Extracorporeal photochemotherapy is a new form of immunotherapy which involves the extracorporeal photoinactivation of peripheral blood cells by 8-methoxypsoralen in the presence of ultraviolet A irradiation, followed by readministration of the cells. To explore the efficacy of this therapy in the treatment of autoimmune disease, four patients with a lengthy history of corticosteroid and immunosuppressive drug-resistant pemphigus vulgaris were initiated on extracorporeal photochemotherapy. Three patients experienced a complete remission in cutaneous disease expression, permitting discontinuation of medications in two and a substantial decrease in the third. Significant reductions in serum antiepidermal cell antibody titers occurred in all four patients. The treatments were well tolerated without the occurrence of adverse events. These results in a small number of patients suggest that extracorporeal photochemotherapy may prove to be a useful tool in the treatment of aggressive autoimmune disease.
Transjugular intrahepatic portosystemic shunt is a nonsurgical procedure used to manage the complications of portal hypertension. This report describes three cases of fluoroscopy-induced radiodermatitis after transjugular intrahepatic portosystemic shunt and reviews the characteristics and treatment of radiation-induced skin reactions.
Although basal cell carcinoma (BCC) is the most common human malignancy, only 21 cases involving the scrotum have been previously reported.Our purpose is to describe three additional cases of scrotal BCC and review the literature summarizing the clinical features and identifying any predisposing factors.We retrospectively reviewed 21 cases of scrotal BCC and described three new cases. Polymerase chain reaction (PCR) was used to detect human papillomavirus (HPV) DNA in our biopsy specimens.Scrotal BCCs present as persistent ulcerations or plaques without identifiable predisposing factors. Lymphatic, pulmonary, or skin metastases were present in 3 of 24 cases (13%) resulting in death in one case. PCR did not detect HPV DNA in our three cases.Scrotal BCC rarely occurs and should be considered in the diagnosis of a persistent scrotal ulcer or plaque. Metastatic disease may be more common than with other BCCs and wide local excision or Mohs micrographic surgery may be the most appropriate initial therapeutic approach.
Many cutaneous diseases have been reported in patients with human immunodeficiency virus infection. We report two patients with pityriasis rubra pilaris and human immunodeficiency virus infection. In one patient, the onset of pityriasis rubra pilaris preceded the discovery of human immunodeficiency virus infection. In the second patient, the onset of pityriasis rubra pilaris occurred shortly after the patient tested positive for human immunodeficiency virus infection. Both patients had a severe form of pityriasis rubra pilaris, and both had a minimal therapeutic response to etretinate.
A 24-year-old man presented complaining of abnormal skin pigmentation on the dorsa of his feet that had been present for 2 years and was becoming progressively worse. He denied any trauma to the area, but was an active windsurfer and snow skier. His inflammatory acne had been treated over the past 6 years with minocycline (orally, 100 mg/d), tretinoin, and topical benzoyl peroxide with erythromycin (Benzamycin). On physical examination, the lesions were symmetric 4×6-cm gray-blue patches on the dorsa of both feet (Figure 1). The pigmentation was localized to the distribution of the extensor digitorum brevis muscle, which was hypertrophied. No mucosal, periungual, or other abnormal cutaneous pigmentation was seen. A 4-mm punch biopsy specimen was obtained down to the skeletal muscle and stained with hematoxylin-eosin (Figure 2), Prussian blue (Figure 3), and Fontana-Masson (Figure 4). What is your diagnosis?
We report a case of fingernail onychomycosis in an immunosuppressed renal transplant patient who was successfully treated with once-weekly fluconazole therapy. Relapse did not develop over the 2-month follow-up period. There were no adverse effects from therapy and the cyclosporin dose did not require adjustment. This case suggests that fluconazole may play a role in the treatment of onychomycosis with once-weekly dosing schedules. Future large-scale clinical trials are indicated to fully evaluate its safety and efficacy in onychomycosis.
