Journal of cutaneous medicine and surgery
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Case Reports
Successful treatment of hidradenitis suppurativa with infliximab in a patient who failed to respond to etanercept.
Hidradenitis suppurativa (HS) is a devastating chronic scarring disease of the axillae, groins, and submammary tissue occurring predominantly in women, with onset at puberty. Multiple treatments have been attempted, with limited success. The association of HS with Crohn disease, psoriasis (PSO), and pyoderma gangrenosum, as well as the seronegative arthropathies, suggests a common immunopathogenesis and has motivated attempts at treatment with anti-tumor necrosis factor (TNF)-alpha agents, already demonstrated to be efficacious in major inflammatory diseases. ⋯ The success of anti-TNF agents such as infliximab in managing HS offers a new therapeutic option and supports an underlying immunologic basis for the disease. The differential response to HS observed with infliximab and etanercept in this patient could be related to differences in structure, binding specificities, or gene suppression.
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Lepromatous leprosy (LL) is a generalized disease, usually with numerous papules, nodules, or plaques containing abundant Mycobacterium leprae and affecting wide areas of the skin. ⋯ The presentation of LL or borderline lepromatous leprosy (BL) as a single cutaneous lesion (or localized lesions) is a rare presentation of multibacillary disease, and such cases can be undertreated. This case also highlights the need to further explore the role of immunoprophylaxis or chemoprophylaxis in the contacts of multibacillary cases.
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Sarcoidosis is a systemic disease that may present as tattoo granulomas. ⋯ Sarcoid granulomas may develop in tattoos as an isolated local reaction or as the presenting sign of systemic sarcoidosis. The reaction itself may provide insight into further understanding the pathogenesis of sarcoidosis.
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Comparative Study Clinical Trial
Open-label study of valacyclovir 1.5 g twice daily for the treatment of uncomplicated herpes zoster in immunocompetent patients 18 years of age or older.
Herpes zoster (shingles) is a common disease caused by a reactivation of the latent varicella-zoster virus (chickenpox), which resides in the dorsal root ganglia. Valacyclovir HCl, the L-valyl ester of acyclovir, is an antiviral drug that is used to accelerate the resolution of the herpes zoster rash and associated pain and reduce the duration of postherpetic neuralgia. ⋯ Oral valacyclovir 1.5 g bid is safe and effective for the treatment of uncomplicated herpes zoster in immunocompetent patients over 18 years of age. Twice-daily dosing may help increase patient compliance and therefore increase the effectiveness of treatment of the acute herpes zoster rash and the prevention of ZAP.
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Review Case Reports
Cutaneous Rosai-Dorfman disease: comprehensive review of cases reported in the medical literature since 1990 and presentation of an illustrative case.
The latest comprehensive review of primary cutaneous Rosai-Dorfman disease was published as part of an exhaustive survey of sinus histiocytosis with massive lymphadenopathy in 1990. Since then, much progress has been made in the understanding of malignant lymphoma and benign disorders of lymphoid and histiocytic origin. ⋯ Purely cutaneous disease without the characteristic lymphadenopathy is rare but has been increasingly reported in the literature. Compared with patients with systemic Rosai-Dorfman disease, patients with primary cutaneous Rosai-Dorfman disease are older, women are more commonly affected, and whites are more likely than blacks to be afflicted.