RESUMO
Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by relapsing eczematous rash with severe pruritus and recurrent infection. Topical emollients and immune-modulators (e.g., corticosteroids and calcineurin inhibitor) are first-line therapies for acute flares. In severe refractory cases, systemic immunosuppression may be required. Increased incidence of AD has been documented in heart-transplant children who receive their transplant or thymectomy before the age of 1 year. The treatment of these patients remains a conundrum for dermatologists. We present a case report of a chronically immunosuppressed transplant patient with severe AD treated with dupilumab and in remission for over 2 years with minimal side effects. We will also discuss impact of transplant immunosuppression in the pathogenesis of AD.
Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/administração & dosagem , Transplante de Coração , Adolescente , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/farmacologia , Dermatite Atópica/imunologia , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/farmacologia , Humanos , Masculino , Células Th2/imunologiaRESUMO
White diseases are a heterogenous group characterized by hypopigmentation or depigmentation. Skin and eye color are determined by the number and size of melanosomes present. Melanin is produced by melanosomes in the melanocytes present within the epidermis of the skin, uvea, and retinal pigmented epithelium (RPE). Conditions altering the number of melanocytes or concentration of melanin result in a lack of pigmentation, appearing as "white diseases" ranging from the well-known albinism and vitiligo to more esoteric white hand syndrome and Degos disease.
Assuntos
Hipopigmentação/diagnóstico , Hipopigmentação/etiologia , Albinismo/diagnóstico , Albinismo/etiologia , Albinismo/terapia , Cor , Cosméticos/efeitos adversos , Diagnóstico Diferencial , Humanos , Hipopigmentação/patologia , Hipopigmentação/terapia , Inflamação/complicações , Líquen Escleroso e Atrófico/diagnóstico , Líquen Escleroso e Atrófico/etiologia , Líquen Escleroso e Atrófico/patologia , Líquen Escleroso e Atrófico/terapia , Papulose Atrófica Maligna/diagnóstico , Papulose Atrófica Maligna/etiologia , Papulose Atrófica Maligna/patologia , Mucosa , Doenças da Unha/etiologia , Nevo com Halo/diagnóstico , Nevo com Halo/etiologia , Nevo com Halo/patologia , Pitiríase Liquenoide/diagnóstico , Pitiríase Liquenoide/etiologia , Pitiríase Liquenoide/terapia , Prognóstico , Preparações Clareadoras de Pele/efeitos adversos , Tinha Versicolor/diagnóstico , Tinha Versicolor/tratamento farmacológico , Tinha Versicolor/etiologia , Vibração/efeitos adversos , Vitiligo/diagnóstico , Vitiligo/etiologia , Vitiligo/terapia , Síndrome de Waardenburg/diagnóstico , Síndrome de Waardenburg/etiologiaRESUMO
Risk of relapse after natalizumab (NAT) cessation and switch to dimethyl fumarate (DMF) is unknown. The objective of this paper is to identify the risk and associated risk factors for relapse after switching from NAT to DMF in relapsing-remitting multiple sclerosis. Patients (n = 30) were treated with NAT for ≥12 months and then switched to DMF in a mean of 50 days. Patient age, annualized relapse rates (ARR), Expanded Disability Status Scale scores (EDSS), and lymphocyte counts were assessed. Overall, eight patients (27 %) had relapses after switching to DMF. Five patients (17 %) suffered severe relapses with multifocal clinical and radiological findings. New lesions by MRI (T2 hyperintense or enhancing) were observed in 35 % of patients. Relapses occurred at a mean of 3.5 months after NAT cessation. Patient age and elevated ARR prior to NAT use were significantly associated with risk of relapse after switch to DMF. Once on DMF for 4 months prior to relapse, lymphocyte count decreased more significantly in patients without relapses than those with relapses. Switching from NAT to DMF correlated with increased relapses. Young patient age, high ARR and stability of lymphocyte counts were risk factors for relapse after transition from NAT to DMF.