- Pathophysiology and Management of Mild to Moderate Pediatric Atopic Dermatitis. [Journal Article]
- JPJ Pediatr Health Care 2018 Mar - Apr; 32(2):S2-S12
- Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition characterized by relapsing pruritic and dry, scaly lesions. AD affects 10% to 20% of children in the United States and sign...
Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition characterized by relapsing pruritic and dry, scaly lesions. AD affects 10% to 20% of children in the United States and significantly affects the quality of life of patients and their families. Primary care providers (PCPs) are often the first point of contact for the management of AD symptoms. As many as 70% of patients with mild to moderate disease can be managed by a PCP, underscoring the need for these providers to understand basic AD pathophysiology and current standards of care. This article will discuss the basic principles of AD diagnosis and management that PCPs need to optimize patient care, including AD pathogenesis, appropriate use of currently available topical therapies, basic skin care practices, and patient/caregiver counseling points. This article is sponsored by Spire Learning and supported by an educational grant from Pfizer Inc.
- If it's red and scaly look for fungus: remember cutaneous protothecosis. [Journal Article]
- JEJ Eur Acad Dermatol Venereol 2018 Feb 14
- A 34-year-old woman presented with a 5-year old history of unilateral facial erythematous plaque and scattered papules. The lesions continue to spread slowly. She complains mild pruritus. No medical ...
A 34-year-old woman presented with a 5-year old history of unilateral facial erythematous plaque and scattered papules. The lesions continue to spread slowly. She complains mild pruritus. No medical history including diabetes or immunosuppression were recorded. Physical examination showed large area of well-demarcated erythematous plaque on the right cheek(Fig.A) with infiltrating pinpointed-flesh papules at the margin with less scales(Fig.B). This article is protected by copyright. All rights reserved.
- Role of the IL-23/IL-17 Axis in Psoriasis and Psoriatic Arthritis: The Clinical Importance of Its Divergence in Skin and Joints. [Review]
- IJInt J Mol Sci 2018 Feb 09; 19(2)
- Psoriasis is a chronic systemic inflammatory disease causing erythematosus and scaly skin plaques; up to 30% of patients with psoriasis develop Psoriatic Arthritis (PsA), which is characterised by in...
Psoriasis is a chronic systemic inflammatory disease causing erythematosus and scaly skin plaques; up to 30% of patients with psoriasis develop Psoriatic Arthritis (PsA), which is characterised by inflammation and progressive damage of the peripheral joints and/or the spine and/or the entheses. The pathogenic mechanisms driving the skin disorder in psoriasis and the joint disease in PsA are sustained by the activation of inflammatory pathways that can be overlapping, but also, at least partially, distinct. Cytokines members of the IL-23/IL-17 family, critical in the development of autoimmunity, are abundantly expressed within the cutaneous lesions but also seem to be involved in chronic inflammation and damage of the synovium though, as it will be here discussed, not in all patients. In this review, we will focus on the state of the art of the molecular features of psoriatic skin and joints, focusing on the specific role of the IL-23/IL-17 pathway in each of these anatomical districts. We will then offer an overview of the approved and in-development biologics targeting this axis, emphasising how the availability of the "target" in the diseased tissues could provide a plausible explanation for the heterogeneous clinical efficacy of these drugs, thus opening future perspective of personalised therapies.
- A secondary syphilis rash with scaly target lesions. [Journal Article]
- OMOxf Med Case Reports 2018; 2018(2):omx089
- A 40-year-old man reported a 5-day history of fever and malaise, followed by a pruritic generalized rash. He had well-demarcated erythematous papules and plaques with scaling. The patient was diagnos...
A 40-year-old man reported a 5-day history of fever and malaise, followed by a pruritic generalized rash. He had well-demarcated erythematous papules and plaques with scaling. The patient was diagnosed with secondary syphilis. The skin biopsy showed a psoriasiform lichenoid dermatitis with plasma cells. The anti-T. pallidum antibody confirmed the presence of spirochetes. He was also found to be hepatitis C virus and human immunodeficiency virus positive. The characteristic rash of secondary syphilis may appear as maculopapular, evolving initially from macules to small reddish-brown papules with minor scaling later. When the scaling is prominent, lesions can be difficult to differentiate from guttate psoriasis. Typical target lesions are most often associated with erythema multiforme, but they can rarely occur in secondary and congenital syphilis. Syphilis should be suspected in high-risk patients presenting a variety of atypical syndromes such as neurologic symptoms, uveitis or cholestatic hepatitis, especially if palmoplantar lesions are present.
- A Possible Case of Statin-Induced Ichthyosis in an Elderly Woman. [Journal Article]
- KJKorean J Fam Med 2018; 39(1):51-53
- Ichthyosis is a heterogeneous group of hereditary or acquired skin disorders, characterized by increased stratum corneum production. Several systemic diseases and many drugs can occasionally cause ac...
Ichthyosis is a heterogeneous group of hereditary or acquired skin disorders, characterized by increased stratum corneum production. Several systemic diseases and many drugs can occasionally cause acquired ichthyosis. We report a case of statin-induced ichthyosis in which the causality between statin and ichthyosis was found possible by using the Naranjo scale. A 79-year-old woman presented with pruritic skin lesions on both legs that appeared erythematous, scaly, and cracked. A clinical diagnosis of acquired ichthyosis was made and the statin was suspected as the cause. The skin lesions improved after 6 weeks of dose reduction of the statin.
- 5-Fluorouracil 0.5% and Salicylic Acid 10.0% (Actikerall) [BOOK]
- BOOKCanadian Agency for Drugs and Technologies in Health: Ottawa (ON)
- According to the British Association of Dermatologists, 15% to 25% of actinic keratosis (AK) lesions spontaneously resolve during a one-year period.1However, AK lesions may develop into invasive squa...
According to the British Association of Dermatologists, 15% to 25% of actinic keratosis (AK) lesions spontaneously resolve during a one-year period.1However, AK lesions may develop into invasive squamous cell carcinoma (SCC) if left untreated.2The rate of progression from AK to SCC is unknown. Mathematical models derived from a study predicted that for an individual with an average of 7.7 AKs, the probability of developing an SCC at the same or nearby site within a 10-year period is approximately 10.3The risk of malignant transformation is higher in patients who are immunocompromised. In Canada, 74,100 new cases of non-melanoma skin cancers (NMSCs) and 270 deaths due to these cancers were predicted for 2011.2AK typically manifests as 2 mm to 6 mm scaly macules, papules, or plaques that are skin to reddish-brown in colour, and may be flat or thickened (hyperkeratotic).4,5Patients with AK are usually referred to dermatologists and diagnosis is frequently made on clinical appearance alone.1A skin biopsy may be required when there is clinical doubt or suspicion of invasive malignancy.1,5Detectable AK may be associated with a field change where the surrounding skin is also altered and subclinical lesions may be present.2Patient input to the CADTH Common Drug Review (CDR) suggests that cosmetic issues are a major concern for patients, and this can have a negative impact on self-confidence. The submitted product is a combination of two topical therapies, 5-fluorouracil 0.5% (5-FU) and salicylic acid 10% (SA). 5-FU is an antimetabolite that is already approved as monotherapy for treatment of AK, although at a concentration of 5%. SA is a keratolytic, and the theory behind its use is to improve penetration of the combination in hyperkeratotic AK. The 5-FU/SA combination under review is administered once daily to affected lesions, until lesions have cleared or for a maximum of 12 weeks. It is indicated for the management of grade I/II hyperkeratotic AK. The objective of this report was to perform a systematic review of the beneficial and harmful effects of 5-FU (0.5%) combined with SA 10% applied topically once daily for the topical treatment of slightly palpable and/or moderately thick hyperkeratotic actinic keratosis (grade I/II) of the face, forehead, and balding scalp in immunocompetent adult patients.
- How relevant are vascular endothelial growth factor and intercellular adhesion molecule in the systemic capillary leak syndrome of psoriasis? [Journal Article]
- ABAn Bras Dermatol 2017 Nov-Dec; 92(6):826-829
- Psoriasis is a chronic disease, characterized by erythematous scaly lesions, presented in eight different forms: plaques, guttate, pustular, erythrodermic, inverse, nail and scalp psoriasis, and psor...
Psoriasis is a chronic disease, characterized by erythematous scaly lesions, presented in eight different forms: plaques, guttate, pustular, erythrodermic, inverse, nail and scalp psoriasis, and psoriatic arthritis. Its development depends on genetic factors, external stimulus and immune response alteration.1 Proinflammatory cytokines such as TNF-alpha, IL-12 and 23 may also be involved. In the worst cases, systemic complications linked to endothelial alterations may occur. A literature review was conducted for a better understanding of what roles VEGF (vascular endothelial growth factor) and ICAM-1 (intercellular adhesion molecule) have, among other cytokines, in systemic capillary leak syndrome, involved in erythrodermic and pustular psoriasis, the most unstable forms of the disease.
- Congenital Langerhans cell histiocytosis: a good prognosis disease? [Case Reports]
- ABAn Bras Dermatol 2017; 92(5 Suppl 1):40-42
- Langerhans cell histiocytosis is rare and more frequent in children. The skin is affected in 50% of the cases and is the only site in 10%. Its course varies from self-limited and localized forms to s...
Langerhans cell histiocytosis is rare and more frequent in children. The skin is affected in 50% of the cases and is the only site in 10%. Its course varies from self-limited and localized forms to severe multisystemic forms. Congenital cases are usually exclusively cutaneous and self-limited, with spontaneous remission in months. This study presents a rare congenital case, initially restricted to the skin, with subsequent dissemination and fatal outcome. A male newborn presented congenital disseminated erythematous scaly lesions. The biopsy was conclusive for Langerhans cell histiocytosis. The patient evolved into the multisystemic form in weeks, when chemotherapy was started, according to the LCH-2009 protocol; however, the patient was refractory to treatment and died.
- Erosive pustular dermatosis of the scalp: reappraisal of an underrecognized entity. [Review]
- JDJ Dtsch Dermatol Ges 2018; 16(1):15-19
- Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis of unknown etiology. Herein, we present a review of the disease and report our own clinical and histopathological experie...
Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis of unknown etiology. Herein, we present a review of the disease and report our own clinical and histopathological experience in eleven patients. EPDS tends to spontaneously affect bald areas of the scalp in elderly individuals. A history of previous surgery at the same site - as observed in four of our patients - is common. Coronary artery disease, cerebrovascular insult, arterial hypertension, diabetes mellitus, and severe cases of cancer were frequent comorbidities. Most patients show an undulating clinical course despite topical anti-inflammatory treatment; in some individuals, the lesions heal with scarring. Histopathology reveals scaly crusts or erosions and granulation tissue-like changes in the dermis, evolving into a scar in more advanced stages. Apart from actinic/local damage, impaired immunity and microcirculation may be predisposing factors of the disease. Similar to pyoderma gangrenosum, EPDS must be considered in the context of nonhealing wounds in the elderly after the differential diagnoses mimicking EPDS have been ruled out. Given that previous or concomitant adjacent basal cell or squamous cell carcinoma is a common finding and that infiltrative variants extending beyond the clinically visible tumor may occur, histological mapping of the surrounding skin may be advisable in doubtful cases.
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- Ink-enhanced dermoscopy is a useful tool to differentiate acquired solitary plaque porokeratosis from other scaly lesions. [Journal Article]
- JAJ Am Acad Dermatol 2017 Dec 06