RESUMEN
SARS-CoV2 pandemic has affected dermatologypractice greatly. In view of the risk of transmission, physicians need to devise methods to perform procedures in a safer way. Our institute has adopted a number of innovative safety precautions steps, which are being outlined here.
Asunto(s)
Acrodermatitis/tratamiento farmacológico , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Metotrexato/administración & dosificación , Neumonía Viral/epidemiología , Piel/patología , Acrodermatitis/diagnóstico , Acrodermatitis/epidemiología , Administración Tópica , Adulto , COVID-19 , Comorbilidad , Fármacos Dermatológicos/administración & dosificación , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Pandemias , SARS-CoV-2RESUMEN
The pandemic of COVID-19 has captivated more than 3 million people across the globe affecting the dermatology practice as well. Due to the novel nature of the virus and concomitant lack of research, standard guidelines have not been set in place regarding the procedures. Currently, due to fear and spread of coronavirus aesthetic practice has taken a seat back. Dermatologic surgeon/aesthetician have to be prepared for the forthcoming alterations in the practice and adjust to the necessary precautionary methods. This articles aims to prepare dermatologist for the upcoming difficulties and precautions to be taken for conducting procedures in amidst of coronavirus.
Asunto(s)
COVID-19/epidemiología , Dermatología , SARS-CoV-2 , COVID-19/prevención & control , COVID-19/transmisión , Desinfección , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos , Respiradores N95 , VentilaciónRESUMEN
Pyoderma gangrenosum (PG) is a rare auto-inflammatory, neutrophilic, ulcerative disorder characterised by acutely painful, rapidly spreading, sterile ulcers over the trunk and lower limbs. The pathogenic mechansim of PG is under constant evolution and drugs are emerging to be a an important trigger. In the literature, 52 cases of drug-induced PG have been documented, of which cocaine laced with levamisole has shown most direct association, with a mean Naranjo score of 9. Other drugs probably associated with PG are isotretinoin, sunitinib, and propylthiouracil. We describe a case of a 59-year-old male who had multiple well-defined ulcers with a violaceous, undermined edge limited to the site of subcutaneous injection of insulin. Histopathological examination showed psoriasiform hyperplasia in the epidermis, with abundant infiltration of neutrophils in the dermis, consistent with the clinical diagnosis of PG. As per the modified Naranjo algorithm, the patient's total score was 7, indicating insulin to be the probable causative agent in our case. So, compiling temporal localisation of lesions to the site of administration of insulin and clinical, histopathological, and Naranjo score evidence all prompt the diagnosis of PG. Insulin stimulates the release of matrix-metalloproteinases 9 which acts as endopeptidases and also results in the chemotaxis of neutrophils, causing ulcer formation. This is the first case reporting PG triggered by insulin.