Nd:YAG Q-switched laser for the treatment of a hemicorporal epidermal nevus: A safe and effective option.

Epidermal nevi are benign proliferations of the epidermis for which different treatments have been used with disappointing results due to their recurrences and anesthetic scars. Topical therapies have generally been ineffective and surgical treatment provides more definitive results, but with high risk of scarring. In recent years, multiple laser modalities have been described for the treatment of these lesions. In the literature, there are no reported cases of treatment of these lesions with Neodymium-doped Yttrium aluminum garnet (Nd:YAG) laser. We present the case of a 3-year-old patient with a hemicorporal epidermal nevus treated with Nd:YAG laser at an early stage with good results.

Accelerated photoaging induced by voriconazole treated with Q-switched Nd:YAG laser: case report and review of the literature.

Voriconazole is an antifungal agent mainly used against aspergillosis. Given its wide spectrum of action and limited adverse effects, it has replaced amphotericin B as the drug of choice in the prophylactic treatment of immunocompromised patients. Several adverse effects are caused by this drug with dermatological reactions accounting for 6% of the total. Such reactions include cheilitis, erythema, erosions, discoid lupus erythematosus, erythema multiforme, photosensitivity reactions, pseudoporphyria, accelerated photoaging and skin cancer. There are few reports on the accelerated photoaging caused by voriconazole and its effective treatment. Here we present the case of a 6-year-old child with a history of chronic granulomatous disease under prolonged treatment with voriconazole, who developed accelerated photoaging lesions secondary to the chronic use of this antifungal agent. Treatment was initiated using Q-switched Nd:YAG laser with good results.

Tranexamic acid-induced toxic epidermal necrolysis.

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) induced by orally administered tranexamic acid in a patient with liver cirrhosis and acute rectal bleeding. CASE SUMMARY: A 67-year-old male with a history of liver cirrhosis due to alcohol consumption with ascitic decompensation, esophageal varices, and multifactorial renal insufficiency presented with rectal bleeding. The patient was prescribed oral tranexamic acid (1000 mg every 8 hours), with partial resolution of symptoms. Ten days after treatment with tranexamic acid began, a purplish macular rash appeared over the patient's trunk. The dose of tranexamic acid was reduced to 1000 mg every 12 hours, adjusting for renal function. In the following days the lesions extended and became confluent with blisters and epidermal necrosis. Multiple mucosal surfaces were also affected. He denied allergies to any medications and had no history of tranexamic acid exposure. Treatment with tranexamic acid was suspended and fluid replacement therapy, oral prednisone therapy (0.4 mg/kg per day), and N-acetylcysteine 2 g every 6 hours was started, with the empiric diagnosis of TEN. Results of a skin biopsy were compatible with TEN. Resolution of the skin lesions was favorable, but after 2 weeks the patient died secondary to acute renal failure, respiratory infection, and multiorgan failure. DISCUSSION: TEN is a rare, severe mucocutaneous adverse reaction. Although infrequent, TEN has a significant impact on public health because of its high mortality. Its pathogenesis is unclear, but it seems to be a form of delayed hypersensitivity. To our knowledge, a well-documented case of TEN following tranexamic acid use has not been reported (MEDLINE search to June 2012). There have been recent reports of skin hypersensitivity reactions through different mechanisms (immunologic and nonimmunologic). The Naranjo probability scale indicates a probable relationship between the development of TEN and tranexamic acid use in our patient. CONCLUSIONS: This appears to be the first report of a case of TEN that occurred in a patient being treated with oral tranexamic acid. Clinicians should be made aware of this potential severe cutaneous adverse reaction that may be caused by tranexamic acid administration.