Hautzeichen bei rheumatologischen Erkrankungen im Kindes- und Jugendalter

Zusammenfassung

Rheumatologische Erkrankungen können sich in einer großen Vielfalt an der Haut manifestieren. Das Spektrum reicht von flüchtigen Exanthemen bis zu tiefer Sklerosierung, Vaskulitis und Pannikulitis. Dank der Zugänglichkeit für Inspektion, Dermatoskopie, Palpation und Biopsien können dermatologische Mitbeurteilungen wertvolle Hinweise für die diagnostische Einordnung geben. Während bei einigen rheumatologischen Erkrankungen, wie kutanem Lupus erythematodes oder Sklerodermie, spezifische Hautzeichen leicht mit dem Auge zu erkennen oder mit den Fingern zu ertasten sind, sind Hautzeichen wie Exantheme, leukozytoklastische Vaskulitis oder Erythema nodosum klar definierte Entitäten, die jedoch verschiedene Ursachen haben können. Gerade im Kindesalter müssen die häufigen, transienten infektassoziierten Varianten von immunologischen Grunderkrankungen abgegrenzt werden. Die Symptome sind teilweise inkomplett oder atypisch und können weiteren Manifestationen vorausgehen, was interdisziplinäre Verlaufsbeurteilungen erfordert. Die hier vorgestellten Hautzeichen rheumatologischer Erkrankungen im Kindes- und Adoleszentenalter illustrieren den Wert einer engen interdisziplinären Zusammenarbeit.

Abstract

Rheumatologic diseases might occur with an extraordinary wide spectrum of skin manifestations ranging from transient erythema to massive sclerosis of deep connective tissue layers, vasculitis or panniculitis. Thanks to its accessibility for inspection, dermatoscopy, palpation and biopsy, dermatological assessment can provide valuable clues for the diagnostic classification.

While some diseases such as cutaneous lupus erythematodes, scleroderma or Gottron’s papules in dermatomyositis are specific features of the associated disease, skin signs such as exanthema, leukocytoclastic vasculitis or erythema nodosum are unspecific with regard to the trigger. Especially in childhood, the frequent infect-associated transient manifestations have to be carefully differentiated from underlying immunological diseases. Because symptoms can be atypical or incomplete and frequently precede systemic involvement, interdisciplinary follow- ups are crucial.

Herein we review typical skin signs of underlying rheumatologic diseases in children and adolescents to illustrate the complementary value of close interdisciplinary collaboration between pediatric rheumatology and pediatric dermatology.

Schlüsselwörter

Figurierte Exantheme - Kollagenose - Vaskulitis - Vaskulopathie - Pannikulitis

Keywords

Figurate exanthema - mixed connective tissue disease - vasculitis - vasculopathy - panniculitis

Publication History

Article published online:
12 May 2023

• Literatur

• 1 Cozzi A, Doria A, Gisondi P. et al. Skin rash and arthritis a simplified appraisal of less common associations. J Eur Acad Dermatol Venereol 2014; 28: 679-688 DOI: 10.1111/jdv.12252. (PMID: 23980929)
• 2 Prendiville JS, Tucker LB, Cabral DA. et al. A pruritic linear urticarial rash, fever, and systemic inflammatory disease in five adolescents: adult-onset still disease or systemic juvenile idiopathic arthritis sine arthritis?. Pediatr Dermatol 2004; 21: 580-588 DOI: 10.1111/j.0736-8046.2004.21513.x. (PMID: 15461768)
• 3 Boer-Auer A, Folster-Holst R. Skin biopsy of inflammatory skin diseases in childhood-when is it reasonable?. Hautarzt 2018; 69: 536-549 DOI: 10.1007/s00105-018-4205-7. (PMID: 29869129)
• 4 Hospach T, von den Driesch P, Dannecker GE. Acute febrile neutrophilic dermatosis (Sweet’s syndrome) in childhood and adolescence: two new patients and review of the literature on associated diseases. Eur J Pediatr 2009; 168: 1-9 DOI: 10.1007/s00431-008-0812-0. (PMID: 18830624)
• 5 Davis MDP, van der Hilst JCH. Mimickers of Urticaria: Urticarial Vasculitis and Autoinflammatory Diseases. J Allergy Clin Immunol Pract 2018; 6: 1162-1170 DOI: 10.1016/j.jaip.2018.05.006. (PMID: 29871797)
• 6 Broekaert SM, Boer-Auer A, Kerl K. et al. Neutrophilic Epitheliotropism is a Histopathological Clue to Neutrophilic Urticarial Dermatosis. Am J Dermatopathol 2016; 38: 39-49 DOI: 10.1097/DAD.0000000000000390. (PMID: 26317390)
• 7 Lachmann HJ, Papa R, Gerhold K. et al. The phenotype of TNF receptor-associated autoinflammatory syndrome (TRAPS) at presentation: a series of 158 cases from the Eurofever/EUROTRAPS international registry. Ann Rheum Dis 2014; 73: 2160-2167 DOI: 10.1136/annrheumdis-2013-204184. (PMID: 23965844)
• 8 Krause K, Grattan CE, Bindslev-Jensen C. et al. How not to miss autoinflammatory diseases masquerading as urticaria. Allergy 2012; 67: 1465-1474 DOI: 10.1111/all.12030. (PMID: 22978406)
• 9 Vanoni F, Lava SAG, Fossali EF. et al. Neonatal Systemic Lupus Erythematosus Syndrome: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 53: 469-476 DOI: 10.1007/s12016-017-8653-0. (PMID: 29116459)
• 10 Chottawornsak N, Rodsaward P, Suwannachote S. et al. Skin signs in juvenile- and adult-onset systemic lupus erythematosus: clues to different systemic involvement. Lupus 2018; 27: 2069-2075 DOI: 10.1177/0961203318805851. (PMID: 30336755)
• 11 Rigante D, Fastiggi M, Ricci F. et al. Handy Hints About Raynaud’s Phenomenon in Children: A Critical Review. Pediatr Dermatol 2017; 34: 235-239 DOI: 10.1111/pde.13129. (PMID: 28523890)
• 12 Pavlov-Dolijanovic S, Damjanov N, Ostojic P. et al. The prognostic value of nailfold capillary changes for the development of connective tissue disease in children and adolescents with primary raynaud phenomenon: a follow-up study of 250 patients. Pediatr Dermatol 2006; 23: 437-442 DOI: 10.1111/j.1525-1470.2006.00278.x. (PMID: 17014637)
• 13 Lakdawala N, Fedeles F. Vasculitis: Kids are not just little people. Clin Dermatol 2017; 35: 530-540 DOI: 10.1016/j.clindermatol.2017.08.004. (PMID: 29191345)
• 14 Barut K, Sahin S, Kasapcopur O. Pediatric vasculitis. Curr Opin Rheumatol 2016; 28: 29-38 DOI: 10.1097/BOR.0000000000000236. (PMID: 26555448)
• 15 Demir S, Sag E, Dedeoglu F. et al. Vasculitis in Systemic Autoinflammatory Diseases. Front Pediatr 2018; 6: 377 DOI: 10.3389/fped.2018.00377. (PMID: 30560109)
• 16 Hedrich CM, Smith EMD, Beresford MW. Juvenile-onset systemic lupus erythematosus (jSLE) – Pathophysiological concepts and treatment options. Best Pract Res Clin Rheumatol 2017; 31: 488-504 DOI: 10.1016/j.berh.2018.02.001. (PMID: 29773269)
• 17 Feldman BM, Rider LG, Reed AM. et al. Juvenile dermatomyositis and other idiopathic inflammatory myopathies of childhood. Lancet 2008; 371: 2201-2212 DOI: 10.1016/S0140-6736(08)60955-1. (PMID: 18586175)
• 18 Bottai M, Tjarnlund A, Santoni G. et al. EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups: a methodology report. RMD Open 2017; 3: e000507 DOI: 10.1136/rmdopen-2017-000507. (PMID: 29177080)
• 19 Spencer-Green G, Crowe WE, Levinson JE. Nailfold capillary abnormalities and clinical outcome in childhood dermatomyositis. Arthritis Rheum 1982; 25: 954-958 DOI: 10.1002/art.1780250807. (PMID: 7115454)
• 20 Bowyer SL, Blane CE, Sullivan DB. et al. Childhood dermatomyositis: factors predicting functional outcome and development of dystrophic calcification. J Pediatr 1983; 103: 882-888 DOI: 10.1016/s0022-3476(83)80706-9. (PMID: 6644423)
• 21 Herrick AL, Ennis H, Bhushan M. et al. Incidence of childhood linear scleroderma and systemic sclerosis in the UK and Ireland. Arthritis Care Res (Hoboken) 2010; 62: 213-218 DOI: 10.1002/acr.20070. (PMID: 20191520)
• 22 Weibel L, Harper JI. Linear morphoea follows Blaschko’s lines. Br J Dermatol 2008; 159: 175-181 DOI: 10.1111/j.1365-2133.2008.08647.x. (PMID: 18503590)
• 23 Li SC. Scleroderma in Children and Adolescents: Localized Scleroderma and Systemic Sclerosis. Pediatr Clin North Am 2018; 65: 757-781 DOI: 10.1016/j.pcl.2018.04.002. (PMID: 30031497)
• 24 Siddiqui F, Kumar M. A 13-year-old girl with a linear dark patch on her forehead: A case of scleroderma en coup de sabre in a child with skin of color presenting with a bruise-like appearance. JAAD Case Rep 2018; 4: 418-420 DOI: 10.1016/j.jdcr.2017.08.018. (PMID: 29984268)
• 25 Guissa VR, Trudes G, Jesus AA. et al. Lupus erythematosus panniculitis in children and adolescents. Acta Reumatol Port 2012; 37: 82-85 (PMID: 22781517)
• 26 Labbe L, Perel Y, Maleville J. et al. Erythema nodosum in children: a study of 27 patients. Pediatr Dermatol 1996; 13: 447-450 DOI: 10.1111/j.1525-1470.1996.tb00722.x. (PMID: 8987051)
• 27 Davatchi F, Shahram F, Chams-Davatchi C. et al. Behcet’s disease in Iran: analysis of 6500 cases. Int J Rheum Dis 2010; 13: 367-373 DOI: 10.1111/j.1756-185X.2010.01549.x. (PMID: 21199472)
• 28 Okada S, Ishikawa Y, Shimomura M. et al. Erythema Nodosum Masking Kawasaki Disease with an Initial Manifestation of Skin Lesions. Yonsei Med J 2019; 60: 312-314 DOI: 10.3349/ymj.2019.60.3.312. (PMID: 30799595)
• 29 Polcari IC, Stein SL. Panniculitis in childhood. Dermatol Ther 2010; 23: 356-367 DOI: 10.1111/j.1529-8019.2010.01336.x. (PMID: 20666823)
• 30 Bader-Meunier B, Rieux-Laucat F, Touzot F. et al. Inherited Immunodeficiency: A New Association With Early-Onset Childhood Panniculitis. Pediatrics 2018; 141: S496-S500 DOI: 10.1542/peds.2017-0213. (PMID: 29610179)
• 31 Torrelo A, Noguera-Morel L, Hernandez-Martin A. et al. Recurrent lipoatrophic panniculitis of children. J Eur Acad Dermatol Venereol 2017; 31: 536-543 DOI: 10.1111/jdv.13858. (PMID: 27515780)
• 32 Levy J, Burnett ME, Magro CM. Lipophagic Panniculitis of Childhood: A Case Report and Comprehensive Review of the Literature. Am J Dermatopathol 2017; 39: 217-224 DOI: 10.1097/DAD.0000000000000721. (PMID: 28195843)
• 33 Grogg KL, Nascimento AG. Subcutaneous granuloma annulare in childhood: clinicopathologic features in 34 cases. Pediatrics 2001; 107: E42 DOI: 10.1542/peds.107.3.e42. (PMID: 11230623)
• 34 Del Pozzo-Magana BR, Ho N. Subcutaneous Fat Necrosis of the Newborn: A 20-Year Retrospective Study. Pediatr Dermatol 2016; 33: e353-e355 DOI: 10.1111/pde.12973. (PMID: 27574011)