Successful treatment with secukinumab of psoriasis-like dermatitis in a patient with holocarboxylase synthetase deficiency.

Holocarboxylase synthetase deficiency (HSD) is a rare autosomal recessive disorder of biotin metabolism. Typical manifestations include irreversible metabolic disorders and erythroderma-like dermatitis. Most patients respond well to biotin supplementation. Psoriasis-like phenotype associated with this disease has been rarely reported in the literature and experiences with the use of biologics in patients with HSD are still lacking. We reported a rare case of recurrent psoriasis-like skin lesions in a 6-year-old child with HSD. The patient did not respond to initial therapy with high-dose oral biotin. Immunofluorescence staining showed an increased number of interleukin (IL)-17A+ cells in his skin lesions. Based on this finding, the patient was successfully treated with human anti-IL-17A monoclonal antibody (secukinumab). He did not report any side effects and remained healthy during the 2-year follow-up. We provide a comprehensive review of the reported cases of HSD with psoriasis-like dermatitis to date. The psoriasis-like phenotype of HSD is controversial in treatment and IL-17A inhibitor is an alternative therapeutic option.

[Effect of comprehensive care for chronic filariasis patients with lymphedema].

OBJECTIVE: To evaluate the effect of chronic filariasis patients with lymphedema after comprehensive cared. METHODS: A total of 386 chronic filariasis patients with lymphedema received the comprehensive care including soaking feet by TCM, washing feet by single Chinese medicine or clear water, preventing and eliminating invasive wound, physical training, raising the limb, and wearing suitable shoes. The attack frequency of inflammation of lymphatic vessels, the stage of lymphedema disease, and leg circumference were observed before and after the care. RESULTS: After the comprehensive care, the attack rates of inflammation of lymphatic vessels decreased from 9.65% to 4.67%, and there was a significant difference (χ2 =7.34, P=0.0067). The proportion of the patients with high stage of lymphedema disease decreased significantly (all P <0.01), and the average leg circumference decreased of 1.06 cm. The skin appearance improved significantly. Other signs, such as pitting edema, ulcer, and skin folds also improved significantly (all P <0.01). CONCLUSION: The comprehensive care for chronic filariasis patients with lymphedema has a remarkable effect and is worthy of further application.