Therapeutic drug monitoring of mycophenolic acid in patients with psoriasis.

Mycophenolate mofetil (MMF) has been shown to be effective in the treatment of psoriasis. MMF is the morpholinoethyl ester of mycophenolic acid (MPA), the active compound. Our objective was to characterize the pharmacokinetic profile of MPA in patients with psoriasis treated with MMF and to examine its correlation with effectiveness and toxicity. Eleven patients with moderate-to-severe chronic plaque psoriasis were treated with oral MMF 30 mg kg-1 daily over a period of 16 weeks. Patients were reviewed at 3, 8 and 16 weeks, checking the Psoriasis Area and Severity Index (PASI) and possible adverse events, and performing MPA C0 (trough) and C1 (1-hour post-dose) plasma levels. The reduction in PASI was statistically significant in all our patients. The drug was well tolerated. There was no significant correlation between C0 and C1 MPA levels and the reduction of PASI, improvement rates of PASI from baseline, weight of the patients and total dosage of MMF. Nevertheless, the highest detected mean levels of MPA C1 were observed in two of the patients with the highest improvement rate of PASI at the end of the study. Although C1 levels do not seem to strongly correlate with the effectiveness of the drug, the finding that the highest detected mean levels of MPA C1 were observed in two of the patients with the highest improvement rate of PASI suggests that the monitoring of C1 could be useful in some individual cases.

Photorejuvenation using topical 5-methyl aminolevulinate and red light.

BACKGROUND: Photodynamic therapy has been proved to be effective in skin rejuvenation. OBJECTIVE: To evaluate clinical efficacy and side effects of photodynamic therapy using topical 5-methyl aminolevulinate and red light for photorejuvenation. METHODS: A randomized, prospective, split-face comparison study of 10 white, adult patients with moderate photodamage, Fitzpatrick skin types 2 or 3, and no occurrence of actinic keratosis was performed. Three treatments using topical methyl aminolevulinate cream, applied for 1 hour on one half of the face and 3 hours on the other half before illumination with red light. A blinded investigator prior to treatment and 2 months after the third treatment evaluated each side of the subject's faces. RESULTS: A moderate improvement in fine lines, tactile roughness, and skin tightness was observed in most of the patients, mostly on the 3-hour time side. There were no changes in mottled pigmentation or telangiectasias. Side effects were observed in all subjects (erythema, edema, scaling) mainly in the 3-hour incubation time side. LIMITATIONS: The small number of patients and the lack of placebo group. CONCLUSION: Methyl aminolevulinic-photodynamic therapy with red light can improve fine lines, tactile roughness and skin tightness in patients with moderate photoaging and no occurrence of actinic keratosis.

Necrobiotic xanthogranuloma.

Necrobiotic xanthogranuloma (NXG) is an uncommon granulomatous disease involving the skin and extracutaneous tissues. In its typical clinical presentation, it consists of multiple indurate yellow-brownish plaques or nodules, usually located on the periorbital area. The lesions often are bilateral and symmetric and frequently show tendency to atrophy and ulceration. Most cases are asymptomatic, and oral mucosal erosions are sometimes present. Ophthalmologic complications are observed in many patients, and NXG may involve other extracutaneous sites. Paraproteinemia is closely associated with NXG, demonstrating a monoclonal gammapathy, and other hematologic or lymphoproliferative disorders also may appear in association with NXG. Large areas of degenerated collagen alternating with granulomatous inflammation, multinucleate giant cells, cholesterol clefts, and lymphoid follicles are the most outstanding histopathologic characteristics of NXG. The prognosis for NXG is good, but no curative treatment is available. Chemotherapy with alkylating agents is the most frequently administered treatment, but oral and intralesional corticosteroids, interferon alpha, plasmapheresis, surgical excision, and radiation therapy also have been used for treatment of this disorder, with variable results.

Perforating neutrophilic and granulomatous dermatitis of the newborn--a clue to immunodeficiency.

We report two newborns with a widespread cutaneous eruption consisting of discrete papules which evolved into vesicles, pustules, crusts, and ulcers. These healed over a 2-week period with scarring. Histopathology showed three main features--histiocytic granulomas, neutrophilic infiltration, and transepidermal elimination of degenerated collagen and debris through hair follicles. Both patients had congenital immunodeficiency. This skin condition of the newborn, with distinct clinical and histopathologic features, is a manifestation of immunodeficiency that has not been previously described.

[Cutaneous marginal zone B-cell lymphoma treated with rituximab]. / Linfoma cutáneo de células B de la zona marginal tratado con rituximab.

Marginal zone B-cell lymphoma (MZL) is probably the most frequent of the primary cutaneous B-cell lymphomas, which are entities with indolent behavior. Clinically, it appears in middle-aged patients as papules, nodules or erythematous plaques, solitary or multiple, on the trunk and proximal part of the limbs. The prognosis is excellent despite frequent cutaneous recurrences. We present the case of a 40-year-old male who, after having several recurrences of MZL over a ten-year period, was treated with rituximab for multiple skin lesions. The patient showed full remission after four weeks of treatment, and developed cytokine-release syndrome after the first infusion of the drug.

[Cutaneous large B-cell lymphoma of the leg]. / Linfoma cutáneo de células grandes B de las piernas.

Large B-cell lymphoma of the leg (LBCLL) accounts for 2 % of primary cutaneous lymphomas, and the EORTC considers it to be of intermediate prognosis. It usually presents in elderly patients, and manifests clinically as erythematous nodules or tumors, often unilateral, on the lower third of the legs. On rare occasions, it presents with extracutaneous dissemination. We present the case of a 77-year-old male who consulted his physician because of an asymptomatic indurated erythematous papule which had appeared one month earlier on his left leg and had quickly and progressively increased in size. Concurrently, other similar lesions had been appearing on the thigh and back of the same leg. Histological analysis detected a large cell lymphoid infiltrate positive for CD20 and bcl-2 throughout the dermis. The extension study was normal. The patient was treated with an intravenous infusion of rituximab for four consecutive weeks, with full remission of the lesions.