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Introduction: Refractory cases of alopecia areata (AA) may be considered a therapeutic challenge. Intralesional methotrexate (IL-MTX) has been used in other dermatological diseases rather than AA. Likewise, its topical use as an immunosuppressant drug may be of interest for the control of the lymphoid infiltrate in AA. On the other hand, the use of fractional ablative laser is supported in literature as an alternative or complementary treatment in AA, whilst the generation of columns of thermal damage may favour the migration of cells and cytokines that are beneficial. Case Presentation: In this paper, we present 2 cases in which IL-MTX and ablative fractional CO2 laser were combined with excellent outcomes. Conclusion: Previous research encompasses a total of 23 patients. Most patients presented with patchy AA. The doses administered ranged from 2.5 to 50 mg with an average frequency of 3 weeks. On average, most patients required a minimum of 3 sessions. One case employed 1% topical methotrexate ointment. Adverse local events were mild and transient. In conclusion, the concomitant application of these treatments has not been reported previously. Specific recommendations relating to the appropriate dosing of the drug, frequency of administration, and requirements for analytical control studies should be determined in further studies.
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ABSTRACT: Herpes zoster is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus. Genital dermatomes are involved in only up to 2% of cases and are probably underrecognized. We present a series of 7 genital herpes zoster cases diagnosed in our Unit of Sexually Transmitted Diseases. None of our patients were positive for HIV test, and only one was taking immunosuppressive medication. We recommend the use of molecular testings to confirm the diagnosis of varicella-zoster virus or herpes simplex virus infection in all cases of genital herpes-like lesions.
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Herpes Genital , Herpes Simples , Herpes Zoster , Genitália , Herpes Genital/diagnóstico , Herpes Genital/tratamento farmacológico , Herpes Simples/diagnóstico , Herpes Zoster/diagnóstico , Herpes Zoster/tratamento farmacológico , Herpesvirus Humano 3 , HumanosAssuntos
Exantema , Prurigo , Dieta , Exantema/diagnóstico , Exantema/etiologia , Feminino , Humanos , Prurido/diagnóstico , Prurido/etiologiaAssuntos
Inibidores de 5-alfa Redutase/efeitos adversos , Angioedema/induzido quimicamente , Dermatite Alérgica de Contato/etiologia , Dutasterida/efeitos adversos , Mesoterapia/efeitos adversos , Alopecia/tratamento farmacológico , Angioedema/diagnóstico , Dermatite Alérgica de Contato/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Mesoterapia/métodos , Pessoa de Meia-IdadeRESUMO
Sonic hedgehog pathway inhibitor Vismodegib is the first systemic treatment to be approved for metastatic or locally advanced basal cell carcinoma non-subsidiary of surgical treatment, and appears to be a promising treatment option for patients with nevoid basal cell carcinoma syndrome. In these patients, where repeated or prolonged treatment may be necessary, the psychological exhaustion caused by the chronicity of less severe adverse effects appears as the main limiting factor in the persistence of the drug in the long term and in the willingness of patients to take the drug again after its suspension. We report our experience with three cases where a drug holiday approach was effective in decreasing the intensity of adverse effects or improving the patient's subjective tolerance to the drug while maintaining clinical response.
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Antineoplásicos , Síndrome do Nevo Basocelular , Carcinoma Basocelular , Preparações Farmacêuticas , Neoplasias Cutâneas , Anilidas/efeitos adversos , Antineoplásicos/efeitos adversos , Síndrome do Nevo Basocelular/diagnóstico , Síndrome do Nevo Basocelular/tratamento farmacológico , Carcinoma Basocelular/tratamento farmacológico , Proteínas Hedgehog/uso terapêutico , Humanos , Piridinas , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
Chlorpromazine is known to produce both systemic phototoxic and photoallergic reactions. However, it may also cause photoallergic contact dermatitis and, albeit exceptionally, allergic contact dermatitis (ACD). We present a series of photoallergic contact dermatitis and ACD to chlorpromazine diagnosed at a tertiary centre cutaneous allergy unit between 1980 and 2019.
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Antipsicóticos/efeitos adversos , Clorpromazina/efeitos adversos , Dermatite Fotoalérgica/etiologia , Adulto , Queilite/induzido quimicamente , Pálpebras , Dermatoses Faciais/induzido quimicamente , Feminino , Dedos , Dermatoses da Mão/induzido quimicamente , Humanos , Pessoa de Meia-Idade , Testes do Emplastro , Estudos RetrospectivosRESUMO
Dupilumab, a biologic drug approved for the treatment of moderate-to-severe atopic dermatitis, has been associated with resolution or improvement in pre-existing alopecia areata. We report a case of significant improvement of AA after Dupilumab-onset treatment for atopic dermatitis and review the literature.
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Alopecia em Áreas/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Adulto , Alopecia em Áreas/complicações , Dermatite Atópica/complicações , Seguimentos , Humanos , Masculino , Resultado do TratamentoAssuntos
Melanoma/epidemiologia , Doenças da Unha/epidemiologia , Neoplasias Cutâneas/epidemiologia , Neoplasias das Glândulas Sudoríparas/epidemiologia , Glândulas Sudoríparas/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Pé , Mãos , Humanos , Masculino , Margens de Excisão , Melanoma/etiologia , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Doenças da Unha/patologia , Doenças da Unha/cirurgia , Unhas/patologia , Unhas/cirurgia , Pele/patologia , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias das Glândulas Sudoríparas/etiologia , Neoplasias das Glândulas Sudoríparas/patologia , Neoplasias das Glândulas Sudoríparas/cirurgia , Glândulas Sudoríparas/cirurgiaAssuntos
Erupções Acneiformes/induzido quimicamente , Inibidores da Angiogênese/efeitos adversos , Proteínas Recombinantes de Fusão/efeitos adversos , Erupções Acneiformes/patologia , Adenocarcinoma/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Fatores de Crescimento do Endotélio VascularRESUMO
BACKGROUND: Since 2009, an increasing number of published cases of allergic contact dermatitis (ACD) from isothiazolinones in Europe was observed, amounting to an epidemic. However, only few studies have assessed the current situation after changes in European regulation. OBJECTIVES: To analyze the incidence of isothiazolinone-related ACD in our area in the last decade. METHODS: A retrospective study analyzed all patients patch tested in the allergy unit in a tertiary hospital in Spain between January 2010 and June 2019. Positive patch-test reactions to methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) and/or MI alone were recorded. RESULTS: A total of 243 patients (9.55%) with positive patch-test reactions to MCI/MI and/or MI alone among 2544 consecutively patch-tested patients were recorded. An initial increase in the prevalence of MCI/MI allergy was observed, from 4.5% in 2010 reaching a peak in 2015, which was followed by a significant decrease until July 2019 with 3.1% prevalence in 2019. CONCLUSIONS: As shown in our data, regulatory interventions have resulted in a dramatic decrease in the prevalence of MCI and MI ACD, reaching a pre-epidemic level of 3.1% in 2019.
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Dermatite Alérgica de Contato/epidemiologia , Dermatite Ocupacional/epidemiologia , Conservantes Farmacêuticos/efeitos adversos , Tiazóis/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Ocupacional/diagnóstico , Dermatite Ocupacional/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes do Emplastro/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , EspanhaAssuntos
Psoríase/metabolismo , Psoríase/patologia , Adulto , Biomarcadores/metabolismo , Doença Crônica , Feminino , Humanos , Inflamação , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND/OBJECTIVES: Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. METHODS: Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). RESULTS: A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. CONCLUSIONS: Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.
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Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/etiologia , Psoríase/complicações , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/etiologia , Pessoa de Meia-IdadeRESUMO
Programmed cell death receptor 1 inhibitors (anti-PD-1) constitute a form of immunotherapy for the treatment of several cancers. They are associated with cutaneous immune-related adverse events (irAE), occurring in up to 50% of patients. Lichenoid dermatitis is frequent and several presentations have been described. Although attempts have been made to study these reactions, they are yet to be fully characterized and the relationship with tumor response is unclear. We describe a case of digital ulcerative lichenoid dermatitis resembling ulcerative cutaneous lichen planus that occurred during pembrolizumab therapy for oral squamous cell carcinoma. The patient developed a painful ulcer on his index finger 18 months into therapy. Biopsy revealed epidermal ulceration with intense lichenoid dermatitis. Immunohistochemical study revealed intense CD8 positivity at the ulcer's edges and marked CD163 positivity at its base. Although idiopathic forms of this type of lichenoid dermatitis are particularly recalcitrant, our case was successfully managed with topical therapy and oncologic treatment did not require modification. One year after ending treatment the patient remains free of disease progression. It is unclear if this reaction is associated with his favorable oncologic response. This report adds an undescribed reaction to the increasing diversity of cutaneous irAE associated with anti-PD-1 therapy.
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Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Erupções Liquenoides/induzido quimicamente , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Úlcera Cutânea/induzido quimicamente , Administração Cutânea , Idoso , Anticorpos Monoclonais Humanizados/uso terapêutico , Antineoplásicos Imunológicos/uso terapêutico , Betametasona/administração & dosagem , Betametasona/análogos & derivados , Carcinoma de Células Escamosas/tratamento farmacológico , Combinação de Medicamentos , Gentamicinas/administração & dosagem , Humanos , Erupções Liquenoides/tratamento farmacológico , Erupções Liquenoides/patologia , Masculino , Neoplasias Bucais/tratamento farmacológico , Pele/patologia , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/patologiaRESUMO
Apocrine hidrocystoma is a rare, benign, cystic tumor of the apocrine sweat glands. They are most commonly located around the eyes and may also be found on the scalp and neck. However, despite the fact that the nipple and areola contain numerous apocrine sweet glands, apocrine hydrocystomas have not been described previously in this area to the best of our knowledge. We report the first case of this cyst in this unsual location.
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Glândulas Apócrinas/patologia , Mamilos/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adulto , Feminino , Humanos , Mamilos/diagnóstico por imagem , Neoplasias das Glândulas Sudoríparas/diagnóstico por imagem , Ultrassonografia MamáriaRESUMO
Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis.