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Background: Disseminated granuloma annulare is a rare clinical variant of granuloma annulare.inflammatory skin condition with unknown etiopathogenesis. Objective: To study clinical aspects of granuloma annulare and its relationship with coexisting pathology and therapeutic options. Methods: We performed a retrospective study in the Craiova Dermatology Clinic on cases of patients hospitalized with disseminated granuloma annulare during 2015-2023. A total of 21 patients were evaluated and monitored for a year after initial diagnosis. Results: We found the following associated pathology: type 2 diabetes mellitus (12 cases), dyslipidaemia (11 cases), overweight and obese (10 cases), hypothyroidism (4 cases), rheumatoid arthritis (1 case) and neoplastic disease in 4 patients. Treatment was complex and effective. Conclusion: Patients with disseminated granuloma annulare should be investigated for internal disease. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic auto-immune disease that affects 2-3% of the general population. It is associated with a series of conditions such as psoriasis arthritis, metabolic syndrome, cardiovascular disease, inflammatory bowel disease, psychiatric manifestations. This review aims to highlight the common pathogenic pathway of psoriasis and comorbidities, especially metabolic syndrome (MetS) and, according to the literature, their evolution with systemic therapy. We conducted an observational study on 51 patients with psoriasis. The metabolic syndrome defined according to National Cholesterol Education şi ATP III criteria (Adult Treatment Panel guidelines), was seen in 54,90% of cases. The common pathogenic pathway of psoriasis and metabolic syndrome is represented by chronic inflammation and cytokines as TNF a and IL 6, IL17 are seen in both cases. Despite the numerous efforts to elucidate the pathogenesis of MetS, the relation between psoriasis and its different components remains complex and fairly unclear. [ABSTRACT FROM AUTHOR]

Relapsing polychondritis is a rare, autoimmune inflammatory condition that involves cartilaginous structures, predominantly those of the ears, nose, and tracheobronchial tree. Other affected structures may include the cardiovascular system, peripheral joints, skin, middle and inner ear, eyes, and central nervous system. Systemic corticosteroid therapy is the treatment of choice. In recent decades, viral infections have been proposed as environmental factors that trigger autoimmunity in genetically predisposed individuals. Respiratory viruses, especially parainfluenzae and coronaviruses, have been associated with the onset of rheumatoid arthritis, while growing evidence describes the occurrence of autoimmune disorders in COVID-19. Clinical case. A 31-year-old patient presented in October 2020 fur infiltrated erythematous-edematous plaques, highly painful, located in the auricles, bilaterally. The disease started a month ago. The patient applied the antibiotic and dermatocorticoid cream locally, without a favorable evolution. From the medical history we notice that the patient presented 4 months ago pain in the radio-carpal joints, later in the joints of the knees and ankles far which she presented to the Rheumatology department. Two weeks ago, she presented with pain in the nasal pyramid and at the eye level. She was diagnosed with chronic hypertrophic rhinitis and conjunctivitis, respectively. The pharyngeal exudate showed Klebsiella pneumoniae present. The other laboratory tests were within normal limits. The patient had a history of asymptomatic infection with SARS-VOC-2 virus, diagnosed by highlighting specific antibodies during investigations to establish the etiology of polychondritis. We performed a biopsy of a fragment of the skin, along with the underlying cartilage, in the pavilion of the left ear. Based on the clinical examination and the histopathoiogical examination, we specified the diagnosis of relapsing polychondritis. We started treatment with Methylprednisolane 32 mg /day, Famotidine 40 mg / day, Rupatadine 10 mg / day, Levofloxacin 500 mg / day, with a slightly favorable evolution. Methotrexate 10 mg/ week treatment was also initiated in December 2020. Discussions. Relapsing polychondritis is a pro-gressive autoimmune condition that affects several organs and tissues. Early recognition of the signs of this rare disease and prompt initiation of anti-inflammatory and immunosuppressive therapy can relieve symptoms and prevent complications, especially those affecting the respiratory tract and heart. Conclusions. The number of case reports describing autoimmune phenomena in COVID-19 is increasing, and these conditions may involve different organs and systems. Although the chronology of pathologies in our case suggests the possible involvement of SARS-CoV-2 infection in the occurrence of Polychondritis, we mention that so far no cases of relapsing Polychondritis associated with this viral infection have been reported. [ABSTRACT FROM AUTHOR]

Introduction. Lymphedema is an excessive regional interstitial accumulation of protein-rich fluids. It can be primary, mainly caused by congenital hypoplasia (Meige's disease) or lymphatic vessel agenesis (Milroy's disease). Infections, malignancies, chronic venous stasis, ionizing radiation, obesity, and congestive heart failure are common causes of secondary lymphedema. Although cutaneous tuberculosis may be accompanied by limgangitis, its association with chronic lymphedema is rarely mentioned in the literature. Case report. A 70-year-old man, attended the Dermatology Clinic due to the appearance of permanent, indurated and infiltrated edema of the right lower limb, with translucent papules on the skin The patient also presented at the level of the right calcaneal region a hyperkeratotic lesion, 1.5 cm in diameter, with an ulcerated center (the clinical appearance suggests a tuberculosis verrucosa cutis). From the medical history we highlight that, 7 years ago, after a sting in the right calcaneal region, an abscess formed at the site of the sting which was curetted in the Surgery Department, but which recurred. After about 6 months, the right lower limb began to grow in diameter due to significant edema. For chronic lymphedema, the patient was treated with Detralex, Pentoxi Retard, Vessel Due F prior to hospitalization, with no notable results. The histopathological examination pleaded for the diagnosis of cutaneous tuberculosis. Specific treatment with tuberculostatics (Isoniazid 300 mg, Rifampicin 600 mg, PyrazinamideWOO mg, Ethambutol 1600 mg,7P) was initiated, with a duration of 9 months, the evolution being favorable with the disappearance of the verrucous lesion from the right calcaneus region, with decreased lymphedema and disappearance of papules in the right lower limb. Discussions. Tuberculosis verrucosa cutis (TVC) is the most common form of exogenous paucibacillary tuberculosis. It is the result of primary inoculation in previously tuberculin-sensitive individuals who maintain moderate to high immunity to M. tuberculosis. It is either self-inoculation or heteroinoculation following an accidental or professional contact. Secondary bacterial infection and chronic lymphedema are possible complications of extensive lesions that usually affect the extremities. TVC can persist for many years if not treated properly. Usually, there is a favorable response to antituberculosis therapy, as in our case. Conclusions. Chronic lymphedema associated with tuberculosis verrucosa cutis can be cured by long-term treatment with tuberculostatics. Early diagnosis and treatment of cutaneous tuberculosis are essential to reduce complications. [ABSTRACT FROM AUTHOR]

Introduction. Leukemia cutis is a rare cutaneous leukemia-specific manifestation and is characterized by infiltrates with paraneoplastic leukocytes or their precursors located in the dermis, subcutaneous tissue, cutaneous annexes and blood vessels. Several terms have been used to describe the various leukemia cutis mani-festations in acute myeloblastic leukemia: the granulocytic sarcoma, the monocytic sarcoma, primary extramedullary leukemia and the chloroma. Clinical case. A 65-year old man from the urban area under evidence of the Hematology Department since August 2018 for acute promyelocytic leukemia (AML-M3 in the FAB classification) was consulted in the Craiova Dermatology Department in January 2019 for several nodular tumor masses that were firm, reddish, of 0.2-2 cm, well defined, located in the left inguinal, lumbar, anterior thorax and scalp areas. The tumor masses appeared 3 weeks ago. The patient received remission induction therapy with cytarabine, idarubicin and all-trans retinoic acid (ATRA), obtaining complete remission (blasts 2-3%), then he continued with consolidation treatment with cytarabine, epirubicin and ATRA. The histopathological aspect and the immunohistochemical staining are compatible with a myeloid sarcoma (extramedullary determination of acute myeloblastic leukemia). The immunophenotyping from marrow aspirate, repeated in the Hematology Department in February 2019 suggested a diagnosis of acute promyelocytic leukemia with positive residual disease which means a relapse. The cutaneous lesions have regressed after hematologic retreatment, with some leftover pigmented spots on the torso. The patient is currently under treatment with cytarabine. Discussions. The incidence of cutis leukemia depends on the type of leukemia, with a frequency of 2-18% of cases in acute myeloblastic leukemia. The physiopathology that underlies the leukemic cell migration to the skin is not clear. Most cases of leukemia cutis in acute promyelocytic leukemia that were described in literature were associated with the use of ATRA, that is associated with a high incidence of extramedullary diseases as relapse after complete remission. There is the possibility that ATRA and anthracyclines may not reach the places where extra-medullary infiltrates occur. Clinically, LC can look like erythematous papules or nodules in 60% of cases. Because of the unspecific clinical aspect of the skin lesions, the cutaneous biopsy and the bone marrow biopsy are necessary for establishing the diagnosis. The prognosis of patients with LC is unfavorable, many also having other extramedullary presentations of leukemia. The treatment of leukemia cutis involves the treatment of the underlying disease. Conclusions. Leukemia cutis is a skin marker of hematologic malignant disease but it is a rare manifestation in acute promyelocytic leukemia. Treatment with ATRA can induce leukemia cutis occurrence. The correct diagnosis of leukemia cutis creates the prerequisites for diagnosing the systemic disease and highlights the leukemia relapse, similar to our case. [ABSTRACT FROM AUTHOR]