1/70. Generalized pustular psoriasis of pregnancy (impetigo herpetiformis).A 17-year-old woman had a sudden eruption of pustules in her intertriginous areas as well as of erythematosquamous plaques on the scalp, elbows, palms and soles in the third trimester of her first pregnancy. Histopathological evaluation of a biopsy revealed typical changes of pustular psoriasis with parakeratosis and abscesses of neutrophils (Kogoj's spongiform pustules). The diagnosis of pustular psoriasis was established by the typical clinical and histopathological findings. Laboratory parameters showed a highly elevated blood sedimentation rate, hypoferric anemia and decreased albumin levels. serum concentrations of parathormone and its metabolites were normal. After systemic treatment with glucocorticosteroids and antibiotics, the lesions improved but did not clear. After delivery of a healthy boy, therapy was switched to retinoid photochemotherapy with isotretinoin and PUVA that resulted in rapid and complete clearing of the eruption. The coincidence of plaque-type psoriasis and a pustular eruption as described previously in impetigo herpetiformis supports the view that this dermatosis of pregnancy is a variant of generalized pustular psoriasis.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
2/70. Stress-induced SAPHO syndrome.We describe the case of a woman with the classic combination of features of synovitis-acne-pustulosis-hyperostosis-osteitis (SAPHO) syndrome, including pustulosis palmo-plantaris and anterior chest wall involvement. The varying symptomology, etiology and pathogenesis of this syndrome and the contribution of stress are discussed. The authors ascribe the dearth of reported cases to lack of awareness and recognition of SAPHO, and not to the real incidence of the syndrome.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
3/70. Generalized pustular psoriasis following withdrawal of oral cyclosporin treatment for palmo-plantar pustulosis.We report the cases of two patients who developed generalized pustular psoriasis on the withdrawal of oral Cyclosporin treatment for persistent palmoplantar pustulosis. This complication does not appear to have been reported previously.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
4/70. Clinical response of psoriasis to low-energy irradiance with the Nd:YAG laser at 1320 nm report of an observation in three cases.BACKGROUND: psoriasis is a perplexing disease for which we have no definitive therapy. many types of lesions and clinical forms exist, from the small, localized indolent papule, to the persistent intractable plaque, to the disabling palmo-plantar involvement to the erythrodermic form. This wide variety of clinical manifestations has made it difficult to apply therapies such as lasers, which can reportedly produce an improvement. Although they have been shown to work, the carbon dioxide laser needs local injection for anesthesia along with healing by second intention, lasting for 3 to 6 weeks, while the flashlamp-pumped dye laser needs to be delivered in individual pulses of 5 to 10 mm in diameter each and repetition rates of only 1 to 2 pulses per second (1-2 Hz). These factors have made both lasers impractical for widespread use given the extensive skin involvement, which is often present. OBJECTIVE: To report on the beneficial effects of this new apparatus in some psoriatic lesions as observed in 3 out of 3 individuals tested. methods: Three patients who had lesions ranging from the small indolent papule to the persistent plaque, resistant to conventional treatment, to plantar involvement, underwent focal treatment with low-energy continuous emission of laser light below the threshold of pain for a total of 4 treatments in a span of 2 weeks. RESULTS: A clinical response was observed in all 3 cases. Improvement was noticed at a 4-week follow-up visit and continued for 3 months. Early recurrence in 1 case was noted at the end of this period. Partial response in a case of plantar involvement was seen. CONCLUSIONS: These findings are not only encouraging to undertake a study in a larger number of patients, with several different fluences and treatment frequencies, but are also intriguing regarding the possible mechanism or mechanisms of action.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
5/70. Epidermolytic hyperkeratosis with polycyclic psoriasiform plaques resulting from a mutation in the keratin 1 gene.Epidermolytic hyperkeratosis (EHK) is a genodermatosis caused by mutations in either the keratin 1 (K1) or keratin 10 (K10) genes, and characterized by erythroderma and blistering at birth, with development of a ribbed, ichthyotic hyperkeratosis and palmoplantar keratoderma. A wide variety of mutations within the highly conserved helix termination motifs of the central rod domains of the K1 or K10 genes correlate with the highly variable phenotypic severity observed in EHK. We report a unique EHK-like phenotype exhibiting autosomal dominant inheritance with variable expressivity in four affected individuals in a single family. Clinically, affected individuals manifest transient blistering at birth followed by chronic diffuse palmoplantar keratoderma without transgradiens. Intermittent flares of non-migratory polycylic erythematous psoriasiform plaques which worsen and abate in severity were present in all affected individuals, but showed immense individual variation in both severity and duration, ranging from weeks to months. Histopathologic examination of the psoriasiform plaques demonstrated the characteristic features of EHK. Sequencing of the K1 gene in affected family members revealed a heterozygous A-to-T transversion at nucleotide 1435 within exon 7, converting isoleucine (ATT) to phenylalanine (TTT), (I479F). The mutation resides within the highly conserved helix termination motif of the helix 2B segment of the K1 gene. This unique clinical phenotype and the associated K1 mutation have not been previously described, and it is referred to here as EHK with polycyclic, psoriasiform plaques (EHK/PPP).- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
6/70. Psoriasiform acral dermatitis: a peculiar clinical presentation of psoriasis in children.Recently an unusual chronic dermatosis, considered a new clinical entity and closely resembling psoriasis, has been described in the literature under the term psoriasiform acral dermatitis (PAD). It is characterized by cutaneous involvement of the digits without nail dystrophy. We describe three young patients, ages 6 to 8 years, in whom this condition was associated with psoriasis. Two children were affected by psoriasis vulgaris, while the third had a palmoplantar psoriasis. All laboratory investigations performed were within normal limits. skin biopsy specimens taken from the fingers of two patients revealed the pathologic features of subacute spongiotic dermatitis. Histologic examination of a biopsy specimen taken from an erythematous squamous patch confirmed the clinical diagnosis of psoriasis in two patients. The dermatitis showed a fluctuating course in all three patients, with only a moderate to strong improvement with therapy with calcipotriol ointment (50 microg/g). During follow-up, two patients experienced marked spontaneous, persistent improvement, while the disease slightly worsened in the third. The children had features similar to those described in PAD, but were also suffering from psoriasis. Whether PAD is a distinctive entity or just a clinical manifestation of psoriasis in children is still an open question. We strongly believe this latter hypothesis, although further studies are needed to confirm it.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
7/70. Pustular psoriasis with a striking linear pattern.Pustular psoriasis has different clinicomorphologic forms such as generalized, localized (mainly palmoplantar or acral), and annular. There are also few cases with a linear distribution pattern. We report a case of pustular psoriasis with a striking linear distribution probably related to Blaschko's lines. We suggest that linear pattern should also be considered among the morphologic variants of pustular psoriasis.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
8/70. Sweet's syndrome presenting as palmoplantar pustulosis.Sweet's syndrome was initially described as a reactive dermatosis characterized by sudden onset of fever, leucocytosis, and raised erythematous plaques infiltrated with neutrophils, and therefore called acute febrile neutrophilic dermatosis. However, later it became obvious that fever and neutrophilia are variable features, and a number of other characteristics have been described. Although the dorsa of the hands are frequently affected, the palmoplantar involvement mimicking pustulosis observed in our case appears to be unusual.- - - - - - - - - - ranking = 5keywords = palm (Clic here for more details about this article) |
9/70. Palmoplantar pustulosis with pustulotic arthroosteitis involving temporal osteomyelitis and meningitis.A 46-year-old man who had been suffering from palmoplantar pustulosis (PPP) for 3 years had anterior chest pain and left temporal pain from six months after the onset of his disease. A bone scan revealed abnormal uptake at the sternoclavicular joint and left temporal region. The head CT and MRI gave the diagnosis of temporal osteomyelitis with meningitis and myositis. His headache continued even after tonsillectomy and was effectively treated with cyclosporine A (3 mg/kg/day). Oral cyclosporine A was beneficial for the osteomyelitis and skin lesions. Sterile lytic bone lesions occurring most often at the sternocostoclavicular joint have been associated with PPP. However, there have been no reports of a PPP patient with temporal osteomyelytic involvement.- - - - - - - - - - ranking = 1keywords = palm (Clic here for more details about this article) |
10/70. Icodextrin cutaneous hypersensitivity: report of 3 psoriasiform cases.BACKGROUND: Icodextrin is proposed as a new osmotic agent for use in peritoneal dialysis. Because of its recent use, adverse reactions are not well known. Cutaneous adverse effects have been described. We report 3 cases of cutaneous hypersensitivity to icodextrin and discuss the pathogenesis of this reaction. OBSERVATIONS: The cutaneous adverse reaction was psoriasiform in our 3 cases. The eruption was generalized with acute generalized exanthematous pustulosis in 1 case, and limited to the palms and soles in 1 case. It occurred 10 to 15 days after icodextrin therapy was initiated. In patient 1, the results of a rechallenge with icodextrin were positive. Icodextrin therapy was discontinued in all patients. CONCLUSIONS: Some cases of cutaneous reactions to icodextrin have been reported in the literature, but they are rare. As in our cases, most eruptions are psoriasiform, limited to the palms and soles, or extensive. Although the etiology is unclear, a hypersensitivity reaction, with the formation of immunocomplexes, is probable.- - - - - - - - - - ranking = 2keywords = palm (Clic here for more details about this article) |
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