Efi Pasmatzi

Dipeptidyl Peptidase-4 Inhibitors Cause Bullous Pemphigoid in Diabetic Patients: Report of Two Cases

Bullous pemphigoid (BP) is an autoimmune disorder characterized by the production of autoantibodies against two antigens (BPAG1 and 2) and can be induced by drugs (1,2). Recently, the development of BP was reported in diabetic patients treated with dipeptidyl peptidase-4 inhibitors (gliptins) plus metformin (3). However, it remains unknown whether gliptins alone or in combination with metformin are responsible for the induction of BP. We report two diabetic patients who developed BP shortly after addition of vildagliptin to their metformin monotherapy. A 59-year-old woman and a 67-year- old man, both with type 2 diabetes that had been controlled with metformin for 6 and 3 years, respectively, presented with an 1- and 3-month history of pruritic …

Cutaneous sarcoidosis : Complete remission after oral isotretinoin therapy

We report a 31-year-old female patient with cutaneous sarcoidosis, who showed a complete remission of her single system skin disease after an 8-month therapy with oral isotretinoin (1 mg/kg/day). At 15-month follow-up, the patient still remained free of recurrence and visceral involvement.

Detection of human papillomavirus DNA in nongenital seborrhoeic keratoses

The histological similarities of seborrhoeic keratoses and common warts led to the investigation of the possible occurrence of human papillomavirus DNA (HPV-DNA) in a large number of nongenital seborrhoeic keratoses using the in situ hybridization technique. All specimens derived from normal skin (n=173) were negative for the applied HPV-DNA probe, whereas the HPV genome was detected in 34 of 173 seborrhoeic keratosis specimens (19.65%). Of 34 HPV-positive specimens, 15 contained types 6/11 and 14 types 31/33/35, and 5 showed no positive reaction to the applied types. These results suggest that a considerable percentage of nongenital seborrhoeic keratoses may be related to an HPV infection.

Anaphylactic shock as the only clinical manifestation of hepatic hydatid disease

The case of a 35‐year‐old man is reported who developed a spontaneous anaphylactic shock as the only clinical manifestation of hepatic hydatidosis. Dermatologists should consider asymptomatic hydatid disease in the differential diagnosis of anaphylactic reactions, particularly in patients from regions in which echinococcosis is endemic.

Epileptic seizures as the sole manifestation of neuro-Behçet's disease: Complete control under interferon-alpha treatment

Behçets disease (BD) is a multisystemic disease of unknown etiopathogenesis with various clinical features including manifestations from central nervous system involvement. We report the case of a patient presented with a 20-year history of BD and a 10-year history of epileptic seizures refractory to various antiepileptic drugs. Under systemic treatment with interferon-alpha 2a (IFN-alpha) a complete remission of the cutaneous manifestations and a seizure-free state were achieved. The impressive therapeutic response of both the seizures and the non-neurological manifestations to IFN-alpha was also observed upon re-administration of this cytokine subsequent to a severe BD relapse. In view of this response and the lack of any other obvious etiology of the seizures in our patient, it seems reasonable to consider them as being the sole manifestation of neuro-BD. The patient is presently completing a 40-month seizure-free follow-up, despite withdrawal of all antiepileptic drugs for the last 35 months. Further studies on large numbers of patients are now warranted to define the therapeutic efficacy and safety of IFN-alpha in neuro-BD and particularly in neuro-BD-related epileptic seizures.

Pyogenic granuloma: complete remission under occlusive imiquimod 5% cream.

An 82‐year‐old man was referred to our department for evaluation and treatment of a recurrent pyogenic granuloma on his right hand. After previous histopathological confirmation of the clinical diagnosis, he had been treated twice with electrocautery, but the lesion recurred 10 and 8 days later, respectively. After a 3‐week topical application of imiquimod 5% cream twice daily under occlusion, complete remission of the lesion was achieved. Apart from an erythematous reaction in the apparently normal surrounding skin, the patient experienced no local or systemic side‐effects. Since discontinuation of treatment he has been followed up for 8 months, and there has been no recurrence.

Reduced expression of the antiapoptotic proteins of Bcl-2 gene family in the lesional epidermis of patients with Darier’s disease

Background:  Dyskeratotic cells in Darier’s disease (DD) are thought to represent apoptotic keratinocytes. Bcl‐2 gene family proteins play a major role in the regulation of apoptosis of epidermal keratinocytes and reveal pleiotropic interactions with intracellular Ca2+ homeostasis. The latter is impaired in DD because of mutations of ATP2A2 gene that encodes the type 2 isoforms of the sarcoplasmic/endoplasmic reticulum (ER) Ca++ ATPase 2 (SERCA2) pump.

Gianotti-Crosti Syndrome after Hepatitis A Vaccination

Gianotti-Crosti syndrome (GCS) is a relatively common skin disorder characterized by a distinctive, self-limiting, non-recurrent erythematous or skin-coloured papulo-vesicular eruption symmetrically distributed mainly on the extremities, buttocks and face of infants and young children and, infrequently, of adults. A wide spectrum of infectious agents, mostly viruses [hepatitis A, B and C, cytomegalovirus (CMV), Epstein-Barr, HIV, human her-pes virus 6, Coxsackie, rota-, echo- and parvovirus, para-influenza, mumps,

Successful treatment of granuloma annulare with imiquimod cream 5%: a report of four cases.

Sir, Granuloma annulare (GA) is a benign and usually asymptomatic granulomatous dermatosis characterized by erythematous, violaceous or skin-coloured necrobiotic papules, often fused into annular arrangements, that most commonly affect the extremities. Although it may resolve spontaneously, GA is frequently resistant to treatment. A variety of topical or systemic therapeutic modalities has been used in its management with varying success (1–3). To our knowledge, there is only one case report of imiquimod, a novel immune response modifier, being therapeutically active in GA (4). We therefore conducted a pilot study to evaluate the efficacy and safety of imiquimod 5% cream in the treatment of this disorder.

Short-term oral isotretinoin therapy does not cause clinical or subclinical peripheral neuropathy.

Background: Subclinical neurophysiologic abnormalities mainly suggestive of sensory fibers dysfunction were observed in some patients after 1 and 3 months of treatment with oral acitretin. Moreover, two cases of peripheral sensory neuropathy and one of sensorimotor polyneuropathy were observed after short‐term oral administration of this compound. Objective: The objective of this prospective study was to investigate whether short‐term treatment with oral isotretinoin can also affect peripheral nerve function. Methods: Serial neurologic and neurophysiologic examinations were performed on 18 young patients with severe nodulocystic acne prior to and 1 and 3 months after the onset of oral isotretinoin treatment (1 mg/kg per day). Results: Clinical neurologic examination before and under treatment disclosed no abnormalities in any of the patients. There were no significant differences between the pre‐ and post‐treatment neurophysiologic parameters. Furthermore, evaluation of the serial neurophysiologic measurements in each patient separately under oral isotretinoin treatment revealed no changes fulfilling the criteria of abnormality. Conclusions: Short‐term administration of oral isotretinoin in young patients does not cause clinical or subclinical neuropathy.