Livedo reticularis in type 2 lepra reaction: A rare presentation

Naveen, K; Athanikar, Sharatchandra B; Hegde, Spandana P; Athanikar, Vidisha S

doi:10.4103/2229-5178.131097

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…We then examined whether mediator production via feedback can generate and control the fading pattern, which remains uninvestigated in the reaction-diffusion models (Fig 1A, 1I and 1J; Eq 2 in Methods). Given the local stimulation reflecting the shape of animal tentacles or capillary structure [10,24,25], the present model reproduced a fading linear or reticular pattern, respectively (Fig 2A and 2B). With circular stimulation, the inflamed area decreased in redness without changing the diameter, and the interior of the inflamed area cleared first and eventually disappeared (Fig 2C).…”

Section: Reaction-diffusion Model Reproduced the Fading Patternsmentioning

confidence: 65%

“…The dilation appears as redness on the skin surface, developing erythema. (B–H) Photographs of erythema with linear [ 24 ] (B), reticular [ 25 ] (C), circular [ 26 ] (D), annular [ 27 ] (E), polycyclic [ 28 ] (F), arcuate [ 29 ](G), or gyrate patterns [ 30 ] (H) . (I) A model for regulatory feedback between pro- and anti-inflammatory mediators.…”

Section: Introductionmentioning

confidence: 99%

“…Erythema patterns in diseased skin differ from those in healthy skin: chronic inflammation in diseased skin appears as expanding erythema with circular, annular, polycyclic, arcuate, or gyrate patterns (Fig 1D -1H) [11]. Erythema expands for [24] (B), reticular [25] (C), circular [26] (D), annular [27] (E), polycyclic [28] (F), arcuate [29](G), or gyrate patterns [30] (H). (I) A model for regulatory feedback between pro-and anti-inflammatory mediators.…”

Section: Introductionmentioning

confidence: 99%

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Diffusive mediator feedbacks control the health-to-disease transition of skin inflammation

Sudo,

Fujimoto

2024

PLoS Comput Biol

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The spatiotemporal dynamics of inflammation provide vital insights into the understanding of skin inflammation. Skin inflammation primarily depends on the regulatory feedback between pro- and anti-inflammatory mediators. Healthy skin exhibits fading erythema. In contrast, diseased skin exhibits expanding erythema with diverse patterns, which are clinically classified into five types: circular, annular, arcuate, gyrate, and polycyclic. Inflammatory diseases with expanding erythema are speculated to result from the overproduction of pro-inflammatory mediators. However, the mechanism by which feedback selectively drives the transition from a healthy fading erythema to each of the five types of diseased expanding erythema remains unclear. This study theoretically elucidates the imbalanced production between pro- and anti-inflammatory mediators and prospective treatment strategies for each expanding pattern. Our literature survey showed that eleven diseases exhibit some of the five expanding erythema, thereby suggesting a common spatiotemporal regulation underlying different patterns and diseases. Accordingly, a reaction-diffusion model incorporating mediator feedback reproduced the five observed types of diseased expanding and healthy fading patterns. Importantly, the fading pattern transitioned to the arcuate, gyrate, and polycyclic patterns when the productions of anti-inflammatory and pro-inflammatory mediators were lower and higher, respectively than in the healthy condition. Further depletion of anti-inflammatory mediators caused a circular pattern, whereas further overproduction of pro-inflammatory mediators caused an annular pattern. Mechanistically, the bistability due to stabilization of the diseased state exhibits circular and annular patterns, whereas the excitability exhibits the gyrate, polycyclic, arcuate, and fading patterns as the threshold of pro-inflammatory mediator concentration relative to the healthy state increases. These dynamic regulations of diffusive mediator feedback provide effective treatment strategies for mediator production wherein skins recover from each expanding pattern toward a fading pattern. Thus, these strategies can estimate disease severity and risk based on erythema patterns, paving the way for developing noninvasive and personalized treatments for inflammatory skin diseases.

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Section: Reaction-diffusion Model Reproduced the Fading Patternsmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Diffusive mediator feedbacks control the health-to-disease transition of skin inflammation

Sudo,

Fujimoto

2024

PLoS Comput Biol

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“…Precipitating factors could be stress, hormonal changes, co-existing infections or treatment with broad-spectrum antibiotics such as ofloxacin, rifampicin, or other macrolides, pregnancy, lactation, and vaccination. Besides nodular lesions, various reported atypical presentations of ENL include pustular, bullous, ulcerated, livedo reticularis, 3 and erythema multiforme-like lesions. 4,5 A Sweet-like syndrome has been reported 6,7 pityriasis lichenoides et varioliformis acuta (PLEVA) like ENL 8 reactive perforating 9 and Lucio phenomenon.…”

Section: Discussionmentioning

confidence: 99%

An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases

et al. 2021

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“…These reactions can vary greatly from patient to patient, with several reports of unique clinical manifestations. [9][10][11][12] The two reactions differ in their pathogenesis with type 1 reactions (T1Rs) typical of a predominate cell-mediated reaction and T2Rs with more of a mixed picture including an overactive humoral response. 13 Although both reactions can cause nerve inflammation and damage, this is more likely to occur in T1Rs.…”

Section: Introductionmentioning

confidence: 99%

Complex Type 2 Reactions in Three Patients with Hansen's Disease from a Southern United States Clinic

Leon

Salinas

McDonald

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract. In non-endemic countries, leprosy, or Hansen's disease (HD), remains rare and is often underrecognized. Consequently, the literature is currently lacking in clinical descriptions of leprosy complications in the United States. Immune-mediated inflammatory states known as reactions are common complications of HD. Type 1 reactions are typical of borderline cases and occur in 30% of patients and present as swelling and inflammation of existing skin lesions, neuritis, and nerve dysfunction. Type 2 reactions are systemic events that occur at the lepromatous end of the disease spectrum, and typical symptoms include fever, arthralgias, neuritis, and classic painful erythematous skin nodules known as erythema nodosum leprosum. We report three patients with lepromatous leprosy seen at a U.S. HD clinic with complicated type 2 reactions. The differences in presentations and clinical courses highlight the complexity of the disease and the need for increased awareness of unique manifestations of lepromatous leprosy in non-endemic areas.

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Livedo reticularis in type 2 lepra reaction: A rare presentation

Cited by 7 publications

References 3 publications

Diffusive mediator feedbacks control the health-to-disease transition of skin inflammation

Diffusive mediator feedbacks control the health-to-disease transition of skin inflammation

An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases

Complex Type 2 Reactions in Three Patients with Hansen's Disease from a Southern United States Clinic

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