C. Ciudad Blanco

Ustekinumab in the Treatment of Severe Atopic Dermatitis: A Preliminary Report of Our Experience With 4 Patients

Patients with atopic dermatitis (AD) often require systemic immunosuppressant treatment, but the use of these drugs is limited by their potential toxicity and/or an insufficient therapeutic response. Recently, Puya et al.1 published the case of a patient with severe AD successfully treated with ustekinumab. We present a retrospective descriptive study of patients with severe AD treated with ustekinumab in our hospital, a reference hospital, between December 2009 and February 2011. There were 4 patients, all men aged between 23 and 29 years, who presented severe AD refractory to oral corticosteroids, phototherapy (Psoralen--UV-A or narrowband UV-B), and to at least 2 systemic drugs, including ciclosporin, azathioprine, methotrexate, and mycophenolate mofetil. All the patients had negative Mantoux and booster effect, negative serology for hepatitis B and C viruses and human immunodeficiency virus, and no history of other systemic diseases, serious infections, or tumors (Table 1). Ustekinumab was prescribed for off-label use, with approval by medical management, and the patients signed the corresponding informed consent. A visual analogue scale (VAS) for pruritus and the Scoring Atopic Dermatitis (SCORAD) index were the tools used to quantify the results, both at baseline and during weeks 4 and 16. The 4 patients were aged between 23 and 29 years (Table 1). The number of injections of ustekinumab during the study period varied between 4 and 6. In all cases the patients were administered subcutaneous doses of 45 mg of the drug, using the regimen usually employed in psoriasis: injections in weeks 0 and 4 and then every 12 weeks. No

Treatment of adult diffuse pityriasis lichenoides chronica with narrowband ultraviolet B: experience and literature review

Pityriasis lichenoides chronica (PLC) is an infrequent dermatosis of unknown aetiology, wholse evolution and response to treatment differs between children and adults. When PLC is recalcitrant or unresponsive to topical treatment, phototherapy is one of the main treatments used. We carried out a prospective study of adult diffuse PLC treated with narrowband ultraviolet B (NB‐UVB). We treated eight patients whose disease showed no response to topical therapy, and obtained a complete response rate of 88% in a mean of 23 sessions (cumulative dose 16.99 J/cm2). However, the relapse rate was 43% in the first 6 months. Our results are similar to those of other published studies but there is much variability between them in the doses applied and the number of sessions needed. Further studies are necessary to devise a protocol for NB‐UVB treatment of PLC.

Hemangiomas glomeruloides y síndrome POEMS

POEMS syndrome is a paraneoplastic manifestation associated with hematopoietic disorders such as multiple myeloma and Castleman disease. POEMS is an acronym for the main clinical features of the syndrome, namely, Polyneuropathy, Organomegaly, Endocrinopathy, M protein, and Skin abnormalities. Glomeruloid hemangiomas are considered to be a specific clinical marker of POEMS syndrome. However, while they are not pathognomonic, their presence should raise suspicion of this syndrome or alert clinicians to its possible future development, as these lesions can appear years before the onset of the syndrome. We report the cases of 2 women with plasma cell dyscrasias and sudden onset of lesions with a vascular appearance and histologic findings consistent with glomeruloid hemangioma. Recognition of this vascular tumor is important for the early diagnosis of POEMS syndrome.