International Journal of Dermatology | 2021
Efficacy of tocilizumab in adult H syndrome: a promising therapeutic option
Abstract
which was clearly lacking in GA lesions. Interestingly, individual red papules ultimately became flattened and pigmented, but new papules appeared along the border of the erythematous plaques and the lesions gradually enlarged, with central hyperpigmentation. In a detailed study on the clinical pigmentation of EAE, pigmentation was more frequently due to basal melanosis than to melanin incontinence. To date, the mechanism of basal melanosis is still unclear; however, interleukin (IL) 5, a crucial cytokine that attracts eosinophils in the dermis, might function to stimulate melanogenesis. In a recent study, mepolizumab and dupilumab, which are antibodies against IL5 and IL4/13, respectively, were effective for the treatment of recalcitrant EAE, indicating that Th2 lymphocytes might be relevant to develop EAE aside from eosinophils. Our case also showed blister formation on the soles, suggesting that EAE can have various clinical appearances depending on the affected sites. The first case involving tense bullae on EAE lesions had improved with systemic prednisolone, an outcome similar to our case. Systemic treatment including prednisolone and antimalarials should be considered for EAE with atypical clinical appearances such as blisters.