Apremilast is a potentially useful treatment for severe palmoplantar pustulosis with extra-palmoplantar symptoms.

Palmoplantar pustulosis (PPP) is a chronic inflammatory skin disorder affecting the palms and soles. In rare cases, severe patients develop acute extra-palmoplantar lesions often accompanied by arthralgia. Such cases with extensive symptoms often necessitate systemic treatments with variable efficacy and potential side effects. Apremilast, known for its broad immune response modulation, presents promise as a therapeutic option for severe PPP with joint and extra-palmoplantar lesions. This case highlights apremilast as a potential systemic treatment for such cases with minimal side effects.

Can Wound Exudate from Venous Leg Ulcers Measure Wound Pain Status?: A Pilot Study.

We investigated the associations between the self-evaluated pain status and two pain biomarker candidates, nerve growth factor and S100A8/A9, in exudate from venous leg ulcer to finally develop an objective pain evaluation method. Patients with venous leg ulcer participated in this cross-sectional observational study conducted between April and October 2014 at two medical facilities. During routine wound care, each participant self-evaluated their pain status at each examination using the 10-point numerical rating scale (present pain intensity) and the short-form McGill Pain Questionnaire 2 (continuous pain, intermittent pain, neuropathic pain, affective descriptors, and total score). Venous leg ulcer exudate sample was collected after wound cleansing. The nerve growth factor and S100A8/A9 concentrations in the venous leg ulcer exudate were measured by enzyme-linked immunosorbent assay and standardized according to the wound area. The association between each pain status and the two standardized protein concentrations was evaluated using Spearman's correlation coefficient. In 30 sample collected from 13 participants, the standardized nerve growth factor concentration was negatively correlated with continuous pain (ρ = -0.47, P = 0.01), intermittent pain (ρ = -0.48, P = 0.01), neuropathic pain (ρ = -0.51, P = 0.01), and total score (ρ = -0.46, P = 0.01). The standardized S100A8/A9 concentration was positively correlated with present pain intensity (ρ = 0.46, P = 0.03) and continuous pain (ρ = 0.48, P = 0.03). Thus, these two proteins may be useful for objective evaluation of wound pain in venous leg ulcer patients.

Visualization of Tumor Necrosis Factor-α Distributions Within Pressure Ulcer Tissue Using the Wound Blotting Method: A Case Report and Discussion.

Wound blotting can be used to visualize the protein distribution on a wound bed through protein collection by attaching a nitrocellulose membrane to the wound surface. This study checked for consistency between the protein distributions determined by wound blotting and those determined by removal of the tissue. A patient who was planning to undergo surgical debridement of an ulcer in the sacral region that was caused by lying down for a long period after a cerebral hemorrhage was recruited in Fujisawa City Hospital, Kanagawa, Japan. Wound blotting was performed just prior to surgical debridement and the debrided tissue embedded in paraffin. The ulcer, which had a 2.9 cm major axis, was divided into 20 areas approximately 0.35 cm2 each, and the consistency of tumor necrosis factor-α positivity between the wound blotting samples and tissue sections was examined in each area. The sensitivity and specificity of wound blotting were 89% and 82%, respectively. This wound blotting method noninvasively revealed the protein distributions within the wound tissue.

Selective cyclooxygenase-2 inhibitor cross-reactivity in aspirin-exacerbated respiratory disease.

Aspirin-induced asthma (AIA) is a severe and difficult-to-treat allergic disease in which acute asthma attacks are induced by nonsteroidal anti-inflammatory drugs. Patients with AIA rarely experience asthma attacks when taking celecoxib, a specific inhibitor of cyclooxygenase (COX) 2. A 33-year-old woman had a severe asthma attack with hypoxia and lost consciousness after oral provocation testing with 15 mg of aspirin and also with 50 mg of celecoxib. After 2 months of treatment with 10 mg/day of oral prednisolone, 1600 µg/day of inhaled fluticasone propionate, montelukast as a leukotriene receptor antagonist (LTRA), and long-term beta-agonist, we again challenged her with a provocation test with up to 200 mg of celecoxib; this time there were neither allergic symptoms nor decrease in forced expiratory volume in 1 second. Patients with severe or poorly controlled asthma may experience asthma attacks even if using selective COX-2 inhibitors. However, treatment with steroids and an LTRAs may inhibit asthma attacks induced by celecoxib.