Successful treatment with bosentan of lower extremity ulcers in a scleroderma patient.

Digital ulcers are a well-known problem in patients with systemic sclerosis. Lower extremity ulcers are less prevalent but are also a challenging and underestimated complication of the disease causing important pain and morbidity. Bosentan, an oral dual endothelin receptor antagonist, has been shown to be effective in preventing digital ulcers in patients with systemic sclerosis. A few recent observations showed the efficacy of bosentan for accelerating the healing of nondigital ulcers in scleroderma patients. This report deals with a 48-year-old patient with systemic sclerosis who developed painful ulcers on the left ankle and hallux. The ulcers were refractory to a combination of vasodilator therapy with a calcium antagonist and several courses of intravenous prostanoids, low molecular weight heparin, aspirin, simvastatin, and intensive local treatment. Bosentan treatment showed spectacular healing of the ulcers already after 4 months of therapy. This case supports the previous few observations of accelerating wound healing of lower extremity ulcers in systemic sclerosis patients with bosentan treatment.

Methylisothiazolinone, an emerging allergen in cosmetics?

BACKGROUND: A few cases on primary sensitization by, and occupational contact dermatitis from, methylisothiazolinone in paints and glues have been published. In cosmetics, methylisothiazoline (MI) is permitted in a concentration of 100 p.p.m., while 15 p.p.m. for the mixture of methylchloroisothiazolinone and methylisothiazoline (MCI/MI). OBJECTIVES: To present cases of sensitization to, and allergic contact dermatitis from, cosmetic products containing methylisothiazolinone only. PATIENTS, MATERIALS, AND METHODS: Seven patients with suspected contact dermatitis - six of them with (peri-)anal lesions and one with facial dermatitis - were patch tested with the baseline series, the own products exposed to, cosmetic ingredients, as well as with methylisothiazolinone 1000 p.p.m. and MCI/MI 200 p.p.m. RESULTS: The patients with anal lesions had become sensitized by wipes for intimate hygiene, and one patient with facial dermatitis by a make-up remover, all containing methylisothiazolinone only. Three out of seven cases would have been missed if only MCI/MI 100 p.p.m., as present in the baseline series, had been tested. CONCLUSION: The inclusion of methylisothiazolinone as a preservative in cosmetics might not represent the solution to the problem of allergic contact dermatitis from isothiazolinones, since it leads to primary sensitization.