Guideline for the diagnosis, treatment and long-term management of cutaneous lupus erythematosus.

Cutaneous lupus erythematosus (CLE) is an inflammatory, autoimmune disease encompassing a broad spectrum of subtypes including acute, subacute, chronic and intermittent CLE. Among these, chronic CLE can be further classified into several subclasses of lupus erythematosus (LE) such as discoid LE, verrucous LE, LE profundus, chilblain LE and Blaschko linear LE. To provide all dermatologists and rheumatologists with a practical guideline for the diagnosis, treatment and long-term management of CLE, this evidence- and consensus-based guideline was developed following the checklist established by the international Reporting Items for Practice Guidelines in Healthcare (RIGHT) Working Group and was registered at the International Practice Guideline Registry Platform. With the joint efforts of the Asian Dermatological Association (ADA), the Asian Academy of Dermatology and Venereology (AADV) and the Lupus Erythematosus Research Center of Chinese Society of Dermatology (CSD), a total of 25 dermatologists, 7 rheumatologists, one research scientist on lupus and 2 methodologists, from 16 countries/regions in Asia, America and Europe, participated in the development of this guideline. All recommendations were agreed on by at least 80% of the 32 voting physicians. As a consensus, diagnosis of CLE is mainly based on the evaluation of clinical and histopathological manifestations, with an exclusion of SLE by assessment of systemic involvement. For localized CLE lesions, topical corticosteroids and topical calcineurin inhibitors are first-line treatment. For widespread or severe CLE lesions and (or) cases resistant to topical treatment, systemic treatment including antimalarials and (or) short-term corticosteroids can be added. Notably, antimalarials are the first-line systemic treatment for all types of CLE, and can also be used in pregnant patients and pediatric patients. Second-line choices include thalidomide, retinoids, dapsone and MTX, whereas MMF is third-line treatment. Finally, pulsed-dye laser or surgery can be added as fourth-line treatment for localized, refractory lesions of CCLE in cosmetically unacceptable areas, whereas belimumab may be used as fourth-line treatment for widespread CLE lesions in patients with active SLE, or recurrence of ACLE during tapering of corticosteroids. As for management of the disease, patient education and a long-term follow-up are necessary. Disease activity, damage of skin and other organs, quality of life, comorbidities and possible adverse events are suggested to be assessed in every follow-up visit, when appropriate.

Randomized, assessor-blind, controlled clinical trial on the efficacy and safety of aromatic oil (10% eucalyptus oil, 10% lavender oil, 10% rosemary oil) shampoo versus 1% permethrin shampoo in the treatment of pediculosis capitis

BACKGROUND: Permethrin shampoo is currently the first-line treatment for pediculosis capitis. However, its widespread use has resulted in the development of resistance.OBJECTIVE: To compare aromatic oil shampoo and 1% permethrin shampoo in terms of efficacy and safetyMETHOD: One hundred fifty-hour patients with active infestation were treated in this randomized, assessor-blind, controlled trial using aromatic oil or permethrin shampoo, applied once weekly for three weeks. Evaluations were conducted at baseline and a week after shampoo application. Complete cure was defined as the absence of live louse on day 21.RESULTS: There were no significant differences between the two groups in terms of complete cure, changes in patient's quality of life and pruritus at day 21. Neither group reported any diverse effects.CONCLUSION: The efficacy and safety of the aromatic oil shampoo was comparable to that of 1%permethrin shampoo in treating pediculosis capitis.

A randomized, double-blind, placebo-controlled trial on the efficacy of simvastatin in the treatment of chronic plaque type psoriasis

BACKGROUND: Psoriasis is a chronic inflammatory disease that also predisposes patients to metabolic syndrome and its components, most prevalent of which is hyperlipidemia. Statins are well-known cholesterol-lowering agents, which recently have been shown to have immunomodulatory and anti-inflamamtory effects.OBJECTIVES: To determine the efficacy of simvastatin in the treatment of chronic plaque type psoriasis through the evaluation of Psoriasis Area and Severity Index (PASI), Physician Global Assessment Scores (PGA) and Dermatology Life Quality Index (DLQI), its effects on lipid profile and its adverse effects.METHOD: Thirty (30) psoriasis patients, with lesions affecting at least 10% body surface area (BSA) were randomly assigned to take simvastatin 40mg/tablet or placebo tablet with application of 5% liquor carbonis detergens in petrolatum for both study groups. Patients were assessed at 4th and 8th week of treatment. Baseline data determined include patient's age, sex, previous medications, underlying diseases, weight, height, body mass index (BMI), PASI, PGA, DLQI, SGPT, SGOT and lipid profile. At 4th and 8th week of treatment, PASI, PGA, DLQI, SGPT, SGOT were obtained with addition of lipid profile, weight, height, and BMI at 8th week. The adverse reactions were also determined.RESULTS: At 4th week of treatment, 80% in the simvastatin group demonstrated moderate improvement (based on 51-74% PASI score reduction) and 20% had mild improvement (PASI 25-50), while 40% in the placebo group showed mild improvement and 60% had no response to treatment (PASICONCLUSION: This randomized controlled trial showed that daily intake of 40 mg simvastatin was effective in the treatment of chronic plaque type psoriasis based on PASI,PGA and DLQI.

Eruptive and milia-like syringoma: A rare case

Syringoma is one of the most common neoplasms of the eccrine gland. Among the different clinical variants, generalized and milia-like syringoma present in only 0.6% of the general population. We present an unusual case of a healthy 26 year old Filipino male with a 9 year history of multiple, asymptomatic, symmetrical, discrete white and skin colored to hyperpigmented papules over the periorbital area, forehead, and chin, later gradually spreading to the trunk and both extremities. Darier's sign was negative. Histopathological examination taken from the whitish and hyperpigmented papule both revealed cystic eccrine ducts lined by 2 rows of epithelial cells showing comma-like tails consistent with syringoma. Treatment with electrodessication was done. The patient was advised that the result is only temporary with a high likelihood of recurrence.