Asunto(s)
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.
Asunto(s)
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.
Asunto(s)
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 RiesgoAsunto(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.
Asunto(s)
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
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.
Asunto(s)
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
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.
Asunto(s)
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
BACKGROUND: Marjolin ulcer (MU) is an aggressive cutaneous malignancy that commonly occurs in those with a chronic wound such as post-burn scar. CASE REPORT: A 20-year-old male who sustained a flame burn over the scalp at 3 months of age developed a nonhealing ulcer over the burn scar 20 years later, which was treated with adequate surgical margins with adjuvant mold brachytherapy. Two months after completion of that treatment, he developed parotid nodal metastasis with positron emission tomography (PET)-positive bilateral cervical, supraclavicular, right suboccipital, and mesenteric lymph nodes that were treated with concurrent chemoradiation. One month later, the patient developed an ulcerative lesion involving the left parotid region with PET showing infiltration of the parotid gland, but with resolution of other previous sites of uptake. The patient was treated surgically with radical parotidectomy with elective neck dissection and reconstruction with locoregional flap. At 6-month follow-up, the patient developed extensive locoregional recurrence and distant metastasis and was started on oral metronomic therapy. The patient was alive with stable disease at 3-month follow-up after initiation of palliative chemotherapy. CONCLUSION: Despite timely multimodality therapy, MU may present with a hostile clinical course with a short disease-free interval and early recurrence.
Asunto(s)
Neoplasias Cutáneas , Humanos , Masculino , Braquiterapia , Quemaduras/terapia , Quemaduras/complicaciones , Terapia Combinada , Disección del Cuello , Recurrencia Local de Neoplasia , Neoplasias de la Parótida/terapia , Neoplasias de la Parótida/patología , Procedimientos de Cirugía Plástica/métodos , Cuero Cabelludo/patología , Neoplasias Cutáneas/terapia , Neoplasias Cutáneas/patología , Úlcera Cutánea/terapia , Úlcera Cutánea/patología , Úlcera Cutánea/etiología , Resultado del Tratamiento , AdultoAsunto(s)
Papulosis Atrófica Maligna , Enfermedades del Pene , Úlcera Cutánea , Humanos , Masculino , Enfermedades del Pene/diagnóstico , Enfermedades del Pene/patología , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/patología , Úlcera Cutánea/etiología , Papulosis Atrófica Maligna/diagnóstico , Papulosis Atrófica Maligna/patología , Papulosis Atrófica Maligna/complicaciones , Persona de Mediana Edad , Dolor/etiología , Dolor/diagnósticoRESUMEN
Due to the dramatic reduction of sea cucumber Isostichopus badionotus populations in the Yucatan Peninsula by overfishing and poaching, aquaculture has been encouraged as an alternative to commercial catching and restoring wild populations. However, the scarcity of broodstock, the emergence of a new disease in the auricularia larvae stage, and the development of skin ulceration syndrome (SUS) in the culture have limited aquaculture development. This study presents the changes in the intestine and skin microbiota observed in early and advanced stages of SUS disease in cultured juvenile I. badionotus obtained during an outbreak in experimental culture through 16S rRNA gene sequencing and histological evidence. Our results showed inflammation in the intestines of juveniles at both stages of SUS. However, more severe tissue damage and the presence of bacterial clusters were detected only in the advanced stages of SUS. Differences in the composition and structure of the intestinal and skin bacterial community from early and advanced stages of SUS were detected, with more evident changes in the intestinal microbial communities. These findings suggest that SUS was not induced by a single pathogenic bacterium. Nevertheless, a decrease in the abundance of Vibrio and an increase in Halarcobacter (syn. Arcobacter) was observed, suggesting that these two bacterial groups could be keystone genera involved in SUS disease.
Asunto(s)
Microbiota , Pepinos de Mar , Piel , Animales , Piel/microbiología , Piel/patología , Pepinos de Mar/microbiología , Acuicultura , ARN Ribosómico 16S/genética , Úlcera Cutánea/microbiología , Úlcera Cutánea/epidemiología , Úlcera Cutánea/patología , Brotes de Enfermedades , Microbioma GastrointestinalAsunto(s)
Coma , Gangrena , Escorbuto , Sepsis , Humanos , Gangrena/etiología , Escorbuto/diagnóstico , Escorbuto/complicaciones , Coma/etiología , Masculino , Úlcera Cutánea/etiología , Úlcera Cutánea/patologíaRESUMEN
In this present study, carried out between November 2020 and July 2023 at Londrina's University Hospital, patients with active lesions of cutaneous leishmaniasis (CL) were analyzed regarding pain perception and anatomopathological aspects of the ulcers. Pain was assessed using a numerical rating scale (NRS) to compare five patients diagnosed with CL with four control patients diagnosed with vascular skin ulcers. Histopathological evaluations were used to investigate the nociceptor neuron-Leishmania interface. Patients with CL ulcers reported less pain compared to patients with vascular ulcers (2.60 ± 2.30 and 7.25 ± 0.95, respectively, p = 0.0072). Histopathology evidenced Leishmania spp. amastigote forms nearby sensory nerve fibers in profound dermis. Schwann cells marker (S100 protein) was detected, and caspase-3 activation was not evidenced in the in the nerve fibers of CL patients' samples, suggesting absence of apoptotic activity in nerve endings. Additionally, samples taken from the active edge of the lesion were negative for bacilli acid-alcohol resistant (BAAR), which excludes concomitant leprosy, in which painless lesions are also observed. Thus, the present data unveil for the first time anatomopathological and microbiological details of painless ulcers in CL patients, which has important clinical implications for a better understanding on the intriguing painless clinical characteristic of CL.
Asunto(s)
Apoptosis , Leishmania , Leishmaniasis Cutánea , Úlcera Cutánea , Humanos , Masculino , Femenino , Leishmaniasis Cutánea/patología , Leishmaniasis Cutánea/parasitología , Adulto , Persona de Mediana Edad , Úlcera Cutánea/parasitología , Úlcera Cutánea/patología , Células Receptoras Sensoriales/patología , Neuronas/patología , Anciano , Piel/parasitología , Piel/patología , Piel/inervaciónRESUMEN
A man with a history of polysubstance use presents with new bullae on his bilateral lower extremities. What is your diagnosis?
Asunto(s)
Muslo , Humanos , Vesícula/patología , Vesícula/etiología , Vesícula/diagnóstico , Úlcera Cutánea/patología , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/etiología , Masculino , Femenino , Persona de Mediana EdadRESUMEN
BACKGROUND: CCD presents as non-caseating granulomas within the skin at a site distant from the GI tract. CCD is a debilitating extraintestinal sequela of CD that can sometimes precede its GI manifestations. In the absence of GI symptoms, the histopathologic and clinical features of CCD can present as a variety of inflammatory skin conditions that can range from ruptured follicle-associated granulomas to cutaneous ulcerations. While a variety of therapeutic options for patients with CCD and concurrent luminal CD have been described in the literature, there is no standard treatment algorithm for the management of refractory CCD with limited or covert GI involvement. CASE REPORT: The authors discuss the case of a 33-year-old female who presented to the wound care clinic with multiple "knife-edged" cutaneous ulcerations involving the intertriginous spaces, found to be consistent with CCD. Her original cutaneous symptoms and diagnosis manifested with minimal GI involvement and responded to IVIG treatment. CONCLUSIONS: This case supports the inclusion of CCD in the differential diagnosis in patients with knife-edged granulomatous skin lesions in intertriginous locations. This clinical condition may present in the setting of no or limited GI symptoms. The management of CCD and a proposed treatment algorithm are also presented.
Asunto(s)
Enfermedad de Crohn , Úlcera Cutánea , Humanos , Femenino , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/terapia , Adulto , Úlcera Cutánea/patología , Úlcera Cutánea/diagnóstico , Úlcera Cutánea/terapia , Úlcera Cutánea/etiología , Diagnóstico Diferencial , Resultado del Tratamiento , Granuloma/patología , Granuloma/diagnóstico , Granuloma/terapia , Inmunoglobulinas Intravenosas/uso terapéuticoRESUMEN
Cytomegalovirus (CMV) infection is common and often self-limited. Reactivation results in a variety of disease presentations, especially in the setting of immunocompromise. While cutaneous manifestations of systemic CMV infection are rare, dermatologic manifestations of CMV are increasingly reported with a wide morphologic spectrum clinically. Three male patients, with untreated human immunodeficiency virus (HIV), penile lichenoid dermatitis treated with long-term topical and intralesional corticosteroids, and metastatic Merkel cell carcinoma on immune checkpoint inhibitor therapy, each presented with isolated cutaneous ulcers. The ulcers were located on the perianal skin, glans of the penis, and distal thumb. In each case, nonspecific histopathologic features were seen. However, very rare dermal cytomegalic cells with nuclear and cytoplasmic inclusions were present and highlighted with an immunohistochemical stain for CMV. Isolated ulcers due to CMV infection may occur in the setting of systemic or localized immunosuppression. A high index of suspicion is needed upon histopathologic evaluation, as few cytomegalic cells may be present and accurate diagnosis is crucial for prompt and appropriate clinical management.
Asunto(s)
Infecciones por Citomegalovirus , Humanos , Infecciones por Citomegalovirus/patología , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/virología , Masculino , Persona de Mediana Edad , Citomegalovirus/aislamiento & purificación , Anciano , Úlcera Cutánea/patología , Úlcera Cutánea/virología , Úlcera Cutánea/diagnóstico , Huésped Inmunocomprometido , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Enfermedades Cutáneas Virales/patología , Enfermedades Cutáneas Virales/diagnóstico , Enfermedades Cutáneas Virales/virologíaRESUMEN
Systemic sclerosis (SSc) is an autoimmune disease characterized by vasculopathy, aberrant immune activation, and extensive tissue fibrosis of the skin and internal organs. Because of the complicated nature of its pathogenesis, the underlying mechanisms of SSc remain incompletely understood. Angiogenic factor with a G-patch domain and a Forkhead-associated domain 1 (AGGF1) is a critical factor in angiogenesis expressed on vascular endothelial cells, associated with inflammatory and fibrotic responses. To elucidate the possible implication of AGGF1 in SSc pathogenesis, we investigated the association between serum AGGF1 levels and clinical manifestations in SSc patients. We conducted a cross-sectional analysis of AGGF1 levels in sera from 60 SSc patients and 19 healthy controls with enzyme-linked immunosorbent assay. Serum AGGF1 levels in SSc patients were significantly higher than those in healthy individuals. In particular, diffuse cutaneous SSc patients with shorter disease duration had higher levels compared to those with longer disease duration and limited cutaneous SSc patients. Patients with higher serum AGGF1 levels had a higher incidence of digital ulcers, higher modified Rodnan Skin Scores (mRSS), elevated serum Krebs von den Lungen-6 (KL-6) levels, C-reactive protein levels, and right ventricular systolic pressures (RVSP) on the echocardiogram, whereas they had reduced percentage of vital capacity (%VC) and percentage of diffusing capacity of the lungs for carbon monoxide (%DLCO) in pulmonary functional tests. In line, serum AGGF1 levels were significantly correlated with mRSS, serum KL-6 and surfactant protein D levels, RVSP, and %DLCO. These results uncovered notable correlations between serum AGGF1 levels and key cutaneous and vascular involvements in SSc, suggesting potential roles of AGGF1 in SSc pathogenesis.