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Liu JC, Dong ST, Shi DM. Acitretin Treatment Improves a Case of Severe Generalized Epidermodysplasia Verruciformis. Mayo Clin Proc 2024; 99:435-436. [PMID: 38432748 DOI: 10.1016/j.mayocp.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 03/05/2024]
Affiliation(s)
- Jun-Cheng Liu
- Department of Clinical Medicine, Jining Medical University, Shandong Province, China
| | - Si-Tan Dong
- Department of Clinical Medicine, Jining Medical University, Shandong Province, China
| | - Dong-Mei Shi
- Department of Dermatology/Laboratory of Medical Mycology, Jining No.1 People's Hospital, Shandong Province, China.
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2
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Chandler DJ, Walker SL. HIV and skin infections. Clin Dermatol 2024; 42:155-168. [PMID: 38142787 DOI: 10.1016/j.clindermatol.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
HIV infection alters the skin microbiome and predisposes to a wide range of cutaneous infections, from atypical presentations of common skin infections to severe disseminated infections involving the skin that are AIDS-defining illnesses. Bacterial infection of the skin, most commonly caused by Staphylococcus aureus, occurs frequently and can result in bacteremia. Nontuberculous mycobacterial infections that are usually localized to the skin may disseminate, and guidance on the treatment of these infections is limited. Herpes simplex can be severe, and less common presentations such as herpetic sycosis and herpes vegetans have been reported. Severe herpes zoster, including disseminated infection, requires intravenous antiviral treatment. Viral warts can be particularly difficult to treat, and in atypical or treatment-resistant cases a biopsy should be considered. Superficial candidosis occurs very commonly in people living with HIV, and antifungal resistance is an increasing problem in non-albicans Candida species. Systemic infections carry a poor prognosis. In tropical settings the endemic mycoses including histoplasmosis are a problem for people living with HIV, and opportunistic infections can affect those with advanced HIV in all parts of the world. Most cutaneous infections can develop or worsen as a result of immune reconstitution in the weeks to months after starting antiretroviral therapy. Direct microscopic examination of clinical material can facilitate rapid diagnosis and treatment initiation, although culture is important to provide microbiological confirmation and guide treatment.
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Affiliation(s)
- David J Chandler
- Dermatology Department, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Global Health & Infection, Brighton and Sussex Medical School, Brighton, UK.
| | - Stephen L Walker
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
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3
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Kosumi H, Natsuga K, Yanagi T, Ujiie H. Systemic Retinoids for Generalized Verrucosis Due to Congenital Immunodeficiency: Case Reports and Review of the Literature. Genes (Basel) 2023; 14:genes14030769. [PMID: 36981039 PMCID: PMC10048204 DOI: 10.3390/genes14030769] [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: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Generalized verrucosis (GV) is a group of immunodeficiency disorders accompanied by widespread human papillomavirus infection. We revisit two cases of GV due to congenital interleukin-7 deficiency successfully treated with systemic retinoids. We also present a review of the literature on the use of systemic retinoids to treat GV. Our review suggests that systemic retinoids are a safe and effective option for managing recalcitrant wart lesions in cases of GV.
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Affiliation(s)
- Hideyuki Kosumi
- Department of Dermatology, Hokkaido University Hospital, Sapporo 060-8638, Japan
| | - Ken Natsuga
- Department of Dermatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Teruki Yanagi
- Department of Dermatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo 060-8638, Japan
| | - Hideyuki Ujiie
- Department of Dermatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo 060-8638, Japan
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4
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Kinariwalla N, Coromilas AJ, Garzon MC, Levin LE, Magro C, Lauren CT. Acquired epidermodysplasia verruciformis (AEV) in three children after cardiac transplantation: A case series and review of the literature. Pediatr Dermatol 2021; 38:1541-1545. [PMID: 34669978 DOI: 10.1111/pde.14701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Acquired epidermodysplasia verruciformis (AEV) describes epidermodysplasia verruciformis developing in an immunocompromised host. There is limited information in the literature regarding AEV in the pediatric population; of the patients reported, most patients described had HIV, with only two reported cases of children who developed AEV post-transplantation. This case series describes three pediatric patients who developed AEV on immunosuppressant therapy following cardiac transplantation. We review risk factors, treatment options, and prognosis of AEV in the pediatric population.
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Affiliation(s)
- Neha Kinariwalla
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Alexandra J Coromilas
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Maria C Garzon
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Laura E Levin
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Cynthia Magro
- Department of Pathology, Weill Cornell Medical College, New York, NY, USA
| | - Christine T Lauren
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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5
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Moore S, Rady P, Tyring S. Acquired epidermodysplasia verruciformis: clinical presentation and treatment update. Int J Dermatol 2021; 61:1325-1335. [PMID: 34403500 DOI: 10.1111/ijd.15857] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 12/01/2022]
Abstract
Acquired epidermodysplasia verruciformis (AEV) is a form of epidermodysplasia verruciformis (EV) that is most commonly found in immunocompromised or immunosuppressed patients. EV is commonly associated with human papillomavirus (HPV), which is often found in EV and AEV lesions. Clinical presentation of AEV in patients with organ transplantation, HIV+, congenital HIV+, hematological diseases, and other iatrogenic immunosuppression are reviewed. Treatment options include topical cidofovir, topical retinoids, topical imiquimod, topical glycolic acid, HPV 9-valent vaccine, acitretin, improving cellular immunity, and changing transplant medication to mycophenolate mofetil.
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Affiliation(s)
- Stephen Moore
- Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA.,Rice University, Houston, Texas, USA
| | - Peter Rady
- Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
| | - Stephen Tyring
- Department of Dermatology, McGovern Medical School at UTHealth, Houston, Texas, USA
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Khalid HN, Abd El Gayed EM, Dawoud RA, Bazid HAS. Measuring the serum level of retinol-binding protein can enhance the treatment of recalcitrant warts. J Cosmet Dermatol 2020; 20:1031-1036. [PMID: 33247626 DOI: 10.1111/jocd.13683] [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: 06/28/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Warts are common benign (60%-65%) self-limited tumors of the epidermis caused by human papillomaviruses (HPVs). However, some warts fail to resolve despite of different treatments and become recalcitrant. Vitamin A has antiproliferative and antikeratinizing properties by which the disruption of HPV replication can be occurred. Concentrations of retinol-binding protein (RBP) and retinol in the circulation highly correlate with each others. AIM To assess the serum level of RBP in patients with resistant warts to evaluate the possible role of retinol in the disease pathogenesis. PATIENTS This case-control study included 30 patients with resistant cutaneous warts (defined as failure of cure after conventional treatment as 12 weeks of salicylic acid application, 4 or more cycles of cryotherapy or electrocautery and/or other physical treatment modalities) and 30 age- and sex-matched healthy controls. RBP level in the serum was measured by ELISA. RESULTS There was a significant difference between cases and controls regarding the level of serum RBP (P = .001). However, serum RBP level did not differ significantly regarding sociodemographic or clinical data (P > .05 each). RBP is a good biomarker for significant early detection and discrimination between cases and controls (P = .001) at a cutoff point < 563.3 mg/l with sensitivity (93%) and specificity (80%). CONCLUSION Low serum RBP level in our studied patients may suggest an important role of retinol in the resistant warts pathogenesis. Thus measuring serum RBP will help to identify patients who are going to have resistant warts in the future.
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Affiliation(s)
- Hesham N Khalid
- Dermatology and Andrology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | - Eman M Abd El Gayed
- Medical Biochemistry Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
| | | | - Heba A S Bazid
- Dermatology and Andrology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Egypt
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Abdelmaksoud A, Lotti T, Anadolu R, Goldust M, Ayhan E, Dave DD, Vestita M, Ebik B, Gupta M. Low dose of isotretinoin: A comprehensive review. Dermatol Ther 2020; 33:e13251. [PMID: 32022958 DOI: 10.1111/dth.13251] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/04/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
Isotretinoin is a first-generation retinoid initially approved for the treatment of severe cases of acne vulgaris (nodulocystic acne). Because of its broad anti-inflammatory and immunomodulatory properties, it has been used beyond its initial approval in a myriad of other indications. Adverse effects of isotretinoin vary from xerosis to teratogenicity. Herein, we reviewed the literature, through date-unlimited PubMed search, from inception till December 2019, using the following search terms: "low-dose isotretinoin" and "dermatology," "isotretinoin and safety," "isotretinoin, off-label uses," "isotretinoin and male fertility," "isotretinoin, iPLEDGE system," aiming to deliver a therapeutic update relevant to clinical practice. All English-language articles were considered with no limitation based on the articles' type. Low-dose isotretinoin is not limited to old and novel dermatological conditions, but also showed promising results in the field of infertility and safety in the field of gastroenterology. We also highlight on the safety profile of the drug and experts' recommendations to enhance safety measures to decrease fetal risk while on isotretinoin.
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Affiliation(s)
- Ayman Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
| | - Torello Lotti
- Department of Dermatology, University of Rome "G.Marconi", Rome, Italy
| | - Rana Anadolu
- Department of Dermatology, Venerology and Dermatopathology, International Dermatology, Dermatopathology, Esthetics and Anti-aging Academy (IDEA), Istanbul, Turkey.,Dermatology Clinic, Ankara, Turkey.,Faculty of Medicine, Department of Dermatology, Ankara University, Ankara, Turkey
| | - Mohamed Goldust
- University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Erhan Ayhan
- Department of Dermatology, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | | | - Michelangelo Vestita
- Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Berat Ebik
- Division of Gastroenterology Diyarbakir, Dicle University Faculty of Medicine, Kıtılbıl, Turkey
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9
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El‐Esawy F, Mustafa AI, El‐Shimi O. Serum retinol‐binding protein: a novel biomarker for recalcitrant cutaneous warts. Int J Dermatol 2019; 58:1435-1438. [DOI: 10.1111/ijd.14475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/17/2019] [Accepted: 04/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Fatma El‐Esawy
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Benha University Benha Egypt
| | - Amany I. Mustafa
- Department of Dermatology, Venereology and Andrology Faculty of Medicine Benha University Benha Egypt
| | - Ola El‐Shimi
- Clinical and Chemical Pathology Department Faculty of Medicine Benha University Benha Egypt
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11
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Dave DD, Abdelmaksoud A. Low dose isotretinoin as an adjuvant therapy for treatment of different clinical variants of warts: A case series. Dermatol Ther 2019; 32:e12836. [DOI: 10.1111/dth.12836] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/08/2018] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
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12
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Zampetti A, Giurdanella F, Manco S, Linder D, Gnarra M, Guerriero G, Feliciani C. Acquired Epidermodysplasia Verruciformis: A Comprehensive Review and a Proposal for Treatment. Dermatol Surg 2013; 39:974-80. [DOI: 10.1111/dsu.12135] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Proietti I, Skroza N, Bernardini N, Nicolucci F, Tolino E, La Viola G, Orsini D, Zuber S, Potenza C. Acitretin in management of diffuse common warts: a case report. Dermatol Ther 2012; 24:581-3. [PMID: 22515673 DOI: 10.1111/j.1529-8019.2012.01408.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Warts are among the most commonly observed dermatological diseases, caused by human papilloma virus (HPV), usually HPV1-2 subtypes; HPV4-7 are rarely found and mostly related to professional exposure (butchers and dairy workers). Different therapeutical approaches are possible, depending on extension and severity of lesions. The present authors describe the case of 32-year-old Caucasian man, who came to our attention for the presence of numerous exophytic papules on the back of both hands and over periungual regions, which appeared about 6 months before. Histological examination confirmed the clinical suspicion of common warts (HPV4). The patient underwent therapy by acitretin for 12 weeks, obtaining during the 8th week of therapy complete resolution of skin lesions. The present authors present this case for the unusual local aggressiveness of viral warts in an immunocompetent patient successfully treated with acitetrin.
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Affiliation(s)
- Ilaria Proietti
- Department of Dermatology "Daniele Innocenzi," University of Rome "Sapienza," Polo Pontino, Italy
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Abstract
BACKGROUND Epidermodysplasia verruciformis (EV) is a genodermatosis, characterized by human papilloma virus infection, with polymorphic and disseminated lesions that develop malignant transformation in approximately half of patients. MATERIALS AND METHODS We describe clinical and epidemiological features of 10 cases of EV during a 5-year period. All were treated using curettage of the nonmalignant wart-like lesions with a curette and application of 35% trichloroacetic acid (TCA) with a cotton bud for a few seconds. RESULTS Ten patients aged 33 to 67, nine women and one man, were treated, mainly presenting flat, brownish, wart-like lesions distributed on the anterior and posterior trunk. Two patients developed squamous cell carcinoma, histologically confirmed, that was surgically removed using fusiform excision. Good cosmetic results were obtained, and there was no reappearance of lesions during a mean follow-up of 3.5 years. CONCLUSION Curettage and application of 35% TCA that we have used in these patients has been shown to be an effective and low-cost alternative, compared to oral, topical, or other physical ablative therapies, with satisfactory cosmetic results and no recurrence during follow-up.
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Affiliation(s)
- Mariana V Hoffner
- Department of Dermatology, Virgen Macarena University Hospital, Seville, Spain.
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Rallis E, Paparizos V, Kyriakis K, Katsambas A. Treatment of epidermodysplasia verruciformis in human immunodeficiency virus-positive patients. J Eur Acad Dermatol Venereol 2009; 23:195-6. [DOI: 10.1111/j.1468-3083.2008.02769.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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