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Yamada A, Umemoto N, Demitsu T, Kitamura O. Acrokeratosis neoplastica (Bazex syndrome): Report of two cases and literature review. Heliyon 2024; 10:e26411. [PMID: 38434419 PMCID: PMC10906289 DOI: 10.1016/j.heliyon.2024.e26411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
The skin often reflects the presence of internal diseases. Acrokeratosis neoplastica (Bazex syndrome) is a unique skin manifestation characterized by its erythematous hyperkeratosis with yellowish, adherent scales on the palm, sole, or other acral locations. There is a potentially high association between Bazex syndrome and malignant pathology, especially squamous cell carcinomas (SCC). To date, various skin conditions have been recognized as diagnostic indicators of insidious malignancies. The recognition of paraneoplastic dermatoses has a strong potential for prompt cancer detection and early therapeutic intervention. Here we describe clinical and forensic cases of Bazex syndrome that are associated with SCC of the glottis and lung. Bazex syndrome has been reported to be associated with a variety of cancers in addition to SCC. We review the clinical manifestations of Bazex syndrome and include updated knowledge on disease pathogenesis.
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Affiliation(s)
- Atsushi Yamada
- Department of Legal Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
- Department of Dermatology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-0834, Japan
| | - Naoka Umemoto
- Department of Dermatology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-0834, Japan
| | - Toshio Demitsu
- Department of Dermatology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama, 330-0834, Japan
| | - Osamu Kitamura
- Department of Legal Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
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Shah MH, Ferrazzano C, Karthikeyan A, Hejazi H, Bhattacharya A, Andrew Awuah W, Isik A. Bazex Syndrome (Acrokeratosis Paraneoplastica): A Narrative Review of Pathogenesis, Clinical Manifestations, and Therapeutic Approaches. Cureus 2023; 15:e45368. [PMID: 37720135 PMCID: PMC10505057 DOI: 10.7759/cureus.45368] [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: 09/16/2023] [Indexed: 09/19/2023] Open
Abstract
Acrokeratosis paraneoplastica, also known as Bazex syndrome, is a relatively understudied yet clinically important dermatological condition that is inextricably associated with squamous cell carcinoma, predominantly of the upper respiratory and gastrointestinal tracts. Manifesting as unique psoriasis-like cutaneous lesions, Bazex syndrome functions as an early warning signal for underlying malignancies, underscoring the urgent need for its timely diagnosis and intervention. Notwithstanding its clinical relevance, the molecular and cellular mechanisms underpinning its pathogenesis are not fully understood. To address these gaps, this comprehensive literature review undertook a meticulous search across reputable databases such as EMBASE, MEDLINE/PubMed, and Web of Science. Our analysis ventures into multiple putative pathogenic pathways, including shifts in Th2 immune responses, aberrant secretion of growth factors, and immunological reactions to tumor-specific antigens. We also detail the clinical phenotypes of Bazex syndrome and their chronological linkage with the corresponding malignancies. Finally, the review evaluates the therapeutic effectiveness of various approaches, including but not limited to targeted cancer treatments, PUVA therapy, and topical corticosteroids. This synthesis aims to arm healthcare providers with a nuanced understanding of Bazex syndrome, facilitating more accurate diagnosis and tailored treatment paradigms.
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Affiliation(s)
- Muhammad Hamza Shah
- Centre for Anatomy, Deanery of Biomedical Sciences, The University of Edinburgh, Edinburgh, GBR
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Carlo Ferrazzano
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Anhukrisha Karthikeyan
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Hamad Hejazi
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Anushri Bhattacharya
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | | | - Arda Isik
- Surgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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Shah R, Truong T, Schwartz RA, Lambert MW, Parish LC, Janniger E, Lambert WC. Annular and acral/facial dyskeratotic paraneoplastic disorders. Clin Dermatol 2023; 41:396-404. [PMID: 37423265 DOI: 10.1016/j.clindermatol.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Annular and acral/facial dyskeratotic paraneoplastic disorders are inflammatory dermatoses that occur in association with distant cancers but are not precursors, extensions, or metastases of them. There are four classical entities under this rubric: two gyrate entities, erythema annulare centrifugum and erythema gyratum repens, and two acral/facial dyskeratotic entities, acrokeratosis paraneoplastic (Bazex syndrome) and tripe palms. Each of these entities may also occur in association with another etiopathogenesis and may present either as a classical entity or as a barely recognizable disease. We discuss these entities, their associated causes, and their differential diagnoses in turn.
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Affiliation(s)
- Rohan Shah
- Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Thu Truong
- Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Departments pf Dermatology and of Pathology, Immunology, and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Muriel W Lambert
- Departments pf Dermatology and of Pathology, Immunology, and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Lawrence Charles Parish
- Department of Dermatology and Cutaneous Biology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA; Jefferson Center for International Dermatology, Philadelphia, Pennsylvania, USA
| | - Edmund Janniger
- Departments pf Dermatology and of Pathology, Immunology, and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - W Clark Lambert
- Departments pf Dermatology and of Pathology, Immunology, and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
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Vaibhav V, Meshram R, Kalonia T. An Unusual Encounter of Skin Condition Mimicking Acrokeratosis Paraneoplastica (Bazex Syndrome). Cureus 2021; 13:e17849. [PMID: 34660055 PMCID: PMC8502012 DOI: 10.7759/cureus.17849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/08/2022] Open
Abstract
Acrokeratosis paraneoplastica is a rare paraneoplastic skin disease in which there are erythematous violaceous, scaly plaques on the hands, feet, and acral locations. There is a relationship between various carcinomas of the aerodigestive tract and skin eruptions. These were the pioneering work done pertaining to a clinical entity that was showing some inter-relationship between a skin condition and carcinoma anywhere inside the body. Bazex syndrome is mostly associated with carcinomas of the upper aero-digestive tract, but other malignancies were also being reported. In this case, the patient was in advancing age with cachexic features along with liver and lung lesions which prompted us to investigate histologically for evidence of malignancy which came out to be negative. In our case, lungs showed features of pulmonary edema with normal histology. When we examined the liver, gross lesions were present but no evidence of malignancy was noted and the liver showed normal parenchyma histologically. Specimens taken from hand and foot showed hyperkeratosis along with bacterial colonies in the overlying epidermis. The spleen showed red pulp with congestion and hemorrhage. Similarly, sections from the kidneys were showing interstitial inflammation and congestion of blood vessels. Specimens from the brain and heart showed unremarkable histology.
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Affiliation(s)
- Vikas Vaibhav
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Raviprakash Meshram
- Forensic Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Tushar Kalonia
- Pathology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Roy B, Lipner SR. A Review of Nail Changes in Acrokeratosis Paraneoplastica (Bazex Syndrome). Skin Appendage Disord 2021; 7:163-172. [PMID: 34055903 DOI: 10.1159/000513828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
Acrokeratosis paraneoplastica (Bazex syndrome) is a rare paraneoplastic dermatosis associated with internal malignancies. Clinical presentation is characterized by erythematous or violaceous scaly plaques involving the digits, nose, ears, palms, and soles. Nail changes commonly present concurrently with cutaneous manifestations. In this review, we characterize nail changes associated with acrokeratosis paraneoplastica. A total of 48 cases were analyzed. Nail findings were nonspecific, with the most common being nail plate thickening, onycholysis, subungual hyperkeratosis, longitudinal ridging, discoloration, and nail plate loss. In most patients, nail changes involved the majority of fingernails and toenails and most often appeared prior to the diagnosis of malignancy. The most common associated underlying malignancies were squamous cell carcinomas of the head and neck. A diagnosis of acrokeratosis paraneoplastica should be considered in patients with onychodystrophy involving multiple nails with accompanying atypical psoriasiform dermatoses. Screening for internal malignancies may significantly decrease morbidity and mortality for these patients.
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Affiliation(s)
- Bipasha Roy
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
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