Treatment of Sweet's syndrome in pregnancy

The Importance and Challenges of Early Diagnosis of Paraneoplastic Skin Syndromes in Cancer Detection-A Review

Skin paraneoplastic syndromes (SPNSs) are a group of disorders that arise as a consequence of cancer but are not directly related to the tumor mass itself. This review aims to provide a comprehensive overview of these syndromes, encompassing their pathophysiology, clinical features, diagnostic approaches, differential diagnosis, and management strategies. These syndromes, which include conditions such as Bazex syndrome, acanthosis nigricans, dermatomyositis, and necrolytic migratory erythema often manifest prior to or concurrently with a cancer diagnosis, serving as potential early warning signs of underlying malignancies. This review delves into the spectrum of SPNSs and their associations with specific cancer types. Special emphasis is placed on the critical role of dermatologists and oncologists in identifying these skin manifestations as potential markers of malignancy. By raising awareness of SPNSs, this paper highlights the pivotal importance of prompt recognition and intervention in reducing cancer-related mortality.

Sweet syndrome: an update on clinical aspects, pathophysiology, and treatment

Sweet syndrome is a neutrophilic dermatosis characterized by an autoinflammatory nature and a sterile neutrophilic infiltrate. It presents with tender, erythematous, edematous papules or plaques, often accompanied by fever. Aim of this review is to summarize the most meaningful aspects of Sweet syndrome, critically discussing old paradigms and novel findings. A search of the English-language literature was conducted using the terms "Sweet syndrome" and "acute febrile neutrophilic dermatosis." MEDLINE (via PubMed) and Web of Science (WOS) databases were consulted up to June 30, 2024. Since its first identification, new clinical and histopathological variants of Sweet syndrome have been described, highlighting its heterogeneity. Additionally, a multitude of clinical conditions have been increasingly reported in association with Sweet syndrome, ranging from malignancies, autoimmune and infectious disorders. The pathogenesis of the disease is unclear and varies according to the associated conditions. One unifying mechanism is the aberrant activation, proliferation, and skin homing of neutrophils. The mainstay of treatment remains systemic corticosteroids; alternatives include colchicine, dapsone, and potassium iodide. Traditional immunosuppressants, biologic agents, and small molecules have also been described as effective in treating Sweet syndrome. Sweet syndrome is a heterogeneous condition with an elusive pathogenesis. Most cases resolve with corticosteroids, but some remain refractory to various therapies, representing an unmet medical need. Recent evidence on the pathomechanisms underlying Sweet syndrome suggests that not only innate but also adaptive immunity might play roles. Further experimental studies are needed and may help identify new therapeutic targets in the future.

Sweet syndrome in pregnancy: A narrative review

The aim of this review is to increase obstetrician awareness of pregnancy-associated Sweet syndrome. Patients present with fever, leukocytosis, and skin eruption, which can mimic other infectious or inflammatory conditions, but do not respond to antibiotics. A search using PubMed, EMBASE, and Web of Science Core Collection was conducted to review all reported cases of pregnancy-associated Sweet syndrome, an acute febrile neutrophilic dermatosis occurring during pregnancy or postpartum. A total of 33 episodes among 30 patients were identified, with the majority (54.5% [18]) of cases occurring within the second trimester. Among the 30 patients, skin lesions most commonly affected the head and neck (73.3% [22]), with rare oral or ocular involvement. Leukocytosis was the most common laboratory finding, reported in 96.7% [29] of patients, with neutrophil predominance noted in 70.0% [21]. The diagnosis was confirmed for all patients with pathognomonic results of skin biopsies. Of the 27 cases detailing treatment, systemic corticosteroids were most frequently used (19 cases), followed by conservative management (seven cases), and dapsone (one case). The dapsone-treated patient and 15 of the 19 steroid-treated patients experienced resolution, but additional management strategies were required in the remaining four individuals. Spontaneous resolution occurred during pregnancy in six of the seven conservatively managed individuals, with one patient experiencing spontaneous abortion shortly after skin eruption at 10 weeks of gestation. No associated maternal deaths were reported. Obstetric complications of pregnancy-associated Sweet syndrome included endomyometritis, sterile placental abscesses, and abdominal wall necrosis. Delivery of healthy infants occurred in 24 of the 25 cases that presented fetal outcome, which included two infants who underwent medically indicated preterm deliveries.

Sweet Syndrome and Neutrophilic Dermatosis of the Dorsal Hands

Sweet syndrome is a rare cutaneous condition with a broad clinical differential diagnosis. It can be classified into 3 subtypes: classic, malignancy-associated, and drug-induced. There are numerous associated disorders and provoking medications. Uncommonly, it can present as a multiorgan disease and cause significant morbidity. Systemic corticosteroids are the gold standard of treatment and yield rapid improvements in both lesions and symptoms. Nonsteroidal therapies may be effective alternatives, although high-quality comparative data are lacking. Some treatments for Sweet syndrome have paradoxically been implicated in the induction of disease.

Rare Autoinflammatory Neutrophilic Dermatoses in Pregnancy: Literature Review

Rare cases of autoinflammatory neutrophilic dermatoses (AINDs) have been reported in patients during pregnancy with associated adverse maternal and fetal outcomes. Due to the rarity and heterogeneous morphology of pregnancy-associated AINDs, clinical diagnosis is often overlooked, and treatment options are limited. In this review, we present the epidemiology, clinical characteristics, therapeutic interventions, maternal and fetal outcomes, and discuss the possible pathophysiology of various pregnancy associated AINDs. Risk factors for the onset and exacerbation of AINDs in pregnancy include older maternal age, disease duration, and specific gestational age. The varied disease courses and conflicting clinical outcomes in both mothers and fetuses demonstrate the importance of symptom recognition and the understanding of the role of pregnancy on AINDs.

Neutrophilic Dermatoses: a Clinical Update

Purpose of Review

Neutrophilic dermatoses are defined by the presence of a sterile neutrophilic infiltrate on histopathology. This review focuses on the pathogenesis, epidemiology, clinicopathological features, diagnosis, and management of four disorders: Sweet syndrome, pyoderma gangrenosum, Behçet syndrome, and neutrophilic eccrine hidradenitis.

Recent Findings

Recent studies have provided insight into the complex pathogenesis of neutrophilic dermatoses. Evidence supports an intricate interplay of abnormal neutrophil function and inflammasome activation, malignant transformation into dermal infiltrating neutrophils, and genetic predisposition.

Summary

Neutrophilic dermatoses have diverse cutaneous and extracutaneous manifestations and may be associated with significant morbidity and mortality. Common underlying associations include infectious, inflammatory, and neoplastic disorders, as well as drug reactions. Emerging diagnostic and therapeutic frameworks identify an expanding role for biologic and targeted anti-inflammatory therapies.

Sweet's Syndrome: An Update

Sweet's syndrome is a serious dermatological disorder characterized by a rapid onset of tender plaques or nodules, fever, joint pain, headache, and oral and genital lesions. According to the clinical features and underlying causes, Sweet's syndrome is divided into three categories, i.e., classical (or idiopathic), malignancy-associated Sweet's syndrome, and drug-induced Sweet's syndrome. It is multifactorial in etiology, and the exact cause is still undetermined. The diagnosis can be confirmed by the routine histopathologic evaluation of skin biopsy from the lesions. The first-line treatment options are topical and systemic steroids. Multiple databases, like Medline/PubMed, Scopus, and Google, were used to identify resources for this literature review. The relevant information was collected from various case reports, case series, reviews, meta-analyses, and large clinical trials reporting clinical description, etiology, diagnosis, and management of Sweet's syndrome. This narrative review aimed to discuss recent understandings related to Sweet's syndrome, both in terms of clinical presentation and management approach.

Multiple painful plaques and the Sweet's syndrome

We present a rare case of Sweet's syndrome. A 39-year-old woman with subjective fevers, polyarthralgia, and malaise presented with worsening painful erythematous plaques on the trunk, arms, and legs. Further examination with biopsy revealed a diagnosis of acute febrile neutrophilic dermatosis, or Sweet's syndrome. Diagnosis by skin biopsy is crucial, and onset requires prompt evaluation for serious associated disorders such as leukemias, inflammatory bowel disease, thyroid disease, sarcoidosis, and infectious etiologies. In general, symptoms and cutaneous manifestations of Sweet syndrome respond rapidly to treatment with systemic corticosteroids or potassium iodide.

The Influence of Pregnancy on the Clinical Evolution and Prognosis of Pre-Existing Inflammatory and Autoimmune Skin Disorders and Their Management

BACKGROUND

Although the possible occurrence of typical dermatoses during pregnancy is well recognized, little is known about the influence of pregnancy on the clinical evolution and prognosis of different pre-existing chronic dermatological disorders.

SUMMARY

In this study a comprehensive search of the available literature and reviews has been undertaken in order to collect and analyze articles reporting pre-existing chronic skin disorders in pregnant women and report current knowledge on their particular clinical and therapeutic aspects.

THE SWEET ICES FOR PREGNANT WOMEN

Daily food consumption norms of an average woman and a pregnant woman have been analysed. It has been established that in a pregnant woman’s diet, it is necessary to increase the content of proteins, fibre, vitamins C, E, D, PP, and B, and reduce fats, carbohydrates (easily digestible), vitamins B5 and H, sodium, magnesium, salts, and water. Taking into account the above-mentioned requirements, eight recipe compositions of sweet ices based on plant raw materials have been suggested. The recipes were selected by linear programming using MS Excel. The products have a low calorific content (26–137 kcal per 80 g), and an increased nutritional value (due to vitamin C, carotene, etc.). For the first time, cereals, various types of seeds, nuts, have been put into the recipe of sweet ices, as well as raw materials, which eliminate physiological complications during pregnancy. The products developed differ in their composition and are made without sugar. However, some recipes include small quantities of honey as it is highly palatable. The chemical composition of the new sweet products has been studied and analysed in details and sugar/acid indices have been calculated. The developed ices have a slightly acidic taste or no acidity at all, which corresponds to the values of sugar/acid indices 13.4–26.6, while the sample from the store, selected for comparison, contains a large amount of sugars, as evidenced by the cloying taste and high sugar/acid index (more than 30). The source of fatty acids in sweet ice for pregnant women Joy is almond nuts. The results of the chromatographic study have shown that this product as for the quantitative fatty acid composition, meets the current requirements. We recommend introducing the sweet ice manufacture technology on the equipment already in use in canneries. The products are formed (poured into moulds where wooden sticks are then inserted) in a Hassia machine. One of the main operations, freezing, is done in a quick freezer GyroFreze. We also recommend manufacturing sweet ices using existing restaurant equipment.