Erythematous Papular Eruption Research Articles

The Dermatological Effects of Box Jellyfish Envenomation in Stinging Victims in Thailand: Underestimated Severity

The dermatological effects of box jellyfish envenomation among stinging victims in Thailand are not well reported, particularly concerning chronic effects. For first aid, different recommendations indicate the necessity for the removal of tentacles in life-threatening situations. This study aimed to describe the dermatological effects of box jellyfish envenomation and propose recommendations regarding first aid for victims in urgent care or life-threatening situations. Surveillance systems and Toxic Jellyfish Networks were established to improve detection and investigation. The networks investigated all severe victims of jellyfish envenomation. A retrospective study was conducted, and victims of stinging by box jellyfish investigated from 1999 to 2021 were included. One hundred and twenty-four victims were recorded. The majority of victims were males (55%), tourists (69%), and Thai nationals (49%). Direct contact had more severe consequences than indirect contact. Dermatological effects included edema, erythematous caterpillar track-like rash, blistering, bullae, papular eruption, necrosis, digital gangrene, recurrent dermatitis, dermal hypersensitivity, numbness, lichenification, hyperpigmentation, keloids, and scarring. Suffering and healing continued from several weeks to many years. Victims with multiple-tentacle box jellyfish stings had papular eruptions and greater severity of skin issues. All fatally envenomed victims collapsed within a few minutes and received incorrect/no first aid. The proposed first aid for life-threatening box jellyfish stings is continuous irrigation of the wound with vinegar for at least 30 s and initiation of cardiopulmonary resuscitation if there is no respiration or heartbeat. Tentacles often detach spontaneously, and removal is not always necessary, thus saving time. The findings provide input for improving diagnosis and treatment guidelines.

Shiitake Flagellate Dermatitis

A man in his early 70s presented with a 3-day history of intensely pruritic erythematous papules and papular vesicular eruption arranged in a flagellate pattern on his neck, trunk, (Figure 1), and extremities with no general symptoms. On questioning, he had eaten undercooked shiitake mushrooms 2 days before the onset of the cutaneous lesions. Laboratory investigation was unremarkable. A skin biopsy revealed spongiosis, marked papillary dermal edema, and a dermal perivascular inflammatory infiltrate mainly composed of lymphocytes and eosinophils.

34307 Paleo prurigo

Prurigo pigmentosa is a rare inflammatory skin disorder triggered by a ketotic state, most commonly described in young women of east Asian descent. It has previously been reported in the context of diabetic ketogenesis, bariatric surgery and deliberately ketotic diets. Recently, increasing numbers of cases have been reported in the Caucasian population, possibly due to the increase in popularity of low carbohydrate diets. We present a case of a 32-year-old Caucasian man presenting with an erythematous papular eruption of the axillae, trunk and inner arms with onset on day 4 of a water fast.

Dapsone as corticosteroid-sparing therapy for Sweet syndrome

To the Editor: Sweet syndrome is a rare cutaneous condition that typically presents as a painful, pruritic, erythematous papular eruption with histologic evidence of dense neutrophilic infiltrates in the upper dermis.1 Classical Sweet syndrome is often associated with a preceding respiratory infection, although the condition can also be induced by hematologic malignancies, medications, and autoimmune diseases.2 While Sweet syndrome can spontaneously resolve, many patients undergo medical management.

AB025. Acute arthritis with dermatitis: a case of multicentric reticulohistiocytosis

A 56-year-old woman presented with a 5-day history of arthralgias and an erythematous papular eruption affecting the face, arms, chest, and upper back, for which she was started on high potency topical corticosteroids. She was noted to have associated synovitis of the hands and wrists bilaterally and was started on celecoxib. One week later, the patient returned with worsening pain and swelling in her hands in addition to new confluent, somewhat firm, erythematous papulonodules on the face, trunk, forearms, and dorsal hands. Two biopsies were performed with evidence of dermal histiocytic proliferation consistent with multicentric reticulohistiocytosis (MRH). Mycobacterial and malignancy screening were completed, and the patient was started on hydroxychloroquine, methotrexate, and systemic corticosteroids. MRH is a rare histiocytic disorder predominantly affecting Caucasian women in the fourth decade of life. Associations include arthritis, which can be mutilating in nature, and malignancy. Given the frequently destructive nature of the associated arthritis, timely diagnosis and treatment is crucial and may prevent long-term disability. Teaching points: (I) highlight the clinical manifestations of MRH, including the differential diagnosis of arthritis-dermatitis syndromes. (II) Underscore that MRH can mimic dermatomyositis. (III) Describe the differential diagnosis of arthritis mutilans (e.g., RA, PsA, gout, MRH). (IV) Examine the evidence for therapeutic options in MRH.

Scabies: A Neglected Global Disease.

Scabies is a skin disease caused by an obligate human parasite mite Sarcoptes scabiei var. hominis. Children under the age of two and elderly individuals are at the greatest risk. Knowledge of this condition is important for an early diagnosis to be made and treatment to be initiated. The review aimed to familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of scabies. A search was conducted using Pubmed with the built-in "Clinical Queries" tool. The search term "Scabies" was used. The categories of "epidemiology", "diagnosis", "therapy", "prevention" and "prognosis" had a limited scope for primary clinical studies. Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. Worldwide, scabies affects 200 to 300 million individuals annually. The average prevalence is estimated to be 5 to 10% in children of developing countries. Transmission usually occurs after close prolonged skin-to-skin contact. Classic scabies is characterized by an erythematous papular eruption, serpiginous burrows, and intense pruritus. Sites of predilection include the webs of the fingers, volar wrists, lateral aspects of fingers, extensor surfaces of elbows and knees, waist, navel, abdomen, buttocks, groins, and, genitals. A clinical diagnosis of classic scabies can be made on the basis of the history and clinical findings. Other clinical variants include crusted scabies, nodular scabies, and bullous scabies. Finding the mite, ova, or fecal pellets on microscopic examination of scrapings taken from skin lesions confirms the diagnosis of scabies infestation. For eradication of scabies mites, the drugs of choice are topical permethrin and oral ivermectin. Scabies is a highly contagious parasitic cutaneous disease that is stigmatising and debilitating. Increased awareness, accurate diagnosis, and prompt treatment are essential for the effective control of scabies and for the prevention of the spread of the disease.

Leukemia cutis: A study from a tertiary care hospital in North India

Background/Objectives: Only anecdotal case reports or small case series have attempted to study the histomorphology patterns of leukemic infiltration. This study explored the possible association of leukemia cutis with, temporal course of disease, subtypes of leukemia, blast count, total leukocyte count, lactate dehydrogenase (LDH) levels, and histopathological patterns. Materials and Methods: Clinical and laboratory data were retrieved from the hospital information system. Selected cases were reviewed by two pathologists. Data in terms of demographics, clinical presentation, bone marrow findings, immunophenotype, and temporal course were recorded where available. Results: Twenty-three diagnosed cases of leukemia cutis were reported during the study period. There was no gender predilection with a wide age range (8–82 years). No particular trend was noted in relation to total leukocyte or bone marrow blast count. Common skin manifestations included multiple erythematous papular eruptions, frequently involving the skin of the limbs. All cases showed a consistently high serum LDH level. 11/23 (48%) showed cutaneous manifestation of undiagnosed leukemia or indicated worsening in a diagnosed case. The histological patterns varied from perivascular to diffuse dermal interstitial infiltration. In addition, subtle changes were seen in the form of fibrosis, thrombosis, and epidermotropism in 12%–50% of cases. The judicious use of a panel of immunohistochemistry was vital to establish a diagnosis. Conclusions: Leukemia cutis is a diagnostic challenge on histopathology due to lack of any specific pattern in absence of a clinical suspicion. Its diagnosis may be an indicator of undiagnosed leukemia or worsening in an already known case of leukemia.

Disseminated Candida tropicalis presenting with Ecthyma-Gangrenosum-like Lesions

Disseminated candidiasis in immunosuppressed patients has been classically associated with an erythematous papular eruption, however more severe presentations are possible. We present a patient who developed disseminated Candida tropicalis that presented with hemorrhagic bullae that progressed to large necrotic ulcers.

Unusual Presentation of Gianotti-Crosti Syndrome due to Epstein-Barr Virus Infection.

Gianotti-Crosti syndrome (GCS) is viral exanthema of childhood. It typically presents with a symmetric erythematous papular and papulovesicular eruption. It has been classically associated with hepatitis B virus, as well as rarely with Epstein-Barr virus (EBV). We report a case of GCS related to EBV infection without the classical systemic symptoms in a five-year-old male patient.

Carbamazepine induced anticonvulsant hypersensitivity syndrome

Anticonvulsant hypersensitivity syndrome (AHS) is a potentially fatal drug-induced, multi-organ syndrome. The syndrome has been reported with anticonvulsants such as carbamazepine, phenytoin, phenobarbitone, and lamotrigine. A 17-year-old female who presented with papules and desquamation all over was diagnosed with AHS. She gave a history of fever, earache, peripheral edema, and erythematous papular eruptions 3 days prior. She gave a history of carbamazepine treatment since 15 days for generalized tonic-clonic seizures. On examination, there was cervical lymph node enlargement without tenderness. Investigations revealed elevated absolute eosinophil count at 550/mm 3 and positive C-reactive protein tests. Carbamazepine was immediately withdrawn. Symptomatic treatment was administered, and resolution of the symptoms was observed. In this case, causalty assessment using Naranjo adverse drug reaction probability scale showed that carbamazepine was a probable cause for the AHS (Score - 7).

Fluconazole-induced Stevens-Jonson syndrome

A 25-year-old girl self-administered tab fluconazole for vulvovaginal candidiasis and developed fever, myalgia and erythematous papular eruptions with itching at both upper and lower lip, mucous membrane of the mouth, vaginal region, which subsequently changed into blister and multiple ulcers. She also had difficulty in swallowing due to painful erosions of the mouth and oropharynx and severe burning pain at vulval and vaginal region. There was bilateral conjunctival hemorrhage. Investigation report revealed leukocytosis and elevated C-reactive protein, which was suggesting the diagnosis of Stevens-Johnson syndrome. She was treated mainly by corticosteroids, antihistamines and antimicrobials and improved. Time taken for resolution of the lesion was 14 days. Rechallenge with the offending drug was not done in the interest of the patient and due to ethical constraints.

Papular mycosis fungoides: report of two patients, literature review, and conceptual re‐appraisal

Recent reports of 10 patients have proposed a papular variant of mycosis fungoides (MF), characterized by the appearance of papules in the absence of patches and the presence of histopathologic features of classic patch/plaque stage MF. Given the overlapping clinical and pathologic features between this proposed entity and lymphomatoid papulosis (LyP)-type B, however, the optimal classification for such cases remains somewhat unclear. Herein, two patients are described who presented to the dermatology clinic with persistent erythematous papular eruptions on the trunk, upper and lower extremities and histopathology compatible with MF. Of note, these patients represent the oldest reported cases of papular MF, and one patient had documented peripheral blood involvement by atypical CD4+ cells. The clinicopathologic characteristics of this purported entity suggest that it may occupy the intersection between MF and CD30+ lymphoproliferative disorders. These two cases expand the clinicopathologic spectrum of papular MF to include older individuals, and further emphasize the importance of recognition of this morphology as a possible MF manifestation. Furthermore, consideration of our cases in conjunction with the previously documented 10 other patients in the literature, offers potential insight into the relationship between MF and CD30+ lymphoproliferative disorders.

P168 Acute generalised exanthematous pustulosis induced by pneumocystis carinii pneumonia (PCP) prophylaxis with dapsone

BackgroundAcute generalised exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction. Most cases are drug related, however the condition has been associated with viral infections.ObjectiveAGEP in the setting of HIV...

More than just a coincidence: Herpes zoster and acne rosacea appearing together as Wolf's isotopic response in an Asian female

Introduction: Wolf’s isotopic response is a rare dermatologic phenomenon defined as the occurrence of a new, unrelated disease at the site of healed lesions of some other disease. We report the first case of Wolf’s isotopic response in a female presenting with rosacea localized to the site of healing zoster lesions. Case Report: A 35­year­old previously healthy Filipino­American woman with no prior history of a dermatologic condition presented to our clinic with a 9­month history of a painful and pruritic unilateral erythematous papular eruption on her right upper cutaneous lip and cheek that respected the midline. At initial presentation she was started on 800 mg acyclovir five times daily for one week for presumed zoster. Four days into her seven­day acyclovir course, her primary care physician obtained cultures for VZV and HSV, but these tests were negative. The vesicular eruptions completely resolved following treatment with acyclovir, leaving only hyperpigmented scars in the unilateral maxillary distribution. Two months after the completion of her acyclovir treatment, she noticed pink dots, which had a prickly and itchy sensation located in the same unilateral distribution as her previous eruptions. Her condition was refractory to a myriad of topical treatments and a skin biopsy was performed which suggested acne rosacea. She was started on isotretinoin and continued for five months with almost complete resolution of papules and symptoms. Conclusion: The pathogenesis of Wolf’s isotopic response is unknown. We review the various etiologies that have been postulated including direct action of viral, particles, immune activation, alterations in neurologic system and vascular changes. Early recognition of Wolf’s isotopic response may result in more timely and effective treatment for patients. Further studies are needed to define the pathogenesis of isotopic response.

Recurrent Gianotti-Crosti syndrome

To the Editor: Gianotti-Crosti syndrome (GCS) classically presents in children as a self-limited, symmetric erythematous papular eruption affecting the cheeks, extremities, and buttocks. While initial reports implicated hepatitis B virus as the etiologic agent, many other bacterial, viral, and vaccine triggers have since been described. A previously healthy 2-year-old boy presented with a 3-week history of a cutaneous eruption that initially appeared on his legs and subsequently progressed to affect his arms and face. Two weeks after onset of the eruption, he was immunized with intramuscular Vaxigrip influenza vaccination (Sanofi Pasteur), and new lesions appeared at the immunization site on his right upper arm. Physical examination demonstrated an afebrile child with erythematous papules on the cheeks, arms, and legs (Fig 1). He had a localized papular eruption on his right upper arm (Fig 2). There was no lymphadenopathy or hepatosplenomegaly. Laboratory investigations revealed leukocytosis (white cell count, 14,600/mm) with a normal differential, reactive thrombocytosis ( platelet count, 1,032,000/mm), a positive urine culture for cytomegalovirus, and positive IgM serology for Epstein-Barr virus (EBV). Histopathologic examination of a skin biopsy specimen from the right buttock revealed a perivascular and somewhat interstitial lymphocytic infiltrate in the superficial and mid-dermis with intraepidermal exocytosis of lymphocytes, mild spongiosis and papillary dermal edema. He was treated with 2.5% hydrocortisone cream, and the eruption resolved. Twelve months later, he presented with a similar papular eruption localized to the left upper arm at the site of a recent intramuscular influenza vaccination (Vaxigrip). Although an infection represents the most important etiologic agent, a second event involving immunomodulation might lead to further disease accentuation, thus explaining the association of GCS with vaccinations. In our case, there was evidence of both cytomegalovirus (CMV) and EBV infection as well as a recent history of immunization. Localized accentuation of papules at the immunization site was unusual, as previous cases of GCS following immunizations have had a widespread and typically symmetric eruption. It is possible that trauma from the injection or a component of the vaccine elicited a Koebner response, causing local accentuation. There are no previous reports of recurrence of vaccine-associated GCS. One report documented recurrence with two different infectious triggers. As GCS is a mild and selflimiting disease, further vaccinations are not contraindicated. Andrei I. Metelitsa, MD, FRCPC, and Loretta Fiorillo, MD, FRCPC

Histiocitose de células de Langerhans com acometimento vulvar e com resposta terapêutica à talidomida: relato de caso

Langerhans cell histiocytosis is a member of a group of rare histiocytic syndromes and is characterized for the proliferation of histiocytes called Langerhans'cells. Its manifestations vary from a solitary injury to systemic involvement, and vulvar lesions are uncommon. We describe a refractory case of cutaneous limited disease in a 57-year-old woman. She presented with a 6-year history of an erythematous papular eruption of the scalp, face, vulva, trunk and axillae. The diagnosis is difficult and in this case it was confirmed through immunohistochemical study and clinical improvement was achieved with thalidomide.

Ritodrine‐induced erythematous papular eruption in 14 pregnant women

Ritodrine hydrochloride, a β2-adrenergic agonist, has been used for the treatment of pre-term labor as a relatively safe agent, although tolerable side-effects have been occasionally reported. The purpose of this study was to assess our clinical experience of skin eruptions caused by ritodrine. Fourteen pregnant women with pruritic skin eruptions associated with the administration of ritodrine for pre-term labor were examined in Saitama Medical Center Hospital between 2005 and 2008. Patients included both primigravidas and multigravidas. Their mean age was 33.7 years (range: 27-41 years). Almost all subjects were in the third trimester of pregnancy. Skin eruptions occurred 7-27 days (mean: 14.9 days) after the start of intravenous or oral ritodrine. In eight patients, the eruption occurred after an increase in the dose of the drug. The reaction was characterized by a pruritic, erythematous, papular eruption, mainly distributed on the abdomen and upper extremities. Lymphocyte transformation tests for ritodrine were positive in five of the eight patients. Ritodrine-induced, erythematous, papular eruption probably occurs more frequently than has been previously estimated. An immunologic mechanism may play a role in the development of this eruption caused by ritodrine, although the reaction is somewhat dependent on the dose.

Bullous eruption in a five-month-old girl

A five-month-old girl was referred to our department for an erythematous papular nonpruritic eruption that evolved into the formation of blisters on the trunk, hands and feet over a two-week period. Her medical history was unremarkable. She had received a combined polio, diphtheria, tetanus and

Isolated symptomatic cutaneous disease in hypereosinophilic syndrome

A 41-year-old Phillipino man presented with a 3-year history of a relapsing and remitting generalized chronic pruritic erythematous papular and plaque-like eruption. Investigations showed a persistently elevated eosinophil count. His disease was limited to cutaneous involvement with an absence of demonstrable internal organ involvement, despite extensive investigations and multidisciplinary review. Other causes of eosinophilia were excluded. A diagnosis of idiopathic hypereosinophilic syndrome was made. Our patient's presentation raises a number of issues related to hypereosinophilic syndrome. In particular, relating to managing hypereosinophilic syndrome and the challenge of minimizing therapy side-effects. Our case highlights the considerable morbidity of untreated isolated cutaneous disease, for which he was hospitalized with suicidal ideations. In a minority of reports, skin involvement is the only manifestation of hypereosinophilic syndrome.

Cutaneous manifestations of Corynebacterium jeikeium sepsis

Corynebacterium jeikeium is a rare but increasingly important cause of septicemia in neutropenic patients that can present with characteristic cutaneous findings. A 61-year-old man with myelodysplastic syndrome developed C. jeikeium sepsis and an erythematous papular eruption while neutropenic from induction chemotherapy. A review of the English language literature shows only six reported cases of hemorrhagic or erythematous papular eruption in C. jeikeium sepsis. The case is presented with an updated literature review of the history, risk factors, and treatment.