P. Rodríguez-Jiménez

Respuesta a omalizumab en 3 casos de urticaria solar

We report 3 cases of solar urticaria in which there was no response or limited response to first-line treatments with high-dose H1 antihistamines or phototherapy. The patients were then treated with omalizumab. Symptoms improved in 2 patients, whose tolerance to sunlight increased considerably; quality of life clearly improved for 1 of these patients. The third experienced no improvement and developed a mild local reaction to the injected medication. We conclude that omalizumab may offer a potentially safe, useful alternative for patients with solar urticaria who do not respond to conventional therapy.

Inducción de fototolerancia con ultravioleta B de banda estrecha en urticaria solar

INTRODUCTION Solar urticaria is an uncommon photodermatosis. First-line treatment is with antihistamines; second-line treatment includes induction of light tolerance using UV phototherapy. OBJECTIVES We aimed to describe and evaluate the effectiveness of a desensitization protocol with narrowband UV-B in patients with solar urticaria. MATERIAL AND METHODS We performed a retrospective study of patients with solar urticaria with an action spectrum in the UV-A range, the visible light range, or both who had received therapy with narrowband UV-B for induction of light tolerance. Short courses of treatment were administered (<20 sessions, 3 per week) during spring. The initial dose was determined according to the skin type. The Skindex-29 was administered before treatment and after summer; a nonvalidated questionnaire was also administered after summer to evaluate disease activity and satisfaction with treatment. RESULTS We included 8 patients with an action spectrum (4 with visible light and 4 with UVA plus visible light). Seventeen courses (1-6 per patient) were administered per year. The number of sessions per year ranged from 11 to 20. The mean dose of narrowband UV-B per course was 7.45J/cm2. No patients experienced flares or adverse effects during treatment. The response was satisfactory in 6 patients. The improvement in the overall Skindex-29 score was greater than 20% in 78.6% of cases. The improvement in the function and symptoms subscales was over 20% in 71% and 64% of cases, respectively. CONCLUSION Induction of light tolerance with narrowband UV-B in solar urticaria is safe and effective in a high percentage of patients.

Successful treatment to a tretinoin/clindamycin gel in a late onset of nevus comedonicus: CAPUSAN et al.

Nevus comedonicus (NC) is a rare abnormality of the pilosebaceous unit development of unknown cause (Kirtak, Inaloz, Karakok, Erguven, & Ozgoztasi, 2004). The prevalence has been estimated to be from 1 in 45,000 to 1 in 100,000, with no gender or race predilection (Happle, 2010). It can occur at birth in 50% of the cases, and in the other 50% it appears later in life, usually before the age of 10. Single cases of late development of NC or NC syndrome have been described (Tchernev et al., 2013). Recently, somatic NEK9 mutations have been identified, suggesting that these are a potential regulator of follicular homeostasis (Dereure, 2017; Levinsohn, Sugarman, McNiff, Antaya, & Choate, 2016). Generally, most treatments have been unsuccessful. An 80-year-old man with a history of osteoarthritis and hypertension, presented with asymptomatic frontal lesion that appeared 30 years before. Physical examination revealed numerous blackish follicular plugs in an area of 14 cm 3 5 cm occupying the entire forehead. At the top right edge there was also a congenital vascular malformation (Figure 1). He did not show any skeletal, dental, or ocular abnormalities. Histopathological study showed dilated infundibula occupied by keratotic material, some of them constituting small superficial cysts (Figure 2). Topical treatment with once daily tretinoin/clindamycin gel 0.025%/1% (Treclinac Gel, Meda Pharma, Spain) was prescribed. Lesions disappeared within four months (Figure 3) with a good tolerance and compliance. Maintenance therapy at patient’s demand was undertaken with 3–4 applications monthly with satisfactory aesthetic results. Aggressive treatment of NC generally is not required. Only in complicated cases (cyst formation, with secondary infection and development of scarring) or for aesthetic reasons can be tried keratolytics such as salicylic acid and 0.1% retinoic acid, vitamin D derivatives as topical calcipotriol, and keratoregulators such as 12% ammonium lactate. Laser (CO2, Erbium Yag, diode laser) or complete surgical removal has also been used. In severe cases, oral retinoids have proven to be partially effective (Tchernev et al., 2013). We have not found reported cases of the combination tretinoin/clindamycin, although there are isolated cases of limited response to tretinoin (Kaliyadan, Nambiar, Al Ameer, & Amri, 2014; Manola, Ljubojević, Lipozencić, & Pustisek, 2003; Polat, Altunay Tuman, Sahin, Dogan, & Boran, 2016). Our patient showed a great improvement with this combination. It is well known that tretinoin inhibits microcomedo formation and decreases cohesiveness of keratinocytes in sebaceous follicles. As for clindamycin, its effect could be similar to that of antibiotics in acne vulgaris, by preventing comedo formation and inflammation, promoting differentiation of cells within the hair follicle unit, reducing sebum secretion and sebocyte proliferation, and killing P. acnes (Levinsohn et al., 2016). The involvement of P. acnes contributes to the production of inflammatory cytokines, antimicrobial peptides, and metalloproteinases from part of the activated cells and participates in the development of comedones (L opez-Estebaranz, FIGURE 1 Bilateral grouped blackish follicular plugs comedo like on the forehead

Long-term treatment of neurofibromatosis 1 with ketotifen. A report of three cases.

Funding sources: None. Conflicts of interest: The authors declare no conflicts of interest. Correspondence to: Esteban Daud en, Department of Dermatology, Hospital Universitario de la Princesa, Diego de Le on, 62; 28009 Madrid, Spain. E-mail: estebandauden@gmail.com Article first published online in Wiley Online Library (wileyonlinelibrary.com): 6 January 2016 DOI 10.1002/ajmg.a.37531 How to Cite this Article: Rodriguez-Jimenez P, Chicharro P, Mu~ noz E, Dauden E. 2016. Long-term treatment of neurofibromatosis 1 with ketotifen. A report of three cases.