1
|
Zahn C, Puga C, Malik A, Khanna D. Painful Raynaud's mimics. Best Pract Res Clin Rheumatol 2024:101948. [PMID: 38704280 DOI: 10.1016/j.berh.2024.101948] [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: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
Raynaud's syndrome is a common finding in many autoimmune conditions. Accurately diagnosing Raynaud's, and differentiating it from mimicking conditions, is imperative in rheumatologic diseases. Raynaud's syndrome and Raynaud's mimickers, especially painful Raynaud's mimickers, can prove a diagnostic challenge for the practicing rheumatologist. Painful Raynaud's mimickers can lead to increased patient stress and unnecessary medical work up; Healthcare providers need to be aware of Raynaud's mimickers when evaluating patient concerns of skin color changes and pain. The present narrative review aims to highlight Raynaud's syndrome, important painful mimickers that may be seen, diagnosis, and updated management recommendations.
Collapse
Affiliation(s)
- Carleigh Zahn
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
| | - Cindy Puga
- Cedars Sinai Internal Medicine Residency, 8700 Beverly Blvd, Becker Bldg. B105 A, Los Angeles, CA, 90048, USA.
| | - Aroosa Malik
- Department of Internal Medicine, Division of Vascular Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
| | - Dinesh Khanna
- Department of Internal Medicine, Division of Rheumatology, University of Michigan, 300 North Ingalls Building - Rm 7C27, Ann Arbor, MI, 48109, USA.
| |
Collapse
|
2
|
Fijałkowska A, Kądziela M, Żebrowska A. The Spectrum of Cutaneous Manifestations in Lupus Erythematosus: A Comprehensive Review. J Clin Med 2024; 13:2419. [PMID: 38673692 PMCID: PMC11050979 DOI: 10.3390/jcm13082419] [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: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Lupus erythematosus (LE) is an autoimmune inflammatory disease with complex etiology. LE may present as a systemic disorder affecting multiple organs or be limited solely to the skin. Cutaneous LE (CLE) manifests with a wide range of skin lesions divided into acute, subacute and chronic subtypes. Despite classic forms of CLE, such as malar rash or discoid LE, little-known variants may occur, for instance hypertrophic LE, chilblain LE and lupus panniculitis. There are also numerous non-specific manifestations including vascular abnormalities, alopecia, pigmentation and nail abnormalities or rheumatoid nodules. Particular cutaneous manifestations correlate with disease activity and thus have great diagnostic value. However, diversity of the clinical picture and resemblance to certain entities delay making an accurate diagnosis The aim of this review is to discuss the variety of cutaneous manifestations and indicate the clinical features of particular CLE types which facilitate differential diagnosis with other dermatoses. Although in diagnostically difficult cases histopathological examination plays a key role in the differential diagnosis of LE, quick and accurate diagnosis ensures adequate therapy implementation and high quality of life for patients. Cooperation between physicians of various specialties is therefore crucial in the management of patients with uncommon and photosensitive skin lesions.
Collapse
Affiliation(s)
| | | | - Agnieszka Żebrowska
- Department of Dermatology and Venereology, Medical University of Lodz, Haller sq. 1, 90-647 Lodz, Poland; (A.F.); (M.K.)
| |
Collapse
|
3
|
Nasir AZ, Burmeister RS. Primary cutaneous marginal zone lymphoma presenting with secondary chilblains of the toes. BMJ Case Rep 2023; 16:e255894. [PMID: 37640411 PMCID: PMC10462931 DOI: 10.1136/bcr-2023-255894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Cutaneous lymphoproliferative disorders include cutaneous manifestations of systemic B-cell or T-cell lymphoma and primary cutaneous lymphomas. Primary cutaneous B-cell lymphomas are subcategorised into four groups: primary cutaneous marginal zone lymphoma (PCMZL), primary cutaneous follicle centre lymphoma, primary cutaneous diffuse large B-cell lymphoma, leg-type and EBV-positive mucocutaneous tumour. Each of these cutaneous lymphoproliferative disorders has unique clinical and pathological features necessitating biopsy and staging to establish proper treatment. We present a case of PCMZL manifesting as secondary chilblains of the toes that was diagnosed with punch skin biopsy. The patient's chilblains resolved with rituximab. This case underscores the importance of considering PCMZL and other cutaneous lymphoproliferative disorders in patients with dermatological manifestations and wounds refractory to first-line treatment.
Collapse
Affiliation(s)
- Ali Zagham Nasir
- Internal Medicine Residency, Trinity Health Saint Mary's - Grand Rapids, Grand Rapids, Michigan, USA
| | - Ryan Scott Burmeister
- Internal Medicine Residency, Trinity Health Saint Mary's - Grand Rapids, Grand Rapids, Michigan, USA
| |
Collapse
|
4
|
Population Characteristics, Symptoms, and Risk Factors of Idiopathic Chilblains: A Systematic Review, Meta-Analysis, and Meta-Regression. BIOLOGY 2022; 11:biology11111651. [DOI: 10.3390/biology11111651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Background: Chilblains/perniosis is a non-freezing cold injury causing painful inflammatory skin lesions. Its pathogenesis remains poorly understood because it is often studied as secondary to other underlying conditions. Methods: We systematically investigated the population characteristics, symptoms, and predisposing factors of chilblains in healthy adults exposed to cool/cold environments. We screened PubMed, Embase, and Cochrane Library, and we adopted PRISMA reporting guidelines (PROSPERO: CRD42021245307). The risk of bias was assessed by two independent reviewers (RTI item bank). Random-effects model meta-analyses were performed to calculate the pooled prevalence of histopathological features. Mixed-effects meta-regressions were used to assess other sources of between-study heterogeneity. Results: Thirteen studies (477 patients) were included. Chilblains affect more women than men, up to 12% of the body skin surface, and most frequently, the hands and fingers. Meta-analyses of nine studies (303 patients) showed a frequent presence of perivascular lymphocytic infiltrate (81%), basal epidermal-cell layer vacuolation (67%), papillary dermal edema (66%), and perieccrine lymphocytic infiltrate (57%). Meta-regressions (p ≤ 0.05) showed that smoking and frequent occupational exposure to water increase the likelihood of histopathological features. Conclusions: The population characteristics, symptoms, and predisposing factors of chilblains revealed in this analysis should be incorporated in medical care to improve the condition’s diagnosis and management.
Collapse
|
5
|
Chronic Cutaneous Lupus Erythematosus in a White Population: Dermoscopic Characteristics by Clinical Subtype, Lesion Location and Disease Duration. Dermatol Ther (Heidelb) 2022; 12:2117-2133. [PMID: 35996053 PMCID: PMC9395958 DOI: 10.1007/s13555-022-00786-y] [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: 06/13/2022] [Accepted: 07/26/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Chronic cutaneous lupus erythematosus (CCLE) comprises three major clinical variants: discoid lupus erythematosus (DLE), chilblain lupus erythematosus (CHLE), and lupus erythematosus profundus, also referred to as lupus erythematosus panniculitis (LEP). The aim of the current study was to systematically describe the dermoscopic features of CCLE in Polish patients with Fitzpatrick skin phototypes I-III. METHODS The videodermoscopic images from patients with various clinical variants of CCLE (DLE, CHLE and LEP) were reviewed. Predefined parameters for dermoscopic evaluation in general dermatology were used to describe the findings in lesions located beyond the scalp. In the analysis of trichoscopic findings in lesions located on the scalp, dermoscopic features of follicular openings, hair shafts, the perifollicular surface, the interfollicular surface and vessel morphology were considered. Based on personal experience, several additional dermoscopic and trichoscopic characteristics were included in the analysis. RESULTS A total of 85 lesions from 26 patients (16 women and 10 men; mean age 40.8 ± 11.2 years) were assessed. DLE on glabrous skin showed polymorphous vessels (89.1%), pink-red background (70.9%), follicular plugs (67.3%) and white scaling (58.2%), while scalp DLE was characterized by polymorphous vessels (83.3%), yellow dots (66.7%), follicular plugs (55.6%) and a reduced number of follicles (55.6%). Labial DLE (n = 2) showed linear branched and linear curved vessels, white structureless areas, red structureless (hemorrhagic) areas and red dots/globules. White scaling (61.1% vs. 34.1%; p = 0.042), gray-brown dots/globules (44.4% vs. 12.2%; p = 0.015) and peripheral pigmentation (100.0% vs. 46.2%; p = 0.036) were significantly more common in long-lasting (> 1 year) DLE lesions. CHLE (n = 5) presented with polymorphous vessels, white scales, pink-red background, red structureless areas and red dots/globules. LEP showed polymorphous vessels, white-yellow scales, follicular plugs, white structureless areas and red hemorrhagic areas. CONCLUSIONS Dermoscopy might be useful in the preliminary diagnosis of DLE, and its role in the diagnosis of CHLE and LEP needs further elucidation.
Collapse
|
6
|
Dubey S, Joshi N, Stevenson O, Gordon C, Reynolds JA. Chilblains in immune-mediated inflammatory diseases: a review. Rheumatology (Oxford) 2022; 61:4631-4642. [PMID: 35412601 PMCID: PMC9383735 DOI: 10.1093/rheumatology/keac231] [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: 02/02/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 01/10/2023] Open
Abstract
Chilblains were first described over a hundred years ago as cutaneous inflammatory lesions, typically on the digits, occurring on cold exposure. Chilblains can be primary, or secondary to a number of conditions such as infections, including COVID-19, and immune-mediated inflammatory disorders (IMIDs) with SLE being the commonest. Chilblain lupus erythematosus (CHLE) was first described in 1888 as cold-induced erythematous lesions before the terms 'chilblains' or 'perniosis' were coined. Diagnostic criteria exist for both chilblains and CHLE. Histopathologically, CHLE lesions show interface dermatitis with perivascular lymphocytic infiltrate. Immunofluorescence demonstrates linear deposits of immunoglobulins and complement in the dermo-epidermal junction. This narrative review focuses on chilblains secondary to immune-mediated inflammatory disorders, primarily the epidemiology, pathogenesis and treatment of CHLE.
Collapse
Affiliation(s)
- Shirish Dubey
- Department of Rheumatology, Oxford University Hospitals NHS FT,Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford,Correspondence to: Shirish Dubey, Department of Rheumatology, Oxford University Hospitals NHS FT, Windmill Road, Oxford OX3 7LD, UK. E-mail:
| | - Nilay Joshi
- Department of Rheumatology, Kettering general Hospital NHS FT, Kettering
| | - Olivia Stevenson
- Department of Rheumatology, Kettering general Hospital NHS FT, Kettering
| | - Caroline Gordon
- Rheumatology Research Group—Institute of Inflammation and Ageing (IIA)
| | - John A Reynolds
- John A Reynolds Rheumatology Research Group, Institute of Inflammation and Ageing (IIA), University of Birmingham,Rheumatology Department, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| |
Collapse
|
7
|
Frumholtz L, Bouaziz JD, Battistella M, Hadjadj J, Chocron R, Bengoufa D, Le Buanec H, Barnabei L, Meynier S, Schwartz O, Grzelak L, Smith N, Charbit B, Duffy D, Yatim N, Calugareanu A, Philippe A, Guerin CL, Joly B, Siguret V, Jaume L, Bachelez H, Bagot M, Rieux-Laucat F, Maylin S, Legoff J, Delaugerre C, Gendron N, Smadja DM, Cassius C. Type I interferon response and vascular alteration in chilblain-like lesions during the COVID-19 outbreak. Br J Dermatol 2021; 185:1176-1185. [PMID: 34611893 PMCID: PMC8652826 DOI: 10.1111/bjd.20707] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 12/14/2022]
Abstract
Background The outbreak of chilblain‐like lesions (CLL) during the COVID‐19 pandemic has been reported extensively, potentially related to SARS‐CoV‐2 infection, yet its underlying pathophysiology is unclear. Objectives To study skin and blood endothelial and immune system activation in CLL in comparison with healthy controls and seasonal chilblains (SC), defined as cold‐induced sporadic chilblains occurring during 2015 and 2019 with exclusion of chilblain lupus. Methods This observational study was conducted during 9–16 April 2020 at Saint‐Louis Hospital, Paris, France. All patients referred with CLL seen during this period of the COVID‐19 pandemic were included in this study. We excluded patients with a history of chilblains or chilblain lupus. Fifty patients were included. Results Histological patterns were similar and transcriptomic signatures overlapped in both the CLL and SC groups, with type I interferon polarization and a cytotoxic–natural killer gene signature. CLL were characterized by higher IgA tissue deposition and more significant transcriptomic activation of complement and angiogenesis factors compared with SC. We observed in CLL a systemic immune response associated with IgA antineutrophil cytoplasmic antibodies in 73% of patients, and elevated type I interferon blood signature in comparison with healthy controls. Finally, using blood biomarkers related to endothelial dysfunction and activation, and to angiogenesis or endothelial progenitor cell mobilization, we confirmed endothelial dysfunction in CLL. Conclusions Our findings support an activation loop in the skin in CLL associated with endothelial alteration and immune infiltration of cytotoxic and type I IFN‐polarized cells leading to clinical manifestations.
Collapse
Affiliation(s)
- L Frumholtz
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - J-D Bouaziz
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - M Battistella
- Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France.,Pathology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - J Hadjadj
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France.,Department of Internal Medicine, National Reference Centre for Rare Systemic Autoimmune Diseases, AP-HP, Hôpital Cochin, F-75014, Paris, France
| | - R Chocron
- Université de Paris, PARCC, INSERM, F-75006, Paris, France.,Emergency Department, AP-HP, Georges Pompidou European Hospital, F-75015, Paris, France
| | - D Bengoufa
- Immunobiology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - H Le Buanec
- Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - L Barnabei
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France
| | - S Meynier
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France
| | - O Schwartz
- Institut Pasteur, Virus and Immunity Unit, F-75015, Paris, France
| | - L Grzelak
- Institut Pasteur, Virus and Immunity Unit, F-75015, Paris, France
| | - N Smith
- Institut Pasteur, Translational Immunology Lab, F-75015, Paris, France
| | - B Charbit
- Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015, Paris, France
| | - D Duffy
- Institut Pasteur, Translational Immunology Lab, F-75015, Paris, France.,Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015, Paris, France
| | - N Yatim
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Institut Pasteur, Translational Immunology Lab, F-75015, Paris, France
| | - A Calugareanu
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - A Philippe
- Institut Pasteur, Cytometry and Biomarkers UTechS, CRT, F-75015, Paris, France
| | - C L Guerin
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Institut Curie, Cytometry Platform, F-75006, Paris, France
| | - B Joly
- Biological Haematology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.,Université de Paris, EA3518, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - V Siguret
- Biological Haematology Department, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.,Université de Paris, INSERM UMR S1140, F-75010, Paris, France
| | - L Jaume
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - H Bachelez
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Imagine Institute, Laboratory of Genetics of Skin Diseases, INSERM U1163, F-75015, Paris, France
| | - M Bagot
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - F Rieux-Laucat
- Université de Paris, Imagine Institute, Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM U1163, F-75015, Paris, France
| | - S Maylin
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - J Legoff
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Team Insight, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | - C Delaugerre
- Virology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France
| | - N Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre Université de Paris (APHP-CUP), F-75015, Paris, France
| | - D M Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, F-75006, Paris, France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation), Assistance Publique Hôpitaux de Paris-Centre Université de Paris (APHP-CUP), F-75015, Paris, France
| | - C Cassius
- Dermatology Department, AP-HP, Hôpital Saint-Louis, F-75010, Paris, France.,Université de Paris, Human Immunology Pathophysiology Immunotherapy, INSERM U976, Institut de Recherche Saint-Louis, F-75010, Paris, France
| | | |
Collapse
|
8
|
McCleskey PE, Zimmerman B, Lieberman A, Liu L, Chen C, Gorouhi F, Jacobson CC, Lee DS, Sriram A, Thornton A, Herz AM, Mirmirani P, Herrinton LJ. Epidemiologic Analysis of Chilblains Cohorts Before and During the COVID-19 Pandemic. JAMA Dermatol 2021; 157:947-953. [PMID: 34160569 DOI: 10.1001/jamadermatol.2021.2120] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance Beginning in March 2020, case reports and case series linked the COVID-19 pandemic with an increased occurrence of chilblains, but this association has not been evaluated in an epidemiologic study. Objective To assess whether a correlation exists between COVID-19 incidence and chilblains incidence. Design, Setting, and Participants A retrospective cohort study was conducted within the Kaiser Permanente Northern California system from January 1, 2016, to December 31, 2020; health plan members of all ages were included. Exposure COVID-19 incidence in 207 location-months, representing 23 geographic locations in northern California across 9 months. Main Outcome and Measures Chilblains incidence was the main outcome. The association of chilblains incidence with COVID-19 incidence across the 207 location-months was measured using the Spearman rank correlation coefficient. Results Of 780 patients with chilblains reported during the pandemic, 464 were female (59.5%); mean (SD) age was 36.8 (21.8) years. COVID-19 incidence was correlated with chilblains incidence at 207 location-months (Spearman coefficient 0.18; P = .01). However, only 17 of 456 (3.7%) patients with chilblains tested during the pandemic were positive for SARS-CoV-2, and only 9 of 456 (2.0%) were positive for SARS-CoV-2 within 6 weeks of the chilblains diagnosis. Test results of 1 of 97 (1.0%) patients were positive for SARS-CoV-2 IgG antibodies. Latinx patients were disproportionately affected by COVID-19 but not by chilblains. Conclusions and Relevance This cohort study found that in northern California, the incidence of chilblains increased during the pandemic but was correlated weakly with the incidence of COVID-19 across 207 location-months. These findings may have resulted from a causal role of COVID-19, increased care-seeking by patients with chilblains during the pandemic, or changes in behavior during shelter in place.
Collapse
Affiliation(s)
- Patrick E McCleskey
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland
| | - Bree Zimmerman
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland.,Department of Pediatrics, The Permanente Medical Group, Northern California, Oakland
| | - Amara Lieberman
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland
| | - Liyan Liu
- Division of Research, The Permanente Medical Group, Northern California, Oakland
| | - Cynthia Chen
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland
| | - Farzam Gorouhi
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland
| | - Christine C Jacobson
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland
| | - David S Lee
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland
| | - Achyuth Sriram
- Department of Pediatrics, The Permanente Medical Group, Northern California, Oakland
| | - Amanda Thornton
- Department of Infectious Disease, The Permanente Medical Group, Northern California, Oakland
| | - Arnd M Herz
- Department of Pediatrics, The Permanente Medical Group, Northern California, Oakland.,Department of Infectious Disease, The Permanente Medical Group, Northern California, Oakland
| | - Paradi Mirmirani
- Department of Dermatology, The Permanente Medical Group, Northern California, Oakland
| | - Lisa J Herrinton
- Division of Research, The Permanente Medical Group, Northern California, Oakland
| |
Collapse
|
9
|
Shakshouk H, Johnson EF, Peters MS, Wieland CN, Comfere NI, Lehman JS. Cutaneous eccrine inflammation and necrosis: review of inflammatory disorders affecting the eccrine apparatus including new associations. Hum Pathol 2021; 118:71-85. [PMID: 34450084 DOI: 10.1016/j.humpath.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/30/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
Despite being frequently overlooked during the examination of histopathological sections, eccrine sweat glands can offer clues for diagnosing various skin conditions. They provide important functions and can lead to several diseases when inflamed or injured. This review article provides information regarding eccrine physiology as well as well-established and novel entities that occur in association with eccrine gland pathology.
Collapse
Affiliation(s)
- Hadir Shakshouk
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Dermatology, Andrology and Venereology, Alexandria University, Alexandria, 21131, Egypt
| | - Emma F Johnson
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Margot S Peters
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Carilyn N Wieland
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Nneka I Comfere
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, MN, 55905, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
| |
Collapse
|
10
|
Canu D, Viallard JF, Lazaro E, Doutre MS. Association of chilblain lupus and anti-Ro/SSA and anti-La/SSB antibodies: a study of 30 cases. Int J Dermatol 2021; 60:e509-e511. [PMID: 34021592 DOI: 10.1111/ijd.15553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Dorine Canu
- Department of Dermatology, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| | - Jean-François Viallard
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Estibaliz Lazaro
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, CHU Bordeaux, Bordeaux, France
| | - Marie-Sylvie Doutre
- Department of Dermatology, Hôpital Saint-André, CHU de Bordeaux, Bordeaux, France
| |
Collapse
|
11
|
Adnexotropic Variants of the Interface Dermatitides: A Review. Dermatopathology (Basel) 2021; 8:135-146. [PMID: 34063840 PMCID: PMC8161827 DOI: 10.3390/dermatopathology8020020] [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: 04/21/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022] Open
Abstract
The interface dermatitides encompass a vast array of cutaneous entities which, at times, may present with particular clinical variants with adnexal predilection. Similarly, hair follicle and eccrine gland involvement of some of these entities has been observed on histopathology. This review aims to describe the various adnexotropic presentations of the interface dermatitides. Recognizing that the adnexa can be a frequent site of involvement of these conditions may aid dermatopathologists in making the correct diagnosis and avoid misinterpreting adnexotropism for other conditions such as the great imitator, mycosis fungoides.
Collapse
|
12
|
Farrell J, Stewart TJ, Rosen R. Characteristics of perniosis in an Australian population. Australas J Dermatol 2021; 62:407-408. [PMID: 33660840 DOI: 10.1111/ajd.13581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Joshua Farrell
- Southern Suburbs Dermatology, Sydney, New South Wales, Australia
| | - Thomas Jonathan Stewart
- Southern Suburbs Dermatology, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert Rosen
- Southern Suburbs Dermatology, Sydney, New South Wales, Australia.,Department of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Lenormand C, Lipsker D. Lupus erythematosus: Significance of dermatologic findings. Ann Dermatol Venereol 2021; 148:6-15. [PMID: 33483145 DOI: 10.1016/j.annder.2020.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/07/2020] [Accepted: 08/31/2020] [Indexed: 11/24/2022]
Abstract
Herein, the different skin manifestations in patients with lupus erythematosus are reviewed, and their diagnostic, pathogenic and prognostic relevance are discussed, as well as their impact on therapeutic choices. The so-called specific lesions of LE result from an autoimmune pathomechanism and they allow diagnosis of LE by simple clinicopathological correlation since the findings are characteristic. They include the classic acute, subacute and chronic variants, characterised microscopically by interface dermatitis; the dermal variants of lupus, such as tumid lupus, displaying dermal perivascular lymphocytic infiltrate with mucin deposition under the microscope, and lupus profundus, in which lymphocytic lobular panniculitis progressing to hyaline fibrosis is found. Antimalarials are the treatment of choice for patients with specific LE lesions. The presence of some dermatological signs is the result of thrombotic vasculopathy. Their recognition allows the identification of lupus patients at increased cardiovascular risk and with a worse overall prognosis. Those signs include reticulated erythema on the tip of the toes, splinter hemorrhages, atrophie blanche, pseudo-Degos lesions, racemosa-type livedo, anetoderma, ulceration and necrosis. Those clinical manifestations, often subtle, must be recognised, and if present, patients should be treated with antiplatelet drugs. Finally, neutrophilic cutaneous lupus erythematosus includes a few entities that suggest that autoinflammatory mechanisms might play a key role in certain lupus manifestations. Among those entities, it is very important to diagnose neutrophilic urticarial dermatosis, which can mimic a classic lupus flare, because it is characterised by rash with joint pain, but immunosuppressants are not helpful. Dapsone is the treatment of choice.
Collapse
Affiliation(s)
- C Lenormand
- Faculty of medicine, University of Strasbourg, and Dermatology clinic, Strasbourg university hospital, Strasbourg, France
| | - D Lipsker
- Faculty of medicine, University of Strasbourg, and Dermatology clinic, Strasbourg university hospital, Strasbourg, France.
| |
Collapse
|
14
|
Talotta R, Robertson E. Autoimmunity as the comet tail of COVID-19 pandemic. World J Clin Cases 2020; 8:3621-3644. [PMID: 32953841 PMCID: PMC7479552 DOI: 10.12998/wjcc.v8.i17.3621] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/29/2020] [Accepted: 08/26/2020] [Indexed: 02/05/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can give rise to different clinical manifestations that are directly related to viral tissue damage or indirectly induced by the antiviral immune response. Hyper-activation of the immune system in an attempt to eradicate the infection may trigger autoimmunity. Several immune-mediated disorders have been described in SARS-CoV-2-infected individuals. These include cutaneous rashes and vasculitis, autoimmune cytopenia, anti-phospholipid syndrome, central or peripheral neuropathy, myositis and myocarditis. On the other hand, rheumatic patients were reported to have similar coronavirus disease 2019 (COVID-19) incidence, morbidity and mortality rates compared to general population. This opinion review will summarize the crucial immunologic steps which occur during SARS-CoV-2-infection that may link autoimmunity to COVID-19 and provides an opportunity for further discussion regarding this association.
Collapse
Affiliation(s)
- Rossella Talotta
- Department of Clinical and Experimental Medicine, Rheumatology Unit, AOU “Gaetano Martino”, University of Messina, Messina 98100, Italy
| | - Erle Robertson
- Department of Otorhinolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19014, United States
| |
Collapse
|
15
|
Lemieux A, Sanchez Vivas NE, Powell J, Jantchou P, Morin MP. Pernio as the clinical presentation of celiac disease: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20940442. [PMID: 32699633 PMCID: PMC7357047 DOI: 10.1177/2050313x20940442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We present the case of a 12-year-old girl with severe pernio as the sole clinical presentation of celiac disease (CD), without associated gastrointestinal symptoms. Lesions greatly improved once a gluten free diet was initiated. At 5-year follow-up, she remains in clinical remission throughout the year with no pharmacological treatment, without skin lesions flare-up in the winter months.
Collapse
Affiliation(s)
- Alexandre Lemieux
- Department of Medicine, Division of Dermatology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
| | | | - Julie Powell
- Division of Dermatology, Department of Pediatrics, CHU Sainte Justine, University of Montreal, Montreal, QC, Canada
| | - Prévost Jantchou
- Division of Gastroenterology, Hepatology and Nutrition, CHU Sainte Justine, Montreal, QC, Canada
| | - Marie-Paule Morin
- Immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte Justine, Montreal, QC, Canada
| |
Collapse
|
16
|
Kanitakis J, Lesort C, Danset M, Jullien D. Chilblain-like acral lesions during the COVID-19 pandemic ("COVID toes"): Histologic, immunofluorescence, and immunohistochemical study of 17 cases. J Am Acad Dermatol 2020; 83:870-875. [PMID: 32502585 PMCID: PMC7265862 DOI: 10.1016/j.jaad.2020.05.145] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND During the coronavirus disease 2019 pandemic, several acral chilblain-like lesions were observed in young patients with suspected, but mostly unconfirmed, infection with severe acute respiratory syndrome coronavirus 2. The histopathologic aspect of these lesions is as yet poorly known. OBJECTIVE To investigate the pathologic features of chilblain-like lesions. METHODS Biopsies were obtained from 17 cases of chilblain-like lesions during the coronavirus disease 2019 pandemic in France and were studied by routine histologic examination, immunohistochemistry, and direct immunofluorescence. The patients had suspected but unconfirmed infection with severe acute respiratory syndrome coronavirus 2 (negative nasopharyngeal polymerase chain reaction and serologic test results). RESULTS Chilblain-like lesions showed many features in common with those reported in idiopathic and autoimmune-related chilblains, including epidermal necrotic keratinocytes, dermal edema, perivascular and perieccrine sweat gland lymphocytic (predominantly CD3/CD4+) inflammation, and frequent vascular changes (endothelialitis, microthromboses, fibrin deposition, and immunoreactant deposits on vessels). CONCLUSIONS Chilblain-like lesions show histopathologic features similar to those of idiopathic and autoimmune-related chilblains, with a high rate of vascular changes and direct immunofluorescence positivity. The role of severe acute respiratory syndrome coronavirus 2 in the development of these puzzling lesions remains to be elucidated.
Collapse
Affiliation(s)
- Jean Kanitakis
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; Department of Anatomic Pathology, Lyon Sud Hospital Center, Pierre Bénite, France.
| | - Cécile Lesort
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Marie Danset
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
17
|
Andina D, Noguera-Morel L, Bascuas-Arribas M, Gaitero-Tristán J, Alonso-Cadenas JA, Escalada-Pellitero S, Hernández-Martín Á, de la Torre-Espi M, Colmenero I, Torrelo A. Chilblains in children in the setting of COVID-19 pandemic. Pediatr Dermatol 2020; 37:406-411. [PMID: 32386460 PMCID: PMC7272985 DOI: 10.1111/pde.14215] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Different skin manifestations of COVID-19 are being reported. Acral lesions on the hands and feet, closely resembling chilblains, have been recognized during the peak incidence of the COVID-19 pandemic. MATERIAL AND METHODS A retrospective review of 22 children and adolescents with chilblain-like lesions seen over a short period of time in the Emergency Department of a children's hospital during the peak incidence of COVID-19 in Madrid, Spain. RESULTS All patients had lesions clinically consistent with chilblains of the toes or feet, with three also having lesions of the fingers. Pruritus and mild pain were the only skin symptoms elicited, and only 10 had mild respiratory and/or GI symptoms. None had fever. Coagulation tests, hemogram, serum chemistry, and lupus anticoagulant were normal in all patients tested. One out of 16 tested cases had elevated D-dimer results, but without systemic symptoms or other laboratory anomalies. SARS-CoV-2 PCR tested in 19 cases was positive in just one case. Skin biopsies obtained in six patients were consistent with chilblains. On follow-up, all cases showed spontaneous marked improvement or complete healing. CONCLUSION Acute chilblains were observed during COVID-19 pandemic in children and teenagers. It is a mildly symptomatic condition with an excellent prognosis, usually requiring no therapy. Etiopathogenesis remains unknown.
Collapse
Affiliation(s)
- David Andina
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lucero Noguera-Morel
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | | | | | | | - Isabel Colmenero
- Department of Pathology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Antonio Torrelo
- Department of Dermatology, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| |
Collapse
|
18
|
Abstract
Idiopathic chilblain is a relatively common yet poorly recognized acrosyndrome. This literature review aims to better understand and draw attention to this disorder. Chilblain is a localized inflammation of the skin that occurs on exposure to cold but non-freezing wet weather. It usually resolves spontaneously. The etiology is uncertain, but vasospasm seems to play a role in this abnormal reaction to cold. Diagnosis is most often based on clinical presentation, but a skin biopsy can be useful in dubious cases. In histology, dermal edema and an inflammatory infiltrate are usually present. A distribution of the infiltrate particularly around the eccrine gland is typical. Systemic symptoms and underlying autoimmune disease should be screened. Avoiding cold and keeping extremities warm is the first recommendation for management, as well as smoking cessation. Calcium channel blockers (in particular nifedipine) seems to be the treatment that has been most evaluated in chilblains. However, their effectiveness is not confirmed by all studies. Topical betamethasone is often used but its effect has not been confirmed by randomized clinical trials. Other treatments, such as pentoxifylline, hydrochloroquine and topical nitroglycerin have shown positive effects only in a reduced number of patients. Acupuncture seems to bring a benefit.
Collapse
Affiliation(s)
- Astrid Nyssen
- Department of Cardiology, CHR Verviers East Belgium Verviers, Belgium.,Department of Vascular Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Farida Benhadou
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Magnée
- Department of Cardiology, CHR Verviers East Belgium Verviers, Belgium
| | - Josette André
- Department of Dermatology and Dermatopathology, Hôpital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Koopmansch
- Department of Dermatology and Dermatopathology, Hôpital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Claude Wautrecht
- Department of Vascular Diseases, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
19
|
Boesjes CM, van Rhijn BD, van Dijk MR, Sigurdsson V. Posttraumatic unilateral perniosis: A case report. JAAD Case Rep 2019; 5:909-911. [PMID: 31646162 PMCID: PMC6804445 DOI: 10.1016/j.jdcr.2019.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Celeste Mirte Boesjes
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bram Doron van Rhijn
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Vigfús Sigurdsson
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
20
|
Wang ML, Chan MP. Comparative Analysis of Chilblain Lupus Erythematosus and Idiopathic Perniosis: Histopathologic Features and Immunohistochemistry for CD123 and CD30. Am J Dermatopathol 2018; 40:265-271. [DOI: 10.1097/dad.0000000000000945] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
21
|
Nazzaro G, Genovese G, Marzano AV. Idiopathic chilblains in myelomonocytic leukemia: not a simple association. Int J Dermatol 2018; 57:596-598. [PMID: 29318596 DOI: 10.1111/ijd.13896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/26/2017] [Accepted: 12/03/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Gianluca Nazzaro
- Dipartimento di Fisiopatologia e dei Trapianti, University of Milan - Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Genovese
- Dipartimento di Fisiopatologia e dei Trapianti, University of Milan - Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo V Marzano
- Dipartimento di Fisiopatologia e dei Trapianti, University of Milan - Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
22
|
Bouaziz JD, Barete S, Le Pelletier F, Amoura Z, Piette JC, Francès C. Cutaneous lesions of the digits in systemic lupus erythematosus: 50 cases. Lupus 2016; 16:163-7. [PMID: 17432100 DOI: 10.1177/0961203306075792] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this study was to observe the clinical and pathologic features of digital lesions in a cohort of 50 patients with systemic lupus erythematosus (SLE). Biopsy and pictures of digital lesions were performed in 50 consecutive patients with SLE and digital lesions. A clinical diagnosis of vasculitis was previously suggested in 36% of cases. Pictures were reviewed by three dermatologists and all the tissue sections were analysed by the same pathologist. Files of patients were reviewed retrospectively. Activity of SLE was established according to the lupus activity index (LAI). Digital lesions in SLE were frequently painful (60%) with a finger-pulp inflammation (70%). According to clinical and pathological correlation, five patients had acute cutaneous lupus, five subacute cutaneous lupus, 21 discoid lupus and 15 chilblain lupus. Two patients presented vasculitis: one had an urticarial vasculitis concomitantly to a lupus flare, the other had an erythema elevatum diutinum, independent of SLE evolution. Thrombosis of dermal vessels was present in two patients with SLE-associated antiphospholipid syndrome and in two patients with chilblain lupus. LAI was > 1.5 in only seven patients. These results highlight the tendency to clinically overestimate the prevalence of cutaneous vasculitis of the fingers in patients without active SLE. Clinical features of cutaneous lupus of the digits are polymorphous. So, a pathological examination of the lesions is often necessary for diagnosis and proper management.
Collapse
Affiliation(s)
- J D Bouaziz
- Department of Dermatology, Hôpital Tenon, Paris, France
| | | | | | | | | | | |
Collapse
|
23
|
Trofimov PN, Antonova OV, Shvyrev DN, Khairutdinov VR, Belousova IE, Samtsov AV. Cutaneous lupus erythematosus: pathogenesis, clinical pattern, diagnostics, therapy. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-5-24-33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
This article contains the latest information about the mechanisms of development of lupus erythematosus based on the literature review. The modern classification of specific and non-specific skin lesions in lupus erythematosus is shown.The authors described the clinical pattern of cutaneous forms of lupus erythematosus very detailed. the data about pathological and immunological criteria for the disease diagnostics, modern methods of pharmacotherapy lupus erythematosus was classified.
Collapse
|
24
|
Abstract
Vascular acrosyndromes are associated with vasomotor disorders. They may be paroxysmal, like Raynaud's phenomenon, whitening of the fingers on exposure to cold, or erythromelalgia, a painful form of erythema induced by exposure to heat. Others are permanent or semi-permanent, such as acrocyanosis, chilblains, spontaneous haematoma of the fingers, acrocholose and digital ischaemia or necrosis. Diagnosis of the type of acrosyndrome at issue is based primarily on clinical examination and history-taking. Capillaroscopy and antinuclear antibody assay are key examinations essential for distinguishing between primary and secondary Raynaud's phenomenon and connective tissue disorders. Complete blood counts, screening for thyroid dysthyroidism, and antinuclear antibody assay can help distinguish between primary erythromelalgia and erythromelalgia secondary to a systemic disease, principally myeloproliferative syndrome. In the case of acrocyanosis, spontaneous digital haematomas and typical bilateral chilblains, examinations are of no value. For the other permanent and semi-permanent acrosyndromes such as digital ischaemia and purpuric or livedoid lesions, screening for arterial or thrombotic disease is necessary.
Collapse
Affiliation(s)
- P Senet
- Service de dermatologie, UF de dermatologie vasculaire, hôpital Tenon, 4, rue de la Chine, 75970 Paris cedex 20, France.
| |
Collapse
|
25
|
Chiewchengchol D, Murphy R, Edwards SW, Beresford MW. Mucocutaneous manifestations in juvenile-onset systemic lupus erythematosus: a review of literature. Pediatr Rheumatol Online J 2015; 13:1. [PMID: 25587243 PMCID: PMC4292833 DOI: 10.1186/1546-0096-13-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/21/2014] [Indexed: 02/04/2023] Open
Abstract
Patients diagnosed with juvenile-onset systemic lupus erythematosus (JSLE) often have skin and oral lesions as part of their presentation. These mucocutaneous lesions, as defined by the American College of Rheumatology (ACR) in 1997, include malar rash, discoid rash, photosensitivity and oral ulcers. It is therefore essential to recognize mucocutaneous lesions to accurately diagnose JSLE. The mucocutaneous lesions can be divided into those with classical histological features (LE specific) and those strongly associated with and forming part of the diagnostic spectrum, but without the classical histological changes of lupus (LE nonspecific). A malar rash is the most commonly associated LE specific dermatological presentation. This skin manifestation is an acute form and also correlates with disease activity. Subacute (polycyclic or papulosquamous lesions) and chronic (discoid lesions) forms, whilst showing classical histological changes supportive of lupus, are less commonly associated with systemic lupus and do not correlate with disease activity. The most commonly associated skin lesions without classical lupus changes are cutaneous vasculitis, oral ulcers and diffuse non-scarring alopecia. These signs frequently relate to disease activity. An understanding of cutaneous signs and symptoms of lupus in children is important to avoid delay in diagnosis. They will often improve as lupus is adequately controlled and their reappearance is often the first indicator of a disease flare.
Collapse
Affiliation(s)
- Direkrit Chiewchengchol
- />Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
- />Institute of Integrative Biology, University of Liverpool, Liverpool, UK
- />Immunology Unit & Center of Excellence in Immunology and Immune-mediated Disease, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ruth Murphy
- />Department of Dermatology, Queens Medical Centre, Nottingham University Teaching Hospitals, Nottingham, UK
| | - Steven W Edwards
- />Institute of Integrative Biology, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- />Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
- />Department of Women’s and Children’s Health, Institute of Translational Medicine, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP UK
| |
Collapse
|
26
|
Oh EH, Jun JB, Ko JY. Childhood Chilblain Lupus Erythematosus. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.4.269] [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]
Affiliation(s)
- Eui Hyun Oh
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Jae-Bum Jun
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Böhm M, Luger TA. Skin in rheumatic disease. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
28
|
|
29
|
Cappel JA, Wetter DA. Clinical characteristics, etiologic associations, laboratory findings, treatment, and proposal of diagnostic criteria of pernio (chilblains) in a series of 104 patients at Mayo Clinic, 2000 to 2011. Mayo Clin Proc 2014; 89:207-15. [PMID: 24485134 DOI: 10.1016/j.mayocp.2013.09.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/26/2013] [Accepted: 09/30/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To further characterize the clinical features, etiologic associations, laboratory findings, and treatment of pernio. PATIENTS AND METHODS This is a retrospective review of patients with pernio seen at our institution between January 1, 2000, and December 31, 2011. RESULTS Of 104 patients with pernio (mean age at diagnosis, 38.3 years), 82 (79%) were women. Pernio affected the toes in 85 patients (82%) and the fingers in 31 (30%). Thirty-eight patients (37%) had at least 1 abnormal laboratory test result, and test results were positive for cold agglutinins in 11 (55%) of 20 tested patients. Results were negative for cryoglobulins in all tested patients (n=53). Four patients (4%) had connective tissue disease (nonlupus) associated with pernio; 3 patients (3%) had an associated hematologic malignant disease. Conservative treatments (eg, warming, drying, and smoking cessation) provided complete response in 23 (82%) of 28 patients with follow-up data. CONCLUSION To our knowledge, this study represents one of the largest single-center case series of pernio to date. Most of the patients did not have an underlying systemic association with pernio, although a few patients had pernio in association with connective tissue disease or hematologic malignant disease.
Collapse
|
30
|
Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun 2014; 48-49:14-9. [PMID: 24486120 DOI: 10.1016/j.jaut.2014.01.021] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 02/08/2023]
Abstract
Lupus erythematosus (LE) is an inflammatory connective tissue disease of generalized autoimmunity characterized by pathogenic autoantibodies and immune complexes, attributed to loss of immune tolerance. Cutaneous involvement, which appears in the majority of patients with the disease, can present as LE-specific or LE-nonspecific manifestations. The LE-nonspecific manifestations include e.g. vascular skin changes and may be associated with systemic organ manifestations or other autoimmune diseases. In contrast, the LE-specific manifestations encompass the various subtypes of cutaneous lupus erythematosus (CLE), which are classified as separate entities without or with less severe systemic organ involvement. In the "Duesseldorf Classification", CLE is subdivided into four different categories: acute CLE (ACLE), subacute CLE (SCLE), chronic CLE (CCLE), and intermittent CLE (ICLE). Differentiation between these subtypes is based on clinical features and average duration of the cutaneous lesions, but can also consider histological changes of skin biopsy specimens and laboratory abnormalities. In addition, direct immunofluorescence and photoprovocation may be applied to confirm the diagnosis in specific cases. Further investigations should be considered dependent on the clinical symptoms of the CLE patient and the results of the laboratory tests. A revised scoring system, the Cutaneous Lupus Erythematosus Disease Area and Severity Index (RCLASI) has recently been validated to assess disease activity and damage in CLE. In this review, we focus on the classification of CLE and the diagnostic procedures to identify and confirm the different subtypes of the disease.
Collapse
Affiliation(s)
- Annegret Kuhn
- Department of Dermatology, University of Muenster, Germany; Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany.
| | - Aysche Landmann
- Division of Immunogenetics, Tumor Immunology Program, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
31
|
Akkurt ZM, Ucmak D, Yildiz K, Yürüker SK, Celik HÖ. Chilblains in Turkey: a case-control study. An Bras Dermatol 2014; 89:44-50. [PMID: 24626647 PMCID: PMC3938353 DOI: 10.1590/abd1806-4841.20142376] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 02/12/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chilblains are rather common in winter months in our country. OBJECTIVES Determination of demographical and clinical characteristics of patients presenting with chilblains in Diyarbakir, Turkey. Evaluation of body mass index (BMI) as risk factor for development of chilblains. METHODS Sixty-nine patients who were diagnosed as chilblains at our outpatient clinics were included in this study. No exclusion criteria were sought. Demographical data including height and weight and answers to questions related to personal history were recorded. A control group consisting of 108 controls were chosen from among patients presenting with complaints of hair loss. Statistical analyses were conducted using SPSS 17.0. RESULTS Of the 69 patients with chilblains, 45 (65.2%) were females and 24 (34.8%) were males. Mean age (± SD) of the patients was 21 ± 9. 71.2% of the patients complained of itching, 51.6% of pain, 31.3% of burning in the lesions. 61.3% of the patients reported recurrence of the lesions every winter season. Mean BMI of the patients was 20.5 ± 2.9. Mean BMI of the controls was 22.4 ± 3.7 and the difference was statistically significant (p=0.01). CONCLUSIONS Low BMI may be a risk factor contributing to development of chilblains in persons exposed to cold weather conditions. Apart from external factors, there seems to be a personal tendency to develop lesions, as many patients report recurrences every year. Diagnosis of chilblains requires wariness, as history of cold exposure may not be evident.
Collapse
Affiliation(s)
- Z Meltem Akkurt
- Assist. Prof. Dicle University Faculty of Medicine, Department of
Dermatology - Diyarbakir, Turkey
| | - Derya Ucmak
- Assist. Prof. Dicle University Faculty of Medicine, Department of
Dermatology - Diyarbakir, Turkey
| | - Kenan Yildiz
- MD - Specialist in Dermatology - Diyarbakir Training and Research
Hospital - Diyarbakir, Turkey
| | - Safiye Kutlu Yürüker
- MD - Specialist in Dermatology - Diyarbakir Training and Research
Hospital - Diyarbakir, Turkey
| | - Heybet Özkaya Celik
- MD - Specialist in Dermatology - Diyarbakir Training and Research
Hospital - Diyarbakir, Turkey
| |
Collapse
|
32
|
Külcü Çakmak S, Gönül M, Oğuz I, Yayla D, Gül Ü, Köse K. Demographical, laboratory and associated findings in patients with perniosis. J Eur Acad Dermatol Venereol 2013; 28:891-4. [DOI: 10.1111/jdv.12199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/17/2013] [Indexed: 11/28/2022]
Affiliation(s)
- S. Külcü Çakmak
- Dermatology Clinic; Ankara Numune Education and Research Hospital; Ankara Turkey
| | - M. Gönül
- Dermatology Clinic; Ankara Numune Education and Research Hospital; Ankara Turkey
| | - I.D. Oğuz
- Dermatology Clinic; Ankara Numune Education and Research Hospital; Ankara Turkey
| | - D. Yayla
- Dermatology Clinic; Ankara Numune Education and Research Hospital; Ankara Turkey
| | - Ü. Gül
- Dermatology Clinic; Ankara Numune Education and Research Hospital; Ankara Turkey
| | - K. Köse
- Faculty of Medicine; Biostatistics Department; Ankara University; Ankara Turkey
| |
Collapse
|
33
|
Pattern of chilblains in a high altitude region of Ladakh, India. Med J Armed Forces India 2013; 71:265-9. [PMID: 26286795 DOI: 10.1016/j.mjafi.2013.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 01/01/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Extreme sub-zero temperature in winters (15 °C to -25 °C), high velocity winds and wind-chill factor pose risk to those who resides at the high altitude environment to develop cold related injuries like chilblains and frostbite. The aim of this study was to study the patterns of chilblains in high altitude region like Ladakh. METHODS The study was conducted at Dermatology outpatient department of Military Hospital, Leh from 1 Sep 2009 to 31 May 2010. Patients, satisfying clinical criteria for the diagnosis of chilblains were included into the study. Detailed history and thorough clinical examination was conducted. Complete blood count and Urine routine examination was carried out in every patient. Anti Nuclear Factor tests were carried out in only those who had history suggestive of connective tissue disease. RESULTS Total 108 (5.75%) were diagnosed to have chilblains. Only a single case of chilblain was found in a local resident (p < 0.005). Family history of chilblains was present in 10 (9.2%) patients, there was recurrence in 12 (11.1%) and 21 patients (19.4%) were smokers. Most (63.8%) of the patients, had BMI between 20 and 22 kg/m(2) (mean = 20.03 kg/m(2); 95% CI = 19.68-20.38 and SD 1.82). 42.1% of cases of chilblains also had hyperhidrosis (p < 0.05). CONCLUSION In a HA area like Ladakh, the non-natives suffer maximum from chilblains. This could be explained by the protective genetic adaptability of natives to extreme cold environment and their protective life style against cold. Low body mass index (BMI) and hyperhidrosis are important associations for development of chilblains.
Collapse
|
34
|
Yang AY, Schwartz L, Divers AK, Sternberg L, Lee JB. Equestrian chilblain: another outdoor recreational hazard. J Cutan Pathol 2013; 40:485-90. [DOI: 10.1111/cup.12082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 12/17/2012] [Accepted: 12/18/2012] [Indexed: 11/29/2022]
|
35
|
El Sayed MJ. Perniosis: a case of painful progressive rash over the distal extremities. J Emerg Med 2012; 43:e473-e474. [PMID: 21982986 DOI: 10.1016/j.jemermed.2011.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 03/10/2011] [Accepted: 06/04/2011] [Indexed: 05/31/2023]
Affiliation(s)
- Mazen J El Sayed
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA
| |
Collapse
|
36
|
Takci Z, Vahaboglu G, Eksioglu H. Epidemiological patterns of perniosis, and its association with systemic disorder. Clin Exp Dermatol 2012; 37:844-9. [DOI: 10.1111/j.1365-2230.2012.04435.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
37
|
Abstract
We report a case of severe perniosis in a long-distance cyclist. This case demonstrates the importance of identifying those at risk of cold-related injuries who are about to embark on extensive travel in cold environments.
Collapse
Affiliation(s)
- Andrew J Neal
- Department of Medicine, Royal Melbourne Hospital, Melbourne, Australia.
| | | | | |
Collapse
|
38
|
Sifuentes Giraldo WA, Ahijón Lana M, García Villanueva MJ, González García C, Vázquez Diaz M. Chilblain lupus induced by TNF-α antagonists: a case report and literature review. Clin Rheumatol 2011; 31:563-8. [DOI: 10.1007/s10067-011-1924-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/16/2011] [Indexed: 11/25/2022]
|
39
|
Böhm M, Luger TA. Skin in rheumatic disease. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
40
|
Vera-Recabarren MA, García-Carrasco M, Ramos-Casals M, Herrero C. Cutaneous lupus erythematosus: clinical and immunological study of 308 patients stratified by gender. Clin Exp Dermatol 2010; 35:729-35. [PMID: 20015282 DOI: 10.1111/j.1365-2230.2009.03764.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Numerous studies involving systemic lupus erythematosus (SLE) have attempted to identify gender differences in patients with lupus erythematosus (LE). However, few reports on cutaneous lupus erythematous (CLE) have identified gender differences. AIM To analyse and compare the prevalence and characteristics of the main clinical and immunological features of male and female patients with CLE. METHODS The medical records of 103 (33.4%) male and 205 (66.6%) female patients with CLE who were treated as inpatients or outpatients between January 1985 and December 2000 were retrospectively studied. All patients were reviewed in detail stratified by a predefined protocol. RESULTS Female patients had a higher prevalence of Raynaud's phenomenon (P < 0.01), chilblain lupus (P = 0.005), arthralgias (P = 0.001) and SLE (P < 0.01). Female patients were also more likely to have an increased erythrocyte sedimentation rate (P < 0.005), higher levels of antinuclear antibodies (P < 0.001) and decreased levels of C3 (P < 0.001), C4 (P < 0.01) and CH50 (P < 0.01). There was a higher prevalence of clinical and laboratory abnormalities in female patients who had both SLE and CLE than in male patients with both conditions. Conclusions. In our series, differences in the expression of CLE existed between male and female patients with respect to the type of lesions, systemic features, and immunological findings.
Collapse
Affiliation(s)
- M A Vera-Recabarren
- Department of Dermatology, Hospital Clinic, University of Barcelona, Catalonia, Spain.
| | | | | | | |
Collapse
|
41
|
Klein RS, Morganroth PA, Werth VP. Cutaneous lupus and the Cutaneous Lupus Erythematosus Disease Area and Severity Index instrument. Rheum Dis Clin North Am 2010; 36:33-51, vii. [PMID: 20202590 DOI: 10.1016/j.rdc.2009.12.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides an overview of cutaneous lupus erythematosus, including classification schemes, disease subtypes, and therapy. It also describes the Cutaneous Lupus Erythematosus Disease Area and Severity Index, a novel clinical outcome instrument that quantifies cutaneous activity and damage in cutaneous lupus erythematosus.
Collapse
|
42
|
Abstract
Pernio is a vasospastic disorder that affects unprotected skin regions of individuals exposed to nonfreezing, damp cold. It may be idiopathic or associated with other systemic diseases, particularly cryopathies and lupus erythematosus. Acute pernio manifests several hours following exposure, whereas chronic pernio may persist even after the cold season has long ended. The pathophysiology is complex and related to patient and environmental factors. Pernio is diagnosed by clinical features. There are no characteristic histopathologic features that confirm the diagnosis, but biopsy of affected areas may exclude the presence of other disorders. Sequelae include superinfection, depigmentation, and scarring. Treatment involves rewarming of the whole body and avoidance of further exposure to cold. The use of the dihydropyridine calcium channel blocker nifedipine promotes faster healing and prevents recurrence.
Collapse
|
43
|
[Lupus erythematosus. Wide range of symptoms through clinical variation, associated diseases and imitators]. Hautarzt 2010; 61:676-82. [PMID: 20549478 DOI: 10.1007/s00105-010-1939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The typical clinical forms of cutaneous lupus erythematosus (LE) are the butterfly rash, acute, subacute and chronic cutaneous lupus, intermediate lupus (lupus tumidus), chilblain- and bullous lupus, lupus profundus, and ulcerating lesions on the mucous membrane. Besides the typical lupus forms, nonspecific skin lesions are also observed such as dermal mucinosis, acneiform skin lesions, different variants of livedo, necrotizing vasculitis with ulcers, purpura, urticaria vasculitis, neutrophilic dermatosis, hyperpigmentation, hair and nail changes as well as overlap syndromes with erythema multiforme, scleroderma, Sjögren syndrome, Raynaud phenomenon, lichen planus, bullous pemphigoid und psoriasis. There are lupus imitators which create differential diagnostic challenges, such as infections with atypical mycobacteria or subcutaneous T-cell lymphoma both of which are similar to lupus profundus. All these skin lesions can present as maximal pathological findings seen in lupus or be caused by a variety of pathological laboratory findings such as the anti-phospholipid antibodies or a deficiency of complement factors. In the latter situation severe lupus often with complications can be expected.
Collapse
|
44
|
Yang X, Perez OA, English JC. Adult perniosis and cryoglobulinemia: a retrospective study and review of the literature. J Am Acad Dermatol 2010; 62:e21-2. [PMID: 20466166 DOI: 10.1016/j.jaad.2009.10.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 10/20/2009] [Accepted: 10/30/2009] [Indexed: 12/13/2022]
|
45
|
Abstract
The acute onset of purple digits is a concerning manifestation and may represent underlying, potentially life-threatening disease. Correctly identifying the etiology of purple digits is essential to proper management, and can aid in the diagnosis of systemic disease. Multiple causes of purple digits and significant overlap in clinical presentation can make diagnosis difficult. Despite the various causes of acute purple digits in the published literature, an algorithmic approach to the evaluation and management of the most common and alarming etiologies has yet to be established. The initial step in evaluating a patient with purple digits is to determine if the cause is associated with hypoxemia or trauma. If the patient is in a stable condition, the dermatologist needs to determine if the process could be related to cold exposure such as Raynaud phenomenon, acrocyanosis, pernio, cryoglobulinemia or frostbite. If the disease occurs independent of temperature, physical examination and histological evaluation of the skin is recommended. The lack of peripheral pulses are concerning for acute arterial thrombosis from peripheral vascular disease or arterial embolism. Non-blanching skin changes on the digit that lack inflammation and microthrombosis most likely represent a bleeding or platelet abnormality; however, if microthrombi are identified a more life-threatening processes such as purpura fulminans or embolic phenomenon may be occurring. Evidence of blood vessel inflammation suggests a leukocytoclastic vasculitis. The patient with a purple blanching digit and normal pulses requires an extensive historical review to help determine the cause. This review presents an algorithmic approach to assist in the evaluation and management of the purple digit.
Collapse
Affiliation(s)
- Patrick J Brown
- Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA
| | | | | |
Collapse
|
46
|
Lutz V, Cribier B, Lipsker D. Chilblains and antiphospholipid antibodies: report of four cases and review of the literature. Br J Dermatol 2010; 163:645-6. [DOI: 10.1111/j.1365-2133.2010.09829.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
47
|
|
48
|
Prakash S, Weisman MH. Idiopathic chilblains. Am J Med 2009; 122:1152-5. [PMID: 19958897 DOI: 10.1016/j.amjmed.2009.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Revised: 07/13/2009] [Accepted: 07/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chilblains is a benign condition infrequently encountered in clinical practice; its resemblance to vasculitis or peripheral thromboemboli can often result in an extensive and unnecessary diagnostic work-up. METHOD Three cases of chilblains seen by our Rheumatology service, along with 113 documented cases, were reviewed. RESULTS Chilblains is characterized by painful red-to-purple papular lesions involving the acral surface of fingers or toes that resolves with symptomatic treatment. Female sex and low body mass index are risk factors. CONCLUSION Distinct clinical features of chilblains can be used for early recognition and management, thus avoiding unnecessary diagnostic testing and delays in patient care.
Collapse
|
49
|
Piga M, Vacca A, Cauli A, Porru G, Mathieu A. Familial chilblain and late contractural arachnodactyly: a novel association? Joint Bone Spine 2009; 76:205-8. [PMID: 19124263 DOI: 10.1016/j.jbspin.2008.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 08/21/2008] [Indexed: 11/17/2022]
Abstract
We report an Italian family suffering from chilblain. Seven members over three generations affected, two of them presenting association with late contractural arachnodactyly. Inflammatory cutaneous lesions following exposure to cold or drop in temperature are called chilblain. Arachnodactyly is an hallmark of hereditary connective tissue disorders such as Marfan's syndrome and Beals' syndrome. The latter, showing joint congenital contractures, is called indeed congenital contractural arachnodactyly. We speculate that an underlying alteration in connective tissue could lead to the association between chilblain lesions and contractural arachnodactyly.
Collapse
Affiliation(s)
- Matteo Piga
- Department of Medical Sciences, University of Cagliari and AOU of Cagliari, Italy
| | | | | | | | | |
Collapse
|
50
|
Hirschmann JV, Raugi GJ. Blue (or purple) toe syndrome. J Am Acad Dermatol 2009; 60:1-20; quiz 21-2. [DOI: 10.1016/j.jaad.2008.09.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 08/26/2008] [Accepted: 09/03/2008] [Indexed: 01/19/2023]
|