Interferon‐induced vitiligo in hepatitis C patients: a case series

Background Vitiligo is an autoimmune disease characterized by depigmented patches and macules. It is associated with many autoimmune diseases, the most common of which is thyroid disease. The association between Interferon (IFN) therapy and vitiligo is rarely reported in the literature, despite its common usage in hepatitis B viral infection, hepatitis C viral infection (HCV), hematological malignancies and melanoma. Case We are reporting eight cases of vitiligo that appeared after treating HCV with IFN. Conclusion Interferon unmasks vitiligo in susceptible individuals.     

Voriconazole‐induced photosensitivity: photobiological assessment of a case series of 12 patients

Background Voriconazole, a broad‐spectrum triazole antifungal agent increasingly used to treat aspergillosis, has been linked with acute photosensitivity and skin carcinogenesis. The action spectrum of the photosensitivity is unknown, while an indirect retinol effect secondary to the antifungal’s impact on CYP450 enzymes has been proposed to contribute to the underlying mechanism. Objectives To perform a detailed photobiological assessment of the photosensitivity presenting in a series of 12 patients treated with voriconazole. Methods  Minimal erythemal dose thresholds (MED) to narrow wavebands of ultraviolet (UV) A, UVB and visible light were determined. Provocation testing was performed to broadband UVA (310–400 nm) and to solar‐simulated radiation (SSR) (290–400 nm). Patients underwent routine photopatch testing and laboratory investigations including serum vitamin A (retinol). Results  Patients (eight men, four women; median age 54 years, range 40–63) experienced moderate‐severe cutaneous erythema (n = 12), burning pain (n = 5), itching (n = 3), scaling (n = 5), vesiculation (n = 5) and oedema (n = 1) following sunlight exposure; increased lentigines (n = 4) and actinic cheilitis (n = 4) were also observed. While the majority (n = 8) of patients showed normal MED thresholds to monochromator phototesting to UVB, UVA and visible light, a low MED to UVA was observed in four patients. Repeated provocation testing with broadband UVA and SSR provoked an abnormal erythema in eight and 10 patients, respectively. Serum retinol levels were mildly elevated in two patients but normal in the majority. Conclusion UVA sensitivity is the predominant finding in acute voriconazole‐induced photosensitivity. We found little evidence of elevated circulating retinol as the causal factor. Patients with voriconazole‐induced photosensitivity require education in appropriate UVA protective measures in addition to consideration of skin surveillance for malignant sequelae.     

Angiotensin‐converting‐enzyme inhibitors and angiotensin II receptor blockers induced pemphigus: A case series and literature review

Pemphigus is a group of autoimmune diseases characterized by the formation of erosions and/or flaccid bullae of the skin and/or mucosae. The definition “drug‐induced pemphigus” has been coined to indicate cases of pemphigus with clinical, histological and immunopathologic features similar to those of the idiopathic disease but induced by systemic ingestion or local use of some drugs. The present authors analyzed a case series of three case reports with clinical and pharmacological features compatible with the diagnosis of angiotensin converting enzyme inhibitors or angiotensin II receptor blocker drug‐induced pemphigus. The patients were visited by the dermatological Unit of Magna Graecia University in Catanzaro. All suspected drug induced pemphigus were treated by suspending the suspected drug and by starting a treatment with systemic corticosteroid drugs, leading to a remission of the clinical manifestations in some months. When a drug induced bullous disease is probable, it is necessary to interrupt the suspected substance and to start a high dose treatment with corticosteroid drugs to resolve the clinical case in a short period of time.     

Human papillomavirus evaluation of vemurafenib‐induced skin epithelial tumors: a case series

Erdheim–Chester disease (ECD) is a rare non‐Langerhans cell histiocytosis defined by heterogeneous multiorgan involvement. Due to the rarity of this disease strong evidence‐based therapies have yet to be established and prognosis has previously been considered to be poor, with more than half of patients dying within 3 years of initial presentation. We describe an 86‐year‐old woman with a 34‐year history of extensive cutaneous and internal nodules with typical pathological and immunophenotypical (CD68⁺/CD1a^?) features of ECD without evidence of the BRAF V600E mutation. The cosmetic appearance of cutaneous nodules and hoarse voice caused by vocal cord nodules has been managed surgically. More aggressive therapies reported for ECD were trialled for this patient, such as radiotherapy and interferon‐α, with no response. This case demonstrates a relatively good prognosis in ECD that has been managed conservatively.     

Corticosteroid‐induced hyperglycemia is increased 10‐fold in patients with pemphigus

This study aimed to highlight the importance of routine screening for hyperglycemia and to develop a standardized, evidence‐based approach for the management of pemphigus patients on prolonged systemic corticosteroid (CS) therapy. A cross‐sectional study was conducted in two university‐affiliated teaching hospitals using a referred sample of 200 patients with a confirmed diagnosis of pemphigus vulgaris, pemphigus foliaceus, or mucous membrane pemphigoid. All patients were receiving systemic CS therapy. A total of 150 patients responded to the survey. Six participants were excluded and 144 were included. The main outcome measure was blood glucose level to detect hyperglycemia. New‐onset hyperglycemia was identified in 40% of patients who received CS therapy. None of the expected variables, including age, body mass index, family history of diabetes, corticosteroid dose, and duration of corticosteroid therapy, were independently associated with new‐onset hyperglycemia. These findings indicate that the prevalence of CS‐induced hyperglycemia in pemphigus patients is 40% and that in patients with pemphigus or MMP, CS therapy is associated with a markedly increased risk for hyperglycemia (odds ratio = 10.7, 95% confidence interval 1.38–83.50) compared with that of patients with the same diseases who do not receive CS therapy.     

Atypical anti‐psychotics in Delusional Parasitosis: a retrospective case series of 20 patients

Background Delusional Parasitosis (DP) is a relatively uncommon condition wherein there is a fixed belief that one is infested with living organisms despite a lack of medical evidence of such infestation. Pimozide has been mooted as specific for the treatment of this condition. Atypical anti‐psychotics have received attention in recent years. Methods We describe the clinical features and treatment responses in a retrospective review of 20 cases treated at this department over a 5 year period, and selectively review the literature. Results The majority were treated with atypical anti‐psychotics and all subjects who followed up showed varying degrees of clinical improvement irrespective of the anti‐psychotic used. Conclusion The evidence for pimozide as first line drug in DP is limited to one small, non‐randomized placebo‐controlled trial. DP responds well to most anti‐psychotics. Prospective randomized trials are needed to clarify optimal treatment of this relatively rare but debilitating condition.     

Azathioprine‐induced Sweet's syndrome: A case series and review of the literature

We present three patients with azathioprine‐induced Sweet's syndrome (AISS) who attended our tertiary institution within a 12‐month period. Established associations exist between Sweet's syndrome and some medications; however, to date links to azathioprine are tentative. While there are case reports of AISS, most have occurred in patients with inflammatory bowel disease (IBD), an underlying predisposition for Sweet's syndrome. Our case series adds to the evidence that the entity of AISS truly exists independent of confounding factors such as concurrent IBD.