RESUMO
Peripheral edema with painful erythema is an increasingly recognized but poorly understood cutaneous adverse reaction to the antifolate agent pemetrexed. It is frequently misdiagnosed as cellulitis, and when it occurs, it is often dose-limiting. The authors report the case of a patient with preexisting lower extremity edema who developed extensive painful, bilateral erythema 5 days after administration of pemetrexed. An eosinophil-rich dermal inflammatory infiltrate was noted histologically. The authors review previously reported cases of pemetrexed-induced pseudocellulitis and discuss possible pathophysiology.
Assuntos
Antineoplásicos/efeitos adversos , Carcinoma Endometrioide/tratamento farmacológico , Celulite (Flegmão)/induzido quimicamente , Toxidermias/etiologia , Neoplasias do Endométrio/tratamento farmacológico , Eosinofilia/induzido quimicamente , Eosinófilos/efeitos dos fármacos , Pemetrexede/efeitos adversos , Pele/efeitos dos fármacos , Biópsia , Carcinoma Endometrioide/secundário , Celulite (Flegmão)/patologia , Toxidermias/patologia , Edema/induzido quimicamente , Neoplasias do Endométrio/patologia , Eosinofilia/patologia , Eosinófilos/patologia , Eritema/induzido quimicamente , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Pele/patologiaRESUMO
Background: Recently two outcome instruments have been developed and validated for assessing cutaneous sarcoidosis in a live, in-person setting. Teledermatology is a rapidly growing field; yet, to date, no instrument has been validated for use in a remote setting, which could ultimately impact clinical trial design. Objective: To assess the interrater reliability of these outcome instruments for store-and-forward teledermatology. Methods: Seven sarcoidosis experts, including both pulmonologists and dermatologists, scored photographs of cutaneous sarcoidosis lesions in 13 patients utilizing the Cutaneous Sarcoidosis Activity and Morphology Index (CSAMI), the Sarcoidosis Activity and Severity Index (SASI) and the Physician Global Assessment (PGA). Interrater reliability was assessed for each instrument and was compared to results obtained from a prior study involving sarcoidosis experts evaluating the same patient population in an in-person setting. Results: Interrater reliability (presented as ICC [95%CI]) was poor for the CSAMI Activity scale (0.36 [0.16 - 0.65]) and the CSAMI Damage scale (0.17 [0.04 - 0.43]) and was fair for the Modified Facial SASI (0.59 [0.36 - 0.82]) and the PGA (0.47 [0.23 - 0.74]). All results were inferior to those obtained from the prior studies validating these instruments for in-person use. Conclusions: Given the superiority of these instruments when utilized in person, it is recommended to have an on-site sarcoidosis expert evaluate cutaneous sarcoidosis lesions whenever possible. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 165-169).
Assuntos
Neoplasias Hematológicas/epidemiologia , Pacientes Internados , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Adulto , Distribuição por Idade , Idoso , Comorbidade , Bases de Dados Factuais , Dermatologia/normas , Dermatologia/tendências , Feminino , Neoplasias Hematológicas/diagnóstico , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Distribuição por SexoRESUMO
Hidradenitis suppurativa (HS) is a disease characterized by chronic follicular occlusion and secondary inflammation of the apocrine glands. The disease is uncommon but not rare. Further epidemiologic study is required to better determine HS prevalence in various populations. Women are affected three times more often than men, although HS tends to be more severe in men. The typical age of onset is in the second and third decades; HS is rare prior to puberty, and the prevalence is lower in older adults. A number of factors (particularly cigarette smoking) and comorbid conditions (especially obesity) are associated with HS, but causative relationships have not been established.
Assuntos
Hidradenite Supurativa , Adolescente , Adulto , Idade de Início , Idoso , Infecções Bacterianas , Criança , Feminino , Genes Dominantes , Hidradenite Supurativa/epidemiologia , Hidradenite Supurativa/etiologia , Hidradenite Supurativa/fisiopatologia , Hormônios/fisiologia , Humanos , Imunidade Celular , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Prevalência , Fatores de Risco , Distribuição por Sexo , Fumar/efeitos adversos , Adulto JovemRESUMO
The diagnosis of hidradenitis suppurativa (HS) is based on a characteristic history and physical exam. The anatomic sites of involvement include the axillae (most common), groin, and buttocks, and the perianal, perineal, and mammary regions. Initially, HS manifests with open comedones (usually with two or more "heads") and tender subcutaneous acneiform papules. Without intervention, the natural history of HS is chronic and progressive. More painful subcutaneous nodules form, which rupture and drain a thick, mucopurulent, foul-smelling fluid. Later, sinus tracts form, and, over time, ropelike fibrotic subcutaneous scarring occurs, which can lead to disabling contractures of the affected limbs. Clinically, the severity of disease is classified using the Hurley staging system, which provides guidance for choosing among treatment options.