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Necrolytic Migratory Erythema
Published in Charles Theisler, Adjuvant Medical Care, 2023
Necrolytic migratory erythema (NME) is a red, blistering rash that spreads across the skin. It particularly affects the skin around the mouth and distal extremities, but may also be found on the lower abdomen, buttocks, perineum, and groin. The dermatosis is usually associated with the glucagonoma syndrome,1 which is due to a slow-growing cancerous tumor located in the alpha cells of the pancreas. NME has also been associated with intestinal malabsorption disorders, hepatic cirrhosis, chronic pancreatitis, inflammatory bowel disease, and non-pancreatic malignancies.2
Skin diseases of the elderly
Published in Robert A. Norman, Geriatric Dermatology, 2020
Pancreatic carcinomas can be associated with two syndromes: subcutaneous fat necrosis and necrolytic migratory erythema. Subcutaneous fat necrosis in adults is characterized by the presence of tender erythematous nodules of the pretibial areas. It is frequently associated with polyarthralgia, fever and eosinophilia. There is an increased level of serum lipase, amylase and trypsin. Necrolytic migratory erythema is the cutaneous manifestation of glucagonoma syndrome. The patients have weight loss, weakness, diabetes, elevated plasma glucagon and hypoamino-acidemia. The mucocutaneous lesions are stomatitis and glossitis, annular or arciform erosive crusted macules or papules involving the central part of the face, lower abdomen, perineum and distal extremities.
Endocrine emergencies with skin manifestations
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
A hallmark of this syndrome is necrolytic migratory erythema. It presents as a painful migratory rash with a predilection for intertriginous areas, especially the anogenital region, perioral area, and distal part of the extremities. It starts as erythematous plaques with occasional bullae, which erode rapidly and form crust. These lesions coalesce into large geographic areas. This rash eventually resolves to reappear again. Patients with glucagonomas may have weight loss, abdominal pain, diabetes, stomatitis, glossitis, cheilitis, nail dystrophy, thromboembolic events, anemia, and neuropsychiatric symptoms. The triad of hyperglucagonemia, necrolytic migratory erythema, and a pancreatic tumor is seen in some cases.
Unremitting chronic skin lesions: a case of delayed diagnosis of glucagonoma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Hameem I. Kawsar, Alma Habib, Azhar Saeed, Anwaar Saeed
In 1942, Dr. Becker and his colleagues described a 45-year-old female who was hospitalized with a history of widespread pruritic erythematovesicular skin eruptions for 8 months that was unresponsive to roentgen irradiation, ultraviolet irradiation, systemic iodides, ferrous sulfate, and high vitamin diet. She died of circulatory collapse and respiratory failure due to ‘shock phenomenon’. Postmortem examination revealed a pancreatic tumor replacing the tail and body of the pancreas. This is the first known reported case of association of pancreatic cancer with cutaneous manifestations [1]. This characteristic skin lesion is now known as necrolytic migratory erythema (NME) due to its migratory nature, erythematous appearance, and histological findings of necrosis of the upper spinous layer [2]. However, this finding in biopsy is nonspecific and can be absent or focally present on biopsy [3]. In 1966, Dr. McGavran and his colleagues described the first case of glucagonoma in a 42-year-old female who presented with bullous and eczematoid dermatitis of the hands, feet, and legs [4]. The diagnosis of glucagonoma is made based on increased serum glucagon level and presence of glucagon secreting tumor in the pancreas. Glucagonoma presenting with constellation of symptoms, known as glucagonoma syndrome, was described in 1974 based on the findings in nine patients presenting with NME, stomatitis, weight loss, and diabetes in seven patients [5]; however, this syndrome was extensively reviewed in 1978 by Dr. Swenson and his colleagues [6]. While NME is described as a characteristic cutaneous manifestation of glucagonoma, it has been reported in other diseases, such as other malignancies (e.g., hepatocellular carcinoma, bronchial carcinoma, jejunal adenocarcinoma, etc.), celiac disease, chronic pancreatitis, liver cirrhosis, inflammatory bowel disease, and nutritional deficiencies [7].
Common and uncommon adverse cutaneous reactions to erlotinib: a study of 20 Chinese patients with cancer
Published in Cutaneous and Ocular Toxicology, 2018
Huiling Zhu, Zhe Zhu, Weining Huang, Xiping Cheng, Jiaxi He, Chunping Xiong, Jiande Han
Erlotinib is an orally administered EGFR-TKI. It is a targeted agent commonly used for treating advanced NSCLC (stage IIIB and IV)1. It is often associated with a peculiar spectrum of skin reactions, including acneiform rash, nail changes, regulatory changes in hair and xerosis. Other reactions include telangiectasia, hyperpigmentation, enhancement of radiation dermatitis, oral aphthous ulcers, vasculitis, necrolytic migratory erythema and transient acantholytic dermatosis3,7,8. Acneiform rash is the most common adverse cutaneous reaction3. The other types of adverse cutaneous reactions are rare. This study reported acneiform rash consisting of most alterations of skin disorders; the other adverse cutaneous reactions such as xerosis and nail and hair changes were not infrequent. It was interesting that anaphylactic cutaneous reactions were observed in six out of 20 cases, and this clinical presentation was hitherto not described except for some lesions reported by Toshiyuki Yamamoto9. In 2013, he reported erlotinib-induced seborrheic dermatitis-like eruption on the face and trunk, superficial erosive lesions on the buttock or genital regions, erythema exclusively involving the umbilicus and prurigo nodules on the buttocks in Japan9. A parallel point existed in morphology between only one case of anaphylactic dermatitis presenting as erosive and scaly erythema (Figure 4) and seborrheic dermatitis-like eruption or superficial erosive erythema9. Other cases of anaphylactic dermatitis were different morphologically from those previously described9. The rash presenting like angioneurotic oedema with severe oral mucosal erosion and a high fever in one of the patients (Figure 1) had never been mentioned earlier. Red macules, papules, plaques and brown pigmentation on the whole body other than localized distribution (Figure 5) were characteristic and distinct morphologically compared with the lesions described as prurigo nodules. Moreover, clinical details in the present study indicated anaphylactic cutaneous reaction, including a high percentage of eosinophils in the peripheral blood, eosinophilic infiltration in the dermis layer and good response to antihistamines and topical steroids, which were absent in the literature. The anaphylactic cutaneous reaction has been reported only in Japan and China hitherto. The speculation regarding its susceptibility in Asian population needs to be confirmed by conducting further studies.