[Pyodermatitis-pyostomatitis vegetans with nasal involvement]. / Pyostomatite-pyodermatite végétante avec atteinte nasale.

BACKGROUND: Pyodermatitis-pyostomatitis vegetans (PPV) is a rare chronic disorder often associated with inflammatory bowel disease. We report an isolated case involving the oral, labial and nasal mucosa. PATIENTS AND METHODS: A 28-year-old man, in good general condition, presented with a 2-year history of painless stomatitis. The physical examination revealed pustular and exophytic lesions of the jugal, gingival and palatine mucosa on an erythematous background, as well as some pustular and crusted lesions of the lower lip and nostrils. Histopathological analysis revealed epithelial hyperplasia and a suprabasal cleft with some signs of acantholysis and numerous neutrophils and eosinophils. Direct and indirect immunofluorescence assay was negative. There was no associated bowel disease. We concluded on a diagnosis of PPV of younger subjects. The lesions disappeared with oral corticosteroids but with steroid dependency. DISCUSSION: PPV is a rare dermatosis associated in more than 75% of cases with inflammatory bowel disease, usually ulcerative colitis. Lesions of the oral mucosa are a constant finding and are characterised by aseptic pustules on an erythematous background. Skin lesions are pustular and more or less exophytic. To our knowledge, there have been no reports to date of intranasal lesions of PPV.

Single-plaque vegetating bromoderma.

Potassium bromide is still in use for the treatment of multidrug-resistant seizures. It is a known cause of severe drug-induced skin disorders. The clinical presentation of bromoderma may be similar to that of pyoderma gangrenosum when occurring with a single lesion. The case of a young girl with a single vegetating plaque of bromoderma on the leg is reported. The presence of pustules at the periphery of the plaque provides the clinical clue to the diagnosis.

First-line single-agent cetuximab in patients with advanced colorectal cancer.

BACKGROUND: The anti-epidermal growth factor receptor (EGFR) antibody cetuximab is active in heavily pretreated patients with metastatic colorectal cancer (mCRC) both in monotherapy and in combination with chemotherapy (CT). This study assesses the antitumor activity of single-agent cetuximab in CT-naive patients. PATIENTS AND METHODS: Phase II clinical trial was used. Patients were EGFR positive by immunohistochemistry and were not candidate for radical surgery, even in the case of substantial tumor shrinkage. Cetuximab was administered weekly. RESULTS: Thirty-nine patients were treated and evaluated. The most common adverse event was skin toxicity (89% any grade; 48% grade 1; 31% grade 2; 10% grade 3). One patient had a complete response and three obtained partial responses (10% overall response rate). Thirteen patients had stable disease (34%). Twenty-two patients experienced progressive disease (56%). Overall median time to progression (TTP) was 2 months, and the responders individual TTP was 12, 9, 9, and 6 months. CONCLUSIONS: Even in chemo-naive patients, cetuximab as single agent is active only in a small fraction of mCRC, similarly to what has been reported for heavily pretreated patients. The extent of benefit when response occurs is, however, such that it is mandatory to intensify the search for the predictive markers of response to cetuximab therapy.

A single-arm, open-label efficacy and tolerability study of diclofenac sodium 3% gel for the treatment of actinic keratosis of the upper and lower lip.

OBJECTIVES AND METHODS: This study is an evaluation of patients diagnosed with actinic keratosis (AK) lesions of the upper and lower lip (both cutaneous and mucosal surfaces), with at least one lesion on the vermilion (mucosal) lip. Patients were treated twice daily with a topical application of diclofenac sodium 3% gel (Solaraze Gel, Doak Dermatologics) for a period of 90 days with a follow-up assessment at 30 days post-treatment. The presence or absence of target and new lesions was assessed and quantified at the initial baseline visit and at each follow-up visit. An investigator global improvement index score assessment and an evaluation of tolerability was also performed at each follow-up visit. CONCLUSION: The application of diclofenac sodium 3% gel provides an effective approach for the treatment of AK of the lip. The cure rate reported in this study for AK of the lip was similar to that of diclofenac sodium 3% gel for AK on skin elsewhere on the body, and has a low incidence of irritation and other adverse reactions, as well as a high rate of patient satisfaction. The unique safety and tolerability profile of diclofenac sodium 3% gel would appear to lend itself well to treatment of the mucosal lip and vermilion, particularly when treatment decisions involve cosmetic appearance during and subsequent to therapy.

Tattoos: dermatological complications.

From the Eskimo in Greenland to the tribes in Polynesia-the whole world knows the art of tattoo. Despite their wide popularity the relation between the skin diseases and the tattooed pictures aren't studied in depth. With the appearance of professional tattoo studios, the risk of infectious complications was reduced. Simultaneously, on a global scale there has been an increase in pseudolymphoma and allergic reactions caused by the introduction of an exogenous pigment into the dermis. The results of our clinical and therapeutic research and review of literature on the subject outline the major problems related to tattoos, i.e. clinical complications. The summarized data showed infectious diseases transmitted through the process of tattooing and many allergic reactions, granulomas and tumors as complications of a tattoo.

Facial pyogenic granuloma-like lesions under isotretinoin therapy.

A male patient with severe cystic acne was treated with 13-cis-retinoic acid in a dosage of 1 mg/kg/day. Early flare-up of his acne and multiple pyogenic-like lesions on his face appeared during the second week of isotretinoin treatment. Histologic study of the lesions revealed granulation tissue. Possible etiologies for this phenomenon are discussed.

[Recurrent agranulocytosis after taking calcium dobesilate]. / Wiederholte Agranulozytose nach Einnahme von Calciumdobesilat.

A 64-year-old woman fell ill with generalized pyoderma and fever up to 40 degrees C. White cell count was 600/microliters, with 96% lymphocytes. Granulopoiesis in the bone marrow was markedly diminished. After treatment with cefotaxime, 2 g twice daily for one week, the blood count returned to normal. 8 months later generalized pyoderma, fever and agranulocytosis (white cell count 700/microliters) recurred. Once again the findings improved on ofloxacin 200 mg twice daily for 9 days. On repeat questioning about previous drug intake the patient stated that each time before the onset of the agranulocytosis she had taken calcium dobesilate, 500 mg twice daily for the preceding 15 and 3 weeks, respectively. Thereupon a lymphocyte transformation test was performed which revealed significant stimulation by calcium dobesilate 4, 8 and 14 weeks after the second episode of agranulocytosis. -Allergic side effects of calcium dobesilate have repeatedly been reported, but there has been no previously published report of agranulocytosis induced by this drug.

Development of folliculitis and pyoderma gangrenosum in association with abdominal pain in a patient following treatment with isotretinoin.

A 19-year-old man with severe acne developed extensive scalp folliculitis and later superficial pyoderma gangrenosum following treatment with isotretinoin. A cyclical neutropenia was noted and bone marrow findings suggested myelodysplasia. We believe that isotretinoin was implicated in the development of overt symptoms in this patient whose haematological condition was previously asymptomatic.

[Pyogenic dermatoses in the workers of the Apsheron oil production industry and the days of incapacity because of them]. / Piogennye dermatozy u rabochikh neftedobyvaiushchei promyshlennosti Apsherona i dni netrudosposobnosti po nim.

A total of 2820 oilmen regularly exposed to industrial oil were examined. Folliculites were detected in 151, furuncles in 63, hydradenitis in 58, phlegmons in 35, panaritium in 30 subjects. The number of invalidity days due to pyogenic dermatoses was 2-3 times higher among the workers exposed to deep oils than among those handling surface oils; this difference is explained by chemical composition and physicochemical characteristics of the extracted oil.

Pyogenic granuloma-like acne lesions during isotretinoin therapy.

Three male patients with severe nodulocystic acne were treated with oral isotretinoin in a dosage of 0.5 to 1.0 mg/kg/day. A flare of their disease developed, characterized by an inflammatory, hemorrhagic, pyogenic, granuloma-like response of previously crusted acne lesions. This reaction occurred between the sixth and ninth weeks of treatment and was confined entirely to the chest and back. The severity of the reaction prompted the administration of oral prednisone and, in two cases, the discontinuation of isotretinoin therapy. In one patient, pyoderma gangrenosum developed on the thigh. The exact incidence of this pyogenic, granuloma-like reaction to isotretinoin is unknown, although we have seen it in three of 66 patients with nodulocystic acne treated with this drug. The cause of the reaction is unknown, but it may be due to the increased skin fragility and vascular proliferation known to be induced by isotretinoin.

Dapsone-responsive, noninfectious verrucous pyoderma. Its occurrence following cisplatin therapy.

A nodular, centrally verrucous, noninfectious pyoderma of the dorsal aspects of the hands and fingers developed in a 66-year-old man with metastatic bladder carcinoma after palliative cisplatin therapy. The dermatosis was clinically similar to erythema elevatum diutinum but biopsy failed to show substantial leukocytoclastic vasculitis. The eruption responded to dapsone. The role of cisplatin in the induction of the dermatosis is speculative.

[Systemic side effects of external corticoids: results of dermatologic studies in children with neurodermititis]. / Systemische Nebenwirkungen durch Externkortikoide: Ergebnisse dermatologischer Untersuchungen an Kindern mit Neurodermitis

Of 111 children with atopic dermatitis who were admitted as in-patients in a German aero-biological childrens clinic, 83 patients (74.8%) had been prescribed a prolonged corticosteroid therapy from their family doctor. For 60 children (54.1%) the corticosteroid application was topital, partly with occlusive dressing or with fluorinated preparations. The remaining 23 children (20.7%) were treated topically and systemically with corticosteroids. Of the 60 children whose atopic dermatitis was treated exclusively with topical corticosteroids, 59 patients (98.3%) showed undesirable side effects. Moreover, irreversible body changes developed through the transcutaneous absorptive processes, which were more evident and appeared more often in girls than in boys.