Acute onset of a vesiculopustular rash in an ICU patient.

A 63 year-old woman with hyperthyroidism was admitted to the Medical Intensive Care Unit for ARDS following damage to her lungs from propylthiouracil. She was placed on 250 mg SSKI PO TID as an alternative therapy until thyroidectomy could be performed. Four days after admission, she abruptly developed an acneiform rash on her face, shown to be iododerma. The eruption rapidly resolved after discontinuation of the SSKI.

Treatment of psoriasis in patients with hepatitis C: from the Medical Board of the National Psoriasis Foundation.

BACKGROUND: Treating psoriasis in patients with concomitant hepatitis C virus (HCV) infection presents a special challenge. Not only is psoriasis exacerbated by interferon therapy, the standard of care for HCV, but many psoriasis therapies are potentially hepatotoxic, immunosuppressive, or both, which has been generally thought to be a contraindication in chronic infections such as HCV. OBJECTIVE: Our aim was to arrive at a consensus on treating psoriasis in patients with concomitant HCV infection. METHODS: Reports in the literature were reviewed regarding common psoriasis therapies and liver toxicity. RESULTS: Topical therapies are first-line therapy for patients with limited psoriasis and HCV. Ultraviolet B phototherapy may be considered as a second-line treatment when needed. Ultraviolet B phototherapies in combination with topical therapies are first line for patients with moderate to severe psoriasis, and are considered safe in those patients with concomitant HCV infection. Other systemic therapies, such as acitretin, etanercept, and, possibly, other tumor necrosis factor inhibitors, are considered second line. Psoralen plus ultraviolet A should also be considered a second-line therapy. LIMITATIONS: There are few evidence-based studies on treating psoriasis with systemic therapy in patients with pre-existing liver disease. CONCLUSIONS: There are no large double-blind clinical trials addressing the treatment of psoriasis in patients with HCV infection and more studies are needed.

Coal tar 2% foam in combination with a superpotent corticosteroid foam for plaque psoriasis: case report and clinical implications.

Psoriasis is a chronic, inflammatory, immune-mediated, multi-system disease that is treated with a variety of medicines, including topical corticosteroids and, historically, coal tar. In this case, the authors evaluated whether combination therapy with coal tar foam 2% and a topical corticosteroid would induce a remission and maintain clearance of plaque-type psoriasis over an eight-week period. A 59-year-old Caucasian woman with plaque psoriasis of her elbows presented to the authors' dermatology clinic and was treated with clobetasol propionate 0.05% emollient foam in combination with coal tar 2% foam twice daily to her elbows for two weeks. After two weeks, the patient was switched to a maintenance regimen of twice-daily coal tar 2% foam during the week and twice-daily application of the corticosteroid on the weekends. The patient exhibited very favorable clearance of her plaque psoriasis on this regimen at her eight-week follow-up visit. In this case, the combination of coal tar 2% foam and clobetasol propionate 0.05% emollient foam twice daily was used effectively to induce remission of localized plaque psoriasis followed by an efficacious maintenance regimen, which incorporated intermittent therapy with both topical agents.