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Exantema , Poliarteritis Nudosa , Úlcera Cutánea , Humanos , Poliarteritis Nudosa/diagnóstico , Poliarteritis Nudosa/tratamiento farmacológico , Poliarteritis Nudosa/complicaciones , Úlcera Cutánea/etiología , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/patología , Resultado del Tratamiento , Exantema/etiología , Exantema/diagnóstico , Piel/patología , Biopsia , Femenino , Masculino , Inmunosupresores/uso terapéuticoRESUMEN
Chronic skin ulcers in patients with suspected pyoderma gangrenosum can, on closer inspection and further workup, have a different cause. Recognition of key features on clinical examination such as the presence of atrophie blanche is key to avoid misdiagnosis of pyoderma gangrenosum and its subsequent treatment with high-dose corticosteroids and other immunosuppressive medications.
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Hidroxiurea , Piodermia Gangrenosa , Trombocitemia Esencial , Humanos , Hidroxiurea/efectos adversos , Hidroxiurea/uso terapéutico , Trombocitemia Esencial/tratamiento farmacológico , Trombocitemia Esencial/complicaciones , Piodermia Gangrenosa/tratamiento farmacológico , Piodermia Gangrenosa/diagnóstico , Piodermia Gangrenosa/patología , Piodermia Gangrenosa/inducido químicamente , Enfermedad Crónica , Femenino , Úlcera Cutánea/patología , Úlcera Cutánea/inducido químicamente , Anciano , Úlcera de la PiernaAsunto(s)
Histiocitosis de Células de Langerhans , Úlcera Cutánea , Humanos , Histiocitosis de Células de Langerhans/complicaciones , Histiocitosis de Células de Langerhans/diagnóstico , Histiocitosis de Células de Langerhans/patología , Úlcera Cutánea/patología , Úlcera Cutánea/etiología , Biopsia , Masculino , Piel/patología , Femenino , Resultado del Tratamiento , InmunohistoquímicaRESUMEN
BACKGROUND: Systemic sclerosis (SSc) is a complex autoimmune connective-tissue disease, characterised by vasculopathy and fibrosis of the skin and internal organs. Activation of microvascular endothelial cells (ECs) causes the intimal hyperplasia that characterises the vascular remodelling in SSc. The most frequent complication of SSc is the development of digital ulcers (DUs). Thymic stromal lymphopoietin (TSLP) may trigger fibrosis and sustain vascular damage. Aim of this study was to evaluate the correlation between serum level of TSLP and DUs. METHODS: 75 consecutive SSc patients were enrolled and serum TSLP levels were measured. The presence of history of DUs (HDU) was evaluated. Recurrent new DUs were defined as the presence of at least 3 episodes of DUs in a 12-months follow up period. The risk of developing new DUs was calculated by applying the capillaroscopic skin ulcer risk index (CSURI). RESULTS: The median value of TSLP was higher in patients with HDU than patients without HDU [181.67 pg/ml (IQR 144.67; 265.66) vs 154.67 pg/ml (IQR 110.67; 171.33), p < 0.01]. The median value of TSLP was higher in patients with an increased CSURI index than patients without an increased CSURI [188 pg/ml (IQR 171.33; 246.33) vs 159.33 pg/ml (IQR 128.67; 218), p < 0.01]. Kaplan-Meier curves demonstrated that free survival from new DUs was significantly (p < 0.01) lower in SSc patients with increased TSLP serum levels. CONCLUSION: TSLP might have a key role in digital microvascular damage of SSc patients.
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Biomarcadores , Citocinas , Dedos , Angioscopía Microscópica , Esclerodermia Sistémica , Úlcera Cutánea , Linfopoyetina del Estroma Tímico , Humanos , Esclerodermia Sistémica/sangre , Esclerodermia Sistémica/patología , Femenino , Masculino , Persona de Mediana Edad , Proyectos Piloto , Citocinas/sangre , Úlcera Cutánea/patología , Úlcera Cutánea/etiología , Úlcera Cutánea/sangre , Adulto , Factores de Riesgo , Biomarcadores/sangre , Dedos/irrigación sanguínea , Anciano , Microvasos/patología , Microvasos/metabolismo , Factores de Tiempo , Regulación hacia Arriba , Recurrencia , Fibrosis , Medición de RiesgoRESUMEN
OBJECTIVE: To develop evidence-based recommendations for the non-pharmacological and pharmacological management of Raynaud's phenomenon (RP) and digital ulcers (DUs) in patients with systemic sclerosis and other immune-mediated connective tissue diseases (CTDs). METHODS: A task force comprising 21 rheumatologists, two surgeons (vascular and plastic), two nurses, and one patient representative was established. Following a systematic literature review performed to inform the recommendations, statements were formulated and discussed during two meetings (one online and one in-person). Levels of evidence, grades of recommendation (GoR), and level of agreement (LoA) were determined. RESULTS: Five overarching principles and 13 recommendations were developed. GoR ranged from A to D. The mean ± standard difference (SD) LoA with the overarching principles and recommendations ranged from 7.8±2.1 to 9.8±0.4. Briefly, the management of RP and DUs in patients with CTDs should be coordinated by a multidisciplinary team and based on shared decisions with patients. Nifedipine should be used as first-line therapy for RP and/or DUs. Sildenafil, tadalafil, and/or iloprost IV are second-line options for severe and/or refractory patients with RP and/or DUs. Sildenafil, tadalafil and/or Iloprost IV, should be prescribed for healing and prevention (also including bosentan) of DUs. In patients with RP and/or DUs, non-pharmacological interventions might be considered as add-ons, but there is limited quality and quantity of scientific evidence supporting their use. CONCLUSIONS: These recommendations will inform rheumatologists, specialist nurses, other healthcare professionals, and patients about a comprehensive and personalized management of RP and DUs. A research agenda was developed to address unmet needs, particularly for non-pharmacologic interventions.
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Enfermedades del Tejido Conjuntivo , Dedos , Enfermedad de Raynaud , Esclerodermia Sistémica , Úlcera Cutánea , Humanos , Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/terapia , Dedos/irrigación sanguínea , Dedos/patología , Portugal , Enfermedad de Raynaud/terapia , Enfermedad de Raynaud/etiología , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/terapia , Úlcera Cutánea/terapia , Úlcera Cutánea/etiologíaAsunto(s)
Dolor Abdominal , Fiebre , Trastornos Puerperales , Úlcera Cutánea , Síndrome de Sweet , Adulto , Femenino , Humanos , Dolor Abdominal/etiología , Diagnóstico Diferencial , Fiebre/etiología , Periodo Posparto , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/etiología , Trastornos Puerperales/patología , Trastornos Puerperales/terapia , Úlcera Cutánea/etiología , Úlcera Cutánea/patología , Síndrome de Sweet/diagnóstico , Síndrome de Sweet/etiología , Síndrome de Sweet/patología , Síndrome de Sweet/terapia , Supuración/diagnóstico por imagen , Supuración/terapia , Drenaje , Antibacterianos/uso terapéutico , Glucocorticoides/uso terapéuticoRESUMEN
Loxosceles rufescens is a spider that may bite humans. To describe the clinical manifestations and treatment of patients with bites caused by L. rufescens, and present scanning electron microscopy of the spider. Twelve patients are described, seven with a confirmed aetiological diagnosis as a sample of the spider was captured. In one case, scanning electron microscopy of the spider was performed. Seven patients presented with a single necrotic ulcer of varying morphology, with a purulent-necrotic bed, located on the neck (one patient), buttock (one patient), thigh (one patient), legs (three patients) and foot (one patient). All patients complained of burning and pain. No systemic symptoms were observed. All patients were treated with sodium hypochlorite solution packs, an equine catalase gel, and polyhexamethylene biguanide cream. Oral analgesics were added. In one patient, oral prednisone was prescribed. Two patients with bacterial superinfections were treated with i.v. piperacillin/tazobactam or i.m. ceftriaxone. All patients recovered within eight weeks, however, a scar developed in five of six patients. The sequence of cutaneous manifestations due to L. rufescens bites is typical. At first, erythema and oedema forms, followed by a vesicle, blister or pustule and, finally, an eschar and scar. Systemic symptoms and signs are rare. To consider this spider as an aetiological agent of necrotic ulcers, it is necessary to capture a sample of the spider, dead or alive, which should then be identified by an expert. Corticosteroids, antibiotics and analgesics are frequently used. Surgery is often necessary.
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Microscopía Electrónica de Rastreo , Necrosis , Úlcera Cutánea , Picaduras de Arañas , Humanos , Picaduras de Arañas/complicaciones , Masculino , Femenino , Adulto , Animales , Persona de Mediana Edad , Úlcera Cutánea/patología , Úlcera Cutánea/etiología , Anciano , Araña Reclusa Parda , Hipoclorito de Sodio/uso terapéuticoRESUMEN
BACKGROUND: Chronic skin ulceration is a serious pathological condition for which the adjuvant use of platelet-rich plasma (PRP) has been indicated. However, evidence for the use of PRP in patients with chronic skin ulcers remains insufficient due to a large heterogeneity in experimental designs, PRP composition, and preparation protocols. OBJECTIVE: To assess previously published reports of the clinical effect of plasma rich in growth factors (PRGF) on chronic skin wounds. METHODS: A comprehensive search of the PubMed, Cochrane Library, and Scopus databases was performed to identify randomized controlled trials (RCTs) assessing the effect of PRGF on chronic ulcer healing, with no limitation regarding publication date (up to September 1, 2022). Percentage area reduction and probability of complete healing in chronic ulcers, pain reduction, infection risk, and cost savings were analyzed. A meta-analysis was performed, and the overall evidence was qualified using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS: A total of 113 studies were identified. After full-text screening, 5 RCTs met the inclusion criteria. The meta-analysis showed a significant effect of PRGF on both wound area reduction (mean difference, 56.90% [95% CI, 52.28-61.51], I² = 0%; P = .56) and on the probability of complete healing (RR, 7.07 [95% CI, 1.84-27.16], I² = 0%; P = .53) in chronic ulcers. The overall risk of bias rating was "some concerns," whereas the certainty of evidence was high for both outcomes. A qualitative analysis suggested that PRGF did not increase infection risk and was able to reduce wound pain. CONCLUSION: The use of PRGF significantly enhances wound area reduction and also the probability of complete healing in chronic ulcers. More studies are needed to assess the effect of PRGF on pain and infection, as well as its cost-effectiveness.
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Péptidos y Proteínas de Señalización Intercelular , Plasma Rico en Plaquetas , Ensayos Clínicos Controlados Aleatorios como Asunto , Úlcera Cutánea , Cicatrización de Heridas , Humanos , Cicatrización de Heridas/efectos de los fármacos , Péptidos y Proteínas de Señalización Intercelular/uso terapéutico , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/terapia , Enfermedad Crónica , Resultado del TratamientoRESUMEN
BACKGROUND: Trigeminal trophic syndrome is a rare cranial and facial condition caused by damage to the central or peripheral branches of the trigeminal nerve. This syndrome consists of a triad of anesthesia, paresthesia, and crescent-shaped facial ulcer involving the ala nasi and sometimes extending to the upper lip. Although previous screening for human immunodeficiency virus in some patients with trigeminal trophic syndrome was negative, we present a unique case of trigeminal trophic syndrome who tested positive for human immunodeficiency virus with eye complications. CASE PRESENTATION: We present a rare case of trigeminal trophic syndrome in a 44-year-old Black African woman who tested positive for human immunodeficiency virus. She presented with a 6-week history of progressive, persistent, and painless left sided facial and scalp ulcerations that started as small skin erosion. Diagnosis of trigeminal trophic syndrome was made on clinical grounds based on the triad of anesthesia, paresthesia, and unilateral crescent-shaped ulcer in the trigeminal dermatome and her past medical history. The ulcer healed completely after counseling and pharmacological therapy, but she later developed left periorbital cellulitis and left upper eyelid full-thickness defect. CONCLUSION: This is by far the first documented case of trigeminal trophic syndrome with a positive human immunodeficiency virus test. Testing for human immunodeficiency virus in patients with trigeminal trophic syndrome is necessary as this can help improve clinical management and treatment outcomes. Seeking the services of specialists remotely in resource constraint settings is beneficial for managing complications associated with trigeminal trophic syndrome.
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Infecciones por VIH , Humanos , Femenino , Adulto , Infecciones por VIH/complicaciones , Enfermedades del Nervio Trigémino/diagnóstico , Celulitis (Flemón)/diagnóstico , Úlcera Cutánea/etiología , Úlcera Cutánea/virología , Parestesia/etiología , Síndrome , Enfermedades de los Párpados/etiología , Enfermedades de los Párpados/diagnósticoAsunto(s)
Piperidinas , Inhibidores de Proteínas Quinasas , Pirimidinas , Humanos , Pirimidinas/administración & dosificación , Pirimidinas/uso terapéutico , Pirimidinas/efectos adversos , Piperidinas/administración & dosificación , Resultado del Tratamiento , Inhibidores de Proteínas Quinasas/administración & dosificación , Inhibidores de Proteínas Quinasas/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Administración Cutánea , Anciano , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/diagnóstico , Inhibidores de las Cinasas Janus/administración & dosificación , Inhibidores de las Cinasas Janus/uso terapéuticoAsunto(s)
Antibacterianos , Úlcera Cutánea , Tobramicina , Humanos , Tobramicina/administración & dosificación , Tobramicina/uso terapéutico , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Enfermedad Crónica , Úlcera Cutánea/tratamiento farmacológico , Administración Tópica , Masculino , Femenino , AncianoRESUMEN
In proper skin healing, inflammation will stop once the harmful microbes are removed. However, an excess and prolongation of inflammation can result in delayed healing. Thus, interventions that can limit the amount of inflammation can help promote wound healing. The use of olive oil in wound therapy has been of great interest. Herein, we will review studies that investigated the use of olive oil on diabetic foot ulcers, pressure ulcers, perineal ulcers, and chronic ulcers.
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Aceite de Oliva , Cicatrización de Heridas , Aceite de Oliva/farmacología , Aceite de Oliva/administración & dosificación , Humanos , Cicatrización de Heridas/efectos de los fármacos , Úlcera Cutánea/terapia , Úlcera Cutánea/tratamiento farmacológico , Pie Diabético/tratamiento farmacológico , Pie Diabético/terapia , Úlcera por Presión/tratamiento farmacológico , Úlcera por Presión/terapiaRESUMEN
ABSTRACT: Skin complications in individuals with an ostomy are widely reported and can cause physical and emotional challenges in everyday life. Chronic parastomal skin complications can be difficult to heal and cause significant pain.Two patients presented to the stomal therapy clinic for treatment and were diagnosed with chronic parastomal skin ulceration. Following standard treatment of wound management, topical corticosteroid ointment, and appliance review, the ulcers either were not improving or had reoccurred. Treatment with a combination cream consisting of 0.2% hyaluronic acid and 1% silver sulfadiazine was initiated, and both patients demonstrated complete healing.Treatment of parastomal skin ulceration with dual-action cream 0.2% hyaluronic acid and 1% silver sulfadiazine was successful for these two patients, with a reduction in pain and purulent fluid noted throughout treatment, in addition to a reduced cost of treatment when compared with standard protocols.
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Antiinfecciosos Locales , Ácido Hialurónico , Sulfadiazina de Plata , Cicatrización de Heridas , Humanos , Ácido Hialurónico/efectos adversos , Ácido Hialurónico/uso terapéutico , Ácido Hialurónico/administración & dosificación , Sulfadiazina de Plata/uso terapéutico , Sulfadiazina de Plata/administración & dosificación , Femenino , Antiinfecciosos Locales/uso terapéutico , Antiinfecciosos Locales/efectos adversos , Enfermedad Crónica , Cicatrización de Heridas/efectos de los fármacos , Masculino , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/etiología , Úlcera Cutánea/terapia , Anciano , Resultado del Tratamiento , Persona de Mediana Edad , Estomía/efectos adversos , Estomía/métodosRESUMEN
Febrile ulceronecrotic Mucha-Habermann disease is a rare and severe variant of pityriasis lichenoides, characterized by sudden onset of generalized ulceronecrotic papules that rapidly coalesce into ulcers associated with high fever. Systemic manifestations such as intravascular disseminated coagulation and pulmonary, cardiac, gastrointestinal, and central nervous system involvement are common. Treatment is based on oral corticosteroids, immunosuppressive drugs such as methotrexate, and general supportive treatment. The present case describes a stepwise approach to a patient with Mucha-Habermann disease with insufficient response to methotrexate.
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Metotrexato , Pitiriasis Liquenoide , Humanos , Fiebre/etiología , Herpes Simple , Inmunosupresores/uso terapéutico , Metotrexato/uso terapéutico , Pitiriasis Liquenoide/patología , Pitiriasis Liquenoide/tratamiento farmacológico , Úlcera Cutánea/etiología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/patologíaRESUMEN
BACKGROUND: Systemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc. METHODS: A systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed. RESULTS: Six recommendations were elaborated regarding the pharmacological treatment of Raynaud's phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found. CONCLUSION: These guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice.
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Enfermedad de Raynaud , Reumatología , Esclerodermia Sistémica , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/tratamiento farmacológico , Humanos , Brasil , Reumatología/normas , Enfermedad de Raynaud/tratamiento farmacológico , Sociedades Médicas , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Rituximab/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Úlcera Cutánea/etiología , Antirreumáticos/uso terapéuticoRESUMEN
OBJECTIVE: Raynaud phenomenon (RP) and digital ulcers (DUs) are the main signs of digital vasculopathy in systemic sclerosis (SSc). Selexipag is an oral prostacyclin agonist approved for SSc-related pulmonary arterial hypertension. Following our previous preliminary short-course report, we herein present long-term data on selexipag safety and efficacy in the treatment of SSc digital vasculopathy. METHODS: Selexipag was administered to patients with SSc with severe digital vasculopathy refractory or with contraindication to all other vasoactive therapies. Each subject was assessed at baseline and after 3, 6, and 12 months. Clinical outcomes related to RP and DUs were evaluated along with modified Rodnan skin score of the fingers. Digital perfusion was assessed by laser speckle contrast analysis (LASCA). Nailfold videocapillaroscopy (NVC) was also performed. RESULTS: Eight patients with SSc (63% female, mean age 50.1 years) received selexipag. After 12 months of treatment, RP was reported to significantly decrease in the number of daily episodes and mean duration (P < 0.001 and P = 0.01, respectively). All patients achieved a complete healing of their DUs (P = 0.03) within 6 months. A progressive reduction of fingers skin score was observed (P = 0.03). No structural changes of capillaries were noted on NVC. Conversely, LASCA revealed an important increase in total digital perfusion (P = 0.004) despite seasonal variability. The safety profile was consistent with that reported in the literature. CONCLUSION: We observed a sustained efficacy of selexipag on SSc digital vasculopathy during 1 year of administration. Our promising results encourage the design of a new randomized controlled trial to evaluate the effect of selexipag on SSc digital vasculopathy.
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Acetamidas , Dedos , Pirazinas , Enfermedad de Raynaud , Esclerodermia Sistémica , Humanos , Femenino , Esclerodermia Sistémica/tratamiento farmacológico , Esclerodermia Sistémica/complicaciones , Masculino , Persona de Mediana Edad , Enfermedad de Raynaud/tratamiento farmacológico , Enfermedad de Raynaud/etiología , Dedos/irrigación sanguínea , Resultado del Tratamiento , Acetamidas/uso terapéutico , Acetamidas/efectos adversos , Adulto , Pirazinas/uso terapéutico , Pirazinas/efectos adversos , Anciano , Úlcera Cutánea/etiología , Úlcera Cutánea/tratamiento farmacológico , Angioscopía Microscópica/métodosRESUMEN
ABSTRACT: Perianal ulcers (PAUs) related to antihemorrhoidal product use have been recently reported in the literature through a few case reports. However, other etiologies of PAU must be ruled out, including infectious disease, inflammatory disease, malignancy, pressure injuries, radiotherapy, and other topical drugs. In this report, the authors describe two cases of PAUs due to an antihemorrhoidal ointment. In case 1, a 68-year-old woman with a history of hemorrhoids presented with PAUs after using an antihemorrhoidal ointment for 2 months. The ulcers were assessed through a histopathologic study and treated with calcium alginate dressings, with complete re-epithelialization occurring after 2 months. In case 2, a 58-year-old woman with a history of hemorrhoids developed painful PAUs while using an antihemorrhoidal ointment for 2 months. No other probable cause was found, and the ulcers were treated by discontinuing the ointment. The ulcers showed marked improvement, and complete re-epithelialization occurred after 6 weeks without additional treatment.
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Hemorroides , Pomadas , Humanos , Femenino , Hemorroides/tratamiento farmacológico , Hemorroides/complicaciones , Anciano , Persona de Mediana Edad , Enfermedades del Ano/tratamiento farmacológico , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/etiología , Úlcera Cutánea/patología , Cicatrización de Heridas/efectos de los fármacosRESUMEN
ABSTRACT: Clinically amyopathic dermatomyositis (CADM) is a rare subtype of dermatomyositis that presents with cutaneous features and no muscle involvement. This case report describes a 26-year-old woman with recurrent and multiple digital ulcerations coinciding with the start of winter each year. There was no evidence of myopathy, and antibody testing yielded negative results. A diagnosis of CADM was ultimately made based on clinicopathologic correlation. The patient's ulcers demonstrated excellent response to a combination therapy of hydroxychloroquine and potent topical and systemic steroids. Herein, the authors discuss the pathologic and immunologic characteristics of CADM.