DOCSLIB.ORG

Specificity of Dermal Mucin in the Diagnosis of Lupus Erythematosus

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Specificity of Dermal Mucin in the Diagnosis of Lupus Erythematosus J Cutan Pathol 2015: 42: 722–729 © 2015 John Wiley & Sons A/S. doi: 10.1111/cup.12504 Published by John Wiley & Sons Ltd John Wiley & Sons. Printed in Singapore Journal of Cutaneous Pathology Specificity of dermal mucin in the diagnosis of lupus erythematosus: comparison with other dermatitides and normal skin† Increased dermal mucin is a feature of lupus erythematosus (LE); Jeremy G. Vincent1 and however, its amount and distribution have not been well May P. Chan1,2 characterized. The differentiation of LE from other forms of 1 dermatitis can be challenging when other features of LE are Department of Pathology, University of Michigan, Ann Arbor, MI, USA and subtle or equivocal. One hundred and thirty-five skin specimens 2Department of Dermatology, University of showing LE, graft vs. host disease, erythema multiforme/fixed Michigan, Ann Arbor, MI, USA drug eruption, lichen planus, polymorphous light eruption †Presented in part at the 103rd Annual Meeting of (PMLE), urticaria, eczematous dermatitis and psoriasis and the United States and Canadian Academy of normal skin with and without photodamage were collected. The Pathology, San Diego, CA, on March 4, 2014. amounts of mucin in the papillary, superficial reticular and deep reticular dermis were scored from 0 to 3 on hematoxylin–eosin (H&E) and alcian blue (AB) stains, and compared between groups. The mean scores in the reticular dermis were significantly higher in LE than in other categories except PMLE and eczematous dermatitis. A combined H&E + AB score of ≥5 in the superficial reticular dermis gave an overall specificity of 85.7%for LE. Mucin in the papillary dermis failed to distinguish among entities. Normal photodamaged skin showed significantly more mucin in the superficial reticular dermis compared to non-photodamaged skin. While LE is associated with increased mucin deposition, scant to moderate amount of mucin alone has limited specificity and is common in other dermatitides or photodamaged skin. Keywords: lupus erythematosus, mucin, photodamage, May P. Chan, MD, polymorphous light eruption, tumid Department of Pathology, University of Michigan, 1301 Catherine Street, Medical Science I, Vincent JG, Chan MP. Specificity of dermal mucin in the M3261, Ann Arbor, MI 48109-5602, USA diagnosis of lupus erythematosus: comparison with other Tel: +1 734 764 4460, Fax: +1 734 764 4690, dermatitides and normal skin. e-mail: [email protected] J Cutan Pathol 2015; 42: 722–729. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Accepted for publication March 15, 2015 Increased dermal mucin is one of the clas- moderate amount of dermal mucin is present, sic features of cutaneous lupus erythematosus but other classic features of LE are subtle or (LE); however, the amount and the distribu- equivocal. tion of mucin have not been well characterized. Increased dermal mucin and superficial to Differentiation of LE from other inflammatory deep perivascular and periadnexal lymphocytic dermatitides can be challenging when scant to infiltrate are fairly constant histopathologic 722 Specificity of dermal mucin features of cutaneous LE.1,2 Additional findings Both hematoxylin–eosin (H&E)- and alcian such as interface dermatitis, basement mem- blue (AB)-stained sections were evaluated for brane thickening and follicular plugging are dermal mucin in three different compartments: seen at varying frequencies depending on the papillary dermis, superficial reticular dermis and specific variant and chronicity of cutaneous deep reticular dermis. The amount of mucin LE.3–6 While the diagnosis of LE is straight- in each compartment was scored separately on forward when all of the above histopathologic H&E and AB as follows: 0, absent; 1 , scant wisps features are present in conjunction with clas- of mucin that are barely noticeable; 2, moder- sic clinical presentation, diagnostic difficulty ate amount of mucin almost filling the spaces arises when clinical information is limited and between collagen fibers; or 3, abundant mucin when only few classic features are observed pools filling and expanding the spaces between histopathologically. For example, other inter- collagen fibers. The H&E and AB scores in face or perivascular dermatitides may present each compartment were then combined to give with variable amount of dermal mucin and thus a total score of 0–6. Four selected cases were closely mimic cutaneous LE. It also remains also stained with colloidal iron for comparison. unclear whether chronic sun exposure may Chi-square and two-tailed t-tests were performed < contribute to mucin deposition to a certain between groups. A p-value of 0.05 was consid- degree. To our knowledge, study on the amount ered statistically significant. The specificities and of dermal mucin in these non-LE conditions is sensitivities of dermal mucin for the diagnosis of lacking in the current literature. LE were calculated using different cut-off com- Our objective was to address the above diagnos- bined scores. tic challenge by comparing the quantity and the distribution of dermal mucin in cutaneous LE Results to a variety of interface, perivascular, spongiotic and psoriasiform dermatitides as well as normal A total of 135 skin samples, including cutaneous skin without dermatitis. We also aimed to study LE (n = 35), GVHD (n = 8), EM/FDE (n = 9), the effect of chronic sun exposure on mucin LP (n = 15), PMLE (n = 11), urticaria (n = 8), deposition by comparing normal skin with and eczematous dermatitis (n = 8), psoriasis (n = 11), without solar elastosis. normal skin with solar elastosis (n = 16) and nor- mal skin without solar elastosis (n = 14) were selected. The LE cases included discoid (n = 8), subacute cutaneous (n = 7), systemic (n = 4), Materials and methods tumid (n = 13) and not-otherwise-specified After approval by the Institutional Review Board, (n = 3) subtypes. None of the patients in the the surgical pathology database at University of non-LE groups had known history of LE. Michigan was searched for ‘lupus erythemato- The mean combined (H&E + AB) mucin sus’, ‘tumid lupus’, ‘discoid lupus’, ‘subacute scores for all entities are summarized in Table 1. cutaneous lupus’, ‘systemic lupus’, ‘eczema’, Four specimens were superficial and were ‘psoriasis’, ‘lichen planus’ (LP), ‘graft vs. host excluded from the calculations for the deep disease’ (GVHD), ‘erythema multiforme’ (EM), reticular dermal compartment. Sixteen cases ‘fixed drug eruption’ (FDE), ‘urticaria’ and (11.9%) had a discrepancy of at least two score ‘polymorphous light eruption’ (PMLE) between points between H&E and AB in at least one com- years 2010 and 2014. All pathologic slides were partment. The p-values obtained from two-tailed retrospectively reviewed and correlated with t-tests between groups are shown in Table 2. clinical data (obtained from requisition form Significantly more mucin was present in both and/or electronic medical record) to confirm superficial and deep reticular dermis in LE when the original diagnoses. Cases with diagnos- compared to GVHD, EM/FDE, LP, urticaria, tic uncertainty were eliminated. ‘Eczematous psoriasis and normal skin (Fig. 1). However, no dermatitis’ refers to cases showing a primarily significant difference was found when compar- spongiotic pattern, including atopic dermatitis, ing LE with PMLE and eczematous dermatitis contact dermatitis, nummular dermatitis and in all three compartments (Figs 2 and 3). Mucin eczematous drug reaction. Normal skin samples in the papillary dermis failed to distinguish LE with and without evidence of photodamage from other entities. Normal photodamaged (solar elastosis) were obtained from the tip skin (with solar elastosis) showed significantly margins of wide local excisions performed for more mucin in the superficial reticular dermis melanoma and Merkel cell carcinoma. compared to normal non-photodamaged skin 723 Vincent & Chan Table 1. Mean combined (H&E + AB) mucin scores Table 2. Comparison of combined (H&E + AB) mucin scores (p-values from two-tailed t-tests) Superficial Deep Papillary reticular reticular Superficial Condition n dermis dermis dermis Papillary reticular Deep reticular dermis dermis dermis LE (all subtypes) 35 3.17 4.57 2.83 DLE 8 2.88 4.25 2.38 LE vs. GVHD 0.1353 0.0015 0.0027 SCLE 7 3.71 4.71 2.57 LE vs. EM/FDE 0.5910 0.0009 0.0019 SLE 4 3.00 3.75 2.25 LE vs. LP 0.9324 <0.0001 <0.0001 TLE 13 3.15 4.92 3.38 LE vs. PMLE 0.4670 0.3240 0.6733 NOS 3 3.00 4.67 3.00 LE vs. urticaria 0.9359 0.0417 0.0476 GVHD 8 4.00 2.50 1.13 LE vs. eczematous 0.5997 0.0580 0.1256 EM/FDE 9 2.89 2.67 1.22 LE vs. psoriasis 0.9824 0.0074 0.0019 LP 15 3.13 2.27 0.75 Photodamaged normal vs. 0.2413 0.0140 0.0821 PMLE 11 3.55 4.09 2.64 non-photodamaged Urticaria 8 3.13 3.38 1.75 normal Eczematous 8 2.88 3.50 2.00 LE vs. normal* 0.4383 <0.0001 <0.0001 Psoriasis 11 3.18 3.18 1.20 GVHD vs. normal* 0.0109 0.8506 0.9136 Normal, 16 3.13 3.06 1.44 EM/FDE vs. normal* 0.9096 0.8799 0.8668 photodamaged LP vs. normal* 0.5876 0.3438 0.1960 Normal, 14 2.71 2.07 0.86 PMLE vs. normal* 0.1429 0.0006 <0.0001 non-photodamaged Urticaria vs. normal* 0.6683 0.1107 0.1268 Eczematous vs. normal* 0.8912 0.0510 0.0331 AB, Alcian blue; DLE, discoid lupus erythematosus; EM, erythema Psoriasis vs. normal* 0.4765 0.1718 0.9275 multiforme; FDE, fixed drug eruption; GVHD, graft vs. host dis- ease; H&E, hematoxylin–eosin; LE, lupus erythematosus; LP, lichen AB, Alcian blue, EM, erythema multiforme; FDE, fixed drug eruption; planus; n, number of cases; NOS, not-otherwise-specified; PMLE, GVHD, graft vs.
Load more

Recommended publications
  • Contact Vitiligo Following Allergic Contact Dermatitis *Ricardo Ruiz-Villaverde, Francisco J Navarro-Triviño
    SUBMITTED 19 JAN 21 REVISION REQ. 17 MAR 21; REVISION 5 APR 21 ACCEPTED 21 APR 21 ONLINE-FIRST: MAY 2021 DOI: https://doi.org/10.18295/squmj.5.2021.078 Contact Vitiligo Following Allergic Contact Dermatitis *Ricardo Ruiz-Villaverde, Francisco J Navarro-Triviño Department of Dermatology, Hospital Universitario San Cecilio, Granada, Spain *Corresponding Author’s e-mail: [email protected] Introduction A 45-year-old man, construction worker, with no personal history of psoriasis, atopic dermatitis, and vitiligo, was referred to our Contact Eczema Department with a chronic hand eczema and skin depigmentation over a period of 12 months. Skin depigmentation appeared few months later regarding the primary eczema. The patient reported the use of rubber gloves for many years. He had noticed itching and mild erythema over both hands. Currently, he wears nitrile gloves at work. Physical examination showed symmetric erythematous-squamous, hyperkeratotic and fissured plaques on both hands (Fig. 1A), and ventral aspect of wrists (Fig. 1B). Skin depigmentation areas showed irregular edges (Fig. 1C). Wood´s lamp examination accentuated the depigmentation areas overlap the eczema (Fig. 2A-B), without vitiligo pattern. No other anatomical sites were involved. Blood test showed no significant alterations, including data from autoimmune thyroiditis, celiac disease, and pernicious anaemia. Patch tests were performed with the European Comprehensive Baseline Series (Chemotechnique Diagnostics, Vellinge, Sweden), rubber additives series (Chemotechnique Diagnostics), and hydroquinone monobenzylether 1% pet (Shoe series, Chemotechnique Diagnosis). The results were interpreted according to the criteria of the International Contact Dermatitis Research Group. Patch tests were read on day (D) 2 and D4.
    [Show full text]
  • FIG. 4A © O O Wo 2015/042110 Al III III II II III III 1 1 II III II II III III II III
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date W O 2015/042110 A l 2 6 March 2015 (26.03.2015) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61P 37/00 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/US20 14/056021 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, ΓΝ , IR, IS, JP, KE, KG, KN, KP, KR, 17 September 2014 (17.09.2014) KZ, LA, LC, LK, LR, LS, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, OM, (25) Filing Language: English PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, SC, (26) Publication Language: English SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, ZW. (30) Priority Data: 61/880,522 20 September 2013 (20.09.2013) (84) Designated States (unless otherwise indicated, for every kind of regional protection available): ARIPO (BW, GH, (71) Applicant: CHILDREN'S MEDICAL CENTER COR¬ GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, ST, SZ, PORATION [US/US]; 55 Shattuck Street, Boston, Mas¬ TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, sachusetts 021 15 (US).
    [Show full text]
  • Scalp Eczema Factsheet the Scalp Is an Area of the Body That Can Be Affected by Several Types of Eczema
    12 Scalp eczema factsheet The scalp is an area of the body that can be affected by several types of eczema. The scalp may be dry, itchy and scaly in a chronic phase and inflamed (red), weepy and painful in an acute (eczema flare) phase. Aside from eczema, there are a number of reasons why the scalp can become dry and itchy (e.g. psoriasis, fungal infection, ringworm, head lice etc.), so it is wise to get a firm diagnosis if there is uncertainty. Types of eczema • Hair clips and headgear – especially those containing that affect the scalp rubber or nickel. Seborrhoeic eczema (dermatitis) is one of the most See the NES booklet on Contact Dermatitis for more common types of eczema seen on the scalp and hairline. details. It can affect babies (cradle cap), children and adults. The Irritant contact dermatitis is a type of eczema that skin appears red and scaly and there is often dandruff as occurs when the skin’s surface is irritated by a substance well, which can vary in severity. There may also be a rash that causes the skin to become dry, red and itchy. on other parts of the face, such as around the eyebrows, For example, shampoos, mousses, hair gels, hair spray, eyelids and sides of the nose. Seborrhoeic eczema can perm solution and fragrance can all cause irritant contact become infected. See the NES factsheets on Adult dermatitis. See the NES booklet on Contact Dermatitis for Seborrhoeic Dermatitis and Infantile Seborrhoeic more details. Dermatitis and Cradle Cap for more details.
    [Show full text]
  • Compensation for Occupational Skin Diseases
    ORIGINAL ARTICLE http://dx.doi.org/10.3346/jkms.2014.29.S.S52 • J Korean Med Sci 2014; 29: S52-58 Compensation for Occupational Skin Diseases Han-Soo Song1 and Hyun-chul Ryou2 The Korean list of occupational skin diseases was amended in July 2013. The past list was constructed according to the causative agent and the target organ, and the items of that 1 Department of Occupational and Environmental list had not been reviewed for a long period. The revised list was reconstructed to include Medicine, College of Medicine, Chosun University, Gwangju; 2Teo Center of Occupational and diseases classified by the International Classification of Diseases (10th version). Therefore, Environmental Medicine, Changwon, Korea the items of compensable occupational skin diseases in the amended list in Korea comprise contact dermatitis; chemical burns; Stevens-Johnson syndrome; tar-related skin diseases; Received: 19 December 2013 infectious skin diseases; skin injury-induced cellulitis; and skin conditions resulting from Accepted: 2 May 2014 physical factors such as heat, cold, sun exposure, and ionized radiation. This list will be Address for Correspondence: more practical and convenient for physicians and workers because it follows a disease- Han-Soo Song, MD based approach. The revised list is in accordance with the International Labor Organization Department of Occupational and Environmental Medicine, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, list and is refined according to Korean worker’s compensation and the actual occurrence of Gwangju 501-717, Korea occupational skin diseases. However, this revised list does not perfectly reflect the actual Tel: +82.62-220-3689, Fax: +82.62-443-5035 E-mail: [email protected] status of skin diseases because of the few cases of occupational skin diseases, incomplete statistics of skin diseases, and insufficient scientific evidence.
    [Show full text]
  • Allergic Contact Rashes Allergic Contact Dermatitis Is Caused by the Body’S Reaction to Something That It Comes in Direct Skin Contact with It
    1812 W. Burbank Blvd. #1046 | Burbank, CA 91506 Tel: (877) 822-2223 | Fax: (323) 935-8804 DermLA.com Allergic Contact Rashes Allergic contact dermatitis is caused by the body’s reaction to something that it comes in direct skin contact with it. Many different substances can cause allergic contact dermatitis, and we call these substances “allergens”. Usually this substance causes no trouble for most people, and may not even be noticed the first time the person is exposed. But once the skin becomes sensitive or allergic to the substance, any exposure will produce a rash. The rash usually doesn’t start until a day or two later, but can start a soon as hours or as late as weeks. You can become allergic or sensitive to anything at anytime, even a product you have used for years. Allergic contact dermatitis is not usually caused by things like acid, alkali, solvent, strong soap or detergent. These harsh compounds, which can produce a reaction on anyone’s skin, are known as “irritants.” Although some chemicals are both irritants and allergens, allergic contact dermatitis results from brief contact with substances that don’t usually provoke a reaction in most people. The dermatitis usually shows redness, swelling and water blisters, from tiny to large. The blisters may break,forming crusts and scales. Untreated, the skin may darken and become leathery and cracked. Allergic contact dermatitis can be difficult to distinguish from other rashes, especially after it been present for a while. The dermatologist and patient will discuss the materials that touch the person’s skin at work and home, and try to identify the allergen.
    [Show full text]
  • Allergic Contact Dermatitis with Sparing of Exposed Psoriasis Plaques
    CASE LETTER Allergic Contact Dermatitis With Sparing of Exposed Psoriasis Plaques Eric Sorenson, MD; Kourosh Beroukhim, MD; Catherine Nguyen, MD; Melissa Danesh, MD; John Koo, MD; Argentina Leon, MD were noted on the face, trunk, arms, and legs, sparing the PRACTICE POINTS well-demarcated scaly psoriatic plaques on the arms and • Patients with plaque-type psoriasis who experience legs (Figure). The patient was given intravenous fluids allergic contact dermatitis (ACD) may present with and intravenous diphenhydramine. After responding to sparing of exposed psoriatic plaques. initial treatment, the patient was discharged with ibupro- • The divergent immunologic milieus present in ACD fen and a taperingcopy dose of oral prednisone from 60 mg and psoriasis likely underly the decreased incidence 5 times daily, to 40 mg 5 times daily, to 20 mg 5 times of ACD in patients with psoriasis. daily over 15 days. Allergic contact dermatitis occurs after sensitization to environmental allergens or haptens. Clinically, ACD is characterizednot by pruritic, erythematous, vesicular papules To the Editor: and plaques. The predominant effector cells in ACD are Allergic contact dermatitis (ACD) is a delayed-type hypersensitivity reaction against antigens to whichDo the skin’s immune system was previously sensitized. The initial sensitization requires penetration of the antigen through the stratum corneum. Thus, the ability of a par- ticle to cause ACD is related to its molecular structure and size, lipophilicity, and protein-binding affinity, as well as the dose and duration of exposure.1 Psoriasis typically presents as well-demarcated areas of skin that may be erythematous, indurated, and scaly to variable degrees. Histologically, psoriasis plaquesCUTIS are characterized by epidermal hyperplasia in the presence of a T-cell infiltrate and neutrophilic microabscesses.
    [Show full text]
  • Pigmented Contact Dermatitis and Chemical Depigmentation
    18_319_334* 05.11.2005 10:30 Uhr Seite 319 Chapter 18 Pigmented Contact Dermatitis 18 and Chemical Depigmentation Hideo Nakayama Contents ca, often occurs without showing any positive mani- 18.1 Hyperpigmentation Associated festations of dermatitis such as marked erythema, with Contact Dermatitis . 319 vesiculation, swelling, papules, rough skin or scaling. 18.1.1 Classification . 319 Therefore, patients may complain only of a pigmen- 18.1.2 Pigmented Contact Dermatitis . 320 tary disorder, even though the disease is entirely the 18.1.2.1 History and Causative Agents . 320 result of allergic contact dermatitis. Hyperpigmenta- 18.1.2.2 Differential Diagnosis . 323 tion caused by incontinentia pigmenti histologica 18.1.2.3 Prevention and Treatment . 323 has often been called a lichenoid reaction, since the 18.1.3 Pigmented Cosmetic Dermatitis . 324 presence of basal liquefaction degeneration, the ac- 18.1.3.1 Signs . 324 cumulation of melanin pigment, and the mononucle- 18.1.3.2 Causative Allergens . 325 ar cell infiltrate in the upper dermis are very similar 18.1.3.3 Treatment . 326 to the histopathological manifestations of lichen pla- 18.1.4 Purpuric Dermatitis . 328 nus. However, compared with typical lichen planus, 18.1.5 “Dirty Neck” of Atopic Eczema . 329 hyperkeratosis is usually milder, hypergranulosis 18.2 Depigmentation from Contact and saw-tooth-shape acanthosis are lacking, hyaline with Chemicals . 330 bodies are hardly seen, and the band-like massive in- 18.2.1 Mechanism of Leukoderma filtration with lymphocytes and histiocytes is lack- due to Chemicals . 330 ing. 18.2.2 Contact Leukoderma Caused Mainly by Contact Sensitization .
    [Show full text]
  • Abstracts from the 9Th World Congress on Itch October 15–17, 2017
    ISSN 0001-5555 ActaDV Volume 97 2017 SEPTEMBER, No. 8 ADVANCES IN DERMATOLOGY AND VENEREOLOGY A Non-profit International Journal for Interdisciplinary Skin Research, Clinical and Experimental Dermatology and Sexually Transmitted Diseases Abstracts from the 9th World Congress on Itch October 15–17, 2017 Official Journal of - European Society for Dermatology and Wroclaw, Poland Psychiatry Affiliated with - The International Forum for the Study of Itch Immediate Open Access Acta Dermato-Venereologica www.medicaljournals.se/adv Abstracts from the 9th World Congress on Itch DV cta A enereologica V Organizing Committee Scientific Committee ermato- Congress President: Jacek C Szepietowski (Wroclaw, Poland) Jeffrey D. Bernhard (Massachusetts, USA) D Congress Secretary General: Adam Reich (Rzeszów, Poland) Earl Carstens (Davis, USA) Congress Secretary: Edyta Lelonek (Wroclaw, Poland) Toshiya Ebata (Tokyo, Japan) cta Alan Fleischer (Lexington, USA) A IFSI President: Earl Carstens (Davis, USA) IFSI Vice President: Elke Weisshaar (Heidelberg, Germany) Ichiro Katayama (Osaka, Japan) Ethan Lerner (Boston, USA) Staff members of the Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland Thomas Mettang (Wiesbaden, Germany) Martin Schmelz (Mannheim, Germany) Sonja Ständer (Münster, Germany) DV Jacek C. Szepietowski (Wroclaw, Poland) cta Kenji Takamori (Tokyo, Japan) A Elke Weisshaar (Heidelberg, Germany) Gil Yosipovitch (Miami, USA) Contents of this Abstract book Program 1000 Abstracts: Lecture Abstracts 1008 Poster Abstracts 1035 Author Index 1059 dvances in dermatology and venereology A www.medicaljournals.se/acta doi: 10.2340/00015555-2773 Journal Compilation © 2017 Acta Dermato-Venereologica. Acta Derm Venereol 2017; 97: 999–1060 1000 9th World Congress of Itch Sunday, October 15, 2017 Abstract # 1:30-3:30 PM IFSI Board meeting DV 5:00-5:20 PM OPENING CEREMONY 5:00-5:10 PM Opening remarks cta Jacek C.
    [Show full text]
  • Allergic Contact Dermatitis Handout
    #30: ALLERGIC CONTACT DERMATITIS PATIENT PERSPECTIVES Allergic contact dermatitis Contact dermatitis is an itchy rash that is caused by something touching (contacting) your skin. The rash is usually red, bumpy, and itchy. Sometimes there are blisters filled with fluid. THERE ARE TWO TYPES OF CONTACT DERMATITIS: COMMON FORMS OF ALLERGIC CONTACT DERMATITIS: 1. Some things that contact skin are very irritating and will cause a rash in most people. This rash is called irritant contact dermatitis. Examples are acids, soaps, cold weather, and friction. » ALLERGIC CONTACT DERMATITIS TO HOMEMADE SLIME 2. Some things that touch your skin give you a rash because you are allergic to them. This rash is called allergic contact dermatitis. » Slime is a homemade gooey These are items that do not bother everyone’s skin. They only substance that many young people cause a rash in people who are allergic to those items. make and play with. » There are several recipes for making WHAT ARE COMMON CAUSES OF ALLERGIC slime. Common ingredients include CONTACT DERMATITIS IN CHILDREN AND boric acid, contact lens solution, WHERE ARE THEY FOUND? laundry detergent, shaving cream, and school glue. Many ingredients » Homemade slime: often irritation (irritant contact dermatitis) being used can cause irritation results from soap or detergent but can have allergic contact (“irritant contact dermatitis”) and some dermatitis to glues and other ingredients can cause allergic contact dermatitis. » Plants: poison ivy, poison oak, poison sumac » Children playing with slime may get » Metals (especially nickel): snaps, jewelry, an itchy rash on their hands. There belt buckles, electronics, toys can be blisters, flaking, peeling, and cracking.
    [Show full text]
  • Seborrheic Dermatitis
    432 Teams Dermatology Done by: Wael Al Saleh & Abdulrahman Al-Akeel Reviewer: Wael Al Saleh & Abdulrahman Al-Akeel 9 Team Leader: Basil Al Suwaine Color Code: Original, Team’s note, Important, Doctor’s note, Not important, Old teamwork 432 Dermatology Team Lecture 9: Atopic dermatitis/ Eczema Objectives 1- To know the definition & classification of Dermatitis/Eczema 2- To recognize the primary presentation of different types of eczema 3- To understand the possible pathogenesis of each type of eczema 4- To know the scheme of managements lines P a g e | 1 432 Dermatology Team Lecture 9: Atopic dermatitis/ Eczema Introduction: A groups and spectrum of related disorders with pruritus being the hallmark of the disease, they also come with dry skin. Every atopic dermatitis is eczema but not every eczema are atopic dermatitis. Atopic dermatitis mean that the patient has eczema (excoriated skin, itching and re-onset) and atopy (atopy; the patient or one of his family has allergic rhinitis, asthma or eczema). It starts early of life (eczema can happen at any time). It classified as: - Acute, characterized by erythema, papules, vesicles, oozing, and crusting. - Subacute, clinically it is represented by erythema, scaling, and crusting. - Chronic, presents with thickening of the skin, skin markings become prominent (lichenification); pigmentation and fissuring of the skin occur. Acute on top of chronic very dry 4 years old boy with chronic, itchy, well defined brownish plaque with bleeding plaques. lichenifications. Ill defined plaques Well defined erythematous excoriated Lichenification is the hallmark for plaques on both cheeks with erosion. chronic course. P a g e | 2 432 Dermatology Team Lecture 9: Atopic dermatitis/ Eczema Dermatitis Classification of dermatitis: Atopic, more common in children Seborrheic (oily skin)- (like naso-labial folds, scalp, ears) Contact dermatitis, substance cause eczema - Allergic - Irritant Nummular, coined shape, usually in the shin.
    [Show full text]
  • Drug Eruptions
    DRUG ERUPTIONS http://www.aocd.org A drug eruption is an adverse skin reaction to a drug. Many medications can cause reactions, especially antimicrobial agents, sulfa drugs, NSAIDs, chemotherapy agents, anticonvulsants, and psychotropic drugs. Drug eruptions can imitate a variety of other skin conditions and therefore should be considered in any patient taking medications or that has changed medications. The onset of drug eruptions is usually within 2 weeks of beginning a new drug or within days if it is due to re-exposure to a certain drug. Itching is the most common symptom. Drug eruptions occur in approximately 2-5% of hospitalized patients and in greater than 1% of the outpatient population. Adverse reactions to drugs are more prevalent in women, in the elderly, and in immunocompromised patients. Drug eruptions may be immunologically or non-immunologically mediated. There are 4 types of immunologically mediated reactions, with Type IV being the most common. Type I is immunoglobulin-E dependent and can result in anaphylaxis, angioedema, and urticaria. Type II is cytotoxic and can result in purpura. Type III reactions are immune complex reactions which can result in vasculitis and type IV is a delayed-type reaction which results in contact dermatitis and photoallergic reactions. This is important as different medications are associated with different types of reactions. For example, insulin is related with type I reactions whereas penicillin, cephalosporins, and sulfonamides cause type II reactions. Quinines and salicylates can cause type III reactions and topical medications such as neomycin can cause type IV reactions. The most common drugs that may potentially cause drug eruptions include amoxicillin, trimethoprim sulfamethoxazole, ampicillin, penicillin, cephalosporins, quinidine and gentamicin sulfate.
    [Show full text]
  • Xerotic Eczema
    433 Dermatology Team Other type of eczema Lecture(10) Other type of eczema [email protected] 1 | P a g e 433 Dermatology Team Other type of eczema Content of lecture: To know the classification of Eczema. To recognize the primary presentation of different types of eczema. To understand the possible pathogenesis of each type of eczema. To know the scheme of managements lines. Color index: slides, doctor notes, 432 notes, Important 2 | P a g e 433 Dermatology Team Other type of eczema 1-Nummular Dermatitis: Coin shaped patches and plaques Secondary to xerosis cutis Primary symptom itch Notice the surrounding xerosis 2- Regional Eczema: A. Ear eczema B. Eyelid dermatitis Note: using of moisturizing C. Nipple eczema woreworse perorbital D. Hand eczema dermatitis. E. Diaper dermatitis F. Juvenile plantar dermatosis A- Ear Eczema Most frequently caused by seborrheic or atopic dermatitis Staph, Strep, or Psoeudomonas Earlobe is pathognomonic of nickel allergy B- Eyelid dermatitis When on one eye only, it is most frequently caused by nail polish When both eyelids are involved, consider mascara, eye shadow, eyelash cement, eyeliner, etc 3 | P a g e 433 Dermatology Team Other type of eczema C- Nipple eczema Painful fissuring, seen especially in nursing mothers. Maybe an isolated manifestation of atopic dermatitis. If persist more than 3 month, and/or unilateral, biopsy is mandatory to rule out Pagets disease . D- Hand eczema Spongiosis histologically . Irritant hand dermatitis- seen in homemakers, nurses. Resulting from excessive exposure to soaps. Pompholyx- tapioca vesicles, on sides of fingers, palms, and soles. Irritant versus allergic. Note: Adult atopic dermatitis has the greatest risk for hand dermatitis E- Juvenile plantar dermatitis Begins as a patchy symmetrical, smooth, red, glazed macules on the base of the great toes Affect age 3 to puberty.
    [Show full text]