[Successful therapy of sacroiliitis in SAPHO syndrome by etanercept]. / Sacroileitis im Rahmen eines SAPHO Syndroms - promptes Ansprechen auf Etanercept.

Painful, aseptic osteitis remains the major problem in the treatment of patients with SAPHO syndrome. We present a child suffering of both sacroiliitis and acne conglobata in the context of SAPHO syndrome. While acne lesions responded well to systemic isotretinoin, sacroiliitis associated pain could be controlled neither by NSAR nor by intralesional or systemic steroid injection. Worse pain limited substantially patient's mobility. This changed immediately after starting etanercept. Within a few days, pain resolved and the patient regained his mobility. This favourable response lasted for 8 months when we tried to stop etanercept under protection with the DMARD sulfazalazin. Unfortunately, within a few days, pain and immobility re-occurred requiring reinstitution of etanercept. This case demonstrates that, similar to other reports, TNF blockade is able to induce prompt and long-lasting response of SAPHO syndrome associated osteoarthritis to TNF blockade.

Perforating folliculitis, angioedema, hand-foot syndrome--multiple cutaneous side effects in a patient treated with sorafenib.

A patient with clear cell renal cell carcinoma was treated with sorafenib, a multikinase inhibitor, which induced a variety of cutaneous side effects. In addition to xerosis, he developed angioedema (AE), hand-foot syndrome (HFS) and perforating folliculitis (PF). The latter three occurred in a dose-dependent manner. AE was observed at the recommended daily dose of 800 mg. Dose reduction to 400 mg prevented its recurrence. At this dose level, the patient exhibited HFS, which cleared upon further reduction of the dose. While receiving 200 mg, the patient developed PF. To the best of our knowledge, this is the first description of a case of PF during treatment with sorafenib.

Treatment of all basal cell carcinoma variants including large and high-risk lesions with 5% imiquimod cream: histological and clinical changes, outcome, and follow-up.

Forty-one patients with 47 basal cell carcinomas (BCCs; 15 superficial, 26 nodular, and 6 sclerodermiform) were treated with 5% imiquimod cream once daily 5 times a week for 6 weeks in an open-label clinical trial. The overall response rate was 95.7%. Local side effects occurred in 68% of the patients as mild to moderate reactions with a clear association to the histological BCC subtype. Follow-up examinations for up to 17 months (median 10 months) showed scars in 14.9% of the patients and a recurrence rate of 6.6%. Overall, imiquimod represents a safe and effective treatment option for a selected cohort of BCC patients. Notably, by the second week of treatment 72.7% of BCC biopsies were histologically tumor-free, which correlated with a substantial decrease of the inflammatory infiltrate by up to 58% between weeks 3 to 6. This early imiquimod response might have important implications for the final definition of potentially shorter imiquimod treatment periods.

Reproducibility of patch tests: comparison of identical test allergens from different commercial sources.

The reproducibility of patch tests is an important determinant of the clinical value of this diagnostic procedure. The aim of the present study was to delineate comparatively the efficiency and reproducibility of identical test reagents from 2 different commercial sources. Purchased in duplicate from brial and Boots-Hermal, 30 allergens from the European standard and an extension series were simultaneously applied to Finn Chambers and affixed next to each other. Out of 2070 paired patch tests in 71 patients, 97.2% presented with concordant-negative results. 60 patch tests were classified as allergic with 95% concordant-positive results. From these paired positive patches, a subgroup of 13 (22.8%) corresponding allergens presented with minor differences in the visible strength of the allergic reaction. Generated by cobalt chloride, formaldehyde and 2-bromo-2-nitropropane-1,3-diol in 1 patient each, discordant results, i.e. 1 positive and 1 negative test in parallel, were found in only 5%. Taken together, we were able to demonstrate that patch test preparations from 2 different companies exhibited a high level of reproducibility. This standardized quality of test reagents from different suppliers provides useful information on several aspects of everyday practice.