Spectrum of cutaneous manifestations in lupus erythematous -a dermatologist perspective

Background: The cutaneous manifestations of lupus erythematosus (LE) specific skin disease consists of acute cutaneous LE (ACLE), Subacute cutaneous (SCLE) and Chronic cutaneous (CCLE). Objective: To evaluate the spectrum of cutaneous manifestation in patients of LE. Methods: A case series of 41 clinically diagnosed cases of LE attending the outpatient department of Dermatology, BPKIHS were evaluated for the specific and non-specific skin changes. Results: All the patients enrolled in the study were female,with the age ranging from 14-64 years. ACLE was detected in 22/41(78.04%). Malar rash was the frequent skin lesion. CCLE was seen in 6/41 (14.63%) patients with classical discoid lesions (localized and generalized) in 4/6(66.66%) and 2/6(33.33%) respectively. Non specific skin lesions were found in 30/ 41(73.17%) of patients. Mucosal ulcers were seen in 23/41(56.09%), Facial telangiectasias 20/41(48.78%), Raynaunds phenomena 22/41(53.65%), Chronic urticaria 9/41(21.95%), Nail changes 12/41(29.26%) and non scarring alopecia was seen in 6/41(14.63%) patients. Eye involvement was seen in 3/41(7.3%), cutaneous vasculitis in 5/41(12.19%) and scaring alopecia in 3/41(7.3%) patients. Conclusion: The cutaneous manifestations of patients with lupus erythematosus (LE) are very frequent, show a great variety and can occur at any stage of the disease. DOI: http://dx.doi.org/10.3126/hren.v10i1.5999 HREN 2012; 10(1): 8-11

Download Full-text

Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature

SAGE Open Medical Case Reports ◽

10.1177/2050313x21997194 ◽

2021 ◽

Vol 9 ◽

pp. 2050313X2199719

Author(s):

Juan Carlos Palomo-Pérez ◽

Maria Elisa Vega-Memije ◽

David Aguilar-Blancas ◽

Erik González-Martínez ◽

Lucia Rangel-Gamboa

Keyword(s):

Respiratory Symptoms ◽

Case Series ◽

Signs And Symptoms ◽

Skin Lesions ◽

World Health ◽

Medical Community ◽

Atypical Pneumonia ◽

Cutaneous Lesions ◽

Cutaneous Manifestations ◽

Mexican Patients

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

Download Full-text

HOMOLOGOUS DISEASE IN THE ADULT RAT, A MODEL FOR AUTOIMMUNE DISEASE

Journal of Experimental Medicine ◽

10.1084/jem.118.4.635 ◽

1963 ◽

Vol 118 (4) ◽

pp. 635-648 ◽

Cited By ~ 75

Author(s):

Peter Stastny ◽

Vernie A. Stembridge ◽

Morris Ziff

Keyword(s):

Autoimmune Disease ◽

Lupus Erythematosus ◽

Connective Tissue Diseases ◽

Skin Lesions ◽

Cutaneous Lesions ◽

Adult Rats ◽

Hydropic Degeneration ◽

Skin Changes ◽

Adult Rat ◽

The One

The cutaneous lesions of adult rats with homologous disease are described, and evidence is presented to indicate that they have an immunologic basis. The skin changes included erythema, purpura, edema, and a variety of inflammatory lesions. In the more active lesions, dermal infiltration, hydropic degeneration, acanthosis, and atrophy of the epidermis with hyperkeratosis and follicular plugging were present. In some cases, ulceration and sloughing were also observed. More chronic lesions were characterized by atrophy of the epidermis and collagenization of the dermis with disappearance of the skin appendages. Rejection of autografts was observed simultaneously with acceptance of homografts. The histologic appearance of autografts undergoing rejection was similar to that of the spontaneous skin lesions, suggesting that the latter, too, had an immunologic basis. In favor of this, also, was the specificity of the dermatitis for the skin of the host, with sparing of neighboring homograft tissue. There was a histologic similarity between the spontaneous skin lesions of homologous disease and those of lupus erythematosus on the one hand, and scleroderma on the other, thus supporting the possibility that the cutaneous lesions of these connective tissue diseases of man may also have an immunologic basis. It was concluded that the adult rat with homologous disease may furnish a model for human autoimmune disease.

Download Full-text

Clinical profile of cutaneous manifestations of connective tissue diseases in North-East India

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20213347 ◽

2021 ◽

Vol 7 (5) ◽

pp. 702

Author(s):

Deepa Mala Subba ◽

Nandakishore Thokchom ◽

Linda Kongbam ◽

Erika Salam ◽

Deepa Yumnam

Keyword(s):

Connective Tissue ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Connective Tissue Diseases ◽

Skin Lesions ◽

Discoid Lupus Erythematosus ◽

Serological Tests ◽

Cross Sectional ◽

Cutaneous Manifestations ◽

North East

Background: Connective tissue diseases (CTDs) are a heterogeneous group of autoimmune disorders having overlapping clinical features. Skin is often involved and it may be the earliest sign of the disease. This study highlighted the various cutaneous manifestations of common CTDs.Methods: A hospital-based cross-sectional study was carried out for a period of two years in 83 patients with CTDs in dermatology OPD, RIMS, Imphal. Detailed history taking, examination and relevant serological tests were performed.Results: The mean age was 39.78±17.29 years with female to male ratio of 4.5:1. Majority of the patients had lupus erythematosus (LE) (N=45) followed by systemic sclerosis (SSc) (N=25), rheumatoid arthritis (RA) (N=6), mixed connective tissue disease (MCTD) (N=4) and morphea (N=3). The most common presentation was raised skin lesions (45.8%) followed by Raynaud’s phenomenon (36.1%), photosensitivity (27.7%), skin tightness (26.5%) and joint pain (19.3%). Among LE patients, chronic cutaneous lupus erythematosus (CCLE) was the commonest variant and localised discoid lupus erythematosus (DLE) (22.9%) was the commonest presentation followed by malar rash and annular subacute lupus erythematosus (SCLE). Skin induration, microstomia and sclerodactyly were seen in most patients of SSc. Antinuclear antibodies were positive in 89.1% of patients. Anti-dsDNA and anti-Sm antibodies were positive in 62.2% and 33.3% of LE patients, anti-Scl 70 antibody was positive in 68% of SSc patients.Conclusions: CTDs are rare but potentially life-threatening. Proper understanding of the spectrum of cutaneous manifestations of CTDs is therefore necessary for early diagnosis and efficient management.

Download Full-text

Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018

Microorganisms ◽

10.3390/microorganisms8081113 ◽

2020 ◽

Vol 8 (8) ◽

pp. 1113

Author(s):

Anna Beltrame ◽

Gianfranco Barabino ◽

Yiran Wei ◽

Andrea Clapasson ◽

Pierantonio Orza ◽

...

Keyword(s):

Infectious Disease ◽

Wide Spectrum ◽

Case Reports ◽

Case Series ◽

Skin Lesions ◽

Clinical Suspicion ◽

High Risk Population ◽

European Guidelines ◽

Eye Involvement ◽

Multibacillary Leprosy

Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.

Download Full-text

Skin Signs

10.1093/med/9780190661304.003.0027 ◽

2018 ◽

Author(s):

Aziz Shaibani

Keyword(s):

Lupus Erythematosus ◽

Neuromuscular Disease ◽

Inflammatory Diseases ◽

Neuromuscular Diseases ◽

Skin Lesions ◽

Underlying Disease ◽

Systemic Lupus ◽

Dark Skin ◽

Skin Changes ◽

Skin Signs

Many neuromuscular diseases are expressed by skin manifestations such as dermatomyositis. Skin changes of dermatomyositis can be of many types and be subtle in dark skin. They include heliotropes, periungual telangiectasia, and thickening and fissuring of the skin. Unlike SLE rash, dermatomyositis rash affects the knuckles. Many systemic inflammatory diseases are associated with neuromuscular disease, such as vasculitis, systemic lupus erythematosus (SLE), and scleroderma. Steroids may lead to acne like skin lesions that should be differentiated from the rash of the underlying disease. This chapter provides examples of skin signs that are associated with neuromuscular diseases.

Download Full-text

Dermatological aspects influencing the practice of physical activities by obese individuals

Fisioterapia em Movimento ◽

10.1590/0103-5150.028.004.ar02 ◽

2015 ◽

Vol 28 (4) ◽

pp. 837-850 ◽

Cited By ~ 2

Author(s):

Kátia Sheylla Malta Purim ◽

Ana Cláudia Kapp Titski ◽

Neiva Leite

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Skin Disease ◽

Acanthosis Nigricans ◽

Skin Diseases ◽

Fungal Infections ◽

Skin Lesions ◽

Cutaneous Manifestations ◽

Routine Therapy

Abstract Objective : The aim of this study was to perform a systematic review of the major skin diseases affecting obese individuals and their influence on physical activity. Methods : Relevant articles were identified by systematically searching PubMed from 2000 to 2014, using the descriptors "skin diseases" and "obesity", "skin disease" and "obesity", "skin diseases" and "physical activity", "skin disease" and "physical activity". The PEDro Scale (in Brazilian Portuguese) was used to rate the methodological quality of the studies. Results : A total of 320 articles were examined in the first phase. In the end, 11 articles met the proposed criteria and were included for analysis in the systematic review. We investigated cutaneous manifestations of diseases and classified them according to their effects under 5 categories: metabolic (n = 10), aesthetic (n = 7), inflammatory (n = 6), mechanical (n = 5) and infectious (n = 3). The most frequent dermatoses among obese were acanthosis nigricans, acrochordon (skin tags), stretch marks, plantar keratodermia, intertrigo, bacterial and fungal infections. Acanthosis nigricans was found to be the most important metabolic implication of obesity. Conclusion : Although neglected, skin lesions are common in obesity and have implications for physical activity because they cause pain, discomfort, friction, infection, inflammation, embarrassment, limitation or difficulty of movement. Strategies to promote skin health may result in a better integration of physical activity into routine therapy and improve the quality of life of obese individuals.

Download Full-text

Cutaneous Manifestations of COVID-19: A Case Series from Brazil

Revista da Sociedade Portuguesa de Dermatologia e Venereologia ◽

10.29021/spdv.78.4.1281 ◽

2020 ◽

Vol 78 (4) ◽

pp. 329-334

Author(s):

David De Almeida Souza ◽

Daniela Alves Pereira Antelo

Keyword(s):

Case Series ◽

Skin Lesions ◽

Daily Routine ◽

Skin Involvement ◽

Cutaneous Manifestations ◽

Infected People ◽

Maculopapular Eruption ◽

The World ◽

Systemic Symptoms ◽

Epidemiological Characteristics

Introduction: Brazil has presented alarming and growing data on infection and deaths from SARS-CoV-2. There are more than 4 500 000 confirmed cases and more than 137 000 deaths ranking second in the world ranking of infected people. In addition to the involvement of the respiratory, cardiovascular, renal and neurological systems, this virus also causes non-specific skin lesions in same patients. Little is known about the pathophysiology of cutaneous involvement. At this moment, we cannot predict a difference in prognosis based on skin lesions. Methods: We conducted an observational case study of 25 patients affected by SARS-CoV-2 who had dermatological lesions. We described the clinical and epidemiological characteristics of each case, demonstrating the polymorphism of the skin lesions and also making a correlation with the chronology of presented systemic symptoms. Results: Twenty five cases of COVID-19 with cutaneous manifestations (urticaria, erythematous rash, maculopapular eruption, pruritus, erythema multiforme-like lesions, dyshidrotic eczema) were observed during, after and before systemic symptoms. A few cases with skin involvement were also observed as isolated symptoms of the viral infection. These data demonstrate the clinical polymorphism related to skin involvement of patients infected with SARS-CoV-2, emphasizing the importance of clinical suspicion by dermatologists when handling suspected cases in the current epidemiological scenario. Conclusion: Although the number of cases in the world stage seems to be regressing, infection by SARS-CoV-2 will be part of the dermatologist's daily routine. As long as we do not have a widely available vaccine and the pandemic takes on an endemic profile, we need to be aware of these manifestations, not only for the proper diagnosis, indication of patient isolation, as well as all the necessary biosafety procedures in dermatology clinics.

Download Full-text

The combined role of clinical, reflectance confocal microscopy and dermoscopy applied to chronic discoid cutaneous lupus and subacutus lupus erythematosus: A case series and literature review

Lupus ◽

10.1177/0961203320958141 ◽

2020 ◽

Vol 30 (1) ◽

pp. 125-133

Author(s):

Sara Mazzilli ◽

Laura Vollono ◽

Laura Diluvio ◽

Elisabetta Botti ◽

Gaetana Costanza ◽

...

Keyword(s):

Confocal Microscopy ◽

Lupus Erythematosus ◽

Cutaneous Lupus Erythematosus ◽

Clinical Manifestations ◽

Case Series ◽

Skin Lesions ◽

Reflectance Confocal Microscopy ◽

Discoid Lupus Erythematosus ◽

Cutaneous Lupus

Main subtypes of cutaneous lupus erythematosus are represented by acute, subacute cutaneous, intermittent and chronic cutaneous lupus erythematosus. Discoid lupus erythematosus represents the most common phenotype of chronic cutaneous lupus erythematosus. The spectrum of clinical manifestations mirrors that of several and distinct histopathological features. Such variability among different CLE subtypes is also observed at dermoscopy. Dermoscopy is nowadays considered an additional valuable method for skin lesions assessment in general dermatology, following and completing the well-known clinical diagnostic steps, such as medical history and clinical examination. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool able to assess the epidermis and upper dermis producing high resolution (horizontal ∼1.25 μm, vertical ∼5 μm), en face tissue sections used for melanocytic and inflammatory evaluation. In this study, we reported dermoscopic and RCM features about 9 patients affected by subacute and chronic lupus erythematosus retrospectively analyzed.

Download Full-text

Cutaneous Manifestations in COVID-19: Report on 31 Cases from Five Countries

Biology ◽

10.3390/biology10010054 ◽

2021 ◽

Vol 10 (1) ◽

pp. 54

Author(s):

Carmen Rodriguez-Cerdeira ◽

Brianda I. Uribe-Camacho ◽

Lianet Silverio-Carrasco ◽

Wennia Méndez ◽

Ashwini R. Mahesh ◽

...

Keyword(s):

Case Series ◽

Skin Lesions ◽

Close Monitoring ◽

Livedo Racemosa ◽

Cutaneous Manifestations ◽

Causal Factors ◽

Qrt Pcr ◽

Previous Contact ◽

Maculopapular Rashes ◽

Dermatologic Manifestations

The increasingly frequent cutaneous manifestations of coronavirus disease (COVID-19) remain to pose a problem to clinicians. Herein, we aimed to describe the clinical and pathological findings of skin lesions in patients with COVID-19. The case series, which was based on the International Dermatological Registry circulated to dermatologists worldwide, was conducted across organizations and societies belonging to five different countries. We documented 31 patients with dermatologic manifestations associated with COVID-19, including maculopapular rashes (16.10%), urticarial lesions (26.80%), pseudochilblains (22.60%), petechiae/purpura (6.50%), distal ischaemia and necrosis (6.50%), livedo racemosa (12.90%), and others (9.70%). Twenty-six cases (83.90%) were qRT-PCR-confirmed COVID-19 cases, two (6.50%) were serologically confirmed, while two others (9.7%) were suspected cases owing to previous contact with COVID-19-positive patients. Therefore, our findings indicate that a febrile rash or even a rash in an afebrile state in the early stages of the disease may be the only clinical manifestation of COVID-19. In the future, we recommend close monitoring of all patients with skin lesions not attributable to other causal factors; in the diagnostic perspective, clinicians should aim to confirm if the skin lesions are associated with COVID-19.

Download Full-text

A study of cutaneous manifestations of systemic lupus erythematosus in Malwa region of India

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20181825 ◽

2018 ◽

Vol 4 (2) ◽

pp. 230

Author(s):

Pankaj Kohli ◽

Komal Sharma ◽

Akshay Tolani

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Demographic Data ◽

Tertiary Care ◽

Age At Onset ◽

Systemic Lupus ◽

Tertiary Care Centre ◽

Cutaneous Manifestations ◽

Malar Rash ◽

Skin Manifestations

Background: Systemic lupus erythematosus (SLE) is an autoimmune disease. SLE is the most common connective tissue disease. Its prevalence varies according to geographical and racial background from 3/10 000 in Caucasians to 20/10 000 in Afro-Caribbeans. Around 90% of affected individuals are women, and the peak age at onset is between 20 and 30 years. Limited studies are available in India which have documented the frequency of cutaneous manifestations of SLE, so, this study was planned to evaluate the frequency of skin manifestations of SLE, in a tertiary care centre of Malwa region of India.Methods: All demographic data including age, sex, weight was collected on a pre-designed proforma. All the patients were evaluated for cutaneous manifestations of SLE i.e. malar rash, discoid rash, oral ulcers, photosensitivity etc. All the information was recorded in designed proforma.Results: Among 100 SLE subjects, 82 (82%) patients had skin manifestations, 18 (18%) patients had oral ulcer and 12 (12%) patients had raynaud’s phenomenon at the time of presentation. Among dermatological manifestations, 42% patients had photosensivity, 35% patients had malar rash, 30% patients had discoid rash, 10% patients had alopecia and 2% patients had bullous lesion.Conclusions: Skin lesions in patients with lupus may be specific or nonspecific. This study covers the SLE-specific cutaneous changes: malar rash, discoid rash, photosensitivity, and oral mucosal lesions as well as SLE nonspecific skin manifestations. A deeper thorough understanding of the cutaneous manifestations of SLE is essential for diagnosis, prognosis, and efficient management. Thus, dermatologists should be involved with other specialties to provide optimal care of SLE patient.

Download Full-text