ABSTRACT
BACKGROUND: Although the incidence of chronic urticaria in children is increasing, research on the disease is limited. OBJECTIVE: We aimed to study the clinical and etiological characteristics of chronic urticaria in pediatric patients. METHODS: From July 2013 to December 2016, patients with chronic urticaria aged less than 18 years answered questionnaires regarding their symptoms and provoking factors or specific exposures related to the disease. Some patients were also investigated with physical provocation and/or laboratory tests. RESULTS: A total of 74 patients (male to female ratio, 1.0) with a mean age of 11.1 years (range, 1.1~18.7 years) were evaluated. The severity of urticaria was classified into mild (23.0%), moderate (43.2%), and severe (33.8%) according to the patient rating scale. Twenty-one patients (28.4%) had a previous history of atopic disease. Some patients reported accompanying angioedema (18.9%) and general symptoms, such as fatigue (14.9%) and nausea or vomiting (8.1%). The etiology was identified in 14 patients (18.9%): 9 patients had dermographic urticaria, 3 patients had cholinergic urticaria, 1 patient had cold urticaria, and 1 patient had dermographic combined with cholinergic urticaria. Results of thyroid autoantibody and antinuclear antibody tests were positive in 4 patients (30.8%) and 13 patients (27.7%), respectively. Remission rates at 1, 2, and 3 years after the onset of chronic urticaria symptoms were 40.6%, 50.7%, and 52.2%, respectively. A mild urticaria severity score and the presence of angioedema seemed to be good prognostic factors for the remission of chronic urticaria. CONCLUSION: Based on the results of this single-center study, further investigation is warranted to determine the incidence, etiology, and distinct features of chronic urticaria in children compared to those in adults.
Subject(s)
Adult , Child , Female , Humans , Angioedema , Antibodies, Antinuclear , Fatigue , Incidence , Nausea , Prognosis , Thyroid Gland , Urticaria , VomitingABSTRACT
Sorafenib is an oral, multi-targeted tyrosine kinase inhibitor with anti-angiogenic and anti-proliferative activity. It is approved for the treatment of unresectable hepatocellular and advanced renal carcinomas. Cutaneous toxicity is relatively common in patients receiving sorafenib. The most frequent cutaneous side effect is the hand-foot syndrome. Other adverse skin reactions include facial erythema, acral erythema, erythema multiforme, subungual splinter hemorrhage, stomatitis, and alopecia. In Korea, two cases of scrotal and perianal dermatitis after sorafenib therapy were reported. We report a 54-year-old male patient with a 2-week history of scrotal eczema who had been treated for chronic hepatitis type B, liver cirrhosis, and hepatocellular carcinoma. After 2 weeks of oral sorafenib (800 mg/day) administration, thick, scaly patches appeared on his scrotum. A skin biopsy specimen from these lesions revealed superficial dermal perivascular lymphocytic and neutrophilic infiltration, and dilatation of the lymphatics in the superficial dermis. The lesions improved after treatment with a topical and systemic steroid for 2 weeks. Herein, we report a rare case of scrotal erythema associated with sorafenib.
Subject(s)
Humans , Male , Middle Aged , Alopecia , Biopsy , Carcinoma, Hepatocellular , Dermatitis , Dermis , Dilatation , Eczema , Erythema Multiforme , Erythema , Hand-Foot Syndrome , Hemorrhage , Hepatitis, Chronic , Korea , Liver Cirrhosis , Neutrophils , Protein-Tyrosine Kinases , Scrotum , Skin , StomatitisABSTRACT
Woringer-Kolopp disease, also known as localized pagetoid reticulosis, is a rare variant of mycosis fungoides that presents as a solitary localized hyperkeratotic patch or plaque on the extremities and follows a benign course. Effective treatments for Woringer-Kolopp disease include skin-directed therapies such as topical nitrogen mustard, high-potency topical steroids, and phototherapy. Surgical excision has been pursued in cases of small, localized lesions. A 39-year-old man presented with a 3-month history of an asymptomatic plaque on his hand. Physical examination showed a 10-mm-diameter solitary round erythematous hyperkeratotic plaque with a slightly raised edge on the dorsum of his left hand. A skin biopsy revealed that numerous atypical lymphocytes had infiltrated the upper dermis and expanded into the epidermis with a pagetoid pattern. These atypical pagetoid cells were strongly positive for CD3, CD8, and T-cell intracellular antigen-1; focally positive for CD4; and negative for CD20, CD30, and CD56. A subsequent general examination revealed no evidence of systemic involvement and the lesion was treated with surgical excision. Here we report a rare case of Woringer-Kolopp disease.
Subject(s)
Adult , Humans , Biopsy , Dermis , Epidermis , Extremities , Hand , Lymphocytes , Mechlorethamine , Mycosis Fungoides , Pagetoid Reticulosis , Phototherapy , Physical Examination , Skin , Steroids , T-LymphocytesABSTRACT
Even though atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases, its treatment remains a challenge in clinical practice, with most approaches limited to symptomatic, unspecific anti-inflammatory, or immunosuppressive treatments. Many studies have shown AD to have multiple causes that activate complex immunological and inflammatory pathways. However, aeroallergens, and especially the house dust mite (HDM), play a relevant role in the elicitation or exacerbation of eczematous lesions in many AD patients. Accordingly, allergen-specific immunotherapy has been used in AD patients with the aim of redirecting inappropriate immune responses. Here, we report three cases of refractory AD sensitized to HDM who were treated with sublingual immunotherapy.
