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Dermatologic diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Holly Edmonds, Dana Ward, Ann G. Martin, Susana Leal-Khouri
PP has an incidence of 1 in 450. It tends to manifest during the second or third trimester. Clinically, the patient presents with erythematous, excoriated papules or nodules along the extensor surfaces most commonly. The lesions can appear eczematous or crusted. This is more common in patients with a history of atopy (79). A laboratory workup is usually not necessary. PP resolves postpartum, but may persist for up to 3 months. Fetal and maternal prognoses are excellent. It may recur in subsequent pregnancies (79). Treatment for pruritus is symptomatic including topical steroids and antihistamines.
Chronic erythematous rash and lesions on trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Atopy means an inherited predisposition to eczema, asthma or hay fever, and atopic individuals may have one or all of these manifestations. It is becoming recognised that an inherited defective skin barrier is important in the cause of the eczema. The protein filaggrin helps bind keratin fibres in the stratum corneum, and this protein has been found to be defective in atopic eczema. The result of this is that corneocytes are deformed, natural moisturising factors are reduced and an increase in skin pH promotes inflammation. This defective barrier results in loss of water, dryness of the skin and penetration of irritants and allergens such as house dust mite, pollen and bacteria. The developing immune system in infants, becomes unbalanced with TH-2 lymphocytes and cytokines predominating over TH-1 cells. A vicious circle develops where the inflammation reduces the barrier, allowing penetration of irritants and allergens (especially bacteria), which causes further inflammation. Autoimmunity and the production of IgE antibodies is likely to be a by-product of these factors.
Disorders of keratinization and other genodermatoses
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
The disease is characterized by scaling, which is prominent over extensors, particularly over the shins (Figure 15.2). The scales here are often dark-colored and polygonal in shape. A fine white scaling is usually present over other areas of the body, like the trunk. The flexures are mostly spared. The affected individuals often have hyperlinear palms, thickening of the skin (keratoderma) of palms and soles, and keratosis pilaris (Figure 15.3). Asthma, atopic dermatitis, and other manifestations of atopy are frequently associated. Symptoms are worse during the winter when the climate is dry.
Comorbidity identification and referral in atopic dermatitis: a consensus document
Published in Journal of Dermatological Treatment, 2022
Javier Ortíz de Frutos, Gregorio Carretero, Raul de Lucas, Susana Puig, Esther Serra, Susana Gómez Castro, Francisco Rebollo Laserna, Estíbaliz Loza, Juan Francisco Silvestre-Salvador
Concerning atopic allergy: In AD, at the first visit/s and periodically during follow-up, the following comorbidities should be actively ruled out: asthma, allergic rhinitis, conjunctivitis, food allergy, eosinophilic esophagitis, and nasal polyposis (LE 5; GR D; LA 92%)Patient-reported atopic comorbidities should be carefully evaluated, given that they are not always correctly diagnosed (LE 5; GR D; LA 100%)Data on family atopic conditions must be collected (LE 5; GR D; LA 92%)Should any atopic comorbidity be suspected, the patient must be referred to the corresponding specialist or primary care physician (LE 5; GR D; LA 100%)
Tinnitus following COVID-19 vaccination: report of three cases
Published in International Journal of Audiology, 2022
Daniela Parrino, Andrea Frosolini, Chiara Gallo, Romolo Daniele De Siati, Giacomo Spinato, Cosimo de Filippis
A clinical description of tinnitus after COVID-19 vaccine and the possible mechanisms responsible for its development is still lacking. This is the first descriptive report of three cases of sudden unilateral tinnitus following BNT162b2 vaccine injection, which rapidly resolved in 2 out of 3 cases. A hypersensitivity reaction may be implicated in the pathogenesis, causing an abnormal autoimmune response (mediated by circulating immune complexes or cytotoxic vestibule-cochlear autoantibodies) or a vasculitic event with subsequent localised damage to the cochlea (Ciorba et al. 2018). Patients’ pre-existing history of atopy (case 2) and autoimmune disorders (cases 1 and 3) may have increased the likelihood of a dysregulated autoimmune response. On the other hand, an immunisation anxiety-related reaction can be postulated, as anxiety has also been related to the severity and persistency of tinnitus (Elarbed et al. 2021). Autoimmune inner ear disease also has to be considered in the differential diagnosis, although it typically differs in clinical presentation (Ciorba et al. 2018). Lastly, a coincidental event may have occurred. We prescribed an MRI to all patients to rule out any possible abnormality of the internal auditory meatus or cerebellopontine angle. As previously reported, no abnormalities were found.
Allergic-like disorders and asthma in patients with common variable immunodeficiency: a multi-center experience
Published in Journal of Asthma, 2022
Limor Rubin, Oded Shamriz, Ori Toker, Ela Kadish, Yaarit Ribak, Aviv Talmon, Alon Y. Hershko, Yuval Tal
Our present study has several limitations. Despite the multicenter enrollment of patients, the final sample size was small, in accordance with the observational nature of the study and the low prevalence of CVID in the general population. Therefore, our conclusions are derived from a hypothesis-generated study, and serve only as a proof of concept. Larger confirmatory studies are needed to strengthen our conclusions. Additionally, with regards to the diagnosis of allergic disorders, no laboratory evidence of atopy was demonstrated in this study, and pulmonary function test and SPT were performed in only some cases. Allergic disorders were diagnosed based on typical clinical manifestations, seasonal appearance of complaints, occurrence of symptoms during childhood or before CVID diagnosis, patient-reported specific irritants, and appropriate response to on-demand therapy with ICS and anti-histamine therapy. The patients exhibited classic clinical symptoms associated with allergic disorders, in parallel with negative SPT results and low IgE, leading us to assume that atopy was mediated through a non-IgE mechanism. However, our study did not include molecular immuno-phenotyping. Therefore, we have defined the atopic symptoms in our cohort as “allergic-like” disorders.