Letter: Alopecia areata during ustekinumab administration: Co-existence or an adverse reaction?

Alopecia areata (AA) is a tissue-specific, T-cell-mediated autoimmune disease characterized by non-scarring hair loss. Ustekinumab is a human immunoglobulin monoclonal antibody that binds with the p40-subunit of interleukin-12 (IL-12) and IL-23 and has been licensed for the treatment of moderate to severe plaque psoriasis. The exact pathogenesis of AA remains unclear. However, increased Th1 serum cytokine levels have been associated with this condition. Thus, IL-12 inhibitors (ustekinumab) would be expected to treat or at least to prevent hair loss. We report two cases of acute AA occurring while on ustekinumab administration.

Perifolliculitis Capitis Abscedens et Suffodiens Treated with Systemic Isotretinoin Monotherapy: Case Report and Review of Current Therapeutic Options.

Perifolliculitis capitis abscedens et suffodiens (PCAS) is a rare, suppurative dermatosis of the scalp, the etiology of which remains unknown. It is characterized by the development of comedones, perifollicular pustules, firm or fluctuant and itchy or painful nodules and abscesses of the scalp, connected by communicating sinuses that may lead to the formation of scarring and irreversible alopecia. Treatment of PCAS is challenging, often leading to unsatisfactory results. We present a case of a 23-year-old Caucasian man with PCAS who was treated successfully with systemic isotretinoin monotherapy and we review the current therapeutic options.

Generalized purpuric lichen nitidus. Report of a case and review of the literature.

Generalized purpuric lichen nitidus is an extremely rare form of lichen nitidus. We present the third documented case of this uncommon dermatosis, which was treated successfully with orally administered cyclosporine. During a 12-month follow-up after the cessation of the drug, no recurrence was noticed.

Successful treatment of patch type mycosis fungoides with tacrolimus ointment 0.1%.

Cutaneous T cell lymphomas (CTCLs) are a heterogenous group of lymphoproliferative disorders caused by clonally-derived, skin-invasive T cells. A variety of skin-directed and systemic therapies are available to treat mycosis fungoides/Sézary syndrome (MF/SS), the therapeutic choices of which are guided by the stage of disease. A 29-year-old man presented at our clinic with pruritic, erythematous macules located on the sternum and the lower back. Histological findings and immunohistochemistry studies showed patch stage MF. The patient was treated with tacrolimus ointment 0.1% twice daily for one month, achieving complete remission. Three months after the first episode a relapse was successfully treated with the same therapeutic regimen. Tacrolimus is an immunomodulatory macrolide that reduces the stimulatory capacity toward T cells and is therefore worth investigating as a treatment of CTCL. Topical tacrolimus has been related to an unknown effect with the risk for secondary malignancies including CTCL. Also, black box warnings have been proposed by the FDA for the topical calcineurin inhibitors. Nevertheless, our results in the treatment of early stage MF are in agreement with other unpublished data that have observed its efficacy. To our knowledge, there is no other case of patch type mycosis fungoides treated with tacrolimus ointment 0.1% in the medical literature.

Drug eruptions in children with ENT infections.

OBJECTIVE: A common problem for the clinician in an outpatient clinic is to distinguish a drug eruption from a viral exanthem in a child. The aim of this study was to describe the common drug eruptions seen in children with ENT infections, suggesting an approach to this problem. METHODS: We studied the cases of ENT patients aged 15-years-old and below, with the clinical diagnosis of cutaneous adverse reactions. Main variables in the assessment of drug etiology in skin eruptions were previous experience with the drug in the general population, alternative explanation for the eruption, timing between the ingestion of the drug and the appearance of the lesions, drug levels or evidence of overdose or long-acting drug, subsequent progression of the eruption and reactions to dechallenge and rechallenge. RESULTS: A total of 47 children were examined during a period of 11 months. The indications for drug prescribed were tonsillitis, pharyngitis, rhinitis, otitis and sinusitis. The most usually implicated drugs were amoxycillin-clavulanic acid, cephalosporin, clindamycin, erythromycin, clarithromycin and paracetamol. The main clinical patterns of the eruptions seen were urticaria, maculopapular rash, fixed drug eruption and erythema multiforme. CONCLUSIONS: Careful clinical examination, detailed history, knowledge of the numerous clinical patterns of the eruptions and the drugs specific reaction rates, as well as oral drug rechallenge, RAST and patch tests if indicated, are essential factors in the management of patients with drug eruptions.

Intertoe Squamous Cell Carcinoma Developed in a Patient with Rheumatoid Arthritis under Etanercept Therapy.

The use of tumor necrosis factor-α (TNF-α) inhibitors in the treatment of various inflammatory conditions has altered the field of medical therapeutics. Squamous cell carcinoma is the second most common cancer of the skin, usually affecting sun-exposed areas of the body. We present here the case of a 75-year-old woman with rheumatoid arthritis, who developed an intertoe squamous cell carcinoma (SCC) of the right foot. According to her history, she received etanercept and methotrexate for 5 years for rheumatoid arthritis. The rare localization of this cancer could suggest a possible linkage of the malignancy to the chronic intake of anti-TNF-α treatment. This is the first reported case of an interdigital SCC developed under the use of an anti-TNF-α agent.

Topical 5% benzoyl peroxide and 3% erythromycin gel: experience with 191 patients with papulopustular acne.

Acne is the most common skin disease, with a relative prevalence of 85%-100% among young individuals. It affects the cosmetic appearance of the patients provoking severe distress. A number of different topical treatments have been used for the treatment of acne. In this study, we investigated the efficacy and safety of the topical treatment with 5% benzoyl peroxide and 3% erythromycin gel in patients with papulopustular acne. One hundred and ninety-one patients with inflammatory acne completed the study. The patients included 54 males and 137 females, mean age 22.3 ± 8.1 years. Topical gel was applied on the face once daily for 3 months. The mean number of non-inflammatory and inflammatory lesions after 3 months of therapy decreased significantly with respect to baseline, with a mean percentage reduction of the non-inflammatory and inflammatory lesions by 42.2% and 57.5%, respectively. In conclusion, topical 5% benzoyl peroxide and erythromycin 3% as monotherapy is efficient for the treatment of papulopustular acne.

Exacerbation of psoriasis under efalizumab therapy.

BACKGROUND: Efalizumab is a recombinant humanized IgG1-kappa isotype monoclonal antibody that binds to CD11a, inhibiting T-cell activation. It has been approved for the treatment of moderate to severe plaque psoriasis. Efalizumab has been associated with the development of skin eruptions during the administration period, and this probably represents the potential psoriasis events observed during its administration. OBJECTIVE: We report a case of exacerbation of psoriasis under efalizumab administration. A reversible increase in lymphocyte count with normal total white blood cell count was also noticed. CONCLUSION: Larger series are probably needed to establish clinical and histopathologic criteria and to determine the terminology used regarding the psoriasis adverse events seen with efalizumab treatment.

[Oxcarbazepine-induced localized penile edema]. / Oxcarbazepin-induziertes lokalisiertes Odem am Penis.

Oxcarbazepine is a analogue of carbamazepine with anticonvulsant and analgesic activity. We report a case of localized penile edema caused by oxcarbazepine. The association between the drug and the adverse reaction was confirmed by rechallenge test. This is the first reported case of oxcarbazepine-induced localized penile edema.