RESUMEN
This case series discusses 3 patients with long-standing eczematous or psoriasiform dermatitis, demonstrated by multiple biopsies. Following off-label treatment with dupilumab, all 3 patients had clinical expansion of disease, with histopathologic features consistent with cutaneous T-cell lymphoma (CTCL) on subsequent biopsy. We postulate that this expansion likely was secondary to an exacerbation of extant CTCL following exposure to dupilumab. A proposed mechanism of promotion of CTCL is based on the functional increase in IL-13 available for binding at the upregulated IL-13 receptor (IL-13R) α2 site on cells, following blockade of the α1 receptor with dupilumab. This progression merits further investigation.
Asunto(s)
Anticuerpos Monoclonales Humanizados/administración & dosificación , Dermatitis/tratamiento farmacológico , Eccema/tratamiento farmacológico , Linfoma Cutáneo de Células T/diagnóstico , Anticuerpos Monoclonales Humanizados/efectos adversos , Biopsia , Dermatitis/patología , Progresión de la Enfermedad , Eccema/patología , Femenino , Humanos , Interleucina-13/inmunología , Linfoma Cutáneo de Células T/etiología , Linfoma Cutáneo de Células T/patología , Masculino , Persona de Mediana Edad , Uso Fuera de lo Indicado , Psoriasis/tratamiento farmacológico , Psoriasis/patologíaAsunto(s)
Dermatosis Facial/diagnóstico , Síndrome de Hamartoma Múltiple/diagnóstico , Dermatosis de la Mano/diagnóstico , Anciano , Diagnóstico Diferencial , Dermatosis Facial/patología , Femenino , Síndrome de Hamartoma Múltiple/patología , Dermatosis de la Mano/patología , Humanos , Índice de Severidad de la EnfermedadAsunto(s)
Carcinoma Basocelular/etiología , Trasplante de Corazón , Huésped Inmunocomprometido , Inmunosupresores/efectos adversos , Punciones/efectos adversos , Radioterapia/efectos adversos , Neoplasias Cutáneas/etiología , Adulto , Neoplasias Óseas/radioterapia , Antebrazo , Humanos , Masculino , Sarcoma de Ewing/radioterapia , Piel/patologíaRESUMEN
We report two cases of late recurrence of eruptive locoregional metastatic melanoma occurring 6 and 9 years after definitive surgical treatment. Each case (stage IB and IA) occurred after initiation of the subcutaneous anti-tumor necrosis factor medications etanercept and adalimumab, respectively. We discuss the association of immune suppression and melanoma. These cases illustrate a previously unrecognized and potentially causal relationship between tumor necrosis factor-alpha inhibition and reactivation of latent melanoma.
Asunto(s)
Anticuerpos Monoclonales/efectos adversos , Antirreumáticos/efectos adversos , Inmunoglobulina G/efectos adversos , Melanoma/inducido químicamente , Recurrencia Local de Neoplasia/inducido químicamente , Neoplasias Cutáneas/inducido químicamente , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados , Antirreumáticos/administración & dosificación , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Etanercept , Femenino , Humanos , Inmunoglobulina G/administración & dosificación , Inmunoglobulina G/uso terapéutico , Inyecciones Subcutáneas , Melanoma/diagnóstico por imagen , Melanoma/patología , Melanoma/secundario , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Psoriasis/tratamiento farmacológico , Receptores del Factor de Necrosis Tumoral/administración & dosificación , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/secundarioAsunto(s)
Eritema Pernio/diagnóstico , Eritromelalgia/diagnóstico , Temperatura , Terminología como Asunto , Adulto , Femenino , Humanos , SíndromeAsunto(s)
Dermatitis/diagnóstico , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Onicomicosis/diagnóstico , Escabiosis/complicaciones , Escabiosis/diagnóstico , Cuero Cabelludo , Preescolar , Diagnóstico Diferencial , Enfermedades del Sistema Endocrino/genética , Factores de Transcripción Forkhead/genética , Humanos , Enfermedades del Sistema Inmune/genética , Enfermedades Intestinales/genética , Masculino , Escabiosis/patología , SíndromeRESUMEN
BACKGROUND: Many methods have been proposed for the treatment of acne scars with variable cosmetic results. Subcision has been successfully used, although complications often include a hyperpigmented and hypertrophic wound healing response. Nonablative skin resurfacing with a 1320-nm Nd:YAG laser has also been proposed; however, the results are generally inferior to those of more invasive modalities. OBJECTIVE: The objective was to improve on the results of 1320-nm Nd:YAG nonablative laser resurfacing by combining this treatment of acne scars with needle subcision. METHODS: A split-face trial was conducted in a patient with severe rolling and boxcar acne scars. One side of the face was treated with two sessions of subcision alone, spaced 6 weeks apart, whereas the other side was treated with two sessions of subcision spaced 6 weeks apart and 1320-nm Nd:YAG laser sessions every 2 weeks starting after the first subcision. At the conclusion of the split-face trial, the unlasered side was then treated with six biweekly sessions of 1320-nm Nd:YAG. RESULTS: Although the use of subcision resulted in an improvement of the patient's acne scars, the combination of subcision and nonablative laser resurfacing was superior in topography, pigmentation, and overall appearance of the acne scars. CONCLUSION: This case illustrates that dual treatment with subcision and 1320-nm Nd:YAG nonablative laser resurfacing is a well-tolerated and highly effective regimen for the improvement of facial acne scars, compared to subcision alone.