Subcutaneous granuloma annulare

No abstract available</p

Subcutaneous granuloma annulare

No abstract available</p

Erosive lesions of the oral mucosa: a diagnostic approach based on clinical cases

Erosive and ulcerative lesions of the oral mucosa reperesent a major problem in dermatological practice; a new diagnostic approach helps to prevent misdiagnosis and improves the treatment.Leziunile eroziv-ulcerative ale mucoasei orale constituie o problemă comună şi complexă din punctul de vedere al diagnosticului, aspectul clinic fiind adesea nespecific. Ele pot fi datorate unor cauze variate, de la simple traumatisme (fizice, mecanice, chimice), la stomatite infecţioase sau maladii sistemice autoimune, până la procese proliferative maligne. Orientarea diagnostică se sprijină pe investigaţii paraclinice ţintite în funcţie de natura patogenică a condiţiei suspicionate. Pornind de la datele anamnezice şi aspectul clinic, se poate elabora un arbore decizional al etapelor de evaluare pentru diagnosticul de certitudine. Astfel, în funcţie de evoluţie şi aspectul clinic, leziunile eroziv-ulcerative orale se pot clasifica în acute solitare (posttraumatice), acute multiple (de exemplu gingivo-stomatita herpetică), cronice solitare (de exemplu carcinomul scuamocelular oral) şi cronice multiple (de exemplu pemfigusul vulgar). Exemplificăm patologia eroziv-ulcerativă a mucoasei orale cu câteva cazuri afl ate în evidenţa Clinicii Dermatologice a Spitalului Clinic Universitar C.F. Iaşi. Importanţa încadrării nosologice corecte a unei stomatite eroziv-ulcerative rezidă în evitarea erorilor de diagnostic, care întârzie tratamentul corect al unor condiţii morbide cu impact sever

THE IMPORTANCE OF DUAL DERMATOLOGIC AND PSYCHIATRIC APPROACH IN PSYCHOCUTANEOUS DISORDERS

Psychodermatology or psychocutaneous medicine is a relatively old domain, built on well studied and documented connections between mental / psychic and skin. Numerous studies highlight the idea that evolution of a significant percentage of dermatoses is negatively influenced by psychological factors and stress and that mental state affects not only how the disease is perceived but its severity as well. It is estimated that 30-40% of dermatological patients show a concurrent mental disorder or psychological problems that may be the causative, predisposing or aggravating factor of the cutaneous disease. Morbid conditions such as psoriasis, atopic dermatitis, alopecia areata, vitiligo, severe acne have a marked negative impact on patient quality of life through both debilitating and chronic character of the diseases and by their psychosocial consequences: decreased self-esteem, embarrassment, depression, social phobia, social discrimination to employment, family and couple relations alteration. Collaboration with a psychiatrist for optimal management of psihocutaneous disorders is essential but difficult to acheive because most patients with such morbidity refuse (do not accept) the referral to psychiatric/psychologic consultation. Therefore the dermatologists need to have knowledge on pharmacological and non-pharmacological means useful in treating these disorders and to reconsider the importance of training in the field of psihodermatology. Cutaneous side effects of psychotropic drugs must also be known because they are more frequently encountered than most common psychiatric side effects of drugs used in dermatology

Pyostomatitis Vegetans

Pyostomatitis vegetans is a rare oral disorder with unclear pathogenesis, that may be associated with inflammatory gastro-intestinal diseases, cutaneous involvement or with other disorders of the joints, eyes or liver. The etiology of the extraintestinal manifestations of inflammatory bowel diseases is obscure, but it is believed that the injured intestinal mucosa may trigger immune responses related to inflammatory processes in extraintestinal areas. Oral manifestations include amicrobial pustules and yellow ulcerations with a typical aspect of snail tracts on the bucal and labial mucosa and on the dorsum of the tongue. Histopathological exam shows epithelial acanthosis and superficial ulcerations, as well as eosinophilic and neutrophilic infiltrate in the subjacent connective tissue. Intraepithelial and subepithelial milliary abcesses may also be present. The available therapeutical alternatives (systemic and topical corticosteroids, sulphones, retinoids) have a relatively poor and transitory effect. We present the case of a teenage girl with oral lesions and histopathological features suggestive for pyostomatitis vegetans, persistent for approximately one year, with no other cutaneous or systemic involvement

PYOSTOMATITIS VEGETANS

Pyostomatitis vegetans is a rare oral disorder with not clear pathogeny, which can be associated with inflammatory gastro-intestinal diseases, cutaneous manifestations or other disorders at articular, hepatic or ocular level. The oral condition is manifested through amicrobian pustule and yellow ulcerations having the „snail tracts” aspect on the jugal and labial mucosa and the tongues dorsal side. The histopathologic analysis reveals epithelial acantosis and superficial ulcerations, as well as neutrophilic and eosinophilic infiltrate into the subiacent conjunctive tissue. The available therapies (systemic and topic corticosteroids) have a relative and transitory benefit. We present the case of a female teenager with oral lesions and histopathologic modifications at their level significant for pyostomatitis vegetans, 1 year old, without other cutaneous or systemic change

THE IMPACT OF SYSTEMIC CORTICOSTEROID THERAPY ON ORAL HEALTH: COMPLICATIONS AND MANAGEMENT STRATEGIES

Corticosteroids, including glucocorticoids, mineralocorticoids, and androgenic hormones, are hormonal mediators produced by the adrenal glands and are widely used in the treatment of various conditions, including dental diseases. While systemic corticosteroid therapy offers significant therapeutic benefits, it is crucial to understand the potential adverse effects on oral health. This paper aims to highlight the impact of systemic corticosteroid therapy on oral health, focusing particularly on the associated complications and management strategies. The paper emphasizes specific complications that may occur in the oral cavity as a result of corticosteroid use, the most important being an increased susceptibility to oral infections such as candidiasis and impaired bone metabolism, with a significant reduction in the mineral density of the mandibular bone (BMD), as well as delayed wound healing, the occurrence of oral ulcers, and changes in the oral microbiome. Furthermore, the importance of rigorous oral care and regular dental monitoring for patients undergoing systemic corticosteroid therapy is underlined. The role of oral health specialists in the early detection and efficient management of oral complications, as well as patient education regarding proper oral hygiene practices and possible side effects, is of crucial importance. In conclusion, it is essential for healthcare providers to be vigilant regarding the potential oral health complications associated with systemic corticosteroid therapy, and early detection, prevention, and the implementation of appropriate management strategies are fundamental for optimizing oral health outcomes in patients undergoing corticosteroid treatment

ANGULAR CHEILITIS: A MULTIDISCIPLINARY APPROACH TO DIAGNOSIS AND MANAGEMENT

Angular Cheilitis (AC) represents a multifaceted oral pathology characterized by erythematous lesions at the labial commissures. Despite its prevalence, AC is often inadequately addressed due to its polymorphic etiology, which can encompass infectious agents, nutritional deficits, and systemic conditions. This article provides a systematic review of the pathophysiology, clinical presentation, and etiological factors of AC, including nutritional deficiencies, infectious agents, and systemic diseases. Emphasizing a multidisciplinary strategy, we discuss the collaborative roles of dental, medical, and dermatological expertise in the accurate diagnosis and effective management of AC. We outline diagnostic criteria, appropriate laboratory tests, and imaging techniques tailored to address the multifaceted nature of the condition. Management strategies encompass a range of options from topical treatments and medications to dietary modifications and preventative measures, with an emphasis on evidence-based practices. This review advocates for integrated care models to optimize treatment efficacy, patient compliance, and to mitigate the recurrence of AC. Our analysis aims to enhance the understanding of AC and to provide a framework for its management, contributing to better patient care and opening avenues for future research

Schwannoma of the Upper Limb: Retrospective Study of a Rare Tumor with Uncommon Locations

Background: Although schwannoma (neurilemmoma) is the most common tumor of the peripheral nerve, its low incidence, slow growth and vague symptoms often lead to misdiagnosis or delayed diagnosis. The aim of the study is to present a series with a large number of schwannomas in the upper limbs, some with very rare occurrence. Methods: We report 17 patients with a mean age of 58.5 years and upper limb schwannomas, located on the median, ulnar and radial nerves, but also on the posterior interosseous nerve and digital collateral nerves. The diagnosis was made by clinical examination and imaging tests, and in no case was a preoperative biopsy performed. Surgical treatment was established based on symptoms or aesthetic concerns. In all cases, a diagnosis of schwannoma was confirmed through histopathological and immunohistochemical examinations. Results: For all patients, a complete tumor enucleation was performed under a surgical microscope. No recurrence was recorded at 2 years after surgery. Patient satisfaction was good, with complete socio-professional integration in all cases. Conclusions: Although more frequently present on the main nerve trunks, schwannoma may be present on the collateral digital nerves in rare cases. A correct technique with complete tumor excision offers excellent postoperative outcomes and avoids recurrences