RESUMO
Unfractionated heparin (UFH) is frequently used in the treatment of venous thromboembolism and acute coronary syndrome. There are many common cutaneous adverse reactions to this medication. We present a unique case of hemorrhagic bullae limited to the oral mucosa that developed within 6 hours of a patient receiving UFH.
Assuntos
Hemorragia/induzido quimicamente , Heparina/efeitos adversos , Mucosa Bucal/patologia , Dermatopatias Vesiculobolhosas/induzido quimicamente , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Hemorragia/diagnóstico , Heparina/administração & dosagem , Humanos , Masculino , Dermatopatias Vesiculobolhosas/diagnósticoRESUMO
Bullous systemic lupus erythematosus (BSLE) is a rare complication of systemic lupus erythematosus (SLE) characterized by cutaneous vesicles and bullae with a primarily neutrophilic infiltrate on histopathology. Bullous SLE is a heterogeneous disease without pathognomonic clinical features, making the diagnosis and differentiation from other blistering diseases challenging. We present the case of a single patient with SLE in whom 3 different clinical appearances of BSLE manifested over 5 years. The cutaneous eruption dramatically improved with rituximab at the initial presentation and continued to respond to rituximab during subsequent flares over the subsequent 5 years.
Assuntos
Lúpus Eritematoso Sistêmico/tratamento farmacológico , Rituximab/administração & dosagem , Dermatopatias Vesiculobolhosas/tratamento farmacológico , Adolescente , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/patologia , Pele/patologia , Dermatopatias Vesiculobolhosas/diagnóstico , Dermatopatias Vesiculobolhosas/etiologia , Resultado do TratamentoAssuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Doenças da Boca/tratamento farmacológico , Boca/patologia , Fármacos Neuromusculares/uso terapêutico , Escleroderma Sistêmico/fisiopatologia , Adulto , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Boca/fisiopatologia , Doenças da Boca/etiologia , Doenças da Boca/fisiopatologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/terapiaRESUMO
BACKGROUND: Secondary intention healing and purse-string closures are simple but extremely useful methods for the dermatologic surgeon to master. OBJECTIVE: To review the literature on the use of these two types of closures and offer recommendations based on our collective experiences. METHODS: A literature review was performed using the terms "secondary intention healing" and "purse-string closure." The evidence and recommendations from the resultant references were summarized in our article and synthesized with our own experiences. RESULTS: Twenty-eight sources were cited overall with fifteen related to secondary intention healing, eleven pertaining to purse-string closures, and one randomized, blind clinical trial comparing the two modalities. CONCLUSION: The art of dermatologic surgery often requires a tailored approach to the patient and can involve a spectrum of closures, from the simplest to most complex. This variety not only provides more reconstruction options, but are also necessary to keep dermatologic surgery cost-effective. Certain locations or situations are more amenable for these two types of closures than others. The use of secondary intention healing, either alone or in conjunction with purse-string closures, should be in every dermatologic surgeon's armamentarium.
