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Zeitschrift Fur Gastroenterologie Jun 2024As of now, there exists no established therapy for ELP. Retinoids, which are standard in treating cutaneous LP, do not exhibit positive effects in ELP. While topical...
As of now, there exists no established therapy for ELP. Retinoids, which are standard in treating cutaneous LP, do not exhibit positive effects in ELP. While topical glucocorticosteroids often yield favorable responses in esophageal inflammation, some cases prove recalcitrant or refractory. In such instances, various immunosuppressive therapies have been attempted with variable success.This report details a severe case of ELP that showed resistance to prednisolone, acitretin, alitretinoin, adalimumab, tacrolimus, hydroxychloroquine plus mycophenolate mofetil, and cyclophosphamide. The initiation of the JAK inhibitor tofacitinib induced an impressive clinical, endoscopic, and histological remission. This positive response to a JAK inhibitor is discussed in the context of our evolving understanding of the immune-mediated pathogenesis of this disease.
PubMed: 38917831
DOI: 10.1055/a-2300-0375 -
Cureus May 2024Mal De Meleda is a rare genetic disorder characterized by palmoplantar keratoderma, often presenting challenges in diagnosis and management. This case report discusses...
Mal De Meleda is a rare genetic disorder characterized by palmoplantar keratoderma, often presenting challenges in diagnosis and management. This case report discusses an 18-year-old male presenting with thickened, yellowish skin on both palms and soles, accompanied by itching and cracking. A diagnosis of the transgradiens variant of Mal De Meleda was established through clinical and histopathological examination. Treatment with oral acitretin and topical moisturizers resulted in significant improvement. This report highlights the importance of recognizing rare variants of palmoplantar keratoderma and the need for a multidisciplinary approach to diagnosis and management.
PubMed: 38903266
DOI: 10.7759/cureus.60717 -
BMJ Case Reports Jun 2024Hypertrophic discoid lupus erythematosus is a rare variant of chronic cutaneous lupus erythematosus and is often challenging to treat. A male in his early 60s presented...
Hypertrophic discoid lupus erythematosus is a rare variant of chronic cutaneous lupus erythematosus and is often challenging to treat. A male in his early 60s presented with diffuse erythematous, crusty, pruritic plaques on his upper and lower extremities, face, upper back, dorsal aspect of the hands and chest. He also described prolonged morning stiffness, swelling of his fingers and wrists, oral sores and Raynaud's phenomenon. He was positive for antinuclear antibody and anti-SSA antibody and had low C3 and C4 proteins. The skin biopsy was consistent with hypertrophic discoid lupus erythematosus. He was diagnosed with systemic lupus erythematosus. Skin lesions were refractory to treatment with topical corticosteroids, topical acitretin, hydroxychloroquine, azathioprine or mycophenolate. Anifrolumab infusions were initiated with a near-complete resolution of cutaneous symptoms within 3 months.
Topics: Humans; Male; Lupus Erythematosus, Discoid; Middle Aged; Treatment Outcome; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal
PubMed: 38890107
DOI: 10.1136/bcr-2023-258487 -
Drugs in R&D Jun 2024PD-1 inhibitors have revolutionized cancer therapies and are being used to treat an expanding array of cancers. To best serve patients, clinicians should be familiar...
BACKGROUND AND OBJECTIVE
PD-1 inhibitors have revolutionized cancer therapies and are being used to treat an expanding array of cancers. To best serve patients, clinicians should be familiar with the spectrum of skin manifestations associated with PD-1 inhibitor therapy. Here, we report a unique case of hypertrophic lichen planus (HLP) in a 64-year-old man treated with pembrolizumab; the presentation initially suggested a squamous cell carcinoma (SCC) morphology, then evolved into a morphology more typical of hypertrophic lichen planus. This case underscores the need for caution in diagnosing eruptive SCCs associated with PD-1 inhibitor therapy. In such instances, maintaining a high suspicion for lichenoid reactions as sequelae of PD-1 inhibitor treatment and starting an empiric trial of therapy for lichenoid dermatitis may be warranted to ensure timely management of lesions.
METHODS
We describe a case of hypertrophic lichen planus mimicking squamous cell carcinoma in the setting of PD-1 inhibitory therapy with pembrolizumab. A PubMed literature review was conducted to identify other cases and determine the incidence of lichenoid reactions imitating squamous cell carcinoma in the setting of PD-1 inhibitor use.
RESULTS
Our case is one of the few available pieces of literature describing eruptive hypertrophic lichen planus imitating SCC in the setting of PD-1 inhibitor use. Initial skin nodule biopsy appeared histologically compatible with squamous cell carcinoma. Repeat biopsy of the skin lesions revealed histological features consistent with hypertrophic lichen planus. Over time, lower extremity lesions evolved into a more typical appearance of hypertrophic lichen planus. Treatment with topical 0.05% clobetasol ointment and oral acitretin 25 mg led to complete resolution of lesions within 2-3 months.
CONCLUSIONS
This case underscores the significance of maintaining vigilance for lichenoid reactions as potential sequelae of PD-1 inhibitor therapy. It highlights the variability in initial presentation and the potential for lesions to transform over time. Timely recognition and appropriate management, including high-potency topical corticosteroids and oral acitretin, are crucial for achieving favorable outcomes in patients experiencing such reactions. More studies are necessary to fully analyze the rate of HLP occurrence as a consequence of PD-1 inhibitor use.
PubMed: 38877280
DOI: 10.1007/s40268-024-00461-x -
International Journal of Dermatology Jun 2024Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the accumulation of hyaline-like material in the skin, oral mucosa, larynx, and brain....
OBJECTIVES
Lipoid proteinosis (LP) is a rare autosomal recessive disorder characterized by the accumulation of hyaline-like material in the skin, oral mucosa, larynx, and brain. This study aimed to evaluate the dermatological findings and treatment responses of patients diagnosed with LP.
METHODS
This retrospective study included 41 patients diagnosed with LP at our clinic between May 2018 and January 2023. The diagnosis of LP was established in 22 patients by detecting mutations in the ECM1 gene. In comparison, in 19 patients, it was based on typical clinical findings and histopathological examination of lesioned skin. Clinical and demographic data such as dermatological findings, treatments received, and responses to treatment were recorded from patient files.
RESULTS
All patients exhibited skin thickening and acneiform scars. The most commonly observed additional dermatological findings were moniliform blepharosis (60.9%), varioliform scars (29.2%), waxy papules and plaques (24.3%), and blisters with crusts (19.5%). Verrucous lesions, diffuse yellow plaques, and scarring alopecia were observed in adult patients, while hypopigmented lesions and blisters with crusts were seen in the pediatric age group. The most frequently used treatments were acitretin (14.6%) and systemic steroids (9.7%). No improvement in skin lesions was observed in patients treated with acitretin, whereas complete resolution of blisters with crusts was noted in patients treated with systemic steroids.
CONCLUSIONS
In addition to the existing literature on dermatological manifestations of LP, hypopigmented lesions and atrophoderma vermiculatum-like lesions can also be observed in these patients. We believe that short-term systemic steroid therapy for vesiculobullous lesions can be considered for treatment. We think prospective studies with more patients and requiring long-term follow-up are needed regarding the effectiveness of acitretin treatment.
PubMed: 38876475
DOI: 10.1111/ijd.17331 -
Cureus May 2024Acrokeratosis verruciformis of Hopf (AKVH) is a rare genetic skin condition associated with an gene mutation, thus affecting keratinization. Classically, AKVH appears...
Acrokeratosis verruciformis of Hopf (AKVH) is a rare genetic skin condition associated with an gene mutation, thus affecting keratinization. Classically, AKVH appears in childhood over acral sites as symmetrical, flat, verruca plana-like lesions with an autosomal dominant inheritance, while sporadic cases affect atypical sites in adulthood. As this entity can closely mimic other verrucous skin conditions, identifying characteristic histopathological changes is essential to make a diagnosis in the absence of genetic studies, especially in resource-poor countries. This is the first reported case of AKVH from North-East India clinically mimicking extensive verruca vulgaris in an adult with a possible sporadic occurrence. AKVH is usually difficult to treat and superficial ablation is the treatment of choice. However, this case highlights the role of cryotherapy with acitretin in the management of AKVH with a rapid response.
PubMed: 38854358
DOI: 10.7759/cureus.60000 -
Indian Journal of Dermatology 2024Retinoids are used topically as well as orally, and the most commonly used oral retinoids are isotretinoin and acitretin. Mucocutaneous adverse effects are frequently...
Retinoids are used topically as well as orally, and the most commonly used oral retinoids are isotretinoin and acitretin. Mucocutaneous adverse effects are frequently seen with the use of systemic retinoids, the most common being cheilitis, which is dose-dependent and seen in almost all patients using it. To study the comparative effect of topical tacrolimus 0.1% ointment versus topical white soft petrolatum jelly in the treatment of cheilitis due to retinoids. A total of 26 patients with cheilitis post-treatment with isotretinoin were enrolled in this cross-sectional study conducted over a period of 6 months. They were randomized into two groups of 13 patients each to receive topical tacrolimus 0.1% ointment and soft petrolatum jelly twice daily, respectively. Patients were followed up weekly with clinical photographs. Resolution of cheilitis was assessed on the basis of photograph and ICGS score. About 84.6% of patients of group A and 53.8% of patients of group B showed resolution of symptoms within 1 week of treatment. A significant difference was seen in duration for complete cheilitis resolution and relapse rate in the two groups. Our study concludes that oral retinoid-induced cheilitis shows faster and more significant resolution with twice-daily topical tacrolimus 0.1% ointment application compared to twice-daily topical petrolatum jelly.
PubMed: 38841226
DOI: 10.4103/ijd.ijd_67_23 -
Anais Da Academia Brasileira de Ciencias 2024The epidemiology of psoriasis and cutaneous mycoses is scarce in Brazil. Thus, this cross-sectional study aimed to characterize the distribution of these diseases in...
The epidemiology of psoriasis and cutaneous mycoses is scarce in Brazil. Thus, this cross-sectional study aimed to characterize the distribution of these diseases in Paraná. Data was obtained from the Outpatient Information System (SIA - Sistema de Informações Ambulatoriais), between 2016 and 2020. The procedures were filtered by the International Classification of Diseases (ICD). A total of 201,161 outpatient procedures were registered for psoriasis and psoriatic arthritis. The distribution concerning gender was similar (50.93% feminine; 49.07% masculine). The mean age was 51.55 years. The most frequent procedure was methotrexate dispensing (23.17%), followed by acitretin (14.29%) and adalimumab (12.55%). Adjusting to total population, the prevalence of procedures was 0.35%. Regarding cutaneous mycoses, 1,756 procedures were registered. 65% of them referred to females. White race/color was predominant (82.97%). The mean age was 37.6 years. The distribution concerning age varied according to the type of mycosis. Medical appointments (48.92%) and surgical pathology exam/biopsy (38.71%) were the most frequent procedures. The prevalence of procedures was 0.004%. This is the first epidemiological study using SIA about the population affected by psoriasis, psoriatic arthritis, and cutaneous mycoses in a Brazilian state. We believe that these findings allow relevant contribution to science and public policies in Brazil.
Topics: Humans; Brazil; Male; Female; Psoriasis; Cross-Sectional Studies; Middle Aged; Prevalence; Adult; Dermatomycoses; Young Adult; Adolescent; Aged; Sex Distribution; Age Distribution; Child
PubMed: 38808876
DOI: 10.1590/0001-3765202420230828 -
Dermatologic Clinics Jul 2024Oral psoriasis therapies include both older traditional immunosuppressants, such as methotrexate, cyclosporine, and acitretin, as well as newer, more targeted agents,... (Review)
Review
Oral psoriasis therapies include both older traditional immunosuppressants, such as methotrexate, cyclosporine, and acitretin, as well as newer, more targeted agents, such as apremilast, deucravacitinib, and oral interleukin-23 receptor antagonists. Patients may prefer oral therapies to injectable therapies based on the route of administration. Both older and newer oral psoriasis therapies can be utilized effectively in the treatment of psoriasis. Here, we will review oral agents used in the treatment of psoriasis as well as provide commentary on their role in our current, evolving psoriasis treatment paradigm.
Topics: Humans; Psoriasis; Administration, Oral; Thalidomide; Acitretin; Immunosuppressive Agents; Methotrexate; Cyclosporine; Dermatologic Agents; Piperidines; Pyrazoles; Pyrimidines; Pyrroles; Antibodies, Monoclonal, Humanized; Keratolytic Agents; Indoles; Nicotinic Acids; Antibodies, Monoclonal
PubMed: 38796267
DOI: 10.1016/j.det.2024.02.013