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Zouboulis CC, Kaleta KP, Broniatowska E, Jarienė V, Nikolakis G. Atrophic papulosis (Köhlmeier-Degos disease) in children and adolescents-A cross-sectional study and literature review. J Eur Acad Dermatol Venereol 2023; 37:810-816. [PMID: 36606530 DOI: 10.1111/jdv.18844] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Atrophic papulosis (Köhlmeier-Degos disease, Degos disease) is a rare thrombo-obliterative microangiopathy of unknown pathogenesis. It usually affects people between the ages of 20 and 50. However, it can occur at any age. The condition is considered uncommon in children. OBJECTIVE Clinical characterization of paediatric patients with atrophic papulosis. METHODS Single-centre prospective cohort study with data derived from the international Degos Disease Registry collected between 2000 and 2021. RESULTS Among 96 registered patients with atrophic papulosis fulfilling the criteria, 19 were aged 0 to completed 17 years at the time of onset. The median age at the time of onset was 5 years, ranging from 0 to 1 years for girls to 8 years for boys. In contrast to adult patients (male-to-female ratio 1:2.2), there was a male predominance in paediatric patients with a male-to-female ratio of 1.7:1. Systemic involvement, in particular gastrointestinal, central nervous system and cardiac, was more frequent in children than in adult patients. There were no statistically significant differences between family history, multisystem involvement, mortality and median survival time in the two groups. CONCLUSIONS Atrophic papulosis has some distinct features in the paediatric population. It presents an important and still under-recognized problem. Therefore, it is mandatory to pay attention to the typical skin lesions in combination with neurological or gastrointestinal symptoms in order to make a prompt and accurate diagnosis.
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Affiliation(s)
- Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Katarzyna P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - Elżbieta Broniatowska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University, Krakow, Poland
| | - Vaiva Jarienė
- Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, Kaunas, Lithuania
| | - Georgios Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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2
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Li ZG, Zhou JM, Li L, Wang XD. Malignant atrophic papulosis: Two case reports. World J Clin Cases 2022; 10:12971-12979. [PMID: 36569027 PMCID: PMC9782946 DOI: 10.12998/wjcc.v10.i35.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/16/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Malignant atrophic papulosis is a rare and potentially lethal thrombo-occlusive microvasculopathy characterized by cutaneous papules and gastrointestinal perforation. The precise pathogenesis of this disease remains obscure.
CASE SUMMARY We describe the case of a 67-year-old male patient who initially presented with cutaneous aubergine papules and dull pain in the epigastrium. One week after symptom onset, he was admitted to the hospital for worsening abdominal pain. Exploratory laparotomy showed patchy necrosis and subserosal white plaque lesions on the small intestinal wall, along with multiple perforations. Histological examination of the small intestine showed extensive hyperemia, edema, necrosis with varying degrees of inflammatory reactions in the small bowel wall, small vasculitis with fibrinoid necrosis and intraluminal thrombosis in the mesothelium. Based on the mentioned evidence, a diagnosis of malignant atrophic papulosis was made. We also present the case of a 46-year-old man with known cutaneous manifestations, abdominal pain, nausea and vomiting. His physical examination showed positive rebound tenderness. A computed tomography scan revealed free intraperitoneal air. He required surgical intervention on admission and then developed an esophageal perforation. He ultimately died of a massive hemorrhage.
CONCLUSION In previously published cases of this disease, the cutaneous lesions initially appeared as small erythematous papules. Subsequently, the papules became porcelain-white atrophic depression lesions with a pink, telangiectatic peripheral rim. In one of the patients, the cutaneous lesions appeared as aubergine papules. The other patient developed multiple perforations in the gastrointestinal tract. Due to malignant atrophic papulosis affecting multiple organs, many authors speculated that it is not a specific entity. This case series serves as additional evidence for our hypothesis.
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Affiliation(s)
- Zhi-Gui Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Ming Zhou
- Department of Clinical Medicine, West China School of Medicine, Sichuan University, Chengdu 610207, Sichuan Province, China
| | - Li Li
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Dong Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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3
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Ai W, Liang Z, Li F, Yu H. Degos disease with multiple intestinal perforations: A missed-opportunity case report and literature review. Front Cardiovasc Med 2022; 9:910288. [PMID: 36324742 PMCID: PMC9618646 DOI: 10.3389/fcvm.2022.910288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Degos disease, also known as malignant atrophic papulosis (MAP), is a rare systemic obstructive vascular disease with unknown pathophysiology, which can affect multiple systems, especially gastrointestinal tract and central nervous system. Intestinal perforations with MAP is associated with high mortality rate and ambiguous treatment outcomes. Case presentation Here we report a missed-opportunity case of Degos disease characterized by generalized skin eruption and multiple intestinal perforations. Definite diagnosis of Degos disease was finally concluded after two exploratory laparotomy operations and skin biopsies. Due to the delayed diagnosis and treatment, the patient died after being discharged automatically in spite of application of aspirin and low-dose subcutaneous heparin. In view of such circumstances, we searched the Pubmed using “Degos [Title] OR Malignant Atrophic Papulosis [Title]” AND “perforation [Title] OR perforations [Title]” and make a detailed analysis of the result. Conclusions Degos disease is a rare systemic obstructive vascular disease with unknown pathologic mechanism and unavailable treatment methods. Diagnosis is usually based on the presence of pathognomonic skin lesions and tissue biopsy. Gastrointestinal involvement can cause serious and lethal conditions with high mortality. Currently, how to achieve a satisfying prognosis of MAP with intestinal perforations becomes the most urgent problem in front of medical staff.
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Becker LL, Ebstein F, Horn D, Zouboulis CC, Krüger E, Kaindl AM, Eger A, Kallinich T, Biskup S, Schmid S, Stenzel W, Münzfeld H, Blume-Peytavi U. Interferon receptor dysfunction in a child with malignant atrophic papulosis and CNS involvement. Lancet Neurol 2022; 21:682-686. [PMID: 35841902 DOI: 10.1016/s1474-4422(22)00167-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/14/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lena-Luise Becker
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Institute for Cell Biology and Neurobiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
| | - Frédéric Ebstein
- Institute of Medical Biochemistry and Molecular Biology, Greifswald University Medicine, Greifswald, Germany
| | - Denise Horn
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Christos C Zouboulis
- Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Dessau, Germany; Departments of Dermatology, Venerology, Allergology, and Immunology, Dessau Medical Center, Dessau, Germany
| | - Elke Krüger
- Institute of Medical Biochemistry and Molecular Biology, Greifswald University Medicine, Greifswald, Germany
| | - Angela M Kaindl
- Department of Pediatric Neurology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Center for Chronically Sick Children, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Institute for Cell Biology and Neurobiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
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5
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Croitoru D, Lu JD, Ling SC, Wales P, Levy R. Laparoscopic Detection of Malignant Atrophic Papulosis (MAP) in a Pediatric Patient. J Eur Acad Dermatol Venereol 2022; 36:e1052-e1054. [PMID: 35857385 DOI: 10.1111/jdv.18446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- David Croitoru
- Division of Dermatology, Department of Medicine, University of Toronto Ontario, Canada
| | - Justin D Lu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Simon C Ling
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Wales
- Division of General and Thoracic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rebecca Levy
- Division of Dermatology, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Section of Dermatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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6
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Zouboulis CC, Theodoridis A, Makrantonaki E. Inflammation and thrombo-occlusive vessel signalling in benign atrophic papulosis (Köhlmeier-Degos disease). J Eur Acad Dermatol Venereol 2022; 36:2195-2198. [PMID: 35748122 DOI: 10.1111/jdv.18362] [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: 03/18/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although the merely cutaneous, benign form of the extremely rare disease atrophic papulosis (Köhlmeier-Degos disease) may occasionally develop into the systemic, malignant form with time, it is unclear whether it itself exhibits any systemic characteristics. OBJECTIVE To determine whether benign atrophic papulosis exhibits inflammatory and thrombo-occlusive signals and to classify it according to the Chapel-Hill classification of vasculitis. METHODS In a monocentric, controlled study, levels of cytokines (IL-1β, IL-6, IL-8, IFNγ, MCP-1, VEGF, TNFα, TGF-β1), antiphospholipid antibodies (cardiolipin IgG/A/M, cardiolipin IgG, cardiolipin IgM, β2-glycoprotein IgG/A/M, phosphatidyl choline, phosphatidyl serine, phosphatidyl inositol, phosphatidyl ethanolamine and sphingomyelin A), antibodies against proteinase-3 IgG and myeloperoxidase IgG, antinuclear antibodies and extractable nuclear antigen were assessed in blood samples of six benign atrophic papulosis patients and six age- and sex-matched healthy controls. RESULTS IL-8 was only detectable in patients' serum. VEGF was reduced and cardiolipin IgG/A/M and β2-glycoprotein antibodies were increased in the patients' group. ANA were only detected in three patients, ENA were throughout negative. No differences were detected between the other investigated markers. CONCLUSIONS This is the first study evaluating systemic inflammatory and thrombo-occlusive vessel signalling in benign atrophic papulosis and provide evidence of a non-antineutrophil cytoplasmatic antibodies immune-complex small vessel vasculitis according to the Chapel-Hill classification. These findings corroborate its systemic character despite the apparent missing involvement of systemic organs.
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Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - A Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - E Makrantonaki
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
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7
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Kaleta KP, Jarienė V, Theodoridis A, Nikolakis G, Zouboulis CC. Atrophic papulosis (Köhlmeier-Degos disease) revisited. A cross-sectional study on 105 patients. J Eur Acad Dermatol Venereol 2022; 36:2190-2194. [PMID: 35610757 DOI: 10.1111/jdv.18260] [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: 03/07/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrophic papulosis is a very rare vascular disease of unknown pathogenesis, mostly described by case reports. OBJECTIVE To assess demographic data and prognosis in patients with atrophic papulosis. METHODS Single-centre study on a series of 105 patients with atrophic papulosis, diagnosed 2000-2021. Patients referred and diagnosed at the evaluation centre and patients' clinical data provided by the Degos Support Network and evaluated by the authors for confirming diagnosis for skin lesions and fulfilling the diagnostic criteria for a malignant subset. A unique set of variables was collected from all patients. RESULTS The mean age of disease onset was 33.3±18.3 years and the male-to-female ratio 1:1.6. The family history rate was 8.1%. The classification into a benign, merely cutaneous one (benign atrophic papulosis), and malignant atrophic papulosis, associating cutaneous and visceral lesions was confirmed due to their striking prognostic difference. Benign atrophic papulosis was detected in 41% of the patients with no deaths occurring throughout the follow-up period (median 3.00 years; range 0.13-23). Malignant atrophic papulosis was reported in 59% of patients with 47.5% multisystemic involvement and a median skin lesion onset to systemic symptoms duration of 0.54 years (-6 to 20). Gastrointestinal tract and central nervous system were equally involved; however, the neurological sign-caused death rate was slightly higher. The disease-specific mortality rate of malignant atrophic papulosis was 22.6%. CONCLUSIONS Atrophic papulosis presents with striking prognostic difference of benign - merely cutaneous - involvement or quickly developing - into less than one year - malignant subset, associating cutaneous and visceral lesions and multiorgan involvement in 1/2 of the patients, which leads to premature, disease-specific mortality in 1/4 of the cases. Central nervous system and gastrointestinal tract involvement complications are the major reasons for disease-specific death. Over the years the diagnosis of severe nervous system involvement has become more common.
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Affiliation(s)
- K P Kaleta
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany.,Department of Dermatology, Jagiellonian University Medical College, Krakow, Poland
| | - V Jarienė
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany.,Department of Skin and Venereal Diseases, Lithuanian University of Health Sciences (LUHS), Hospital of LUHS Kauno Klinikos, Kaunas, Lithuania
| | - A Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - G Nikolakis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
| | - C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Brandenburg, Dessau, Germany
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8
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Degos disease complicated by constrictive pericarditis in remote phase: a case report. J Cardiothorac Surg 2022; 17:59. [PMID: 35365165 PMCID: PMC8973571 DOI: 10.1186/s13019-022-01810-0] [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: 07/21/2021] [Accepted: 03/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Degos disease, also known as malignant atrophic papulosis, is characterised by cutaneous manifestations due to chronic thrombo-obliterative vasculopathy. There have been reports of the rare late-onset Degos disease complicated by constrictive pericarditis (CP). This study reports a case of CP caused by Degos disease that developed 20 years after diagnosis. CASE PRESENTATION A 62-year-old woman who had been taking aspirin for 20 years for Degos disease was hospitalised for worsening of heart failure. The patient was diagnosed with CP and underwent pericardiectomy. Pathological findings suggested the involvement of Degos disease. The postoperative course was uneventful, and her heart failure and Degos disease did not worsen. CONCLUSIONS The study findings suggests that Degos disease can cause long-term CP. Aspirin effectively inhibited the progression of Degos disease, and surgical treatment was necessary when heart failure due to CP was refractory to treatment.
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9
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Magro C, Shapiro L. Exploring the pathophysiologic basis of constrictive pericarditis of Kohlmeier Degos disease: A case series and review of the literature. Ann Diagn Pathol 2022; 59:151943. [DOI: 10.1016/j.anndiagpath.2022.151943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
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10
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Lu L, Lin B, Dai R, Fan X, Yu Y, Qi Y, Zhu X, Zhou P. A Case of Benign Atrophic Papulosis in a Young Male. Ann Dermatol 2022; 34:309-311. [PMID: 35948336 PMCID: PMC9365653 DOI: 10.5021/ad.20.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 10/22/2020] [Accepted: 12/05/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lingyi Lu
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
| | - Bingjiang Lin
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
| | - Ru Dai
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
| | - Xin Fan
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
| | - Yingzhe Yu
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
| | - Ying Qi
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
| | - Xiaoxia Zhu
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
| | - Ping Zhou
- Department of Dermatology, Ningbo First Hospital, Zhejiang University, Zhejiang, P. R. China
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11
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Adelman M, Gordon Spratt EA, Friedman BJ. An Elderly Female with Progressive Inflammatory Scar-Like Papules. Indian J Dermatol 2021; 66:326-328. [PMID: 34446962 PMCID: PMC8375541 DOI: 10.4103/ijd.ijd_214_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Madeline Adelman
- Department of Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Ben J Friedman
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI, USA
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12
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Leyens J, Bender TTA, Mücke M, Stieber C, Kravchenko D, Dernbach C, Seidel MF. The combined prevalence of classified rare rheumatic diseases is almost double that of ankylosing spondylitis. Orphanet J Rare Dis 2021; 16:326. [PMID: 34294115 PMCID: PMC8296612 DOI: 10.1186/s13023-021-01945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) affect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classification. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objective of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely define this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the specified criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatology was estimated as the sum of the individually determined prevalences. RESULTS A total of 76 syndromes and diseases were identified, including vasculitis/vasculopathy (n = 15), arthritis/arthropathy (n = 11), autoinflammatory syndromes (n = 11), myositis (n = 9), bone disorders (n = 11), connective tissue diseases (n = 8), overgrowth syndromes (n = 3), and others (n = 8). Out of the 76 diseases, 61 (80%) are classified as chronic, with a remitting-relapsing course in 27 cases (35%) upon adequate treatment. Another 34 (45%) diseases were predominantly progressive and difficult to control. Corticosteroids are a therapeutic option in 49 (64%) syndromes. Mortality is variable and could not be determined precisely. Epidemiological studies and prevalence data were available for 33 syndromes and diseases. For an additional eight diseases, only incidence data were accessible. The summed prevalence of all RDs was 28.8/10,000. CONCLUSIONS RDs in rheumatology are frequently chronic, progressive, and present variable symptoms. Treatment options are often restricted to corticosteroids, presumably because of the scarcity of randomized controlled trials. The estimated combined prevalence is significant and almost double that of ankylosing spondylitis (18/10,000). Thus, healthcare systems should assign RDs similar importance as any other common disease in rheumatology.
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Affiliation(s)
- Judith Leyens
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Neonatology and Pediatric Care, Children's University Hospital, Bonn, Germany
| | - Tim Th A Bender
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Institute of Human Genetics, University Hospital, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
| | - Christiane Stieber
- Institute of General Practice and Family Medicine, University Hospital, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Radiology, University Hospital, Bonn, Germany
| | - Christian Dernbach
- Division of Medical Psychology and Department of Psychiatry, University Hospital, Bonn, Germany
| | - Matthias F Seidel
- Department of Rheumatology, Spitalzentrum-Centre hospitalier, Biel-Bienne, Switzerland.
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13
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Narang I, Chohan B, Bleiker TO. Degos disease with renal cell carcinoma. Clin Exp Dermatol 2021; 46:1653-1655. [PMID: 34184287 DOI: 10.1111/ced.14752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/28/2022]
Affiliation(s)
- I Narang
- Department of Dermatology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Chohan
- Department of, Pathology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - T O Bleiker
- Department of Dermatology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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14
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Zouboulis CC, Shapiro LS, Magro CM. Atrophic papulosis: the wedge-shaped skin necrosis overlays an active lesion. J Eur Acad Dermatol Venereol 2021; 35:e672-e674. [PMID: 34014578 DOI: 10.1111/jdv.17377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - L S Shapiro
- Rheumatology, Albany Medical College, Ballston Spa, NY, USA
| | - C M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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15
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Kim PJ, Lytvyn Y, Kashetsky N, Bagit A, Mufti A, Yeung J. Clinical manifestations and treatment outcomes in degos disease: a systematic review. J Eur Acad Dermatol Venereol 2021; 35:1655-1669. [PMID: 33914972 DOI: 10.1111/jdv.17311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
Degos disease (atrophic papulosis) is a rare vasculopathy with cutaneous and systemic manifestations. Although potentially fatal, the characteristics of and treatments for Degos disease variants are not adequately described. We conducted a systematic review to summarize cutaneous and systemic presentations, treatments and outcomes of malignant (MAP) and benign (BAP) variants of Degos disease. A comprehensive search was conducted on Embase, MEDLINE, CINAHL and CENTRAL on 27 October 2020, which yielded 254 original studies reporting cases of Degos disease. A total of 357 patients were included in the analysis. Mean age of onset was 33.9 years. MAP was most commonly reported (63.8%, n = 228/357), with 56.6% (n = 129/228) mortality. Cutaneous lesions were usually asymptomatic (26.3%, n = 81/308) and localized to the trunk (57.7%, n = 206/357) and extremities (56.8%, n = 203/357). Systemic involvement developed within 2 years on average, ranging from 0 to 28 years. Anti-platelet monotherapy had a complete resolution rate of 42.3% (n = 11/26) in BAP and 20.0% (n = 7/35) in MAP. Based on the findings of the study, most cases of Degos disease are malignant with high mortality, and even benign cutaneous cases may develop systemic disease in as late as 28 years. Anti-platelet monotherapies may prove effective against both variants. Further studies are needed to confirm these findings.
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Affiliation(s)
- P J Kim
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Y Lytvyn
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - N Kashetsky
- Faculty of Medicine, Memorial University, St. John's, NL, Canada
| | - A Bagit
- Faculty of Health Sciences, Brock University, St. Catharines, ON, Canada
| | - A Mufti
- Department of Dermatology, University of Toronto, Toronto, ON, Canada
| | - J Yeung
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Department of Dermatology, University of Toronto, Toronto, ON, Canada.,Probity Medical Research, Waterloo, ON, Canada
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16
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Lu JD, Sachdeva M, Silverberg OM, Shapiro L, Croitoru D, Levy R. Clinical and laboratory prognosticators of atrophic papulosis (Degos disease): a systematic review. Orphanet J Rare Dis 2021; 16:203. [PMID: 33957947 PMCID: PMC8101154 DOI: 10.1186/s13023-021-01819-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 12/14/2022] Open
Abstract
Background Degos disease is a rare vascular disorder with a cutaneous-limited form, benign atrophic papulosis (BAP), and a systemic variant, malignant atrophic papulosis (MAP). Despite the poor prognosis of MAP, no study has established features associated with systemic disease. Objectives The aims of this systematic review were to: (1) summarize clinical features and treatments implemented for patients with MAP and BAP (2) identify clinical and laboratory factors associated with the development of MAP, compared to BAP. Methods We systematically searched MEDLINE and Embase from inception to April 2020. Demographic and clinical features of Degos patients were presented descriptively; multivariable logistic regression was performed to identify associations with MAP. Results We identified 99 case studies, comprising 105 patients. MAP (64%) had a 2.15 year median survival time from cutaneous onset, most often with gastrointestinal or central nervous system involvement. We found that elevations in either of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) were associated with systemic involvement (OR 2.27, p = 0.023). Degos secondary to an autoimmune connective tissue disease was found to be inversely associated with MAP (OR 0.08, p = 0.048). Conclusions Elevated ESR or CRP is associated with MAP and may be a predictor of systemic involvement for patients with Degos disease. In addition, secondary Degos disease is associated with a favourable prognosis. Clinicians should be aware of the differences between primary and secondary Degos and the utility of ESR or CRP in identifying disease evolution to systemic involvement. The utility of ESR and CRP to identify systemic involvement should be further explored. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01819-z.
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Affiliation(s)
- Justin D Lu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Lee Shapiro
- Department of Medicine, Division of Rheumatology, Albany Medical College, Albany, NY, USA
| | - David Croitoru
- Division of Dermatology, Department of Medicine, Women's College Hospital, 76 Grenville St, 3rd Floor, Toronto, ON, M5S 1B2, Canada.
| | - Rebecca Levy
- Department of Dermatology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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17
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Beato Merino M, Diago A, Fernandez-Flores A, Fraga J, García Herrera A, Garrido M, Idoate Gastearena M, Llamas-Velasco M, Monteagudo C, Onrubia J, Pérez-González Y, Pérez Muñoz N, Ríos-Martín J, Ríos-Viñuela E, Rodríguez Peralto J, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda J, Velasco Benito V. Clinical and Histopathologic Characteristics of the Main Causes of Vascular Occusion — Part II: Coagulation Disorders, Emboli, and Other. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2020.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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18
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Wang HQ, Guan Y, Gong XP, Chen YT, Ji C. Case Report: Pediatric Malignant Atrophic Papulosis With Small Bowel Perforation and Positivity of Anticardiolipin Antibody. Front Pediatr 2021; 9:764797. [PMID: 34956979 PMCID: PMC8703221 DOI: 10.3389/fped.2021.764797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Malignant atrophic papulosis (MAP) is a life-threatening vasculopathy affecting the skin, gastrointestinal tract, central nervous system, pleural membrane, and pericardium. MAP carries a poor prognosis primarily because of its systemic involvement. It is extremely rare in children. Herein, we report a pediatric case of MAP with small bowel perforation and anticardiolipin antibody positivity.
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Affiliation(s)
- Hai-Qing Wang
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yu Guan
- Department of Dermatology, Fujian Children's Hospital, Fuzhou, China
| | - Xiao-Pan Gong
- Department of Dermatology, Dermatology Hospital of Fuzhou, Fuzhou, China
| | - You-Tao Chen
- Department of Pediatrics, Fujian Maternity and Child Health Hospital, Fuzhou, China
| | - Chao Ji
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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19
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Tummidi S, Nagendran P, Gedela S, Ramani JR, Shankaralingappa A. Degos disease: a case report and review of the literature. J Med Case Rep 2020; 14:204. [PMID: 33115514 PMCID: PMC7594340 DOI: 10.1186/s13256-020-02514-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
Background Degos disease is a very rare syndrome with multisystem vasculopathy of unknown cause. It can affect the skin, gastrointestinal tract, and central nervous system. However, other organs such as the kidney, lungs, pleura, and liver can also be involved. Case presentation A 35-year-old Hindu woman presented to our dermatology outpatient department with complaints of depigmented painful lesions. A skin punch biopsy taken from the porcelain white atrophic papules which revealed features of Degos disease. Conclusion The diagnosis of Degos disease is usually based on the presence of the pathognomonic skin lesions and a tissue biopsy demonstrating a wedge-shaped area of necrosis with thrombotic occlusion of the small arterioles. No specific treatment is currently available for this disease.
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Affiliation(s)
- Santosh Tummidi
- Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India.
| | - Prabhakaran Nagendran
- Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Swaroopa Gedela
- Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Jami Rupa Ramani
- Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
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20
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Beato Merino MJ, Diago A, Fernandez-Flores A, Fraga J, García Herrera A, Garrido M, Idoate Gastearena MA, Llamas-Velasco M, Monteagudo C, Onrubia J, Pérez-González YC, Pérez Muñoz N, Ríos-Martín JJ, Ríos-Viñuela E, Rodríguez Peralto JL, Rozas Muñoz E, Sanmartín O, Santonja C, Santos-Briz A, Saus C, Suárez Peñaranda JM, Velasco Benito V. Clinical and Histopathologic Characteristics of the Main Causes of Vascular Occusion - Part II: Coagulation Disorders, Emboli, and Other. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:103-117. [PMID: 33075291 DOI: 10.1016/j.ad.2020.10.004] [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: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 12/15/2022] Open
Abstract
Vascular occlusion has multiple, diverse clinical manifestations, some of which can have grave consequences for patients. It also has a wide variety of causes, including thrombi, which we recently addressed in partI of this review. In this second part, we look at additional causes of vascular occlusion.
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Affiliation(s)
- M J Beato Merino
- Servicio de Anatomía Patológica, Hospital Universitario La Paz, Madrid, España
| | - A Diago
- Servicio de Dermatología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Fernandez-Flores
- Servicio de Anatomía Patológica, Hospital Universitario El Bierzo, Ponferrada, León, España.
| | - J Fraga
- Servicio de Anatomía Patológica, Hospital Universitario de La Princesa, Madrid, España
| | - A García Herrera
- Servicio de Anatomía Patológica, Hospital Clínic, Barcelona, España
| | - M Garrido
- Servicio de Anatomía Patológica, Hospital Universitario 12 de Octubre, Madrid, España
| | - M A Idoate Gastearena
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Departamento de Citología, Histología y Anatomía Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - M Llamas-Velasco
- Servicio de Dermatología, Hospital Universitario de La Princesa, Madrid, España
| | - C Monteagudo
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Valencia, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J Onrubia
- Servicio de Anatomía Patológica, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, España
| | | | - N Pérez Muñoz
- Servicio de Anatomía Patológica, Hospital Universitari General de Catalunya, Quirónsalud, Sant Cugat del Vallès, Barcelona, España
| | - J J Ríos-Martín
- Servicio de Anatomía Patológica, Hospital Universitario Virgen Macarena, Sevilla, España
| | - E Ríos-Viñuela
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - J L Rodríguez Peralto
- Departamento de Anatomía Patológica, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación I+12, Madrid, España
| | - E Rozas Muñoz
- Departamento de Dermatología, Hospital de San Pablo, Coquimbo, Chile
| | - O Sanmartín
- Servicio de Dermatología, Fundación Instituto Valenciano de Oncología, Valencia, España
| | - C Santonja
- Servicio de Anatomía Patológica, Fundación Jiménez Díaz, Madrid, España
| | - A Santos-Briz
- Servicio de Anatomía Patológica, Hospital Universitario de Salamanca, Salamanca, España
| | - C Saus
- Servicio de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J M Suárez Peñaranda
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - V Velasco Benito
- Servicio de Anatomía Patológica, Hospital Universitario de Cruces, Barakaldo, Vizcaya, España
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21
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Abdel-Raouf HM, Ahmed AM, Touni AA. Asymptomatic skin lesions with bowel perforation and cerebrovascular stroke in a young adult male. Int J Dermatol 2020; 60:e176-e178. [PMID: 32710556 DOI: 10.1111/ijd.15074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Hamza M Abdel-Raouf
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Almostafa M Ahmed
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed A Touni
- Department of Dermatology and Venereology, Faculty of Medicine, Minia University, Minia, Egypt
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22
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Degos disease: A radiological-pathological correlation of the neuroradiological aspects of the disease. Ann Diagn Pathol 2020; 47:151545. [PMID: 32505971 DOI: 10.1016/j.anndiagpath.2020.151545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 11/22/2022]
Abstract
Malignant atrophic papulosis (Degos disease) is an unusual thrombotic microangiopathy of uncertain etiology. The disease characteristically involves the skin and internal organs, with nervous system involvement more common in children. We present a case with diverse neurological manifestations including cranial nerve palsies, gait instability, and urinary incontinence. The patient also developed white papular lesions on her lower extremities and back. Magnetic resonance imaging (MRI) demonstrated progressive intracranial and spinal abnormalities. Despite treatment with numerous biologic agents, the patient had persistent clinical deterioration and expired one month after admission. We highlight the extensive neurologic manifestations of Degos disease correlated with neuroradiological imaging and pathological features. Nervous system involvement in Degos disease requires careful neurologic and dermatologic exam with central nervous system (CNS) magnetic resonance imaging to distinguish it from non-organic etiologies of similar symptoms.
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23
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Razanamahery J, Payet‐Revest C, Mareschal A, Saizonou I, Bonnet L, Gil H, Humbert S, Magy‐Bertrand N. Early failure of eculizumab in a patient with malignant atrophic papulosis: Is it time for initial combination therapy of eculizumab and treprostinil? J Dermatol 2019; 47:e22-e23. [DOI: 10.1111/1346-8138.15120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jerome Razanamahery
- Department of Internal Medicine Besancon University Hospital Besancon France
| | | | - Adrien Mareschal
- Department of Dermatology Besancon University Hospital Besancon France
| | - Ines Saizonou
- Department of Pathology Besancon University Hospital Besancon France
| | - Louise Bonnet
- Department of Neurology Besancon University Hospital Besancon France
| | - Helder Gil
- Department of Internal Medicine Besancon University Hospital Besancon France
| | - Sebastien Humbert
- Department of Internal Medicine Besancon University Hospital Besancon France
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24
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Brown AE, Qiu CC, Drozd B, Sklover LR, Vickers CM, Hsu S. The color of skin: white diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:561-579. [PMID: 31896410 DOI: 10.1016/j.clindermatol.2019.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease.
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Affiliation(s)
- Ashley E Brown
- McGovern Medical School, University of Texas Health Science Center at Houston,Houston, Texas, USA.
| | - Connie C Qiu
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Brandy Drozd
- McGovern Medical School, University of Texas Health Science Center at Houston,Houston, Texas, USA
| | - Lindsay R Sklover
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Conor M Vickers
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Sylvia Hsu
- Department of Dermatology, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania, USA
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25
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Sacchelli L, Sechi A, Neri I, Gurioli C, Baraldi C, Misciali C, Patrizi A, Dika E. Degos disease in three patients with a common systemic involvement. GIORN ITAL DERMAT V 2018; 155:237-239. [PMID: 30375206 DOI: 10.23736/s0392-0488.18.05930-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Lidia Sacchelli
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy -
| | - Andrea Sechi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlotta Gurioli
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Emi Dika
- Dermatology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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26
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27
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Zhao Q, Zhang S, Dong A. An Unusual Case of Abdominal Pain. Gastroenterology 2018; 154:e1-e2. [PMID: 28870529 DOI: 10.1053/j.gastro.2017.08.061] [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: 06/19/2017] [Revised: 08/14/2017] [Accepted: 08/29/2017] [Indexed: 12/02/2022]
Affiliation(s)
- Qian Zhao
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Shengwang Zhang
- Department of Radiology, The Third Xiangya Hospital, Central South University, Changsha, Hunan
| | - Aisheng Dong
- Department of Nuclear Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China
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28
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Huang YC, Wang JD, Lee FY, Fu LS. Pediatric Malignant Atrophic Papulosis. Pediatrics 2018; 141:S481-S484. [PMID: 29610176 DOI: 10.1542/peds.2016-4206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/24/2022] Open
Abstract
Malignant atrophic papulosis (MAP), also known as Degos disease, is an extremely rare disease that is characterized by its unique skin presentation (namely, central, porcelain-white atrophic lesions with a telangiectatic rim). MAP has the following 2 variants: cutaneous MAP is manifested in the skin alone, whereas systemic MAP affects the gastrointestinal tract, central nervous system, lungs, and other internal organs. Some patients who presented with only cutaneous symptoms at first may develop systemic symptoms several years later. Although the exact pathologic mechanisms are unclear, Magro et al suggested in a recent study that MAP is a vascular injury syndrome that involves complement component C5b-9 complex deposition and high expression of interferon-α. The prognosis of systemic MAP is poor and typically fatal within a few years. Nonetheless, because the C5b-9 complex is detected in MAP, some researchers have suggested combined treatment with eculizumab (a humanized monoclonal antibody against C5) and treprostinil (a prostacyclin analog). Here, we report on a girl with systemic MAP who had severe central nervous system involvement and responded to eculizumab.
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Affiliation(s)
- Yung-Chieh Huang
- Departments of Pediatrics and.,Division of Pediatrics, Puli Branch, Taichung Veterans General Hospital, Nantou, Taiwan; and
| | | | - Fang-Yi Lee
- Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Lin-Shien Fu
- Departments of Pediatrics and .,Department of Pediatrics, National Yang-Ming University, Taipei, Taiwan
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29
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Hu P, Mao Z, Liu C, Hu X, Kang H, Zhou F. Malignant atrophic papulosis with motor aphasia and intestinal perforation: A case report and review of published works. J Dermatol 2018. [PMID: 29516548 PMCID: PMC6001538 DOI: 10.1111/1346-8138.14280] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30‐year‐old female patient with systemic manifestation of MAP 10 days after delivery of a full‐term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.
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Affiliation(s)
- Pan Hu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhi Mao
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chao Liu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xin Hu
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongjun Kang
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Feihu Zhou
- Department of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China
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30
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Murthy AS, Kinsler V. White scarlike lesions in a female infant with bilious emesis and sixth nerve palsy. Pediatr Dermatol 2018; 35:242-243. [PMID: 29575076 DOI: 10.1111/pde.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aditi S Murthy
- Section of Pediatric Dermatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Veronica Kinsler
- Pediatric Dermatology, Great Ormond Street Hospital for Children, London, UK.,Genetics and Genomic Medicine, Institute of Child Health, University College of London, London, UK
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31
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Vision Loss, Rash, and Abnormal Brain Magnetic Resonance Imaging in a 17 Year Old. J Neuroophthalmol 2017; 37:303-308. [DOI: 10.1097/wno.0000000000000500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zouboulis C, Theodoridis A, Brunner M, Magro C. Benign atrophic papulosis (Köhlmeier-Degos disease): the wedge-shaped dermal necrosis can resolve with time. J Eur Acad Dermatol Venereol 2017; 31:1753-1756. [DOI: 10.1111/jdv.14355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/30/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C.C. Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Theodore Fontane Medical University of Brandenburg; Dessau Germany
| | - A. Theodoridis
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Theodore Fontane Medical University of Brandenburg; Dessau Germany
- Freiburg Veins Center; Freiburg Germany
| | - M. Brunner
- Departments of Dermatology, Venereology, Allergology and Immunology; Dessau Medical Center; Theodore Fontane Medical University of Brandenburg; Dessau Germany
| | - C.M. Magro
- Department of Pathology and Laboratory Medicine; Weill Cornell Medicine; New York NY USA
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34
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Calderón-Castrat X, Yuste-Chaves M, Hernández A, Santos-Briz A, Fernández-López E. Degos disease, not just a scar: lethal outcome in spite of immunomodulatory therapy. J Eur Acad Dermatol Venereol 2017; 31:e435-e438. [DOI: 10.1111/jdv.14245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- X. Calderón-Castrat
- Department of Dermatology; University Hospital of Salamanca; Salamanca Spain
| | - M. Yuste-Chaves
- Department of Dermatology; University Hospital of Salamanca; Salamanca Spain
| | - A. Hernández
- Department of Neuropediatrics; University Hospital of Salamanca; Salamanca Spain
| | - A. Santos-Briz
- Department of Pathology; University Hospital of Salamanca; Salamanca Spain
| | - E. Fernández-López
- Department of Dermatology; University Hospital of Salamanca; Salamanca Spain
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35
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Calderón-Castrat X, Castro R, Peceros-Escalante J, Villate Caballero M, Chian C, Ballona R. Congenital Degos Disease: Case Report and Dermoscopic Findings. Pediatr Dermatol 2017; 34:e109-e115. [PMID: 28317162 DOI: 10.1111/pde.13096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric Degos disease is rare, with only 36 cases reported in the medical literature. Classically the diagnosis has been established according to pathognomonic histopathologic findings, but when these features are not present, there may be a delay in diagnosis. We report the second congenital case of Degos disease, highlighting the clinical and dermoscopic findings.
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Affiliation(s)
| | - Rosa Castro
- Department of Dermatology, Instituto Nacional de Salud del Niño, Lima, Perú
| | | | | | - Cesar Chian
- Department of Pathology, Hospital Nacional Arzobispo Loayza, Lima, Perú
| | - Rosalía Ballona
- Department of Dermatology, Instituto Nacional de Salud del Niño, Lima, Perú
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Vinay K, Sawatkar G, Dogra S, Saikia UN. Systemic lupus erythematosus with Degos disease: role of dermatoscopy in diagnosis. Int J Dermatol 2017; 56:770-772. [DOI: 10.1111/ijd.13629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/12/2017] [Accepted: 03/17/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Keshavamurthy Vinay
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Gitesh Sawatkar
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology; Postgraduate Institute of Medical Education and Research; Chandigarh India
| | - Uma N. Saikia
- Department of Histopathology; Postgraduate Institute of Medical Education and Research; Chandigarh India
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Pinho A, Cardoso JC, Vieira R, Figueiredo A. New onset of few atrophic white papules of the trunk and limbs. Clin Exp Dermatol 2016; 41:948-950. [DOI: 10.1111/ced.12925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Pinho
- Department of Dermatology; Hospitais da Universidade de Coimbra; Centro Hospitalar e Universitário de Coimbra; Coimbra Portugal
| | - J. C. Cardoso
- Department of Dermatology; Hospitais da Universidade de Coimbra; Centro Hospitalar e Universitário de Coimbra; Coimbra Portugal
| | - R. Vieira
- Department of Dermatology; Hospitais da Universidade de Coimbra; Centro Hospitalar e Universitário de Coimbra; Coimbra Portugal
| | - A. Figueiredo
- Department of Dermatology; Hospitais da Universidade de Coimbra; Centro Hospitalar e Universitário de Coimbra; Coimbra Portugal
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Toledo AE, Shapiro LS, Farrell JF, Magro CM, Polito J. Laparoscopy shows superiority over endoscopy for early detection of malignant atrophic papulosis gastrointestinal complications: a case report and review of literature. BMC Gastroenterol 2015; 15:156. [PMID: 26527039 PMCID: PMC4630896 DOI: 10.1186/s12876-015-0387-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 10/22/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The malignant form of atrophic papulosis (Köhlmeier-Degos disease) is a rare thrombo-occlusive vasculopathy that can affect multiple organ systems. Patients typically present with distinctive skin lesions reflective of vascular drop out. The small bowel is the most common internal organ involved, resulting in considerable morbidity and mortality attributable to ischemic microperforations. Determination of the presence of gastrointestinal lesions is critical in distinguishing systemic from the benign, cutaneous only disease and in identifying candidates for treatment. CASE PRESENTATION We describe an 18 year old male who first presented with cutaneous atrophic papulosis but became critically ill from small bowel microperforations. He had an almost immediate and dramatic response to treatment. Prior to his presentation with acute abdomen he had upper and lower endoscopy showing areas of nonspecific patchy erythema. At laparotomy, innumerable characteristic lesions with central pearly hue and erythematous border were seen. PubMed was used for a literature search using the keywords malignant atrophic papulosis, Degos disease, endoscopy, laparoscopy and laparotomy. This search yielded 200 articles which were further analyzed for diagnostic procedures and findings. Among the 200 articles we identified only 11 cases in which endoscopy was performed. Results of endoscopy and laparotomy in our patient with malignant atrophic papulosis were compared to those in the literature. Endoscopy of the gastrointestinal tract has shown gastritis and non-specific inflammation whereas laparoscopy shows white plaques with red borders on the serosal surface of the small bowel and the peritoneum. From personal communications with other physicians worldwide, we identified three additional unpublished cases in which endoscopy revealed only minimal changes while laparoscopy showed dramatic lesions. From our experience the endoscopic findings are often subtle and nonspecific, whereas laparascopy or laparotomy will reveal pathognomic lesions on the serosal surface of the intestine. CONCLUSION Our report contrasts the endoscopic and laparoscopic findings in malignant atrophic papulosis which suggest laparoscopy is the more powerful means of detecting gastrointestinal involvement. Imaging studies may serve as a key indicator of systemic progression. Based on our experience, laparoscopy should be performed when there is a high index of suspicion for gastrointestinal malignant atrophic papulosis, even if endoscopic examination is non-diagnostic or normal.
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Affiliation(s)
- A E Toledo
- Steffens Scleroderma Center, Saratoga Springs, NY, USA. .,The Center for Rheumatology, Albany and Saratoga Springs, NY, USA.
| | - L S Shapiro
- Steffens Scleroderma Center, Saratoga Springs, NY, USA. .,The Center for Rheumatology, Albany and Saratoga Springs, NY, USA. .,Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
| | - J F Farrell
- Steffens Scleroderma Center, Saratoga Springs, NY, USA. .,The Center for Rheumatology, Albany and Saratoga Springs, NY, USA. .,Albany College of Pharmacy and Health Sciences, Albany, NY, USA.
| | - C M Magro
- Weill Cornell College of Cornell University, New York, NY, USA.
| | - J Polito
- Gastroenterology Consultants, Albany, NY, USA.
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Abstract
A variety of neurologic diseases have cutaneous manifestations. These may precede, coincide with, or follow the neurologic findings. An array of autoimmune, genetic, and environmental factors play a role in expression and severity of the neurologic burden in these conditions. This chapter emphasizes congenital and genetic disorders, but we also discuss the pathophysiology and manifestation of various acquired neurocutaneous disorders with an emphasis Behcet's disease, dermatomyositis, Sjögren's syndrome, systemic lupus erythematosus, scleroderma, Parry-Romberg syndrome and Degos disease.
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Affiliation(s)
- Amre Nouh
- Department of Neurology, Hartford Hospital - University of Connecticut, Hartford CT, USA
| | - Jodi Speiser
- Section of Dermatopathology, Department of Pathology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
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Two cases of Degos disease with different prognosis. Postepy Dermatol Alergol 2014; 31:425-7. [PMID: 25610362 PMCID: PMC4293389 DOI: 10.5114/pdia.2014.44020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/10/2014] [Accepted: 04/28/2014] [Indexed: 01/26/2023] Open
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Flühler C, Stinco G, di Meo N, Bonin S, Degrassi F, Bussani R, Cova M, Trevisan G. Malignant form of atrophic papulosis with lethal abdominal involvement. J Eur Acad Dermatol Venereol 2014; 30:126-8. [DOI: 10.1111/jdv.12612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Flühler
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
| | - G. Stinco
- Institute of Dermatology; Department of Experimental and Clinical Medicine; University of Udine; Gemona del Friuli Italy
| | - N. di Meo
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
| | - S. Bonin
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
| | - F. Degrassi
- Department of Radiology; Cattinara Hospital; University of Trieste; Trieste Italy
| | - R. Bussani
- Department of Histopathology; Ospedale di Cattinara di Trieste; University of Trieste; Strada di Fiume Trieste Italy
| | - M.A. Cova
- Department of Radiology; Cattinara Hospital; University of Trieste; Trieste Italy
| | - G. Trevisan
- Insitute of Dermatology and Venereology; Ospedale Maggiore di Trieste; University of Trieste; Trieste Italy
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Zaharia D, Truchot F, Ronger-Savle S, Balme B, Thomas L. Benign form of atrophic papulosis developed at injection sites of pegylated-alpha-interferon: is there a pathophysiological link? Br J Dermatol 2014; 170:992-4. [DOI: 10.1111/bjd.12773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- D. Zaharia
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - F. Truchot
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - S. Ronger-Savle
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - B. Balme
- Department of Pathology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
| | - L. Thomas
- Department of Dermatology; Lyon 1 University - Centre Hospitalier Lyon Sud; 69495 PIERRE BENITE Cedex France
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