Cutaneous Manifestations Research Articles

Case report: Reactive granulomatous dermatitis presenting with inguinal erythematous plaques in a patient administered with pravastatin

An identical group of disorders has been called “interstitial granulomatous dermatitis” and “palisaded neutrophilic and granulomatous dermatitis.” In addition, a drug-induced subset of this condition has been named “interstitial granulomatous drug reaction (IGDR).” More recently, “reactive granulomatous dermatitis (RGD)” has been proposed as an umbrella term encompassing these three disorders. A considerable number of RGD cases are associated with systemic conditions, including autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus, inflammatory bowel disease, and malignancies. IGDR has also been shown to be caused by certain medications. We present a case of a 74-year-old Japanese man showing an asymptomatic, well-demarcated erythema eruption on the bilateral inguinal region extending to the lower abdomen and proximal thigh area. He had hyperlipidemia and had been taking pravastatin for 4 years. A biopsy specimen taken from the erythematous lesion revealed infiltration of lymphocytes and histiocytes in the upper and lower dermis. Interstitial infiltrates of histiocytes and lymphocytes were found as they were dispersed between collagen bundles. Immunostaining showed CD68+ macrophages intermingled with CD4+ and CD8+ T cells. Based on the clinical and histologic findings, the eruption was diagnosed as RGD. Because of the possibility of IGDR, pravastatin was stopped. His eruption completely disappeared within 6 months after the discontinuation. The list of drugs that cause RGD includes angiotensin-converting enzyme inhibitors, antihistamines, β-blockers, antidepressants, anticonvulsants, tocilizumab and ustekinumab. In addition, various statins have been reported to induce drug eruptions. The eruption types are mainly eczematous or lichenoid reactions, with psoriasiform or ichthyosiform reactions occurring rarely. There was only one report documenting that RGD occurred in patients administered rosuvastatin, with annular, violaceous plaques distributed on the extremities, proximal trunk and intertriginous areas. Pravastatin induces lichenoid eruption, but RGD has not been documented. Our case suggests that RGD is underestimated as an adverse effect of statins possibly because of its unusual cutaneous manifestations.

Idiopathic Inflammatory Myopathies-associated Interstitial Lung Disease in Adults.

Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of autoimmune diseases characterized by muscle involvement and various extramuscular manifestations. Interstitial lung disease (ILD) is one of the most common extramuscular manifestations of IIM and is associated with significant mortality and morbidity. The clinical phenotypes, treatment responses, and prognosis of IIM-ILD are significantly related to myositis-specific antibody (MSA) profiles, with some racial differences. The features associated with MSA in IIM-ILD could also be relevant to cases of ILD where MSA is present but does not meet the criteria for IIM. The anti-melanoma differentiation-associated gene 5 antibody is highly associated with rapidly progressive ILD (RP-ILD), especially in Asian populations, and with characteristic cutaneous manifestations, such as skin ulcers. Radiologically, ground-glass opacities, consolidations, and nonsegmental linear opacities were more predominant than reticular opacities and honeycombing. While the mortality rate is still around 30%, the prognosis can be improved with early intensive therapy with corticosteroids and multiple immunosuppressants. In contrast, anti-aminoacyl-tRNA synthetase (ARS) antibodies are associated with chronic ILD, although RP-ILD is also common. Patients with anti-ARS antibodies often show lung-predominant presentations, with subtle muscle and skin involvement. Radiologically, reticular opacities, with or without consolidation, are predominant and may progress to honeycombing over time. Combination therapy with corticosteroids and a single immunosuppressant is recommended to prevent relapses, which often lead to a decline in lung function and fatal long-term outcomes. Significant advances in immunology and genetics holds promise for fostering more personalized approaches to managing IIM-ILD.

49985 The Cutaneous Manifestations of VEXAS Syndrome

49985 The Cutaneous Manifestations of VEXAS Syndrome

Cutaneous Manifestations of Liver Disease: A Narrative Review.

Chronic liver disease is a major cause of morbidity and mortality. The most common extrahepatic manifestations are dermatological. The pathophysiology of these dermatological manifestations is not clear, but it is postulated that the mechanisms involved include generalized vasodilatation, hyperdynamic blood circulation, and altered estrogen metabolism. The most common cutaneous manifestations of liver disease are Terry's nails and pruritus. Terry's nails consist of leukonychia with a distal pink band and the absence of the lunula. The main differential diagnosis is Lindsay's nails. Vascular manifestations of liver disease include palmar erythema and arachnoid nevi, the latter located in the vascular territory of the superior vena cava and occurring in chronic alcohol-associated liver disease. Dermatological manifestations generally resolve with improvement or remission of liver disease, and there is no specific treatment for them. However, bile acid chelators are the first line of treatment for cholestatic pruritus. Studying dermatological manifestations of liver disease contributes to early diagnosis and treatment, potentially improving the patient's prognosis.

Cutaneous Manifestations of Sexually Transmitted Infections

Cutaneous Manifestations of Sexually Transmitted Infections

51703 Vascular Cutaneous Manifestations of COVID and RNA Viral Pathogens: a systematic review

51703 Vascular Cutaneous Manifestations of COVID and RNA Viral Pathogens: a systematic review

Cutaneous Manifestations of Sexually Transmitted Infections: Human Papillomavirus

Cutaneous Manifestations of Sexually Transmitted Infections: Human Papillomavirus

53449 Assessing the Approach to Description of Cutaneous Manifestations Associated with Atopic Dermatitis in Real-World Clinical Practice

53449 Assessing the Approach to Description of Cutaneous Manifestations Associated with Atopic Dermatitis in Real-World Clinical Practice

53577 Cutaneous manifestations, presenting symptoms, and tumor prevalence by race and sex in Neurofibromatosis 1 patients: a retrospective cohort study at an academic institution, NY, NY

53577 Cutaneous manifestations, presenting symptoms, and tumor prevalence by race and sex in Neurofibromatosis 1 patients: a retrospective cohort study at an academic institution, NY, NY

SÍNDROME DE RENDU-OSLER-WEBER E APLASIA MEDULAR TRANSITÓRIA ASSOCIADA AO PARVOVÍRUS B19: RELATO DE CASO

Hereditary hemorrhagic telangiectasia, also known as Rendu-Osler-Weber syndrome, is an uncommon genetic disease characterized by arteriovenous malformations mainly in skin and mucous membranes, but also in visceral organs, lungs and even central nervous system, causing intermittent hemorrhagic episodes, some of them potentially severe. Their main consequence is iron deficiency anemia. Parvovirus b19 is a DNA virus with proerythroblast tropism whose infection is generally asymptomatic, but might cause cutaneous manifestations, such as infectious erythema, articular symptoms and medullary aplasia, rarely seen in immunocompetent individuals. The aim of this study is to demonstrate the association of these two diseases and their potential correlation. In this report we describe a 54 years old woman with a history of epistaxis since childhood, who presented worsening hemorrhagic episodes, melena, dyspnea at rest and pancytopenia. During investigation the diagnosis of Rendu-Osler-Weber syndrome was made, and posteriorly it was identified that her clinical worsening and pancytopenia was caused by medullary aplasia associated to parvovirus b19infection.

Atypical Presentation of SLE

Systemic lupus erythematosus (SLE) presents with a wide array of cutaneous manifestations. The classical cutaneous features are malar rash, discoid rash, annular and papulosquamous lesions. There can also be some atypical manifestations. We present the case report of a patient, which satisfies the ACR/EULAR 2019 criteria for lupus and presented with unusual manifestation of a petechial rash.

Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 - October 2023.

From September 2022 an increase in Corynebacterium diphtheriae (C. diphtheriae)infections was reported in Europe. Our study focuses on 31 adolescent and young adult refugees with cutaneous C. diphtheriae infections detected in Germany. We examined treatment regimens and outcomes to provide targeted insights into the management of this infection. We distributed a standardized survey, focused on children and adolescents presenting to paediatric clinics through the German Paediatric Infectious Diseases Society (DGPI) and additional professional contacts in Germany. Data were extracted from routine medical documentation and reported anonymously. A total of 31 individuals with cutaneous C. diphtheriae infection were reported by 9 centres. Two of these showed diphtheria toxin (DT) related systemic symptoms and four exhibited systemic inflammation requiring complex management. The remaining 25 cases, with exclusively cutaneous manifestations, were afebrile. Treatment with topical antiseptics and systemic antibiotics, mainly aminopenicillin/beta-lactamase inhibitors (BLI) (35%) or clindamycin (25%), achieved eradication in all but two cases treated with aminopenicillin/BLI. Treatment duration varied between 5 and 17 days. In refugees presenting with chronic skin wounds, C. diphtheriae should be included into the differential diagnosis. Fever seems to be a valuable marker to differentiate severe cases with potentially DT-mediated sequelae from exclusively cutaneous diphtheria (CD). For afebrile CD, topical antiseptics and oral antibiotic therapy with clindamycin for 7 days, followed by clinical surveillance appears to be a safe treatment regimen. Patients with CD who present with fever or pharyngitis should be thoroughly investigated including blood and pharyngeal swab cultures.

A practical guide to recognize allergic and immunologic skin diseases: diagnosis at first sight

Allergic and immunologic skin diseases are becoming increasingly common and this requires clinicians to be able to recognize and diagnose them. A joint meeting (GET TOGETHER 2022) of the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to review the current knowledge on the differential diagnosis of contact dermatitis, atopic dermatitis, hereditary angioedema, urticaria, and cutaneous mastocytosis. The most important aspects to take into consideration when faced with a new cutaneous manifestation are the clinical features of the lesions, their distribution, age of onset, and comorbidities/aggravating factors. The document does not aim to provide an exhaustive and comprehensive description of all allergic and immunologic skin diseases. Instead, it should be a reference tool for the clinician who is faced with the onset of a new skin manifestation and its differential diagnosis.

Systemic Mastocytosis in a 70-Year-Old Female Filipino With Cutaneous, Bone Marrow, and Gastrointestinal Manifestations: A Case Report

Systemic Mastocytosis in a 70-Year-Old Female Filipino With Cutaneous, Bone Marrow, and Gastrointestinal Manifestations: A Case Report

MPN-263 Systemic Mastocytosis in a 70-Year-Old Female Filipino With Cutaneous, Bone Marrow, and Gastrointestinal Manifestations: A Case Report

MPN-263 Systemic Mastocytosis in a 70-Year-Old Female Filipino With Cutaneous, Bone Marrow, and Gastrointestinal Manifestations: A Case Report

Violaceous nodules of the extensor joints - a clinicopathological challenge.

Antineutrophilic cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a condition characterized by vessel inflammation and may have a variety of etiologies. Among these, cocaine and its common adulterant, levamisole, have been described to contribute to the development of AAV with distinct cutaneous manifestations. Classically, these manifestations involve purpuric or necrotic lesions involving the ears, nose, and extremities. However, we present a case of cocaine-induced AAV presenting with violaceous nodules on the dorsal hands in order to demonstrate that this condition may not always present with retiform purpura and skin necrosis.

Malignant transformation of post-radiation induced erosive lichen planus to squamous cell carcinoma.

Radiation therapy is commonly used to treat various types of malignancies during or after radiation. Approximately 95% percent of patients develop common skin manifestations including dermatitis, atrophy and fibrosis. Rare manifestations, including non-melanoma skin cancers, morphea, cutaneous angiosarcoma and bullous pemphigoid, have been reported post-treatment. The development of lichen planus (LP) from radiation therapy is exceedingly rare, with only 14 previous cases reported. Of these, none were associated with malignant transformation. Malignant transformation from LP is uncommon, with reported cases mainly in oral manifestations of LP at rates of ∼1%-2%. Classic cutaneous manifestations of LP have not been associated with an increased risk of malignancy. We report a unique case of erosive cutaneous LP with malignant transformation in a previously radiated site. Our case highlights a novel cutaneous adverse event to radiation treatment and emphasises the importance of considering erosive LP on the differential when evaluating recalcitrant erosions in a previously radiated area and to monitor closely for transformation to squamous cell carcinoma.

Cutaneous T cell Lymphoma in Skin of Color: A Review.

People of color (POC) affected by skin cancer suffer disproportionately from worse morbidity and mortality. Although skin cancers occur most frequently in White individuals overall, cutaneous T-cell lymphoma (CTCL) is an exception. CTCL is a rare skin cancer comprising several subtypes of non-Hodgkin lymphoma; each contains a unique clinical profile that varies with race. Our aim is to review and compile the differences in epidemiology, clinical presentation, treatments, and outcomes of the CTCL subtypes in Black, Asian or Pacific-Islander (API), and Hispanic patients. The current literature supports that there are nuances in the course of CTCL that differ with race. Across multiple studies, racial differences in incidence patterns have been reported, with the highest rates among Black patients. Cutaneous manifestation of CTCL are highly variable in POC, and the predilection for clinical CTCL variants often differs with race, as well as severity of cutaneous involvement (BSA). Response to and type of treatment also differs among POC, and may be partially attributable to the varying CTCL subtypes experienced by certain races. Prognostic factors tend to vary with race, although Black patients consistently experience poor outcomes, while API patients may have a more favorable prognosis. Currently, there is no definitive conclusion to account for differences observed in CTCL skin of color patients, however biologic and socioeconomic factors have been proposed as potential drivers. As POC comprise an increasing portion of our population, adequate physician awareness and knowledge of racial nuances in CTCL are necessary to begin addressing these disparities.

Zosteriform Cutaneous Metastasis from Breast Cancer: A Case Report

Introduction: Cutaneous metastases are observed in approximately 10% of oncology patients, often indicating either a persistent solid tumor or the recurrence of neoplastic disease. The most prevalent cause of cutaneous metastases in females is breast cancer. Patients with breast cancer may exhibit cutaneous manifestations at the initial diagnosis; however, these metastases more frequently emerge well after the initial diagnosis and treatment. The cutaneous lesions resulting from metastatic breast carcinoma display considerable variability in appearance. Typically, they manifest as firm, flesh-colored to red, smooth or ulcerated, or crusted nodules, papules, and plaques on the ipsilateral chest wall and breast. Additionally, unusual sites for breast cancer cutaneous metastases include the eyelids, inframammary folds, ipsilateral lymphedematous arm, scalp, subungual nail bed, and umbilicus. Skin metastases can also occur in mastectomy scars and radiation therapy ports. Several distinct patterns of skin metastases are recognized in breast cancer patients: carcinoma erysipelatoides, carcinoma telangiectoides, and carcinoma encuirasse. Recently, carcinoma hemorrhagiectoides has also been documented. The pleomorphic nature of breast cancer metastases can mimic various benign and malignant conditions, such as collision tumors, cysts, dermatofibromas, milia-en-plaque, melanoma, non-melanoma skin cancers, cellulitis, folliculitis, herpes zoster, paronychia, erythema annulare centrifugum, urticaria, alopecia areata, dermatitis, hidradenitis suppurativa, scleroderma, angiokeratoma, angiosarcoma, lymphangioma circumscriptum, purpura, and pyogenic granuloma. Consequently, it is crucial to consider the possibility of cutaneous metastasis from breast cancer in any patient, whether previously diagnosed with breast cancer or not, who presents with new or treatment-resistant cutaneous lesions. Confirmation of the diagnosis necessitates a biopsy of the skin lesion. ...........

Severity and organ distribution of graft-versus-host disease with post-transplant cyclophosphamide versus calcineurin inhibitor plus methotrexate/mycophenolate mofetil or sirolimus in allogenic HLA-matched or single-allele mismatched stem cell transplantation.

This retrospective single center study aims to describe changes in the severity and organ-specific distribution of GvHD, by comparing the outcomes of 3 distinct GvHD prophylaxis approaches. Between January 2012 and June 2022, 226 patients underwent allogeneic hematopoietic stem cell transplantation from HLA-matched or 1-allele mismatched related or unrelated donors. Fifty-eight (26%) received prophylaxis with calcineurin inhibitor in combination with mycophenolate mofetil or a short course of methotrexate (Cohort-1), 87 (38%) tacrolimus plus sirolimus (Cohort-2), and 81 (36%) post-transplant cyclophosphamide (PTCy) plus tacrolimus (Cohort-3). The incidence of grade II-IV aGvHD was 69% vs. 41.4% vs. 27.2%; p < .01. The most significant reduction with PTCy was observed in both stage 3-4 skin and lower gastrointestinal (GI) involvement (p < .01). The incidence of moderate-to-severe cGvHD at 12 months was 34.5% vs. 34.5% vs. 6.2%; p < .01. Moderate-to-severe skin and GI cGvHD was less common after PTCy (p < .01). The 1-year GvHD-free/relapse-free survival was higher with PTCy (p < .01). Our study indicates that PTCy-based GvHD prophylaxis reduces the frequency and severity of both acute and chronic GvHD, with a notable decrease in severe GI and cutaneous manifestations. The higher GRFS may result in lower GvHD-related mortality, leading to an improved quality of life among survivors.