Facial angiofibromas treated with topical rapamycin: an excellent choice with fast response.

Tuberous sclerosis (TS) is the second most common genodermatosis in our country and one of its main characteristics is the presence of facial angiofibromas. These benign tumors can be really bothersome for some patients and there is not a gold-standard treatment. Laser therapy has been used with good responses but it is a painful option and recurrence is guaranteed. TS develops as a result of a mutation of one of two genes, TSC1 or TSC2, which encode for hamartin and tuberin, respectively. TSC1 and TSC2 are tumor suppressors that inhibit mTOR, which if mutated results in mTOR activation, leading to an increase in protein translation. This eventually induces formation of hamartomatous tumors in patients with TSC. Oral rapamycin had been reported to be effective for the treatment of various tumors, apparently because of its action of inhibiting the m-TOR complex. Recently it has been suggested that the drug may be effective when applied topically. We report the 6th case of facial AF treated with topical rapamycin, 1 percent, once per day. An excellent response was achieved surprisingly rapidly. We propose this option as a safe and effective therapy.

Focal skin toxicity related to methotrexate sparing psoriatic plaques.

Methotrexate (MTX) is an antimetabolite and antifolate drug used in the treatment of cancer and autoimmune diseases. MTX inhibits DNA synthesis by competitive inhibition of dihydrofolate reductase in immunologically active cells. It also decreases inflammation by other mechanisms. Cutaneous toxicity is usually dose-related and generally occurs when recommended guidelines are ignored or there is a decrease in renal excretion. Self-medication is a problem with unknown prevalence. Signs of MTX toxicity include bone marrow suppression, hepatotoxicity, and mucocutaneous toxicity. Painful erosions of psoriatic plaques and, less commonly, erosions in patients without psoriasis have been reported as an early sign of MTX toxicity. To our knowledge, this is the first case of skin toxicity related to MTX that affected the normal skin and spared the psoriatic plaques.