Airway management of a patient with linear immunoglobulin A bullous dermatosis:A case report

BACKGROUND There is limited literature on managing the airway of patients with linear immunoglobulin A(IgA)bullous dermatosis,a rare mucocutaneous disorder that leads to the development of friable bullae.Careful clinical decision making is necessary when there is a risk of bleeding into the airway,and a multidisciplinary team approach may lead to decreased patient morbidity during these high-risk scenarios,especially when confronted with an unusual cause for bleeding.CASE SUMMARY A 45-year-old African American female presented to our ambulatory surgical center for right corneal transplantation due to corneal perforation after blunt trauma in the setting of cicatricial conjunctivitis and diffuse corneal neovascularization from linear IgA bullous dermatosis.The diagnosis of IgA dermatosis was recent,and the patient had been lost to follow-up.The severity of the disease and extent of airway involvement was unknown at the time of the surgery.Significant airway bleeding was noticed upon intubation and the otorhinolaryngology team had to be called to the operating room.The patient required transfer to the intensive care unit where a multidisciplinary team was involved in her case.The patient was extubated on postoperative day 4.CONCLUSION A multidisciplinary approach to treating this disease is the best course of action before a surgical procedure.In our case,key communication between the surgery,anesthesia,and dermatology teams led to the quick and safe treatment of our patient’s disease.Ambulatory surgery should not be considered for these cases unless they are in full remission and there is no mucous membrane involvement.

Transient Acantholytic Dermatosis: A Case Report and Literature Review

Transient acantholytic dermatosis (TAD, Grover disease) is a benign skin disease with a nonspecific rash that may present as a reddish-brown, dermatomal edematous papule or herpetiform rash with a partially central horny plug. This disease is usually self-limiting and can subside within weeks or months, but it may also have a chronic progression with a trend towards long-term recurrence. The patient is an 80-year-old male who visited the clinic due to recurring erythema and blisters all over his body that had been present for over 2 years. Based on the patient’s course, laboratory tests and histopathological findings were consistent with the diagnosis. The final diagnosis was transient acantholytic dermatosis. The patient has a long course of the disease, a wide range of skin lesions and he has the different subtypes of pathological manifestations. This case and corresponding literature review help us have a clear understanding of Grover’s disease, which has received reference value for the diagnosis and treatment of this disease in clinical work.

Is it relevant a correct intimate cleansing in the treatment of vulvar dermatosis?

Background: Vulvar dermatoses are inflammatory disorders of genital skin causing itch, pain, dysuria and dyspareunia. Objective: To compare the efficacy of two intimate cleansers as adjuvants in the treatment of the two common vulvar dermatoses: Lichen sclerosus (LS) and lichen simplex chronicus (LSC). Method: 32 patients with the diagnosis of LS or LSC initially treated with Mometasone furoate 0.1% cream were then randomly assigned to receive either cleanser A (cleaner based on amigdalus dulcis, malva, jojoba oil, PCL solid, Hyaluronic acid) or cleanser B (cleaner based on Cocoyl Wtheat Amino Acids, Maltodextrins, Aveena sativa, Caprylic Glycol) twice a day in association with lanolin cream one application daily for 30 days, following which the lanolin cream was applied only when needed as a rescue treatment. The amount of the rescue cream used, rubbing, applicability and pleasantness of the product were classified before and after 60 days of treatment. Results: The differences between the two treatments for rubbing, applicability and pleasantness of the product were statistically non-significant, while “as needed” use of the emollient lanolin cream was significantly superior in a total number of doses in the B group versus the A group (8.25 vs 5.28 (P < 0.001). Conclusion: The parameters showed a high score for both the cleansers, demonstrating the acceptability of these products by the women. The best results of the cleaner A can be attributed to not only to the pool of moisturizing and emollient active ingredients but that of the soothing effects as well. This shows that the role of intimate cleanser is not only for vulval cleansing, but can also play a therapeutic role of moisturization and emollience.

Epidemiological Profile of Dermatosis among Automobile Repair and Maintenance Garages in the City of Parakou in 2020

Background: Occupational dermatoses, also called occupational dermatitis or occupational dermatitis, are very common in the workplace and are still a topical subject. All over the world, especially in developed countries. They handicap the professional activities of the workers. Purpose: To determine the epidemiological profile of dermatosis among automobile repair and maintenance garages in Parakou. Methods: It was a cross-sectional and descriptive study carried out from 20 April to 17 May 2020. The sampling method was non-probabilistic. Data collected from a questionnaire, clinical examination and worksite observation were analyzed with Epi Info 7.2.2.1 software. Results: The participation rate was 98.08%. The sex ratio (male/female) was 178. The mean age of the respondents was 25.80 ± 10.22 years. Respondents with less than 5 years of experience in the field were 61.22%. Mechanics were the most numerous. In the sample, 95.81% had frequent skin contact with fuels, 84.08% had contact with motor oils and 15.92% had contact with dilute battery electrolyte solutions. The frequency of dermatosis was 73.46%. Hands and wrists were the most affected seats (47.35%). Some (33.84%) wore them before the start of the activity in the garage but in 66.22% of them, the dermatosis had occurred because of their arrival in the garage. Among these skin diseases, keratoderma predominated at 80.01%. Conclusion: Dermatosis is very common among garage owners in Parakou.

Diagnostic Sign of Terra Firma-Forme Dermatosis

Background: Terra Firma-Forme Dermatosis (TFFD), a benign skin condition which presents with asymptomatic brown to black plaques which resemble dirty skin. Aim: To document a new case presentation with TFFD in the Arab region which is considered as one of the differential diagnoses of dirty neck. Case presentation: A 15-year-old girl presented with a history of asymptomatic brownish dirt-like lesion on the nape and sides of the neck for 4-years duration, not resolved by wash with water and soap and confused with other dermatoses like acanthosis nigricans or atopic dermatitis. The diagnosis of TFFD was confirmed when the lesions were completely resolved after gentle swabbing with 70% isopropyl alcohol. Conclusion: TFFD is rarely reported in Arab region and should be considered when evaluating cases of dirty neck-like presentation of atopic dermatitis or acanthosis nigricans.

Erosive Pustular Dermatosis of the Scalp After Excision and Skin Grafting of Scalp Squamous Cell Carcinoma

Introduction:Erosive pustular dermatosis of the scalp(EPDS)is an uncommon condition with unknown etiology.The clinical exclusive diagnosis needs to be differentiated from similar diseases.Case presentation:A 68-year-old woman presented with an eight-month history of a chronic scalp eruption.She had been diagnosed as squamous cell carcinoma by biopsy nine months ago,and had been treated by surgical excision and skin grafting.One month later,she was referred for evaluation of the newly enlarged lesion which was observed at the skin grafting site.She was diagnosed of EPDS based on characteristics of lesions,clinicopathological findings and laboratory data.The condition had clinically improved with systemic steroid therapy and topical tacrolimus for two weeks.Relapses occurred after complete withdrawal of both treatments.After repeating the above therapy and applying topical tacrolimus as maintenance therapy,the condition was well controlled at the one-year follow-up.Discussion:EPDS is an uncommon inflammatory dermatosis with main incidence rate of elderly patients and female predominance.The diagnosis of EPDS cant be made only by histopathological examination,which is helpful for differential diagnosis.Microbiological investigations commonly remain negative.For the high risk of relapse,it is important for clinicians to be aware of maintenance treatment and a long-term management.Conclusion:It should be recognized by clinicians that EPDS is an uncommon and relapse disease,leading to serious cosmetic problems.The treatment lacks evidence-based medicine data,clinician should choose the appropriate therapy according to the condition of patients.

Clinical variants of pityriasis rosea

Pityriasis rosea(PR) is a common erythemato-squamous dermatosis which almost always, is easily diagnosed. Mostly the disease presents in its classical form. However, clinical dermatology is all about variations and PR is not an exception. Variants of the disease in some cases may be troublesome to diagnose and confuse clinicians. Prompt diagnosis and treatment of the condition becomes necessary to avoid unnecessary investigations. We hereby review and illustrate atypical presentations of the disease, including diverse forms of location and morphology of the lesions, the course of the eruption, and its differential diagnoses.

Evaluation of the Therapeutic Response and Improvement in the Quality of Life of the Patient with Darier Disease to Acitretin through an Analogy between Close Relatives

Darier disease (DD), also known as follicular keratosis, is a rare autosomal dominant hereditary acantholytic dermatosis caused by a mutation in the ATP2A2 gene. Skin lesions are characterized by persistent confluent papules, preferentially located on the seborrheic areas of the face, chest and back. The hands, feet and nails are also commonly affected. DD has a chronic course with frequent relapses. Their treatment is often difficult and unsatisfactory. We present the case of a 54-year-old male with a history of keratotic papules with a brownish-black color, with a foul-smelling, pruritic and ardent appearance on the back and trunk, since the age of 19, which worsen in the summer. His 27-year-old daughter has a similar picture with her skin lesions started at age of 17 in the region below the breast, back, trunk, feet and hands. After the skin biopsy, the diagnosis was confirmed and acitretin 30 mg/day was instituted. The importance of this case report is to alert health professionals that the diagnosis of DD should be considered in family members of patients, especially those in the first degree, and also in patients with follicular keratolytic dermatoses, being an important differential diagnosis of this group of patients diseases.

Pyoderma gangrenosum:An important dermatologic condition occasionally associated with rheumatic diseases

Pyoderma gangrenosum(PG) presents with refractory,sterile,deep ulcers most often on the lower legs.Clinically,PG exhibits four types,i.e.,ulcerative,bullous,pustular,and vegetative types.PG may be triggered by surgical operation or even by minor iatrogenic procedures such as needle prick or catheter insertion,which is wellknown as pathergy.PG is sometimes seen in association with several systemic diseases including rheumatoid arthritis(RA),inflammatory bowel disease,hematologic malignancy,and Takayasu's arteritis.In particular,various cutaneous manifestations are induced in association with RA by virtue of the activation of inflammatory cells(neutrophils,lymphocytes,macrophages),vasculopathy,vasculitis,drugs,and so on.Clinical appearances of ulcerative PG mimic rheumatoid vasculitis or leg ulcers due to impaired circulation in patients with RA.In addition,patients with PG sometimes develop joint manifestations as well.Therefore,it is necessary for not only dermatologists but also rheumatologists to understand PG.

Vulvar Dermatoses: Effect of a Synergistic Treatment with a Moisturizing and Healing Product on the Course of the Disease

Background: Vulvar dermatoses are inflammatory disorders of genital skin causing itch, burning, and plaques with overlying excoriation and linear fissures. Objective: To assess the effectiveness of a soft foam based on Tiab&reg;system (TF), complex of titanium micro crystals covalently bound with silver ions associated with hyaluronic acid, in the supportive treatment of lichen sclerosus (LS) and lichen simplex chronicus (LSC), the two common vulvar dermatoses. Method: 20 patients with the diagnosis of LS or LSC received an 4-week treatment, during which the subjects applied Mometasone furoate in the form 0.1% cream were treated with Mometasone furoate 0.1% cream in combination with TF once a day. Clinical symptoms (itching and burning) and signs (vulvar suface disruption) were documented at baseline and at the end of the four-week treatment. Results: There was a significant reduction of symptoms between the basal scores and the symptoms complaints at 4-week treatment. Moreover, a significant reduction of excoriations and linear fissures was observed. Conclusion: The present study shows that daily application of TF can be an effective adjunct for the treatment of vulvar dermatosis. The foam had not only a moisturizer action, it may also be associated with a reduction in epithelial disruption in the form of excoriations and fissures.

Mycosis fungoides: A mimicker of benign dermatoses

Mycosis fungoides, the most common primary cutaneous lymphoma, may present with a broad spectrum of clinical features. As both clinical and dermatopathological findings in mycosis fungoides occasionally closely imitateother dermatoses, correct diagnosis may be a challenge both for clinicians as well as dermatopathologists. As a consequence, diagnosis of cutaneous lymphoma may be initially missed and, therefore, prompt and adequate therapeutic measures delayed. Hence, the purpose of our article was to give an overview of hitherto published "mimickers" of mycosis fungoides with a review of its diverse clinical features to alert the clinicians about the wide spectrum of this dissimulating disease. By integrating our own encountered atypical cases of mycosis fungoides we provide a comprehensive illustrated histological and moleculargenetic workup thereof and thereby critically revise the different available diagnostic tools of daily routine. Finally, we derive a practical algorithm to obtain the correct diagnosis even in such ambiguous cases of mycosis fungoides.

Trichoscopy: Essentials for the dermatologist

Noninvasive in vivo imaging techniques have become an important diagnostic aid for dermatology. Dermoscopy, also known as dermatoscopy, has been shown to increase the clinician's diagnostic accuracy when evaluating cutaneous neoplasms. Dermoscope, both hand-held and videodermoscope, are nowadays a basic instrument for almost all the dermatologists around the world. Trichoscopy is the term coined for dermoscopic imaging of the scalp and hair. Routinely using dermoscopy and recognizing the structures and patterns of the different types of alopecia will likely improve the observer's sensitivity for diagnosis and followup of hair and scalp disorders. Structures which may be visualized by trichoscopy include hair shafts of different types, the number of hairs in one pilosebaceous unit, hair follicle openings(dots), the peri and interfollicular areas and the vasculature. This review summarizes the current knowledge about trichoscopic findings which may aid in the diagnosis of alopecia. Besides diagnosing alopecia, it has the potential for obviating unnecessary biopsies and when a biopsy is still needed it is helpful in choosing an ideal biopsy site. Moreover, trichoscopy can be a valuable tool for evaluating the treatment response photographically at each follow-up. Finally, we have discussed the utility of dermoscopy in inflammatory scalp disorders and infections.

Contribution of Dermatopathology in the Diagnosis of Cutaneous Diseases in Côte d’Ivoire

Introduction: Dermatopathology is a fundamental complementary examination for the diagnosis of certain skin conditions when the clinic is hesitant. We therefore initiated this work in order to determine the contribution of dermatopathology in the diagnostic management of certain dermatoses at the Treichville University Hospital Centre of Abidjan. Material and methods: This is a cross-sectional descriptive study with data collection from medical records in the dermatology-venereology and pathological anatomy departments of the Treichville University Hospital Centre. Results: We included and analyzed 184 patients with a sex ratio of 1.2. 46.2% of lesions were generalized with 2% mucosal localization. Erythematosquamous lesions (24.45%) and papules (22.82%) were the most biopsied lesions. The single biopsy sample accounted for 71.2% of the cases and the lesion size ranged from 0.5 cm to 10 cm. Biopsy parts of the lesion alone accounted for 65.2% versus 34.8% for those straddling healthy skin and lesion. Histological diagnosis was established in 91.3%. Kaposi disease accounted for 14.9% of cases followed by psoriasis 11.3%. In the case of three diagnostic hypotheses, the concordance was 84.8%. It was 76.6% for two hypotheses mentioned and 52.3% for a single hypothesis. Conclusion: This work shows that in more than half of the cases, the clinical hypotheses and the histological diagnosis match. It suggests however to continue the training of dermatologists to improve the skin biopsies and invites to initiate clinicopathological confrontations to better refine the diagnoses.

Prurigo Pigmentosa and Confluent and Reticulated Papillomatosis a Spectrum of One Disease: A New Case Report

Background: Prurigo Pigmentosa (PP) is a rare inflammatory dermatitis first discovered in 1971. Characterized by a sudden eruption of pruritic reticulated, pink-brown papules coalescing into plaques distributed symmetrically over shoulders, neck, chest, and back. Various triggers have been identified, including the ketogenic diet. Clinicopathological presentation looks similar to confluent and reticulated papillomatosis (CARP) which is a rare dermatosis of unknown etiology characterized by hyperkeratotic pigmented papules & peripheral reticulation involving seborrheic areas. Aim: To document a new case presentation of PP caused by a low-carbohydrate restricted diet and discuss the comparison with CARP clinically, pathologically, and treatment modalities. Case report: A 15-year-old childhood male developed PP 3 weeks after self-initiating a low carbohydrate-restricted ketogenic diet for weight management. Clinically and histopathologically the lesion looks similar to CARP, treated successfully with re-introduction of high carbohydrates in his food, a short course of systemic steroids in combination with oral doxycycline capsules for the one-month duration. Conclusion: PP & CARP have been considered a spectrum of one disease, and PP is a pruritic variant from CARP caused by a low carbohydrate-restricted diet.

Oral Pathergy in Sweet’s Syndrome Following Food Bolus Injury

Pathergy is a unique and dramatic clinical finding of exuberant inflammation in response to local trauma. This incompletely understood phenomenon presents with sterile pustules and ulcers after minor cuts or scrapes, and can be tested by a pricking the skin with a sterile needle. Historically, pathergy was thought to be pathognomonic for Behcet’s syndrome, though it has also been described in several other inflammatory conditions such as pyoderma gangrenosum and acute febrile neutrophilic dermatosis (Sweet’s syndrome). Recognizing Sweet’s syndrome specifically can be challenging due to its atypical clinical course, and understanding the relationship between Sweet’s syndrome and pathergy can offer an important diagnostic clue. We present a case of Sweet’s syndrome presenting with upper airway obstruction and pathergy. To our knowledge, this is the first documented case of Sweet’s syndrome presenting with oral pathergy.

Effects of Qingre Huoxue Jiedu Formula on Nerve Growth Factor-Induced Psoriasis

Objective:To elucidate the mechanisms of 4 effective components from a Chinese medicine formula,namely Qingre Huoxue Jiedu Formula(QHJ heat-and toxin-clearing and blood-activating formula),in the treatment of nerve growth factor(NGF)-induced psoriasis.Methods:Keratinocyte proliferation and T cell proliferation models were developed using NGF.An NGF solution(NGF+DMEM,100 ng/mL)was added to all induced groups and treated groups and were cultured for 24 h,while a solution with NTRK1 antagonist(K252 a+DEME,300 nmol/L)was added and cultured for 1 h.The models were used to evaluate the effects of the treatment with each of the 4 components of QHJ,namely shikonin,paeonol,astilbin and ursolic acid.Cell apoptosis and proliferation were measured by flow cytometry analysis and CCK8 assay,respectively.The mRNA expression levels of Bax,Bcl-xl,and NGF receptor(NGFR)were assessed by quantitative real-time PCR(qRT-PCR)and Western blot analysis,respectively.Results:(1)All QHJ-treated groups showed significantly increased cell apoptosis and inhibition of cell proliferation compared with the NGF-induced groups(P<0.05).In addition,treatment with QHJ plus NTRK1 significantly enhanced cell apoptosis and inhibition of cell proliferation compared with cells treated with QHJ only(P<0.05),particularly in cells treated with ursolic acid.(2)QHJ-treated groups showed higher protein expression levels of Bax,Bcl-xl compared with other groups(P<0.05).Additionally,treatment with QHJ plus NTRK1 significantly increased the protein expression levels of Bax,Bcl-xl and NGFR compared with those treated with QHJ only(all P<0.05),especially in those treated with shikonin.Conclusion:The action mechanism of QHJ on psoriasis might be through enhancing cell apoptosis and inhibition of cell proliferation,and upregulating the expression level of Bax,Bcl-xl and NGFR.

Anti-inflammatory Effects of Ampelopsis Japonica Root on Contact Dermatitis in Mice

Objective:To investigate the anti-inflammatory potential of Ampelopsis japonica on contact dermatitis(CD).Methods:A total of 38 Balb/c mice were divided into 5 groups by using a random number table:normal mice(n=6),CID model mice(n=8),CD mice treated with 3 or 30 mg/kg of the ethanol extract of A.japonica(EEAJ,n=8)and 7.5 mg/kg dexamethasone treated CD mice(DEX,n=8).CD was induced using topical application of 1-fluoro-2,4-dinitrofluorobenzene in mice.EEAJ and DEX were topically applied to the shaved skin of each mouse for 6 days,and the effects of EEAJ and DEX on skin lesions and color,histopathological abnormalities such as epidermal hyperplasia and immune cell infiltration,and tumor necrosis factor(TNF)-α,interleukin-6(IL-6),and monocyte chemoattractant protein-1(MCP-1)production were investigated.The effects on changes in body weights and spleen/body weight ratio were also investigated.Results:EEAJ at 30 mg/kg significantly prevented scaling,erythema and enlargement of skin weight compared to using carbon dioxide.EEAJ also prevented epithelial hyperplasia and immune cell infiltrations induced by repeated application of DNFB(P<0.01).In addition,EEAJ significantly lowered levels of TNF-α,IL-6 and MCP-1(P<0.05 or P<0.01).The anti-inflammatory effects of EEAJ were similar to those of DEX.Conclusion:A.japonica may be a new therapeutic agent with the potential to reduce or replace corticosteroids and its mechanisms are closely related to regulation of TNF-α production.