Priscila Giavedoni

Acne fulminans successfully treated with cyclosporine and isotretinoin

E-mail: jacoblevittmd@gmail.com REFERENCES 1. Fowler J Jr, Jackson M, Moore A, Jarratt M, Jones T, Meadows K, et al. Efficacy and safety of once-daily topical brimonidine tartrate gel 0.5% for the treatment ofmoderate to severe facial erythema a of rosacea: results of two randomized, double-blind, vehicle-controlledpivotal studies. JDrugsDermatol 2013;12:650-6. 2. Rhaman MQ, Ramaesh K, Montgomery DM. Brimonidine for glaucoma. Expert Opin Drug Saf 2010;9:483-91. 3. Galderma Laboratories LP. Mirvaso (brimondine) 0.33% topical gel package insert. Available at: http://www.accessdata.fda. gov/drugsatfda_docs/label/2013/204708lbl.pdf. 4. Mortuaire G, de Gabory L, Francois M, Masse G, Bloch F, Brion N, et al. Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice. Critical review of the literature by a medical panel. Eur Ann Otorhinolaryngol Head Neck Dis 2013;130:137-44.

Square alopecia: A new type of transient alopecia of the scalp following fluoroscopically endovascular embolization

Endovascular interventional procedures are the first choice of treatment for many vascular intracranial lesions, especially those with complex anatomy. These procedures may cause numerous skin lesions depending on the dose of radiation to which patients have been exposed. In this report, we presented a case of a 38-year-old man who developed a square plaque of alopecia in the occipital area after two selective embolization of a left posterior parasagittal arteriovenous malformation. The alopecia was transient and the hair grew up 2 months later after the last procedure. This case illustrates one of the effects of radiation on the scalp and expands our knowledge about the clinical manifestation of this transient disease.

Delayed Allergic Reactions to Jellyfish Stings: Usefulness of Ultrasonographic Evaluation: Ultrasonographic Features of Delayed Allergic Reactions After Jellyfish Stings

Jellyfish stings often cause immediate local skin reactions, and, less frequently, the affected individuals may develop delayed allergic reactions days or months after the sting. Here, we present 4 such cases. In all cases, color Doppler ultrasonography was performed at the time of diagnosis, and in 3 of the cases, clinical follow‐ups with ultrasonographic evaluations were performed. Ultrasonography initially showed dermal thickening with decreased echogenicity that progressively normalized during follow‐up. Ultrasonography was useful in quantifying inflammation by measuring the thickness of the dermis and was more precise than standard clinical follow‐up of cutaneous lesions in these cases.

Assessment of Treatment of Refractory Granuloma Faciale With Intralesional Rituximab

Importance Granuloma faciale (GF) is a rare, benign inflammatory dermatosis of unknown cause. Some reports have suggested that it could be part of the spectrum of IgG4-related sclerosing diseases. Granuloma faciale is characterized by single or multiple red-brown nodules, most frequently occurring on the face, and it can produce severe disfigurement. Treatment is difficult, and poor outcomes are often seen. Rituximab is a monoclonal antibody against CD-20 approved by the US Food and Drug Administration for treatment of some autoimmune and tumoral diseases. Objective To evaluate the treatment of refractory GF with intralesional rituximab. Design, Setting, and Participants In this case series, 3 patients with biopsy-proved refractory GF who underwent treatment at a dermatology outpatient clinic of a tertiary referral hospital were evaluated. The study was conducted from August 2015 to December 2017. Interventions Doses of 0.5 to 1 mL/cm2 of intralesional rituximab, 10 mg/mL, were administered monthly for 6 months and thereafter depending on clinical response. In 2 patients, peripheral blood B-cell counts were monitored before and during treatment, and in 1 patient, only during treatment. Main Outcomes and Measures Reduction in size of the lesions, ultrasonography evaluation, subjective improvement, and adverse events were monitored throughout the course of therapy. Results All 3 of the patients were men (ages from 30s to 60s). They showed a significant reduction in the size and thickness of GF both clinically and on ultrasonography evaluation. Two patients had a complete response and the third, a partial response. A reduction in peripheral blood B-cell count was observed in the 3 patients, suggesting that the action of rituximab could be systemic. No severe adverse reactions were reported. Conclusions and Relevance Intralesional rituximab may represent a novel and well-tolerated therapy for refractory GF.

More than skin deep

We present the case of a woman in her 50s with past medical history significant for psoriasis treated with methotrexate on a stable dose for the past 20 years, diabetes mellitus and chronic kidney disease. In the setting of a long flight, dehydration and non steroidal anti-inflammatory drug consumption, the patient presented to the emergency department with oral mucositis and cutaneous erosions and ulcers of the psoriasis plaques. MTX levels were normal corroborated by three different measurements in 24 h. Initially the complete blood count tests were significant for macrocytic, thrombocytopenia (82.000 103/L) and impaired kidney function. The patient was diagnosed of acute methotrexate toxicity and started on intravenous folinic acid. In 24 h the patient developed severe pancytopenia. She required treatment with colony-stimulating factors, platelet and blood transfusions. After 10 days, the CBC improved to normal levels and the cutaneous lesions resolved.

Alopecic and aseptic nodule of the scalp in a girl

Alopecic and aseptic nodule of the scalp is a rare entity characterized by the presence of nodules or cysts with sterile punctured material and negative cultures accompanied by nonscarring alopecia in the scalp of young men. We describe a case in which an 11‐year‐old girl presented with a nodular, fluctuant, round lesion on the vertex with localized alopecia. High‐resolution ultrasound showed a hypoechoic lesion with increased flow on Doppler imaging and culture of the citrine‐yellowish material obtained by puncture was negative. The patient showed complete clinical response to treatment with topical indomethacin.

Remission Time after Rituximab Treatment for Autoimmune Bullous Disease: A Proposed Update Definition

A therapeutic endpoint is a very important tool to evaluate response in clinical trials. In 2005, a consensus statement identified two late endpoints of disease activity in pemphigus: complete remission off therapy and complete remission on therapy, both definitions applying to patients without lesions for at least 2 months. The same period of time was considered for partial remission off/on therapy. These definitions were later applied to bullous pemphigoid and are considered in most studies on autoimmune bullous disease. These endpoints were established for different adjuvant agents, but at that moment, rituximab was not considered. Rituximab is known for the long duration of its effect, and in most studies relapses have been reported later than 6 months after treatment. In our opinion, time to remission after rituximab treatment should be redefined.