Lamotrigine and its relationship with Stevens-Johnson syndrome and toxic epidermal necrolysis / Lamotrigina y su relación con el síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica

Lamotrigine is an antiepileptic drug that has been widely used for epilepsy, as a mood stabilizer (for type 1 bipolar disorder) and in the management of neuropathic pain, it is used both in monotherapy and in complementary therapy. Considered relatively new, approved by the Food and Drug Administration in 1994, its benefits include a greater margin of safety compared to other anticonvulsants. However, although in a lower percentage, it causes severe adverse skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. A review is made about the probable pathways that trigger this delayed hypersensitivity immune response.

La lamotrigina es un fármaco anticonvulsivo que ha sido utilizado ampliamente para tratar la epilepsia, como estabilizador del ánimo (en casos de trastorno bipolar tipo 1) y en el manejo del dolor neuropático; se usa tanto en monoterapia como en terapia complementaria. Considerado como un medicamento relativamente nuevo, aprobado por la Food and Drug Administration en 1994, dentro de sus beneficios se encuentra un mayor margen de seguridad en comparación con otros anticonvulsivos; sin embargo, aunque en menor porcentaje, es causa de reacciones cutáneas adversas graves, como el síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica. En el presente estudio se realiza una revisión de las probables vías que desencadenan esta respuesta inmunitaria de hipersensibilidad tardía.

Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial.

BACKGROUND: Vitamin D has immunomodulatory effects both in the innate and adaptive immune systems, and there is growing scientific evidence demonstrating its relevance in inflammatory processes such as AD. HYPOTHESIS: If vitamin D3 promotes the skin immune system, then it should improve the response to treatment of patients with AD. METHODS: A randomized, double-blind placebo-controlled clinical trial was conducted, which included 65 patients with AD according to Hanifin-Rajka criteria and the severity scale (SCORAD). The patients were divided into two groups to receive either vitamin D3 5000 IU/day (n = 33) or placebo (n = 32), plus baseline therapy (topical steroid, soap substitute, and emollient) during 3 months. RESULTS: Fifty-eight of the 65 enrolled subjects were included in the analysis. At the end of the intervention, the treated group achieved higher levels of 25(OH)D (P < 0.001). At week 12, those patients who registered serum levels of 25(OH)D ≥20 ng/ml, regardless of whether or not they had received supplementation, showed a lower SCORAD compared to those with levels <20 ng/ml (P < 0.001). Eighty percent of the patients with serum levels <20 ng/ml (n = 9) had moderate-severe AD despite standard treatment. Vitamin D levels ≥20 ng/ml associated with baseline therapy strongly favored remission of atopic dermatitis (P = 0.03). No significant differences were found between patients with serum levels of ≥20 ng/ml vs. ≥30 ng/ml. CONCLUSIONS: Reaching serum levels of 25(OH)D > 20 ng/ml in conjunction with standard therapy is sufficient to achieve a reduction in severity (SCORAD) in patients with AD.

A case series and a review of the literature on foreign modelling agent reaction: an emerging problem.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

What Is Vitamin D3 and Its Potential Use in Dermatology?

There are many clinical studies that show the importance of vitamin D in multiple skin disorders. Understanding the molecular elements of cathelicidin expression might lead to new treatments and help explain mechanisms of current therapies. Overall, current data are generating many questions and expectations and require larger trials to confirm the therapeutic use of vitamin D3 supplementation. Vitamin D now represents a vast and promising field of research to dermatologists.

Best way to perform a punch biopsy.

Nail punch biopsy is used to obtain a tissue sample for the diagnosis and treatment of nail diseases. The best results will be possible if the surgeon is familiar with the anatomy and physiology of the nail apparatus. A punch biopsy can be used in all regions of the nail apparatus in the presence or absence of nail plate. When the procedure is performed with a careful handling of the anatomic site and specimen, in most cases a successful diagnosis can be achieved.