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Muacevic A, Adler JR, Alhowaish AK, Alshammari WS. Erythema Dyschromicum Perstans After Adalimumab Treatment. Cureus 2022; 14:e32264. [PMID: 36620779 PMCID: PMC9815781 DOI: 10.7759/cureus.32264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Tumor necrosis factor (TNF) is a cytokine that regulates immunity by binding to the cytokine receptor (TNFR), which has a role in treating inflammatory, neoplastic, and autoimmune diseases. Medications, including etanercept, infliximab, and adalimumab, are examples of TNF-alpha blockers. Adalimumab is a fully human immunoglobulin monoclonal antibody approved for use in the treatment of psoriasis, psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease, and hidradenitis suppurativa according to the American College of Rheumatology. However, there are few reports of cases where its administration was associated with skin reactions. In the present paper, we report a case of a psoriatic male patient who developed a cutaneous reaction of the face following treatment with adalimumab.
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Leung N, Oliveira M, Selim MA, McKinley-Grant L, Lesesky E. Erythema dyschromicum perstans: A case report and systematic review of histologic presentation and treatment. Int J Womens Dermatol 2018; 4:216-222. [PMID: 30627620 PMCID: PMC6322153 DOI: 10.1016/j.ijwd.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/28/2018] [Accepted: 08/08/2018] [Indexed: 01/19/2023] Open
Abstract
Objective Erythema dyschromicum perstans (EDP) can be difficult to diagnose and treat; therefore, we reviewed the literature to assess whether histology can be used to differentiate lichen planus pigmentosus (LPP) from EDP and determine which treatments are the most effective for EDP. We also present a case of a patient who was treated successfully with narrow-band ultraviolet B (NB-UVB). Methods A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted up to July 2017 using four databases. Results Histologic analyses from the literature reveal a significant percentage of melanophages, lymphocytic infiltrates, and basal vacuolar degeneration in EDP, and a significant histologic overlap with LPP. The review of the literature on treatment outcomes showed that NB-UVB and tacrolimus were effective with minimal side effects. Clofazimine was effective, but demonstrated significant-to-intolerable side effects. Griseofulvin, isotretinoin, and dapsone provided unsatisfactory results as lesions recurred after discontinuation. Lasers were largely ineffective and may cause postinflammatory hyperpigmentation and fibrosis. Conclusion A diagnosis of EDP should not be based on histologic findings alone. Clinical history, morphology, and distribution should be used to differentiate EDP and LPP. NB-UVB and tacrolimus are promising treatments for EDP with minimal side effects. This is the first report to our knowledge of sustained resolution of EDP after treatment with NB-UVB at long-term follow-up of 4 years. Larger studies are needed to confirm these findings.
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Affiliation(s)
- N Leung
- Duke University School of Medicine, Duke University, Durham, North Carolina
| | - M Oliveira
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - M A Selim
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.,Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - L McKinley-Grant
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - E Lesesky
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
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Kumarasinghe SPW, Pandya A, Chandran V, Rodrigues M, Dlova NC, Kang HY, Ramam M, Dayrit JF, Goh BK, Parsad D. A global consensus statement on ashy dermatosis, erythema dyschromicum perstans, lichen planus pigmentosus, idiopathic eruptive macular pigmentation, and Riehl's melanosis. Int J Dermatol 2018; 58:263-272. [PMID: 30176055 DOI: 10.1111/ijd.14189] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/18/2018] [Accepted: 07/17/2018] [Indexed: 01/19/2023]
Abstract
Ashy dermatosis (AD), lichen planus pigmentosus (LPP), erythema dyschromicum perstans (EDP), and idiopathic eruptive macular pigmentation are several acquired macular hyperpigmentation disorders of uncertain etiology described in literature. Most of the published studies on these disorders are not exactly comparable, as there are no clear definitions and different regions in the world describe similar conditions under different names. A consensus on the terminology of various morphologies of acquired macular pigmentation of uncertain etiology was a long-felt need. Several meetings of pigmentary disorders experts were held to address this problem. A consensus was reached after several meetings and collation of e-mailed questionnaire responses and e-mail communications among the authors of publications on the above conditions. This was achieved by a global consensus forum on AD, LPP, and EDP, established after the 22nd International Pigment Cell Conference held in Singapore in 2014. Thirty-nine experts representing 18 countries participated in the deliberations. The main focus of the deliberations was terminology of the conditions; as such, we present here the consensus statement of the forum and briefly review the available literature on the subject. We have not attempted to discuss treatment modalities in detail.
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Affiliation(s)
| | - Amit Pandya
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Michelle Rodrigues
- Department of Dermatology, St Vincent's Hospital, Fitzroy, Vic, Australia
| | - Ncoza C Dlova
- Department of Dermatology, College of Health Sciences, Durban, South Africa
| | - Hee Young Kang
- Department of Dermatology, Ajou University, Suwon, South Korea
| | - M Ramam
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India
| | - Johannes F Dayrit
- Department of Dermatology, Research Institute for Tropical Medicine, Metro Manila, Philippines
| | | | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rato M, Monteiro AF, Aranha J, Tavares E. Ashy dermatosis with involvement of mucous membranes. An Bras Dermatol 2017; 92:17-20. [PMID: 29267435 PMCID: PMC5726666 DOI: 10.1590/abd1806-4841.20176133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/09/2016] [Indexed: 11/22/2022] Open
Abstract
Ashy dermatosis is a rare condition, of unknown aetiology, in which mucous membranes are typically spared. The authors report the case of a 57-year-old female with a history of asymptomatic gray-bluish macules located on the trunk and oral mucosa. There were no relief changes on examination. Skin biopsies from the oral mucosa and trunk were performed and both were compatible with ashy dermatosis. The patient started treatment with oral clofazimine but due to the absence of clinical improvement the drug was discontinued three months later. This case report illustrates an atypical case of ashy dermatosis owing to the involvement of mucous membranes, which is rarely described in the literature.
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Affiliation(s)
- Margarida Rato
- Derpatment of Dermatology at Hospital de Santarém, EPE - Santarém, Portugal
| | | | - João Aranha
- Derpatment of Dermatology at Hospital de Santarém, EPE - Santarém, Portugal
| | - Ermelindo Tavares
- Derpatment of Dermatology at Hospital de Santarém, EPE - Santarém, Portugal
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Vashi NA, Wirya SA, Inyang M, Kundu RV. Facial Hyperpigmentation in Skin of Color: Special Considerations and Treatment. Am J Clin Dermatol 2017; 18:215-230. [PMID: 27943085 DOI: 10.1007/s40257-016-0239-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Differences in cutaneous diseases in people of color call for nuanced evaluation and management. One of the most common dermatological complaints from patients with skin of color is dyspigmentation, particularly hyperpigmentation. The challenge for clinicians is to establish correct diagnoses along with consistently successful treatments to meet the needs of the increasingly diverse population served. This review focuses on facial hyperpigmentation and outlines the most common skin disorders and treatment options.
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Melo CRFD, Sá MCD, Carvalho S. Erythema dyschromicum perstans in a child following an enteroviral meningitis. An Bras Dermatol 2017; 92:137-138. [PMID: 28225976 PMCID: PMC5312198 DOI: 10.1590/abd1806-4841.201745144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/05/2015] [Indexed: 11/22/2022] Open
Abstract
A healthy 6-year-old boy presented with an erythematous macular exanthema,
meningeal signs and fever, initially diagnosed with probable bacterial
meningitis and treated with antibiotic and anti-inflammatory drugs. Enteroviral
meningitis was confirmed, but the skin lesions continued to evolve and the
patient was ultimately diagnosed with erythema dyschromicum perstans. The boy
was followed during three years until the spontaneous resolution of the
dermatosis.
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Affiliation(s)
| | - Mário Correia de Sá
- Pediatric Department, Centro Hospitalar Vila Nova de Gaia/Espinho - Vila Nova de Gaia, Portugal
| | - Sónia Carvalho
- Pediatric Department, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
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Vera Izaguirre DS, Zuloaga Salcedo S, González Sánchez PC, Sánchez Lara K, Chávez Tapia N, Hojyo Tomoka MT, Domínguez Soto L, Cuevas González JC, Rodríguez Lobato E, Vega Memije ME. Actinic prurigo: a case-control study of risk factors. Int J Dermatol 2013; 53:1080-5. [PMID: 23968196 DOI: 10.1111/ijd.12168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Actinic prurigo (AP) is an idiopathic photodermatosis that usually onsets during childhood and predominates in women. It is characterized by the symmetrical involvement of sun-exposed areas of the skin, lips, and conjunctiva. OBJECTIVES This study aimed to analyze the risk factors associated with AP using a case-control design. METHODS All patients diagnosed with AP during 1990-2006 at Dr. Manuel Gea González General Hospital in Mexico City were included. Respective controls were recruited. Race, demographic, geographic, socioeconomic, environmental, clinical, and nutritional risk factors were assessed. RESULTS A total of 132 persons were enrolled. These included 44 cases and two control groups comprising, respectively, dermatology and non-dermatology outpatients without AP or any autoimmune disease. Distribution by gender, age, place of birth, place of residence, and economic status did not differ significantly among the three groups. A total of 256 variables were analyzed. Only 19 variables were found to be statistically significant (P < 0.05). These were: use of a boiler; use of firewood; car ownership; use of earthenware; mixed material housing; socioeconomic level 1; sun exposure; use of soap; lemon consumption; use of moisturizing hair cream; living with pets in the house; living with farm animals; age; having a family member with AP; having had surgery; having had trauma; having been hospitalized; use of oral medication; and use of herbal medication. Of 40 macro- and micronutrients analyzed, 11 were found to have statistically significant effects (P < 0.05). CONCLUSIONS Multiple epidemiologic, geographic, clinical, and immunologic factors are involved in the etiology of AP. This study proposes a clear line for research directed at specific risk factors that refer to an individual's clinical, allergic, health, and socioeconomic status. Further study should also investigate the etiologic role of diet in AP and the molecular mechanisms behind the development of AP to establish whether AP is caused by exposure to polycyclic aromatic hydrocarbons.
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Cherobin ACFP, Oliveira FOD, Baeta IGR, Vale ECSD. Case for diagnosis. An Bras Dermatol 2012; 87:151-2. [PMID: 22481670 DOI: 10.1590/s0365-05962012000100025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 04/25/2011] [Indexed: 11/22/2022] Open
Abstract
Dyschromicum erythema perstans, or ashy dermatosis, is a rare chronic acquired skin disease characterized by gray hyperpigmented patches with erythematous borders. Its etiology is unknown and there is no specific treatment for the condition. We report a case of ashy dermatosis in a 41-year-old patient with extensive lesions on the trunk and limbs.
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Cutrì FT, Ruocco E, Pettinato G, Ciancia G. Lichen planus pigmentosus-like ashy dermatosis. Dermatol Reports 2011; 3:e46. [PMID: 25386298 PMCID: PMC4211508 DOI: 10.4081/dr.2011.e46] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/18/2011] [Accepted: 10/24/2011] [Indexed: 12/02/2022] Open
Abstract
Ashy dermatosis, also known as erythema dyschromicum perstans, is an idiopathic dermal melanosis of unknown etiology. We here describe an unusual case of 63-year-old Caucasian male with ashy dermatosis and skin lesion of lichen pigmentosus-like. No treatment was tried because the lesions were totally asymptomatic. After a control, three months later, all lesions had cleared up. This case is of interest because it proves the existence of ashy dermatosis with clinical aspect lichen planus pigmentosus-like. This is the first case in the literature of lichen planus pigmentosus-like ashy dermatosis confirming the view that ashy dermatosis is a variant of lichen planus without the typically band-like infiltrate and Max Joseph spaces.
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Affiliation(s)
| | | | - Guido Pettinato
- Department of Anatomopathology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Ciancia
- Department of Anatomopathology, University of Naples Federico II, Naples, Italy
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Skin microbiota: microbial community structure and its potential association with health and disease. INFECTION GENETICS AND EVOLUTION 2011; 11:839-48. [PMID: 21463709 DOI: 10.1016/j.meegid.2011.03.022] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 03/24/2011] [Accepted: 03/25/2011] [Indexed: 12/22/2022]
Abstract
Skin, the largest human organ, is a complex and dynamic ecosystem inhabited by a multitude of microorganisms. Host demographics and genetics, human behavior, local and regional environmental characteristics, and transmission events may all potentially drive human skin microbiota variability, resulting in an alteration of microbial community structure. This alteration may have important consequences regarding health and disease outcomes among individuals. More specifically, certain diversity patterns of human microbiota may be predictive or diagnostic of disease. The purpose of this review is to briefly describe the skin microbiota, outline the potential determining factors driving its variability, posit the likelihood of an association between the resulting microbial community structure on the skin with disease outcomes among individuals, and finally, to present some challenges and implications for studying the skin microbiota.
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Current concepts: dermatopathology of pigmentary alteration disorders in the Hispanic population. ACTA ACUST UNITED AC 2008; 24:211-21. [PMID: 19256311 DOI: 10.1016/j.yadr.2008.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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