Dermatological emergencies: What the term encompasses and key features in their diagnosis
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Pustules are well-circumscribed pus-filled lesions on the skin surface. They can be either infective or noninfective in origin, characterized by the presence or absence of fever, respectively. The morphology is also important to arrive at the correct diagnosis as follows: Pustular lesions with fever, suspect infective origin such as impetigo, folliculitisPustular lesions without fever (sterile pustules) Coalescing pustules to form lakes of pus—pustular psoriasisNoncoalescing discreet pustules—acute generalized exanthematous pustulosis (corroborative drug history may be obtained in almost 90% of cases)
Prevention and Management of Complications
Yates Yen-Yu Chao, Sebastian Cotofana, Anand V Chytra, Nicholas Moellhoff, Zeenit Sheikh in Adapting Dermal Fillers in Clinical Practice, 2022
Prolonged erythema in the treated area could originate from infection, skin surface irritation, bleeding, and allergic tissue reaction, worsening of erythematous skin conditions, or vascular occlusion. The associated symptoms of pain, tenderness, swelling, warmness, stinging, vesicles, or pustules are valuable for a differential diagnosis. Allergic reactions or irritation usually are related to injection preparation and postinjection cares. Maneuvers of bleeding control should proceed by compression instead of wipes, especially in sensitive thin skin. Cleansing of injection fields could be accomplished with different choices of disinfectant based on the patient's previous history of contact allergy. Using commercial-pack facial masks or skincare products immediately after injection should be discouraged. Some behaviors involving repeated contact of contaminated hands and gauzes with the injection fields are problematic. Repeated wipe-pattern maneuvers to stop bleeding can also result in surface skin disruption.
Herpes Simplex Virus and Human CNS Infections
Sunit K. Singh, Daniel Růžek in Neuroviral Infections, 2013
HSV-1 and HSV-2 infect the stratified (squamous) epithelium cells of oral and genital mucosa and of the skin surface. Thereafter, the virus enters various mucosal or nerve endings from which it spreads predominantly by axonal route to corresponding neurons (Bergstrom and Lycke 1990; Goodpasture 1929; Nahmias and Roizman 1973; Whitley et al. 2007). As a result of this, and in combination with occasional viremia, both HSVs can cause many fold clinical symptoms (Table 7.6). Some of them are well-defined clinical entities such as herpetic encephalitis, keratoconjunctivitis, and neonatal infections (including encephalitis, hepatitis, suprarenal gland necrosis, and disseminated skin disease). The classical recurrent blister within the hornified skin epithelium may turn into pustule, while ulcerations occur in the oropharyngeal or genital area.
A brief guide to pustular psoriasis for primary care providers
Published in Postgraduate Medicine, 2021
Jeffrey J. Crowley, David M. Pariser, Paul S. Yamauchi
In terms of medical history, individuals should be asked about a history or family history of psoriasis or pustular psoriasis, and recent use of medication (e.g. corticosteroids and their association with GPP flare; a new prescription and possible acute generalized exanthematous pustulosis [AGEP] – see below). Laboratory tests may be necessary to assess disease severity, and the extent of any systemic complications associated with acute GPP, including the following [9,30,34]: a) inflammation – leukocytosis with neutrophilia, elevated erythrocyte sedimentation rate, and C-reactive protein, increased plasma globulins (IgG or IgA); b) loss of plasma proteins into tissues – hypoproteinemia and hypocalcemia; c) oligemia – elevated blood urea nitrogen and creatinine; d) liver damage – elevated aspartate transaminase, alanine transaminase, and/or bilirubin; e) kidney damage – positive urinary albumin; and f) secondary bacterial infection – positive bacterial cultures (pustules and/or blood). Histopathological examination of a skin biopsy (including pustule/s) confirms the diagnosis. (Detailed description is beyond the scope of this report, but can be found in these publications [9–11].)
Generalized pustular psoriasis: current management status and unmet medical needs in Japan
Published in Expert Review of Clinical Immunology, 2021
Mayumi Komine, Akimichi Morita
The second type of GPP clinical course is characterized by recalcitrant widespread eruptions that never fully resolve even after a GPP flare [2,25]. In our clinical practices, these patients sometimes present with arthritis with deformity or ankylosis. The eruption is so widespread that there are usually no healthy, uninvolved areas of skin. The eruptions are ill-demarcated, with less indurated edematous erythema and occasional pustule formation, which are different from those of the typical plaque-type psoriasis in which the erythema is keratinizing. Before biologics became available, these patients were treated with oral retinoids in combination with cyclosporine, with unsatisfactory results. In our experience, these patients seldom have an acute phase exacerbation, but widespread eruption with occasional pustule formation continues if they are not treated with biologics, and triggers such as infections can exacerbate symptoms [3]. However, treatment with biologics can be effective and may contribute to improvements in quality of life (QoL) [26].
A review of IL-36: an emerging therapeutic target for inflammatory dermatoses
Published in Journal of Dermatological Treatment, 2022
Jonwei Hwang, Jonathan Rick, Jennifer Hsiao, Vivian Y. Shi
Emerging trials for treatment are summarized in Table 4. Spesolimab (BI 655130) is a humanized monoclonal immunoglobulin G1 anti-IL36R antibody that binds to domain 2 of the human IL-36R protein (53). Spesolimab was studied for safety, tolerability, pharmacokinetics, pharmacogenomics, and efficacy in a phase 1 open-label, single-arm study of seven adults with a history of GPP. No serious adverse events (AEs) were reported and a GPP Physician Global Assessment (GPPGA) score of clear or almost clear (0 or 1) was achieved in all patients by week 4. Mean percent improvement in Generalized Pustular Psoriasis Area and Severity Index (GPPASI) scores from baseline was 59.0% at week 1, 73.2% at week 2, and 79.8% at week 4. Pustules were completely cleared in six patients by week 2 [54]. For palmoplantar pustulosis (PPP), a phase 2a RCT found no significant difference between spesolimab treatment and control, a phase 2b study is planned (55,56). Spesolimab once monthly is currently recruiting phase 2b trials for efficacy and safety in 120 adults with GPP (57). Another 5-year study to assess long-term efficacy and safety in patients who have completed trials for spesolimab is recruiting (58). Imsidolimab (ANB019), a humanized monoclonal antibody against IL-36R, has completed a phase 2 study for efficacy and safety in eight adults with GPP, no results are published (59).
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