146 results on '"Purpura therapy"'
Search Results
2. Granulomatous pigmented purpuric dermatosis.
- Author
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Mendes SR, Gameiro AR, Cardoso JC, and Reis JP
- Subjects
- Female, Humans, Middle Aged, Pigmentation Disorders etiology, Pigmentation Disorders therapy, Pruritus etiology, Pruritus therapy, Purpura etiology, Purpura therapy, Pigmentation Disorders pathology, Pruritus pathology, Purpura pathology
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2021
- Full Text
- View/download PDF
3. Drug-induced cutaneous vasculitis and anticoagulant-related cutaneous adverse reactions: insights in pathogenesis, clinical presentation, and treatment.
- Author
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Guzman AK and Balagula Y
- Subjects
- Anti-Infective Agents adverse effects, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Anticonvulsants adverse effects, Antidiuretic Agents adverse effects, Antipsychotic Agents adverse effects, Biological Factors adverse effects, Cardiovascular Agents adverse effects, Factor Xa Inhibitors adverse effects, Humans, Purpura pathology, Purpura therapy, Skin Diseases, Vascular pathology, Skin Diseases, Vascular therapy, Vasculitis pathology, Vasculitis therapy, Purpura chemically induced, Purpura diagnosis, Skin Diseases, Vascular chemically induced, Skin Diseases, Vascular diagnosis, Vasculitis chemically induced, Vasculitis diagnosis
- Abstract
Drug-induced vasculitis and anticoagulant-related skin reactions are commonly encountered in the inpatient and outpatient settings. The spectrum of clinical presentation is broad and ranges from focal, skin-limited disease, to more extensive cutaneous and soft tissue necrosis, to potentially fatal systemic involvement. The prompt recognition of these adverse events can have a significant impact on patient morbidity and mortality. We highlight the key features of the clinical presentation with an emphasis on primary lesion morphology, distribution, and epidemiology of purpuric drug reactions. The proposed pathophysiology, histologic findings, and therapeutic interventions of these potentially life-threatening diseases are discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
4. A generalized purpuric eruption with histopathologic features of leucocytoclastic vasculitis in a patient severely ill with COVID-19.
- Author
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Caputo V, Schroeder J, and Rongioletti F
- Subjects
- COVID-19, Coronavirus Infections therapy, Humans, Male, Middle Aged, Pandemics, Pneumonia, Viral therapy, Purpura therapy, SARS-CoV-2, Betacoronavirus, Coronavirus Infections complications, Coronavirus Infections diagnosis, Pneumonia, Viral complications, Pneumonia, Viral diagnosis, Purpura pathology, Purpura virology, Vasculitis, Leukocytoclastic, Cutaneous pathology
- Published
- 2020
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5. Cerebral Microhemorrhage and Purpuric Rash in COVID-19: The Case for a Secondary Microangiopathy.
- Author
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Shoskes A, Migdady I, Fernandez A, Ruggieri P, and Rae-Grant A
- Subjects
- Aged, Betacoronavirus isolation & purification, COVID-19, Cerebral Hemorrhage diagnostic imaging, Cerebral Hemorrhage therapy, Cerebral Small Vessel Diseases diagnostic imaging, Cerebral Small Vessel Diseases therapy, Coronavirus Infections complications, Coronavirus Infections diagnosis, Coronavirus Infections therapy, Disease Progression, Fatal Outcome, Host-Pathogen Interactions, Humans, Male, Pandemics, Pneumonia, Viral complications, Pneumonia, Viral diagnosis, Pneumonia, Viral therapy, Purpura diagnosis, Purpura therapy, SARS-CoV-2, Betacoronavirus pathogenicity, Cerebral Hemorrhage virology, Cerebral Small Vessel Diseases virology, Coronavirus Infections virology, Pneumonia, Viral virology, Purpura virology
- Abstract
Introduction: Since the emergence of Coronavirus Disease 19 (COVID-19) pandemic, multiple neurologic complications in infected patients have been reported. Despite these reports, the mechanism of COVID-19 nervous system injury is not well understood. We report the case of a COVID-19 patient with diffuse microhemorrhages on brain MRI, positive anticardiolipin antibodies, and purpuric rash with biopsy showing a thrombotic vasculopathy, all features suggestive of secondary microangiopathy., Case Report: A 69-year-old male with history of hypertension, chronic kidney disease, and hypothyroidism presented with one week of dyspnea, cough, diarrhea, and fevers. Chest x-ray demonstrated bibasilar consolidations and nasopharyngeal reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. He had subsequent respiratory decline requiring intubation the day after admission. He developed a truncal morbilliform rash and diffuse purpura, a biopsy of which showed small dermal blood vessels with intraluminal microthrombi consistent with thrombotic vasculopathy. He was found to have elevated aCL IgM and IgG and equivocal lupus anticoagulant study. Brain MRI obtained for persistent encephalopathy showed innumerable areas of susceptibility weighted imaging changes throughout the bilateral juxtacortical white matter, corpus callosum, basal ganglia, and brainstem, as well as multiple small areas of FLAIR hyperintensities, consistent with microhemorrhage DISCUSSION: While there have been several reported cases of neurologic manifestations of COVID-19, the pathophysiology may not be related to neurotropism of the virus itself. The new development of antiphospholipid antibodies and thrombotic vasculopathy in dermal blood vessels in this patient suggest a secondary microangiopathy potentially related to a virally-induced inflammatory state., Competing Interests: Declarations of Competing Interest None, (Copyright © 2020 Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
6. COVID-19-related thrombotic microangiopathy in a cirrhotic patient.
- Author
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Airoldi A, Perricone G, De Nicola S, Molisano C, Tarsia P, and Belli LS
- Subjects
- Acute Kidney Injury etiology, Betacoronavirus, COVID-19, Coronavirus Infections complications, Disease Progression, Erythrocyte Transfusion, Factor Xa Inhibitors adverse effects, Fibrin Fibrinogen Degradation Products metabolism, Fondaparinux adverse effects, Hematuria etiology, Hematuria physiopathology, Hematuria therapy, Hepatorenal Syndrome etiology, Humans, Liver Cirrhosis complications, Male, Melena etiology, Melena physiopathology, Melena therapy, Mesenteric Ischemia drug therapy, Middle Aged, Pandemics, Platelet Transfusion, Pneumonia, Viral complications, Portal Vein, Purpura etiology, Purpura physiopathology, Purpura therapy, SARS-CoV-2, Severity of Illness Index, Thrombotic Microangiopathies etiology, Thrombotic Microangiopathies metabolism, Thrombotic Microangiopathies therapy, Acute Kidney Injury physiopathology, Coronavirus Infections physiopathology, Hepatorenal Syndrome physiopathology, Liver Cirrhosis physiopathology, Pneumonia, Viral physiopathology, Thrombotic Microangiopathies physiopathology
- Abstract
Competing Interests: Declaration of Competing Interest None
- Published
- 2020
- Full Text
- View/download PDF
7. Retiform purpura: A diagnostic approach.
- Author
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Georgesen C, Fox LP, and Harp J
- Subjects
- Biopsy, Clinical Laboratory Techniques, Diagnosis, Differential, Humans, Medical History Taking, Physical Examination, Purpura etiology, Purpura pathology, Purpura therapy, Skin Diseases, Vascular etiology, Skin Diseases, Vascular pathology, Skin Diseases, Vascular therapy, Purpura diagnosis, Skin Diseases, Vascular diagnosis
- Abstract
Retiform purpura is a specific morphology within the spectrum of reticulate eruptions of vascular origin. It develops when blood vessels serving the skin are compromised resulting in downstream cutaneous ischemia, purpura, and necrosis. Identifying retiform purpura is important particularly in the acutely ill patient. It may elucidate the underlying diagnosis, provide prognostic information, and suggest a treatment approach. The differential diagnosis of retiform purpura is vast, reflecting the myriad conditions that can lead to cutaneous vessel wall damage or lumen occlusion. In this article, we give an overview of the differential diagnosis of this cutaneous morphology, provide an approach to workup, and highlight updates in treatment of some of the more common conditions that manifest as retiform purpura., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
8. Retiform purpura: Workup and therapeutic considerations in select conditions.
- Author
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Georgesen C, Fox LP, and Harp J
- Subjects
- Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis complications, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis pathology, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis physiopathology, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis therapy, Calciphylaxis complications, Calciphylaxis pathology, Calciphylaxis physiopathology, Calciphylaxis therapy, Cryoglobulinemia complications, Cryoglobulinemia pathology, Cryoglobulinemia physiopathology, Cryoglobulinemia therapy, Humans, Purpura physiopathology, Purpura therapy, Risk Factors, Skin Diseases, Vascular physiopathology, Skin Diseases, Vascular therapy, Systemic Vasculitis complications, Systemic Vasculitis pathology, Systemic Vasculitis physiopathology, Systemic Vasculitis therapy, Purpura diagnosis, Purpura etiology, Skin Diseases, Vascular diagnosis, Skin Diseases, Vascular etiology
- Abstract
In this article we focus on updates in select etiologies of retiform purpura. These causes of retiform purpura, in addition to bacterial or fungal sepsis, disseminated intravascular coagulation, purpura fulminans, and catastrophic antiphospholipid syndrome, are important diagnoses with potential for morbidity and mortality. Important aspects in the pathophysiology, patient demographics and risk factors, updates in the diagnostic workup, histopathology, and treatment of these specific conditions are discussed., (Copyright © 2019 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
9. A case of lichen aureus successfully treated with 595 nm wavelength pulsed-dye laser.
- Author
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Arreola Jauregui IE, López Zaldo JB, Huerta Rivera G, Soria Orozco M, Bonnafoux Alcaraz M, Paniagua Santos JE, and Vázquez Huerta M
- Subjects
- Biopsy, Female, Humans, Lichenoid Eruptions diagnosis, Lichenoid Eruptions pathology, Middle Aged, Purpura diagnosis, Purpura pathology, Skin pathology, Skin radiation effects, Treatment Outcome, Lasers, Dye therapeutic use, Lichenoid Eruptions therapy, Low-Level Light Therapy instrumentation, Purpura therapy
- Abstract
Background: Lichen aureus (LA) is a variant of pigmented purpuric dermatosis (PPDs) that typically presents with the acute onset of a solitary, unilateral, purple to rust-yellow colored lichenoid patch or plaque on lower extremities. Treatment remains challenging and is based on anecdotal case reports often with poor results., Aims: Describe a case of LA successfully treated with 595 nm wavelength pulsed-dye laser (PDL)., Patient/method: A 46-year-old woman with segmental LA was treated using a 595 nm PDL at a uniform spot size of 10 mm, with pulse durations of 10 milliseconds and fluence of 6 J/cm2. The patient had received previous treatments with no improvement., Results: Clearance was archived after three sessions with PDL. Sessions were performed at intervals of 4 weeks, with no serious adverse events nor recurrence., Conclusion: We hypothesize the favorable clinical outcome with PDL is due to the affinity of the wavelength for oxyhemoglobin (allowing uniform vessel penetration and energy delivery to fragile capillaries and intraluminal blood) and to its anti-inflammatory profile. PDL seems to be an alternative for patients with progressive LA that have failed other therapies., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2020
- Full Text
- View/download PDF
10. Update and Review of Bleeding Considerations in Dermatologic Surgery: Hemostatic Techniques and Treatment Strategies for Bleeding Complications.
- Author
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Iyengar S, Yeager DG, Cohen JL, and Ozog DM
- Subjects
- Ecchymosis etiology, Ecchymosis therapy, Hematoma etiology, Hematoma therapy, Humans, Postoperative Complications etiology, Purpura etiology, Purpura therapy, Skin blood supply, Blood Loss, Surgical prevention & control, Dermatologic Surgical Procedures adverse effects, Hemostatic Techniques, Perioperative Care methods, Postoperative Complications therapy
- Abstract
Background: There are many intraoperative and postoperative techniques to aid hemostasis in dermatologic procedures. An updated understanding is critical for the surgeon., Objective: To provide an updated review of methods for hemostasis and therapies for postprocedural purpura and ecchymosis applicable to dermatology., Materials and Methods: A review of Ovid MEDLINE was performed to review the English-language medical literature of hemostatic options and their use in cutaneous surgery. All available publication years were included from 1946 to present., Results: A comprehensive and current list of hemostatic options used in the intraoperative and postoperative period is provided along with traditional and emerging therapies for postprocedural purpura and ecchymosis., Conclusion: A myriad of options exist for minimizing and treating bleeding complications. The appropriate use and updated knowledge of hemostatic options is provided.
- Published
- 2020
- Full Text
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11. Giant placental chorioangioma followed by circulatory failure of the newborn and infantile hemangioma: Case report.
- Author
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Suga S, Araki S, Aramaki S, Shibata E, and Kusuhara K
- Subjects
- Adrenergic beta-Antagonists therapeutic use, Anemia, Hemolytic therapy, Disseminated Intravascular Coagulation etiology, Disseminated Intravascular Coagulation therapy, Edema therapy, Erythrocyte Transfusion, Female, Hemangioma diagnostic imaging, Hemangioma drug therapy, Hemangioma pathology, Hepatomegaly etiology, Humans, Hypoalbuminemia etiology, Hypoalbuminemia therapy, Infant, Newborn, Lip Neoplasms drug therapy, Placenta Diseases diagnostic imaging, Plasma, Pregnancy, Pregnancy Complications, Neoplastic diagnostic imaging, Propranolol therapeutic use, Purpura etiology, Purpura therapy, Respiratory Distress Syndrome, Newborn therapy, Shock therapy, Splenomegaly etiology, Thrombocytopenia etiology, Thrombocytopenia therapy, Tumor Burden, Ultrasonography, Prenatal, Vasoconstrictor Agents therapeutic use, Anemia, Hemolytic etiology, Edema etiology, Hemangioma complications, Lip Neoplasms pathology, Placenta Diseases pathology, Pregnancy Complications, Neoplastic pathology, Respiratory Distress Syndrome, Newborn etiology, Shock etiology
- Abstract
Placental chorioangioma (CA) is a benign placental tumor. No specific treatment is required for asymptomatic cases. We report a female infant born to a mother with giant placental CA. However fetal growth was normal and, fetal hydrops was not detected by ultrasound examination until delivery, she had hydrops, subgaleal hematoma, thrombocytopenia, hemolytic anemia, respiratory distress and circulatory failure after birth. She was successfully treated without any neurological sequelae. At 2 months of age, infantile hemangioma appeared in her lower lip. The present case suggested that giant placental CA might cause postnatal problems and be associated with the development of infantile hemangioma.
- Published
- 2020
- Full Text
- View/download PDF
12. Acute retiform purpura caused by Morganella morganii .
- Author
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Calado R, Relvas M, Brites MM, and Cardoso JC
- Subjects
- Acute Disease, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Bandages, Disseminated Intravascular Coagulation diagnosis, Enterobacteriaceae Infections therapy, Humans, Levofloxacin therapeutic use, Male, Purpura therapy, Skin Diseases, Bacterial therapy, Enterobacteriaceae Infections diagnosis, Morganella morganii, Purpura microbiology, Skin Diseases, Bacterial diagnosis
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2019
- Full Text
- View/download PDF
13. Improved clinical outcome following liver transplant in patients with ethylmalonic encephalopathy.
- Author
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Tam A, AlDhaheri NS, Mysore K, Tessier ME, Goss J, Fernandez LA, D'Alessandro AM, Schwoerer JS, Rice GM, Elsea SH, and Scaglia F
- Subjects
- Biomarkers, Brain Diseases, Metabolic, Inborn diagnosis, Brain Diseases, Metabolic, Inborn genetics, Consanguinity, Female, Humans, Infant, Magnetic Resonance Imaging, Male, Mitochondrial Proteins genetics, Mutation, Nucleocytoplasmic Transport Proteins genetics, Phenotype, Purpura diagnosis, Purpura genetics, Treatment Outcome, Brain Diseases, Metabolic, Inborn therapy, Liver Transplantation adverse effects, Liver Transplantation methods, Purpura therapy
- Abstract
Ethylmalonic encephalopathy (EE) is a rapidly progressive autosomal recessive mitochondrial disease caused by biallelic pathogenic variants in the ETHE1 gene that encodes the mitochondrial sulfur dioxygenase. It is characterized by neurodevelopmental delay and regression, pyramidal and extrapyramidal signs, recurrent petechiae, chronic diarrhea, and orthostatic acrocyanosis. Laboratory findings include elevated serum levels of lactate and C4-C5 acylcarnitines, and elevated urinary excretion of ethylmalonic acid and C4-C6 acylglycines, notably isobutyrylglycine and 2-methylbutyrylglycine. These findings are attributed to deficiency of the mitochondrial sulfur dioxygenase resulting in toxic accumulation of hydrogen sulfide metabolites in vascular endothelium and mucosal cells of the large intestine. Medical management has thus far been directed toward decreasing the accumulation of hydrogen sulfide metabolites using a combination of metronidazole and N-acetylcysteine. More recently, orthotopic liver transplant (OLT) has been reported as a new therapeutic option for EE. Here, we report two additional cases of EE who achieved psychomotor developmental improvement after 7- and 22-months following OLT. The second case serves as the longest developmental outcome follow-up reported, thus far, following OLT for EE. This report provides additional evidence to validate OLT as a promising therapeutic approach for what was considered to be a fatal disease., (© 2019 Wiley Periodicals, Inc.)
- Published
- 2019
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14. Clinical Profile of Levamisole-Adulterated Cocaine-Induced Vasculitis/Vasculopathy: A 30-Case Series.
- Author
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Muñoz-Vahos CH, Herrera-Uribe S, Arbeláez-Cortés Á, Jaramillo-Arroyave D, González-Naranjo LA, Vásquez-Duque G, Restrepo-Escobar M, Correa-Londoño LA, Arias-Restrepo LF, and Vanegas-García AL
- Subjects
- Adjuvants, Pharmaceutic adverse effects, Adjuvants, Pharmaceutic pharmacology, Adult, Autoantibodies blood, Colombia, Dopamine Uptake Inhibitors pharmacology, Drug Contamination, Female, Humans, Male, Necrosis, Patient Care Management methods, Skin pathology, Treatment Outcome, Cocaine pharmacology, Cocaine-Related Disorders complications, Glomerulonephritis chemically induced, Glomerulonephritis diagnosis, Glomerulonephritis immunology, Glomerulonephritis therapy, Levamisole adverse effects, Levamisole pharmacology, Purpura chemically induced, Purpura diagnosis, Purpura immunology, Purpura therapy, Vasculitis chemically induced, Vasculitis diagnosis, Vasculitis immunology, Vasculitis therapy
- Abstract
Objectives: The aims of this study were to describe clinical and laboratory manifestations of patients with levamisole-adulterated cocaine-induced vasculitis/vasculopathy and to propose a skin classification according to the distribution and severity of lesions., Methods: We report the characteristics of 30 patients admitted with levamisole-adulterated cocaine-induced vasculitis/vasculopathy in 4 high-complexity institutions in Colombia, from December 2010 to May 2017. We compare our findings with the main published series., Results: Median age was 31 years (interquartile range, 27-38 years) with a male-to-female ratio of 5:1. Eighty-three percent of the patients had retiform purpura affecting the limbs, buttocks, face, or abdomen; 73% had ear necrosis, 50% cutaneous ulcers, 17% genital necrosis, 13% oral ulcers, and 10% digital necrosis. Cutaneous involvement was classified according to the frequency of the compromised corporal area, and purpuric lesions were stratified in 4 grades of severity. Anti-neutrophil cytoplasmic autoantibodies were positive in 85% of the cases, lupus anticoagulant in 73%, and antinuclear autoantibodies in 57%; rheumatoid factor was negative in all cases. We found nephritis in 17 cases (57%). Prednisolone was used in most of the patients (70%), with other immunosuppressive agents being used in a lower percentage. Improvement was observed in 93% of the patients, but symptoms recurred in 40%, attributed to relapses in consumption. End-stage chronic renal disease developed in 10% of the cases, and 1 patient died., Conclusions: Because of rising cocaine consumption and levamisole adulteration frequency, levamisole-adulterated cocaine-induced vasculitis/vasculopathy is becoming more common. Detailed characterization of skin involvement coupled with multiple antibody positivity is essential for a diagnosis. Renal involvement is frequent, clinically and histologically heterogeneous, and potentially serious.
- Published
- 2019
- Full Text
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15. Therapeutic strategies for pigmented purpuric dermatoses: a systematic literature review.
- Author
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Plachouri KM, Florou V, and Georgiou S
- Subjects
- Adult, Female, Humans, Male, Pigmentation Disorders therapy, Purpura therapy
- Abstract
Background: Pigmented purpuric dermatoses (PPDs) is a group of diseases with distinguishing clinical characteristics, characterized mainly by purpuric skin lesions. The course of PPDs is chronic and recurrences are common. Although PPDs are considered to be benign, the associated symptoms, such as pruritus, and their cosmetic effect can be extremely distressing to patients. So far no evidence-based treatment has been found to be drastically effective in a large scale of patients., Materials and Methods: This paper is a systematic overview of all the reported successful treatments described in the literature. Articles derived from the databases PubMed and SCOPUS and published between 1990 and 2018, were analyzed for this review. The study was conducted according to the PRISMA Guidelines., Results: In the literature there are several case series and case reports, demonstrating encouraging results with the use of various agents, such as local calcineurin-inhibitors, colchicine, pentoxifylline, immunosuppresants, UV- and Laser-therapy., Conclusion: To our knowledge, this is the first review focusing on the therapeutic strategies for pigmented purpuric dermatoses. This paper aims to raise awareness for the need to conduct larger systematic studies in order to adequately evaluate the effectiveness of the above mentioned therapeutic strategies.
- Published
- 2019
- Full Text
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16. What is that rash?
- Author
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Speirs L, McVea S, Little R, and Bourke T
- Subjects
- Edema therapy, Female, Humans, Infant, Treatment Outcome, Edema diagnosis, Fever diagnosis, Fever therapy, Purpura diagnosis, Purpura therapy
- Abstract
Case History: A healthy 15-month-old girl presented to the emergency department with a 24-hour history of fever and rash. The initial blanching rash developed into non-blanching areas with associated leg swelling. She had received no recent medications, had no known drug allergies and no unwell contacts.On examination, she was feverish at 38.6°C, capillary refill time was <2 s with warm peripheries, heart rate 169 bpm and blood pressure 94/59 mm Hg. A palpable purpuric rash was evident on all four limbs and face (figure 1) although the trunk was spared. Her legs were tense and oedematous to the knee.edpract;103/1/25/EDPRACT2016311782F1F1EDPRACT2016311782F1Figure 1Rash at presentation.Initial investigations: Haemoglobin level: 131 g/L, white cell count: 16.6×10
9 /L, neutrophils: 11.1×109 /L and platelets: 407×109 /LCoagulation screen: normalC reactive protein level: 20 mg/LLactate level: 1.7 mmol/LIntravenous ceftriaxone was commenced following blood culture and meningococcal PCR. The following day, while remaining systemically well, she developed a vesicular rash on her trunk and back (figure 2).edpract;103/1/25/EDPRACT2016311782F2F2EDPRACT2016311782F2Figure 2Vesicular rash., Questions: What is the diagnosis? Henoch-Schonlein purpura (HSP)Meningococcal septicaemiaAcute haemorrhagic oedema of infancy (AHOI)Vasculitic urticariaGianotti-Crosti syndromeWhat further investigation is required? Check viral serology including Epstein-Barr virus and hepatitis B virusComplement levels and autoimmune screenSkin biopsyLumbar puncture and audiologyNo further investigationHow should this child be managed? Complete 7 days of ceftriaxone treatmentOral aciclovirOral steroidsRegular follow-up with urinalysis and blood pressure monitoringStop antibiotics if cultures were negative at 48 hours and discharge Answers are on page ▪▪., Competing Interests: Competing interests: None., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)- Published
- 2018
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17. Acral retiform purpura.
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Li JY, Ivan D, and Patel AB
- Subjects
- Aged, Biopsy, Needle, Blood Component Removal methods, Cryoglobulinemia diagnosis, Cryoglobulinemia etiology, Follow-Up Studies, Humans, Immunohistochemistry, Male, Multiple Myeloma complications, Multiple Myeloma physiopathology, Purpura etiology, Renal Insufficiency, Chronic complications, Renal Insufficiency, Chronic physiopathology, Risk Assessment, Treatment Outcome, Cryoglobulinemia therapy, Plasma Exchange methods, Purpura pathology, Purpura therapy
- Published
- 2017
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18. Laser acupuncture improves skin color deformation by cupping: A pilot study.
- Author
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Kim SB
- Subjects
- Acupuncture Therapy, Adult, Combined Modality Therapy, Erythema physiopathology, Humans, Male, Pilot Projects, Purpura physiopathology, Skin physiopathology, Skin Pigmentation, Skin Temperature, Young Adult, Erythema therapy, Laser Therapy, Purpura therapy
- Abstract
Negative pressure of cupping induces skin deformation such as ecchymosis and purpura in a circular shape. Thus, there is a desire to treat skin before depigmentation and scarring occurs. Therefore, we introduce laser therapy, a widely used technique treat pigmentation in dermatology. Various parameters of laser therapy can be applied, so to determine the optimal exposure parameters that do not damage the surrounding tissues, the subjects were divided into four groups: a non-stimulation group and three laser groups (4 J/cm2 group, 6 J/cm2 group, and 8 J/cm2 group). We selected the wavelength and output of laser as follows: 660nm and 50mW. The 40 were divided into four groups of 10. In the first experiment, we measured skin temperature using Digital infrared thermography in order to observe whether the laser could cause heat damage. In the second experiment, each group received the assigned laser therapy protocol every 24 hours for 72 hours. We obtained a skin image using a cross polarization technique. Previous studies have shown that a*and E.I (erythema index) represent the degree of skin erythema (hemoglobin content). M.I (melanin index) indicates the degree of skin pigmentation (melanin content). Hence, skin color information was analyzed with the a*, erythema index (E.I), and melanin index (M.I) for 72 hours. None of the laser exposure parameters led to skin damage by heating or energy dissipation. The results of a*, E.I, and M.I of all groups showed the different recovery rates towards the normal skin color information before cupping. As energy density increases, the result of a* and E.I showed the fast recovery rate. There was no significant different between M.I at non-stimulation group and M.I at 4 J/cm². Therefore, the least energy density as 6 J/cm² is need for the recovery of melanin content. The a*, E.I, and M.I at 8 J/cm² group rather than other groups were significantly recovered to normal skin color. In conclusion, the laser therapy (energy density: 8 J/cm²) has a significant recovery of the skin erythema and skin pigmentation except to skin damage.
- Published
- 2016
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19. Diffuse reticulate purpura in a boy with anorexia nervosa.
- Author
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Garrido Colmenero C and Aneiros Fernández J
- Subjects
- Adolescent, Anorexia Nervosa therapy, Diagnosis, Differential, Humans, Male, Purpura therapy, Anorexia Nervosa complications, Anorexia Nervosa diagnosis, Purpura etiology
- Published
- 2015
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20. Mitochondrial diseases caused by toxic compound accumulation: from etiopathology to therapeutic approaches.
- Author
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Di Meo I, Lamperti C, and Tiranti V
- Subjects
- Humans, Muscular Dystrophy, Oculopharyngeal, Ophthalmoplegia congenital, Brain Diseases, Metabolic, Inborn genetics, Brain Diseases, Metabolic, Inborn physiopathology, Brain Diseases, Metabolic, Inborn therapy, Intestinal Pseudo-Obstruction genetics, Intestinal Pseudo-Obstruction physiopathology, Intestinal Pseudo-Obstruction therapy, Mitochondrial Diseases etiology, Mitochondrial Diseases physiopathology, Mitochondrial Diseases therapy, Mitochondrial Encephalomyopathies genetics, Mitochondrial Encephalomyopathies physiopathology, Mitochondrial Encephalomyopathies therapy, Mitochondrial Proteins genetics, Mutation, Nucleocytoplasmic Transport Proteins genetics, Purpura genetics, Purpura physiopathology, Purpura therapy, Thymidine Phosphorylase genetics
- Abstract
Mitochondrial disorders are a group of highly invalidating human conditions for which effective treatment is currently unavailable and characterized by faulty energy supply due to defective oxidative phosphorylation (OXPHOS). Given the complexity of mitochondrial genetics and biochemistry, mitochondrial inherited diseases may present with a vast range of symptoms, organ involvement, severity, age of onset, and outcome. Despite the wide spectrum of clinical signs and biochemical underpinnings of this group of dis-orders, some common traits can be identified, based on both pathogenic mechanisms and potential therapeutic approaches. Here, we will review two peculiar mitochondrial disorders, ethylmalonic encephalopathy (EE) and mitochondrial neurogastrointestinal encephalomyopathy (MNGIE), caused by mutations in the ETHE1 and TYMP nuclear genes, respectively. ETHE1 encodes for a mitochondrial enzyme involved in sulfide detoxification and TYMP for a cytosolic enzyme involved in the thymidine/deoxyuridine catabolic pathway. We will discuss these two clinical entities as a paradigm of mitochondrial diseases caused by the accumulation of compounds normally present in traces, which exerts a toxic and inhibitory effect on the OXPHOS system., (© 2015 The Authors. Published under the terms of the CC BY 4.0 license.)
- Published
- 2015
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21. Pigmented purpuric dermatosis: clinicopathologic characterization in a pediatric series.
- Author
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Coulombe J, Jean SE, Hatami A, Powell J, Marcoux D, Kokta V, and McCuaig C
- Subjects
- Age of Onset, Biopsy, Child, Female, Humans, Interviews as Topic, Male, Purpura diagnosis, Quebec, Retrospective Studies, Purpura therapy
- Abstract
Pigmentary purpuras (PPs) are a group of chronic disorders of unknown origin seldom described in children. With this study we sought to better characterize PP eruptions, including clinical evolution and management. A retrospective chart review from 2003 to 2013 querying characteristics of children with a biopsy-proven diagnosis of PP in the Centre Hospitalier Universitaire Ste-Justine dermatology clinic (Montreal, Quebec, Canada) was performed. Follow-up was obtained through telephone interviews. Descriptive statistical analysis was used. Of the 17 subjects, 8 were male and the mean age of onset was 9 years. PP was asymptomatic in 11 patients, pruritic in 3, and of cosmetic concern in 3. Schamberg's disease was the most frequent subtype in 12 cases. Resolution of PP was found in 13 cases with a median duration of less than 1 year (range 6 months-9 years). Five patients experienced spontaneous clearing without treatment, and improvement was observed in 75% of cases treated with topical corticosteroids and 100% with narrowband ultraviolet B (nbUVB). No associated disease, significant drug exposure, or contact allergens were found. Those findings support that PPs in children are idiopathic, chronic eruptions that can benefit from watchful waiting, although topical corticosteroids or nbUVB are may be useful if the patient or family desires faster resolution. This study was limited by its small size, its retrospective nature, and selection and recall bias., (© 2015 Wiley Periodicals, Inc.)
- Published
- 2015
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22. Treatment of purpura with lasers and light sources.
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Morton LM, Smith KC, Dover JS, and Arndt KA
- Subjects
- Botulinum Toxins, Type A administration & dosage, Botulinum Toxins, Type A adverse effects, Humans, Intense Pulsed Light Therapy adverse effects, Intense Pulsed Light Therapy methods, Laser Therapy adverse effects, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures methods, Purpura etiology, Time Factors, Laser Therapy methods, Patient Selection, Purpura therapy
- Abstract
The potential for bruising is a frequent concern for patients undergoing minimally invasive procedures, particularly injection-based soft tissue fillers and botulinum toxin type A. Decreasing the risk of this side effect with good technique and careful patient selection is key, but interventions that quicken the resolution of bruising are also helpful. Many practitioners have employed the theory of selective photothermolysis, using laser and light devices, to target hemoglobin and its breakdown products to speed time to bruise resolution. 585-595 nm pulsed dye, pulsed 532 nm and 1064 nm long-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers and intense pulsed light may be utilized with best results achieved when treatment is performed 1-2 days after the appearance of purpura. Specific therapy recommendations, side effects and contraindications will be addressed in this review.
- Published
- 2013
23. A general rehabilitation inpatient with exercise-induced vasculitis.
- Author
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Cushman D and Rydberg L
- Subjects
- Cellulitis diagnosis, Diagnosis, Differential, Exanthema etiology, Exanthema therapy, Humans, Male, Middle Aged, Purpura diagnosis, Purpura etiology, Purpura therapy, Vasculitis therapy, Exanthema diagnosis, Exercise, Vasculitis diagnosis, Vasculitis etiology
- Abstract
While on our general inpatient rehabilitation floor, a 58-year-old man with no hematologic or dermatologic history developed an erythematous patch on his medial ankle that turned more purpuric, with a slight orange tint, and was associated with mild pruritus. The diagnosis of exercise-induced vasculitis was made after initially being mistaken for cellulitis. This common exanthem is often misdiagnosed. Due to its association with exercise, the physiatrist should be aware of its presence in both the inpatient and outpatient settings., (Copyright © 2013 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
- Full Text
- View/download PDF
24. Skin conditions of baseball, cricket, and softball players.
- Author
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Farhadian JA, Tlougan BE, Adams BB, Leventhal JS, and Sanchez MR
- Subjects
- Anabolic Agents adverse effects, Androgens adverse effects, Contusions diagnosis, Contusions etiology, Contusions therapy, Dermatitis, Contact diagnosis, Dermatitis, Contact etiology, Dermatitis, Contact therapy, Drug Eruptions diagnosis, Drug Eruptions etiology, Drug Eruptions therapy, Humans, Purpura diagnosis, Purpura etiology, Purpura therapy, Skin Diseases diagnosis, Skin Diseases therapy, Skin Diseases, Infectious diagnosis, Skin Diseases, Infectious etiology, Skin Diseases, Infectious therapy, Steroids adverse effects, Sunburn diagnosis, Sunburn etiology, Sunburn therapy, Baseball injuries, Skin Diseases etiology
- Abstract
Each year in the United States over 80 million people participate in bat-and-ball sports, for example baseball and softball. Cricket, the world's second most popular sport, is enjoyed by hundreds of millions of participants in such countries as India, Pakistan, Australia, New Zealand, Bangladesh, South Africa, West Indies, Sri Lanka, United Kingdom, and Zimbabwe. Although any player can develop skin disease as a result of participation in these bat-and-ball sports, competitive team athletes are especially prone to skin problems related to infection, trauma, allergy, solar exposure, and other causes. These diseases can produce symptoms that hinder individual athletic performance and participation. In this review, we discuss the diagnosis and best-practice management of skin diseases that can develop as a result of participation in baseball, softball, and cricket.
- Published
- 2013
- Full Text
- View/download PDF
25. Satisfactory response to phototherapy in pigmented purpuric dermatosis.
- Author
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Ciudad C, Cano N, and Suárez R
- Subjects
- Aged, Humans, Male, Phototherapy, Pigmentation Disorders therapy, Purpura therapy
- Published
- 2013
- Full Text
- View/download PDF
26. How to spot cocaine-induced pseudovasculitis.
- Author
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Lutfy J, Noland ME, and Jarmuske M
- Subjects
- Adult, Autoimmune Diseases diagnosis, Blister therapy, Diagnosis, Differential, Female, Humans, Length of Stay, Purpura therapy, Vasculitis diagnosis, Blister chemically induced, Blister diagnosis, Cocaine adverse effects, Cocaine-Related Disorders etiology, Purpura chemically induced, Purpura diagnosis
- Abstract
The prevalence of cocaine-induced pseudovasculitis (CIP) causing cutaneous destruction is increasing, and plastic surgeons need to be aware of this condition because they are a part of the multidisciplinary treatment team. Differentiation of CIP from a true autoimmune vasculitis can be exceedingly challenging, and misdiagnosis with ensuing treatment may be fatal. This article is a succinct review of CIP, guided by a clinical case of 30% total body surface area skin necrosis, to familiarize the reader with this syndrome. Diagnostic aids include history of cocaine use, localized disease manifestation to skin or mucosa, discordance of antineutrophil cytoplasmic antibody and target antibody patterns typical for true vasculitis, and testing for antihuman neutrophil elastase and levamisole. Treatment is primarily supportive, and wound care, with regard to dressings and surgery, is a cross between to that of burns and meningococcemia patients.
- Published
- 2013
- Full Text
- View/download PDF
27. Altered sulfide (H(2)S) metabolism in ethylmalonic encephalopathy.
- Author
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Tiranti V and Zeviani M
- Subjects
- Anti-Infective Agents therapeutic use, Brain Diseases, Metabolic, Inborn drug therapy, Brain Diseases, Metabolic, Inborn therapy, Humans, Metronidazole therapeutic use, Models, Biological, Oxidation-Reduction, Purpura drug therapy, Purpura therapy, Signal Transduction, Brain Diseases, Metabolic, Inborn metabolism, Hydrogen Sulfide metabolism, Purpura metabolism
- Abstract
Hydrogen sulfide (sulfide, H(2)S) is a colorless, water-soluble gas with a typical smell of rotten eggs. In the past, it has been investigated for its role as a potent toxic gas emanating from sewers and swamps or as a by-product of industrial processes. At high concentrations, H(2)S is a powerful inhibitor of cytochrome c oxidase; in trace amounts, it is an important signaling molecule, like nitric oxide (NO) and carbon monoxide (CO), together termed "gasotransmitters." This review will cover the physiological role and the pathogenic effects of H(2)S, focusing on ethylmalonic encephalopathy, a human mitochondrial disorder caused by genetic abnormalities of sulfide metabolism. We will also discuss the options that are now conceivable for preventing genetically driven chronic H(2)S toxicity, taking into account that a complete understanding of the physiopathology of H(2)S has still to be achieved.
- Published
- 2013
- Full Text
- View/download PDF
28. Effective AAV-mediated gene therapy in a mouse model of ethylmalonic encephalopathy.
- Author
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Di Meo I, Auricchio A, Lamperti C, Burlina A, Viscomi C, and Zeviani M
- Subjects
- Animals, Brain Diseases, Metabolic, Inborn pathology, Dioxygenases metabolism, Disease Models, Animal, Genetic Therapy adverse effects, Humans, Mice, Purpura pathology, Thiosulfates blood, Treatment Outcome, Brain Diseases, Metabolic, Inborn therapy, Dependovirus genetics, Dioxygenases genetics, Genetic Therapy methods, Genetic Vectors, Mitochondrial Proteins genetics, Purpura therapy
- Abstract
Ethylmalonic encephalopathy (EE) is an invariably fatal disease, characterized by the accumulation of hydrogen sulfide (H(2)S), a highly toxic compound. ETHE1, encoding sulfur dioxygenase (SDO), which takes part in the mitochondrial pathway that converts sulfide into harmless sulfate, is mutated in EE. The main source of H(2)S is the anaerobic bacterial flora of the colon, although in trace amount it is also produced by tissues, where it acts as a 'gasotransmitter'. Here, we show that AAV2/8-mediated, ETHE1-gene transfer to the liver of a genetically, metabolically and clinically faithful EE mouse model resulted in full restoration of SDO activity, correction of plasma thiosulfate, a biomarker reflecting the accumulation of H(2)S, and spectacular clinical improvement. Most of treated animals were alive and well >6-8 months after birth, whereas untreated individuals live 26 ± 7 days. Our results provide proof of concept on the efficacy and safety of AAV2/8-mediated livergene therapy for EE, and alike conditions caused by the accumulation of harmful compounds in body fluids and tissues, which can directly be transferred to the clinic., (Copyright © 2012 EMBO Molecular Medicine.)
- Published
- 2012
- Full Text
- View/download PDF
29. Derm emergencies: detecting early signs of trouble.
- Author
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McQueen A, Martin SA, and Lio PA
- Subjects
- Blister diagnosis, Blister therapy, Dermatitis, Exfoliative diagnosis, Dermatitis, Exfoliative therapy, Diagnosis, Differential, Emergency Medical Services, Fasciitis, Necrotizing diagnosis, Fasciitis, Necrotizing therapy, Humans, Mucocutaneous Lymph Node Syndrome diagnosis, Mucocutaneous Lymph Node Syndrome therapy, Physical Examination methods, Psoriasis diagnosis, Psoriasis therapy, Purpura diagnosis, Purpura therapy, Soft Tissue Infections diagnosis, Soft Tissue Infections therapy, Algorithms, Emergencies, Family Practice methods, Skin Diseases diagnosis, Skin Diseases therapy
- Abstract
Life-threatening dermatologic conditions do not always present with classic findings. This review--and the accompanying images--will help you recognize and respond to them without delay.
- Published
- 2012
30. An approach to the patient with retiform purpura.
- Author
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Wysong A and Venkatesan P
- Subjects
- Dermatology, Diagnosis, Differential, Early Diagnosis, Humans, Predictive Value of Tests, Purpura etiology, Referral and Consultation, Risk Factors, Skin pathology, Treatment Outcome, Hospitals, Inpatients, Purpura diagnosis, Purpura therapy
- Abstract
Retiform purpura consists of branching purpuric lesions caused by a complete blockage of blood flow in the dermal and subcutaneous vasculature. The differential diagnosis for retiform purpura is broad, including vasculitides of the small and medium vessels as well as microvascular occlusion due to thrombotic, infectious, and embolic phenomena. Determining the etiology of this important dermatologic sign can be a diagnostic challenge; however, an organized approach can improve the speed and accuracy of diagnosis and identify an effective treatment. This review focuses on early recognition, evaluation, and treatment of hospitalized patients with retiform purpura. Specifically, vasculitis, protein C and S deficiencies, heparin necrosis, warfarin necrosis, antiphospholipid antibody syndrome, disseminated intravascular coagulation, cryoglobulinemia, calciphylaxis, and cholesterol embolization syndrome will be discussed in detail. These conditions are commonly seen in consultative dermatology and can have multiorgan involvement, complicated laboratory evaluation, and long-term therapeutic implications., (© 2011 Wiley Periodicals, Inc.)
- Published
- 2011
- Full Text
- View/download PDF
31. Flexural and extensoral eruptions in dermatologic disease.
- Author
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Husain Z, Cohen PJ, Schwartz RA, and Lambert WC
- Subjects
- Acanthosis Nigricans diagnosis, Acanthosis Nigricans etiology, Acanthosis Nigricans therapy, Dermatitis diagnosis, Dermatitis etiology, Dermatitis pathology, Dermatitis therapy, Dermatomyositis diagnosis, Dermatomyositis pathology, Erythema Multiforme diagnosis, Erythema Multiforme etiology, Erythema Multiforme therapy, Erythema Nodosum diagnosis, Erythema Nodosum etiology, Erythema Nodosum therapy, Humans, Pemphigus, Benign Familial diagnosis, Pemphigus, Benign Familial therapy, Psoriasis diagnosis, Psoriasis epidemiology, Psoriasis therapy, Purpura diagnosis, Purpura etiology, Purpura therapy, Skin Diseases diagnosis, Skin Diseases, Infectious diagnosis, Skin Diseases, Infectious etiology, Skin Diseases, Infectious pathology, Skin Diseases, Infectious therapy, Skin Diseases pathology
- Abstract
Dermatologic eruptions can be generalized or localized to specific areas of the body. Eruptions in specific body regions may suggest specific diagnosis. Recognizing such clinical patterns can facilitate the identification of the underlying pathology. In this contribution, we shall discuss those dermatologic lesions that tend to affect the flexure and extensor surfaces., (Copyright © 2011. Published by Elsevier Inc.)
- Published
- 2011
- Full Text
- View/download PDF
32. Annular lesions on the lower limbs of young female.
- Author
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Morais P, Peralta L, Magina S, Bettencourt H, and Azevedo F
- Subjects
- Adolescent, Female, Humans, Leg Dermatoses pathology, Leg Dermatoses therapy, Pigmentation Disorders pathology, Pigmentation Disorders therapy, Purpura pathology, Purpura therapy, Leg Dermatoses diagnosis, Pigmentation Disorders diagnosis, Purpura diagnosis
- Published
- 2010
33. Case report: psychogenic purpura.
- Author
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Sotiriou E, Apalla Z, Apalla K, and Panagiotidou D
- Subjects
- Antidepressive Agents, Second-Generation therapeutic use, Cognitive Behavioral Therapy, Combined Modality Therapy, Female, Humans, Life Change Events, Middle Aged, Psychophysiologic Disorders diagnosis, Psychophysiologic Disorders therapy, Purpura diagnosis, Purpura therapy, Recurrence, Remission, Spontaneous, Risk Factors, Sertraline therapeutic use, Psychophysiologic Disorders psychology, Purpura psychology
- Published
- 2010
- Full Text
- View/download PDF
34. Purpura-associated congenital lymphedema.
- Author
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Berti S, Pieri A, Lotti T, Duranti A, Panelos J, De Martino M, and Moretti S
- Subjects
- Child, Diagnosis, Differential, Female, Glucocorticoids therapeutic use, Humans, Knee pathology, Lymphedema diagnosis, Lymphedema therapy, Purpura diagnosis, Purpura therapy, Saphenous Vein pathology, Saphenous Vein surgery, Skin Diseases, Papulosquamous diagnosis, Skin Diseases, Papulosquamous therapy, Stockings, Compression, Syndactyly complications, Syndrome, Thigh pathology, Toes abnormalities, Treatment Outcome, Lymphedema complications, Lymphedema congenital, Purpura complications, Skin Diseases, Papulosquamous complications
- Abstract
An 8-year-old girl referred to our Department for a two-month worsening of congenital primary lymphedema of the lower limb and for the appearance of several purpuric lesions on the right thigh and knee. We diagnosed a lichenoid pigmented purpura of Gougerot and Blum in a patient with Milroy disease, complicated by an insufficiency of anterior saphena. We treated the patient with topical steroids and compression stockings, until surgical intervention of phlebectomy. We report this case for the rarity of the disease, for the even more rare association with lichenoid pigmented purpura and for cutaneous immunopathological findings.
- Published
- 2009
- Full Text
- View/download PDF
35. Eczema craquelé with purpura: a sign of internal malignancy or malabsorption syndrome?
- Author
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Kraigher O and Brenner S
- Subjects
- Adenocarcinoma surgery, Diagnosis, Differential, Eczema complications, Eczema therapy, Humans, Malabsorption Syndromes diagnosis, Male, Middle Aged, Pancreatic Neoplasms surgery, Purpura complications, Purpura therapy, Adenocarcinoma diagnosis, Eczema diagnosis, Pancreatic Neoplasms diagnosis, Purpura diagnosis
- Abstract
We describe a patient with eczema craquelé associated with adenocarcinoma of the pancreas. Following a Whipple operation, zinc malabsorption was ruled out as the cause based on the distribution of the dermatitis, alkaline phosphatase levels within reference range, and response to pancreatic enzyme replacement therapy. Because the patient's skin changes appeared following removal of the malignancy and resolved shortly after the second course of pancreatic enzyme replacement therapy, fat malabsorption probably was responsible for the skin changes rather than a direct paraneoplastic expression of the cancer. The occurrence of purpura with eczema craquele has not been previously described in the literature. These findings raise the possibility that generalized eczema craquele is a diagnostic clue to a malignancy and argue for adding it to the list of cutaneous paraneoplastic syndromes.
- Published
- 2009
36. Gingival hypertrophy and anemia.
- Author
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Masferrer E, Canal L, Alvarez A, and Jucglà A
- Subjects
- Anemia diagnosis, Anemia therapy, Gingival Hypertrophy pathology, Gingival Hypertrophy therapy, Humans, Male, Middle Aged, Purpura etiology, Purpura pathology, Purpura therapy, Scurvy complications, Scurvy therapy, Anemia etiology, Gingival Hypertrophy etiology, Scurvy pathology
- Published
- 2009
- Full Text
- View/download PDF
37. Long-term remission in a patient with refractory thrombotic thrombocytopenic purpura treated with rituximab and plasma exchange.
- Author
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Basquiera AL, Damonte JC, Abichaín P, Sturich AG, and García JJ
- Subjects
- Antibodies, Monoclonal, Murine-Derived, Combined Modality Therapy, Humans, Immunologic Factors therapeutic use, Rituximab, Antibodies, Monoclonal therapeutic use, Plasma Exchange, Platelet Count, Purpura drug therapy, Purpura therapy, Purpura, Thrombotic Thrombocytopenic drug therapy, Purpura, Thrombotic Thrombocytopenic therapy
- Published
- 2008
- Full Text
- View/download PDF
38. Review: platelet alloantigens and antibodies and their clinical significance.
- Author
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Norton A, Allen DL, and Murphy MF
- Subjects
- Antigens, Human Platelet genetics, Autoimmune Diseases blood, Autoimmune Diseases complications, Autoimmune Diseases immunology, Humans, Platelet Transfusion adverse effects, Purpura epidemiology, Purpura physiopathology, Purpura prevention & control, Purpura therapy, Thrombocytopenia diagnosis, Thrombocytopenia epidemiology, Thrombocytopenia immunology, Thrombocytopenia physiopathology, Antibodies immunology, Antigens, Human Platelet immunology
- Published
- 2004
39. Palpable purpura in an elderly man.
- Author
-
Chartier TK, Johnson RA, Kaminer M, and Tahan S
- Subjects
- Aged, Humans, Male, Purpura therapy, Scurvy therapy, Palpation adverse effects, Purpura diagnosis, Purpura etiology, Scurvy complications, Scurvy diagnosis
- Published
- 2003
- Full Text
- View/download PDF
40. Intractable livedoid vasculopathy successfully treated with hyperbaric oxygen.
- Author
-
Yang CH, Ho HC, Chan YS, Liou LB, Hong HS, and Yang LC
- Subjects
- Adolescent, Adult, Chronic Disease, Female, Humans, Male, Pain etiology, Pain prevention & control, Hyperbaric Oxygenation methods, Leg Ulcer therapy, Pigmentation Disorders therapy, Purpura therapy, Skin Diseases, Vascular therapy
- Abstract
We describe a new method for treating livedoid vasculopathy. The typical presentation of livedoid vasculopathy includes chronic, recurrent painful ulcers, satellite scar-like atrophy and telangiectasia involving the lower extremities. Histologically, these lesions show areas of ulceration and dermal vessel occlusion without frank inflammatory cell infiltration. There is currently no satisfactory therapy available for this disease. Hyperbaric oxygen (HBO) has recently established itself as one of the most effective methods of treating ischaemic wounds, including diabetic ulcers. We used this therapy in two patients whose lesions were resistant to multiple therapeutic modalities. Not only did their ulcers respond rapidly to the HBO therapy, but the disturbing wound pain also resolved at the same time. To our knowledge, this is the first successful trial of HBO therapy in livedoid vasculopathy. We believe this to be a very promising new therapy for livedoid vasculopathy and to be worth further investigation.
- Published
- 2003
- Full Text
- View/download PDF
41. Retiform purpura.
- Author
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Pol-Rodriguez MM, Crane S, Feinberg DL, Glusac EJ, and Bolognia JL
- Subjects
- Aged, Cryoglobulinemia pathology, Cryoglobulinemia therapy, Humans, Male, Multiple Myeloma pathology, Multiple Myeloma therapy, Purpura pathology, Purpura therapy, Cryoglobulinemia etiology, Multiple Myeloma complications, Purpura etiology
- Published
- 2003
- Full Text
- View/download PDF
42. Palpable purpura in an asthmatic woman with eosinophilia.
- Author
-
Kim KH and Alapati U
- Subjects
- Aged, Asthma therapy, Churg-Strauss Syndrome therapy, Eosinophilia therapy, Female, Humans, Purpura therapy, Asthma etiology, Asthma pathology, Churg-Strauss Syndrome complications, Churg-Strauss Syndrome pathology, Eosinophilia etiology, Eosinophilia pathology, Palpation, Purpura etiology, Purpura pathology
- Published
- 2003
- Full Text
- View/download PDF
43. Modulating diseased skin with tissue engineering: actinic purpura treated with Apligraf.
- Author
-
Banta MN and Kirsner RS
- Subjects
- Aged, Biomedical Engineering, Forearm, Humans, Male, Purpura pathology, Wound Healing, Collagen therapeutic use, Purpura therapy, Skin, Artificial
- Abstract
Background: Actinic purpura (AP) is an important medical issue and quality of life issue in the elderly. Current treatment of AP is limited to prevention of cutaneous aging., Objective: To assess the utility of tissue engineered skin (Apligraf, Organogenesis, Canton, MA) as a tissue modulator in diseased skin and as treatment for AP., Methods: A thin partial-thickness section of AP was removed from the forearm of an elderly gentleman and replaced with fenestrated Apligraf. Healing, durability and cosmetic outcome were assessed., Results: Apligraf-treated skin healed rapidly with good clinical "take." Lack of new skin tears and resultant erosions or ulcer formation suggests improved durability of the Apligraf-treated area occurred., Conclusion: These results suggest that tissue engineered skin modulates aged dermal tissue to behave in a more sturdy fashion. Furthermore, in selected cases Apligraf may represent a treatment option for AP.
- Published
- 2002
- Full Text
- View/download PDF
44. Purpura and vasculitis: unapproved treatments.
- Author
-
Katsambas A and Riga P
- Subjects
- Administration, Topical, Anti-Inflammatory Agents administration & dosage, Dermatologic Agents administration & dosage, Humans, Immunosuppressive Agents administration & dosage, Purpura drug therapy, Vasculitis drug therapy, Complementary Therapies, Purpura therapy, Vasculitis therapy
- Published
- 2002
- Full Text
- View/download PDF
45. Palmar petechiae in dermatitis herpetiformis: a case report and clinical review.
- Author
-
McCleskey PE, Erickson QL, David-Bajar KM, and Elston DM
- Subjects
- Anti-Infective Agents therapeutic use, Dapsone therapeutic use, Dermatitis Herpetiformis diagnosis, Dermatitis Herpetiformis therapy, Diagnosis, Differential, Diet Therapy, Fluorescent Antibody Technique, Direct, Hand Dermatoses diagnosis, Hand Dermatoses therapy, Humans, Male, Middle Aged, Purpura diagnosis, Purpura therapy, Dermatitis Herpetiformis complications, Hand Dermatoses etiology, Purpura etiology
- Abstract
Palmar petechiae or purpura is an unusual finding in dermatitis herpetiformis (DH) that occurs in children but is only rarely reported in adults. We describe a 46-year-old man with DH who presented with the classic pruritic papulovesicular eruption and associated volar finger and palmar petechiae. We discuss recent advances in the pathogenesis and treatment of DH.
- Published
- 2002
46. Chronic pigmented purpura associated with odontogenic infection.
- Author
-
Satoh T, Yokozeki H, and Nishioka K
- Subjects
- Aged, Anti-Bacterial Agents therapeutic use, Chronic Disease, Dental Scaling, Diagnosis, Differential, Humans, Hyperpigmentation complications, Hyperpigmentation diagnosis, Hyperpigmentation pathology, Hyperpigmentation therapy, Leg, Male, Middle Aged, Periodontitis complications, Periodontitis diagnostic imaging, Periodontitis therapy, Pulpitis complications, Pulpitis diagnostic imaging, Pulpitis therapy, Purpura complications, Purpura pathology, Purpura therapy, Radiography, Periodontitis diagnosis, Pulpitis diagnosis, Purpura diagnosis
- Abstract
Five patients with chronic pigmented purpura associated with odontogenic infection are described. Four patients had Schamberg's disease, and one had itching purpura. These patients were resistant to topical corticosteroid treatment, but appearance of purpuric spots ceased after treatment for periodontitis, pulpitis, or both. No circulating immune complexes were detected, and neither immunoglobulin nor complement was deposited in the papillary vessels of the skin. Odontogenic infection might be one of the precipitating factors for chronic pigmented purpura.
- Published
- 2002
- Full Text
- View/download PDF
47. Post-transfusion purpura: case report.
- Author
-
Kumar R, Ghali A, Ekaldious AW, Mahmoud OI, and Al-Lumai AS
- Subjects
- Adult, Aged, Antigens, Human Platelet analysis, Female, Humans, Immunoglobulins, Intravenous, Integrin beta3, Plasmapheresis, Purpura immunology, Purpura therapy, Thrombocytopenia etiology, Purpura etiology, Transfusion Reaction
- Abstract
Post-transfusion purpura (PTP) is a rare bleeding disorder of platelet alloimmunization that perhaps occurs as an anamnestic reaction. Most commonly, it is observed in PlA1-negative subjects previously sensitized with PlA1 platelet antigen either through PlA1-positive pregnancy or PlA1-positive transfusion. PTP appears with sudden severe thrombocytopenia, purpura, and often life-threatening hemorrhage within 5-10 days of blood transfusion. It is believed to be self-resolving. Yet inactivity risking dangerous bleeding can be disastrous. Treatment with intravenous immunoglobulin, corticosteroids, exchange transfusion, and plasmapheresis has been reported with variable success. No single modality, however, is effective in all cases. Not more than 150 cases of PTP seem to have been reported. We present two such cases. Both were multiparous PlA1-negative women given a blood transfusion for the first time. Corticosteroid therapy failed in both. One responded to intravenous immunoglobulin, while for the other plasmapheresis was the only life-saving modality. One of them subsequently required a blood transfusion for surgical intervention, which could be given uneventfully.
- Published
- 2001
- Full Text
- View/download PDF
48. The management of fever and petechiae: collaborative studies are needed.
- Author
-
Richards C, Thimm A, Clark J, Thomson AP, Newton T, and Riordan FA
- Subjects
- Child, Fever complications, Humans, Purpura complications, Algorithms, Fever therapy, Purpura therapy
- Published
- 2001
- Full Text
- View/download PDF
49. Very low platelet counts in post-transfusion purpura falsely diagnosed as heparin-induced thrombocytopenia. Report of four cases and review of literature.
- Author
-
Lubenow N, Eichler P, Albrecht D, Carlsson LE, Kothmann J, Rossocha WR, Hahn M, Quitmann H, and Greinacher A
- Subjects
- Acute Disease, Aged, Blood Platelets immunology, Diagnosis, Differential, Diagnostic Errors, Female, Humans, Isoantibodies adverse effects, Isoantibodies blood, Male, Middle Aged, Purpura therapy, Thrombocytopenia chemically induced, Thrombocytopenia therapy, Heparin adverse effects, Platelet Count, Purpura diagnosis, Purpura immunology, Thrombocytopenia diagnosis, Transfusion Reaction
- Abstract
Differential diagnosis between post-transfusion purpura (PTP) and heparin-induced thrombocytopenia (HIT) can be difficult in the initial stages of thrombocytopenia, as the early clinical presentations are often similar. Four patients are described who were suspected clinically of suffering from HIT. All four patients had recent blood transfusions and platelet alloantibodies, thus the diagnosis of PTP was made. One lethal gastrointestinal and one retroperitoneal hemorrhage developed in two of the four patients. Unusually, one patient was male and two different platelet alloantibodies were present in his serum; in another patient platelet alloantibodies and HIT-antibodies were detectable. To arrive at the right diagnosis as quickly as possible is vitally important since treatment, which has to be initiated promptly, is very different for the two syndromes. Thus, we suggest that in patients where HIT is suspected, additional information should be sought. If features consistent with PTP (such as a recent blood transfusion or a marked drop in platelet count to below 15 Gpt/L) are present, we recommend parallel testing for platelet alloantibodies to rule out PTP.
- Published
- 2000
- Full Text
- View/download PDF
50. Autoerythrocyte sensitization (psychogenic purpura): a case report and review of the literature.
- Author
-
Anderson JE, DeGoff W, and McNamara M
- Subjects
- Adolescent, Adult, Diagnosis, Differential, Ecchymosis etiology, Female, France, History, 19th Century, History, 20th Century, Humans, Pain etiology, Purpura diagnosis, Purpura history, Purpura therapy, Syndrome, United States, Mental Disorders complications, Purpura etiology
- Abstract
Autoerythrocyte sensitization (psychogenic purpura) is an unusual diagnosis, but one that has a characteristic dermatologic manifestation of painful bruising. A typical case is presented, as well as a review of the literature. Treatment consists of psychiatric therapy, which is most effective when initiated early in the disease, so early diagnosis will not only minimize the cost of the medical evaluation but will also benefit the patient.
- Published
- 1999
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