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F1000Research 2020Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases characterized by detachment of the epidermis and mucous membrane.... (Review)
Review
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening diseases characterized by detachment of the epidermis and mucous membrane. SJS/TEN are considered to be on the same spectrum of diseases with different severities. They are classified by the percentage of skin detachment area. SJS/TEN can also cause several complications in the liver, kidneys, and respiratory tract. The pathogenesis of SJS/TEN is still unclear. Although it is difficult to diagnose early stage SJS/TEN, biomarkers for diagnosis or severity prediction have not been well established. Furthermore, optimal therapeutic options for SJS/TEN are still controversial. Several drugs, such as carbamazepine and allopurinol, are reported to have a strong relationship with a specific human leukocyte antigen (HLA) type. This relationship differs between different ethnicities. Recently, the usefulness of HLA screening before administering specific drugs to decrease the incidence of SJS/TEN has been investigated. Skin detachment in SJS/TEN skin lesions is caused by extensive epidermal cell death, which has been considered to be apoptosis via the Fas-FasL pathway or perforin/granzyme pathway. We reported that necroptosis, i.e. programmed necrosis, also contributes to epidermal cell death. Annexin A1, released from monocytes, and its interaction with the formyl peptide receptor 1 induce necroptosis. Several diagnostic or prognostic biomarkers for SJS/TEN have been reported, such as CCL-27, IL-15, galectin-7, and RIP3. Supportive care is recommended for the treatment of SJS/TEN. However, optimal therapeutic options such as systemic corticosteroids, intravenous immunoglobulin, cyclosporine, and TNF-α antagonists are still controversial. Recently, the beneficial effects of cyclosporine and TNF-α antagonists have been explored. In this review, we discuss recent advances in the pathophysiology and management of SJS/TEN.
Topics: Apoptosis; Epidermis; Humans; Necrosis; Stevens-Johnson Syndrome
PubMed: 32595945
DOI: 10.12688/f1000research.24748.1 -
Frontiers in Immunology 2023The skin functions as a physical barrier and represents the first line of the innate immune system. There is increasing evidence that toll-like receptors (TLRs) are... (Review)
Review
The skin functions as a physical barrier and represents the first line of the innate immune system. There is increasing evidence that toll-like receptors (TLRs) are involved in the pathomechanisms of not only infectious diseases, but also non-infectious inflammatory diseases. Interestingly, it has been demonstrated that TLRs recognize both exogenous threats, e.g. bacteria and viruses, and endogenous danger signals related to inflammation, cell necrosis, or tissue damage. Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease, which is associated with impaired skin barrier function, increased skin irritability to non-specific stimuli, and percutaneous sensitization. The impairment of skin barrier function in AD allows various stimuli, such as potential allergens and pathogens, to penetrate the skin and activate the innate immune system, including TLR signaling, which can lead to the development of adaptive immune reactions. In this review, I summarize the current understanding of the roles of TLR signaling in the pathogenesis of AD, with special emphasis on skin barrier function and inflammation.
Topics: Humans; Dermatitis, Atopic; Toll-Like Receptors; Skin; Inflammation; Necrosis; Noncommunicable Diseases
PubMed: 37731494
DOI: 10.3389/fimmu.2023.1239244 -
Journal of Veterinary Diagnostic... Mar 2018Gangrenous dermatitis (GD) is a disease of chickens and turkeys that causes severe economic losses in the poultry industry worldwide. Clostridium septicum, Clostridium... (Review)
Review
Gangrenous dermatitis (GD) is a disease of chickens and turkeys that causes severe economic losses in the poultry industry worldwide. Clostridium septicum, Clostridium perfringens type A, and occasionally Clostridium sordellii are considered the main causes of GD, although Staphylococcus aureus and other aerobic bacteria may also be involved in some cases of the disease. GD has become one of the most significant diseases of commercial turkeys in the United States. Several infectious and/or environmental immunosuppressive factors can predispose to GD. Skin lesions are considered to be the main portal of entry of the microorganism(s) involved. GD is characterized by acute onset of mortality associated with gross skin and subcutaneous tissue lesions consisting of variable amounts of serosanguineous exudate together with emphysema and hemorrhages. The underlying skeletal muscle can also be involved. Ulceration of the epidermis may be also noticed in cases complicated with S. aureus. Microscopically, necrosis of the epidermis and dermis, and subcutaneous edema and emphysema are commonly observed. Gram-positive rods can be identified within the subcutis and skeletal muscles, usually associated with minimal inflammatory infiltrate. A presumptive diagnosis of GD can be made based on history, clinical signs, and gross anatomic and microscopic lesions. However, confirmation should be based on demonstration of the causative agents by culture, PCR, immunohistochemistry, and/or fluorescent antibody tests.
Topics: Animal Husbandry; Animals; Chickens; Clostridium perfringens; Clostridium septicum; Dermatitis; Gangrene; Poultry Diseases; Skin; Staphylococcus aureus; Turkeys
PubMed: 29145799
DOI: 10.1177/1040638717742435 -
Archives of Disease in Childhood Apr 1988A four year old girl presented with varicella gangrenosa, and haematological investigations showed a disseminated intravascular coagulation. The child subsequently...
A four year old girl presented with varicella gangrenosa, and haematological investigations showed a disseminated intravascular coagulation. The child subsequently developed a unilateral deep venous thrombosis. She was treated with oral steroids and intravenous heparin and made a full recovery.
Topics: Chickenpox; Child, Preschool; Disseminated Intravascular Coagulation; Female; Gangrene; Humans; Purpura; Skin; Thrombophlebitis
PubMed: 3365017
DOI: 10.1136/adc.63.4.444 -
The American Journal of Tropical... Oct 2017
Topics: Adult; Arm; Back; Biopsy; Granuloma; Humans; Male; Necrosis; Skin; Tuberculin Test; Tuberculosis, Cutaneous
PubMed: 29031284
DOI: 10.4269/ajtmh.17-0377 -
Dermatology Online Journal Jan 2015We describe a rare case of a patient with pancreatic adenocarcinoma who presented initially with a rash on her lower legs. Skin biopsy showed lobular panniculitis and...
We describe a rare case of a patient with pancreatic adenocarcinoma who presented initially with a rash on her lower legs. Skin biopsy showed lobular panniculitis and characteristic "ghost" adipocytes consistent with pancreatitic panniculitis. This clinical case is an interesting example where a seemingly innocuous skin condition heralds an underlying malignant disease process.
Topics: Adenocarcinoma; Adipocytes; Fat Necrosis; Female; Humans; Middle Aged; Pancreatic Neoplasms; Panniculitis; Skin
PubMed: 25612121
DOI: No ID Found -
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 -
Journal of General Internal Medicine Jan 2014
Topics: Aged; Anticoagulants; Drug Eruptions; Female; Humans; Leg Dermatoses; Necrosis; Obesity; Skin; Warfarin
PubMed: 23943419
DOI: 10.1007/s11606-013-2560-8 -
The New England Journal of Medicine Dec 2016
Topics: Adenovirus Infections, Human; Aged; Female; Humans; Hypotension; Myocarditis; Respiratory Insufficiency; Shock, Cardiogenic; Skin; Stroke Volume
PubMed: 27959752
DOI: 10.1056/NEJMicm1602055 -
Indian Pediatrics Apr 2015
Topics: Administration, Intravenous; Ceftriaxone; Child; Female; Hand; Humans; Necrosis; Nicolau Syndrome; Skin
PubMed: 25929650
DOI: No ID Found