Asunto(s)
Estimulación Encefálica Profunda/métodos , Neoplasias de Cabeza y Cuello/cirugía , Cirugía de Mohs/métodos , Enfermedad de Parkinson/terapia , Cuero Cabelludo , Neoplasias Cutáneas/cirugía , Anciano de 80 o más Años , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/diagnóstico , Humanos , Masculino , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/diagnóstico , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Clinical trials are currently underway to evaluate the benefit of dupilumab in treating allergic contact dermatitis (ACD). Dupilumab use has been reported to improve ACD reactions in some patients, but not all. Varying clinical responses to T helper 2 (TH2) inhibition challenge the classical view that ACD proceeds through a TH1-dominant pathway. Selective TH2 inhibitors, such as dupilumab, may attenuate ACD when the delayed hypersensitivity response is due to TH2-predominate activation; conversely, it may have no effect on ACD if it is elicited via TH1 or TH17 pathways. We hypothesize that allergen-specific T-cell responses and patient-specific factors both play an important role in determining which pathways are recalled in delayed hypersensitivity reactions.
Asunto(s)
Dermatitis Alérgica por Contacto/inmunología , Células TH1/inmunología , Células Th17/inmunología , Células Th2/inmunología , Alérgenos/efectos adversos , Anticuerpos Monoclonales Humanizados/uso terapéutico , Dermatitis Alérgica por Contacto/tratamiento farmacológico , Dermatitis Alérgica por Contacto/etiología , HumanosRESUMEN
A 26-year-old woman with Crohn disease and palmoplantar psoriasis on ustekinumab presented with a diffuse and intensely pruritic rash with a few pin-point pustules within days after initiation of an over-the-counter Align brand probiotic. Biopsy revealed psoriasiform and spongiotic dermatitis with spongiform subcorneal pustules and scattered eosinophils, consistent with acute generalized exanthematous pustulosis. Our case highlights a unique presentation of acute generalized exanthematous pustulosis following probiotic exposure with fewer than usual pustular lesions. IL23 suppression by ustekinumab may have contributed to the patient's reduced pustular presentation.
Asunto(s)
Pustulosis Exantematosa Generalizada Aguda/etiología , Probióticos/efectos adversos , Pustulosis Exantematosa Generalizada Aguda/patología , Adulto , Enfermedad de Crohn/complicaciones , Diagnóstico Diferencial , Femenino , Humanos , Psoriasis/complicaciones , Psoriasis/tratamiento farmacológico , Ustekinumab/uso terapéuticoRESUMEN
Injection site reactions with biologic medications are encountered with variable frequency. Although there is no clear definition, they commonly manifest with pain and irritation at the injection site. Previously proposed reaction classification systems may be impractical or insufficient, and more intuitive nomenclature may benefit clinical dermatologists and patients. Negative injection experiences (NIE) are common reasons for biologic medication nonadherence. Here we provide clinical classifications and recommendations for mitigating these reactions. We categorized NIEs into the following: (a) physical, due to the needle and injection process, (b) irritant, related to properties of the injected solution, and (c) allergic, both immediate and delayed.
Asunto(s)
Productos Biológicos , Cumplimiento de la Medicación , Productos Biológicos/efectos adversos , Humanos , Reacción en el Punto de Inyección/diagnóstico , Reacción en el Punto de Inyección/etiología , Reacción en el Punto de Inyección/prevención & controlRESUMEN
Pemphigus vulgaris is the most common form of pemphigus affecting an estimated 30,000-40,000 people in the United States. Costs of systemic and immunoglobulin therapies for pemphigus vulgaris have remained persistently high. Herein, we address the current costs and changes in costs of immunosuppressive treatments, anti-inflammatory treatments, and immunoglobulin treatments covered by Medicaid for pemphigus vulgaris from 2013-2020.
Asunto(s)
Antiinflamatorios/economía , Costos de los Medicamentos/estadística & datos numéricos , Inmunoglobulinas/economía , Inmunosupresores/economía , Medicaid/economía , Pénfigo/tratamiento farmacológico , Corticoesteroides/economía , Corticoesteroides/uso terapéutico , Antiinflamatorios/uso terapéutico , Humanos , Inmunoglobulinas/uso terapéutico , Inmunosupresores/uso terapéutico , Estados UnidosRESUMEN
We present a special case of an 8-year-old girl diagnosed with severe drug reaction with eosinophilia and systemic symptoms due to trimethoprim-sulfamethoxazole for urinary tract infection prophylaxis for congenital vesicoureteral reflux. The patient is believed to have developed drug reaction with eosinophilia and systemic symptoms because of her underlying renal disease.