Sulfamethoxypyridazine-responsive pemphigoid nodularis: a report of two cases.

Pemphigoid nodularis is a chronic and uncommon variant of bullous pemphigoid. The condition is characterized by the presence of prurigo nodularis-like lesions, possible history of blistering, and immunohistochemical findings of bullous pemphigoid. These patients are often unresponsive to conventional therapy with potent topical and systemic steroids and different immunosuppressive agents used alone or in combination. We describe two cases of pemphigoid nodularis treated successfully with sulfamethoxypyridazine without any adverse effects.

Peripheral neuropathy associated with nodular prurigo.

Nodular prurigo is characterized by nodules and papules that are intensely pruritic. Thalidomide is used to treat patients with recalcitrant disease. Because thalidomide may cause peripheral neuropathy, it is current practice to perform nerve conduction studies to exclude subclinical neuropathy before treatment. The clinical record of eight patients with nodular prurigo, in whom thalidomide treatment was proposed, were looked at. Five of them showed evidence of subclinical neuropathy, thereby contraindicating the use of thalidomide. None of the patients had any symptoms of a peripheral neuropathy and none was taking any medications with a recognized potential to cause peripheral neuropathy. We propose that nodular prurigo may be associated with an underlying peripheral neuropathy in a subset of patients. In patients with nodular prurigo and demonstrable peripheral neuropathy, there may be a role for treatment with agents such as amitryptiline and gabapentin, which are normally used for neuropathic pain.

Cutaneous manifestations of the malignant carcinoid syndrome.

BACKGROUND: The incidence of carcinoid tumours is approximately 1.5 per 100 000 of the population. The malignant carcinoid syndrome, which is caused by circulating neuroendocrine mediators produced by the tumour, occurs in less than 10% of patients. Cutaneous involvement, although recognized in this rare syndrome, has rarely been reported. OBJECTIVES: To examine a series of patients with the malignant carcinoid syndrome, to establish the prevalence and types of cutaneous involvement and to assess whether these could be used as indicators of disease activity, progression and prognosis. METHODS: Patients with the malignant carcinoid syndrome who attended a multidisciplinary clinic for neuroendocrine tumours over a 23-month period between February 2001 and December 2002 were invited to participate in the study. This involved completion of a standard history proforma and a detailed cutaneous examination with findings recorded by clinical photography. RESULTS: Twenty-five patients were enrolled. All but one had experienced flushing, three had rosacea, five had clinical features of pellagra and two had scleroderma. Flushing was generally an early manifestation of the syndrome, whereas both the pellagra and scleroderma tended to occur in more advanced disease. CONCLUSIONS: This descriptive case series indicates that cutaneous features are not uncommon in the syndrome. They are readily diagnosed on clinical examination, and may be useful indicators of disease activity and prognosis.