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Wichyanrat S. Concurrent and prolonged embedded earring at the earlobe as a possible factor of erosive lichen planus. Clin Case Rep 2024; 12:e9431. [PMID: 39258026 PMCID: PMC11386241 DOI: 10.1002/ccr3.9431] [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: 05/08/2024] [Revised: 07/24/2024] [Accepted: 08/28/2024] [Indexed: 09/12/2024] Open
Abstract
Key Clinical Message Embedded earrings in adults have been reported to be a possible cause of erosive oral lichen planus. Abstract Erosive lichen planus is rare and its cause cannot be determined. Embedded earring in the earlobes is rare clinical presentation in adult. The concurrent nature of these two conditions has not been previously, described in the published literature. Unexpectedly, we removed the earring from the earlobe and successfully treated erosive oral lichen planus. We hypothesized that prolonged embedded earring is a possible factor that induced erosive lichen planus in this case.
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Affiliation(s)
- Sutthinun Wichyanrat
- Division of Dermatology, Department of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
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2
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Roach K, Roberts J. A comprehensive summary of disease variants implicated in metal allergy. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2022; 25:279-341. [PMID: 35975293 PMCID: PMC9968405 DOI: 10.1080/10937404.2022.2104981] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Allergic disease represents one of the most prominent global public health crises of the 21st century. Although many different substances are known to produce hypersensitivity responses, metals constitute one of the major classes of allergens responsible for a disproportionately large segment of the total burden of disease associated with allergy. Some of the most prevalent forms of metal allergy - including allergic contact dermatitis - are well-recognized; however, to our knowledge, a comprehensive review of the many unique disease variants implicated in human cases of metal allergy is not available within the current scientific literature. Consequently, the main goal in composing this review was to (1) generate an up-to-date reference document containing this information to assist in the efforts of lab researchers, clinicians, regulatory toxicologists, industrial hygienists, and other scientists concerned with metal allergy and (2) identify knowledge gaps related to disease. Accordingly, an extensive review of the scientific literature was performed - from which, hundreds of publications describing cases of metal-specific allergic responses in human patients were identified, collected, and analyzed. The information obtained from these articles was then used to compile an exhaustive list of distinctive dermal/ocular, respiratory, gastrointestinal, and systemic hypersensitivity responses associated with metal allergy. Each of these disease variants is discussed briefly within this review, wherein specific metals implicated in each response type are identified, underlying immunological mechanisms are summarized, and major clinical presentations of each reaction are described.Abbreviations: ACD: allergic contact dermatitis, AHR: airway hyperreactivity, ASIA: autoimmune/ autoinflammatory syndrome induced by adjuvants, BAL: bronchoalveolar lavage, CBD: chronic beryllium disease, CTCL: cutaneous T-cell lymphoma, CTL: cytotoxic T-Lymphocyte, DRESS: drug reaction with eosinophilia and systemic symptoms, GERD: gastro-esophageal reflux disease, GI: gastrointestinal, GIP: giant cell interstitial pneumonia, GM-CSF: granulocyte macrophage-colony stimulating factor, HMLD: hard metal lung disease, HMW: high molecular weight, IBS: irritable bowel syndrome, Ig: immunoglobulin, IL: interleukin, LMW: low molecular weight, PAP: pulmonary alveolar proteinosis, PPE: personal protective equipment, PRR: pathogen recognition receptor, SLE: systemic lupus erythematosus, SNAS: systemic nickel allergy syndrome, Th: helper T-cell, UC: ulcerative colitis, UV: ultraviolet.
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Affiliation(s)
- Ka Roach
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
| | - Jr Roberts
- Allergy and Clinical Immunology Branch (ACIB), National Institute of Occupational Safety and Health (NIOSH), Morgantown, WV, USA
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3
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Kanazawa N. Designation of Autoinflammatory Skin Manifestations With Specific Genetic Backgrounds. Front Immunol 2020; 11:475. [PMID: 32256502 PMCID: PMC7093487 DOI: 10.3389/fimmu.2020.00475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Abstract
“Autoinflammatory disease (AiD)” has first been introduced in 1999 when the responsible gene for the familial Hibernean fever or autosomal dominant-type familial Mediterranean fever-like periodic fever syndrome was reportedly identified as tumor necrosis factor receptor superfamily 1. Linked with the rapid research progress in the field of innate immunity, “autoinflammation” has been designated for dysregulated innate immunity in contrast to “autoimmunity” with dysregulated acquired immunity. As hereditary periodic fever syndromes represent the prototype of AiD, monogenic systemic diseases are the main members of AiD. However, skin manifestations provide important clinical information and there are even some AiDs originating from skin diseases. Recently, AiD showing psoriasis and related keratinization diseases have specifically been designated as “autoinflammatory keratinization diseases (AiKD)” and CARD14-associated psoriasis and deficiency of interleukin-36 receptor antagonist previously called as generalized pustular psoriasis are included. Similarly, a number of autoinflammatory skin diseases can be proposed; autoinflamatory urticarial dermatosis (AiUD) such as cryopyrin-associated periodic syndrome; autoinflammatory neutrophilic dermatosis (AiND) such as pyogenic sterile arthritis, pyoderma gangrenosm, and acne syndrome; autoinflammatory granulomatosis (AiG) such as Blau syndrome; autoinflammatory chilblain lupus (AiCL) such as Aicardi-Goutieres syndrome; autoinflammatory lipoatrophy (AiL) such as Nakajo-Nishimura syndrome; autoinflammatory angioedema (AiAE) such as hereditary angioedema; and probable autoinflammatory bullous disease (AiBD) such as granular C3 dermatosis. With these designations, skin manifestations in AiD can easily be recognized and, even more importantly, autoinflammatory pathogenesis of common skin diseases are expected to be more comprehensive.
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Affiliation(s)
- Nobuo Kanazawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
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4
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[Facial manifestations of granulomatous diseases]. Hautarzt 2019; 68:542-547. [PMID: 28593339 DOI: 10.1007/s00105-017-3994-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinical manifestations of granulomatous diseases are a recurring challenge in everyday dermatological practice. Clinical presentation and histological patterns are variable, depending on the particular disease. Knowledge about the differential diagnosis of granulomatous changes in the face is of decisive importance for making a rational diagnosis and therapy considering the patient's well-being. Therefore, histological and clinical characteristics of important granulomatous diseases that typically manifest on the face are presented here.
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5
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Matsudate Y, Yamashita M, Fujii Y, Urano Y. Contact granulomatous hypersensitivity to indium in a patient with orofacial granulomatosis. Contact Dermatitis 2019; 81:293-294. [PMID: 30957231 DOI: 10.1111/cod.13284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/05/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Michiko Yamashita
- Division of Pathology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Yoshiyuki Fujii
- Division of Pathology, Tokushima Red Cross Hospital, Tokushima, Japan
| | - Yoshio Urano
- Division of Dermatology, Tokushima Red Cross Hospital, Tokushima, Japan
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6
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Wang TC, Chan KC. An embedded earring backing in the tragus. EAR, NOSE & THROAT JOURNAL 2018; 96:236-239. [PMID: 28719703 DOI: 10.1177/014556131709600714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Ta-Chin Wang
- School of Medicine, Chang Gung University, Taiwan
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7
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Marsidi N, Beijnen JH, van Zuuren EJ. Palladium-induced granulomas analysed with inductively coupled plasma mass spectrometry. Contact Dermatitis 2018; 79:41-42. [PMID: 29492982 PMCID: PMC6001695 DOI: 10.1111/cod.12979] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 01/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Nick Marsidi
- Department of DermatologyLeiden University Medical CentreLeidenThe Netherlands
| | - Jos H. Beijnen
- Department of Clinical PharmacologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
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8
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Holl-Ulrich K, Rose C. [Non-infectious granulomatous inflammation: Focus on the lungs and skin]. DER PATHOLOGE 2017; 37:172-82. [PMID: 26670175 DOI: 10.1007/s00292-015-0119-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whereas a granulomatous reaction represents a physiologically useful immune defense mechanism against many infections, in autoimmune diseases granuloma formation and the concomitant inflammatory mechanisms may provoke a potentially organ-threatening reaction. Morphologically, several defined sub-types of granuloma have long been known, e.g. foreign body granuloma, tuberculous granuloma,sarcoid, pseudosarcoid, rheumatoid and rheumatic fever granulomas. However, in practice, assigning granulomas to a certain etiology from a biopsy or resection specimen can be a challenging diagnostic process. This article gives a practically oriented overview of the clinically most relevant non-infectious granulomatous diseases. The etiology, epidemiology, clinical correlation and morphology of granulomatous diseases are discussed, focussing on the lungs and skin.
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Affiliation(s)
- K Holl-Ulrich
- Konsultations- und Referenzzentrum für Vaskulitis-Diagnostik, Institut für Pathologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland. .,Gemeinschaftspraxis für Pathologie am Lademannbogen, Hamburg, Deutschland.
| | - C Rose
- Dermatopathologie Lübeck, Lübeck, Deutschland
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9
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Abstract
A large list of foreign substances may penetrate the skin and induce a foreign body granulomatous reaction. These particles can enter the skin by voluntary reasons or be caused by accidental inclusion of external substances secondary to cutaneous trauma. In these cases, foreign body granulomas are formed around such disparate substances as starch, cactus bristles, wood splinters, suture material, pencil lead, artificial hair, or insect mouthparts. The purpose of this article is to update dermatologists, pathologists, and other physicians on the most recent etiopathogenesis, clinical presentations, systemic associations, evaluation, and evidence-based management concerning foreign body granulomatous reactions of skin.
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Affiliation(s)
- Ana M Molina-Ruiz
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain.
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avda. Reyes Católicos 2, Madrid 28040, Spain
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10
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Muris J, Goossens A, Gonçalo M, Bircher AJ, Giménez-Arnau A, Foti C, Rustemeyer T, Feilzer AJ, Kleverlaan CJ. Sensitization to palladium and nickel in Europe and the relationship with oral disease and dental alloys. Contact Dermatitis 2015; 72:286-96. [DOI: 10.1111/cod.12327] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 11/01/2014] [Accepted: 11/15/2014] [Indexed: 01/09/2023]
Affiliation(s)
- Joris Muris
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology; K.U. Leuven University Hospital; Kapucijnenvoer 33 3000 Leuven Belgium
| | - Margarida Gonçalo
- Department of Dermatology; Faculty of Medicine, University Hospital, University of Coimbra; Praceta Mota Pinto 3000-075 Coimbra Portugal
| | - Andreas J. Bircher
- Allergy Unit, Department of Dermatology; University Hospital Basel; Spitalstrasse 26 4031 Basel Switzerland
| | - Ana Giménez-Arnau
- Department of Dermatology; Hospital del Mar. Parc de Salut Mar, Universitat Autònoma de Barcelona; Passeig Maritim 25-29 08003 Barcelona Spain
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology; Dermatological Clinic, University of Bari; Policlinico di Bari, Piazza Giulio Cesare 11 70124 Bari Italy
| | - Thomas Rustemeyer
- Department of Dermatology; VU University Medical Centre; De Boelelaan 1117 1081 HV Amsterdam The Netherlands
| | - Albert J. Feilzer
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - Cornelis J. Kleverlaan
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
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11
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Muris J, Goossens A, Gonçalo M, Bircher AJ, Giménez-Arnau A, Foti C, Bruze M, Andersen KE, Rustemeyer T, Feilzer AJ, Kleverlaan CJ. Sensitization to palladium in Europe. Contact Dermatitis 2014; 72:11-9. [DOI: 10.1111/cod.12295] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 07/16/2014] [Accepted: 07/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Joris Muris
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - An Goossens
- Contact Allergy Unit, Department of Dermatology; K. U. Leuven University Hospital, Kapucijnenvoer 33; 3000 Leuven Belgium
| | - Margarida Gonçalo
- Department of Dermatology; University Hospital and Faculty of Medicine, University of Coimbra; Praceta Mota Pinto 3000-075 Coimbra Portugal
| | - Andreas J. Bircher
- Allergy Unit, Department of Dermatology; University Hospital Basel, Spitalstrasse 26; 4031 Basel Switzerland
| | - Ana Giménez-Arnau
- Department of Dermatology; Hospital del Mar, Universitat Autònoma; Passeig Maritim 25-29 08003 Barcelona Spain
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology; Dermatological Clinic, University of Bari; Policlinico di Bari, Piazza Giulio Cesare 11, 70124 Bari Italy
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology; Skåne University Hospital, Lund University, SE-20502; Malmö Sweden
| | - Klaus Ejner Andersen
- Department of Dermatology and Allergy Centre; Odense University Hospital, University of Southern Denmark, DK-5000; Odense Denmark
| | - Thomas Rustemeyer
- Department of Dermatology; VU University Medical Centre; De Boelelaan 1117 1081 HV Amsterdam The Netherlands
| | - Albert J. Feilzer
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
| | - Cornelis J. Kleverlaan
- Department of Dental Materials Science; Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam; Gustav Mahlerlaan 3004 1081 LA Amsterdam The Netherlands
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12
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Abstract
BACKGROUND Body piercing is a known and popular method of body ornamentation. Modern body piercing includes wearing jewelry in such body areas as the helix (ear), eyebrows, nose, lips, tongue, chin, nipples, navel, and genitals. The current piercing definition does not comprise piercing of the earlobe; however, this body area is still the most common on which jewelry is worn. The aim of this research is to present a spectrum of complications after auricle piercing and to consider including earlobe piercing in the modern definition of body piercing. METHODS Studied group consisted of 75 patients treated in the Department of Plastic, Reconstructive, and Aesthetic Surgery (Medical University of Lodz, Lodz, Poland) for complications after auricle piercing. Age of participants ranged from 7 to 62 years (mean age 23.7 years). RESULTS The most common complications in the examined group were post-traumatic tearing of the earlobe and keloid formation. Of all the patients with complications after auricle piercing, most had lesions located in earlobes; it seems that complications in earlobes are significantly more common than in the helix (P < 0.001). CONCLUSIONS The fashion of body piercing is not safe. Complications after earlobe piercing are similar to those occurring in other sites of the auricle after piercing. Moreover, due to its prevalence, complications after earlobe piercing are statistically more common, which is why it is worth considering including earlobe piercing in the modern definition of body piercing.
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Affiliation(s)
- Marta Fijałkowska
- Department of Plastic, Reconstructive and Aesthetic Surgery, Institute of Surgery, Medical University of Lodz, Lodz, Poland
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13
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Requena L, Cerroni L, Kutzner H. Histopathologic patterns associated with external agents. Dermatol Clin 2012; 30:731-48, vii. [PMID: 23021056 DOI: 10.1016/j.det.2012.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A large number of foreign substances may penetrate the skin for both voluntary and involuntary reasons. The voluntary group includes the particulate materials used in tattoos and cosmetic fillers, whereas the involuntary group is almost always caused by accidental inclusion of external substances secondary to cutaneous trauma. This article focuses on the histopathologic findings seen in cutaneous reactions to exogenous agents, with special emphasis on the microscopic morphology of the external particles in recognizing specifically the involved substance (something that is becoming increasingly important in the event of litigation).
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Affiliation(s)
- Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz, Universidad Autónoma, Avenida Reyes Católicos 2, Madrid 28040, Spain.
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14
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González-Pérez R, Ruiz-Carrillo G, Soloeta R. Sarcoid-type allergic contact granuloma caused by earrings in a boy. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:73-4. [PMID: 22445565 DOI: 10.1016/j.adengl.2010.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 12/26/2010] [Indexed: 11/28/2022] Open
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15
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Granuloma alérgico de contacto tipo sarcoideo por pendientes en un niño. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:73-4. [DOI: 10.1016/j.ad.2010.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 12/23/2010] [Accepted: 12/26/2010] [Indexed: 11/22/2022] Open
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Fijałkowska M, Pisera P, Kasielska A, Antoszewski B. Should we say NO to body piercing in children? Complications after ear piercing in children. Int J Dermatol 2011; 50:467-9. [DOI: 10.1111/j.1365-4632.2010.04778.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Faurschou A, Menné T, Johansen JD, Thyssen JP. Metal allergen of the 21st century-a review on exposure, epidemiology and clinical manifestations of palladium allergy. Contact Dermatitis 2011; 64:185-95. [DOI: 10.1111/j.1600-0536.2011.01878.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Abstract
A 45-year-old woman had a 1-year history of multiple small papules on both upper eyelids that waxed and waned in size and disappeared in the vicinity of a steroid injection site. Acne agminata (lupus miliaris disseminatus faciei, acnitis, papular tuberculid) is a rare form of necrotizing granulomatous inflammation of the dermis that has received scant attention in the ophthalmologic literature. The diagnosis is reached by excluding other forms of necrotizing granulomatous dermatitis based on clinical and histologic features.
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19
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Kluger N, Guillot B. Complications des piercings. Ann Dermatol Venereol 2010; 137:153-8. [DOI: 10.1016/j.annder.2009.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 09/13/2009] [Indexed: 10/20/2022]
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20
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Mahendra G, Pandit H, Kliskey K, Murray D, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties. Acta Orthop 2009; 80:653-9. [PMID: 19995315 PMCID: PMC2823316 DOI: 10.3109/17453670903473016] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Necrosis and inflammation in peri-implant soft tissues have been described in failed second-generation metal-on-metal (MoM) resurfacing hip arthroplasties and in the pseudotumors associated with these implants. The precise frequency and significance of these tissue changes is unknown. METHOD We analyzed morphological and immunophenotypic changes in the periprosthetic soft tissues and femoral heads of 52 revised MoM arthroplasties (fracture in 21, pseudotumor in 13, component loosening in 9, and other causes in 9 cases). RESULTS Substantial necrosis was observed in the periprosthetic connective tissue in 28 of the cases, including all pseudotumors, and 5 cases of component loosening. A heavy, diffuse inflammatory cell infiltrate composed mainly of HLA-DR+/CD14+/CD68+ macrophages and CD3+ T cells was seen in 45 of the cases. Perivascular lymphoid aggregates composed of CD3+ cells and CD20+ B cells were noted in 27 of the cases, but they were not seen in all cases of component loosening or pseudotumors. Plasma cells were noted in 30 cases. Macrophage granulomas were noted in 6 cases of component loosening. In the bone marrow of the femoral head, a macrophage and T cell response was seen in 31 of the cases; lymphoid aggregates were noted in 19 of the cases and discrete granulomas in 1 case. INTERPRETATION Our findings indicate that there is a spectrum of necrotic and inflammatory changes in response to the deposition of cobalt-chrome (Co-Cr) wear particles in periprosthetic tissues. Areas of extensive coagulative necrosis and a macrophage and T lymphocyte response occur in implant failure and pseudotumors, in which there is also granuloma formation. The pathogenesis of these changes is uncertain but it may involve both a cytotoxic response and a delayed hypersensitivity (type IV) response to Co-Cr particles.
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Affiliation(s)
- Gayana Mahendra
- Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Headington, Oxford, UK
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Capriotti K, Lee JB, Hyde P. Allergic contact granuloma: an uncommon reaction to pierced earrings in a child. Pediatr Dermatol 2009; 26:620-1. [PMID: 19840328 DOI: 10.1111/j.1525-1470.2009.00999.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Allergic contact dermatitis associated with pierced earrings typically presents as erythematous patches and plaques, with prominent spongiosis histologically. The most common inciting metal is nickel. Allergic contact granulomatous reactions to pierced earrings are rare, and are often more nodular in appearance and associated with metals other than nickel. We hereby report the first case of allergic contact granulomas associated with pierced earrings in a child.
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Affiliation(s)
- Kara Capriotti
- Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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22
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Misago N, Inoue T, Narisawa Y. Delayed reaction after an octopus bite showing a giant cell-rich granulomatous dermatitis/panniculitis. J Cutan Pathol 2008; 35:1068-72. [DOI: 10.1111/j.1600-0560.2007.00947.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CLM, Ostlere S, Athanasou N, Gill HS, Murray DW. Pseudotumours associated with metal-on-metal hip resurfacings. ACTA ACUST UNITED AC 2008; 90:847-51. [PMID: 18591590 DOI: 10.1302/0301-620x.90b7.20213] [Citation(s) in RCA: 691] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report 17 patients (20 hips) in whom metal-on-metal resurfacing had been performed and who presented with various symptoms and a soft-tissue mass which we termed a pseudotumour. Each patient underwent plain radiography and in some, CT, MRI and ultrasonography were also performed. In addition, histological examination of available samples was undertaken. All the patients were women and their presentation was variable. The most common symptom was discomfort in the region of the hip. Other symptoms included spontaneous dislocation, nerve palsy, a noticeable mass or a rash. The common histological features were extensive necrosis and lymphocytic infiltration. To date, 13 of the 20 hips have required revision to a conventional hip replacement. Two are awaiting revision. We estimate that approximately 1% of patients who have a metal-on-metal resurfacing develop a pseudotumour within five years. The cause is unknown and is probably multifactorial. There may be a toxic reaction to an excess of particulate metal wear debris or a hypersensitivity reaction to a normal amount of metal debris. We are concerned that with time the incidence of these pseudotumours may increase. Further investigation is required to define their cause.
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Affiliation(s)
- H Pandit
- Nuffield Orthopaedic Centre, Oxford, England
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Pandit H, Vlychou M, Whitwell D, Crook D, Luqmani R, Ostlere S, Murray DW, Athanasou NA. Necrotic granulomatous pseudotumours in bilateral resurfacing hip arthoplasties: evidence for a type IV immune response. Virchows Arch 2008; 453:529-34. [PMID: 18769936 DOI: 10.1007/s00428-008-0659-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 07/21/2008] [Accepted: 08/18/2008] [Indexed: 12/12/2022]
Abstract
Clinical, radiological and histological findings were analysed in four patients who developed bilateral pseudotumours following metal-on-metal (MoM) resurfacing arthroplasties of both hips. Using a panel of monoclonal antibodies directed against HLA-DR, macrophages (CD14, CD68), dendritic cells (DC-SIGN, S100, CD11c), B cells (CD20), and T cells (CD3, CD4, CD8), the nature of the heavy inflammatory response seen in these cases was examined. Bilateral masses developed in periprosthetic soft tissues following the second MoM arthroplasty; these were characterised histologically by extensive coagulative necrosis, a heavy macrophage infiltrate and the presence of granulomas containing macrophages and giant cells; there was also a diffuse lymphocyte and variable plasma cell and eosinophil polymorph infiltrate. Immunohistochemistry showed strong expression of HLA-DR, CD14 and CD68 in both granulomatous and necrotic areas; lymphocytes were predominantly CD3+/CD4+ T cells. The clinical, morphological and immunophenotypic features of these necrotic granulomatous pseudotumours, which in all cases develop following a second resurfacing hip arthroplasty, is suggestive of a type IV immune response, possibly to MoM metal alloy components.
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Affiliation(s)
- H Pandit
- Nuffield Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, University of Oxford, Headington, Oxford, OX3 7LD, UK
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Abstract
Recently, piercing and tattooing have gained increasing popularity worldwide, through all social classes and age groups. Besides pierced ear lobes, piercing of the tongue, nose, nipples, belly button, and even the genitals is quite common. The variety of tattoos range from temporary henna tattoos to permanent makeup and permanent tattoos, where the pigments are deposed in the dermis. These trends are supplemented by more invasive methods of body modification such as implanting, scarification, or branding. Parallel with the increasing popularity of piercing and tattoos, the knowledge about associated complications rose. Complications depend substantially on the circumstances in which body modifications are applied, the materials used, and the body region concerned. This article gives an overview of the most common complications of body modification methods, which mainly result from shortcomings in the application itself or in hygiene regimens. Consequences may be as severe as life-threatening events or permanent malfunction of different organs.
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Abstract
BACKGROUND The sinonasal system is rarely involved in the clinical picture of sarcoidosis. In the absence of pulmonary disease, sinonasal sarcoidosis is extremely rare. PATIENTS AND METHODS Four patients with isolated sarcoidosis of the nose and the sinuses are reported; in one of these patients the histological evidence was found in the mucosa of the nasopharynx. RESULTS None of these patients was found to have a pulmonary illness or any other extrapulmonary manifestation of sarcoidosis. Retrospectively, two patients fulfilled the more specific diagnostic criteria for sinonasal sarcoidosis reported in the literature. CONCLUSION Sarcoidosis should be considered in the differential diagnosis of inflammatory sinonasal disease, especially if the mucosa shows signs of granulation, but it should also be considered when an incidental finding of rhinosinusitis is recorded. Rhinosurgical intervention seems to be an appropriate therapy in terms of improving the symptoms of the disease, despite the prolonged period of postoperative healing and the necessity for individual treatment with medication. Following histological confirmation of the diagnosis, adequate medication and further appropriate diagnostic procedures drawing on internal medicine are essential.
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Affiliation(s)
- D Kleemann
- HNO-Klinik, Müritz-Klinikum GmbH, Weinbergstr. 19, 17192 Waren, Müritz.
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Antoszewski B, Jędrzejczak M, Kruk-Jeromin J. Complications after body piercing in patient suffering from type 1 diabetes mellitus. Int J Dermatol 2007; 46:1250-2. [DOI: 10.1111/j.1365-4632.2007.03372.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Doumat-Batch F, Cuny JF, Brocard FG, Barbaud A, Schmutz JL. Stria of pregnancy only in the site of a navel piercing (first reported case). J Eur Acad Dermatol Venereol 2007; 21:840-1. [PMID: 17567328 DOI: 10.1111/j.1468-3083.2006.02042.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Although earrings have been worn since time immemorial, most clinicians will have noticed more and more patients over the past 30 years who have been seen to have single or multiple piercing almost anywhere into the skin. This article will try to trace the history of body piercing, its comparatively recent popularity, where on the body piercing occurs, and the requirement for guidelines and legislation to try to ensure that the risks inherent in body piercing are lessened.
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Affiliation(s)
- Michael Waugh
- Nuffield Hospital Leeds, West Yorkshire LS1 3EB, UK.
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Goossens A, De Swerdt A, De Coninck K, Snauwaert JE, Dedeurwaerder M, De Bonte M. Allergic contact granuloma due to palladium following ear piercing. Contact Dermatitis 2006; 55:338-41. [PMID: 17101008 DOI: 10.1111/j.1600-0536.2006.00952.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Two cases of sarcoidal-type allergic contact granuloma due to metals in ear piercing are presented, the first to palladium (Pd) only, and the second to Pd and possibly also to other metals. Both the patients developed papulonodular lesions at the helices following ear piercing, which after 3-4 weeks, became more granulomatous and very resistant to treatment. Indeed, repeated intralesional injections with corticosteroids produced only a temporary regression of the lesions. Biopsies from the persistent granulomatous lesions from the helices in both the patients and the positive test to Pd in case 2, 3 weeks after the patch-testing procedure, demonstrated epithelioid granulomas, with some multinucleate histiocytes surrounded by a lymphocytic-histiocytic infiltrate. Areas of fibrinoid necrosis were found in both the helix biopsies. An infectious pathology was excluded. Patch testing showed a strong positive reaction to Pd only in case 1 and to Pd and nickel in case 2. Chemical analysis of the earring of patient 1 confirmed the presence of Pd; however, analysis of the earrings of the second patient did not show the presence of Pd, but showed the presence of nickel and copper. Both the clinical and histological findings concur with some rarely reported similar observations in the literature.
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Affiliation(s)
- An Goossens
- Department of Dermatology, University Hospital, K.U. Leuven, Belgium.
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