History of Psoriasis and Parapsoriasis
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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. -
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. -
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]. -
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. -
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 -
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. -
Blistering, Papulosquamous, Connective Tissue and Alopecia Kathleen Haycraft, DNP, FNP/PNP-BC, DCNP, FAANP Objectives
Blistering, Papulosquamous, Connective Tissue and Alopecia Kathleen Haycraft, DNP, FNP/PNP-BC, DCNP, FAANP Objectives • Identify examples of papulosquamous disease and state treatment options • Identify examples of connective tissue disease and state treatment options • Identify examples of blistering diseases and state treatment options • Identify examples of alopecia and state treatment options Papulosquamous Psoriasis • Latin means “itchy plaque”. • In truth it is less itchy than yeast and eczema • Variable • Painful in high friction spots Psoriasis Plaque ©kathleenhaycraft Psoriasis ©kathleen haycraft ©kathleenhaycraft The clue to the vaginal pic ©kathleenhaycraft ©kathleenhaycraft Plantar Psoriasis ©kathleenhaycraft Palmar Psoriasis ©kathleenhaycraft Nivolumab induced Psoriasis ©[email protected] Psoriasis and its many forms • Plaque..85% • Scalp • Palmoplantar • Guttate • Inverse • Erythrodermic • Psoriatic arthritis • Psoriatic nails Cause • Affects 2 to 5% of the population • Many mediators including the T cell lymphocyte. • Many chemicals downstream including TNF alpha, PDE, Il 12, 23, 17 as well as a variety of inflammatory cytokines • These chemicals are distributed throughout the body • Imbalance between pro inflammatory and anti-inflammatory chemicals • Can be triggered by strep, HIV, Hepatitis, and a wide variety of infectious organisms Psoriasis causes • Koebner phenomenon after surgery or trauma • Drugs such as beta blockers, lithium, antimalarials • The cytokines result in proliferation of keratinocytes and angiogenesis (resulting in the Auspitz sign) • May be mild to severe and location of scalp, genitalia, face may trump degree of psoriasis (BSA- Comorbidities • Reviewed in the cutaneous manifestations of systemic disease • Range from depression to MI, psoriatic arthritis, malignancy, Dm • Future treatments may be based on how they treat the comorbids • Diagnose with visual or biopsy Treatment • Topical corticosteroids..caution to not over use particularly in high risk areas. -
Pityriasis Rosea DANIEL L
CARING FOR COMMON SKIN CONDITIONS Pityriasis Rosea DANIEL L. STULBERG, M.D., Utah Valley Regional Medical Center, Provo, Utah JEFF WOLFREY, M.D., Good Samaritan Regional Medical Center, Phoenix, Arizona Pityriasis rosea is a common, acute exanthem of uncertain etiology. Viral and bacterial causes have been sought, but convincing answers have not yet been found. Pityriasis O A patient informa- rosea typically affects children and young adults. It is characterized by an initial herald tion handout on pityriasis rosea, written patch, followed by the development of a diffuse papulosquamous rash. The herald by the authors of this patch often is misdiagnosed as eczema. Pityriasis rosea is difficult to identify until the article, is provided on appearance of characteristic smaller secondary lesions that follow Langer’s lines (cleav- page 94. age lines). Several medications can cause a rash similar to pityriasis rosea, and several diseases, including secondary syphilis, are included in the differential diagnosis. One small controlled trial reported faster clearing of the exanthem with the use of ery- thromycin, but the mechanism of effect is unknown. Resolution of the rash may be has- tened by ultraviolet light therapy but not without the risk of hyperpigmentation. Top- ical or systemic steroids and antihistamines often are used to relieve itching. (Am Fam Physician 2004;69:87-92,94. Copyright© 2004 American Academy of Family Physicians.) This article is one in a ityriasis rosea is a common skin cytes, a decrease in T lymphocytes, and an ele- series coordinated by condition characterized by a her- vated sedimentation rate.6 Daniel L. Stulberg, M.D., director of der- ald patch and the later appear- Unfortunately, even though electron matology curriculum at ance of lesions arrayed along microscopy shows some viral changes and the Utah Valley Family Langer’s lines (cleavage lines). -
Approach to Pediatric Psoriasis”, a Podcast Made for Pedscases.Com at the University of Alberta
Welcome to “Approach to Pediatric Psoriasis”, a podcast made for PedsCases.com at the University of Alberta. I am Dr. Harry Liu, a dermatology resident at the University of British Columbia, and I am David Jung, a medical student at the University of British Columbia. This podcast will provide an organized approach to understand pediatric psoriasis, a common dermatological condition in pediatric population. We would like to thank Dr. Joseph Lam, a pediatric dermatologist practicing in Vancouver, BC, Canada, for developing this podcast with us! 1 After listening to this podcast, we expect the learner to be able to: 1. Describe the typical clinical presentations of psoriasis 2. Discuss the underlying pathophysiology of psoriasis 3. Identify different types of psoriasis and their unique characteristics 4. Recall epidemiological risk factors and comorbidities associated with psoriasis 5. List common treatment options for pediatric psoriasis 2 First, we’d like to present a case. It is your day at an urban pediatric clinic as a fourth- year elective student. Your first patient is Lucy, an 8-year-old girl brought in by her mother for the concern of a newly developed rash. On history, Lucy has had the rash on her knees for about 3 months. The rash has gradually increased in size and has become quite scaly. When Lucy scratches, her mother also notices some bleeding. The mother is quite concerned because the rash has made many kids at school avoid Lucy. Before the development of the rash, Lucy had an episode of culture proven group A Streptococcal (GAS) pharyngitis which resolved with oral antibiotics; she is otherwise very healthy. -
Dermatological Indications of Disease - Part II This Patient on Dialysis Is Showing: A
“Cutaneous Manifestations of Disease” ACOI - Las Vegas FR Darrow, DO, MACOI Burrell College of Osteopathic Medicine This 56 year old man has a history of headaches, jaw claudication and recent onset of blindness in his left eye. Sed rate is 110. He has: A. Ergot poisoning. B. Cholesterol emboli. C. Temporal arteritis. D. Scleroderma. E. Mucormycosis. Varicella associated. GCA complex = Cranial arteritis; Aortic arch syndrome; Fever/wasting syndrome (FUO); Polymyalgia rheumatica. This patient missed his vaccine due at age: A. 45 B. 50 C. 55 D. 60 E. 65 He must see a (an): A. neurologist. B. opthalmologist. C. cardiologist. D. gastroenterologist. E. surgeon. Medscape This 60 y/o male patient would most likely have which of the following as a pathogen? A. Pseudomonas B. Group B streptococcus* C. Listeria D. Pneumococcus E. Staphylococcus epidermidis This skin condition, erysipelas, may rarely lead to septicemia, thrombophlebitis, septic arthritis, osteomyelitis, and endocarditis. Involves the lymphatics with scarring and chronic lymphedema. *more likely pyogenes/beta hemolytic Streptococcus This patient is susceptible to: A. psoriasis. B. rheumatic fever. C. vasculitis. D. Celiac disease E. membranoproliferative glomerulonephritis. Also susceptible to PSGN and scarlet fever and reactive arthritis. Culture if MRSA suspected. This patient has antithyroid antibodies. This is: • A. alopecia areata. • B. psoriasis. • C. tinea. • D. lichen planus. • E. syphilis. Search for Hashimoto’s or Addison’s or other B8, Q2, Q3, DRB1, DR3, DR4, DR8 diseases. This patient who works in the electronics industry presents with paresthesias, abdominal pain, fingernail changes, and the below findings. He may well have poisoning from : A. lead. B. -
Differential Diagnosis in Dermatology
Differential Diagnosis in Dermatology ZohrehTehranchi Dermatologist COMMON ACNE AND CYSTIC ACNE Rosacea Rosacea PERIORAL DERMATITIS ECZEMA/DERMATITIS Chronic irritant dermatitis Dyshidrotic eczematous dermatitis Childood atopic dermatitis Autosensitization dermatitis (“id” reaction): dermatophytid Seborrheic dermatitis PSORIASIS VULGARIS Pemphigus vulgaris BULLOUS PEMPHIGOID (BP) Pityriasis rosea small-plaque parapsoriasis Large-plaque parapsoriasis (parapsoriasis en plaques) LICHEN PLANUS (LP) GRANULOMA ANNULARE (GA) Erythema multiforme ERYTHEMA NODOSUM Actinic keratoses Bowen disease (Squamous cell carcinoma in situ) Bowen disease and invasive SCC Squamous cell carcinoma: invasive on the lip Squamous cell carcinoma, well differentiated Squamous cell carcinoma, undifferentiated Squamous cell carcinoma, advanced, well differentiated, on the hand Keratoacanthoma showing different stages of evolution BASAL CELL CARCINOMA (BCC) Basal cell carcinoma, ulcerated: Rodent ulcer A large rodent ulcer in the nuchal and Bas cell calarcinoma: sclerosing type retroauricular area extending to the temple Basal cell carcinoma, sclerosing, nodular, Superficial basal cell carcinoma: solitary lesion and multiple lesions Superficial basal cell carcinoma, invasive Basal cell carcinoma, pigmented Dysplastic nevi Superficial spreading melanoma: arising within a dysplastic nevus Congenital nevomelanocytic nevus Melanoma: arising in small CNMN Melanoma in situ: lentigo maligna Melanoma in situ, superficial spreading type Superficial spreading melanoma, vertical -
Errata to the 7/1/2016 Prioritized List
Errata to the 7/1/2016 Prioritized List 1) On 6/29/2017, the following corrections were made: a. Website addresses were corrected for the new Oregon Health Authority Web site in all guideline notes referencing a Coverage Guidance. In addition, a web address in the Multisector Interventions section on Tobacco Use was updated. b. M67.0 (Short Achilles tendon (acquired)) was moved to line 297 NEUROLOGICAL DYSFUNCTION IN POSTURE AND MOVEMENT CAUSED BY CHRONIC CONDITIONS from line 382 DYSFUNCTION RESULTING IN LOSS OF ABILITY TO MAXIMIZE LEVEL OF INDEPENDENCE IN SELF- DIRECTED CARE CAUSED BY CHRONIC CONDITIONS THAT CAUSE NEUROLOGICAL DYSFUNCTION c. Psoriasis corrections: i. Add psoriasis, parapsoriasis and similar ICD-10 codes to line 544 MILD PSORIASIS; DERMATOPHYTOSIS: SCALP, HAND, BODY, DEEP-SEATED 1. L40.0 Psoriasis vulgaris 2. L40.1 Generalized pustular psoriasis 3. L40.2 Acrodermatitis continua 4. L40.3 Pustulosis palmaris et plantaris 5. L40.4 Guttate psoriasis 6. L40.8 Other psoriasis 7. L40.9 Psoriasis, unspecified 8. L41.0 Pityriasis lichenoides et varioliformis acuta ii. Add psoriatic arthropathy ICD-10 codes to line 50 RHEUMATOID ARTHRITIS AND OTHER INFLAMMATORY POLYARTHROPATHIES) and remove from line SEVERE INFLAMMATORY SKIN DISEASE 1. L40.51 Distal interphalangeal psoriatic arthropathy 2. L40.52 Psoriatic arthritis mutilans 3. L40.53 Psoriatic spondylitis 4. L40.54 Psoriatic juvenile arthropathy 5. L40.59 Other psoriatic arthropathy d. Add line 544 to Guideline Note 21 SEVERE INFLAMMATORY SKIN DISEASE, and append “See Guideline Note 57 for the definition of mild psoriasis included on line 544.” e. Add line 430 to Guideline Note 57 MILD PSORIASIS and append “See Guideline Note 21 for the definition of moderate/severe psoriasis included on line 430.” f.