ABSTRACT
We report a case of a 49 year old woman who developed biopsy-proven xanthomas on her hands and arms after initiation of Mycophenolate mofetil therapy for systemic lupus erythematosus (SLE) and subsequently went into remission upon cessation of the medication.
Subject(s)
Alopecia Areata , Adult , Child , Egypt , Humans , Severity of Illness Index , Tumor Necrosis Factor-alphaABSTRACT
Background: Rhinophyma is a dermatologic condition that can lead to severe disfiguration and psychological distress. Many therapies, both medical and surgical, have been reported, but few with acceptable and reproducible cosmesis. Objective: We assessed the efficacy of erbium-doped yttrium aluminium garnet (Er:YAG) laser resurfacing as a treatment modality for rhinophyma of all degrees. Design, Setting, and Participants: Eleven Caucasian male patients were classified into categories of mild, moderate, or severe rhinophyma and were treated at the University of Rochester Medical Center with a dual mode Er:YAG fully ablative laser. Measurements: Severity was graded as mild, moderate, or severe, based on the degree of distortion of normal anatomy. Results: The Er:YAG laser allowed for increased ablative precision, a decreased risk of complications, shorter downtime, and improved outcomes compared to currently available treatments. Conclusion: Our results suggest Er:YAG laser resurfacing is an effective treatment modality, with low risk and excellent, reproducible cosmetic outcomes, for patients with rhinophyma of any severity.
ABSTRACT
BACKGROUND: Basal cell cancer is the most common cutaneous malignancy. It rarely presents with locally advanced or metastatic disease. Rare presentations such as intraorbital invasion remain a difficult clinical problem with significant potential morbidity. There is no review of sonic hedgehog pathway inhibitors (HPIs) for intraorbital basal cell cancer, and evidence regarding optimal management is limited. OBJECTIVE: To evaluate the evidence for the management of intraorbital basal cell cancer with HPIs. METHODS: A search to identify evidence for treatment intraorbital basal cell cancers with HPIs to date was performed in PubMed database and OVID using the phrases "basal cell cancer/carcinoma/BCC," "intraorbital," "orbital," "ocular," "periocular," "vismodegib," "GDC-0449," "sonidegib," and "LDE224," in various combinations with Boolean operators "AND" and "OR." RESULTS: Rigorous clinical trials have previously reported the use of vismodegib and sonidegib in locally advanced and metastatic basal cell carcinoma (BCC). However, specific descriptions of treatment of intraorbital tumors are rarely presented in detail adequate for analysis. Twenty-two cases of intraorbital BCC treated with vismodegib have been described in the literature, and no cases using sonidegib were identified. These vary in quality, but highlight important questions regarding optimal treatment duration, follow-up, and adjunctive therapies. Reports describing locally advanced BCC in various facial and periocular locations, but without specific mention of intraorbital invasion, were excluded. CONCLUSION: Vismodegib is an attractive eye and vision-sparing option in patients with locally advanced intraorbital basal cell cancer whose other options often include exenteration, radiation, or other radical surgery.
Subject(s)
Anilides/therapeutic use , Antineoplastic Agents/therapeutic use , Carcinoma, Basal Cell/drug therapy , Carcinoma, Basal Cell/surgery , Hedgehog Proteins/antagonists & inhibitors , Neoplasm Recurrence, Local/drug therapy , Orbital Neoplasms/drug therapy , Pyridines/therapeutic use , Skin Neoplasms/surgery , Administration, Oral , Anilides/administration & dosage , Antineoplastic Agents/administration & dosage , Humans , Lacrimal Apparatus , Male , Middle Aged , Pyridines/administration & dosage , Salvage TherapySubject(s)
Exanthema/diagnosis , Methotrexate/administration & dosage , Pruritus/diagnosis , Psoriasis , Triamcinolone/administration & dosage , Biopsy/methods , Dermatologic Agents/administration & dosage , Diagnosis, Differential , Drug Administration Routes , Humans , Male , Physical Examination/methods , Psoriasis/pathology , Psoriasis/physiopathology , Psoriasis/therapy , Skin/pathology , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Head and neck dermatitis is a subtype of atopic dermatitis driven by Malassezia yeast. OBJECTIVE: We sought to evaluate the response of these patients to systemic azole antifungals. METHODS: We queried the electronic medical records from our institution for patients that were referred for allergy patch testing, were ultimately given the diagnosis of head and neck dermatitis, and were treated with oral azole antifungals over a 2-year period. RESULTS: Twenty-four patients met inclusion criteria and were analyzed. Most patients noted their characteristic flare beginning during their teenage, young adult, or adult years. All were noted to have some involvement of the head and neck, and 17 responded to treatment. The mean time taking an azole antifungal medication was 8 months, with a mean overall follow-up of 10 months. LIMITATIONS: This was a retrospective descriptive study, from a single institution, of a limited number of patients, and did not use a validated scoring system. CONCLUSION: Itraconazole and other azole antifungals were an effective treatment for more than two-thirds of adult patients with head and neck predominant atopic dermatitis.
