Michal Solomon

Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults

Background  Atopic dermatitis (AD) is a common inflammatory skin disease. Methotrexate (MTX) was suggested as an effective treatment option in cases of moderate‐to‐severe atopic dermatitis. This study assessed the efficacy and safety of treatment with low weekly doses of methotrexate for moderate‐to‐severe AD in adults.

Liposomal amphotericin B treatment of cutaneous leishmaniasis due to Leishmania tropica

Background  Cutaneous leishmaniasis (CL) is endemic in Israel, and in the past, has been attributed almost exclusively to Leishmania major. Over the last decade or so, an increase in Leishmania tropica (L. tropica) infections has occurred in several regions of Israel. Topical treatment of Old World CL is usually the rule, however, in some cases systemic treatment is indicated. Liposomal amphotericin B (L‐AmB) is efficacious and safe for treating visceral leishmaniasis but its role in treating various forms of CL is yet to be defined. In this study, we summarize the efficacy and safety of L‐AmB treatment in a series of Israeli patients with L. tropica infection.

Treatment of cutaneous leishmaniasis with intralesional sodium stibogluconate.

Background  Cutaneous leishmaniasis is endemic in Israel. Leishmania major is the most prevalent species that cause cutaneous leishmaniasis. Current treatment options are limited and there are few investigations in search of alternative ones.

The effectiveness of combined Chinese herbal medicine and acupuncture in the treatment of atopic dermatitis.

BACKGROUND Patients with atopic dermatitis increasingly use complementary medicine. OBJECTIVE The objective of this study was to assess the effectiveness of the combination of Chinese herbal medicine and acupuncture for the treatment of atopic dermatitis. METHODS Twenty (20) patients between the ages of 13 and 48 who had mild-to-severe atopic dermatitis were given a combined treatment of acupuncture and Chinese herbal medicine and were followed prospectively. The patients received acupuncture treatment twice a week and the Chinese herbal formula 3 times daily for a total of 12 weeks. Assessments were performed before treatment, and at weeks 3, 6, 9, and 12 of treatment. The primary outcomes were defined as the changes in the Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), and patient assessment of itch measured on a visual analogue scale (VAS). RESULTS After 12 weeks of treatment, an improvement in EASI was noted in 100% of patients, when compared with the baseline. The mean EASI fell from 4.99 to 1.81; the median percentage of decrease was 63.5%. Moreover, 78.8% of patients experienced a reduction in DLQI and VAS, as compared with the baseline. The mean DLQI decreased from 12.5 to 7.6 at the end of treatment, with 39.1% improvement. Mean VAS decreased from 6.8 to 3.7, with 44.7% improvement. No adverse effects were observed. CONCLUSIONS The results of this study suggest that the combination of acupuncture and Chinese herbal medicine have a beneficial effect on patients with atopic dermatitis and may offer better results than Chinese herbal medicine alone.

Evidence for Methotrexate as a Useful Treatment for Steroid- dependent Chronic Urticaria

Chronic urticaria is a relatively common disorder that can be severe and may impair quality of life. The management of recalcitrant chronic urticaria that is not responding to histamine antagonists includes short-term systemic corticosteroids, anti-inflammatory drugs (colchicine, dapsone and sulfasalazine) and immunomodulatory agents, such as cyclosporine, methotrexate, plasmapheresis and intravenous immunoglobulin. We report here our retrospective experience with the use of methotrexate in 8 patients (2 males and 6 females) with recalcitrant chronic urticaria who were not responding to high-dose first- and second-generation antihistamines. The mean duration of the disease prior to methotrexate treatment was 12 ± 8 months. Patients were treated for a mean duration of 4.5 months with a mean dose of 15 mg methotrexate/week. A complete response was achieved in 7 out of 8 patients (87%). Five out of the 7 patients were disease-free during a period of 1-10 months follow-up after discontinuing methotrexate and prednisone therapy. No serious adverse effects were reported. Methotrexate is an effective and safe treatment for chronic urticaria in patients who are not responsive to conventional therapy.

False-Positive Plasmodium falciparum Histidine-Rich Protein 2 Immunocapture Assay Results for Acute Schistosomiasis Caused by Schistosoma mekongi

ABSTRACT We report seven cases of false-positive Plasmodium falciparum histidine-rich protein 2 (PfHRP2) malaria assay results in patients with acute schistosomiasis caused by Schistosoma mekongi. PfHRP2 assays were negative in travelers infected with Schistosoma mansoni or Schistosoma haematobium (n = 13). Malaria was ruled out and rheumatoid factor was negative in all patients.

Methotrexate is an effective and safe adjuvant therapy for pemphigus vulgaris

BACKGROUND Pemphigus vulgaris (PV) is a chronic, autoimmune blistering disease. Most patients require long term therapy with systemic steroids as a first line of treatment. Immunosuppressive agents such as methotrexate (MTX) are administrated as second line therapy. Only a few reports have assessed MTX efficacy, with contradictory results. OBJECTIVE The aim of this study was to evaluate MTX as an adjuvant therapy in patients with PV. METHODS A retrospective study of 30 PV patients treated with MTX as an adjuvant therapy. Disease severity score and prednisone dosage served as assessing measures. RESULTS All patients were treated with 15 mg MTX per week. Of the 25 patients defined as severe or moderate disease at the beginning of treatment, 21 (84%) improved and downgraded their severity status at 6 months of treatment. In 21 patients (76.6%) we were able to reduce the prednisone dose. There was a significant improvement in the severity score (p=0.00001) and in prednisone dose (p=0.0001). Four patients (13%) suffered from mild side effects. CONCLUSION MTX treatment is safe and beneficial as a steroid-sparing agent in PV.

Tropical Skin Infections Among Israeli Travelers

Infectious skin disorders are common dermatologic illnesses in travelers. Knowledge of post-travel-related infectious skin disorders will allow for effective pre- and post-travel counseling. All cases of returning travelers seen in our center seeking care for infectious skin diseases were included in this study. For a comparison, data on returned travelers with non-infectious skin diseases and healthy travelers who had pre-travel consultations in our institution were also analyzed. Altogether, skin-related diagnosis was reported in 540 ill travelers, and among them, 286 (53%) had infectious skin diseases. Tropical skin infection was diagnosed in 64% of the infectious cases. Travelers returning from Latin America were significantly more ill with tropical skin infections than those traveling to Asia and Africa, The most common diagnoses were cutaneous leishmaniasis, myiasis, and cutaneous larva migrans. In conclusion, tropical skin infections are common among Israeli travelers, especially among those who visited Latin America.

Recurrent furunculosis in returning travelers: newly defined entity.

BACKGROUND Bacterial skin infection is a common dermatologic problem in travelers, which usually resolves without sequela. In contrast, post-travel recurrent furunculosis (PTRF) is a new unique entity of a sequential occurrence of many furuncles seen after returning home from a trip to the Tropics. OBJECTIVE The objective of this study was to characterize the disease course and possible causes of PTRF. METHODS A retrospective study was conducted on a group of young, healthy individuals (16 males and 5 females), who presented with PTRF after returning from tropical countries. RESULTS In all patients, the first furuncle appeared toward the end of the trip and continued for several months after returning home. The average duration of disease was 8.4 months with an average of 4.2 recurrences. Along the disease course, subsequent recurrences became shorter and milder with longer inter-recurrence intervals. Bacterial cultures most commonly grew methicillin-sensitive Staphylococcus aureus (MSSA, 76.5%). Nasal colonization was demonstrated in 47% of patients. There were neither companion travelers nor family members experiencing furuncles. CONCLUSIONS PTRF should be defined as a clinical entity with prolonged travel to the Tropics being its major risk factor. In the authors opinion, a transient immune change in a subpopulation of travelers ignites a series of recurrent furuncles, resolving upon restoration of normal immunity.

Leishmaniose cutanée de l’Ancien Monde : une maladie ancienne en attente de nouveaux traitements

Vieille comme le monde, la leishmaniose cutanée localisée (LCL) est le plus souvent associée dans l’Ancien Monde aux espèces Leishmania major et Leishmania tropica et, dans une moindre mesure, L.infantum. Les lésions de LCL sont indolores à type d’ulcères, de papules ou de nodules. La leishmaniose cutanée peut guérir d’elle-même sans traitement après une période de sept à 12 mois, mais elle laisse des cicatrices défigurantes [1]. La leishmaniose cutanée peut (rarement) se disséminer localement avec des nodules sous-cutanés, une lymphangite nodulaire ou une adénopathie régionale dans laquelle s’accumulent des amastigotes. Dans certains cas, hors du commun, l’infection à L. major et L. tropica peut se transformer en une leishmaniose cutanée diffuse [2]. Par ailleurs, il y a un doute quant à la viscéralisation de souches dermotropes. En effet, durant la guerre du Golfe, L. tropica a été rapportée comme cause de maladie viscérale, mais l’identification de l’espèce a été ensuite discutée [3]. La leishmaniose est une maladie très répandue, affectant 88 pays, dont 72 pays en voie de développement et 13 parmi les moins développés. Bien que la leishmaniose soit considérée comme une maladie tropicale, elle est également endémique dans d’autres pays, principalement dans le bassin méditerranéen, le sud de l’Europe, la Turquie et Israël. La forme la plus répandue dans le sud de l’Europe est la leishmaniose viscérale (LV), principalement en tant que co-infection leishmaniose/VIH et les toxicomanes par voie intraveineuse ont été identifiés comme la principale population à risque [4]. Dans les autres pays méditerranéens et du Moyen-Orient, la LCL est la maladie la plus répandue. Quatre-vingt-dix pour cent des cas de LCL sont situés dans sept pays : Afghanistan, Algérie, Brésil, Iran, Pérou, Arabie Saoudite et Syrie [5]. Ces régions sont particulièrement attrayantes pour les touristes européens et donc, les médecins européens doivent prendre conscience de l’existence de cette maladie et se familiariser avec sa prise en charge. Des rapports en France ont indiqué un long délai avant le diagnostic définitif et un taux élevé de diagnostics erronés de la part des médecins généralistes [6]. Des constatations semblables ont été faites dans d’autres pays où des cas ont été importés. Étant donné que les espèces de phlébotomes transmettant la maladie se nourrissent la nuit, la plupart des personnes infectées sont celles qui passent la nuit à l’extérieur, comme le personnel militaire. En Israël, le taux d’infection chez le personnel