Alopecia universalis after discontinuation of pegylated interferon and ribavirin combination therapy for hepatitis C: a case report.

For the last decade, the combination therapy of pegylated interferon (Peg-IFN) plus ribavirin (RBV) has been considered as the standard of care treatment for chronic hepatitis C virus (HCV) infection. However, it has been associated with an increased incidence of many adverse cutaneous reactions and emergence of autoantibodies or even autoimmune diseases. We report a case of irreversible alopecia universalis (AU) with complete hair loss extended to the whole body, which started after discontinuation of Peg-IFN/RBV combination therapy for chronic HCV infection. In conclusion, this case represents an uncommon presentation of a common disease. Physicians must be aware of the potential adverse reactions of an antiviral therapy containing IFN, which might occur even after the discontinuation, and fully inform the patient at the beginning of his treatment course. We hope that interferon-free regimens will utterly supplant interferon-based therapy for most or all HCV patients avoiding the emergence of autoimmune manifestations.

A case of guttate psoriasis after primary herpetic gingivostomatitis.

Herpetic gingivostomatitis and anogenital herpes are widely known manifestations of sexually transmitted herpesvirus infections. What is less recognized is the potential causative role of such infections in triggering immune-mediated skin disorders such as guttate psoriasis. We describe the case of a 23-year-old man with an acute episode of guttate psoriasis related to primary herpetic gingivostomatitis. The diagnosis of guttate psoriasis was pathologically confirmed and the condition fully regressed after proper antiviral therapy. This case adds herpes simplex virus to the growing list of pathogens capable of acting as triggers for guttate psoriasis and highlights the need for better insight of the relationship between psoriasis and viral infections.

Repair of the donor areas defects after split-thickness skin grafts utilizing an advanced epithelialization dressing.

INTRODUCTION: The management of surgical wounds of the donor areas for split-thickness skin grafts might be difficult in terms of pain, risk of infection, and delayed healing. MATERIALS AND METHODS: In the period from September 2011 to June 2012, 12 patients affected by large ulcerated basal cell carcinoma (BCC) of the lower legs, 2 patients affected by squamous cell carcinoma (SCC), and 1 patient presenting malignant melanoma located on the scalp, with split-thickness skin grafts were treated. In the 12 BCC patients, the donor site areas were situated on the anterior or lateral site of the contralateral thigh and in 3 other patients on the forearms. Immediately after dermatome skin removal of 0.3 mm layer of epidermis, the donor sites were treated by applying an advanced epithelialization dressing consisting of pure cellulose film in all patients. The wound surfaces were covered by the cellulose dressing with 1 cm of excess. Bleeding was controlled with slight compression with sterile gauzes before the medication was applied. Multiple small cuts of the cellulose dressing, with a No. 11 surgical blade were made, in order to avoid hematoma formation or fluid accumulation. A mild compression bandage was used in all patients. The patients were visited after 7, 14, and 21 days. The bandage was removed after 1 week and the medical device was left at the site for other 7 days. RESULTS: After 2 weeks, the medical device was partially detached on the underlying areas showing almost completely reepithelialization. Almost no pain was referred by the patients. In the authors' experience, this medical device markedly reduces the level of pain especially at the time of dressing application, after the surgical procedure, and during the healing process. No infections were observed. The healing process was fast and produced good aesthetic results. CONCLUSIONS: The use of Cuticell® Epigraft BSN medical device simplifies the management and healing of the donor areas for split-thickness skin grafts.