Painful Eruption Research Articles

Rosacea Fulminans following Initiation of Deucravacitinib.

Rosacea fulminans developed in a middle-aged caucasian man 10 days after initiating Deucravacitinib for chronic plaque psoriasis. The painful papulopustular eruption resolved without scarring after discontinuation of deucravacitinib, and treatment with a short-course of oral prednisolone. This case is notable as it is the first reported instance of rosacea fulminans linked to the use of a JAK inhibitor.

Real-world use of spesolimab for the treatment of generalized pustular psoriasis: reports from four cases

Generalized pustular psoriasis (GPP) is a rare, chronic, autoinflammatory skin disease characterized by painful widespread pustular eruptions. Patients with GPP experience a substantial physical, social, and emotional burden, with significant impacts on their quality of life. Historically, treatment for GPP in the United States mainly involved off-label use of therapies approved to treat plaque psoriasis. Dysregulation of the interleukin-36 (IL-36) pathway appears to play a key role in the pathophysiology of GPP. Spesolimab is a first-in-class humanized monoclonal antibody that binds specifically to the IL-36 receptor and antagonizes IL-36 signaling. In September 2022, spesolimab was approved by the U.S. Food and Drug Administration for the treatment of GPP flares in adults and was subsequently approved for GPP flare treatment in other countries across the world. Here, we describe 4 cases from our respective clinical practices, in which individuals with GPP were treated successfully with spesolimab. These cases demonstrate the difficulties experienced by patients with GPP regarding the disease burden and its effect on patients’ lives. These cases also illustrate some of the challenges that health care professionals may face when seeking to initiate spesolimab treatment, as well as highlighting the need for wider awareness of both the impact and severity of GPP and of the efficacy of spesolimab in GPP treatment.

Herpes Zoster and Post-Herpetic Neuralgia-Diagnosis, Treatment, and Vaccination Strategies.

Herpes zoster is caused by the reactivation of latent varicella infection within the sensory ganglia, caused by the varicella-zoster virus (VZV). The disease is classically characterized by a painful unilateral vesicular eruption. Complications of the disease include herpes zoster ophthalmicus, Ramsay Hunt syndrome, acute retinal necrosis, and post-herpetic neuralgia. In this paper, we discuss the epidemiology, pathogenesis, clinical features, diagnosis, management, and vaccination strategies of herpes zoster and post-herpetic neuralgia. This paper was developed with input from specialists from Singapore's public sectors-dermatologists, family physicians, and infectious diseases specialists. The diagnosis of herpes zoster is clinical and can be aided with laboratory investigations. Early initiation of antivirals, within 72 h of onset, can reduce the severity and duration of the condition and decrease the intensity of pain. In patients with a high risk of post-herpetic neuralgia, early initiation of anticonvulsants or tricyclic antidepressants can be considered. Herpes zoster is highly preventable, with the advent of the recombinant zoster vaccine (RZV) providing an overall vaccine efficacy of 97.2%. Procedures such as epidural blocks and subcutaneous or intracutaneous injections of local anesthetics and steroids can be considered for patients with a high risk of post-herpetic neuralgia to reduce its incidence. This article serves as a guideline for clinicians in the diagnosis, investigations, management, and prevention of herpes zoster. With the majority of adults in Singapore currently at risk of developing herpes zoster due to varicella immunization being only introduced in 2020, it is important for clinicians to recognize and manage herpes zoster appropriately.

Rare presentation of drug-induced oral erythema multiforme and its management: a case report

Aim. This case report discusses a rare variant of drug-induced erythema multiforme, focusing on its clinical features, diagnosis, and management. Background. Drug-induced erythema multiforme (DI-EM) is a hypersensitivity reaction occurring due to exposure to certain medications. DI-EM typically presents as erythematous and painful lesions on the oral mucosa, including the lips, tongue, and buccal mucosa. Case description. A 42-year-old male was referred to the Oral Medicine clinic with a chief complaint of painful lip ulceration and eruptions on the body after consuming medications. A detailed history was taken, and after a thorough examination, a perilesional biopsy for histopathological and immunopathological tests was performed. Following the exclusion of all other conditions with a similar presentation, a diagnosis of drug-induced erythema multiforme (DI-EM) was established. Conclusion. DI-EM can pose a diagnostic challenge due to its presentation. However, a diagnosis can be established by excluding other conditions associated with chronic inflammation or the formation of vesicles or bullae. Clinical Significance. DI-EM is a rare variant of EM with a very low prevalence in the general population, making it a challenging condition to diagnose due to its similarity in presentation with other mucocutaneous disorders. A thorough medical history, along with histopathology and immunology tests, coupled with ruling out other diseases and noting a positive history of recent drug consumption, aids in recognizing this condition, given the absence of any confirmatory diagnostic test. Early diagnosis and cessation of causative drugs, along with supportive medications, contribute to the complete resolution of the condition.

A genome-wide meta-analysis of palmoplantar pustulosis implicates TH2 responses and cigarette smoking in disease pathogenesis

Palmoplantar pustulosis (PPP) is an inflammatory skin disorder that mostly affects smokers and manifests with painful pustular eruptions on the palms and soles. Although the disease can present with concurrent plaque psoriasis, TNF and IL-17/IL-23 inhibitors show limited efficacy. There is therefore a pressing need to uncover PPP disease drivers and therapeutic targets. We sought to identify genetic determinants of PPP and investigate whether cigarette smoking contributes to disease pathogenesis. We performed a genome-wide association meta-analysis of 3 North-European cohorts (n= 1,456 PPP cases and 402,050 controls). We then used the scGWAS program to investigate the cell-type specificity of the association signals. We also undertook genetic correlation analyses to examine the similarities between PPP and other immune-mediated diseases. Finally, we applied Mendelian randomization to analyze the causal relationship between cigarette smoking and PPP. We found that PPP is not associated with the main genetic determinants of plaque psoriasis. Conversely, we identified genome-wide significant associations with the FCGR3A/FCGR3B and CCHCR1 loci. We also observed 13 suggestive (P< 5×10-6) susceptibility regions, including the IL4/IL13 interval. Accordingly, we demonstrated a significant genetic correlation between PPP and TH2-mediated diseases such as atopic dermatitis and ulcerative colitis. We also found that genes mapping to PPP-associated intervals were preferentially expressed in dendritic cells and often implicated in T-cell activation pathways. Finally, we undertook a Mendelian randomization analysis, which supported a causal role of cigarette smoking in PPP. The first genome-wide association study of PPP points to a pathogenic role for deregulated TH2 responses and cigarette smoking.

A Painful Knee Eruption.

A Painful Knee Eruption.

Ophthalmic herpes zoster in an immunocompetent five-year-old child

The goal of this clinical case is to report a case of ophthalmic zoster in a five-year-old boy and to insist on the relevance of early antiviral treatment (aciclovir) so as to minimize corneal affection and preserve visual function. We report the case of a five-year-old boy of preschool age with no notable pathological history who came for consultation with a painful eruption affecting the forehead, the upper eyelid, the nose. The clinical examination showed many erythematous vesicles affecting the left hemi-face. The diagnosis of ophthalmic zoster has been retained. Minimum biological laboratory assessment is normal. The treatment was local antiseptic and systemic aciclovir with high dose for ten days. The evolution was favorable. Zoster is rare in children. The ophthalmic form is exceptional. The diagnosis is clinical and should mention some bladdery lesions grouped in bunches with a disposition which follows a metamere. It can be responsible for serious ocular complications. The particularity of our observation is the presence of zoster in an immunocompetent child and the ophthalmic localization, that remains exceptional in children.

“A Randomized Clinico-comparative Trial of Dwiharidradi Kalk Lepam and Kumkumadi Tailam in the Management of Mukhadushika w.s.r. to Acne vulgaris” – A Original Case Series

Background: mukhadushika is one of the major diseases, which is being found in wide population of the world due to illiteracy, excessive consumption of oily food material and unhealthy diet etc. The painful eruptions encircled by meda, which are comparable to shalmali's thorns on the face throughout adolescence age and are known as yuvan pidika, tarunyapidika and mukhadushika. According to modern view, it is called acne vulgaris. It is a skin disease of pilosebaceous gland, it characterized by formation of open and closed comedones, papules, pustules and nodulocytic lesions, chiefly on cheeks, forehead, upper trunk, back region etc. Case report: patients attending the o.p.d. of govt. Dhanwantari ayurveda hospital, ujjain (m.p.) having the signs and symptoms of mukhadushika (̴acne vulgaris) were screened and the diagnosis was achieved based on careful history taking and clinical examination. 40 clinically diagnosed patients of mukhadushika were registered for trial and they were divided randomly in two groups. Conclusion: it can be concluded that clinically dwiharidradi kalk lepam and kumkumadi tailam combine work better to manage the mukhadushika (̴acne vulgaris).

POSTSURGICAL ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS: TIMING IS EVERYTHING

<h3>Introduction</h3> Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction commonly caused by antibiotics. <h3>Case Description</h3> A 62-year-old male was evaluated for a painful and burning pustular eruption three days after a hip arthroplasty. Medication timeline was notable for intraoperative (3 days prior) receipt of cefazolin, dexamethasone, hydromorphone, ropivacaine, and tranexamic acid. Two days prior, he received oxycodone, ondansetron, omeprazole, sennosides, and dexamethasone. One day prior to presentation he received meloxicam and aspirin. Physical examination revealed confluent erythema studded with pinhead-sized sterile pustules on the bilateral thighs, under arms (Figure 1A), and trunk. Complete blood count with differential showed mild neutrophilia (7.59; ref 1.56-6.45 × 10⁻⁹/L) and a complete metabolic panel was within normal limits. Histopathology of a punch biopsy from the right thigh revealed subcorneal pustules with epidermal spongiosis, mild papillary dermal edema and a mixed perivascular infiltrate (Figure 1B) consistent with AGEP. He was instructed to avoid all beta-lactams, non-steroidal antiinflammatory agents (NSAIDs), and steroids. The eruption completely resolved within 10 days of avoidance measures and antihistamines. There were plans to perform patch testing to cefazolin, prednisone, and dexamethasone. Unfortunately, the patient was lost to follow-up. <h3>Discussion</h3> AGEP is diagnosed clinically and confirmed by a skin biopsy. Patch testing may be utilized to evaluate for the culprit agent; but when this is not available, the timeline between medication exposure and index reaction may aid in causal agent identification. The median time from exposure to onset of AGEP is 1 day for antibiotics versus 11 days for all other medications.

Painful and Pruritic Eruptions on the Entire Body.

A 36-year-old man presented with painful tender blisters and rashes on the entire body, including the ears and tongue. The rash began as a few pinpointed red dots on the abdomen, which subsequently increased in size and spread over the last week.

Characterization of plasma metabolites and proteins in patients with herpetic neuralgia and development of machine learning predictive models based on metabolomic profiling

Herpes zoster (HZ) is a localized, painful cutaneous eruption that occurs upon reactivation of the herpes virus. Postherpetic neuralgia (PHN) is the most common chronic complication of HZ. In this study, we examined the metabolomic and proteomic signatures of disease progression in patients with HZ and PHN. We identified differentially expressed metabolites (DEMs), differentially expressed proteins (DEPs), and key signaling pathways that transition from healthy volunteers to the acute or/and chronic phases of herpetic neuralgia. Moreover, some specific metabolites correlated with pain scores, disease duration, age, and pain in sex dimorphism. In addition, we developed and validated three optimal predictive models (AUC > 0.9) for classifying HZ and PHN from healthy individuals based on metabolic patterns and machine learning. These findings may reveal the overall metabolomics and proteomics landscapes and proposed the optimal machine learning predictive models, which provide insights into the mechanisms of HZ and PHN.

Monkeypox: Cutaneous clues to clinical diagnosis

Monkeypox: Cutaneous clues to clinical diagnosis

Patient-reported quality of life in patients suffering from acute herpes zoster-a systematic review with meta-analysis.

Herpes Zoster (HZ) is a common painful, debilitating condition caused by reactivation of the varicella-zoster virus. It is characterized by a painful skin eruption which is very complex to treat. Studies have reported that HZ negatively affects Quality of Life (QoL), but no large systematic review on this topic has been published to date. This systematic review aims to summarize the current data on patient-reported QoL amongst patients diagnosed with HZ. We searched Medline, Embase, Cochrane Library, CINAHL, and PsycINFO. The primary outcome was the change in percent impairment of QoL compared to normative data. Secondary outcomes were meta-analyses comparing reported QoL to a control group or normative data. We assessed a total of 536 studies for inclusion. Thirteen studies were included in the systematic review and five studies in the meta-analyses. The total number of patients was 5472. This systematic review and meta-analysis found lower reported QoL amongst patients diagnosed with acute herpes zoster compared to normative values. Our data show that acute herpes zoster significantly reduces the quality of life of the patients affected.

Eosinophilic cellulitis after BNT162b2 mRNA Covid‐19 vaccine

A 71-year-old woman with history of treated high blood pressure and atrial fibrillation presented with a painful eruption of the right arm and forearm. Symptoms started the day following the second dose of the BNT162b2 COVID-19 vaccine (Pfizer/BioNTech) with a localized injection site reaction that progressively worsened. She had no reaction after the first vaccine injection 3 weeks before.

Painful Psoriasiform Plaques.

A 45-year-old woman presented to the emergency department with a painful skin eruption and malaise of 5 weeks’ duration. She had an orthotopic liver transplant 5 years prior and was on mycophenolate mofetil and tacrolimus for graft rejection prophylaxis.

25656 Vulvar discoid lupus erythematosus: An unusual site for cutaneous lupus erythematosus

A 46-year-old woman presented with a 1-month history of a pruritic rash on trunk and face. On examination, she had well-defined erythematous scaly thin plaques photodistributed on the face, chest, ears, and neck. Biopsy demonstrated an interface dermatitis with increased dermal mucin. Laboratory evaluation was remarkable for a positive ANA 1:1280, but negative Ro/SS-A and La/SS-B antibodies. She was diagnosed with subacute cutaneous lupus erythematosus on the basis of clinical-pathologic findings. Tobacco cessation and strict sun protection were recommended, and she was prescribed hydroxychloroquine 200 mg twice daily and topical triamcinolone ointment. She was lost to follow-up during the COVID pandemic but was seen 6 months later with a persistent painful eruption of the vulva of several months’ duration. The patient had been hospitalized for this eruption and surgical debridement was performed which revealed a nonspecific neutrophilic infiltrate and tissue necrosis. Immunohistochemistry stain was negative for herpesvirus. She was treated with intravenous antibiotics and referred back to us. Upon her return visit, she had stopped smoking but was only taking hydroxychloroquine 200 mg daily. On examination, she had scarred erythematous patches on the labia minora and inguinal folds. Biopsy demonstrated a vacuolar interface dermatitis with superficial epidermal necrosis, dermal edema, and superficial and deep perivascular and periappendageal lymphoplasmacytic inflammation, favoring a diagnosis of discoid lupus erythematosus. We recommended increasing the hydroxychloroquine to 200 mg twice daily and continuing topical triamcinolone ointment.

Trigeminal Herpes Zoster: Case Report

Herpes Zoster is an acute, self-limiting, viral infection caused by the reactivation of the Varicella Zoster Virus (VZV) that remains latent in the dorsal root ganglion. It commonly affects the older people and immunocompromised individuals. Diabetes patients present an increased risk for Herpes Zoster due to their impaired cell-mediated immunity. Clinically it manifests with tingling, pruritus and painful vesicular eruptions along the affected nerve. The most commonly affected dermatomes are the thoracic and lumbar; trigeminal nerve can be involved and the ophtalmic nerve is the mostly affected. The diagnosis is based on clinical examination and laboratory confirmation. Treatment consists of antiviral therapy and is indicated to reduce acute pain symptoms, limit the spread and duration of the lesions, and prevent complications. The objective of the present study was to present a case report of Herpes Zoster involving the first and second division of the trigeminal nerve, in a 55 year old, male, diabetes patient.

A CONCEPTUAL STUDY ON ETIOLOGY AND AYURVEDIC MANAGEMENT OF MUKHADUSHIKA W.S. R TO ACNE VULGARIS: A REVIEW

Ayurveda is considered an ancient healthcare system of India which is based on the eternal principle of healthy life. The whole clinical approach of Ayurveda is based on the preventive, promotive &amp; curative aspects that aim of Ayurveda. Now a days, the whole world is gradually turning towards Ayurveda for a safe and complete cure of diseases, especially in the field of skin problems, Ayurveda can contribute remarkably. Skin is known as the larg- est organ of the human body, which performs many functions like thermoregulation, vitamin D synthesis, sensory perception, immunological function etc. But besides this, it also seems an important symbol of beauty. Acne vul- garis is the most common problem affecting the normal texture of skin bothering teenagers today. This skin con- dition lights the mankind and caricature of youth. Acne vulgaris is known as a disease of the pilosebaceous folli- cle characterized by non-inflammatory (open and closed comedones) and inflammatory lesions (papules, pustules, and nodules). Four major factors involved in the disease production are inflammation, rise in sebum production, cornification of pilosebaceous ducts and microbial involvement. In Ayurveda, Shalmali thorn-like eruptions on the face of a youth caused by Kapha, Vata and Rakta are known as Yuvanpidika. They are also known as Mukha- dushika.1The painful eruptions packed with Meda, similar to the thorns of Shalmali having their site on the face of adults are known as Yuvanpidika2. This article describes the Ayurvedic review of Mukhadushika with Nidan, Pur-varoop, Roop, Samprapti and Chikitsa along with its modern counterpart of Acne with its definition, causative factors, and types of acne, complications and treatment modalities. Keywords: Mukhadushika, Ksudrarogas, Yuvanpidika, Acne vulgaris, Shalmali

Active Herpes Zoster Mimicking Worsening of Axillary Lymph Node Metastases of Breast Cancer after Chemotherapy on 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography.

A woman in her 60s presented to our hospital with a left breast mass that was diagnosed as breast cancer. 18F-Fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) revealed intense, hot uptake in the cancerous mass and left axillary lymph node metastasis. After chemotherapy, another PET/CT scan was performed. Although the mass and left axillary lymph nodes shrank and FDG uptake decreased, enlarged lymph nodes with high FDG uptake appeared in the right axilla. The patient had a painful vesicular eruption on the front to the back of the right upper hemithorax, which was diagnosed as active herpes zoster. Active herpes zoster mimics a worsening axillary lymph node metastasis on the PET/CT scan.

Painful papules on the dorsum of the tongue

A 10-year-old boy presented with a 5-day history of a painful eruption of the tongue, accompanied by difficulty in feeding, excessive salivation and intermittent fever. Physical examination revealed multiple pink papules on the anterior part of the dorsum of the tongue (Fig. 1). There were no other mucosal, labial or skin lesions. He had submental and submandibular lymphadenopathy. What is the most likely diagnosis? (Answer on page ••) The topography of the lesions corresponded to the location of fungiform papillae. A clinical diagnosis of eruptive familial lingual papillitis (EFLP) was made. The eruption resolved spontaneously within 5 days. EFLP is an acute inflammatory condition involving the fungiform papillae of the tongue that affects especially children, with a median age of 3.5 years.1 Although the exact aetiology is unknown, viral infections have been suggested as a trigger factor.2 Clinically, EFLP is characterised by an acute onset of multiple erythematous, whitish to yellow or pink papules that correspond to enlarged fungiform papillae. The eruption involves typically on the tip, the lateral borders and/or the dorsum of the tongue.3 Pain, burning or itch, difficulty in feeding and excessive salivation are usually associated. Fever and cervical lymphadenopathy may also be noted. Familial transmission is possible.2 In our case, no other family members had experienced a lingual eruption. Spontaneous resolution is seen in 1 day to 3 weeks. However, recurrence is possible.1