Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well ...recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.
Mastocytosis (M) represents a systemic pathology characterized by increased accumulation and clonal proliferation of mast cells in the skin and/or different organs. Broadly, M is classified into two ...categories: Cutaneous mastocytosis (CM) and systemic mastocytosis (SM). In children, CM is the most frequent form. Unfortunately, pathogenesis is still unclear. It is thought that genetic factors are involved, but further studies are necessary. As for features of CM, the lesions differ in clinical forms. The most important fact is evaluating a pediatric patient with CM. It must comprise laboratory exams (with baseline dosing of total serum tryptase), a skin biopsy (with a pathological exam and, if the diagnosis is unclear, immunohistochemical tests), and a complete clinical evaluation. It is also defining to distinguish between CM and other diseases with cutaneous involvement. As for the management of CM in children, the first intervention implies eliminating trigger factors. The available cures are oral H1 and/or H2 antihistamines, oral cromolyn sodium, oral methoxypsoralen therapy with long-wave psoralen plus ultraviolet A radiation, potent dermatocorticoid, and calcineurin inhibitors. In children, the prognosis of CM is excellent, especially if the disease's onset is in the first or second years of life.
Morphea is an inflammatory skin disease with self-limited evolution, presenting as localized sclerosis of the skin and/or underlying tissues. The incidence is not exactly known; the disease occurs ...more frequently in women, and there is no sex prevalence. Pathogenesis of morphea remains still controversial. Several theories exist and the Borrelia burgdorferi infection is not yet elucidated. The aim of this report is to present the main mechanisms involved in the etiophatogenesis of morphea and also the thepapeutic options. A case of a 60-year-old woman is presented, who was referred to the clinic for an erythematous-violaceus, asymptomatic eruption, located on the trunk and legs, for appoximately 2 months. The patient's medical history revealed an infection with Borrelia 1 year previously. After diagnosis of morphea was established, and with systemic therapy (corticosteroids and methotrexate), the evolution was favorable.
Infantile hemangiomas (IHs), boasting a prevalence ranging from 4% to 10%, stand as the most commonly encountered benign tumors during the early stages of human life. We present the case of a ...2-year-9-month-old child who was born preterm with very low birth weight (VLBW), 1010 g birth weight, at 27 weeks gestational age. During pregnancy, her mother had anemia and needed cervical cerclage. On her 10th day of life, the appearance of a frontal hemangioma could be observed. The hemangioma was situated at the hairline. At the age of one month, another hemangioma could be observed on her right arm. The hemangiomas were treated with propranolol oral suspension for 10 months and afterwards with local ointment for 2 months. This choice of treatment delivered great results, with no adverse reactions reported. In this case report, we underlined the risk factors for IH, possible complications, and available treatment options.
Metastatic cutaneous lesions are seen more commonly in breast cancer than in any other malignancy in women. Secondary breast cancer happens when cancer cells spread from the breast to other parts of ...the body. Sometimes breast cancer cells can spread to the skin. This can happen through the blood or lymphatic system. The presence of skin metastases signifies widespread systemic disease and a poor prognosis. The chest wall, the abdomen, the back, and the upper extremities are common sites.We present the case of a 69-year-old woman presented to our Surgery Department in June 2019, after appearing in the Dermatology Department a week ago, for the appearance of multiple subcutaneous painless, hardened, skin-colored nodules spread to the cervical region, anterior chest walls and upper limbs. Anatomopathological examination of the skin biopsy, performed on the anterior face of the left arm, showed dermal fragment with neoplastic, suggestive for lobular breast carcinoma (stage IV). The patient was referred to the oncological surgery department where our patient underwent a left total mastectomy and sentinel lymph node biopsy. The technique of mastectomy was the Madden technique. The surgery has no healing character, being more a necessity intervention that seeks to avoid the complications of the local evolution of the disease, such as ulceration, hemorrhage or suppuration, the possibility of applying the other forms of treatment (radiotherapy and / or polychemotherapy), elimination of a source of permanent metastatic sowing thus leading to more efficient treatment.
Scabies is a human ectoparasitosis caused by Sarcoptes scabei var. hominis. World-wide around 300 million patients are affected. Infants and children have the highest incidence rates. Poverty and ...overcrowding are social factors contributing to a higher risk of transmission and treatment failure. The leading symptom of the infestation is itch. Complications are bacterial infections that are responsible for mortality. Diagnosis is clinical. Non-invasive imaging technologies like dermoscopy can be used. Polymerase chain reaction (PCR) is less sensitive and specific than microscopy of skin scrapings. Treatment of choice is topical permethrin 5%. Ivermectin is the only oral drug FDA-approved for scabies. It should be used in cases non-responsive to topical therapy and in case of high number of infested patients in addition to topical therapy. Pseudo-resistance to treatment is not uncommon. New drugs are on the horizon.
What is Known:
• Pruritus is the leading symptom causing sleep disturbances and scratching with the risk of secondary bacterial infections.
• Treatment failure is related to inappropriate application of topical drugs and asymptomatic family members.
What is New:
• COVID-19 pandemic and migration are contributing to an increased incidence of scabies.
• New compounds to treat scabies are on the horizon.
Granuloma annulare (GA) is a benign skin condition of unknown etiology. It can manifest itself in several clinical forms: localized, generalized, subcutaneous or perforating. The association between ...GI and diabetes, dyslipidemia or neoplasms is not yet elucidated. Although the diagnosis is clinical in most cases, a histopathological examination may be necessary. We presented the case of a 52 years old patient, diabetic, hypertensive, who reffered to our clinic, with a rash or macular-papular, pruritic, eruption, localization on the lower limbs and abdomen, in the evolution of 6 months. We performed skin biopsy with histopathological examination, which revealed: dermal nodular infiltrates consisting of palisadiate histiocytes, in several mucin collections and signified by lymphocytes with perivascular arrangement, typical modifications for an annular granuloma lesion. We have initiated systemic treatment with isotretinoin, associated with dermatocorticoids, with favorable evolution. Diagnosis, aș well aș the management of a patient with generalized GI, can sometimes be difficult. The histopathological examination, in combination with a suggestive clinical picture, makes the diagnosis. Treatment is indicated in severe cases, with multiple, symptomatic, persistent lesions.
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