Antibiotics inhibit tumor and disease activity in cutaneous T-cell lymphoma.

It has been proposed that CD4 T-cell responses to Staphylococcus aureus (SA) can inadvertently enhance neoplastic progression in models of skin cancer and cutaneous T-cell lymphoma (CTCL). In this prospective study, we explored the effect of transient antibiotic treatment on tumor cells and disease activity in 8 patients with advanced-stage CTCL. All patients experienced significant decrease in clinical symptoms in response to aggressive, transient antibiotic treatment. In some patients, clinical improvements lasted for more than 8 months. In 6 of 8 patients, a malignant T-cell clone could be identified in lesional skin, and a significant decrease in the fraction of malignant T cells was observed following antibiotics but an otherwise unchanged treatment regimen. Immunohistochemistry, global messenger RNA expression, and cell-signaling pathway analysis indicated that transient aggressive antibiotic therapy was associated with decreased expression of interleukin-2 high-affinity receptors (CD25), STAT3 signaling, and cell proliferation in lesional skin. In conclusion, this study provides novel evidence suggesting that aggressive antibiotic treatment inhibits malignant T cells in lesional skin. Thus, we provide a novel rationale for treatment of SA in advanced CTCL.

Treatment of acne scars with fractional CO2 laser at 1-month versus 3-month intervals: an intra-individual randomized controlled trial.

BACKGROUND: Treatment of acne scars with ablative fractional CO2 laser appears to be an effective and well-tolerated treatment. However, so far the influence of treatment interval has not been evaluated. OBJECTIVE: To evaluate whether treatment of acne scars with fractional CO2 laser resurfacing at 1-month interval achieves better results with no difference in the occurrence of adverse effects, than treatment given at 3-months interval. METHODS: Patients (n = 13) with symmetrical atrophic acne scars on right and left sides of the mid-face and lower-face were randomized to two fractional CO2 laser treatments at 1-month versus 3-month intervals. Blinded on-site evaluations were performed 1 and 6 months after the last treatment on 10-point scales. Endpoints were scar atrophy, patient satisfaction, and adverse effects. RESULTS: Pre-operatively, acne scars were moderately atrophic (5.86 ± 1.87). After treatment acne scars appeared with less atrophy on both treated sides 1 month postoperatively (1-month interval 1.96 ± 1.23, P < 0.0001; 3-months interval 1.82 ± 1.08, P = 0.0006) and 6 months postoperatively (1-month interval 1.56 ± 1.24, P = 0.0021; 3-months interval 1.33 ± 1.66, P = 0.0002). The treatment interval did not influence the improvement of scar atrophy at any time postoperatively (P = 0.81). Patients were moderately and equally satisfied with the treatment result on facial sides (P = 0.93). Postoperative adverse effects were minor and not influenced by the treatment interval. CONCLUSIONS: Fractional CO2 laser resurfacing improves atrophic acne scars and a treatment interval of either 1-month or 3-months does not seem to influence the improvement of scar atrophy nor the occurrence of postoperative adverse effects.

Abatacept is a promising treatment for patients with disseminated morphea profunda: presentation of two cases.

Morphea profunda is a rare disease that mainly affects young women and often has a progressive course with physical and psychological sequelae. The skin becomes sclerotic after an initial inflammatory reaction and joint contractures can develop. The aetiology is unknown. Until now, no successful therapy has been proven for this morphea variant. On the basis of new insights into the key role of effector T cells in scleroderma, in particular Th-17, T-cell directed therapies are expected to have promising effects. We report here the first two cases of morphea profunda treated with abatacept. Abatacept had a clinical effect on the active disease, in addition to softening old sclerotic lesions.

Ibrutinib-Associated Skin Toxicity: A Case of Maculopapular Rash in a 79-Year Old Caucasian Male Patient with Relapsed Waldenstrom's Macroglobulinemia and Review of the Literature.

Waldenstrom's macroglobulinamia (WM) is a rare malignant lymphoproliferative disorder, characterized by monoclonal IgM paraproteinemia and neoplastic proliferation of malignant lymphoplasmacytoid cells in the bone marrow. Traditionally, WM has been treated with modalities similar to those used in the management of other indolent lymphomas. Just recently, based on impressive clinical trial results in heavily pretreated WM patients, a new Bruton Tyrosine Kinase-inhibitor, Ibrutinib, has been approved for the treatment of this disorder. As the use of Ibrutinib in WM outside clinical trials is still limited, only few clinical reports illustrating treatment side effects are currently available. Here we review the current literature specific on Ibrutinib-associated rash in hematologic patients, and report on an elderly patient with WM, who developed a red maculopapular non-pruritic rash 12 weeks after starting Ibrutinib therapy. Without modifications of the ongoing Ibrutinib schedule, the rash regressed within two weeks of treatment with topical steroid-containing dermatological compounds.

Actinic keratosis: a cross-sectional study of disease characteristics and treatment patterns in Danish dermatology clinics.

OBJECTIVES: The incidence of actinic keratosis (AK) is increasing, and several treatment options are available. The aim of this study was to describe clinical characteristics and treatment patterns in patients with AK treated by Danish dermatologists. METHODS: A multicenter, non-interventional, cross-sectional study was conducted. Three dermatology hospital departments and seven private dermatology clinics enrolled eligible AK patients consecutively during one week. RESULTS: A total of 312 patients were included. Non-melanoma skin cancer (NMSC) was previously reported in 51.0% of patients and currently suspected in 9.4% of AK-affected anatomical regions. Lesions of AK were located primarily on the face (38.6%), scalp (12.8%), and hands (11.2%). Actinic keratosis commonly presented with multiple AK lesions (38.6%) and field cancerization (38.5%). The treatments used most frequently were cryotherapy (57.7%) and photodynamic therapy (PDT) with methyl aminolevulinate (17.1%) and imiquimod (11.2%). The likelihood of receiving cryotherapy was higher for men (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.10-2.47) and increased with age (2.2% per year, 0.4-4.0%). PDT represented the most frequently applied treatment for severe actinic damage and was more likely to be prescribed to women (OR 4.08, 95% CI 2.22-7.47) and young patients (OR 0.97 per year, 95% CI 0.95-0.99). The prevalence of severe actinic damage (17.3% versus 9.6%) and intake of immunosuppressive medication (29.0 versus 2.0) were higher among hospital patients compared with those treated in private practices (P < 0.0001). CONCLUSIONS: The majority of AK patients in Danish dermatology clinics have a history of skin cancer, and NMSC is suspected in almost 10% of AK-affected regions. Cryotherapy is the most frequently used treatment overall, except in instances of severe actinic damage, in which PDT is the first-choice treatment.

Montelukast treatment of moderate to severe atopic dermatitis in adults: a randomized, double-blind, placebo-controlled trial.

In a randomized, double-blind, placebo-controlled 4-week trial, 59 patients with moderate to severe atopic dermatitis were treated orally with 10 mg of the leukotriene antagonist montelukast. Forty-seven patients completed the study. No difference in efficacy was seen among patients who received montelukast and the group given a placebo.

[Arsenical keratosis treated by dermatome shaving].

Cutaneous malignancy in association with arsenic exposure is a rare but well-documented phenomenon. Signs of chronic arsenic exposure are very rare in Denmark today. However, arsenic was used in the medical treatment of psoriasis vulgaris up till the 1980's and several patients suffer from this arsenic treatment today. This case report shows that arsenical keratosis can be treated by dermatome shaving, a superficial destructive therapy.

[Children with infantile haemangiomas should be worked-up for PHACE syndrome]. / Børn med store faciale hæmangiomer bør udredes for PHACE-syndrom.

Infantile haemangiomas are the most common tumours in infants. Large facial haemangiomas are associated with posterior fossa malformations, haemangiomas, arteriel malformations, cardiac defects and eye anomalies (PHACE) syndrome in 20-31%. The diagnosis requires a large facial haemangiom and the minimum of one extracutaneous manifestation. Infants with large facial haemangiomas are in risk of PHACE syndrome and need to be referred to paediatric expertise. This case represents an infant with a large facial haemangioma, who was diagnosed with a coarctatio aortae and hence the PHACE syndrome.

Dermatofibrosarcoma protuberans diagnosed by a single biopsy.

This brief report is about a 9 year old girl presenting with a 2.5 cm circular blue to violet discoloration on the anterolateral upper left thigh. The first biopsy taken revealed the diagnosis dermatofibrosarcoma protuberans. The patient underwent surgery at a specialized sarcoma center with post operative histology showing free wide resection margin. Preoperative chest x-ray showed no sign of metastasis. This brief report emphasizes the significance of the use of biopsy when cutaneous elements look suspicious and diagnosis is unclear.

Elastosis Perforans Serpiginosa in a patient with Down syndrome treated with imiquimod 5% cream.

Elastosis Perforans Serpiginosa (EPS) is a rare skin disease characterised by hyperkeratotic papules, transepidermal elimination of abnormal elastic fibres, and focal dermal elastosis. The aetiology is unknown, but an association with underlying systemic disorders, including Down syndrome has been described. Treatment is often difficult. A 45-year old man with Down syndrome presented with symmetrical annular elements on forearms and femora. The elements were erythematous with atrophic hypopigmented central healing and peripherally, infiltrated keratotic papules with desquamation. A punch biopsy showed the classical histopathologic features of EPS. We found no clinical signs of cerebrovascular or cardiovascular disease. We initiated topical therapy with imiquimod 5% cream once a day for 6 weeks followed by 3 times weekly for 4 weeks to a single element. As regression of EPS was observed and the patient tolerated the therapy well, treatment of other lesions was commenced, and further regression was seen.