The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism

Manganoni, Ausilia Maria; Venturini, Marina; Scolari, Francesco; Tucci, G; Facchetti, Fabio; Graifemberghi, S; Calzavara‐Pinton, Piergiacomo

doi:10.1111/j.1365-2133.2004.06000.x

Cited by 10 publications

(5 citation statements)

References 8 publications

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“…The changes included increase in visible area, darkening, increase in number and size of brown globules and dots, increase in width and prominence of the pigment network, and formation of branched streaks. In a previous pilot study from our department, we found that these changes were transitory and regressed within 3 months (8).…”

Section: Discussionmentioning

confidence: 72%

“…Previous studies have reported that repeated solar (7) and artificial UVB (280–320 nm) and UVA (320–400 nm) (8) exposure can modify the clinical, dermoscopic and histological features of AMN. However, it is unclear whether the changes are caused by molecular events with a carcinogenic potential and whether these events are dependent on waveband (UVA and UVB) and dose.…”

Section: Introductionmentioning

confidence: 99%

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Dermoscopic, histological and immunohistochemical evaluation of cancerous features in acquired melanocytic nevi that have been repeatedly exposed to UVA or UVB

Manganoni

Sala

Venturini

et al. 2011

Experimental Dermatology

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Previous studies have reported that repeated solar and artificial UVB (280-320 nm) and UVA (320-400 nm) exposures can modify acquired melanocytic nevi (AMN). We therefore investigated the clinical, dermoscopic, histological and immunohistochemical changes in AMN exposed to UVB and UVA radiation. Twenty healthy volunteers with at least three AMN on the trunk were enrolled in the present study and randomized into two groups to receive equally effective doses of narrow-band (NB)-UVB or UVA1. Three exposures per week were delivered for a total of 4 weeks. During exposures, one AMN was left unprotected, a second one was shielded with an opaque adhesive tape and the third nevus was covered with a commercial sunscreen. After the irradiation cycle, the AMN were surgically removed and underwent histological and immunohistochemical assessment of melanocyte/melanogenesis-related proteins (MART-1, tyrosinase, HMB-45), cell cycle activation markers (Ki-67, topoisomerase IIalpha, p53, Cdk2) and transcription factors (microphthalmia-associated transcription factor, STAT3). Nevi that were exposed to NB-UVB or UVA1 also showed statistically significant increase in size and changes in their dermoscopic features, including overall darkening, increased pigment network expression, formation of branched streaks, and increased number and size of brown globules and dots. AMN that had been covered with opaque tape or sunscreen did not show changes in size or dermoscopic features following UVA1 or NB-UVB exposure. Histological and immunohistochemical analysis did not show any significant change in exposed AMN in comparison with AMN shielded with an opaque adhesive tape or covered with the sunscreen.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Dermoscopic, histological and immunohistochemical evaluation of cancerous features in acquired melanocytic nevi that have been repeatedly exposed to UVA or UVB

Manganoni

Sala

Venturini

et al. 2011

Experimental Dermatology

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“…In our series, one patient without cutaneous involvement received a renal biopsy, and 34 patients received a skin biopsy, half of whom were pathologically diagnosed with CCE, consistent with reports that the sensitivity of a skin biopsy specimen was 41-52%. 22,23 Among the laboratory features, the presence of eosinophilia and increase in C-reactive protein are considered a helpful clue to the diagnosis of CCE. 5,8,24 A high prevalence of eosinophilia at CCE diagnosis was observed in our series as well.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Low-Dose Corticosteroids on Short- and Long-Term Renal Outcome in Patients with Cholesterol Crystal Embolism

et al. 2011

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“…[40][41][42][43][44][45] Progressive renal failure due to CCE was also documented in 2 patients undergoing cerebral angiography for carotid artery stenosis. 46 In most of the cases, CCE patients present with abnormal kidney function (acute renal failure 35%, subacute renal failure 56%, and chronic renal failure 9%), but cutaneous manifestations, including ''blue toe'' syndrome (trash foot) and livedo reticularis, 24,25,[47][48][49][50][51] are the earliest clinical finding. [47][48][49][50] Livedo reticularis, the most common sign of skin involvement, is seen in 49% of the cases.…”

Section: Clinical Presentation and Criteria For Diagnosismentioning

confidence: 99%

“…46 In most of the cases, CCE patients present with abnormal kidney function (acute renal failure 35%, subacute renal failure 56%, and chronic renal failure 9%), but cutaneous manifestations, including ''blue toe'' syndrome (trash foot) and livedo reticularis, 24,25,[47][48][49][50][51] are the earliest clinical finding. [47][48][49][50] Livedo reticularis, the most common sign of skin involvement, is seen in 49% of the cases. 50 It is described as red-blue mottling in a net-like configuration 52 and is generally bilateral, involving legs and feet.…”

Section: Clinical Presentation and Criteria For Diagnosismentioning

confidence: 99%

Cholesterol Crystal Embolization:A Possible Complication of Peripheral Endovascular Interventions

Paraskevas

Koutsias

Mikhailidis

et al. 2008

Journal of Endovascular Therapy

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Cholesterol crystal embolization (CCE) is a possible complication of peripheral endovascular interventions. The diagnosis of CCE is suggested by the gradual onset of peripheral cutaneous manifestations (e.g., livedo reticularis, blue toe syndrome) accompanied by progressive increases in blood urea nitrogen and creatinine levels following an invasive arterial procedure. On occasion, it may present with non-specific clinical signs and symptoms, which contributes to underdiagnosis. CCE is associated with significant morbidity and mortality. Prompt recognition of the presenting signs and symptoms, as well as a combination of treatment modalities is essential to reduce the risk of morbidity and mortality. CCE should always be part of the differential diagnosis in patients with progressively deteriorating renal function following a peripheral endovascular intervention. After the presentation of CCE, avoidance of anticoagulation and further invasive vascular procedures (e.g., angiography), along with symptomatic and supportive therapeutic measures, may help to achieve a better outcome.

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The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism

Cited by 10 publications

References 8 publications

Dermoscopic, histological and immunohistochemical evaluation of cancerous features in acquired melanocytic nevi that have been repeatedly exposed to UVA or UVB

Dermoscopic, histological and immunohistochemical evaluation of cancerous features in acquired melanocytic nevi that have been repeatedly exposed to UVA or UVB

The Effect of Low-Dose Corticosteroids on Short- and Long-Term Renal Outcome in Patients with Cholesterol Crystal Embolism

Cholesterol Crystal Embolization:A Possible Complication of Peripheral Endovascular Interventions

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