Dermatological Manifestations of Internal Malignancies

Introduction: The skin is said to be the mirror of internal organs. Cutaneous manifestations may occur in many internalmalignancies. It may precede, follow, or occur concurrently with the onset of internal malignancy.Aim: This study aims to asses the frequency and significance of dermatological manifestations in patients with internalmalignancies.Methods: A total of 125 proven patients with various internal malignancies presenting to our outpatient department with skinlesions were included in the study.Results: According to our study, males were more commonly affected than females and the common age group was 40–60 years.The most common skin manifestations observed were cutaneous infections followed by cutaneous metastasis.Conclusion: Skin reflects the course of any internal disease. Identification of these skin manifestations may aid in both earlydiagnosis and treatment of internal malignancies.

Clinical and electrophysiological profiles in early recognition of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes syndrome / 中华医学杂志(英文版)

Background@#The detection of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome at early stage is challenging for neurologists. Since polyneuropathy could be the first manifestation, it could be misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP). The present study aimed to determine the clinical and electrophysiological features of POEMS syndrome to distinguish from CIDP.@*Methods@#The data of a group of patients with POEMS (n = 17) and patients with CIDP (n = 17) in Zhongshan Hospital Fudan University from January 2015 to September 2017 were analyzed in this retrospective study. The clinical features, neurological symptoms, and electrophysiological findings were compared between the two groups.@*Results@#Clinically, patients with POEMS demonstrated significantly more neuropathic pain in the lower extremities than patients with CIDP (58.8% vs. 11.8%, P = 0.01). Multisystem features like edema, skin change, organomegaly, and thrombocytosis were also pointed towards the diagnosis of POEMS syndrome. Electrophysiologically, terminal latency index (TLI) was significantly higher in patients with POEMS than that in patients with CIDP (median nerve: 0.39 [0.17–0.52] vs. 0.30 (0.07–0.69), Z = –2.413, P = 0.016; ulnar nerve: 0.55 [0.23–0.78] vs. 0.42 [0.12–0.70], Z = –2.034, P = 0.042). Patients with POEMS demonstrated a higher frequency of absent compound muscle action potential of the tibial nerve (52.9% vs. 17.6%, P = 0.031), less conduction block (ulnar nerve: 0 vs. 35.3%, P = 0.018), and less temporal dispersion (median nerve: 17.6% vs. 58.8%, P = 0.032) than CIDP group. The combination of positive serum monoclonal protein and high TLI (if either one or both were present) discriminated POEMS from CIDP with a sensitivity of 94.1% and 47.1% and specificity of 76.5% and 100.0%, respectively.@*Conclusions@#POEMS syndrome could be distinguished from CIDP through typical clinical and electrophysiological characteristics in practice. The combination of serum monoclonal protein and high TLI might raise the sensitivity of detecting POEMS syndrome.

Raynaud's Phenomenon: Its Prevalence in Systemic Sclerosis and Its Relationship with the Onset and with the Subsets of Systemic Sclerosis - An Experience from the Kashmir Valley, India / Fenómeno de Raynaud: su prevalencia en la esclerosis sistémica y sus relación con el inicio y los subconjuntos de la esclerosis sistémica - una experiencia del Valle de Kashmir, India

ABSTRACT Background: Raynaud's phenomenon (RP) is a very common clinical sign in patients with systemic sclerosis (SSc). Within the same country, its prevalence may vary depending on climactic changes. Usually, it predates the onset of cutaneous involvement in SSc, but in rare cases, it can follow the skin changes in these patients. Its evolution differs in the two subsets of SSc (limited and diffuse) and can serve as a clinical pointer to differentiate between the two disease subsets. Objective: To study the prevalence of RP in SSc and report its relationship with the onset and with the subsets of SSc. Methods: A prospective observational study of 56 patients with SSc was carried out at the Postgraduate Department of Dermatology, STDs and Leprosy of Shri Maharaja Hari Singh Hospital, Kashmir, India. Results: Of the 56 patients, 40 (71.4%) had limited SSc (lSSc) and 16 (28.6%) had diffuse SSc (dSSc). Raynaud's phenomenon was seen in 54 (96.4%) of the 56 patients, comprising 39 (97.5%) of the 40 patients with lSSc and 15 (93.8%) of the 16 patients with dSSc. Thirteen (81.3%) patients with dSSc and two (5%) patients with lSSc had a short history (less than one year) of RP preceding the skin changes. Twenty-six (65%) patients with lSSc and only two (12.5%) patients with dSSc had a long history (more than one year) of RP preceding the cutaneous manifestations. Six (15%) of the 40 patients with lSSc had a simultaneous onset of RP and skin changes. In five (12.5%) of the 40 patients with lSSc, RP followed the skin changes. Conclusion: Raynaud's phenomenon was very common in these patients with SSc. Patients with lSSc had a longer history of RP compared with those with dSSc. It could occur simultaneously with skin changes or even postdate the onset of skin changes.

RESUMEN Antecedentes: El fenómeno de Raynaud (FR) es una manifestación clínica muy común en pacientes con esclerosis sistémica (ES). Dentro del mismo país, su prevalencia puede variar en función de los cambios climáticos. Generalmente, precede al inicio de la afección cutánea en la ES, pero en raros casos puede seguir a los cambios de piel en estos pacientes. Su evolución difiere en los dos subconjuntos de ES (limitada y difusa), y puede servir como indicador clínico para poder diferenciar entre estos dos subconjuntos. Objetivo: Estudiar la prevalencia de FR en la ES y reportar sus relación con el inicio y los subconjuntos de ES. Métodos: Se realizó un estudio observacional prospectivo de 56 pacientes con ES en el Departamento de Posgrado de Dermatología, Enfermedades de Transmisión Sexual y Lepra del Hospital Shri Maharaja Hari Singh, India. Resultados: De los 56 pacientes, 40 (71.4%) tenían ES limitada (ESL) y 16 (28.6%) tenían ES difusa (ESD). El fenómeno de Raynaud se observó en 54 (96.4%) de los 56 pacientes, abarcando 39 (97.5%) de los 40 pacientes con la variante ESL y 15 (93.8%) de los 16 pacientes con la variante ESD. Trece (81.3%) pacientes con ESD y dos (5%) pacientes con ESL tenían una historia corta (menos de un año) de FR, que precedía a los cambios cutáneos. Veintiséis pacientes (65%) con ESL y solamente dos (12.5%) pacientes con ESD tenían una historia larga (más de un año) de FR, que precedía a las manifestaciones cutáneas. Seis (15%) de los 40 pacientes con ESL tuvieron un inicio simultáneo de FR y cambios de piel. En cinco (12.5%) de los 40 pacientes con ESL, FR siguió a los cambios de la piel. Conclusión: El fenómeno de Raynaud fue muy común en estos pacientes con ES. Los pacientes con ESL tuvieron una historia más larga de FR, a diferencia de aquellos con ESD. El fenómeno de Raynaud podía ocurrir simultáneamente con cambios cutáneos o incluso presentarse tras el comienzo de los cambios cutáneos.

Síndrome de POEMS, el desafío diagnóstico de un caso infrecuente / POEMS syndrome, the diagnostic challenge of an infrequent case / Síndrome de POEMS, o desafio diagnóstico de um caso infrequente

Se reporta el caso de un hombre de 45 años con síntomas y signos consistentes con el Sindrome de POEMS (del inglés: polineuropatía, organomegalia, endocrinopatía, gammapatía monoclonal y cambios dérmicos), un raro desorden paraneoplásico. El mismo contaba con antecedentes de tabaquismo, hipotiroidismo y últimamente había perdido 20 kg de peso. Se destaca que una historia clínica y revisión detallada seguida de estudios de laboratorio, radiología y biopsia de médula ósea, entre otros, son herramientas necesarias para reconocer los componentes de este síndrome y no demorar el diagnóstico. El paciente presentó 2 criterios obligatorios (gammapatía monoclonal y neuropatia periférica sensitivo-motora), un criterio mayor (lesión ósea) y varios criterios menores (desórdenes endocrinos, manifestaciones cutáneas, organomegalia). Actualmente se encuentra bajo supervisión hematológica y continúa su seguimiento neurológico, lo que muestra una buena respuesta a la terapia específica. Las enfermedades raras como este síndrome resultan un desafío diagnóstico para los profesionales de la salud.

The case of a 45 - year- old- man whose symptoms and signs were consistent with POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes), a rare paraneoplastic disorder, has been reported. He had a previous history of smoking, hypothyroidism and a 20 kg weight loss. It was emphasized that a detailed clinical history and examination followed by laboratory and radiological studies and bone marrow biopsy, among others tests, were necessary in order to recognise the components of this syndrome and not to delay the time of diagnosis. This patient had two mandatory criteria (monoclonal gammopathy and sensorimotor polyneuropathy), one major criterion (bone lesion) and several minor criteria (endocrine disorders, cutaneous manifestations, organomegaly). He is currently under the supervision of the doctors of the hematology department and continues neurological follow-up, having a good response to the specific therapy. Rare diseases like this syndrome are a diagnostic challenge for health professionals.

Informa-se o caso de um homem de 45 anos com sintomas e sinais compatíveis com a Síndrome de POEMS (do inglês: polineuropatia, organomegalia, endocrinopatia, gamopatia monoclonal e alterações cutâneas), um distúrbio paraneoplásico raro. O homem tinha antecedentes de tabagismo, hipotiroidismo e ultimamente tinha perdido 20 kg de peso. Enfatizamos que um prontuario médico e exame detalhado, seguido de estudos de laboratório e radiológicos, e uma biópsia de medula óssea, dentre outros, são ferramentas necessárias para reconhecer os componentes desta síndrome e não demorar o tempo de diagnóstico. Nosso paciente apresentou dois critérios obrigatórios (gamopatia monoclonal e neuropatia periférica sensório-motora), um critério maior (lesão óssea) e vários critérios menores (anormalidades endócrinas, alterações cutâneas, organomegalia). Encontra-se atualmente sob supervisão hematológica e continua seu seguimento neurológico, mostrando uma resposta boa à tera,pia concreta. Doenças raras como essa síndrome são um desafio diagnóstico para os profissionais da saúde.

Correlation between blood aryl hydrocarbon receptor, cytochrome P-450 1A1 mRNA expression and skin changes in people with endemic arsenic poisoning / 中华地方病学杂志

Objective Though measuring the expression levels of blood aryl hydrocarbon receptor (AhR) and cytochrome P-450 1A1 (CYP1A1),to explore the relationship between the expression levels and chronic arsenic poisoning induced skin changes.Methods Totally 233 residents were selected in Hanggin Rear Banner arsenic exposure area of Bayannur City,according to water arsenic concentrations,these people were divided into control (＜ 10 μg/L,55 people),low (10-＜ 100 μg/L,47),medium (100-＜ 200 μg/L,45) and high (≥200 pg/L,86) arsenic exposure groups.Real-time PCR was used to detect the expression levels of blood AhR and CYP1A1 mRNA,which were presented in median and quartile [M (Q1-Q3)],and the relationships between their expression levels and keratosis,depigmentation of skin were analyzed.Results The relative expression levels of AhR and CYP1A1 mRNA in high-dose groups were 3.18 × 10-3 (2.42 × 10-3-4.45 × 10-3) and 1.58 × 10-3 (0.80 ×10-3-2.73 × 10-3),which were higher than those in control groups [2.30 × 10-3 (1.53 × 10-3-3.20 × 10-3) and 1.00 × 10-3 (0.59 × 10-3-2.09 × 10-3)],and the difference were statistically significant (all P ＜ 0.05).Compared with control group,the detectable rates of arsenic poisoning,keratosis and depigmentation of skin were higher,and the differences were statistically significant (x2 =20.187,15.848,21.595,all P ＜ 0.05).The detectable rates of arsenic poisoning,keratosis and depigmentation of skin were increased with increase of water arsenic concentrations (x2 =19.012,15.269,16.868,all P ＜ 0.05).Compared with normal [2.54 × 10-3 (1.79 × 10-3-3.43 × 10-3),2.57 × 10-3 (1.78 × 10-3-3.52 × 10-3)],AhR mRNA relative expression levels [4.45 × 10-3 (3.47 × 10-3-8.04 × 10-3),4.45 × 10-3 (4.02 × 10-3-6.25 × 10-3)] of degree Ⅲ keratosis and depigmentation of skin were increased,and the differences were statistically significant (all P ＜ 0.05).Conclusions Chronic arsenic exposure affects the expression level of AhR and CYP1A1 mRNA.Blood AhR mRNA expression may have relationship with endemic arsenic poisoning induced skin change,but blood CYP1A1 mRNA expression may have nothing to do with endemic arsenic poisoning induced skin change.

Clinical features and treatment on 21 cases of POEMS syndrome / 中国医师进修杂志

Objective To improve the recognition in clinical features,diagnosis and treatment of POEMS syndrome.Method Twenty-one cases of POEMS syndrome were analyzed retrospectively.Results The major clinical features were shown as follows: 21 cases of polyneuropathy, organomegaly, edema and skin changes, 13 cases of monoclonal plasma proliferative disorder, 19 cases of endocrinopathy, 1 case of sclerotic bone lesions, 1 case of Castleman disease,5 cases of papilledema.Conclusions POEMS syndrome is a rare multi-system damage disease.Screening for POEMS syndrome with serum protein electrophoresis, immunofixation electrophoresis,electromyogram and radionuclide bone scanning are essential for all patients with unexplained peripheral neuropathy or multi-system damage.If the index of suspicion is high enough, bone marrow cytomorphologic examination or biopsy with immunohistochemical staining may be required,in order to make an early diagnosis and try to avoid misdiagnosis and mistherapy.

Neonatal skin diseases / 소아과

Several physiological skin changes such as vernix caseosa, cutis marmorata, physiologic desquamation, and sebaceous hyperplasia have been described in the neonatal period. There are also clinical characteristics of skin peculiar to neonate and infancy. Skin disorders observed during neonatal and infancy period can be divided into transient skin lesions, birth marks, and other diseases. Transient skin lesions include milia, sebaceous gland hyperplasia, erythema neonatorum, transient neonatal pustular melanosis, and acne neonatorum. Nevocellular nevus, mongolian spot, vascular malformation, hemangioma, epidermal nevus, and sebaceous nevus belong to birth marks. There are several common skin diseases such as miliaria, diaper dermatitis, atopic dermatitis, seborrheic dermatitis, and cutaneous candidiasis.

A Clinical Study of Physiological Skin Changes in the Third Trimester of Pregnancy / 대한피부과학회지

BACKGROUND: The skin shows many physiological changes during pregnancy. Although these physiological skin changes do not usually impair the health of the mother or the fetus, some can be cosmetically significant and of importance to the dermatologist. OBJECTIVE: The aim of our study was to determine the incidence and clinical findings of these skin changes during pregnancy. METHODS: We made a prospective study of 157 women in the third trimester of pregnancy who visited the prenatal care clinic at Seoul National University Hospital from January 1996 to June 1996. Women with pathological pregnaneies were excluded. RESULTS: The results of the study are summarized as follows. 1. Various skin changes occurred such as pigmentary alteration, vascular changes, striae, abnormalities in hair growth, and nail changes. In all subjects, one or more of these changes were found. 2. The incidence of hyperpigmentation was highest among the skin changes. The incidence of hyperpigmentation of areola and nipple was 100%. Linea nigra were observed in 81.5%. 3. Palmar erythema, suprapubic hirsutism, and abdominal striae were observed in 36.3%, 14.0%, and 40.1 %, respectively. CONCLUSION: Physiological skin changes during pregnancy were various and observed with high frequency. The incidences of vascular changes, hair and nail changes in Korean pregnant women were reported for the first time.