A. Alomar

Occupational dermatoses from cutting oils.

230 patients with occupational dermatitis in I ho metallurgic industry were studied with standard patch tests (GEIDC) and an oil series. An occupational and clinical questionnaire survey was carried out, Responses to paraphenylenediamine, chrome, cobalt in the standard series, and benzisothiazolone, triethanolamine, and Grotan BK® were the main positive results.

Review of 26 cases of classical pyoderma gangrenosum: clinical and therapeutic features

BACKGROUND: Classical pyoderma gangrenosum (CPG) is an uncommon, idiopathic, neutrophilic skin disease, generally associated with other skin conditions and systemic diseases, and with several treatment options. OBJECTIVE: The objective of this review was to know the clinical and therapeutic features of our cases of CPG. METHODS: Twenty‐six cases of CPG were included; 65 episodes of PG and 120 treatment courses were analysed; and the mean follow‐up was 4.6 years. RESULTS: 21 cases (80%) had lesions on the lower extremities, 16 (61%) had recurrences, 22 (84%) had some disease associated, and 13 (50%) had autoimmune inflammatory conditions. Ciclosporin A (CSA) was used in 22 (84%) patients and 51 (78%) episodes, and prednisone (PDN) was used in 15 (57%) patients and 26 (40%) episodes. CONCLUSIONS: CSA efficacy was excellent, with an early response and acceptable toxicity, although it did not seem to have any impact on the incidence of PG recurrences.

Therapy of paraneoplastic pemphigus with Rituximab: a case report and review of literature.

Paraneoplastic pemphigus (PNP) is an autoimmune blistering disease with poor prognosis when associated with malignant neoplasm. We report the case of a patient with PNP associated with a CD20+ non‐Hodgkin follicular lymphoma who was treated with Rituximab plus corticosteroids and short courses of cyclosporin. One and a half years after Rituximab therapy, oral ulcerations had cleared and oral methylprednisolone was slowly tapered down without further recurrences. In the course of the disease, the patient developed sepsis due to Listeria monocytogenes and viral infections by human herpes virus 1 and 3. At the end‐stage of the disease she developed a cutaneous infection from Mycobacterium chelonae. The patient died 2 years and 7 months after the onset of PNP. Rituximab may be useful for PNP therapy, but further studies are necessary to confirm this hypothesis.

Efficacy of imiquimod for the expression of Bcl-2, Ki67, p53 and basal cell carcinoma apoptosis.

Backgroundu2002 Imiquimod is a modifier of the immune response that has been proven to be an effective treatment for basal cell carcinoma (BCC). However, its mechanism of action is still unknown.

Onset of flexural psoriasis during infliximab treatment for Crohn's disease

disease. The patient has now been followed up for 12 months and remains clinically free of disease. These are the first reported cases of Bowen’s treated successfully with diclofenac HA gel. The histological and clinical clearance of Bowen’s disease in our patients after 80–90 days of topical application of diclofenac HA gel indicates that this therapy may be of help in this condition. One patient experienced moderate inflammation at the application site that necessitated early discontinuation, without loss of efficacy. Adverse effects of this preparation have been reported in 51–72% of patients, with local irritation and dryness being the most commonly reported. The mechanism of action of diclofenac HA gel is as yet unknown. However, diclofenac has been shown to inhibit murine angiogenesis induced by chronic granulomatous reaction and to exhibit an antitumour effect in murine colon-26 growth. It is postulated that this antitumour mode of action may be related to the inhibition of the cycloxygenase pathway that is mediated by nonsteroidal anti-inflammatory drugs, specifically to reduction of prostaglandin E2 synthesis via substance P. The good clinical response to this therapy in our two cases suggest that diclofenac HA gel may be a useful addition to the array of pharmacological treatments available for Bowen’s disease. However, further studies to ascertain optimum dosage regimens and long-term followup are recommended.

Adverse cutaneous reactions to anakinra in patients with rheumatoid arthritis: clinicopathological study of five patients

Backgroundu2002 Anakinra, a recombinant human form of interleukin‐1 receptor antagonist, is used to treat patients with active rheumatoid arthritis (RA).

Topical tacrolimus 0.1% ointment (Protopic®) reverses nickel contact dermatitis elicited by allergen challenge to a similar degree to mometasone furoate 0.1% with greater suppression of late erythema

The aim of this study was to evaluate the ability of topical tacrolimus 0.1% under occlusion for 48u2003h to suppress nickel‐elicited allergic contact dermatitis in a randomized, petrolatum‐ and mometasone furoate 0.1% ointment‐controlled double‐blind, intra‐individual study which included 28 women volunteers. 3 closed patch tests (Finn Chambers® on Scanpor, Epitest Ltd Oy, Tuusula, Finland) containing 0.1u2003ml of 5% nickel sulfate in petrolatum were applied on day 0. After removal on day 2, the study compounds were applied under occlusion for 48u2003h. The eczema reaction and the degree of erythema were evaluated clinically and by reflectance spectrophotometry at days 4 and 7, respectively. Mean visual scores corresponding to petrolatum‐treated sites were significantly higher than those corresponding to both mometasone furoate and tacrolimus at days 4 (Pu2003<u20030.001) and 7 (Pu2003<u20030.001). In both tacrolimus‐ and mometasone furoate‐treated sites, there was a significant decrease in visual scores with time (Pu2003<u20030.001) from day 2 to day 7, and the corresponding mean decreases in scores were 0.73 and 1.04, respectively. The difference between both was 0.30 in favour of tacrolimus (95% confidence intervals, −0.04 and 0.65), although this did not reach statistical significance (Pu2003=u20030.084). Mean erythema index values were similar at day 2. Significant differences among treatment sites were seen at days 4 (Pu2003<u20030.001) and 7 (Pu2003<u20030.001). The decrease was significantly more pronounced on day 7 in patches where tacrolimus had been supplied (Pu2003<u20030.5). This method might provide useful means to compare different concentrations and/or presentations of tacrolimus or other calcineurin inhibitors and topical anti‐inflammatory agents.

Open study of the efficacy and mechanism of action of topical imiquimod in basal cell carcinoma

Imiquimod is an immune‐response modifier that has been shown to be effective in the treatment of superficial and nodular basal cell carcinoma (BCC). The objective of this open‐label study was to investigate the effectiveness of imiquimod 5% cream in superficial, nodular, and infiltrative BCC. Fifty‐five Caucasian patients with primary BCC measuring 8u2003mm or more in diameter with a superficial, nodular, or infiltrative histological pattern were included in the study. Four groups of BCC (A, B, C, and D) and two dosing regimens were studied: 35 BCCs (groups A, B, and C) were treated with imiquimod three times weekly and 20 BCCs (group D) were treated with imiquimod five times weekly. Histological samples were obtained before treatment, during treatment (on day 22 in group A, day 15 in group B, and day 8 in groups C and D), and 6u2003weeks after treatment. All patients were followed‐up for a minimum of 2u2003years. In the biopsy specimens obtained, the expression of Bcl‐2, p53, and Ki‐67, apoptotic index (Tunel technique), and the number of CD3+, CD8+, CD20+, CD56+, CD68+, granzyme B+, and S‐100+ cells in the peritumoural inflammatory infiltrate, were determined and quantified. Of the 55 BCCs treated with imiquimod 41 (74%) were in complete remission after 2u2003years of follow‐up. These comprised 4/4 superficial BCCs, 7/8 (88%) nodular BCCs, and 30/43 (70%) infiltrative BCCs. Multi‐variate analysis demonstrated that baseline tumour size was the most powerful independent prognostic variable (Pu2003<u20030.05). Treatment with imiquimod increased the apoptotic index (Pu2003<u20030.05), reduced Bcl‐2 expression (Pu2003<u20030.05), and increased the number of CD3+, CD8+, CD20+, CD68+, granzyme B+, and S‐100+ cells in the inflammatory infiltrate of the BCC (Pu2003<u20030.05). In conclusion, imiquimod induced an antitumour immune response mediated by lymphocytes and macrophages, reduced Bcl‐2 expression and increased the apoptotic index of BCC, and was clinically effective in 74% of BCCs after a 2‐year follow‐up period.

Imatinib-associated lichenoid eruption : acitretin treatment allows maintained antineoplastic effect

the nail plate. It is thought to be due to a defect in keratinization with persistence of keratohyaline granules and air trapping within the nail. Our patient presents with true transverse leuconychia of her thumbnails and fingernails which resolved spontaneously during the third trimester of both her pregnancies. The leuconychia decreased in intensity from the thumb to the little finger on both hands and was also associated with transverse yellow bands, most prominent on her thumbnails. Neither phenomenon is readily explained. The menstrual cycle has previously been reported as a cause of transverse leuconychia. The onset of our patient’s leuconychia with the commencement of her menses and its ‘disappearance’ and subsequent ‘reappearance’ during and following each pregnancy also implies a hormonal influence. The exact aetiology of her leuconychia remains unknown. No similar cases have been reported to date.

Bortezomib‐associated cutaneous vasculitis

Bortezomib (Velcade , Ortho Biotech, Issy-les-Moulineaux, France) is the first of a new class of drugs known as proteasome inhibitors mainly used in haematological malignancies such as multiple myeloma refractory to prior treatment and non-Hodgkin’s lymphoma (mantle cell lymphoma). Several cutaneous adverse effects of bortezomib have been reported but are poorly characterized. We report two cases of cutaneous vasculitis, which appears to be a rather typical manifestation in bortezomib-treated patients. Patient 1: A 58-year-old man was diagnosed with stage IIIA IgA kappa multiple myeloma. His disease was refractory to polychemotherapy and progressed despite autologous peripheral blood stem cell transplantation. He was treated with bortezomib at a dose of 1Æ3 mg m on days 1, 4, 7 and 10 of every 21 days. On day 4 of the first cycle, the patient suddenly developed asymptomatic erythemato-purpuric papules and plaques on the neck and upper trunk (Fig. 1). A skin biopsy specimen showed slight epidermal hyperplasia with focal spongiosis, occasional keratinocyte necrosis and vacuolar change of the basal layer. Within the dermis there was a moderately dense inflammatory infiltrate composed of lymphocytes, neutrophils with a certain degree of leucocytoclasis, a small number of eosinophils and many mononucleated epithelioid histiocytes that tended to concentrate around capillaries in the dermal superficial plexus, consistent with granulomatous vasculitis (Fig. 2). Endothelial cells showed tumefaction and there were free extravasated erythrocytes in the superficial dermis. A 1-week course of prednisone 30 mg daily was prescribed and the lesions healed in a few days leaving residual hyperpigmentation. On day 4 of the second treatment cycle, the rash recurred and responded to the same treatment. A protective dose of 20 mg prednisone was administered before each following bortezomib cycle and the lesions did not reappear. Patient 2: A 61-year-old woman was diagnosed with stage III-B IgG lambda multiple myeloma. She presented with disease progression despite polychemotherapy, interferon treatment and peripheral blood stem cell transplantation. She started treatment with bortezomib. Immediately after the second dose of the second cycle she developed erythematopurpuric papules and plaques on the neck, back and arms. A skin biopsy showed occasional vacuolar change of the basal layer with occasional keratinocyte necrosis and dyskeratosis. A perivascular lymphomononuclear infiltrate with some neutrophils and epithelioid cells and a certain degree of leucocytoclasis, endothelial cell tumefaction and free extravasated erythrocytes were observed in the superficial dermis, consistent with an early vasculitis lesion. She was treated with prednisone 30 mg daily, tapered over 10 days. The lesions healed completely in a few days. Rashes have been reported in 8–18% of patients in clinical trials of bortezomib; reports of cutaneous manifestations such Fig 1. Erythemato-purpuric papules and plaques symmetrically distributed on the neck, upper trunk and back of patient 1. Fig 2. A skin biopsy specimen from patient 1 showed a moderately dense mixed inflammatory infiltrate composed of lymphocytes, neutrophils with a certain degree of leucocytoclasis, some eosinophils and many mononucleated histiocytes that tended to form granulomas around capillaries in the dermal superficial plexus. Endothelial cells frequently showed tumefaction and there were free extravasated erythrocytes in the dermis.