Experience in treating patients with rubrophytosis with nizoral

A total of 201 patients suffering from trichophytosis induced by T. rubrum have been effectively treated with nizoral combined with external management: removal of the nail plates, keratolytic and fungicidal therapy. Treatment with this drug should be preceded by a comprehensive clinical and laboratory examination.     

Neoadjuvant immunotherapy with combined ipilimumab and nivolumab in patients with melanoma with primary or in transit disease

The introduction of new therapeutic agents has revolutionized the treatment of metastatic melanoma. The approval of adjuvant anti-programmed death-1 monotherapy with nivolumab or pembrolizumab, and dabrafenib plus trametinib has recently set a new landmark in the treatment of stage III melanoma. Now, clinical trials have shown that immune checkpoint blockade can be performed in a neoadjuvant setting, an approach established as a standard therapeutic approach for other tumour entities such as breast cancer. Recent studies suggest that a pathological response achieved by neoadjuvant immunotherapy is associated with long-term tumour control and that short neoadjuvant application of checkpoint inhibitors may be superior to adjuvant therapy. Most recently, neoadjuvant ipilimumab plus nivolumab in stage III melanoma was reported. With two courses of dose-optimized ipilimumab (1 mg kg⁻¹) combined with nivolumab (3 mg kg⁻¹), pathological responses were observed in 77% of patients, while only 20% of patients experienced grade 3 or 4 adverse events. However, the neoadjuvant trials employing combined immune checkpoint blockade conducted so far have excluded patients with in transit metastases, a common finding in stage III melanoma. Here we report four patients with in transit metastases or an advanced primary tumour who have been treated with neoadjuvant ipilimumab plus nivolumab according to the OpACIN-neo trial scheme (arm B). All patients achieved radiological disease control and a pathological response. None of the patients has relapsed so far. Linked Comment:   Blankenstein and van Akkooi. Br J Dermatol 2020; 183 :421–422 .     

Dermatofibroma with Myxoid Changes in a Patient with Psoriasis

A 38-year-old female with psoriatic arthritis developed a dermatofibroma (DF) on her upper arm. Its position was not exactly on a psoriatic plaque; however, psoriatic lesions were present diffusely around the DF lesion. Histological examination revealed the typical features of DF with myxoid changes in the portion between the tumor nest and the overlying epidermis. The mast cell number was significantly increased over that of solitary DFs without myxomatous lesions. It was suggested that mast cells may play a role in induction of the myxoid changes in the DF lesion in this case.     

Hypertriglyceridemia in patients with psoriasis treated with cyclosporine.

Eight patients received cyclosporine at doses of 2.0 to 7.5 mg/kg/day. Seven of these patients had increased fasting plasma triglyceride levels with cyclosporine therapy compared with pretreatment values, which peaked after 1 month of therapy. Four patients experienced elevations in fasting triglycerides, over the upper limits for age- and sex-matched controls, which were at least two times higher than their baseline values. It was striking that all four of these patients had previously had hypertriglyceridemia while using etretinate and three of these patients had preexisting hypertriglyceridemia before both etretinate and cyclosporine therapy. Triglyceride elevation did not correlate with cyclosporine levels. Thus cyclosporine, similar to etretinate, unmasks a latent tendency for mild to moderate hypertriglyceridemia. Fasting triglyceride levels should be monitored during cyclosporine therapy, especially after 1 to 2 months of use, and in patients with preexisting increased triglycerides and/or a history of etretinate use.     

Experience with Cyclosporine in Children with Chronic Idiopathic Urticaria

Abstract: Background: The identification of an autoimmune mechanism for many patients with chronic idiopathic urticaria (CIU) was used as a rational for a controlled clinical trial of cyclosporine for adults with CIU not responsive to usual measures. That randomized placebo controlled clinical trial demonstrated clinical efficacy, acceptable safety, and a suggestion of inducing remission in such patients. Objective: To report our experience with cyclosporine in pediatric patients with CIU. Methods: Fifty‐four patients with CIU were referred to us during the period from 2000 through June of 2005. Seven of those, aged 9–16, failed therapy with high dose antihistamines even with the addition of alternate morning prednisone. Neoral brand of cyclosporine, 3 mg/kg/day divided b.i.d., was initiated in these patients. Cyclosporine serum concentrations, blood urea nitrogen (BUN), creatinine, and blood pressure were routinely monitored. Results: All had cessation of hives. This occurred after 1–4 weeks for six of the seven and 8 weeks for one. While some experienced relapses, all were eventually off of all medications and free of hives. None of the seven experienced any adverse effects. Conclusions: Our experience in children is consistent with a previous controlled clinical trial in adults and supports the efficacy and safety of cyclosporine for CIU. However, we recommend that it be reserved for those whose CIU that is resistant to conventional measures and that patients be carefully monitored with cyclosporine serum concentrations and measures of renal function.     

Onycholysis associated with capecitabine in patients with breast cancer

BACKGROUND: Onycholysis, which is separation of the nail plate from the nail bed at its distal and lateral attachments, can cause pain and impair function and is a well-known side effect of traditional chemotherapeutic agents. OBJECTIVES: We present two cases of onycholysis associated with capecitabine in women with advanced breast cancer, who were initially referred for evaluation of onychomycosis and review the literature on capecitabine. CONCLUSION: Owing to the increased frequency of use of capecitabine for different cancers, physicians should be aware of this side effect.     

Lipoatrophy in patients with AIDS: treatment with polymethylmethacrylate in Amazonas, Brazil

Background The use of antiretroviral therapy (ART) in AIDS has been associated with lipodystrophic syndrome, which is characterized by metabolic alterations and abnormal corporal fat distribution. Our goal was to describe and evaluate the use of polymethylmethacrylate (PMMA) to treat lipoatrophy in patients with AIDS from Amazonas, Brazil. Methods Patients with AIDS undergoing ART and presenting with facial lipoatrophy were invited to participate in the study. A face‐to‐face interview was conducted, and patients were treated with applications of PMMA 30%. Results A total of 49 cases were included. The mean age was 45 (SD 6.1) years old, and the mean educational level (measured in schooling years) was 10.5 (SD 3.2) years of schooling. The median of CD4 cell count was 482.5 (interquartile range: 338–574.5) cells/mm³. Stavudine and zidovudine were the most frequently prescribed ART drugs. The total number of PMMA injections ranged from one to five times, and side effects were not frequent. A total of 42 (85.7%) patients reported satisfaction after a follow‐up of more than 12 months, presenting good fullness of the deformity. Conclusions Our data showed that patients with AIDS with lipoatrophy related to ART could safely benefit from PMMA‐based treatment.     

糖皮质激素联合免疫球蛋白治疗中毒性表皮坏死松解症15例疗效观察

目的:探讨糖皮质激素联合静脉注射免疫球蛋白(IVIG)治疗中毒性表皮坏死松解症(TEN)的临床疗效、不良反应和转归。方法:回顾性分析15例TEN患者采用糖皮质激素联合免疫球蛋白治疗的临床资料。结果:15例TEN患者均伴有黏膜糜烂,皮损(表皮已剥脱或即将剥脱)面积占体表面积的(19.40±6.51)％;糖皮质激素用量(以泼尼松为标准量):(1.5～2.0)mg/(kg·d);IVIG用量:(0.2～0.4)g/(kg·d),连续用药(6.0±1.3)d。联合用药第(3.0±1.3)天开始起效,痊愈9例,共治疗(23.60±5.49)d;基本痊愈5例,共治疗(16.70±3.14)d;死亡1例。所有患者均可耐受IVIG治疗。结论:糖皮质激素联合IVIG治疗TEN具有协同作用,可明显提高疗效和减少死亡,减少糖皮质激素引起的不良反应。     

Etoricoxib challenge in patients with chronic urticaria with NSAID intolerance

Patients with chronic urticaria frequently experience flares of hives following the ingestion of chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs). The pathogenic mechanism of these reactions is based on cyclooxygenase-1 (COX-1) enzyme inhibition. In most cases, nonselective NSAIDs, which inhibit both COX-1 and COX-2, are responsible for such adverse reactions; in contrast, analgesic and anti-inflammatory drugs exerting limited inhibition on COX-1 are generally better tolerated by these patients. This study aimed to detect tolerability of etoricoxib, a selective COX-2-inhibiting drug, in patients with chronic urticaria with a history of NSAID intolerance. Single-blind, placebo-controlled oral challenges with increasing doses of etoricoxib were carried out in 17 adult patients with chronic urticaria exacerbated by NSAID. All patients tolerated the drug at therapeutic doses. The study suggests that etoricoxib, with its favourable COX-1/COX-2 ratio, is well tolerated by patients with chronic urticaria exacerbated by NSAID intolerance.