecular abnormality is t(4;11)(q21.3;q23.3)/KMT2A-AFF1 followed by t(1;22)(p13.3;q13.1)/RBM15-MKL1 and t(8;16)(p11.2;p13.3)/KAT6A-CREBBP. Common clinical features include prominent hepatosplenomegaly and a high incidence of skin involvement, sometimes in the absence of bone marrow disease. A distinctive feature is the occurrence of spontaneous remission in some cases, particularly in association with t(8;16). In this review, we summarise current knowledge of the clinical, cytogenetic and molecular features of neonatal leukaemia and discuss clinical management of these cases.

Topics: Antineoplastic Agents; Dendritic Cells; Diagnosis, Differential; Exanthema; Gene Order; Histone-Lysine N-Methyltransferase; Humans; Infant, Newborn; Leukemia; Myeloid-Lymphoid Leukemia Protein; Remission, Spontaneous; Treatment Outcome

PubMed: 29806701
DOI: 10.1111/bjh.15246

Authors: Yale Liu, Hao Wang, Mark Taylor...

Inflammatory conditions represent the largest class of chronic skin disease, but the molecular dysregulation underlying many individual cases remains unclear. Single-cell RNA sequencing (scRNA-seq) has increased precision in dissecting the complex mixture of immune and stromal cell perturbations in inflammatory skin disease states. We single-cell-profiled CD45 immune cell transcriptomes from skin samples of 31 patients (7 atopic dermatitis, 8 psoriasis vulgaris, 2 lichen planus (LP), 1 bullous pemphigoid (BP), 6 clinical/histopathologically indeterminate rashes, and 7 healthy controls). Our data revealed active proliferative expansion of the T and Trm components and universal T cell exhaustion in human rashes, with a relative attenuation of antigen-presenting cells. Skin-resident memory T cells showed the greatest transcriptional dysregulation in both atopic dermatitis and psoriasis, whereas atopic dermatitis also demonstrated recurrent abnormalities in ILC and CD8 cytotoxic lymphocytes. Transcript signatures differentiating these rash types included genes previously implicated in T helper cell (T2)/T17 diatheses, segregated in unbiased functional networks, and accurately identified disease class in untrained validation data sets. These gene signatures were able to classify clinicopathologically ambiguous rashes with diagnoses consistent with therapeutic response. Thus, we have defined major classes of human inflammatory skin disease at the molecular level and described a quantitative method to classify indeterminate instances of pathologic inflammation. To make this approach accessible to the scientific community, we created a proof-of-principle web interface (RashX), where scientists and clinicians can visualize their patient-level rash scRNA-seq-derived data in the context of our T2/T17 transcriptional framework.

Topics: Dermatitis, Atopic; Exanthema; Humans; Psoriasis; Skin; Skin Diseases

PubMed: 35427179
DOI: 10.1126/sciimmunol.abl9165

Review

Authors: Nina R O'Connor, Maura R McLaughlin, Peter Ham...

Rashes are extremely common in newborns and can be a significant source of parental concern. Although most rashes are transient and benign, some require additional work-up. Erythema toxicum neonatorum, acne neonatorum, and transient neonatal pustular melanosis are transient vesiculopustular rashes that can be diagnosed clinically based on their distinctive appearances. Infants with unusual presentations or signs of systemic illness should be evaluated for Candida, viral, and bacterial infections. Milia and miliaria result from immaturity of skin structures. Miliaria rubra (also known as heat rash) usually improves after cooling measures are taken. Seborrheic dermatitis is extremely common and should be distinguished from atopic dermatitis. Parental reassurance and observation is usually sufficient, but tar-containing shampoo, topical ketoconazole, or mild topical steroids may be needed to treat severe or persistent cases.

Topics: Exanthema; Humans; Infant, Newborn; Prognosis

PubMed: 18236822
DOI: No ID Found

Authors: Jose M Villalon-Gomez

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

Review

Authors: Mario E Lacouture, Milan J Anadkat, René-Jean Bensadoun...

BACKGROUND

Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention and treatment of these untoward events. The purpose of this panel was to develop evidence-based recommendations for EGFRI-associated dermatologic toxicities.

METHODS

A multinational, interdisciplinary panel of experts in supportive care in cancer reviewed pertinent studies using established criteria in order to develop first-generation recommendations for EGFRI-associated dermatologic toxicities.

RESULTS

Prophylactic and reactive recommendations for papulopustular (acneiform) rash, hair changes, radiation dermatitis, pruritus, mucositis, xerosis/fissures, and paronychia are presented, as well as general dermatologic recommendations when possible.

CONCLUSION

Prevention and management of EGFRI-related dermatologic toxicities is critical to maintain patients' health-related quality of life and dose intensity of antineoplastic regimens. More rigorous investigation of these toxicities is warranted to improve preventive and treatment strategies.

Topics: Antineoplastic Agents; ErbB Receptors; Exanthema; Humans; Internationality; Practice Guidelines as Topic; Pruritus; Skin Diseases

PubMed: 21630130
DOI: 10.1007/s00520-011-1197-6

Authors: Viktoria Vandrup Sigsgaard, Ditte Marie L Saunte, Susanne Fabricius...

Topics: Adult; Exanthema; Face; Herpes Zoster; Humans; Male

PubMed: 30618366
DOI: No ID Found

Authors: Jakob Lillemoen Drivenes, Anette Bygum

Topics: Humans; Exanthema

PubMed: 37376940
DOI: 10.4045/tidsskr.23.0223

Review

Authors: Tiffany Yvonne Loh, Philip R Cohen

Drug-induced photosensitivity reactions are significant adverse effects. Ketoprofen is one of the most common drugs that can cause skin rash in sun-exposed areas. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ketoprofen, are often used for a variety of symptoms, including pain and fever. An understanding of the presentation and clinical course of ketoprofen-induced photosensitivity is necessary to correctly diagnose and manage this condition. Ketoprofen-induced photosensitivity reactions usually present as photoallergic dermatitis, which is a cell-mediated immune process. The benzophenone moiety in ketoprofen plays a major role in ketoprofen's ability to act as a photosensitizer. Several agents, such as fenofibrate and octocrylene have been found to be associated with aggravation of ketoprofen-induced photoallergic dermatitis or cross-photosensitization, and these reactions result from structural similarities with ketoprofen. Treatment of ketoprofen-induced photoallergic dermatitis includes discontinuation of ketoprofen, topical or systemic corticosteroids and avoidance of sun exposure and agents known to exacerbate dermatitis. In conclusion, photoallergic dermatitis is a significant adverse effect of ketoprofen. Some agents known to worsen dermatitis may be found in sun protection products (notably, octocrylene in sunscreen). Educating the patient to avoid these products is critical to treatment. Since NSAIDs, such as ketoprofen, are used commonly for a variety of illnesses, drug-induced photoallergic dermatitis should be high on the differential in individuals using these medications who present with acute onset of a rash in sun-exposed areas.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Dermatitis, Photoallergic; Exanthema; Humans; Ketoprofen; Photosensitivity Disorders; Sunscreening Agents

PubMed: 28474616
DOI: 10.4103/ijmr.IJMR_626_16

Authors: Nikolaos Fytanidis, Charalampos Papagoras

Topics: Humans; Psoriasis; Exanthema

PubMed: 36752507
DOI: 10.1093/rheumatology/kead073