Autoeczematization: A Strange Id Reaction of the Skin

Bertoli, M; Schwartz, Robert A.; Jänniger, Camila K.

doi:10.12788/cutis.0342

Cited by 9 publications

(15 citation statements)

References 31 publications

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“…After investigation to rule out infectious and rheumatologic etiologies with similar presentation, our biopsy demonstrated that the severe rash in our patient was an autoeczematization reaction. Equivocal findings on biopsy have been reported by Bertoli et al showing psoriasiform spongiotic dermatitis with mononuclear cells, eosinophils and lymphohistiocytic infiltrates [ 4 ]. The histopathological findings from our skin biopsy align with our theory that the distant rash is T cell mediated.…”

Section: Discussionmentioning

confidence: 64%

“…Patients with chronic stasis dermatitis are at a 37% lifetime risk of developing autoeczematization later in the course of the disease when compared to the general population [ 4 , 6 ]. We postulate that stasis dermatitis causes a reaction involving T cells in the absence of interferon signaling, an autoeczematization reaction.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies demonstrated evidence of a similar reaction in a patient with hypostatic dermatitis, wherein, an elevated level of activated helper T cells was noted despite no production of interferon from peripheral mononuclear leukocytes [ 9 ]. Bertoli et al state that these antigenic keratinocytes are able to produce cytokines - thymic stromal erythropoietin, IL-25, and IL-33 - that lead to activation of T-cells that travel to distant sites and cause an id reaction [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…We do also encourage early treatment of the inciting factor, in this case, the primary venous stasis, which could lead to improvement of the distal id reaction, a finding seen with the use of compression stockings [ 4 ]. Treatment of the stasis dermatitis with prednisone, and at distant sites with clobetasol ointment, triamcinolone ointment, and doxepin also provided initial improvement but could prove futile in cases of treatment-resistant eczema, as with our patient.…”

Section: Discussionmentioning

confidence: 99%

“…Biopsies of these vesicles demonstrate a form of eczema with interstitial edema and the presence of lymphocytic infiltrates such as T cells [ 3 ]. In most instances, autoeczematization that presents with vesicular eruptions primarily on the palms is associated with dermatophyte infections such as tinea pedis and capitis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis

Bhagat¹,

Otles²,

Salmon³

et al. 2022

Cureus

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Autoeczematization, the dissemination of a local eczematous reaction to a distal site, is closely associated with lower extremity edema. Our patient is a 50-year-old man with a past medical history of drug-induced lupus to hydralazine and recent bilateral cellulitis in his lower extremities. He was presented with complaints of vesicles on his palms and soles and a scaling rash that had spread over his torso, arms, and trunk. Laboratory studies found no evidence of an active rheumatological condition with complement C3 and C4 levels being normal and no anti-dsDNA, anti-histone, anti-Smith, anti-ribonucleoprotein (anti-RNP), anti-centromere, anti-neutrophil cytoplasmic antibodies (ANCA), anti-Ro, or anti-La antibodies present. Moreover, syphilis, HIV, gonorrhea, chlamydia, rickettsia antibody, and Borrelia burgdorferi antibody testing was negative suggesting a non-infectious etiology of the rash. Hypothesizing a dermatologic origin of the rash, a skin biopsy was performed that revealed intermittent foci of moderate hyperparakeratosis and mild hypergranulosis indicative of eczematous dermatitis. Unfortunately, treatment of the disseminated rash with 10 mg of daily oral prednisone and topical triamcinolone acetonide 0.1% ointment proved inefficient, and methotrexate therapy was advised. We posit that cellulitis, a soft tissue infection under the skin, is a potential cause of disruption of the skin barrier that leads to activation of autosensitized T cells. These activated T cells circulate to distal areas of the skin and may lead to autoeczematization. The treatment of these id reactions with corticosteroids - both topical and oral - may be insufficient at reducing dermatitis and require the application of systemic methotrexate or cyclosporine. Through this case, we demonstrate the importance of treating id reactions by stepping up the intensity of treatment due to the severity of autosensitization-driven eczema.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A Case of Severe Disseminated Autoeczematization Secondary to Cellulitis

Bhagat¹,

Otles²,

Salmon³

et al. 2022

Cureus

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Eczematous Disorders

Mughal,

Ingram

2024

Rook's Textbook of Dermatology

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Eczematous disorders comprise manifestations of inflammatory skin conditions that may be aspects of atopic dermatitis, contact dermatitis or other conditions that in the main have an eczema‐like nature in both their presentation and response to treatment. Eczema and its management is covered in other chapters of this book. However, it is useful to consider the common aspects of nummular eczema, asteatotic eczema, lichenification and erythroderma in more detail together as sometimes the distinction between diagnoses is difficult with considerable overlap. Infectious eczema, whilst sharing physical characteristics with other eczemas, will respond differently to treatments. There are differences in how eczema presents on the hands, lower legs and the eyelids. Finally some other eczematous conditions are covered such as pityriasis alba and post‐traumatic eczema.

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