Epidemic dropsy: A mimic of scleroderma?
Systemic sclerosis (SSc) is an autoimmune connective tissue disease involving the skin and internal organs and characterized pathologically by microvascular damage and increased deposition of connective tissue. Skin changes seen in SSc include edema, inflammation, induration, thickening, and progres...
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SAGE Publishing
2017-01-01
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| Series: | Indian Journal of Rheumatology |
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| Online Access: | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2017;volume=12;issue=6;spage=185;epage=188;aulast=Wakhlu |
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| author | Anupam Wakhlu Rasmi Ranjan Sahoo |
| author_facet | Anupam Wakhlu Rasmi Ranjan Sahoo |
| author_sort | Anupam Wakhlu |
| collection | DOAJ |
| description | Systemic sclerosis (SSc) is an autoimmune connective tissue disease involving the skin and internal organs and characterized pathologically by microvascular damage and increased deposition of connective tissue. Skin changes seen in SSc include edema, inflammation, induration, thickening, and progressive skin fibrosis. Histologically, skin fibrosis, accumulation of compact collagen in the dermis, effacement of rete pegs, infiltration by CD4+ T cells, and skin atrophy are observed. The “toxic oil syndrome” reported from Spain caused an outbreak of a scleroderma-like illness and was caused by ingestion of contaminated rapeseed cooking oil. Epidemic dropsy is caused by ingestion of mustard oil contaminated with the oil of Argemone mexicana. The major alkaloids in Argemone oil are sanguinarine and dihydrosanguinarine. These alkaloids produce widespread capillary dilatation, increased capillary permeability, and endothelial proliferation, akin to the toxic oil syndrome. Cutaneous manifestations include erythematous and tender bilaterally symmetrical pitting edema usually involving lower limbs, skin thickening and tethering, pigmentation, and presence of telangiectasias. The dermatopathology observed in epidemic dropsy includes atrophy and flattening of rete pegs, hypertrophy of and deposition of collagen, vascular dilatation and proliferation, and subcutaneous inflammation and fibrosis. Epidemic dropsy usually presents with subacute multisystem involvement, which may mimic a connective tissue disease. Skin involvement in epidemic dropsy may closely mimic cutaneous manifestations in SSc, both clinically and histologically. Thus, the clinician needs to be aware that epidemic dropsy with cutaneous involvement, especially if encountered sporadically, may be mistakenly diagnosed as scleroderma. |
| format | Article |
| id | doaj-art-a9778289760f4cd79e4939c6673cd77e |
| institution | Kabale University |
| issn | 0973-3698 0973-3701 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Indian Journal of Rheumatology |
| spelling | doaj-art-a9778289760f4cd79e4939c6673cd77e2025-02-03T12:00:45ZengSAGE PublishingIndian Journal of Rheumatology0973-36980973-37012017-01-01126185188Epidemic dropsy: A mimic of scleroderma?Anupam WakhluRasmi Ranjan SahooSystemic sclerosis (SSc) is an autoimmune connective tissue disease involving the skin and internal organs and characterized pathologically by microvascular damage and increased deposition of connective tissue. Skin changes seen in SSc include edema, inflammation, induration, thickening, and progressive skin fibrosis. Histologically, skin fibrosis, accumulation of compact collagen in the dermis, effacement of rete pegs, infiltration by CD4+ T cells, and skin atrophy are observed. The “toxic oil syndrome” reported from Spain caused an outbreak of a scleroderma-like illness and was caused by ingestion of contaminated rapeseed cooking oil. Epidemic dropsy is caused by ingestion of mustard oil contaminated with the oil of Argemone mexicana. The major alkaloids in Argemone oil are sanguinarine and dihydrosanguinarine. These alkaloids produce widespread capillary dilatation, increased capillary permeability, and endothelial proliferation, akin to the toxic oil syndrome. Cutaneous manifestations include erythematous and tender bilaterally symmetrical pitting edema usually involving lower limbs, skin thickening and tethering, pigmentation, and presence of telangiectasias. The dermatopathology observed in epidemic dropsy includes atrophy and flattening of rete pegs, hypertrophy of and deposition of collagen, vascular dilatation and proliferation, and subcutaneous inflammation and fibrosis. Epidemic dropsy usually presents with subacute multisystem involvement, which may mimic a connective tissue disease. Skin involvement in epidemic dropsy may closely mimic cutaneous manifestations in SSc, both clinically and histologically. Thus, the clinician needs to be aware that epidemic dropsy with cutaneous involvement, especially if encountered sporadically, may be mistakenly diagnosed as scleroderma.http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2017;volume=12;issue=6;spage=185;epage=188;aulast=WakhluArgemone mexicanadihydrosanguinarineepidemic dropsysanguinarinesclerodermaskin involvementsystemic sclerosistoxic oil |
| spellingShingle | Anupam Wakhlu Rasmi Ranjan Sahoo Epidemic dropsy: A mimic of scleroderma? Indian Journal of Rheumatology Argemone mexicana dihydrosanguinarine epidemic dropsy sanguinarine scleroderma skin involvement systemic sclerosis toxic oil |
| title | Epidemic dropsy: A mimic of scleroderma? |
| title_full | Epidemic dropsy: A mimic of scleroderma? |
| title_fullStr | Epidemic dropsy: A mimic of scleroderma? |
| title_full_unstemmed | Epidemic dropsy: A mimic of scleroderma? |
| title_short | Epidemic dropsy: A mimic of scleroderma? |
| title_sort | epidemic dropsy a mimic of scleroderma |
| topic | Argemone mexicana dihydrosanguinarine epidemic dropsy sanguinarine scleroderma skin involvement systemic sclerosis toxic oil |
| url | http://www.indianjrheumatol.com/article.asp?issn=0973-3698;year=2017;volume=12;issue=6;spage=185;epage=188;aulast=Wakhlu |
| work_keys_str_mv | AT anupamwakhlu epidemicdropsyamimicofscleroderma AT rasmiranjansahoo epidemicdropsyamimicofscleroderma |