Continuous subcutaneous foslevodopa/foscarbidopa infusion for the treatment of motor fluctuations in Parkinson's disease: Considerations for initiation and maintenance.

Background: As Parkinson's disease (PD) advances, management is challenged by an increasingly variable and inconsistent response to oral dopaminergic therapy, requiring special considerations by the provider. Continuous 24 h/day subcutaneous infusion of foslevodopa/foscarbidopa (LDp/CDp) provides steady dopaminergic stimulation that can reduce symptom fluctuation. Objective: Our aim is to review the initiation, optimization, and maintenance of LDp/CDp therapy, identify possible challenges, and share potential mitigations. Methods: Review available LDp/CDp clinical trial data for practical considerations regarding the management of patients during LDp/CDp therapy initiation, optimization, and maintenance based on investigator clinical trial experience. Results: LDp/CDp initiation, optimization, and maintenance can be done without hospitalization in the clinic setting. Continuous 24 h/day LDp/CDp infusion can offer more precise symptom control than oral medications, showing improvements in motor fluctuations during both daytime and nighttime hours. Challenges include infusion-site adverse events for which early detection and prompt management may be required, as well as systemic adverse events (eg, hallucinations) that may require adjustment of the infusion rate or other interventions. A learning curve should be anticipated with initiation of therapy, and expectation setting with patients and care partners is key to successful initiation and maintenance of therapy. Conclusion: Continuous subcutaneous infusion of LDp/CDp represents a promising therapeutic option for individuals with PD. Individualized dose optimization during both daytime and nighttime hours, coupled with patient education, and early recognition of certain adverse events (plus their appropriate management) are required for the success of this minimally invasive and highly efficacious therapy.

A young boy with symmetric hyperkeratotic plaques: progressive symmetric erythrokeratoderma (PSEK).

In this report, a case is presented of a child, descendent from parents originating in the Virgin Islands, with symmetric and progressive hyperpigmented, hyperkeratotic plaques consistent with progressive symmetric erythrokeratoderma (PSEK). Additional family members were also affected in an autosomal dominant pattern of inheritance. Erythrokeratodermas are rare genodermatoses that have characteristic clinical presentations of well-demarcated, hyperkeratotic, and erythematous plaques. Three types exist, differentiated by their clinical presentation. In this report, a case of progressive symmetric erythrokeratoderma (PSEK) is presented. The clinical features, pathogenesis, and treatment options for erythrokeratodermas are discussed.

Vitiligo therapy: where are we now?

Vitiligo is a disfiguring skin disease. Many insights into its pathogenesis have been identified in recent years; however, treatment remains a challenge. In this article, the various treatment options for the treatment of vitiligo are outlined and newer treatment options are discussed.

Generalized pustules in a healthy woman.

A healthy 47-year-old woman developed diffuse pustules and edema of the skin after exposure to diltiazem and cephalexin. Bacterial, fungal and viral cultures were sterile suggesting a noninfectious etiology. A skin biopsy showed spongiosis, subcorneal collections of neutrophils, papillary dermal edema and a superficial perivascular mixed cell infiltrate. The clinical and histopathologic findings were consistent with acute generalized exanthematous pustulosis (AGEP). The patient was treated with supportive care and the pustular dermatitis cleared. AGEP is a rare complication of drug therapy and should be considered in the differential diagnosis of patients presenting with acute onset pustular dermatitis. Drug reactions are an uncommon and unpredictable complication of medical therapy. Cutaneous drug reaction rates occur with a frequency of 1% to 8% and can be higher for certain classes of drugs. They can range from mild morbilliform eruptions to more severe forms such as drug-hypersensitivity syndrome, toxic epidermal necrolysis or anaphylaxis. Acute generalized exanthermatous pustulosis (AGEP) is a rare presentation of a drug reaction and can be difficult to distinguish from other pustular dermatoses. Herein we review a case of AGEP and include a discussion of salient clinical and histological features of AGEP.

Generalized granuloma annulare.

Granuloma annulare is an inflammatory condition that is primarily idiopathic, but it has been associated with certain diseases, most notably diabetes mellitus. Lesions usually resolve, but resolution is less likely to occur with diffuse disease. This case report presents a patient with diffuse granuloma annulare. Recent advances in pathogenesis and treatment options are discussed.

Progressive and symmetric erythrokeratoderma.

A case of progressive and symmetric erythrokeratoderma in a 9-year-old boy is presented. The evidence for loricrin as a candidate gene for this disorder as well as the clinical features of this disease are reviewed.

Verrucous plaque on the foot.

Amelanotic melanoma can present clinically in multiple ways, often mimicking benign processes. This makes diagnosis more difficult and often delays proper medical attention. This case report highlights the importance of having a high suspicion of melanoma in cases that do not behave clinically as expected.