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Wound healing and ulcers
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Treatments include systemic therapies such as corticosteroids, cyclosporine, mycophenolate mofetil, azathioprine, or dapsone. Topical therapies include gentle wound care, topical tacrolimus and pimecrolimus. Surgical debridement should be avoided as the pathergy phenomenon can lead to enlargement of the wound.
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
For the pathergy test, a sterile blunt needle is inserted into the skin of the forearm. The development of an inflammatory papule or pustule within 24–48 hours constitutes a positive result, reflecting an overactive immune response to minor injuries. Histologic studies of these lesions reveal mononuclear cell infiltrates and keratinocytes. The pathergy test is helpful but is not sensitive or specific for the diagnosis of BD; positive results are more common in Mediterranean patients.
Retinoids in Other Skin Diseases
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
Uwe Wollina, Piotr Brzezinski, André Koch
Behçet's disease is a multisystemic neutrophilic disorder with endemic hot-spots in the Mediterranean region, along the Silk Road, and on the Korean peninsula. It is characterized by recurrent oral and genital ulcerations, uveitis, and central nervous system vasculitis (36). Tretinoin has demonstrated ex vivo an inhibitory activity in peripheral mononuclear blood cells from patients with active Behçet's disease by the nuclear factor-kappa pathway in a dose-dependent manner with 0.01 μmol as the lowest dosage investigated (37). A single-blinded, controlled study investigated safety and efficacy of isotretinoin in 30 patients with Behçet's disease. Isotretinoin was used at a daily dosage of 20 mg for 3 months. The regimen reduced oral and cutaneous ulcers and other features of the Clinical Manifestation Index and minimized C-reactive protein and pathergy tests (38).
Retinal Capillary Reperfusion from Ischemic Retinal Vasculitis in Henoch–Schönlein Purpura: A Case Report
Published in Ocular Immunology and Inflammation, 2022
Min Seung Kang, Han Jo Kwon, Ji Eun Lee
Physical examination revealed multiple erythematous, purpuric macules scattered on the patient’s arms, lower legs, and back. Blood pressure was within the normal range. Chest X-ray showed no active lung lesion. Normal abdominal anatomy was assessed using computed tomography imaging. Laboratory tests were as follows with their normal ranges: hemoglobin, 15.9 g/dL (12.0–17.5); white blood cell count, 8.2 k/μL (4.0–10.0); neutrophil percentage, 90.2% (36.0–66.0); platelet count, 278.0 k/μL (140.0–440.0); prothrombin time, 9.7 s (11.0–13.0); activated partial thromboplastin time, 23.7 s (21.0–35.0); serum creatinine, 0.9 mg/dL (0.4–1.3); erythrocyte sedimentation rate, 52.0 mm/h (0.0–20.0); C-reactive protein, 17.5 mg/L (0.0–0.5); and urine red blood cells, 2+ per high-power field (4+ or less). Serum antinuclear antibody, lupus anticoagulant, complement C3/C4, IgA levels, antiphospholipid antibody, anticardiolipin antibody, and cytoplasmic and perinuclear anti-neutrophil cytoplasmic antibodies (ANCA) were within normal limits. The pathergy test result was negative. Differential diagnostic workup for infectious causes of retinal vasculitis was performed in the serum to screen for syphilis, human immunodeficiency virus-related eye diseases, rubella, and toxoplasmosis, but all the results were negative. Also, the tuberculin skin test was negative.
Atypical Pyoderma gangrenosum: a case of delayed recognition
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Anum Qureshi, Kia Persaud, Sajida Zulfiqar, Ranadheer Dande, Chahat Puri, Shankar Awasthi
PG is a diagnosis of exclusion and the skin manifestations can be mistaken for a variety of infectious and non-infectious etiologies. These include cutaneous tuberculosis, leishmaniasis, sporotrichosis or other fungal infections, vasculitis, malignancy, or thrombophilias [9–11]. The diagnosis is often clinical, but skin biopsy, while not diagnostic, can help support the diagnosis, and typically reveals a dermal neutrophilic infiltrate. In practice, the initial workup of the typical presenting lesions includes wound cultures which usually grow skin commensals, most commonly staphylococcus. This prompts antibiotic therapy, which may be associated with worsening of the skin condition as the underlying disease process remains untreated. A delay in making the correct diagnosis can lead to inappropriate debridement which leads to progressive enlargement of the ulcers with deep tissue involvement due to pathergy phenomenon. With prolonged unrecognized disease, wound cultures may reveal growth of more resistant organisms such as pseudomonas aeruginosa [5].
Evaluation of different classification criteria in children with Behcet disease: results from a single referral center
Published in Expert Review of Clinical Immunology, 2020
Rabia Miray Kisla Ekinci, Ebru Esen, Ahmet Hakan Erol, Selcuk Sızmaz, Dilek Karagoz, Derya Ufuk Altintas, Sibel Balcı
Oral aphthous ulcers were the first symptom in 11 (68.8%) patients, three (18.7%) patients presented uveitis, and the remaining two (12.5%) patients presented skin symptoms as the first symptom of BD. Pathergy was positive in only five (31.2%) patients. Overall, the most frequent symptoms were oral aphthous (93.8%), joint involvement (75%), genital ulcers (50%), erythema nodosum (50%), and uveitis (37.5%) among pediatric BD patients. Of six patients with BD related uveitis, three had panuveitis, two patients had anterior chamber involvement and only one patient had isolated posterior retina involvement. One patient suffered from deep venous thrombosis as vascular involvement and another one had pseudotumor cerebri as a neurological manifestation. Table 2 summarizes the clinical manifestations of pediatric BD patients included in the study.