Manifestaciones cutáneas en niños con diabetes mellitus y obesidad

Obesity and diabetes are chronic diseases that affect people all over the world, and their incidence is increasing in both children and adults. Clinically, they affect a number of organs, including the skin. The cutaneous manifestations caused or aggravated by obesity and diabetes are varied and usually bear some relation to the time that has elapsed since the onset of the disease. They include soft fibromas, acanthosis nigricans, striae, xerosis, keratosis pilaris, plantar hyperkeratosis, fungal and bacterial skin infections, granuloma annulare, necrobiosis lipoidica, psoriasis, and atopic dermatitis.In this review article we present the skin changes found in children with diabetes mellitus and obesity and related syndromes and highlight the importance of the skin as a tool for establishing clinical suspicion and early diagnosis of systemic disease.     

The dermatological consequences of obesity

Obesity is emerging as a global epidemic with at least 300 million people thought to be obese worldwide. This has implications for health professionals including dermatologists. Recent interest has focused on the role of obesity in psoriasis, but obesity is implicated in many dermatoses. Perhaps most worrying is emerging data which suggest that obesity may constitute a risk factor for the development of skin cancer. Its rising incidence ensures that obesity‐related skin disease will represent an increasing proportion of dermatologists’ work load. In this article, we review dermatoses associated with obesity and review the epidemiology and treatment for obesity.     

Covid-19 pandemic and the skin

In the beginning of the COVID-19 outbreak, skin manifestations, if present, were not paid enough attention. Then, the focus moved toward the impact of the prolonged use of personal protective measures in both healthcare workers and patients. In the meantime, attention is increasingly paid to dermatology as a result of the concern for certain groups of dermatologic patients, including those whose condition may worsen by the thorough disinfection measures and those treated with immunosuppressants or immunomodulators. Following patients with psoriasis on biological therapy, as well as other inflammatory and autoimmune cutaneous disorders such as atopic dermatitis, pemphigus, pemphigoid diseases, and skin cancer provoked the interest of dermatologists. Finally, an intriguing question to the dermatologic society was whether skin changes during COVID-19 infection exist and what could be their diagnostic or prognostic value. Here, we summarize skin conditions during the COVID-19 pandemic, patient information, and expert recommendations and give an overview about the registries launched to document skin changes during COVID-19, as well as details about certain patient groups infected with SARS-CoV-2, for example, psoriasis, atopic dermatitis, and autoimmune bullous diseases.     

The impact of obesity on skin disease and epidermal permeability barrier status

Background Obese subjects frequently show skin diseases. However, less attention has been paid to the impact of obesity on skin disorders until now. Objective The purposes of this study are: to highlight the incidence of some dermatoses in obese subjects and to study the water barrier function of the obese skin using transepidermal water loss (TEWL). Methods Sixty obese subjects and 20 normal weight volunteers were recruited. Obese group was further divided into three body mass index (BMI) classes: class I (BMI 30–34.9 kg/m²), class II (BMI 35–39.9 kg/m²) and class III (BMI 40 g/m²). All subjects attended dermatological examination for skin diseases. To assess barrier function, TEWL measurements were performed on the volar surface of the forearm using a tewameter. Results The results of this study showed that: (i) obese subjects show a higher incidence of some dermatoses compared with normal‐weight controls; in addition the dermatoses are more, frequent as BMI increases; (ii) the rate of TEWL is lower in obese subjects, than in the normal‐weight subjects, particularly in patients with intra‐abdominal obesity. Conclusion Specific dermatoses as skin tags, striae distensae and plantar hyperkeratosis, could be considered as a cutaneous stigma of severe obesity. The low permeability of the skin to evaporative water loss is observed in obese subjects compared with normal weight control. Although the physiological mechanisms are still unknown, this finding has not been previously described and we believe that this may constitute a new field in the research on obesity.     

Gender aspects in skin diseases

Gender differences in medicine have been recognized in anatomy, physiology, as well as in epidemiology and manifestations of various diseases. With respect to skin disorders, males are generally more commonly afflicted with infectious diseases while women are more susceptible to psychosomatic problems, pigmentary disorders, certain hair diseases, and particularly autoimmune as well as allergic diseases. Significantly, more female sex‐associated dermatoses can be identified than the male sex‐associated dermatoses. Dermatoses in the genital area differ between men and women. Gender differences also exist in the occurrence and prognosis of certain skin malignancies. The mechanisms underlying gender differences in skin diseases remain largely unknown. Differences in the skin structure and physiology, effect of sex hormones, ethnic background, sociocultural behaviour and environmental factors may interact to exert the influences. A better understanding of gender differences in human health and diseases will allow the development of novel concepts for prevention, diagnosis and therapy of skin diseases.     

Pediatric dermatohistopathology – histopathology of skin diseases in newborns and infants

While neonatal skin physiology has been thoroughly examined using non‐invasive techniques in recent years, only few systematic studies and review articles addressing the histopathology of neonatal skin have been published thus far. In most cases, histopathological findings of dermatoses in neonatal skin do not significantly differ from those seen in adult skin. Nevertheless, a comprehensive knowledge of embryonic and fetal skin development as well as the microanatomical structure of neonatal skin can contribute to a better understanding of various dermatoses of infancy. In the first part of this review article, we present the histopathological features of such skin diseases, which, though generally rare, almost exclusively appear during the first weeks of life due to distinctive structural and functional features of neonatal skin. The second part is dedicated to classic dermatoses of infancy and their histopathological features.     

Smoking and the skin

Cigarette smoking has been associated with significant morbidity affecting all systems of the body, including the integumentary system. We review the many dermatologic hazards of tobacco use. It is important to distinguish between the effects of tobacco smoke from effects of pure nicotine on the skin. All skin cells express several subtypes of the nicotinic class of acetylcholine receptors, including the α7 receptor. Many chronic dermatoses are affected by smoking either negatively or positively. Elucidation of positive associations with a particular disease can lead to improvement from smoking cessation, whereas inverse correlation may lead to development of a disease-specific treatment with nicotinergic agonists.     

Paraneoplastic pityriasis lichenoides in cutaneous lymphoma: case report and review of the literature on paraneoplastic reactions of the skin in lymphoma and leukaemia

Paraneoplastic dermatoses are non-neoplastic skin disorders which occur in the context of an underlying malignant neoplasm. The classic paraneoplastic dermatoses are mostly associated with solid internal malignancies. They only rarely occur in the context of nodal or primary cutaneous lymphomas. Apart from these classic paraneoplastic dermatoses, there are additional skin disorders reported to occur in close association with haematological and lymphoproliferative disorders which can thus be regarded as paraneoplastic manifestations. We report for the first time two patients with pityriasis lichenoides et varioliformis acuta in association with mycosis fungoides. In addition, we review the literature on paraneoplastic dermatoses of the skin which have been described in patients with leukaemias and primary cutaneous lymphomas.     

Vascular diseases in the mature patient

Aging results in both anatomic and physiologic changes in the skin’s structure and vascular system. These vascular changes result in a wide array of dermatologic findings, ranging from the benign to the highly morbid. Herein, we review the impact of both intrinsic and common extrinsic factors of aging on cutaneous vasculature and highlight the manifestations of microvascular, venous, arterial, lymphatic, and neuropathic alterations in the geriatric population.     

Smoking and the skin

Smoking is the main modifiable cause of disease and death in the developed world. Tobacco consumption is directly linked to cardiovascular disease, chronic bronchitis, and many malignant diseases. Tobacco also has many cutaneous effects, most of which are harmful. Smoking is closely associated with several dermatologic diseases such as psoriasis, pustulosis palmoplantaris, hidrosadenitis suppurativa, and systemic and discoid lupus erythematosus, as well as cancers such as those of the lip, oral cavity, and anogenital region. A more debatable relationship exists with melanoma, squamous cell carcinoma of the skin, basal cell carcinoma, and acne. In contrast, smoking seems to protect against mouth sores, rosacea, labial herpes simplex, pemphigus vulgaris, and dermatitis herpetiformis. In addition to the influence of smoking on dermatologic diseases, tobacco consumption is also directly responsible for certain dermatoses such as nicotine stomatitis, black hairy tongue, periodontal disease, and some types of urticaria and contact dermatitis. Furthermore, we should not forget that smoking has cosmetic repercussions such as yellow fingers and fingernails, changes in tooth color, taste and smell disorders, halitosis and hypersalivation, and early development of facial wrinkles.     

Skin biopsy for inflammatory and common neoplastic skin diseases: optimum time, best location and preferred techniques. A critical review

The diagnosis of skin diseases, particularly inflammatory dermatoses, is based primarily on clinical information. Pathologic examination of the biopsied specimen often serves as a complementary or confirmative part of the diagnosis. However, the clinical diagnosis of skin diseases may be challenging, as the clinical information and appearance of skin lesions invariably overlap. Evidence for a correct diagnosis may be lacking without histopathologic examination of skin biopsies. It is well known that the histologic diagnosis of inflammatory and other skin diseases requires clinicopathologic correlation, and there is evolution of skin lesions into different stages as the diseases progress. Other factors important for accurate dermatopathologic diagnosis are optimum time, best location and preferred techniques of skin biopsy. In searching for available information concerning when, where and how to take skin biopsies, it is noted that there are only limited practical guidelines currently available. We present this review article in hopes that our collective dermatopathologic and dermatologic experience can provide a quick reference for accurate diagnosis and proper management of skin diseases.     

Impact of COVID-19 on autoimmune blistering diseases

Since the beginning of the COVID-19 outbreak, attention has gradually moved from the respiratory manifestations of the disease toward its dermatologic aspects. The need for wearing personal protective measures and their cutaneous side effects, detection of related or specific COVID-19 skin eruptions, and the evaluation of certain risk groups of immunosuppressed dermatologic patients have initiated significant discussions about various therapeutic interventions and, in particular, about biologic therapy for psoriasis and for autoinflammatory, orphan, or malignant cutaneous disorders. Autoimmune bullous dermatoses have been of concern due to their chronic course, at times life-threatening prognosis, and the need for prolonged and often aggressive immunomodulatory therapy. We have summarized the current knowledge regarding the impact of COVID-19 infection on autoimmune bullous dermatoses, including recommendations for the main treatment strategies, available patient information, and the registries organized for documentation during the COVID-19 pandemic.     

Genital diseases in the mature man

Elderly men are at higher risk of developing genital dermatologic problems, including inflammatory and neoplastic conditions due to age-related physiologic changes, immunosenescence, comorbidities, and iatrogenesis. Clinical manifestations of genital dermatoses in men are varied and may include itching, pain, redness, dermatitis, lumps, and ulcers. Even when asymptomatic, the psychologic impact may be significant. Sexual or urinary dysfunction may complicate genital dermatoses. Early and accurate diagnosis is essential to reduce morbidity and mortality from premalignant and malignant conditions and also to prevent sexual dysfunction and unnecessary anxiety in the case of benign entities.     

Miscellaneous skin disease and the metabolic syndrome

The link between the metabolic syndrome (MetS) and skin diseases is increasingly important, with new associations being discovered. The association between MetS and psoriasis or MetS and hidradenitis suppurativa is well known, although the relationship between MetS and various autoimmune or inflammatory diseases has only recently attracted interest. Some inflammatory skin diseases, such as vitiligo, scleredema, recurrent aphthous stomatitis, Behçet disease, rosacea, necrobiosis lipoidica, granuloma annulare, skin tags, knuckle pads, and eruptive xanthomas, have possible associations with MetS. In this review, we examine the state of knowledge involving the relationship between MetS and these dermatologic diseases.     

Marine mollusks and the skin

Human contact with marine mollusks such as shellfish, marine snails, octopuses, and squids may result in human illness including dermatologic disorders. These range from minor traumatic injury of the skin to more serious systemic illnesses that include dermatologic manifestations. Notable among these are dermatologic manifestations of illness caused by toxins from ingested mollusks, stings of the cone snail, and envenomation by the bite of the blue-ringed octopus. Cone snail and blue-ringed octopus envenomations, although rare, can be deadly due to neuromuscular paralysis. Management of dermatologic illnesses caused by marine mollusks depends upon the nature of the exposure. Attention to local measures is usually sufficient for minor cuts and abrasions. Conversely, cone snail and blue-ringed octopus envenomations require immediate attention, possibly including cardiopulmonary resuscitation.     

Self-reported skin morbidity among adults: associations with quality of life and general health in a Norwegian survey

Life-quality studies among dermatologic patients have shown that chronic skin diseases have an impact on patients' lives. The purpose of this study was to assess the burden of skin morbidity at a community level. This was presented as prevalence of self-reported skin morbidity and dermatologic life-quality items. The association of skin disease and general health measures like feeling depressed and self-reported general health were measured. The method used was a questionnaire on self-reported skin complaints, including variables such as demographic, psychosocial, general health, dermatologic life-quality items. The design of the study was cross-sectional, with answers from 18,770 adult responders. The results confirmed that skin morbidity is common; itch was the dominating symptom. Younger adults reported more social problems as a result of skin problems than older. The life-quality domain most affected by skin disease was the social one. In a regression model skin disease was as well as rheumatism more strongly associated with feeling depressed than asthma, diabetes, and angina pectoris. Skin disease was also strongly associated with reporting poor general health, although less than other nondermatologic chronic diseases. In conclusion, in this study skin morbidity was strongly associated with general health measures among adults in a population-based setting. To the best of our knowledge these associations have not been described previously at a community level.     

Dermatologic manifestations of musicians: a case report and review of skin conditions in musicians

Chronic practice and performance with a musical instrument predisposes musicians to several unique and characteristic dermatoses, reflecting the hours of dedication to practice to advance their artistic skill. This article briefly discusses a case of a professional musician with a unique allergic contact dermatitis to nickel sulfate and possibly palladium and cobalt chloride in his tuba. We also review several dermatologic causes and manifestations of musical instrument-related dermatitides.     

Inflammatory arthritis and crystal arthropathy: Current concepts of skin and systemic manifestations

Systemic inflammatory disorders frequently involve the skin, and when cutaneous disease develops, such dermatologic manifestations may represent the initial sign of disease and may also provide valuable prognostic information about the underlying disorder. Familiarity with the various skin manifestations of systemic disease is therefore paramount and increases the likelihood of accurate diagnosis, which may facilitate the implementation of an appropriate treatment strategy. An improvement in quality of life and a reduction in the degree of morbidity may also be a realized benefit of accurate recognition of these skin signs. With this context in mind, this review highlights the salient clinical features and unique dermatologic manifestations of rheumatoid arthritis, adult-onset Still’s disease, and the crystal arthropathy, gout.     

Paraneoplastic cutaneous manifestations: concepts and updates

The skin often signals systemic changes. Some neoplastic diseases that affect internal organs may trigger several cutaneous manifestations. Although these dermatoses are relatively unusual, the recognition of some typical paraneoplastic dermatoses may lead to the early diagnosis of a neoplasm and determine a better prognosis. In this review article, we discuss the paraneoplastic cutaneous manifestations strongly associated with neoplasms, which include acanthosis nigricans maligna, tripe palms, erythema gyratum repens, Bazex syndrome, acquired hypertrichosis lanuginosa, necrolytic migratory erythema, Leser-Trélat sign and paraneoplastic pemphigus. We also review the clinical manifestations of each condition and include updated knowledge on disease pathogenesis.