RESUMO
Foreign body granuloma can be caused by endogenous compounds as well as various injectable materials. In oriental medicine, pharmacopuncture combining herbal medicine administration and injection is one of the commonly used procedures. Hwangryunhaedok-tang (HHT, a.k.a., Huang-Lian-Jie-Du-Tang in China), an oriental medicinal herb known to produce anti-inflammatory effects, has been recently made in pharmacopuncture products and commonly used for various disorders. An 88-year-old female presented with multiple tender nodules on the left parietal scalp and forehead. The diagnosis of foreign body granuloma caused by HHT pharmacopuncture was revealed by more detailed previous treatment history of postherpetic neuralgia and histopathologic examination. Herein, we report a foreign body granuloma as a delayed adverse reaction caused by non-standard administration of herbal extracts, considered biologically inert.
RESUMO
Background: Systemic remedies such as cyclosporine, methotrexate, and retinoids are off-license treatment options that are considered for severe chronic hand eczema (CHE) that is resistant to first-line treatment. Objectives: The objective of this study was to determine the optimal treatment of CHE patients, including those with atopic dermatitis, and to compare the efficacy between cyclosporine and alitretinoin. Methods: This study was retrospective and included CHE patients who visited the Department of Dermatology at Hanyang University Seoul Hospital in Korea between March 2013 and February 2020. Results: A total of 95 CHE patients was included in this study. In the cyclosporine treatment group, there were more patients with severe baseline Investigator Global Assessment (IGA) (P = 0.033) and higher immunoglobulin E (IgE) level (P = 0.019). The mean recurrence duration was 15.9 weeks in the alitretinoin group and 22.9 weeks in the cyclosporine group, the difference between which was not statistically significant. In a subgroup analysis according to treatment drug, only the low IgE group showed a better recurrence profile for alitretinoin treatment compared to cyclosporine treatment (P = 0.039). When comparing the cumulative recurrence rate during the treatment period and subsequent follow-up periods, the cyclosporine group showed a greater incidence of recurrence than the alitretinoin group in all follow-up periods. The results of our study are consistent with the previously reported efficacy of alitretinoin. Despite the rapid response in the cyclosporine group, 12 weeks of CHE treatment with alitretinoin showed superior efficacy compared to cyclosporine treatment. Conclusions: Both alitretinoin and cyclosporine groups showed efficacy in patients with CHE. Cyclosporine is an alternative treatment of CHE that is refractory to alitretinoin or relapses after its use, especially in the presence of atopic dermatitis.
