Assuntos
Glucocorticoides/administração & dosagem , Vasculite por IgA/tratamento farmacológico , Vasculite por IgA/patologia , Prednisona/administração & dosagem , Idade de Início , Humanos , Vasculite por IgA/complicações , Nefropatias/complicações , Nefropatias/patologia , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Prognóstico , Diálise RenalRESUMO
Thromboangiitis obliterans (TAO) or Buerger's disease is a vascular inflammatory thrombotic occlusive and segmental disease affecting distal small and medium-sized arteries of the limbs. Tobacco is the main trigger factor and avoiding it is the main treatment. Frequently, it is necessary to use high-potency vasodilators, such as iloprost, bosentan, sildenafil, or alprostadil, to relieve symptoms and reduce the risk of amputation. Iloprost is the only one that has been shown to be effective in randomized clinical trials. We report the third case of TAO treated with sildenafil and a new case treated with bosentan. This condition can be diagnosed and treated by a dermatologist. We would like to highlight the excellent clinical response despite the fact that patients continued to smoke. This finding may have important therapeutic implications because early treatment may prevent amputation and can be effective even during the process of giving up smoking.
Assuntos
Mãos/irrigação sanguínea , Citrato de Sildenafila/uso terapêutico , Sulfonamidas/uso terapêutico , Tromboangiite Obliterante/tratamento farmacológico , Vasodilatação/efeitos dos fármacos , Vasodilatadores/uso terapêutico , Adulto , Bosentana , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Tromboangiite Obliterante/diagnóstico , Tromboangiite Obliterante/fisiopatologia , Resultado do TratamentoRESUMO
Pruritus is a symptom that significantly affects the patient's quality of life in cutaneous T cell lymphoma (CTCL). The most effective treatments are those that address the condition itself; however, it is often not possible to control this symptom. Lymphoma-related pruritus normally becomes more severe as CTCL progresses, constituting an important factor for quality of life in these patients. Substance P is a neuromodulator which appears to play a key role in pruritus. Aprepitant is a neurokinin-1 receptor antagonist affecting the substance P receptor. So far, several cases have been documented with an antipruritic response to the drug aprepitant in advanced-stage mycosis fungoides (MF). In this paper, we describe an excellent response to aprepitant in a female patient with severe pruritus secondary to hypopigmented stage I MF. We would also like to stress the absence of nausea and vomiting of this combined therapy of interferon and aprepitant. Aprepitant could improve tolerance to interferon.
Assuntos
Antipruriginosos/uso terapêutico , Hipopigmentação/etiologia , Morfolinas/uso terapêutico , Micose Fungoide/complicações , Antagonistas dos Receptores de Neurocinina-1/uso terapêutico , Prurido/tratamento farmacológico , Neoplasias Cutâneas/complicações , Adulto , Aprepitanto , Feminino , Humanos , Micose Fungoide/patologia , Estadiamento de Neoplasias , Prurido/etiologia , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
Sneddon syndrome is a rare systemic vasculopathy affecting the skin as livedo racemosa and the central nervous system as stroke. A 31-year-old man with a history of livedo racemosa presented with a partial left third nerve palsy. Skin biopsy showed signs of endotheliitis with obliteration of dermal blood vessels due to intimal proliferation and fibrin thrombi consistent with Sneddon syndrome. The patient was treated with platelet antiaggregant therapy with complete resolution of his third nerve palsy. Clinicians should be aware of Sneddon syndrome because prompt diagnosis and treatment may prevent potential morbidity and mortality.
Assuntos
Doenças do Nervo Oculomotor/etiologia , Nervo Oculomotor/patologia , Síndrome de Sneddon/complicações , Adulto , Biópsia , Diagnóstico Diferencial , Movimentos Oculares , Seguimentos , Humanos , Angiografia por Ressonância Magnética , Masculino , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/fisiopatologia , Pele/patologia , Síndrome de Sneddon/diagnóstico , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Carcinoma de Células Escamosas/diagnóstico , Neoplasias Esofágicas/diagnóstico , Neoplasias Cutâneas/secundário , Metástase NeoplásicaRESUMO
Lichen planus follicularis tumidus (LPFT) represents an uncommon variety of lichen planus (LP). Clinically, it presents with prominent purplish lesions or white-pigmented yellowish cysts and comedones. Histopathologically, it is similar to lichen planopilaris, and it is additionally characterized by follicles and cysts surrounded by a lichenoid lymphocytic infiltrate. The most common location is the retroauricular region, and it may be associated with other variants of LP. Herein, we describe the case of a 50-year-old woman with a history of lower limb hypertrophic LP who subsequently presented with multiple pink, tumid, pruritic plaques with white-yellow cysts and comedones extensively affecting the bilateral face. Histopathologic examination revealed a lichenoid infiltrate surrounding the follicles and cysts. We diagnosed LPFT and began treatment with topical corticosteroids, antihistamines, systemic corticosteroids and oral acitretin without improvement. Subsequently, the patient had an acceptable response to cyclosporine at doses of 5 mg/kg/day with remission of itching and tumidity but with residual cysts and comedones remaining. To date, the literature contains only 16 cases of LPFT. To our knowledge, this is the most severe case and is the only one with cessation of disease activity in response to cyclosporine.