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Nail changes in systemic diseases and drug reactions
Published in Eckart Haneke, Histopathology of the NailOnychopathology, 2017
The most important differential diagnosis is subcutaneous granuloma annulare. In contrast to deep-seated granuloma annulare, rheumatoid nodules are usually devoid of mucin. Epithelioid sarcoma may mimic rheumatoid nodules. Suture granulomas, particularly when the suture material is not included in the section, may be difficult to rule out on histological grounds alone.137 Rheumatic nodules occurring in rheumatic fever do not exhibit the central fibrinoid necrosis.138,139 Multicentric reticulohistiocytosis presents in about one-half of the patients with warty to flesh-colored nodules in a coral bead distribution along the free margin of proximal nail folds; this may be isolated or in association with an erosive arthritis, and malignant neoplasms are found in approximately 25%. Histologically, oncocytic macrophages and numerous multinucleate giant cells with eosinophilic finely granular cytoplasm giving the aspect of ground glass are characteristic.140 Pernio is a distinct injury induced by humid cold characterized by painful, burning, or pruritic violaceous or erythematous papules and infiltrates on fingers, toes, and distal extremities; histologically they are characterized by a marked T-lymphocytic perivascular infiltrate around superficial and deep vessels and endothelial swelling, with edema in the papillary dermis but without fibrinoid necrosis. Epidermal pallor may be present. An interface dermatitis with vacuolar basal cell degeneration is typical for chilblain lupus erythematosus. Cold-induced blister, for example, after cryotherapy of warts, shows a loss of cellular outline of the keratinocytes and ghost-like alterations of the epidermis.141 Dermal and deep-seated infections to mycobacteria and some fungi may require special stains to be ruled out.
Environmental Injuries
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Soo Jung Kim, Alexander V. Nguyen
Differential diagnosis: Pernio may be differentiated from chilblain lupus erythematosus, cryoglobulinemia, acrocyanosis, RP, cold panniculitis, leukemia cutis, and COVID-19 associated vasculitis of the digits in the right clinical context.
Use of calcium channel blockers in dermatology: a narrative review
Published in Expert Review of Clinical Pharmacology, 2021
Yang Lo, Lian-Yu Lin, Tsen-Fang Tsai
Off-label use in dermatology is common and is sometimes inevitable due to the lack of approved medication. CCB is among the most commonly prescribed medications for the control of hypertension. Its relative safety and the possibility of using it topically open the door to its use in dermatology. The best known mode of action of CCB is its use as a vasodilator and an inhibitor of smooth muscle contraction. These properties explain their use in atrophie blanche, chilblain lupus erythematosus, chronic anal fissure, pain from leiomyoma, Raynaud’s phenomenon, pernio and possibly also facial wrinkles. Among these diseases, the strongest evidence exists for its use in anal fissures and facial wrinkles, and topical preparation is used in both indications. The use of topical CCB for treating facial wrinkle is interesting. Currently, botulinum toxin injection remains the most common treatment for treating dynamic facial wrinkles, but some of the patients who are afraid of the injection procedure might benefit from topical CCB. However, the evidence is still limited due to the small number of subjects and the best concentration dosing, frequency and formulation require further study.
The Jakinibs in systemic lupus erythematosus: progress and prospects
Published in Expert Opinion on Investigational Drugs, 2019
Ruxolitinib has been used to treat cutaneous chilblain lupus erythematosus (ChLE) [66]. In this case report, a 68-year-old woman presented with photosensitivity skin rash that was diagnosed to be ChLE. Skin biopsy revealed mild interface dermatitis with mucin deposits accompanied by lesional expression of IFN-regulated proteins (MxA, CXCL10). The skin lesions flared after discontinuation of ruxolitinib which was prescribed for her co-existing active myeloproliferative disorder (primary myelofibrosis). Upon re-challenge of the Jakinib, the skin lesions responded again completely. The authors went on to study lesional skin biopsies taken from patients with different subsets of cutaneous lupus using an anti-phospho-JAK2-antibody [67]. Strong expression of activated JAK2 in the epidermis could be demonstrated in patients with cutaneous lupus in contrast to those with skin psoriasis and atopic dermatitis in which the JAK2 expression was significantly lower, and healthy controls in whom JAK2 expression was absent. In separate experiments, ruxolitinib was shown to decrease of CXCL10 and CXCL9 expression of cultured keratinocytes after stimulation with synthetic DNA and RNA. As CXCL10 is a key regulator of the interface dermatitis in cutaneous lupus, JAK inhibition was proposed to be a promising therapeutic option of this disease through the interruption of IFN-induced STAT-1 phosphorylation.