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Balazic E, Axler E, Konisky H, Khanna U, Kobets K. Pentoxifylline in dermatology. J Cosmet Dermatol 2023; 22:410-417. [PMID: 36208009 DOI: 10.1111/jocd.15445] [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: 08/14/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pentoxifylline was initially marketed for use in patients with intermittent claudication due to chronic occlusive arterial disease of the extremities but has since been shown to have several off-label uses in dermatology. AIMS The aim of this review is to increase awareness of the several applications of pentoxifylline in the field of dermatology. METHODS A comprehensive PubMed search was conducted in May 2022 using the following phrases "dermatology" AND "pentoxifylline." Our search period spanned 34 years from 1988 to 2022. All available literature was reviewed. Reference lists of identified articles were included. Studies were excluded if they were not in English and if the study was out of scope. Eighty-one articles were included in this review. RESULTS Pentoxifylline has been used to treat various dermatological conditions including peripheral vascular disease, vasculitis and vasculopathies, chilblains, pigmented purpuric dermatosis, granuloma annulare, necrobiosis, keloids, lichen sclerosis et atrophicus, scars, radiation-induced fibrosis, vitiligo, alopecia areata, leishmaniasis, and leprosy. CONCLUSIONS Pentoxifylline's use in dermatology is growing. However, there are limited larger studies and randomized control trials on the use of pentoxifylline in dermatology and more investigation is needed to evaluate its use for many dermatologic conditions. Pentoxifylline's unique mechanism of action as well as its good tolerability, cost-effectiveness, and minimal drug interactions make it a convenient primary or adjunctive option in many dermatological conditions.
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Affiliation(s)
- Eliza Balazic
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Eden Axler
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Hailey Konisky
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Urmi Khanna
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kseniya Kobets
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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Sattler SS, Magro CM, Shapiro L, Merves JF, Levy R, Veenstra J, Patel P. Gastrointestinal Kohlmeier-Degos disease: a narrative review. Orphanet J Rare Dis 2022; 17:172. [PMID: 35443671 PMCID: PMC9022239 DOI: 10.1186/s13023-022-02322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 04/09/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Kohlmeier-Degos (K-D) disease is a rare obliterative vasculopathy that can present as a benign cutaneous form or with potentially malignant systemic involvement. The gastrointestinal tract is most frequently involved in systemic disease and mortality is often related to bowel perforations. Herein, we provide information to providers and patients regarding gastrointestinal K-D symptomology, pathology, treatment, and diagnosis, with a focus on the importance of timely diagnostic laparoscopy. We present three new cases of gastrointestinal K-D to highlight varying disease presentations and outcomes. Body Based on reviewed reports, perforation is preceded by at least one gastrointestinal symptom: abdominal pain/cramping, anorexia/weight loss, vomiting, diarrhea, nausea, gastrointestinal bleeding, obstipation, constipation, and abdominal fullness. Perforation most commonly occurs in the small intestine and often results in sepsis and death. Although underutilized, laparoscopy is the most sensitive and specific diagnostic technique, demonstrating serosal porcelain plaques similar to those on the skin and characteristic for K–D. The combination of eculizumab and treprostinil is presently the most effective treatment option for gastrointestinal K–D. The pathology of gastrointestinal K-D is characterized by an obliterative intimal arteriopathy eventuating in occlusive acellular deposits of mucin and collagen along with an extravascular pauci-cellular sclerosing process resembling scleroderma confined to the subserosal fat. C5b-9 and interferon-alpha are both expressed in all caliber of vessels in the affected intestine. While C5b-9 blockade does not prevent the intimal expansion, enhanced type I interferon signaling is likely a key determinant to intimal expansion by, causing an influx of monocytes which transdifferentiate into procollagen-producing myofibroblast-like cells. Conclusion Prompt laparoscopic evaluation is necessary in any K–D patient with an abdominal symptom to facilitate diagnosis and treatment initiation, as well as to hopefully decrease mortality. Those with gastrointestinal K–D should start on eculizumab as soon as possible, as onset of action is immediate. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02322-9.
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Affiliation(s)
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lee Shapiro
- Division of Rheumatology, Albany Medical College, 6 Medical Park Drive, Malta, NY, 12020, USA.
| | - Jamie F Merves
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca Levy
- Division of Dermatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jesse Veenstra
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Puraj Patel
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
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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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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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Ali YN, Hamed M, Azita N. Lethal systemic degos disease with prominent cardio-pulmonary involvement. Indian J Dermatol 2012; 56:564-7. [PMID: 22121280 PMCID: PMC3221225 DOI: 10.4103/0019-5154.87157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 48-year-old man presented with acute abdominal pain underwent laparotomy that revealed two perforated ulcers in jejunum. He had skin lesions with porcelain white atrophic scar which were ignored for 3 years, whereas the disease revealed own malignant nature and progressed to nervous, gastrointestinal, and cardiopulmonary systems. The diagnosis of Degos disease was established on the basis of clinical and histopathological features. He expired due to cardio-pulmonary insufficiency after 5 months from the onset of systemic involvement. Autopsy showed diffuse fibrotic changes in serosal membranes and internal organs. Distribution of skin lesions that involved palmoplantar surfaces, genitalia and scalp and, furthermore, course of disease as rapid progressive cardio-polmunary involvement are remarkable point in this patient. On the other hand, this case highlights importance of clinicopathologic correlation, specially in the dermatologic field.
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Yamaguchi N, Isomoto H, Nakayama T. Clinical challenges and images in GI. Image 2: Malignant atrophic papulosis (Degos' disease) with systemic manifestations. Gastroenterology 2008; 135:1464, 1807. [PMID: 18851969 DOI: 10.1053/j.gastro.2008.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Naoyuki Yamaguchi
- Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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Saglik E, Baykal C, Buyukbabani N, Inanc M. Malignant atrophic papulosis: endocardial involvement and positive anticardiolipin antibodies. J Eur Acad Dermatol Venereol 2006; 20:602-3. [PMID: 16684293 DOI: 10.1111/j.1468-3083.2006.01339.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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