The Journal of dermatological treatment
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Depression, anxiety, and obsessive compulsive symptoms are known to be common among patients with acne vulgaris. In contrast to earlier reports, a number of recent studies suggested isotretinoin to be beneficial for depression and anxiety symptoms in acne patients. Moreover, its effects on obsessive compulsive symptomatology are still widely unknown. ⋯ Besides worsening of obsessive doubting, successful treatment with oral isotretinoin seems to be related with improvement in depression, anxiety, and obsessive rumination symptoms in acne vulgaris patients. These changes were not reflected in the disability level that acne patients have reported.
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To critically review the body of clinical trials that report the rates of skin cancer in patients on a biologic therapy, in order to discern whether this therapy is associated with any increase risk of skin cancer. ⋯ Biologic medications are highly efficacious and have a relatively good safety profile; however, high-quality evidence suggests that use of biologic therapies may be associated with an increased risk of detection of NMSC. Psoriatic patients may be at an increased risk due to history of treatment with other therapies also known to increase the risk of skin cancer. As such, it may be important to consider biologic therapies as an additional risk factor for development of NMSC and implement regular skin examinations for patients on these therapies.
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Acitretin is a time-honored treatment for psoriasis. During the last decade biologics have revolutionized the treatment of psoriasis. This raises the question: What is the position of acitretin as a classical systemic treatment for psoriasis in the era of biologics? Based on the mode of action of acitretin, it is evident that at least one antipsoriatic treatment has to be available in the armamentarium of antipsoriatic treatments that is not immunosuppressive, intended for those patients who are contraindicated for immunosuppressive treatment. ⋯ However, acitretin in combination with phototherapy has an efficacy at least comparable with the other classical systemic treatments. Based on several clinical studies it can be concluded that acitretin is an important treatment option in case of contraindications for immunosuppression, such as patients with infections or cancer-prone patients. Furthermore, some evidence is available for high efficacy of the combination of acitretin and biologics.
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Topical imiquimod 5% cream has been used successfully to treat eyelid basal cell carcinoma, Bowen's disease of the eyelid and eyelid lentigo maligna. We report a case of borderline lentigo maligna on the eyelid that proved difficult to treat with surgery and, when the patient deferred surgery for personal reasons, imiquimod 5% cream was used with complete resolution of the lesion and no recurrence so far over a 3-year period of follow-up. The use of imiquimod in lentigo maligna and around the eye is discussed.
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Case Reports
Pott's disease with scrofuloderma and psoas abscess misdiagnosed and treated as hidradenitis suppurativa.
A 29-year-old man with painless ulcers on the lumbar and inguinal regions associated with purulent discharge of 1.5 years' duration presented to our outpatient clinic. Dermatological examination revealed palpable nodules, discharging sinuses and scars on the left lumbar, gluteal and inguinal regions. According to the clinical, histopathological, scintigraphy, and magnetic resonance imaging findings as well as mycobacteriological examinations, the patient was diagnosed with Pott's disease with scrofuloderma and psoas abscess. Herein, we present an interesting case of Pott's disease with scrofuloderma and psoas abscess mistreated as hidradenitis suppurativa for a long time.