DOCSLIB.ORG

Successful Treatment of Refractory Pityriasis Rubra Pilaris With

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Successful Treatment of Refractory Pityriasis Rubra Pilaris With Letters Discussion | The results of this study reveal important differ- OBSERVATION ences in the microbiota of HS lesions in obese vs nonobese pa- tients. Gut flora alterations are seen in obese patients,4,5 and Successful Treatment of Refractory Pityriasis HS has been associated with obesity. It is possible that altered Rubra Pilaris With Secukinumab gut or skin flora could have a pathogenic role in HS. Pityriasis rubra pilaris (PRP) is a rare inflammatory skin dis- Some of the limitations of the present study include the order of unknown cause. It is characterized by follicular use of retrospective data and the lack of a control group con- hyperkeratosis, scaly erythematous plaques, palmoplantar sisting of patients with no history of HS. Although these cul- keratoderma, and frequent progression to generalized tures were obtained from purulence extruding from HS le- erythroderma.1 Six types of PRP are distinguished, with type sions, the bacterial culture results could represent skin or gut 1 being the most common form in adults. Disease manage- flora contamination. Information about the specific ana- ment of PRP is challenging for lack of specific guidelines. Topi- tomic locations of HS cultures was not available. Because only cal emollients, corticosteroids, and salicylic acid alone or com- the first recorded culture of each patient was analyzed, it is un- bined with systemic retinoids, methotrexate, and tumor known if the culture results would change with time and fur- necrosis factor (TNF) inhibitors are considered to be most ther antibiotic therapy. The use of data obtained from swab- helpful.2,3 Unfortunately, PRP often resists conventional treat- based cultures may also represent a potential limitation because ment. We report the case of a 67-year-old man with refrac- DNA-based approaches to microbial analysis may yield more tory PRP who was successfully treated with secukinumab. information and lead to identification of organisms that are not cultivable. The use of more advanced microbiome tech- Report of a Case |A 67-year-old man presented with an acute gen- niques may be an important consideration for future studies. eralized, erythematous and scaly eruption with spared patches These data indicate that further research is needed to eluci- of unaffected skin on his chest (Figure 1A). He also had pal- date the role of specific bacterial species in the pathogenesis moplantar keratoderma, nail dystrophy, and severe pruritus. of HS and may suggest a role for targeted treatment of spe- Skin biopsy confirmed the clinical diagnosis of PRP. Before on- cific bacterial species in this disorder. set of the PRP, he had not taken any new medication, and there was no evidence for allergies or chronic skin disorders in his Alessandra Haskin, BA personal or family history. Laboratory tests ruled out any in- Alexander H. Fischer, MPH fection, atopic disposition, autoimmune disease, or cancer. Ginette A. Okoye, MD Treatment was started with acitretin, 35 mg/d, correspond- ing to 0.5 mg/kg of body weight. In addition, acute flares were Author Affiliations: Ms Haskin was a student at Howard University College of treated with short-term systemic corticosteroid regimens com- Medicine, Washington, DC, at the time of the study. (Haskin); Department of bined with topical class IV corticosteroids. Dermatology, The Johns Hopkins School of Medicine, Baltimore, Maryland After 5 months of treatment, he still had severe pruritus and (Fischer, Okoye). presented with erythroderma, scaling, and palmoplantar kera- Accepted for Publication: May 26, 2016. toderma. Because there were several contraindications for con- Corresponding Author: Ginette A. Okoye, MD, Department of Dermatology, ventional immunosuppressive treatments, treatment was The Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave, Ste 2500, Baltimore, MD 21224. switched to secukinumab, a monoclonal anti–interleukin(IL)- Published Online: July 20, 2016. doi:10.1001/jamadermatol.2016.2337. 17A antibody approved for the treatment of moderate to Author Contributions: Ms Haskin and Dr Okoye had full access to all the data in severe plaque psoriasis. After giving written informed con- the study and take responsibility for the integrity of the data and the accuracy sent, the patient received 2 subcutaneous injections of of the data analysis. secukinumab, 150 mg each, once a week for 5 weeks, followed Study concept and design: Haskin, Okoye. by monthly injections. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: All authors. After 3 weeks of secukinumab treatment, the scaling Statistical analysis: Fischer. and pruritus were clearly reduced, and after 8 weeks, pruri- Conflict of Interest Disclosures: None reported. tus and erythema had completely cleared (Figure 1B). Corre- 1. Matusiak Ł, Bieniek A, Szepietowski JC. Bacteriology of hidradenitis spondingly, the typical histopathological features of PRP suppurativa: which antibiotics are the treatment of choice? Acta Derm Venereol. such as hyperplasia, acantholytic dyskeratosis, and hyper- 2014;94(6):699-702. keratosis (Figure 2A) had disappeared after 8 weeks of treat- 2. Lapins J, Jarstrand C, Emtestam L. Coagulase-negative staphylococci are the ment with secukinumab (Figure 2B). After 6 months, the most common bacteria found in cultures from the deep portions of hidradenitis suppurativa lesions, as obtained by carbon dioxide laser surgery. Br J Dermatol. palmoplantar keratoderma had also disappeared, and nail 1999;140(1):90-95. growth was normal. No clinical or laboratory adverse effects 3. Revuz JE, Canoui-Poitrine F, Wolkenstein P, et al. Prevalence and factors were registered. associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol. 2008;59(4):596-601. Discussion | The treatment options for PRP are mainly based on 4. Bervoets L, Van Hoorenbeeck K, Kortleven I, et al. Differences in gut clinical observations and are partly adopted from psoriasis microbiota composition between obese and lean children: a cross-sectional therapy because psoriasis shares some clinical and histopatho- study. Gut Pathog. 2013;5(1):10. logical features with PRP.4 In the last decade, various biologi- 5. Ferrer M, Ruiz A, Lanza F, et al. Microbiota from the distal guts of lean and obese adolescents exhibit partial functional redundancy besides clear cal therapies have improved the treatment options of psoria- differences in community structure. Environ Microbiol. 2013;15(1):211-226. sis. Some case reports have also reported successful treatment 1278 JAMA Dermatology November 2016 Volume 152, Number 11 (Reprinted) jamadermatology.com Copyright 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 Letters Figure 1. Clinical Images Before and After Secukinumab Treatment of Pityriasis Rubra Pilaris A Before treatment B After treatment A, At presentation. B, After 8 weeks of treatment with secukinumab. Figure 2. Hematoxylin-Eosin–Stained Histopathological Images of Punch Biopsy Specimens From Pityriasis Rubra Pilaris (PRP) Lesions on the Back A Before treatment B After treatment A, The typical histopathological features of PRP are seen, such as hyperplasia, acantholytic dyskeratosis, and hyperkeratosis (original magnification ×400). B, These features had disappeared after 8 weeks of treatment with secukinumab (original magnification ×400). of PRP with TNF and IL-12/23 antagonists.3,5 We demonstrate for Author Affiliations: Department of Dermatology, Medical Center–University of Freiburg, Freiburg, Germany. the first time to our knowledge that the IL-17A inhibitor secukinumab is effective in the treatment of severe, therapy- Corresponding Author: Christoph M. Schempp, MD, PhD, Department of Dermatology, Medical Center–University of Freiburg, Hauptstr 7, D-79104 refractory PRP. Secukinumab was approved for the treatment of Freiburg, Germany ([email protected]). 6 moderate to severe plaque psoriasis in 2015. In the present pa- Correction: This article was corrected on November23, 2016, to add omitted tient with PRP, skin alterations almost completely disappeared third author’s name in print versions. after 6 months of treatment. We cannot completely exclude the Published Online: October 5, 2016. doi:10.1001/jamadermatol.2016.3885 possibility that, at least in part, spontaneous remission of PRP oc- Conflict of Interest Disclosures: None reported. curred because up to 80% of type 1 PRP type 1 is self-limited with- Additional Contributions: We thank the patient for granting permission to out treatment within 3 years after onset.2 However, we started publish this information. treatment in a phase of severe, generalized PRP with acute exac- 1. Albert MR, Mackool BT. Pityriasis rubra pilaris. Int J Dermatol. 1999;38(1):1-11. erbations, and spontaneous healing is unlikely in this case. Fur- 2. Ross NA, Chung HJ, Li Q, Andrews JP, Keller MS, Uitto J. Epidemiologic, ther studies are required to evaluate the efficacy and safety of IL-17 clinicopathologic, diagnostic, and management challenges of pityriasis rubra antagonists in larger cohorts of patients with PRP. pilaris: a case series of 100 patients. JAMA Dermatol. 2016;152(6):670-675. 3. Petrof G, Almaani N, Archer CB, Griffiths WA, Smith CH. A systematic review of the literature on the treatment of pityriasis rubra pilaris type 1 with Daniel Schuster, MD TNF-antagonists. J Eur Acad Dermatol Venereol. 2013;27(1):e131-e135. Andrea
Load more

Recommended publications
  • Tinea Versicolor Mimicking Pityriasis Rubra Pilaris
    Tinea Versicolor Mimicking Pityriasis Rubra Pilaris Capt Matthew J. Darling, MC, USAF; CPT Matthew C. Lambiase, MC, USA; Capt R. John Young, MC, USAF Tinea versicolor is a common noninvasive cuta- neous fungal disease. We recount a case of tinea versicolor that mimicked type I (classic adult) pityriasis rubra pilaris. A 54-year-old white man reported a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and treatment with oral antihistamines. Results of a skin examination revealed erythematous plaques; islands of spared skin; and follicular erythematous keratotic papules on the trunk, shoulders, and upper arms. A lesion was scraped to obtain skin scales for potassium hydroxide staining. Examination of the stained samples revealed the characteristic “spaghetti and meatballs,” confirming the diagnosis. Cutis. 2005;75:265-267. Case Report A 54-year-old white man presented with a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and oral antihistamine therapy. Erythem- atous scaly plaques were noted over the trunk and extremities (Figure 1). Islands of spared skin were most notable on the trunk (Figure 2). Follicular, erythematous, keratotic papules were noted on the shoulders and upper arms (Figure 3). Results of Wood lamp examination revealed a yellow-green Figure 1. Erythematous scaly plaques and islands of fluorescence of the plaques. Results of potassium spared skin on the chest. hydroxide (KOH) staining revealed numerous yeast and hyphae. The patient was diagnosed with tinea versicolor and treated with itraconazole 200 mg/d for 2 weeks.
    [Show full text]
  • Coexistence of Vulgar Psoriasis and Systemic Lupus Erythematosus - Case Report
    doi: http://dx.doi.org/10.11606/issn.1679-9836.v98i1p77-80 Rev Med (São Paulo). 2019 Jan-Feb;98(1):77-80. Coexistence of vulgar psoriasis and systemic lupus erythematosus - case report Coexistência de psoríase vulgar e lúpus eritematoso sistêmico: relato de caso Kaique Picoli Dadalto1, Lívia Grassi Guimarães2, Kayo Cezar Pessini Marchióri3 Dadalto KP, Guimarães LG, Marchióri KCP. Coexistence of vulgar psoriasis and systemic lupus erythematosus - case report / Coexistência de psoríase vulgar e lúpus eritematoso sistêmico: relato de caso. Rev Med (São Paulo). 2019 Jan-Feb;98(1):77-80. ABSTRACT: Psoriasis and Systemic lupus erythematosus (SLE) RESUMO: Psoríase e Lúpus eritematoso sistêmico (LES) são are autoimmune diseases caused by multifactorial etiology, with doenças autoimunes de etiologia multifatorial, com envolvimento involvement of genetic and non-genetic factors. The purpose de fatores genéticos e não genéticos. O objetivo deste relato of this case report is to clearly and succinctly present a rare de caso é expor de maneira clara e sucinta uma associação association of autoimmune pathologies, which, according to some rara de patologias autoimunes, que, de acordo com algumas similar clinical features (arthralgia and cutaneous lesions), may características clínicas semelhantes (artralgia e lesões cutâneas), interfere or delay the diagnosis of its coexistence. In addition, it podem dificultar ou postergar o diagnóstico de sua coexistência. is of paramount importance to the medical community to know about the treatment of this condition, since there is a possibility Além disso, é de suma importância à comunidade médica o of exacerbation or worsening of one or both diseases. The conhecimento a respeito do tratamento desta condição, já que combination of these diseases is very rare, so, the diagnosis existe a possibilidade de exacerbação ou piora de uma, ou de is difficult and the treatment even more delicate, due to the ambas as doenças.
    [Show full text]
  • Neonatal Dermatology Review
    NEONATAL Advanced Desert DERMATOLOGY Dermatology Jennifer Peterson Kevin Svancara Jonathan Bellew DISCLOSURES No relevant financial relationships to disclose Off-label use of acitretin in ichthyoses will be discussed PHYSIOLOGIC Vernix caseosa . Creamy biofilm . Present at birth . Opsonizing, antibacterial, antifungal, antiparasitic activity Cutis marmorata . Reticular, blanchable vascular mottling on extremities > trunk/face . Response to cold . Disappears on re-warming . Associations (if persistent) . Down syndrome . Trisomy 18 . Cornelia de Lange syndrome PHYSIOLOGIC Milia . Hard palate – Bohn’s nodules . Oral mucosa – Epstein pearls . Associations . Bazex-Dupre-Christol syndrome (XLD) . BCCs, follicular atrophoderma, hypohidrosis, hypotrichosis . Rombo syndrome . BCCs, vermiculate atrophoderma, trichoepitheliomas . Oro-facial-digital syndrome (type 1, XLD) . Basal cell nevus (Gorlin) syndrome . Brooke-Spiegler syndrome . Pachyonychia congenita type II (Jackson-Lawler) . Atrichia with papular lesions . Down syndrome . Secondary . Porphyria cutanea tarda . Epidermolysis bullosa TRANSIENT, NON-INFECTIOUS Transient neonatal pustular melanosis . Birth . Pustules hyperpigmented macules with collarette of scale . Resolve within 4 weeks . Neutrophils Erythema toxicum neonatorum . Full term . 24-48 hours . Erythematous macules, papules, pustules, wheals . Eosinophils Neonatal acne (neonatal cephalic pustulosis) . First 30 days . Malassezia globosa & sympoidalis overgrowth TRANSIENT, NON-INFECTIOUS Miliaria . First weeks . Eccrine
    [Show full text]
  • Acquired Thrombotic Thrombocytopenic Purpura in a Patient with Pernicious Anemia
    Hindawi Case Reports in Hematology Volume 2017, Article ID 1923607, 4 pages https://doi.org/10.1155/2017/1923607 Case Report Acquired Thrombotic Thrombocytopenic Purpura in a Patient with Pernicious Anemia Ramesh Kumar Pandey, Sumit Dahal, Kamal Fadlalla El Jack Fadlalla, Shambhu Bhagat, and Bikash Bhattarai Interfaith Medical Center, Brooklyn, NY, USA Correspondence should be addressed to Ramesh Kumar Pandey; [email protected] Received 14 January 2017; Revised 2 March 2017; Accepted 23 March 2017; Published 4 April 2017 Academic Editor: Kazunori Nakase Copyright © 2017 Ramesh Kumar Pandey et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Acquired thrombotic thrombocytopenic purpura (TTP) has been associated with different autoimmune disorders. However, its association with pernicious anemia is rarely reported. Case Report. A 46-year-old male presented with blood in sputum and urine for one day. The vitals were stable. The physical examination was significant for icterus. Lab tests’ results revealed leukocytosis, macrocytic anemia, severe thrombocytopenia, renal dysfunction, and unconjugated hyperbilirubinemia. He had an elevated LDH, low haptoglobin levels with many schistocytes, nucleated RBCs, and reticulocytes on peripheral smear. Low ADAMTS13 activity (<10%) with elevated ADAMTS13 antibody clinched the diagnosis of severe acquired TTP,and plasmapheresis was started. There was an initial improvement in his hematological markers, which were however not sustained on discontinuation of plasmapheresis. For his refractory TTP, he was resumed on daily plasmapheresis and Rituximab was started. Furthermore, the initial serum Vitamin B12 and reticulocyte index were low in the presence of anti-intrinsic factor antibody.
    [Show full text]
  • Erythema Annulare Centrifugum ▪ Erythema Gyratum Repens ▪ Exfoliative Erythroderma Urticaria ▪ COMMON: 15% All Americans
    Cutaneous Signs of Internal Malignancy Ted Rosen, MD Professor of Dermatology Baylor College of Medicine Disclosure/Conflict of Interest ▪ No relevant disclosures ▪ No conflicts of interest Objectives ▪ Recognize common disorders associated with internal malignancy ▪ Manage cutaneous disorders in the context of associated internal malignancy ▪ Differentiate cutaneous signs of leukemia and lymphoma ▪ Understand spidemiology of cutaneous metastases Cutaneous Signs of Internal Malignancy ▪ General physical examination ▪ Pallor (anemia) ▪ Jaundice (hepatic or cholestatic disease) ▪ Fixed erythema or flushing (carcinoid) ▪ Alopecia (diffuse metastatic disease) ▪ Itching (excoriations) Anemia: Conjunctival pallor and Pale skin Jaundice 1-12% of hepatocellular, biliary tree or pancreatic cancer PRESENT with jaundice, but up to 40-60% eventually develop it World J Gastroenterol 2003;9:385-91 For comparison CAN YOU TELL JAUNDICE FROM NORMAL SKIN? JAUNDICE Alopecia Neoplastica Most common report w/ breast CA Lung, cervix, desmoplastic mm Hair loss w/ underlying induration Biopsy = dermis effaced by tumor Ann Dermatol 26:624, 2014 South Med J 102:385, 2009 Int J Dermatol 46:188, 2007 Acta Derm Venereol 87:93, 2007 J Eur Acad Derm Venereol 18:708, 2004 Gastric Adenocarcinoma: Alopecia Ann Dermatol 2014; 26: 624–627 Pruritus: Excoriation ▪ Overall risk internal malignancy presenting as itch LOW. OR =1.14 ▪ CTCL, Hodgkin’s & NHL, Polycythemia vera ▪ Biliary tree carcinoma Eur J Pain 20:19-23, 2016 Br J Dermatol 171:839-46, 2014 J Am Acad Dermatol 70:651-8, 2014 Non-specific (Paraneoplastic) Specific (Metastatic Disease) Paraneoplastic Signs “Curth’s Postulates” ▪ Concurrent onset (temporal proximity) ▪ Parallel course ▪ Uniform site or type of neoplasm ▪ Statistical association ▪ Genetic linkage (syndromal) Curth HO.
    [Show full text]
  • Psoriasis and Vitiligo: an Association Or Coincidence?
    igmentar f P y D l o is a o n r r d e u r o s J Solovan C, et al., Pigmentary Disorders 2014, 1:1 Journal of Pigmentary Disorders DOI: 10.4172/jpd.1000106 World Health Academy ISSN: 2376-0427 Letter To Editor Open Access Psoriasis and Vitiligo: An Association or Coincidence? Caius Solovan1, Anca E Chiriac2, Tudor Pinteala2, Liliana Foia2 and Anca Chiriac3* 1University of Medicine and Pharmacy “V Babes” Timisoara, Romania 2University of Medicine and Pharmacy “Gr T Popa” Iasi, Romania 3Apollonia University, Nicolina Medical Center, Iasi, Romania *Corresponding author: Anca Chiriac, Apollonia University, Nicolina Medical Center, Iasi, Romania, Tel: 00-40-721-234-999; E-mail: [email protected] Rec date: April 21, 2014; Acc date: May 23, 2014; Pub date: May 25, 2014 Citation: Solovan C, Chiriac AE, Pinteala T, Foia L, Chiriac A (2014) Psoriasis and Vitiligo: An Association or Coincidence? Pigmentary Disorders 1: 106. doi: 10.4172/ jpd.1000106 Copyright: © 2014 Solovan C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Letter to Editor Dermatitis herpetiformis 1 0.08% Sir, Chronic urticaria 2 0.16% The worldwide occurrence of psoriasis in the general population is Lyell syndrome 1 0.08% about 2–3% and of vitiligo is 0.5-1%. Coexistence of these diseases in the same patient is rarely reported and based on a pathogenesis not Quincke edema 1 0.08% completely understood [1].
    [Show full text]
  • Causes and Features of Erythroderma 1 1 2 1 Grace FL Tan, MBBS, Yan Ling Kong, MBBS, Andy SL Tan, MBBS, MPH, Hong Liang Tey, MBBS, MRCP(UK), FAMS
    391 Erythroderma: Causes and Features—Grace FL Tan et al Original Article Causes and Features of Erythroderma 1 1 2 1 Grace FL Tan, MBBS, Yan Ling Kong, MBBS, Andy SL Tan, MBBS, MPH, Hong Liang Tey, MBBS, MRCP(UK), FAMS Abstract Introduction: Erythroderma is a generalised infl ammatory reaction of the skin secondary to a variety of causes. This retrospective study aims to characterise the features of erythroderma and identify the associated causes of this condition in our population. Materials and Methods: We reviewed the clinical, laboratory, histological and other disease-specifi c investigations of 225 inpatients and outpatients with erythroderma over a 7.5-year period between January 2005 and June 2012. Results: The most common causative factors were underlying dermatoses (68.9%), idiopathic causes (14.2%), drug reactions (10.7%), and malignancies (4.0%). When drugs and underlying dermatoses were excluded, malignancy-associated cases constituted 19.6% of the cases. Fifty-fi ve percent of malignancies were solid-organ malignancies, which is much higher than those previously reported (0.0% to 25%). Endogenous eczema was the most common dermatoses (69.0%), while traditional medications (20.8%) and anti-tuberculous medications (16.7%) were commonly implicated drugs. In patients with cutaneous T-cell lymphoma (CTCL), skin biopsy was suggestive or diagnostic in all cases. A total of 52.4% of patients with drug-related erythroderma had eosinophilia on skin biopsy. Electrolyte abnormalities and renal impairment were seen in 26.2% and 16.9% of patients respectively. Relapse rate at 1-year was 17.8%, with no associated mortality.
    [Show full text]
  • The Coexistence of Systemic Lupus Erythematosus and Psoriasis: Is It Possible?
    CASE REPORT The Coexistence of Systemic Lupus Erythematosus and Psoriasis: Is It Possible? Hendra Gunawan, Awalia, Joewono Soeroso Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo Hospital, Surabaya, Indonesia Corresponding Author: Prof. Joewono Soeroso, MD., M.Sc, PhD. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Airlangga University - Dr. Soetomo Hospital. Jl. Mayjen. Prof. Dr. Moestopo 4-6, Surabaya 60132, Indonesia. email: [email protected]; [email protected]. ABSTRAK Lupus eritematosus sistemik (LES) adalah penyakit autoimun kronik eksaserbatif dengan manifestasi klinis yang beragam. Psoriasis vulgaris adalah penyakit kulit yang menyerang 1-3% dari populasi. Patofisiologi mengenai tumpang tindihnya penyakit tersebut belum sepenuhnya diketahui. Hal ini menyebabkan adanya tantangan tersendiri dalam tatalaksana kedua penyakit tersebut. Dua orang laki-laki dengan LES dan psoriasis vulgaris dilaporkan dengan manifestasi klinis eritroderma berulang dengan fotosensitif. Perbaikan klinis dicapai setelah terapi kombinasi metilprednisolon dengan metotrexat. Adanya LES yang tumpang tindih psoriasis vulgaris merupakan suatu fenomena klinis yang langka. Hubungan kedua penyakit tersebut dapat berupa saling mendahului atau tumpang tindih pada suatu waktu yang sama dan memiliki hubungan dengan adanya anti- Ro/SSA. Adanya tumpang tindih dari dua penyakit tersebut memberikan paradigma baru dalam patofisiologi, diagnosis, dan tatalaksana di masa mendatang. Kata kunci: lupus eritematosus sistemik, psoriasis vulgaris, psoriatic artritis, overlap syndrome. ABSTRACT Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with various clinical disorders and frequent exacerbations. Psoriasis vulgaris is a common skin disorder which affect 1-3% of general populations. The pathophysiology regarding the coexistence of these diseases is not fully understood. Therapeutic challenges arise since the treatment one of these diseases may aggravate the other.
    [Show full text]
  • Acne, Eczema and Psoriasis
    Acne, Eczema and Psoriasis Dr Rebecca Clapham Aims • Classification of severity • Management in primary care – tips and tricks • When to refer • Any other aspects you may want to cover? Acne • First important aspect is to assess severity and type of lesions as this alters management Acne - Aetiology • 1. Androgen-induced seborrhoea (excess grease) • 2. Comedone formation – abnormal proliferation of ductal keratinocytes • 3. Colonisation pilosebaceous duct with Propionibacterium acnes (P.acnes) – esp inflammatory lesions • 4. Inflammation – lymphocyte response to comedones and P. acnes Factors that influence acne • Hormonal – 70% females acne worse few days prior to period – PCOS • UV Light – can benefit acne • Stress – evidence weak, limited data – Acne excoriee – habitually scratching the spots • Diet – Evidence weak – People report improvement with low-glycaemic index diet • Cosmetics – Oil-based cosmetics • Drugs – Topical steroids, anabolic steroids, lithium, ciclosporin, iodides (homeopathic) Skin assessment • Comedones – Blackheads and whiteheads • Inflammed lesions – Papules, pustules, nodules • Scarring – atrophic/ice pick scar or hypertrophic • Pigmentation • Seborrhoea (greasy skin) Comedones Blackheads Whiteheads • Open comedones • Closed comedones Inflammatory lesions Papules/pustules Nodules Scarring Ice-pick scars Atrophic scarring Acne Grading • Grade 1 (mild) – a few whiteheads/blackheads with just a few papules and pustules • Grade 2 (moderate)- Comedones with multiple papules and pustules. Mainly face. • Grade 3 (moderately
    [Show full text]
  • Adalimumab – Safe and Effective Therapy for an Adolescent Patient with Severe Psoriasis and Immune Thrombocytopenia
    Acta Dermatovenerol Croat 2019;27(2):121-123 CASE REPORT Adalimumab – Safe and Effective Therapy for an Adolescent Patient with Severe Psoriasis and Immune Thrombocytopenia Mariusz Sikora, Patrycja Gajda, Magdalena Chrabąszcz, Albert Stec, Małgorzata Olszewska, Lidia Rudnicka Department of Dermatology, Medical University of Warsaw, Warsaw, Poland Corresponding author: ABSTRACT Psoriasis has been linked to several comorbidities, including metabolic Mariusz Sikora, MD, PhD syndrome, atopy, and celiac disease. However, the association between immune thrombocytopenia and psoriasis has rarely been described. We report the case of an Department of Dermatology adolescent with severe psoriasis and concomitant immune thrombocytopenia who Medical University of Warsaw obtained remission during treatment with adalimumab. Increased concentration of Koszykowa 82A tumor necrosis factor-α seems to be a pathogenic linkage and therapeutic target for 02-008 Warsaw both diseases. Poland KEY WORDS: adalimumab, immune thrombocytopenia, psoriasis, tumor necrosis fac- [email protected] tor-alpha Received: January 16, 2019 Accepted: May 15, 2019 INTRODUCTION CASE PRESENTATION Psoriasis is a chronic inflammatory disease that We present a case of 16-year-old girl with an 8- affects about 2% of the population worldwide. The year history of plaque psoriasis. Over the course of pediatric subset of the psoriasis population is an im- disease, the patient was treated with topical agents, portant subgroup since nearly one third of patients narrow band UVB phototherapy (3 sessions/week for with psoriasis experience disease onset in childhood 4 months), acitretin (0.5 mg/kg bw/day for 5 months), (1,2). The affected children and adolescents face a methotrexate (20 mg/week for 7 months), and cyclo- combination of physical and psychosocial challeng- sporine (3.5 mg/kg bw/day for 6 months); however, es.
    [Show full text]
  • Pityriasis Rubra Pilaris: a Rare Inflammatory Dermatosis Aine Kelly, Aoife Lally
    BMJ Case Reports: first published as 10.1136/bcr-2017-224007 on 11 February 2018. Downloaded from Images in… Pityriasis rubra pilaris: a rare inflammatory dermatosis Aine Kelly, Aoife Lally Department of Dermatology, St DESCRIPTION Vincent’s University Hospital, An 18-year-old Caucasian woman presented with Dublin, Ireland a 2-week history of a pruritic rash commencing on the face and spreading distally to the trunk Correspondence to and limbs. There were no associated systemic Dr Aine Kelly, 107545606@ umail. ucc. ie symptoms. Her medical history was unremark- able and there was a family history of hypothy- Accepted 19 January 2018 roidism. Physical examination revealed extensive confluent scaly erythema with islands of sparing on the trunk and scaling of the scalp. There was hyperkeratotic plugging of the hair follicles (figure 1 and figure 2). There was a waxy orange keratoderma affecting the palms and soles with associated painful fissuring (figure 3). A clinical Figure 2 Close-up view of trunk showing small diagnosis of pityriasis rubra pilaris (PRP) was follicular papules with central keratin plug. made. Histopathology of involved skin showed focal parakeratosis and orthokeratosis alter- nating in both horizontal and vertical directions with an underlying perivascular inflammatory infiltrate. The patient had a raised thyroid stimu- lating hormone (TSH) and normal T4 indicative of subclinical hypothyroidism. Treatment for her skin was initiated with methotrexate and titrated to a dose of 15 mg weekly. There was complete http://casereports.bmj.com/ Figure 3 Waxy orange keratoderma affecting the palms and soles with associated painful fissuring. remission at 16 weeks. This case fits the descrip- tion of classical adult-type PRP.
    [Show full text]
  • Treatment of Refractory Pityriasis Rubra Pilaris with Novel Phosphodiesterase 4
    Letters Discussion | Acrodermatitis continua of Hallopeau, also Additional Contributions: We thank the patient for granting permission to known as acrodermatitis perstans and dermatitis repens, publish this information. is a rare inflammatory pustular dermatosis of the distal fin- 1. Saunier J, Debarbieux S, Jullien D, Garnier L, Dalle S, Thomas L. Acrodermatitis continua of Hallopeau treated successfully with ustekinumab gers and toes. It is considered a variant of pustular psoriasis and acitretin after failure of tumour necrosis factor blockade and anakinra. or, less commonly, its own pustular psoriasis-like indepen- Dermatology. 2015;230(2):97-100. 1 dent entity. Precise pathophysiology and incidence 2. Kiszewski AE, De Villa D, Scheibel I, Ricachnevsky N. An infant with are unknown. Case literature suggests predominance in acrodermatitis continua of Hallopeau: successful treatment with thalidomide women, but the disease affects both sexes and, rarely, and UVB therapy. Pediatr Dermatol. 2009;26(1):105-106. children.2 3. Jo SJ, Park JY, Yoon HS, Youn JI. Case of acrodermatitis continua accompanied by psoriatic arthritis. J Dermatol. 2006;33(11):787-791. Acrodermatitis continua of Hallopeau initially presents 4. Sehgal VN, Verma P, Sharma S, et al. Acrodermatitis continua of Hallopeau: as erythema overlying the distal digits that evolves into evolution of treatment options. Int J Dermatol. 2011;50(10):1195-1211. pustules.2 The nail bed is often involved, with paronychial 5. Lutz V, Lipsker D. Acitretin- and tumor necrosis factor inhibitor-resistant 3 and subungual involvement and atrophic skin changes. acrodermatitis continua of Hallopeau responsive to the interleukin 1 receptor Most patients experience a chronic, relapsing course involv- antagonist anakinra.
    [Show full text]