Vasculopathy related to cocaine adulterated with levamisole: A review of the literature.

BACKGROUND: Recently, there have been numerous case reports and series describing patients presenting with cutaneous vasculopathy that has been linked to the levamisole frequently found in cocaine. OBJECTIVE: The purpose of this study was to review all published case reports and series of patients reported with cutaneous vasculopathic findings of lemavisole induced vasculopathy (LIV) associated with cocaine use. METHODS: A review of PubMed was performed searching the keywords: levamisole, cocaine, in combination with vasculitis, and vasculopathy. Twenty-two case reports and series were available with sufficient data on reported patients to be included. Four patients from the authors' clinical experience are included as well. RESULTS: A number of common clinical and pathological findings are reviewed, including lower extremity (46/55 patients, 84%) and ear involvement (40/55 patients, 73%), and positive anti-neutrophil cytoplasmic antibodies (ANCA) findings (p-ANCA 42/48 patients, 88%; anti human neutrophil elastase 11/11 patients, 100%). Similar numbers of patients were treated with systemic corticosteroids as were treated conservatively; there was comparable improvement on follow up. CONCLUSIONS: There are a number of clinical and laboratory findings that are commonly found in patients with LIV. There is currently insufficient data to recommend treatment with systemic corticosteroids in patients with this condition.

Skin lightening cream induced dermatitis and atrophy.

We present the case of a Malian woman who had been using skin-lightening creams for an excess of 5 years. On presentation to our clinic she had multiple areas of atrophy and striae with erythema. She had been using a topical estrogen cream over all effected areas for two weeks. We present this case to draw attention to the serious problem of widespread and unregulated use of skin lightening creams in Africa. Herein we include a review of the literature on the prevalence of the problem as well as associated side effects of commonly implicated medications.

Are biologics safe in the treatment of atopic dermatitis? A review with a focus on immediate hypersensitivity reactions.

Traditional systemic agents used for the treatment of atopic dermatitis (AD) are associated with significant potential toxicities and often do not provide adequate therapeutic responses. Biologic agents hold promise for a more targeted and less toxic approach to AD systemic therapy. Patients with AD, however, may theoretically be at higher risk of developing IgE-mediated reactions to protein-based therapies. We performed a review of publications reporting the use of biologics in the treatment of AD. Of the 261 patients with AD identified who were exposed to a biologic therapy, no type-I immediate hypersensitivity reactions were reported. One infusion reaction occurred with infliximab and two patients had "mild respiratory difficulty" with interferon-gamma. Thrombocytopenia may occur at a higher rate than expected in patients treated with efalizumab. Combined, these data support the safety of biologics in the treatment of AD and the further development of new biologics for this population should be encouraged.

A case series of refractory cutaneous sarcoidosis successfully treated with infliximab.

INTRODUCTION: Sarcoidosis is a systemic granulomatous disease of unknown cause. The management of sarcoidosis remains problematic. Systemic and topical corticosteroids are the mainstay of therapy but may cause unacceptable side effects. Biologic therapies, such as infliximab, have recently been proposed as another treatment option for cutaneous sarcoidosis. CASE REPORT: The authors describe three patients who were diagnosed with cutaneous sarcoidosis with systemic involvement. All of the patients were refractory to conventional therapies but responded to infliximab therapy. CONCLUSION: Infliximab is an alternative medication for refractory sarcoidosis that has a relatively benign side-effect profile. However, definite indications, dosage, interval, and duration of treatment for cutaneous sarcoidosis are not firmly established.

Polycystic kidney disease: inheritance, pathophysiology, prognosis, and treatment.

Both autosomal dominant and recessive polycystic kidney disease are conditions with severe associated morbidity and mortality. Recent advances in the understanding of the genetic and molecular pathogenesis of both ADPKD and ARPKD have resulted in new, targeted therapies designed to disrupt cell signaling pathways responsible for the abnormal cell proliferation, dedifferentiation, apoptosis, and fluid secretion characteristic of the disease. Herein we review the current understanding of the pathophysiology of these conditions, as well as the current treatments derived from our understanding of the mechanisms of these diseases.

Spontaneous eruptive keloid-like cutaneous lesions in a renal transplant patient: a form of nephrogenic systemic fibrosis?

This is a case report of a 63-year-old man post renal transplant who developed eruptive keloids, many of which developed with no history of previous trauma. Reports of spontaneous keloids are rare in the literature, and given his history of renal failure, we have considered a connection with nephrogenic systemic fibrosis (NSF). With no history of prior keloid formation, the patient developed a large number of lesions with a wide distribution, which then subsequently healed without keloid formation. Additionally, the lesions stained positive for CD68 and factor XIIIa, both of which are correlated with the lesions of NSF. However, the patient did not present with the classic clinical presentation of NSF, had no history of exposure to gadolinium, and staining for CD34 was negative. In conclusion, NSF is a relatively new disease, the details of which have yet to be clearly established. This case may represent a variant of NSF.

A mechanism-based classification of dermatologic reactions to biologic agents used in the treatment of cutaneous disease: Part 1.

Biologic therapies are an efficacious new method of controlling a number of chronic conditions. Data regarding these medications continues to emerge, giving clinicians a greater understanding of their side effects profiles. The biologic agents used in dermatology, particularly the tumor necrosis factor-alpha inhibitors, have a number of varied dermatologic side effects. In this two-part article, we perform a review of literature regarding the cutaneous side effects of infliximab, etanercept, adalimumab, rituximab, efalizumab, and alefacept. In Part 1, we will discuss cutaneous infections, malignancy, rebound phenomenon, eczema, atopic dermatitis, lichenoid reactions, granulomatous disease, pruritus, acne, and progressive multifocal leukoencephalopathy.

A mechanism-based classification of dermatologic reactions to biologic agents used in the treatment of cutaneous disease: Part 2.

Biologic therapies are an efficacious new method of controlling a number of chronic conditions. Data regarding these medications continues to emerge, giving clinicians a greater understanding of their side effects profiles. The biologic agents used in dermatology, particularly the tumor necrosis factor-alpha inhibitors, have a number of varied dermatologic side effects. In this two-part article, we perform a review of literature regarding cutaneous side effects of infliximab, etanercept, adalimumab, rituximab, efalizumab, and alefacept. In this second part, we discuss injection site reactions, infusion reactions, vasculitis, drug-induced lupus erythematosus, psoriasiform lesions, rebound phenomenon, eczema, atopic dermatitis, and hypersensitivity reactions.