Asunto(s)
Adenosina Desaminasa/deficiencia , Adenosina Desaminasa/genética , Péptidos y Proteínas de Señalización Intercelular/deficiencia , Péptidos y Proteínas de Señalización Intercelular/genética , Úlcera de la Pierna/genética , Enfermedades Cutáneas Genéticas/diagnóstico , Adulto , Enfermedad Crónica , Consanguinidad , Humanos , Úlcera de la Pierna/patología , Masculino , Linaje , Enfermedades Cutáneas Genéticas/genéticaRESUMEN
Lower-limb ulcers in systemic sclerosis patients are rarely reported. The aim of this study was to describe the main causes and outcomes of lower-limb ulcers in systemic sclerosis patients and to assess factors associated with ischaemic causes (arterial disease and/or microvascular impairment). A retrospective, multicentre, case-control study was conducted in 2013 and 2014, including 45 systemic sclerosis patients presenting lower-limb ulcers between 2008 and 2013. The estimated prevalence of lower-limb ulcers among systemic sclerosis patients was 12.8%. Ulcers were related to venous insufficiency in 22 cases (49%), ischaemic causes in 21 (47%) and other causes in 2 (4%). Complete healing was observed in 60% of cases in a mean time of 10.3 months; 59% relapsed during a mean follow-up of 22 months. Ischaemic lower-limb ulcer outcomes were poor, with a 28.6% amputation rate. Logistic-regression multivariate analyses between ischaemic lower-limb ulcer cases and matched systemic sclerosis-controls identified past or concomitant digital ulcer and cutaneous sclerosis of the feet as independent risk factors associated with ischaemic lower-limb ulcers.
Asunto(s)
Isquemia/epidemiología , Úlcera de la Pierna/epidemiología , Esclerodermia Sistémica/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica , Distribución de Chi-Cuadrado , Progresión de la Enfermedad , Femenino , Francia/epidemiología , Humanos , Isquemia/diagnóstico , Isquemia/terapia , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/terapia , Recuperación del Miembro , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Esclerodermia Sistémica/diagnóstico , Esclerodermia Sistémica/terapia , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas , Adulto JovenAsunto(s)
Carcinoma de Células Escamosas/complicaciones , Liquen Plano/complicaciones , Neoplasias Cutáneas/complicaciones , Úlcera Cutánea/complicaciones , Adulto , Anciano , Carcinoma de Células Escamosas/patología , Femenino , Enfermedades del Pie/complicaciones , Mano , Humanos , Masculino , Neoplasias Cutáneas/patologíaAsunto(s)
Fibrosarcoma/etiología , Joyas/toxicidad , Neoplasias Inducidas por Radiación/patología , Neoplasias de los Tejidos Blandos/etiología , Tórax/patología , Anciano de 80 o más Años , Resultado Fatal , Fibrosarcoma/patología , Humanos , Masculino , Metástasis de la Neoplasia , Esclerosis/etiología , Neoplasias de los Tejidos Blandos/patología , Torio/toxicidad , Uranio/toxicidadRESUMEN
OBJECTIVES: The broader and prolonged use of anti-tumor necrosis factor (TNF) agents in inflammatory bowel disease (IBD) could expose patients to an increased risk of adverse reactions, including dermatological complications. We assessed the cumulative incidence of anti-TNF-induced cutaneous adverse reactions in IBD patients, their risk factors, their dermatological management, and their outcome in a large cohort of IBD patients. METHODS: In a single-center observational retrospective study, including all consecutive adult IBD patients treated with an anti-TNF agent between 2001 and 2014, all patients with dermatological complications under anti-TNF therapy were identified in a well-defined cohort of IBD patients. We conducted a survival analysis to determine the cumulative incidence of dermatological complications and risk factors for developing any dermatological complications, cutaneous infections, and psoriasiform lesions. Survival curves were estimated by the Kaplan-Meier method, and we used a Cox proportional hazards model to test the association between parameters and time to each event: any dermatological complication, cutaneous infections, and psoriasis lesions. RESULTS: Among 583 IBD patients, 176 dermatological complications occurred, involving 20.5% of patients. Median duration of follow-up was 38.2 months (range: 1-179). Psoriasiform lesions (10.1%; 59/583) and cutaneous infections (11.6%, 68/583) were the most frequently observed, with a cumulative incidence of, respectively, 28.9% and 17.6% at 10 years. They led to anti-TNF discontinuation, respectively, in 18.6% and 2.9% of patients. In case of switching to another anti-TNF agent for psoriasiform lesions, recurrence occurred in 57% of patients. Ulcerative colitis was associated with a lower risk of developing cutaneous infections than Crohn's disease (hazard ratio (HR)=0.25; 95% confidence interval (CI)=0.09-0.68; P=0.007). Higher dosing of anti-TNF agent was associated with a higher risk of developing cutaneous infections (HR=1.99; 95% CI=1.09-3.64; P=0.025). A younger age at time of anti-TNF initiation was associated with a higher risk of dermatological complications (HR=2.25; 95% CI=1.39-3.62; P<0.001). CONCLUSIONS: Dermatological complications involve one of five patients treated with anti-TNF therapy after a 14-year follow-up. Association of cutaneous infections with higher anti-TNF dosing suggests a dose-dependent effect. Discontinuation of anti-TNF therapy due to dermatological complications is required in one out of five patients with psoriasiform lesions, but specific dermatological treatment allows to continue anti-TNF therapy in half of them.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Erupciones por Medicamentos/epidemiología , Psoriasis/epidemiología , Enfermedades Cutáneas Infecciosas/epidemiología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antiinflamatorios no Esteroideos/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados/administración & dosificación , Anticuerpos Monoclonales Humanizados/efectos adversos , Niño , Relación Dosis-Respuesta a Droga , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/patología , Femenino , Humanos , Incidencia , Infliximab , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Prevalencia , Modelos de Riesgos Proporcionales , Psoriasis/inducido químicamente , Psoriasis/tratamiento farmacológico , Estudios Retrospectivos , Factores de Riesgo , Enfermedades Cutáneas Infecciosas/inducido químicamente , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: Modern dressings (MDs) may have a low sensitization rate, but there is a lack of prospective studies in patients with chronic leg ulcers (CLUs) to evaluate this. OBJECTIVES: To determine the rate of sensitization (contact allergy) to MDs and substances present in dressings. PATIENTS AND METHODS: A prospective multicentre study was carried out in patients with CLUs at five French dermatology departments; patch tests were performed with the European baseline series and with an additional 27 individual allergens and 10 MDs. RESULTS: Among 354 patients (226 women and 128 men) with CLUs, 59.6% had at least one positive patch test reaction to an MD and 19% had at least one sensitization to an MD. The number of positive test reactions per patient was correlated with the duration of ulcerative disease, but not with ulcer duration, the cause of the ulcer, or the presence of surrounding eczematous lesions. For 11 of 45 patients sensitized to Ialuset cream®, more detailed information could be obtained with sensitization to sodium dehydroacetate (5 cases) or Lanette SX® (3 cases). CONCLUSIONS: Sensitization to MDs is not rare. It is absolutely necessary to label all components of MDs on their packaging and to avoid some sensitizing molecules, such as colophonium derivatives or any strong sensitizers.
Asunto(s)
Vendajes/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Úlcera de la Pierna/terapia , Anciano , Enfermedad Crónica , Femenino , Humanos , Masculino , Pruebas del Parche , Estudios ProspectivosAsunto(s)
Blefaritis/etiología , Neoplasias de la Mama/secundario , Neoplasias de la Conjuntiva/secundario , Conjuntivitis/etiología , Neoplasias de los Párpados/diagnóstico , Anciano , Biopsia , Blefaritis/diagnóstico , Neoplasias de la Mama/diagnóstico , Neoplasias de la Conjuntiva/diagnóstico , Conjuntivitis/diagnóstico , Diagnóstico Diferencial , Neoplasias de los Párpados/complicaciones , Femenino , HumanosRESUMEN
Nicorandil, a nicotinamide ester, was first reported to be involved in the induction of oral ulcers in 1997. Since then, many reports of single or multiple nicorandil-induced ulcerations (NIUs) have been reported. We hypothesised that in the case of high-dosage nicorandil or after an increased dosage of nicorandil, nicotinic acid and nicotinamide (two main metabolites of nicorandil) cannot appropriately merge into the endogenous pool of nicotinamide adenine dinucleotide/phosphate, which leads to abnormal distribution of these metabolites in the body. In recent or maintained trauma, nicotinamide increases blood flow at the edge of the raw area, inducing epithelial proliferation, while nicotinic acid ulcerates this epithelial formation, ultimately flooding the entire scar. We demonstrate, by comparison to a control patient non-exposed to nicorandil, an abnormal amount of nicotinic acid (×38) and nicotinamide (×11) in the ulcerated area in a patient with NIUs. All practitioners, especially geriatricians, dermatologists and surgeons, must be aware of these serious and insidious side effects of nicorandil. It is critical to rapidly reassess the risk-benefit ratio of this drug for any patient, and not only for those with diverticular diseases.
Asunto(s)
Niacina/metabolismo , Niacinamida/metabolismo , Nicorandil/efectos adversos , Úlcera Cutánea/inducido químicamente , Úlcera Cutánea/metabolismo , Vasodilatadores/efectos adversos , Anciano de 80 o más Años , Femenino , Humanos , Nicorandil/metabolismo , Úlcera Cutánea/patologíaAsunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Fármacos Dermatológicos/uso terapéutico , Psoriasis/tratamiento farmacológico , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Fármacos Dermatológicos/efectos adversos , Femenino , Humanos , Psoriasis/complicaciones , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/terapia , Índice de Severidad de la Enfermedad , UstekinumabAsunto(s)
Nicorandil/efectos adversos , Úlcera Cutánea/inducido químicamente , Vasodilatadores/efectos adversos , Desbridamiento , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/cirugía , Femenino , Humanos , Persona de Mediana Edad , Úlcera Cutánea/cirugía , Cicatrización de Heridas/efectos de los fármacosAsunto(s)
Antiinflamatorios/efectos adversos , Atención/efectos de los fármacos , Candidiasis Bucal/tratamiento farmacológico , Clobetasol/efectos adversos , Fármacos Dermatológicos/efectos adversos , Cefalea/inducido químicamente , Genio Irritable/efectos de los fármacos , Liquen Plano Oral/tratamiento farmacológico , Penfigoide Ampolloso/tratamiento farmacológico , Trastornos del Inicio y del Mantenimiento del Sueño/inducido químicamente , Absorción , Administración Cutánea , Administración Tópica , Anciano , Agresión/efectos de los fármacos , Antiinflamatorios/administración & dosificación , Antiinflamatorios/farmacocinética , Antiinflamatorios/uso terapéutico , Candidiasis Bucal/complicaciones , Clobetasol/administración & dosificación , Clobetasol/farmacocinética , Clobetasol/uso terapéutico , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/farmacocinética , Fármacos Dermatológicos/uso terapéutico , Sobredosis de Droga , Humanos , Liquen Plano Oral/complicaciones , Masculino , Mucosa Bucal/efectos de los fármacos , Penfigoide Ampolloso/complicaciones , Absorción CutáneaRESUMEN
Lichen sclerosus et atrophicus (LSA) is an inflammatory disease that affects the genitals, which was first described by Hallopeau in 1887 and is of unknown etiology. Only 15% of patients have an associated extra-genital form, and 2.5% have an isolated extra-genital form. LSA treatment remains poorly codified and mostly empirical. Here, we report a case of LSA, of mainly cutaneous form, which was effectively treated using extracorporeal photochemotherapy (ECP). Remission was achieved quickly, after the fourth session, with excellent treatment tolerance. ECP is now recognized as an effective treatment for erosive lichen planus, graft-versus-host disease (GVHD), and scleroderma. Thus, we began ECP treatment for our cases of LSA based on clinical and/or anatomopathological similarities between LSA and these commonly ECP-treated disorders. The fact that ECP is effective in LSA, GVHD, erosive lichen planus, and scleroderma strengthen the hypothesis that there is a common link between these four conditions.
Asunto(s)
Liquen Escleroso y Atrófico/terapia , Fotoféresis , Femenino , Humanos , Liquen Escleroso y Atrófico/patología , Persona de Mediana Edad , Inducción de RemisiónAsunto(s)
Pustulosis Exantematosa Generalizada Aguda/patología , Enfermedad de Hashimoto/patología , Pustulosis Exantematosa Generalizada Aguda/tratamiento farmacológico , Adulto , Antitiroideos/uso terapéutico , Carbimazol/uso terapéutico , Colchicina/uso terapéutico , Diagnóstico Diferencial , Femenino , Enfermedad de Hashimoto/tratamiento farmacológico , Humanos , Tiroxina/uso terapéutico , Moduladores de Tubulina/uso terapéuticoAsunto(s)
Granuloma Anular/diagnóstico , Enfermedades del Pene/diagnóstico , Administración Tópica , Anciano de 80 o más Años , Antiinflamatorios/administración & dosificación , Clobetasol/administración & dosificación , Diagnóstico Diferencial , Granuloma Anular/tratamiento farmacológico , Humanos , Masculino , Enfermedades del Pene/tratamiento farmacológicoRESUMEN
Mutations in two genes encoding cell cycle regulatory proteins have been shown to cause familial cutaneous malignant melanoma (CMM). About 20% of melanoma-prone families bear a point mutation in the CDKN2A locus at 9p21, which encodes two unrelated proteins, p16(INK4a) and p14(ARF). Rare mutations in CDK4 have also been linked to the disease. Although the CDKN2A gene has been shown to be the major melanoma predisposing gene, there remains a significant proportion of melanoma kindreds linked to 9p21 in which germline mutations of CDKN2A have not been identified through direct exon sequencing. The purpose of this study was to assess the contribution of large rearrangements in CDKN2A to the disease in melanoma-prone families using multiplex ligation-dependent probe amplification. We examined 214 patients from independent pedigrees with at least two CMM cases. All had been tested for CDKN2A and CDK4 point mutation, and 47 were found positive. Among the remaining 167 negative patients, one carried a novel genomic deletion of CDKN2A exon 2. Overall, genomic deletions represented 2.1% of total mutations in this series (1 of 48), confirming that they explain a very small proportion of CMM susceptibility. In addition, we excluded a new gene on 9p21, KLHL9, as being a major CMM gene.