The Journal of dermatology
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A 25-year-old male presented with pruritic papules over his trunk and extremities. The pruritic eruption had appeared on the arms 5 months before and gradually spread over the trunk. Blood tests showed a white blood cell count of 13 760/microL with 42.2% eosinophils. ⋯ The addition of cyclosporine resulted in improvement of his symptoms. Both drugs were successfully tapered without relapsing symptoms. Hypereosinophilic syndrome with cutaneous necrotizing vasculitis is a rare condition, and this case suggests that cyclosporine may be a useful therapeutic adjunct in facilitating steroid tapering.
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Nicolau syndrome is a rare but well-recognized cutaneous adverse drug reaction at the site of i.m. injection of certain drugs. Clinically, it is characterized by severe pain immediately after the injection followed by an erythematous reticular patch that may result in a necrotic ulcer and scarring at the injection site. We describe a 60-year-old woman with a painful, violaceous, crusted plaque after i.m. diclofenac administration to her right buttock. ⋯ A clinical diagnosis of Nicolau syndrome due to diclofenac injection was made, and reconstructive surgery of the wound was performed. Although diclofenac is a widely used non-steroidal anti-inflammatory drug, Nicolau syndrome following i.m. diclofenac injection has rarely been reported in the published work. Application of a cold compress was considered an aggravating factor in our patient.
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Letter Case Reports
Necrotizing fasciitis of the leg due to Photobacterium damsela.
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Minocycline-induced nail pigmentation is an uncommon side-effect. It usually develops after years of the therapy, and coincides with other pigmented sites. ⋯ No other pigmentation was found elsewhere on the skin, mucous membranes, teeth or sclerae of them. Our cases demonstrate that nail pigmentation can occur after short-term minocycline therapy, and propose the possibility that nail discoloration may precede other pigmentary changes.
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The term autoinflammatory syndromes describes a distinct group of systemic inflammatory diseases apparently different from infectious, autoimmune, allergic and immunodeficient ones. Originally, it was almost synonymous with clinically defined hereditary periodic fever syndromes, including familial Mediterranean fever, hyper immunoglobulin D syndrome with periodic fever and tumor necrosis factor receptor-associated periodic syndrome. ⋯ These diseases are all caused by or associated with mutations of genes regulating innate immunity and have common clinical features accompanied with activation of neutrophils and/or monocytes/macrophages. In this review, major autoinflammatory syndromes are summarized and the pathophysiology of related skin disorders is discussed in association with dysregulated innate immune signaling.