RESUMO
BACKGROUND: There is currently a lack of evidence-based therapies that are safe and effective for plaque-type morphea. We aimed to evaluate the therapeutic potential and safety profile of imiquimod 5% cream in plaque-type morphea. METHODS: We enrolled 25 adult patients from two Canadian centers with histologically confirmed plaque-type morphea. Imiquimod 5% was applied to a representative plaque, and vehicle was applied to a control plaque for 9 months. Treatment efficacy was assessed with the Dyspigmentation, Induration, Erythema, and Telangiectasias (DIET) score, histology, and ultrasound evaluation. RESULTS AND CONCLUSIONS: Twenty-two patients completed the entire length of the study. Imiquimod 5% was superior to vehicle in reducing DIET scores at 3, 6, 9, and 12 months (p < .05). Induration demonstrated the greatest response. Histologic evaluation showed significant improvement or resolution of disease. However, no ultrasonographic differences were found in dermal and hypodermal thicknesses between the treatment and vehicle groups (p > .05). Adverse effects were minimal and well tolerated.
Assuntos
Aminoquinolinas/administração & dosagem , Esclerodermia Localizada/tratamento farmacológico , Adjuvantes Imunológicos/administração & dosagem , Administração Cutânea , Administração Tópica , Adulto , Relação Dose-Resposta a Droga , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Humanos , Imiquimode , Masculino , Estudos Prospectivos , Esclerodermia Localizada/diagnóstico por imagem , Esclerodermia Localizada/patologia , Fatores de Tempo , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: The pathogenesis of lupus vulgaris, a form of cutaneous tuberculosis, is not always clear, especially in patients who do not have coexistent extracutaneous tuberculosis and in patients with single lesions. OBJECTIVES: To report a case of lupus vulgaris in a locus minoris resistentiae (a site of reduced resistance) and to use a unique set of clinical circumstances and laboratory tests to reconstruct the pathogenesis of the lesion and the response to treatment. CONCLUSION: Lupus vulgaris can occur in a locus minoris resistentiae; local trauma and possibly other factors, such as increased temperature, topical corticosteroids, and the virulence of the infecting strain, may facilitate the growth of Mycobacterium tuberculosis present at a locus minoris resistentiae as a result of a silent bacillemia.
Assuntos
Queimaduras/microbiologia , Traumatismos Faciais/microbiologia , Lúpus Vulgar/diagnóstico , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Quimioterapia Combinada , Feminino , Humanos , Lúpus Vulgar/tratamento farmacológico , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Lichen planus (LP) is a condition with many clinical variants that can be quite varied in their presentation. OBJECTIVE: We report a case of a 60-year-old woman who presented with a very unusual palmoplantar eruption characterized by violaceous pustule-like papules that was subsequently diagnosed as LP. METHODS: The above case is reported, along with biopsy results. The patient was subsequently treated with a combination of topical corticosteroids and oral acitretin, and her clinical course was followed. RESULTS: The eruption responded dramatically to our combination treatment and resolved by the 2-month follow-up. CONCLUSION: Palmoplantar LP is a rare variant of LP that bears little resemblance to its classic LP. This condition responds well to a combination of potent topical corticosteroids and oral acitretin.