Degos disease: report of a case and review of the literature.

We report the case of a 20-year-old woman with one-year history of asymptomatic pink papules on the abdomen, with central atrophy. Fever and symptoms suggesting involvement of other organs were absent. Histological examination revealed wedge-shaped area of cutaneous ischemia extending into the deep dermis with superficial and deep perivascular lymphocytic infiltrate. On this basis, we diagnosed malignant atrophic papulosis. Laboratory tests and instrumental investigation did not reveal any systemic involvement. The rarity of this disease makes early diagnosis challenging, even if clinical and histological patterns of the skin lesions are peculiar.

Extracorporeal photopheresis: a useful therapy for patients with steroid-refractory acute graft-versus-host disease but not for the prevention of the chronic form.

BACKGROUND: Extracorporeal photopheresis (ECP) has been used successfully to treat severe steroid-refractory acute and chronic graft-versus-host disease (aGVHD, cGVHD) since the late 1990s. OBJECTIVES: To evaluate retrospectively the efficacy and safety of ECP in patients with aGVHD. We also assessed whether ECP may play a role in the prevention of cGVHD. PATIENTS AND METHODS: Nine consecutive patients with allografts with aGVHD grade II-III, as defined by consensus criteria, and refractory to steroids, were treated with ECP. ECP was started at a median interval of 46·3 days (range 10-70) from aGVHD onset. Patients were treated initially on two consecutive days (one cycle) at 1-week intervals until improvement and then every 2 weeks. Treatment was then tapered off individually. To evaluate statistical relationships with outcome after 30, 60 and 90 days of ECP, all clinical and historical variables of the patients before treatment were analysed. RESULTS: All patients survived and responded within 90 days. The average aGVHD score was 1·72 at aGVHD onset, 2·44 when ECP was started and then gradually declined to 0·44 on day 90. At the same time, the average dose of methylprednisolone declined from 2·22 mg kg(-1) to 0·27 mg kg(-1) (day 90), while the average dose of ciclosporin declined from 2·46 mg kg(-1) to 0·77 mg kg(-1) (day 90). Six of nine patients showed a complete skin response after 90 days of treatment. All patients with liver and gastrointestinal tract involvement had complete responses after 90 days, apart from one patient. All our patients developed cGVHD, seven of nine while still on maintenance regimen (6-13 months after haematopoietic stem cell transplantation, HSCT) and the other two patients after suspension of ECP (6 and 9 months after HSCT). CONCLUSIONS: ECP is effective in patients with mild to moderate steroid-refractory aGVHD (grade II-III). On the other hand, ECP did not prevent the development of cGVHD in our patients.

Induced psoriasis after rituximab therapy for rheumatoid arthritis: a case report and review of the literature.

Rituximab is a human/murine monoclonal antibody targeting the CD20 antigen on B-lymphocytes surface. Although it has been licensed for treatment of non-Hodgkin's lymphoma, nowadays it is also a novel therapy for autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Despite the increasing evidence regarding the safety and efficacy of rituximab in these conditions, many cutaneous adverse events have been reported. Here, we describe the case of a 69-year-old patient, affected by rheumatoid arthritis, who developed psoriatic lesions on her trunk and arms, three months after the second course of rituximab. Similar cases appearing in the literature will also be briefly mentioned.

Papular-purpuric "gloves and socks" syndrome.

Papular-purpuric "gloves and socks" syndrome (PPGSS), is an acute dermatosis characterized by a papular-purpuric edematous rash in a distinct ''gloves and socks'' distribution often accompanied by fever, asthenia and lymphadenophaties. It is mainly caused by parvovirus B19 (B19V) but other viruses and drugs such as trimethoprim/sulfametaxol or chemotherapics may be involved. We describe a case of PPGSS with a serologically proven B19V infection in a 42-year-old Italian kindergarten teacher suffering from acute bacterial pharyngitis Immunoglobulin M by enzyme-linked immunosorbent assay (ELISA) to parvovirus B19 were positive. Histological examination showed dermal-ipodermal inflammation with evidence of leukocytoclastic vasculitis principally interesting the small venules The cutaneous rash resolved after 2 weeks. We reported our case to support that PPGSS is an immunomediated disease and that B19V morbidity varies with the immunologic and hematologic status of the host. In addition, a patient with PPGSS might be infectious at the moment of diagnosis, with significant implication for susceptible contacts.