Skin Manifestations In Patients Research Articles

Vascular skin manifestations in patients with severe COVID-19 in intensive care units: a monocentric prospective study.

BackgroundVarious skin manifestations have been reported during the coronavirus disease 2019 (COVID-19) pandemic. Among these are acral vascular skin lesions in non-severe patients, but few studies have focused specifically on patients with severe COVID-19 admitted to the intensive care unit (ICU).ObjectivesWe aimed to assess the frequency of acral vascular skin manifestations (AVSM) in patients admitted to the ICU based on systematic dermatological examination.Materials & MethodsWe conducted a clinical, observational and prospective study in the ICU of Lille University Hospital (France). All adult patients with RT-PCR-confirmed severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) infection were included on May 5th and 6th, 2020.ResultsA total of 39 patients with severe COVID-19 were examined (34 males and five females; median age: 61 [55–59]). We observed AVSM in 11/39 patients (28%) including five with acral necrotic lesions, three with haemorrhagic blisters, one with acral live-doid rash, and one with erosive distal lesions. Chilblain or chilblain-like lesions were not seen, unlike ambulatory or non-severe patients described in the literature. There was no difference regarding the median length of stay in the ICU, initial symptoms of COVID-19 or baseline characteristics, except for a lower BMI in patients with AVSM. All patients had biological coagulation abnormalities (e.g. higher levels of fibrinogen or D-dimers), but there was no difference between patients with and without AVSM.ConclusionAVSM are infrequent and heterogenous and seem to be non-specific to patients with severe SARS-CoV-2, and possibly unrelated to COVID-19. The pathophysiology of AVSM described during the COVID-19 pandemic is not fully elucidated.

Main Causes of Skin Traumas and Damage in Patients with COVID-19

COVID-19 can affect multiple organs including heart and blood vessels, kidneys, gut, and brain. This study aimed to assess all aspects of skin traumas and damages in COVID-19. The main causes of skin trauma in COVID-19 and its consequences can be examined in four parts, including cutaneous manifestations that appear during COVID-19, drug reactions that occur during hospitalization or outpatient treatment of patients, skin damages caused by over-washing or rinsing with inappropriate detergents, or inappropriate use of personal protective equipment (mask, gloves,.), and changes the duration of COVID-19 in patients with autoimmune, chronic and inflammatory underlying skin diseases. The rate of skin manifestations in patients with COVID-19 in the range of 1.8%-20.4%, including vascular lesions (petechiae, purpura, livedo reticularis, pernio, and chilblain lesions), urticaria and maculopapular rash, and other less common skin manifestations such as erythema multiforme, pityriasis rosea, suite syndrome. These skin manifestations were commonly seen in men aged 45-89 years. The most lesions distribution ( 69.4%) was in the body, but in 19% of cases, lesions were observed in the hands and feet. Patients with COVID-19 receive multiple viral treatments, antibiotics, and various anti-inflammatory drugs. Receiving these drugs has led to cutaneous manifestations in some patients. Medical staff is prone to various traumatic skin conditions, due to the long-term use of personal protective equipment. These conditions include itching, redness, skin irritation, contact dermatitis, and worsening of underlying diseases. The effects of COVID-19 on the skin system can be serious and long-lasting. Adequate treatment and supportive therapy can prevent the long-lasting consequences and disability of the patient.

Various skin manifestations related to inflammatory bowel disease: A nationwide cross‐sectional study on the Korean population

Inflammatory bowel disease (IBD) presents with various extraintestinal manifestations. As part of them, various skin diseases are suggested to be related to IBD. We aimed to identify the epidemiology and risk of developing skin manifestations in patients with IBD. We used Korean insurance claims data and selected patients with IBD and age/sex-matched non-IBD subjects between 2013 and 2017 using the diagnosis code and prescription records of IBD-specific medications. The prevalence and risk of concurrent skin diseases were estimated. We identified 64837 patients with IBD. Reactive skin eruptions including pyoderma gangrenosum and erythema nodosum were associated with IBD with highest odds ratios among three categories of reactive, inflammatory, and autoimmune skin diseases. Inflammatory skin diseases including rosacea, psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne conglobata were significantly associated with IBD, but the association was less marked compared to reactive skin eruptions. The patients with IBD also had a higher risk of autoimmune skin diseases including vitiligo and alopecia areata than non-IBD subjects. We determined that IBD was related to various skin diseases including reactive, inflammatory, and autoimmune skin diseases. Considering these relationships can allow better management of patients with IBD and comorbid skin diseases.

Association between skin manifestations and glycemic control in patients with diabetes mellitus type II

Background/Aim. Diabetes mellitus (DM) can be associated with numerous skin diseases. This study aimed to determine the pattern and incidence of skin manifestations in patients with type 2 DM and their link to glycemic control. Methods. This cross-sectional study was conducted at the Skin and Venereal Diseases Clinic, University Clinical Centre of the Republic of Srpska in Banja Luka, Bosnia and Herzegovina, from January 2016 to January 2018. Adult patients of both genders suffering from type 2 DM and cutaneous manifestations participated in the study. Glycemic control was assessed according to the values of glycated hemoglobin (HbA1c) of 7%. Results. The mean age of 105 study participants (46% m ale and 5 4% female) was 6 8.4 ? 10 years, while the mean HbA1c was 8.3 ? 1.6%. Unsatisfactory glycemic control was found in 74.3% of patients with the mean HbA1c at 8.9 ? 1.4%, while satisfactory glycemic control was found in 25.7% of patients, with the mean HbA1c at 6.7 ? 0.2% (p < 0.001). Infections were the most frequent skin diseases (43.9%). Bacterial infections were most common (26.7%), followed by fungal infections (24.8%), xerosis (17.1%), psoriasis (15.2%), fibroma molle (14.3%), diabetic ulcer (7.7%), prurigo (6.7%), and stasis dermatitis (5.7%). Other skin manifestations were found at a lower rate. A significant association was found between unsatisfactory glycemic control and skin infections (p = 0.009). Conclusion. The most common skin manifestations in patients with type 2 diabetes are infections. They occurred more often in patients with unsatisfactory glycemic control.

The effect of foot reflexology massage on pruritus in hemodialysis patients.

BACKGROUND:Pruritus is a common skin manifestation in patients undergoing hemodialysis. Pruritus has a negative impact on the quality of life of patients receiving hemodialysis. This study was aimed to investigate the effect of foot reflexology massage on pruritus in hemodialysis patients.MATERIALS AND METHODS:A quasi-experimental study was conducted on 90 hemodialysis patients referred to Khatam-al-Anbiya and Ali-Ebne Abi-Taleb hospitals affiliated to Zahedan University of Medical Sciences in 2019. Patients with moderate-to-severe pruritus scores obtained from the Pruritus Severity Scale (PSS) were included in the study. They were randomly divided into intervention and control groups using shuffling cards or envelopes. The intervention group received nine sessions of foot reflexology massage 3 days a week for 20 min (10 min on each foot) with an emphasis on the solar plexus point. The participants in both groups again completed the PSS 48 h after the intervention. Data were analyzed using the SPSS version 24, independent t-test, Chi-square test, and paired t-test.RESULTS:The results of this study demonstrated that foot reflexology massage significantly reduced itching or pruritus in hemodialysis patients (P < 0.001). Pruritus scores in the control group were statistically significant (P < 0.001). There was no significant statistically difference between the two groups in terms of the pruritus scores before the intervention (P = 0.59).CONCLUSION:Our findings showed that the foot reflexology massage could relieve itching or pruritus in hemodialysis patients. It is, therefore, recommended that it can be used as an effective intervention technique to alleviate itching in hemodialysis patients.

Clinical and Laboratory Findings among Patients with Toxocariasis in Medic Medical Center, Ho Chi Minh City, Vietnam in 2017-2019.

Background:Human toxocariasis is prevalent in many countries but this disease has been rarely reported from Vietnam. We aimed to investigate the clinical and laboratory findings and assess possible association between these findings in patients with toxocariasis in Vietnam.Methods:A prospectively study, between October 2017 and June 2019 was performed involving 120 toxocariasis patients at Medic Medical Center, Ho Chi Minh City, Vietnam. The diagnosis of toxocariasis was established based on clinical, laboratory (eosinophilia, raised IgE concentration) and serological (positive Toxocara IgG ELISA test) evaluation as well as the exclusion of other helminthic coinfection.Results:The most frequently reported manifestation was of skin (n = 93, 77.5%), including urticarial (n= 69, 57.5%) followed by neurologic, gastrointestinal and pulmonary signs/symptoms. Hepatic involvement occurred in 8.3% of the patients. No significant relationship between clinical findings and laboratory parameters was found except the higher values of eosinophil count and IgE concentration among patients with liver involvement. There was a significant relationship between eosinophil count and IgE concentration (r=0.389, P<0.001). Serological findings did not show a correlation with clinical and other laboratory findings.Conclusion:Our data revealed a wide range of clinical symptoms/signs and a high incidence of skin manifestations in patients with toxocariasis. Eosinophil count and IgE concentration are valuable markers for the evaluation of the disease.

Clinicopathologic correlations of COVID-19–related cutaneous manifestations with special emphasis on histopathologic patterns

Skin is one of target organs affected by the novel coronavirus SARS-CoV-2, and in response to the current COVID-19 pandemic, a fast body of literature has emerged on related cutaneous manifestations. Current perspective is that the skin is not only a bystander of the general cytokines storm with thrombophilic multiorgan injury, but it is directly affected by the epithelial tropism of the virus, as confirmed by the detection of SARS‐CoV‐2 in endothelial cells and epithelial cells of epidermis and eccrine glands. In contrast with the abundance of epidemiologic and clinical reports, histopathologic characterization of skin manifestations is limited. Without an adequate clinicopathologic correlation, nosology of clinically similar conditions is confusing, and effective association with COVID-19 remains presumptive. Several patients with different types of skin lesions, including the most specific acral chilblains-like lesions, showed negative results at SARS-CoV-2 nasopharyngeal and serologic sampling. The aim of this review is to provide an overview of what has currently been reported worldwide, with a particular emphasis on microscopic patterns of the skin manifestations in patients exposed to or affected by COVID-19. Substantial breakthroughs may occur in the near future from more skin biopsies, improvement of immunohistochemistry studies, RNA detection of SARS-CoV-2 strain by real-time polymerase chain reaction-based assay, and electron microscopic studies.

An itchy erythematous papular skin rash as a possible early sign of COVID-19: a case report

BackgroundSeveral recent studies suggest the possibility of a skin rash being a clinical presentation of coronavirus disease 2019 (COVID-19). The purpose of this case report is to bring attention to skin manifestations in the early stage of COVID-19 in order to support frontline physicians in their crucial activity of case identification.Case presentationThe patient is an Italian 32-year-old female nurse who had several close contacts with multiple patients with COVID-19 as part of her professional workload. On March 13, 2020, the patient developed an itchy, erythematous papular rash (sparing only her face, scalp, and abdomen), which lasted for 10 days. The rash was accompanied by a feeling of general fatigue that gradually worsened over the following days and has continued for 5 months (until the end of July 2020). During the first week of remote assessment carried out by her general practitioner, the patient gradually developed a dry cough, intermittent fever, and diarrhoea and then had a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Her skin manifestations disappeared completely 48 days after the onset of the disease, followed by the disappearance of the dry cough.ConclusionsIn light of recent studies, this case report suggests that skin manifestations, when taken into account with other situational factors (such as profession and patient history) should be taken into proper consideration by frontline physicians as possibly being caused by SARS-CoV-2. Early identification of COVID-19 is a key part of the strategy of case detection and case isolation. To enhance this activity, further research is needed to establish frequency, symptoms, signs, and pathogenesis of skin manifestations in patients with COVID-19.

Skin manifestations in patients hospitalized with confirmed COVID-19 disease: a cross-sectional study in a tertiary hospital.

BackgroundCOVID‐19 cutaneous manifestations have been recently described and classified in five different clinical patterns, including acral erythema‐edema (pseudo‐chilblain), maculopapular exanthemas, vesicular eruptions, urticarial lesions, and livedo or necrosis.ObjectivesThe objective of this study was to examine the skin of hospitalized patients with a confirmed diagnosis of COVID‐19 disease and describe the real prevalence of skin manifestations.MethodsA cross‐sectional study, which included hospitalized patients in Cruces University Hospital from April 14–30, 2020, with a laboratory‐confirmed diagnosis of COVID‐19 (with polymerase chain reaction and/or serology tests), was conducted. Entire body surface examination was performed by experienced dermatologists to search for cutaneous manifestations related to COVID‐19 disease.ResultsFrom a sample of 75 patients, 14 (18.7%) developed cutaneous manifestations possibly related to COVID‐19. We found six patients with acral erythema‐edema (pseudo‐chilblain) (42.8%), four patients with maculopapular exanthemas (28.6%), two patients with urticarial lesions (14.3%), one patient with livedo reticularis‐like lesions (7.15%), and one patient with vesicular eruption (7.15%).ConclusionsOur study provides a more plausible relationship between the main cutaneous patterns and COVID‐19 in hospitalized patients as all of them had a confirmatory laboratory test. Skin manifestations are frequent but mild with spontaneous resolution. These findings are nonspecific and can be similar to other viral infections and adverse drug reactions in hospitalized patients.

Perspectiva de la dermatología y COVID-19

La evidencia científica sobre manifestaciones cutáneas producidas por el nuevo coronavirus SARS-CoV-2 (COVID- 19) cada vez es mayor. La exacerbación de enfermedades cutáneas preexistentes y las lesiones por uso prolon­gado de elementos de protección personal son emergentes. Los especialistas en dermatología deben conocerlas, orientar en su prevención y tratamiento.&#x0D; En este artículo se revisan las manifestaciones cutáneas en pacientes con COVID-19, las lesiones en piel que han surgido en trabajadores de la salud, la perspectiva de la teledermatología como herramienta para combatir la pandemia, algunas consideraciones especiales y protección de la piel y membranas mucosas.

Detection of subclinical skin manifestation in patients with psoriasis and psoriatic arthritis by fluorescence optical imaging

ObjectivesTo investigate the frequency of subclinical skin inflammation in both hands by fluorescence optical imaging (FOI) in patients with psoriasis/psoriatic arthritis (Pso/PsA) vs. rheumatoid arthritis (RA) and healthy individuals, and to correlate these findings with cardiovascular (CV) risk factors.Patients and methodsThe FOI scans were analyzed retrospectively to detect clinically invisible skin enhancement (0–3 scale) in both hands without relationship to underlying joints or blood vessels. We further characterized the FOI patterns and sorted the scans into groups based on the assumed diagnosis (Pso/PsA, RA, and healthy controls), which was compared with the physician’s diagnosis. Furthermore, the associations between CV risk factors and imaging findings were investigated by regression analyses.ResultsWe included FOI scans of patients with Pso/PsA (n = 80), RA (n = 78), and healthy controls (n = 25). Subclinical skin enhancement on the back of their hands was more common in Pso/PsA (72.5%) than in RA patients (20.5%) and healthy individuals (28.0%) (p < 0.001). Based on the FOI pattern, the majority of patients with Pso/PsA (72.5%), RA (76.9%), and healthy controls (68.0%) were classified correctly using the physician-based diagnosis as reference (overall agreement of 74%, kappa = 0.57). No CV risk factors except body weight (kg) were associated with subclinical skin enhancement (OR 1.04, 95% CI 1.02–1.06; p < 0.001).ConclusionSubclinical subdermal skin inflammation was common in Pso/PsA patients using FOI. Based on the FOI pattern, most patients with Pso/PsA and were classified with the correct diagnosis. We demonstrated an important influence of the body weight on our FOI results. FOI may be a helpful novel tool to study microcirculation in rheumatic diseases with skin involvement.

Most chilblains observed during the COVID-19 outbreak occur in patients who are negative for COVID-19 on polymerase chain reaction and serology testing.

SummaryBackgroundAcral lesions, mainly chilblains, are the most frequently reported cutaneous lesions associated with COVID‐19. In more than 80% of patients tested, nasopharyngeal swabs were negative on reverse transcription polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 when performed, and serology was generally not performed.MethodsA national survey was launched on 30 March 2020 by the French Society of Dermatology asking physicians to report cases of skin manifestations in patients with suspected or confirmed COVID‐19 by using a standardized questionnaire. We report the results for acral manifestations.ResultsWe collected 311 cases of acral manifestations [58.5% women, median age 25.7 years (range 18–39)]. The most frequent clinical presentation (65%) was typical chilblains. In total, 93 cases (30%) showed clinical suspicion of COVID‐19, 67 (22%) had only less specific infectious symptoms and 151 (49%) had no clinical signs preceding or during the course of acral lesions. Histology of skin biopsies was consistent with chilblains. Overall, 12 patients showed significant immunological abnormalities. Of the 150 (48%) patients who were tested, 10 patients were positive. Seven of 121 (6%) RT‐PCR‐tested patients were positive for SARS‐CoV‐2, and five of 75 (7%) serology‐tested patients had IgG anti‐SARS‐CoV‐2. Tested/untested patients or those with/without confirmed COVID‐19 did not differ in age, sex, history or acral lesion clinical characteristics.ConclusionsThe results of this survey do not rule out that SARS‐CoV‐2 could be directly responsible for some cases of chilblains, but we found no evidence of SARS‐CoV‐2 infection in the large majority of patients with acral lesions during the COVID‐19 lockdown period in France. What is already known about this topic? About 1000 cases of acral lesions, mainly chilblains, were reported during the COVID‐19 outbreak.Chilblains were reported to occur in young people within 2 weeks of infectious signs, which were mild when present.Most cases did not have COVID‐19 confirmed by reverse transcription polymerase chain reaction (RT‐PCR), and few serology results were available. What does this study add? Among 311 patients with acral lesions, mainly chilblains, during the COVID‐19 lockdown period in France, the majority of patients tested had no evidence of SARS‐CoV‐2 infection.Overall, 70 of 75 patients were seronegative for SARS‐Cov‐2 serology and 114 of 121 patients were negative for SARS‐CoV‐2 RT‐PCR.

Skin manifestations in patients with a new coronavirus infection: clinical cases

Clinical cases of cutaneous eruptions in patients with new coronavirus infection (COVID-19) are described. The authors conclude that predominant morphological eruptions in the form of macules, papules and weals are associated with COVID-19. As a rule, eruptions occur simultaneously with the onset of the first signs of the disease or several days later both in adult and children. The severity of COVID-19 does not generally correlate with the severity of skin clinical manifestations. The skin eruptions are most frequently difficult to attribute to a particular diagnosis, and they are often diagnosed as some kind of dermatosis. Skin eruptions regress quite shortly due to COVID-19 treatment and improvements in the patients general condition as well as the use of topical steroids, or even without treatment.

Non-invasive methods for evaluation of skin manifestations in patients with ichthyosis.

Hereditary ichthyoses include a group of diseases characterized by hyperkeratosis, scaling, generalized xerosis, and is frequently associated with erythroderma. They are classified as syndromic and non-syndromic entities. The monitoring of the severity of ichthyosis requires different strategies for immediate analysis, which can comprise visual analogue scales or non-invasive quantitative methods, which collect information on disease progression that may contribute to the management of ichthyosis and aid in delineating clinical trials. In this article, we present a comprehensive review of the existing visual analogue scales, their validation, and their use in studies of disease severity and clinical trials. Interestingly, after many years of study, to date there is not a unanimously accepted tool for assessing the harshness of clinical features. Therefore, we discuss the perspectives of some non-invasive quantitative methods and strategies employed in clinical studies performed in patients with ichthyosis. Advances in these methods provide a rationale of their potential application in the evaluation of ichthyosis severity. Our purpose is to show an overview of non-invasive methodologies for the study of the harshness of ichthyosis.

Skin manifestations in end stage renal disease patients on hemodialysis.

Chronic kidney disease (CKD) is a world public health problem that is related with high morbidity and mortality. CKD patients can present with different skin manifestations, often benign with much impact on quality of patients life. Study Design: Case-series study. Setting: Nephrology Unit Civil Hospital Larkana. Period: From 1st January 2018 to 30th June 2018. Material and methods: 141 patients of ESRD on regular HD for at least 1 month. Patients were chosen randomly for evaluation of cutaneous changes regardless of their gender, age, sex and etiology of ESRD. General and dermatological examination of the skin, hair, nails, and oral mucosa was performed by consultant dermatologist. Data were analyzed by using IBM SPSS version 23.0. Descriptive analyses performed using mean with standard deviation and median with inter quartile ranges of quantitative data set. Count and percentages were reported for categorical data set. Results: In the present study there were one hundred and forty one patients. Out of them skin manifestations of patients, 87.9% had Xerosis, 31.9% found with skin hyper pigmentation, 9.2% had Subungal Hyperkeratosis, 24.1% had Uremic Pruirtis, 45.4% had Pallor, and 6.4% found with Bruises. There were 9.9% cases of Alopecia, 17.7% cases of half n half nail, 1.4% cases of half n half nail with alopecia, 9.2% cases of Koilionychia, 0.7% cases of Koilionychia with alopecia, 2.8% found with koilonychias and half n half nail, 2.1% with leuconycia and koilionychia, 15.5% with Leuconychia, 2.1% found with Leuconychia and alopecia, and 0.7% found with Leuconychia, koilonychia &amp; alopecia in Hair and Nail changes. Conclusion: The range of skin manifestations vary in different studies. Although often benign with much impact on quality of patient’s life and life can be threatening. Early treatment of skin disorders can improve the quality of life.

Clinical features and risk factors of pruritus in patients with chronic renal failure.

Dermatological manifestations are common in systemic diseases, such as chronic kidney disease. The present study investigated the clinical features and possible influencing factors of pruritus in patients with chronic renal failure (CRF). A total of 382 inpatients were enrolled from the Department of Nephrology at The Second Affiliated Hospital of Chongqing Medical University. A total of 138 subjects were hemodialysis patients, 41 were peritoneal dialysis patients, and 203 were chronic renal failure patients. The patients' clinical performance was observed, and the data was recorded for analysis. The prevalence of pruritus in hemodialysis patients was greater than that in peritoneal dialysis patients. A total of 187 patients were accompanied by xerodermia and 109 patients had pruritus at the same time. With effective and regular dialysis, pruritus could be alleviated in 40% of patients. The intensity of pruritus in the enrolled patients ranged from mild itching to irritability during day and night periods. Moreover, pruritus was intermittent or persistent, and/or limited to generalized. Following treatment, 35% of patients had poor results. A significant difference was noted in the levels of serum urea nitrogen, creatinine, serum phosphorus, calcium × phosphorus, and parathyroid hormone (PTH) between patients with pruritus and non-pruritus. Xerodermia is a common skin manifestation in patients with chronic renal failure and is associated with the occurrence of pruritus. Local cold and heat stimulation can relieve pruritus to some extent, and adequate hemodialysis can also relieve itching.

Quality of Life is Markedly Impaired by Rheumatological and Skin Manifestations in Patients with Type 1 Diabetes: A Questionnaire Survey.

IntroductionTo estimate lifetime prevalence of diabetes-related upper limb and non-acquired skin manifestations in a representative type 1 diabetes (T1D) population and to identify associations between these conditions and quality of life.MethodsA questionnaire on these complications and measures of quality of life (World Health Organization–Five Well-Being Index [WHO-5]), depression, and diabetes-specific burden (Problem Areas in Diabetes [PAID] scale) was sent to all T1D patients in a Danish clinic (N = 583).ResultsThe response rate was 68.6%. Lifetime prevalence of any upper limb soft tissue lesion was 72%; prevalence of any skin lesion was 10.5%. Frozen shoulder and vitiligo were most common upper limb and skin manifestation, at a prevalence of 53 and 9.1%, respectively. Compared to patients with no skin lesion, those with at least one skin lesion had more depression (19 vs. 33%; P < 0.01) and lower WHO-5 scores. Frozen shoulder was associated with lower WHO-5 scores (P < 0.001), more depression (29 vs. 14%; P < 0.001), and a higher PAID score (P < 0.01). A diagnosis of carpal tunnel syndrome was associated with lower WHO-5 scores (P < 0.001), a higher risk of depression (29 vs. 16%; P < 0.01), and a higher PAID score (P < 0.001).ConclusionUpper limb soft tissue lesions and diabetes-specific non-acquired skin lesions are very common in patients with T1D and strongly associated with impaired life quality and increased risk of depression.

Occurrence of skin manifestations in patients of the Swiss Inflammatory Bowel Disease Cohort Study.

Background/AimsExtraintestinal cutaneous manifestations of IBD represent a severe disease complication and an early and accurate treatment might positively influence the disease course. Using the patient collective of the Swiss IBD Cohort Study (SIBDCS), we analysed epidemiological as well as clinical factors being associated with the onset of pyoderma gangrenosum, erythema nodosum and aphthous ulcers in IBD patients.MethodsWe included 3266 SIBDCs patients, 1840 with Crohn’s disease (CD) and 1426 with ulcerative colitis (UC) or IBD unclassified (IBDU) and analysed the association of cutaneous manifestations with age, age at diagnosis time, type of disease, gender, family history, HLA-allotype, smoking, intestinal disease activity, therapy and other extraintestinal manifestations (EIM).Results354 CD patients and 136 UC/IBDU patients presented with skin manifestations at any time during their disease course. In both, CD and UC, female gender and younger age at IBD diagnosis were significantly associated with extraintestinal skin manifestations. For CD, we also detected a positive family history as associated factor. As an indicator of more intensive intestinal disease activity, patients with cutaneous manifestations of IBD needed more frequently therapy with antibiotics, steroids, immunomodulators and anti-TNF. Multivariate analysis revealed female gender, younger age at diagnosis and presence of other extraintestinal manifestations as factors being associated with skin EIM in IBD patients and anti-TNF as well as immunomodulatory treatment in CD patients.ConclusionOur results suggest that young females with a positive family history of IBD might be at increased risk for the onset of skin manifestations and require a careful screening for such complications.

Cutaneous manifestations of hematologic malignancies the experience of an Italian dermatology department.

In recent years, dermatologic manifestations in oncohematologic patients have become more common. The aim of our study was to determine the incidence and heterogeneity of skin manifestations in patients followed at our Hematology Department. This observational monocentrical study was conducted on 60 patients. We divided the observed conditions in exanthematous, purpuric, vesicular-bullous, papulonodular, urticarial, and eczematous manifestations. Moreover, all lesions were classified according to pathogenesis, in (a) specific skin manifestations, caused by neoplastic skin infiltration; (b) immune-mediated manifestations, based on immunological mechanisms; and (c) skin lesions due to immunodeficiency. Altogether, 73 clinical manifestations were reported. Specific manifestations (a) were detected in 15.1% of the cases, mainly with papulonodular appearance. Immune-mediated manifestations (b) were found in 37 cases (50.7%), particularly with eczematous or exanthematous appearance, and leukemia was the malignancy most frequently reported in these patients. Eventually, lesions due to immunosuppression (c) were reported in 34.2% of the cases. They were represented by infections and cutaneous malignancies, and usually manifested with papulonodular lesions. Skin lesions in oncohematologic patients are a common event. A multidisciplinary approach based on the collaboration between the hematologist and the dermatologist is crucial to achieve a proper diagnosis, and correctly manage these manifestations.

Assessment of Skin Manifestations in End-Stage Renal Disease Patients Undergoing Hemodialysis in Shahid Beheshti Hospital of Abadan and Vali-e-Asr Hospital of Khorramshahr

Background: The prevalence of skin manifestations in hemodialysis patients is increasing. Objectives: The aim of this study was to evaluate skin manifestations in patients with end-stage renal disease (ESRD) undergoing hemodialysis. Methods: In this descriptive-analytical study, 100 patients undergoing hemodialysis from among 120 patients referring to Shahid Beheshti Hospital of Abadan and Vali-e-Asr Hospital of Khorramshahr were assessed. A demographic questionnaire and a checklist about skin disorders were used for data collection. The data were analyzed by SPSS version 16 software using descriptive and analytical statistics. Results: The most common skin findings were pale skin (87%), dry skin (71%), hyperpigmentation (46%), and purpura (35%). Among nail manifestations, the most common finding was a half-and-half nail (50%) and the rarest symptom was dystrophy (1%). Conclusions: The results of this study indicated that ESRD was associated with multiple skin symptoms, the most prevalent of which were pale skin and dry skin symptoms. Therefore, early diagnosis of these problems is a major step in improving the quality of life of these patients.