Oral sirolimus in the treatment of adult eruptive cherry angiomas

Introduction@#Cherry angiomas are a common type of acquired vascular proliferation of the skin which manifest as single or multiple bright red spots that usually appear on the trunk and arms. They are generally asymptomatic; patients may opt to remove the lesions for cosmetic reasons and prevention of bleeding. Conventionally, most cherry angiomas are treated with curettage, laser, and electrosurgery. Herein, we report a case of multiple cherry angiomas managed alternatively with oral sirolimus. @*Case@#A 47-year-old Filipino female presented with a 10-month history of gradually enlarging multiple bright-red papules and pedunculated nodules with a propensity to spontaneously bleed on gentle manipulation involving the scalp and forehead. Clinicopathological correlation suggests a diagnosis of eruptive cherry angiomas. The patient was started on oral sirolimus, a mammalian target of rapamycin (mTOR) inhibitor.@*Conclusion@#We present a case of a patient with eruptive cherry angiomas who experienced significant decrease in size and bleeding with treatment of oral sirolimus with minimal adverse effects. For patients with eruptive cherry angiomas, especially with contraindicated comorbidities, first-line therapeutic option treatments with oral sirolimus can be beneficial.

A case of COVID-19 with papulovesicular rash that progressed to retiform purpura, accompanied by cherry angiomas

ABSTRACT CONTEXT: Various skin manifestations have been reported in coronavirus disease. It may be difficult to determine the etiology of these lesions in view of the increased frequency of handwashing during the pandemic, along with occurrences of irritant contact dermatitis and allergic contact dermatitis due to disinfectant use; usage of herbal medicine and supplements to strengthen the immune system; and urticarial or maculopapular drug eruptions due to COVID-19 treatment. The variety of associated skin manifestations seen with COVID-19 makes it challenging to identify virus-specific skin manifestations. Petechiae, purpura, acrocyanosis and necrotic and non-necrotic purpura, which can be considered as manifestations of vascular involvement on the skin, have been reported. CASE REPORT: Here, we report a case of eruptive cherry angiomas, which was thought to have developed due to COVID-19, with a papulovesicular rash on distal extremities that progressed over time to reticular purpura. CONCLUSION: The case presented had a papulovesicular rash at the onset, which evolved to retiform purpura, and eruptive cherry angiomas were observed. It should be kept in mind that dermatological signs may vary in patients with COVID-19.

Eruptive pseudoangiomatosis - cherry angiomas with perilesional halo

Eruptive pseudoangiomatosis is a rare viral exanthem characterized by acute onset of hemangiomata-like lesions, however, histological findings are distinct from that of true angiomas. This entity has been reported from Europe, North America, Japan, and Korea till date. Here, we report 12 cases of eruptive pseudoangiomatosis from a tertiary care hospital in Punjab.

Eruptive pseudoangiomatosis - cherry angiomas with perilesional halo

Eruptive pseudoangiomatosis is a rare viral exanthem characterized by acute onset of hemangiomata-like lesions, however, histological findings are distinct from that of true angiomas. This entity has been reported from Europe, North America, Japan, and Korea till date. Here, we report 12 cases of eruptive pseudoangiomatosis from a tertiary care hospital in Punjab.

MRI diagnosis of intracranial extra-encephalon cavernous angiomas / 实用放射学杂志

Objective To investigate MRI diagnosis of intracranial extra-encephalon cavernous angiomas.Methods In 9 intracranial extra-encephalon cavernous angiomas,5 masses located in the parasellar,2 masses in the lateral ventricle triangle,1 mass in the fourth ventricle and 1 mass in temporal subdural space.The MRI features of the masses were analyzed.Results 5 parasellar cavernous angiomas enclosed the ipsilateral internal carotid artery and extended the saddle.The masses showed homogeneous low intensity on T1WI,high intensity on T2WI,obvious enhancement on enhanced scan.Of 2 cavernous angiomas in the right lateral ventricle triangle, 1 mass showed homogeneous low intensity on T 1WI,high intensity on T2WI,obvious enhancement on enhanced scan;the other mass showed isointensity on T1WI,slight high intensity on T2WI,high intensity on DWI,low intensity on SWI and patchy enhancement on enhanced scan.1 cavernous angioma located in the fourth ventricular showed mixed intensity on T 1WI and T2WI,low signal rim around the mass on T2WI,inhomogeneous high intensity on DWI sequence and little enhancement on enhanced scan.1 mass located in temporal subdural space showed homogeneous low intensity on T 1WI,high intensity on T2WI,low intensity on DWI,isointensity on SWI and homogeneous obvious enhancement on enhanced scan.Conclusion The MRI findings of the intracranial extra-encephalon cavernous angiomas are characteristic.Most masses show homogeneous low intensity on T1WI,high intensity on T2WI and obvious enhancement on enhanced scan.The masses should mainly be distinguished from meningiomas.

Angioma en penacho: A propósito de un caso clínico / Tufted angioma: A case report

Se presenta el caso de una paciente de un año de edad, con una lesión tumoral congénita en dorso, eritemato-violácea. Se evidencia al cabo de un año durante el control evolutivo, aumento del volumen y cambio de coloración, por lo que se decide su exéresis completa. El examen histopatológico de la pieza concluyó con el diagnóstico de angioma en penacho (AP). El AP es un tumor vascular benigno, poco frecuente. Aparece sin predilección racial y es igual en ambos sexos. Puede ser congénito o adquirido en la primera infancia, ocasionalmente se presenta en la edad adulta. Su patogenia está poco dilucidada.

Presented the case of a patient of one year old with a congenital, erythematous-violaceous tumoral lesion on back. During the control evolutionary is evidence after a year increase of the volume and change of coloration by what is decides his removal complete. The histopathological examination of the piece ended with a diagnosis of tufted angioma (TA). The TA is a rare, benign vascular tumor. Appears no predilection racial and is equal in both sexes. It can be congenital or acquired in early childhood, it occurs occasionally in adulthood. Its pathogenesis is shortly to become.

Cavernomatosis cerebral múltiple: primer reporte de caso en Perú / Multiple cerebral cavernous: first case report in Peru

La cavernomatosis cerebral (CC), única o múltiple, es la presencia de conductos vasculares distendidos, angiográficamente ocultos, por lo cual clásicamente eran hallazgos incidentales intraoperatorios o en autopsias. Actualmente la resonancia magnética (RM) cerebral, permite identificar éstas lesiones en un mayor número de pacientes. Las manifestaciones clínicas son hemorragias intracerebrales, crisis epilépticas y cefalea. Se reporta el caso de un varón de 55 años, sin antecedentes de importancia que ingresó por presentar cefalea y crisis de arresto del habla. El examen físico fue normal. Estudios tomográficos previos mostraron una lesión hemorrágica única, al realizarse una RM cerebral con protocolo T2-eco gradiente se evidencia múltiples imágenes compatibles con CC múltiple. Es el primer reporte de CC múltiple, entidad poco diagnosticada, que se debe sospechar en pacientes sin antecedentes de riesgo vascular que debutan con hemorragias intracerebrales, crisis epilépticas y/o cefaleas; constituyendo la RM cerebral en protocolo T2-eco gradiente, el estudio indicado para el diagnóstico.

Cerebral cavernomatosis (CC), single or multiple, is the presence of distended vascular channels, angiographically occult, for that, they are classically incidental intraoperative findings at autopsy. Currently the magnetic resonance imaging (MRI) let us identify these lesions in a larger number of patients. Clinical manifestations are intracerebral hemorrhages, seizures and headache. A male, 55, no history of significance is reported; he was admitted for headache and some months later presents speech arrest crisis. On physical examination, nothing unusual. Previous tomographic studies showed a hemorrhagic lesion, when the brain MRI with T2-eco gradient protocol was performed, multiple images observed, were compatible with multiple CC. This is the first report of multiple CC, unfrequent entity that should be suspected in patients with no history of vascular risk who present intracerebral hemorrhage, seizure and / or headache; being the brain MRI, the study indicated for diagnosis.

Cutaneous Manifestations of Diabetes Mellitus: A Cross-Sectional Study in a Tertiary Care Hospital

Background diabetes mellitus (DM) is the most common endocrine disorder. Mucocutaneous manifestations of DM are many and vary from trivial to life-threatening and often herald the onset of diabetes. Aims To study the incidence of mucocutaneous manifestations in diabetes mellitus with respect to demographic data such as age, sex and duration of diabetes mellitus. Materials and methods This is a cross-sectional observational study of 200 diabetic patients with cutaneous manifestations attending skin and diabetic clinic OPD. Detailed history, clinical examination and relevant investigations were done to diagnose the mucocutaneous disorders and complications of diabetes. Results Demographic profile showed majority of cases belonging to 5th decade (33%) and 4th decade (27%) with male preponderance. Cutaneous infections were most common (62%) followed by dermatoses more commonly associated with diabetes (58%). Some patients had more than one cutaneous manifestation. Conclusion Proper skin care and long-term control of blood glucose may reduce the risk of complications and is immensely beneficial to patients in long run.

Experiencia en el tratamiento de los hemangiomas infantiles con propranolol de producción nacional / Experiences in treating infantile hemangiomas with Cuban-made propranolol

INTRODUCCIÓN: los hemangiomas infantiles son los tumores más frecuentes de la infancia. Aunque son de naturaleza benigna, su rápido crecimiento los puede tornar destructivos, incluso con riesgo vital, en alrededor de 1 % de los casos. En la actualidad han sido utilizados los betabloqueadores, como el propranolol oral, con muy buenos resultados. OBJETIVO: evaluar el efecto y seguridad del propranolol de producción nacional para el tratamiento de hemangiomas infantiles en fase proliferativa. MÉTODOS: estudio descriptivo y aplicado -efectuado desde el 1 de diciembre de 2010 hasta el 31 de junio de 2012- de una serie de 21 pacientes con 26 hemangiomas infantiles en fase proliferativa, atendidos en la Consulta de Dermatología del Hospital Pediátrico Docente "Juan Manuel Márquez", y tratados con propranolol de producción nacional por vía oral a 2 mg/kg/día en 2 subdosis. Los pacientes fueron evaluados en consulta quincenal hasta el tercer mes de tratamiento, y después, mensualmente, hasta los 6 meses de duración de este. Se realizó un registro de los efectos adversos. RESULTADOS: en todos los casos, en los primeros días después de comenzado el tratamiento, su efecto positivo (cambios favorables en la coloración o tamaño) fue evidente. Los efectos adversos fueron leves y autolimitados. Se alcanzó respuesta excelente o buena en el 99 % de los pacientes a los 6 meses de tratamiento. CONCLUSIONES: el esquema de tratamiento utilizado con el propranolol oral de producción nacional induce una mejoría rápida de los pacientes con hemangiomas infantiles, acortando considerablemente la evolución natural de estos tumores, con escasos efectos secundarios.

INTRODUCTION: infantile hemangiomas are the most frequent tumors in children. Although they are generally benign, its fast growth may turn them into life-threatening destructive tumors in roughly 1 % of cases. At present, betablockers such as oral propranolol have been used with very good results. OBJECTIVES: to evaluate the effects and safety of Cuban-made propranolol for the treatment of infantile hemangiomas in proliferation phase. METHODS: descriptive applied study of 21 patients with 26 infantile hemangiomas in proliferation phase. It was conducted from December 1st 2010 through June 31st 2012. The patients had been seen at the dermatology department of "Juan Manuel Márquez" teaching pediatric hospital and treated with Cuban-made orally administered propranolol at 2 mg/kg/day divided into 2 sub-doses. They were evaluated every 15 days up to the third month of treatment and monthly up to the 6 months of treatment. Adverse effects were recorded. RESULTS: few days after the beginning of the treatment, the positive effect was evident in all the cases (favorable changes in staining or size). The adverse effects were slight and self-limited. The response to treatment was good or excellent in 99 % of patients after 6 months of treatment. CONCLUSIONS: the treatment with Cuban-made orally administered propranolol induces rapid improvement of infantile hemangiomas in these children, considerably shortening the natural evolution of these tumors with low secondary effects.

Clinical analysis of tufted angiomas in infants / 中华实用儿科临床杂志

Objective To describe and examine the clinical characteristics and spectrum of tufted angiomas (TA) in infants so as to explore the therapeutic approaches to Kasabach-Merritt phenomenon (KMP).Methods The clinical and follow-up data of 24 patients with TA were retrospectively analyzed between Jan.2009 and Mar.2013.The median age of the patients was 7.5 months(ranged from 18 days to 2 years),including l0 male and 14 female.Surgical excision and observation were chosen according to the lesion and conditions of the patients.The mean follow-up period was 3.6 years (1.2 to 5.4 years).The changes in the patients' s condition were established by evaluating platelet counts,and the size of lesion.Results Common clinical features included dusky red or violaceous infiltrating cutaneous lesion,thrombocytopenia,pain or decreased function and hyperhidrosis or hypertrichosis.The following 3 clinical patterns of TA progress were described:spontaneous complete or partial regression (n =2,8.3％),TA without complications and persistence over the years(n =9,37.5％),and TA complicated by KMP(n =13,54.2％).The average interval of development of KMP for delayed cases was 45.2 days(ranged 0 d to 4 months).Each of the 13 patients who developed KMP subsequent to initial presentation was symptomatic at the time KMP was detected(enlarged lesion,n =8;increased lesion firmness with change in cutaneous stain,n =3 ;and respiratory distress,n =2).All of 13 patients were cured by surgery.Complete surgical resections were performed on 10 cases.The thrombocyte count was back to normal within 1-3 days post operation,and hemoglobin and blood coagulation function gradually returned to normal within 1 to 2 weeks.Other 3 cases received major resection surgery.The number of platelets in the patients were unstable,but significantly higher than that of preoperational stage.The platelet count remained above 60 × 109/L.The residue lesions in 2 cases disappeared gradually after the operation and medication were given within 3-6 months.And the other case died of multiple organ failure post-operation.Conclusions Surgical intervention can be applied to TA that severely makes damage to children's appearance or looks or may be complicated with KMP or functional abnormality.A closely monitored policy seems appropriate for the early small tumor without severe complications.And it is necessary to monitor the number of the platelet regularly and find the KMP by as early as possible.TA associated with KMP is vitol to infants.And surgical therapy after clear diagnosis should be done as early as possible.The surgical therapy is a reliable management with higher curative rate,short disease period and minimal side-effect.

Manifestaciones dermatológicas de las enfermedades hepáticas: un enfoque para el médico general / Dermatological manifestations of liver diseases: an approach for the general physician

Las enfermedades hepáticas tienen manifestaciones cutáneas hasta en el 15% al 20% de los casos. Pueden ser muy variadas y ninguna de ellas es patognomónica; sin embargo, sureconocimiento puede ser la base para el inicio de estudios, así como para la primera aproximación hacia la etiología de la hepatopatía. En este artículo se describen las principales manifestaciones cutáneas de las enfermedades hepáticas incluyendo la ictericia, las telangiectasias, los angiomas en araña, el eritema palmar, los xantomas y los xantelasmas, entre otras.

Liver diseases have cutaneous manifestations in up to 15% to 20% of the cases. There are numerous and none of them is pathognomonic. However, its recognition may be the basis for the initiation of studies and be the first approach to the etiology of liver disease. In the present article the main cutaneous manifestations of liver disease are described, including jaundice, telangiectasias, spider angiomas, palmar erythema, xanthomas and xanthelasmas, among others.

Comparative study of campbell de morgan spots in the diabetics and the non- diabetics.

Cutaneous disorders associated with diabetes mellitus are thought to occur in about one third of patients during the course of their disease. The present study was undertaken to assess the incidence and to compare the incidence of Campbell de morgan spots in diabetics and non diabetics. The study was done on 250 patients who attended the Skin OPD. All the cases were noted and compared between diabetics and non diabetic patients. In our study, detailed history with special reference to age, sex, rural/urban background, socioeconomic status, obesity, hypertension, duration of diabetes, type of treatment taken, history of complications and family history of diabetes mellitus was taken from each patient in both the groups. Whenever patients present with multiple skin manifestations, their diabetic status should be checked and controlled; or if they are obese, a high index of suspicion should be kept regarding their diabetic status. The recognition of these findings is the key to treatment and prevention. Patients may demonstrate considerable concern regarding the cosmetic appearance of the lesions. The Incidence of cherry angioma in our study was 56 (44.8%) cases in diabetic group and 50 (40%) cases in non diabetic group.

A comparative imageology study of TOF-MRA and SWI in the diagnosis of intracranial vascularmalformations / 中国综合临床

Objective To study the imaging of arteriovenous malformation(AVM)and cerebral cavernous angiomas(CCA)by 3D-TOF MRA and SWI.Methods The clinical manifestations and MR imaging characteristics of 44 cases with intracranial vascular malformations were retrospectively analyzed.The MRA imaging and SWI imaging of 26 CCA cases and 18 AVM cases were compared.Results The location,size,input.artery and output vein of arteriovenous fistula were clearly showed by 3D-TOF MRA.3D-TOF-MRA did not show the artery of hemangioma.The imaging of SWI can clear display the number and increase of cavernous hemangioma,comparing with the conventional sequence.Moreover,SWI was effective to show the tortuous veins of arteriovenous malformation.However,it was not able to directly show the overview of abnormal blood vessels and big arteries such as input artery.Conclusion 3D-TOF MRA technologies is powerful to show the arteriovenous malformation with high flow velocity and low resistance(Such as AVM),while SWI has advantages in showing the cavernous hemangioma with low flow velocity and small diameters.Joining 3D-TOF-MRA and SWI techniques will improve the detection of cerebral vascular malformations and reduce the misdiagnosis and missed diagnosis.

Fundamentos moleculares de la enfermedad de von Hippel Lindau / Molecular bases of von Hipperl Lindau's disease

La enfermedad de von Hippel Lindau es una rara entidad genética que se caracteriza por la predisposición al cáncer, especialmente angiomas de la retina, hemangioblastomas del sistema nervioso central y carcinoma renal de células claras. Los productos del gen presentan un mecanismo de acción peculiar, pues está relacionado con los procesos de adaptación del organismo a la hipoxia. En este trabajo se presenta una panorámica actualizada de esta enfermedad, con énfasis en los aspectos moleculares

The von Hippel Lindau's disease is uncommon genetic entity characterized by a predisposition to cancer, specially the retina angiomas, hemangioblastomas of central nervous system and the clear cells renal carcinoma. Gene products have a typical action mechanism since it is related to organism adaptation processes to hypoxia. In present paper an updated panorama of this disease emphasizing in molecular processes

Pseudoangiomatosis eruptiva: comunicación de cinco casos familiares recidivantes y revisión de la literatura / Eruptive Pseudoangiomatosis: communication recurrent five familial cases and review of the literature

La pseudoangiomatosis eruptiva (PAE) es un exantema poco frecuente, autolimitado y de etiología desconocida que se caracteriza por la aparición aguda de pápulas asintomáticas, rojo brillantes (símil-angiomas), rodeadas por un halo pálido. La PAE ocurre, por lo general, en niños y es acompañada por síntomas prodrómicos como fiebre, mal estado general, diarrea e infecciones del tracto respiratorio superior. A partir del año 2000 se han reportado varios casos de PAE en adultos. Realizamos una búsqueda en MEDLINE sobre PAE y encontramos 92 casos publicados desde 1969 hasta la fecha. En el presente trabajo comunicamos 5 nuevos casos familiares y recurrentes, pertenecientes a dos familias. Realizamos, además, una revisión de la literatura y análisis de los datos epidemiológicos y clínico-patológicos de estos 97 casos de PAE, enfatizando las diferencias entre la PAE infantil y la del adulto. Esta entidad era considerada como un exantema de origen viral, aunque publicaciones recientes relatan lesiones símil-angioma secundarias a picaduras de insectos y vacunación. Proponemos que la PAE debería ser considerada como un cuadro cutáneo reactivo a diferentes factores desencadenantes, con una presentación clínica y hallazgos histopatológicos característicos.

Eruptive pseudoangiomatosis (EPA) is a rare self-limited exanthem of unknown origin, characterized by the sudden appearance of asymptomatic, bright red angioma-like papules surrounded by a halo of blanching. It occurs primarily in children associated with prodromal symptoms of fever, malaise, diarrhea, and/or upper respiratory tract infection. Since 2000, several adult cases have been reported. We reviewed the MEDLINE reports related to EPA and found that 92 cases have been reported since 1969. Herein we describe five new familial and recurrent cases belonging to two families. We also review the literature and analyze the epidemiologic and clinicopathological data of these 97 EPA cases, highlighting the differences between adult and pediatric groups. Until recent reports of EPA-like lesions due to insect bite and vaccination, EPA was considered to be an exanthem of viral origin. We propose that EPA should be considered a reactive cutaneous disease to several triggering factors, with a characteristic clinical presentation and histopathological findings.

A Case of Tufted Angioma Arising within a Nevus Flammeus / 대한피부과학회지

Tufted angioma is an uncommon, slowly-progressive vascular tumor, found typically in infants, young children and sometimes at birth or during adulthood. It shows a characteristic histopathologic finding, the so-called "cannonball" appearance. Various tumors can be developed in the nevus flammeus, such as pyogenic granuloma, basal cell carcinoma, squamous cell carcinoma, giant proliferative hemangioma and lymphangioma circumscriptum. Tufted angioma can be also accompanied with nevus flammeus and the coexistence of tufted angioma and nevus flammeus is a very rare condition. We report a case of tufted angioma arising within nevus flammeus in the left axilla of a 47 year-old female.