The Journal of dermatological treatment
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Randomized Controlled Trial
The efficacy of combined PUVA and low-dose azathioprine for early and enhanced repigmentation in vitiligo patients.
Immunosuppressive agents are used widely in the treatment of vitiligo. Corticosteroids are used either alone or as adjuvant therapy by many practitioners. Cyclophosphamide and cycloporine-A have also been used with variable success. Azathioprine may have the potential for the treatment of vitiligo alone or in combination with other modalities. ⋯ Azathioprine may potentiate the repigmentary effects of PUVA therapy in vitiligo patients. A limitation of the study is the lack of validated measures for vitiligo assessment.
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Case Reports
Cutaneous adverse effects during therapy with an epidermal growth factor receptor (EGFR) inhibitor.
The use of epidermal growth factor receptor (EGFR) inhibitors for the treatment of solid tumours is now increasing. Cutaneous side effects, namely acneiform eruption, xerosis, telangiectasia, hyperpigmentation, fissures, hair and nail changes, are reported in literature. We describe a case of a man treated with an EGFR-inhibitor (erlotinib) for a cell lung cancer who developed skin manifestations localized in an uncommon area and with an atypical evolution.
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Randomized Controlled Trial Multicenter Study
A randomized study of the safety, absorption and efficacy of pimecrolimus cream 1% applied twice or four times daily in patients with atopic dermatitis.
Pimecrolimus cream 1% (Elidel), a non-steroid inhibitor of inflammatory cytokines, is effective in the treatment of atopic dermatitis, without corticosteroid-related side effects such as skin atrophy. It is indicated for twice-daily application. More frequent applications might be expected either to enhance efficacy or increase toxicity. This study compared the safety, efficacy and systemic absorption of pimecrolimus administered twice daily (recommended dose) and four times daily early in the treatment of patients with moderate to severe atopic dermatitis. ⋯ The data suggest that increasing pimecrolimus application from twice daily to four times daily to treat moderate to severe atopic dermatitis for up to 3 weeks does not alter the safety profile nor does it increase the efficacy of treatment. Systemic absorption of pimecrolimus applied BID and QID is minimal and is not different between dosing regimens. Patients and physicians familiar with the potential hazards of overuse of topical corticosteroids should be reassured that if pimecrolimus is applied at twice the recommended BID dose for short periods of time, there is no effect on safety, tolerability, or systemic absorption.
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Case Reports
Treatment of hidradenitis suppurativa with infliximab in a patient with Crohn's disease.
Hidradenitis suppurativa is a chronic, inflammatory, scarring disease characterized by recurrent flares. Recently, a group of 'autoinflammatory disorders' has been described. These disorders are characterized by recurrent inflammatory episodes not mediated by autoantibodies or antigen-specific T-cells. Some of these autoinflammatory disorders have been successfully treated with anti-tumor necrosis factor antibodies. ⋯ This case suggests that infliximab may be effective in the treatment of hidradenitis suppurativa in association with Crohn's disease. We also suggest that hidradenitis suppurativa may be closely linked with this new group of autoinflammatory disorders.
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Leukocytoclastic vasculitis (LcV) is the most common form of vasculitis of the skin and usually results from deposition of immune complexes at the vessel wall. It presents in different forms and in association with different diseases. When IgA is the dominant immunoglobulin in immune complexes, systemic involvement is likely in both children and adults (Henoch-Schönlein purpura--HSP). ⋯ In chronic or relapsing LcV we suggest colchicine as a first-line and dapsone as a second-line therapy. Corticosteroids may reduce the incidence of severe renal insufficiency in children according to some studies, but there is no study showing such an effect in adults. Severe systemic vasculitis requires immunosuppressive strategies.