RESUMO
Epidermolysis bullosa pruriginosa, a genetic mechanobullous disease, manifests at birth or late in life and is characterised by intense pruritus, resulting in lichenified or nodular prurigo-like lesions and scarring most prominent on the shins. Treatment is unsatisfactory. We report a patient treated with success using a combination of topical and systemic agents.
Assuntos
Epidermólise Bolhosa Distrófica/tratamento farmacológico , Administração Tópica , Amitriptilina/uso terapêutico , Analgésicos/uso terapêutico , Quimioterapia Combinada , Epidermólise Bolhosa Distrófica/patologia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Humanos , Ketamina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mirtazapina/uso terapêutico , Prurido/tratamento farmacológico , Prurido/etiologiaRESUMO
Allergic contact dermatitis (ACD) is a type IV, delayed-type reaction caused by skin contact with low-molecular-weight organic chemicals and metal ions that activate antigen-specific T cells, primarily T-helper 1 (Th1), in a sensitized individual, leading to skin eczema.First-line treatments are based on avoidance of causal agents and topical corticosteroids/immunomodulators. In recalcitrant cases, chronic oral immunosuppressive agents may be used, but they may have serious adverse effects and do not address the immunological disfunction. We report a case of severe ACD, unresponsive to topical or oral immunosuppressive therapy, which resolved itself after treatment with teriflunomide (TF) 14 mg/daily used for multiple sclerosis. TF is a once-daily, oral selective and reversible dihydroorotate dehydrogenase inhibitor, revealing a new treatment option for ACD.
Assuntos
Crotonatos/uso terapêutico , Dermatite Alérgica de Contato/tratamento farmacológico , Eczema/tratamento farmacológico , Toluidinas/uso terapêutico , Dermatite Alérgica de Contato/patologia , Di-Hidro-Orotato Desidrogenase , Eczema/patologia , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Hidroxibutiratos , Pessoa de Meia-Idade , Nitrilas , Oxirredutases atuantes sobre Doadores de Grupo CH-CH/antagonistas & inibidores , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Pyodermatitis vegetans (PV) is a rare inflammatory dermatosis of unknown etiology and difficult diagnosis characterized by vesiculopustular, exudative, and vegetating plaques usually localized in the axillary, genital, and oral region. It bears similarities to pemphigus vegetans but clinical history, histology, and immunofluorescence help confirm the diagnosis. Pyodermatitis vegetans is often associated with an underlying gastrointestinal disorder, especially ulcerative colitis. No standardized treatment plan is available for PV. Its evolution tends to follow the progression of the underlying disorder. We report a patient with vulvar PV with good response to systemic antibiotics and corticosteroids.
Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Prednisolona/uso terapêutico , Pioderma/tratamento farmacológico , Doenças da Vulva/tratamento farmacológico , Idoso , Quimioterapia Combinada , Feminino , Humanos , Pioderma/patologia , Doenças da Vulva/patologiaAssuntos
Poluição do Ar em Ambientes Fechados , Anti-Inflamatórios não Esteroides/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Dermatite Ocupacional/etiologia , Indústria Farmacêutica , Dermatoses Faciais/etiologia , Indometacina/análogos & derivados , Adulto , Braço , Feminino , Humanos , Indometacina/efeitos adversos , Pescoço , TóraxRESUMO
A 50-year-old man presented with a scaly erythema of the face, upper chest, forearms, and dorsum of the hands. He has been treated with cyamemazine for 6 months. Photopatch tests were performed and the patient was diagnosed with photoallergic reaction to cyamemazine. The drug was discontinued and a course of oral steroids was prescribed. The patient was advised to avoid light exposure. There has been no evidence of recurrence during a six-month follow-up period. Photoallergic reactions are much less frequent than phototoxic disorders. It is well known that several drugs including neuroleptics of the phenothiazine family may produce a skin eruption on light-exposed areas by dose-dependent (phototoxic) or photoallergic mechanisms. It is believed that photopatch testing, which is the clinical investigation of choice for suspected photoallergic reactions, is significantly underused in Europe and probably world-wide.
Assuntos
Ansiolíticos/efeitos adversos , Dermatite Fotoalérgica/diagnóstico , Fenotiazinas/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Dermatite Fototóxica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Testes do EmplastroRESUMO
Vesico-bullous subacute cutaneous lupus erythematosus is an uncommon and severe presentation. The authors report an exuberant case of vesico-bullous subacute cutaneous lupus erythematosus successfully treated with dapsone and hydroxychloroquine.
Assuntos
Vesícula/diagnóstico , Lúpus Eritematoso Cutâneo/diagnóstico , Antirreumáticos/uso terapêutico , Vesícula/tratamento farmacológico , Vesícula/etiologia , Dapsona/uso terapêutico , Antagonistas do Ácido Fólico/uso terapêutico , Humanos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Cutâneo/complicações , Lúpus Eritematoso Cutâneo/tratamento farmacológico , Masculino , Pessoa de Meia-IdadeRESUMO
Pellagra is a nutritional disease caused by the deficiency of niacin. We describe a case of pellagra as the initial presentation of Crohn disease, which has been rarely described in the literature.
Assuntos
Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Pelagra/etiologia , Dor Abdominal/etiologia , Albuminas/uso terapêutico , Anti-Infecciosos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Doença de Crohn/tratamento farmacológico , Diarreia/etiologia , Feminino , Humanos , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Niacina/uso terapêutico , Pelagra/tratamento farmacológico , Prednisolona/uso terapêutico , Vitaminas/uso terapêutico , Redução de PesoRESUMO
Granuloma annulare is a benign, usually self-limited, dermatosis of unknown cause. Generalized lesions occur in approximately 15 percent of patients with GA and may cause mild to severe cosmetic disfigurement. The treatment of generalized granuloma annulare can be challenging. We report the case of a 36-year-old male patient with a generalized granuloma annulare who had failed topical and systemic glucocorticoids, systemic retinoids, dapsone, minocycline, PUVA therapy, and hydroxicloroquine and was successfully treated with adalimumab, an anti-TNF-α monoclonal antibody. Adalimumab may be an additional option in the treatment of recalcitrant forms of granuloma annulare.
Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Granuloma Anular/tratamento farmacológico , Adalimumab , Adulto , Granuloma Anular/patologia , Humanos , Masculino , Resultado do TratamentoRESUMO
Lichen planus pemphigoides is a rare autoimmune dermatosis characterized by bullous lesions arising on lichen planus (LP) papules and on clinically uninvolved skin, coexistence of histological features of LP and bullous pemphigoid and linear deposits of IgG and/or C3 along the basal membrane zone on direct immunofluorescence of peribullous skin. LPP has been reported to be associated with several medications such as ramipril, cinnarizine, simvastatin, captopril, psoralen ultraviolet A therapy and antituberculous medications. We report a case of a 41-year-old woman with LPP associated with a weight reduction drug.
Assuntos
Fármacos Antiobesidade/efeitos adversos , Líquen Plano/induzido quimicamente , Penfigoide Bolhoso/induzido quimicamente , Adulto , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Fármacos Antiobesidade/administração & dosagem , Fármacos Antiobesidade/uso terapêutico , Dapsona/administração & dosagem , Dapsona/uso terapêutico , Feminino , Humanos , Líquen Plano/diagnóstico , Líquen Plano/tratamento farmacológico , Líquen Plano/imunologia , Penfigoide Bolhoso/diagnóstico , Penfigoide Bolhoso/tratamento farmacológico , Penfigoide Bolhoso/imunologia , Resultado do TratamentoRESUMO
Kaposi sarcoma remains an important cause of morbidity in HIV-infected patients. Regardless of the recent pharmacological progress, treatment of this malignancy is still disappointing. We report the case of a patient with Kaposi sarcoma in an unusual localization, the penis, which completely resolved with highly active antiretroviral therapy alone.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , HIV-1 , Neoplasias Penianas/tratamento farmacológico , Sarcoma de Kaposi/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Penianas/imunologia , Neoplasias Penianas/patologia , Sarcoma de Kaposi/imunologia , Sarcoma de Kaposi/patologia , Resultado do Tratamento , Carga Viral/efeitos dos fármacos , Carga Viral/imunologiaRESUMO
Varicella is a common benign childhood disease that often presents in adolescents and adults in a more severe form. We report a previously healthy 50-year-old man who developed multiple necrotic cutaneous ulcers associated with fever, asthenia and anorexia. Physical examination revealed few tense hemorrhagic vesicles on the trunk and necrotic cutaneous ulcers scattered over the entire cutaneous surface. After the diagnosis of varicella with varicella pneumonia was established, treatment with acyclovir was instituted. His poor response to treatment was indicative of immune compromise; an underlying peripheral T-cell lymphoma was discovered.
Assuntos
Varicela/etiologia , Linfoma de Células T Periférico/complicações , Neoplasias Primárias Desconhecidas/diagnóstico , Progressão da Doença , Evolução Fatal , Herpes Zoster Oftálmico/etiologia , Humanos , Hospedeiro Imunocomprometido , Linfoma de Células T Periférico/diagnóstico , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Mielofibrose Primária/etiologia , RecidivaAssuntos
Antígenos CD8/análise , Linfoma Cutâneo de Células T/imunologia , Linfoma Cutâneo de Células T/patologia , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/patologia , Adulto , Complexo CD3/análise , Feminino , Citometria de Fluxo , Humanos , Imuno-Histoquímica , Linfoma Cutâneo de Células T/diagnóstico , Fenótipo , Receptores de Antígenos de Linfócitos T alfa-beta/análise , Receptores de IgG/análise , Neoplasias Cutâneas/diagnósticoAssuntos
Granuloma Anular/diagnóstico , Pênis , Tela Subcutânea/patologia , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , MasculinoRESUMO
Pityriasis rubra pilaris is a chronic inflammatory dermatosis of unknown etiology and great clinical variability. It has been divided into six categories. Types III, IV, and V occur in childhood and are distinguished by their clinical presentation, age of onset, and course. We report a 19-year-old male patient with a 2-week history of pruritic, scaling dermatosis of the hands, feet, elbows, and knees. He had no family history of skin disease. On physical examination, we observed circumscribed, reddish-orange, scaling plaques affecting the elbows and knees and a waxy palmoplantar keratoderma. The skin biopsy showed acanthosis, alternating orthokeratosis, parakeratosis, and follicular plugging suggestive of pityriasis rubra pilaris. The patient started treatment with oral acitretin, 25 mg every other day. The treatment was tolerated well, and after 6 months the lesions had resolved completely. Pityriasis rubra pilaris is a chronic papulosquamous disorder of unknown pathogenesis, characterized by reddish-orange scaly plaques, palmoplantar keratoderma, and keratotic follicular papules. There is still no consensus regarding the treatment, but therapeutic options include systemic retinoids, particularly acitretin in the recommended dose of 0.5 to 0.75 mg/kg/day. In our case, the patient was treated with a low-dose regimen of acitretin, which was effective and well tolerated.