R. Izu

Allergic contact dermatitis from a cream containing Centella asiatica extract

A 42-year-old housewife, with no atopic history, developed severe dermatitis of the legs, without previous sun exposure, after the application of a vasotonic cream (BlasteostimuJina®). She was patch tested, using Finn Chambers® and TRUE Test® and reading at 2 and 4 days, with the GEIDC standard series, the Blasteostimulina® cream and its ingredients. We found strongly positive reactions to neomycin (another component of the cream), colophony, fragrance-mix and carba-mix in the GEIDC standard series, as well as a positive reaction to Blasteostimulina® cream. On testing with the fragrance series (Chemotechnique), we found positive reactions to cinnamic aldehyde, geraniol, hydroxycitronellal, jasmine synthetic, Bulgarian rose oil, ylang-ylang oil, Bourbon geranium oil, neroli essence, lemon grass essence and cananga oil (all2% pet.). In the rubber series (Chern-

Allergic contact cheilitis from a lipstick containing oxybenzone.

this open test was negative, we proceeded to patch test with FlexidoJ® spray (as is) and its individual components, and with a non-steroidal anti-inflammatory drug (NSAID) series. The 2nd patient was also tested with piroxicam. We found strongly positive reactions in both patients to FlexidoJ® spray (as is) and to fepradinol 0. I%, 0.5%, I% and 5% aq., with a + + + reaction to the highest concentration. 20 healthy controls patch tested with fepradinol 5% aq. were all negative. The 1st patient was also positive to nickel, but otherwise both patients were entirely negative to the other components of FlexidoJ® spray (benzyl alcohol, essence and propylene glycol) and all other NSAIDs tested (salicylic acid, thiosalicylic acid, indomethacin, paracetamol, benzydamine, piketoprofen, ketoprofen, ibuprofen, naproxen, phenylbutazone, bufexamac and, in Case no. 2. only, piroxicam).

Photoaggravated allergic contact dermatitis due to topical thiabendazole

Case Report A 40-year-old male patient consulted us in April 1992 with severe acute eczema on sun-exposed areas of the face and neck. He had presented with rosacea in January 1991 and been treated with oral tetracycline and topical thiabendazole 10% in o/w emulsion for 3 months. For the last month, he had been treated with the thiabendazole preparation alone. 2 days before consulting us, and after intense solar exposure, he developed erythema, itching and scaling on sun-exposed areas of the face and neck, coinciding more-or-less with areas where he had applied the thiabendazole cream. We measured his MED for UVA and UVB, both being normal. After phototesting, patch and photopatch testing were performed with Leukotest® and TRUE TestTM. Patch tests were read at D2 and D4. Photopatch tests were irradiated with UVA (10 J/cm2) at D2 and read 1 and 2 days after irradiation. We patch and photopatch tested with the GEIDC standard series, his own toiletries (aftershave lotion and eau de cologne) and the 10% thiabendazole cream. We found positive reactions to the thiabendazole cream on patch and photopatch testing, the rest of the tests being negative. Subsequently, we patch and photopatch tested with thiabendazole 2% pet. and an imidazole series (Table 1), to detect cross-reaction. Only the

Tratamiento de linfomas cutáneos de células T con bexaroteno

Resumen Introduccion La eleccion del tratamiento en los linfomas cutaneos de celulas T (LCCT) depende del estadio clinico de la enfermedad y del estado general del paciente. Hasta hoy no existe ningun tratamiento curativo para esta enfermedad y el objetivo es controlar los sintomas y prevenir la progresion de la enfermedad. El bexaroteno es un retinoide agonista especifico de los receptores X de los retinoides con actividad antitumoral. Su uso fue aprobado por la Food and Drug Administration (FDA) como tratamiento de LCCT refractarios a al menos una terapia sistemica previa. Pacientes y metodos Realizamos un estudio descriptivo de 9 pacientes que han sido tratados con bexaroteno en la Unidad de Linfomas de nuestro servicio. Analizamos las caracteristicas clinicas de los pacientes y eficacia del tratamiento y recogemos los efectos secundarios presentados. Resultados La respuesta global al tratamiento fue del 44,4% (4/9). Un total de 2 pacientes presentaron una remission completa y los otros dos, una remision parcial. La tolencia al tratamiento fue buena y los efectos secundarios mas frecuentes fueron la hipertrigliceridemia, la hipercolesterolemia y el hipotiroidismo central. Conclusiones Aunque se trata de una serie de unicamente 9 pacientes los resultados que obtuvimos son similares a los descritos previamente. El bexaroteno es una opcion terapeutica eficaz en este grupo heterogeneo de enfermedades.INTRODUCTION The choice of treatment in cutaneous T-cell lymphomas (CTCLs) depends on the clinical stage of the disease and the patients general condition. To date, there is no curative treatment for this disease, and the objective is to control the symptoms and prevent the disease from progressing. Bexarotene is an X receptor-specific retinoid with anti-tumor activity. Its use as treatment for CTCLs refractory to at least one prior systemic therapy has been approved by the FDA. PATIENTS AND METHODS We carried out a descriptive study of 9 patients treated with bexarotene in the Lymphoma Unit of our department. We analyzed the clinical characteristics of the patients and the efficacy of the treatment, and we collected data on the side effects that appeared. RESULTS The overall response to the treatment was 44.4% (4/9). 2 patients had full remission and 2 had partial remission. Tolerance to the treatment was good, and the most frequent side effects were hypertriglyceridemia, hypercholesterolemia and central hypothyroidism. CONCLUSIONS Even though this is a series of only 9 patients, the results that we obtained are similar to ones previously described. Bexarotene is an effective therapeutic option in this heterogeneous group of diseases.

Vitronectin and dermcidin serum levels predict the metastatic progression of AJCC I-II early-stage melanoma.

Like many cancers, an early diagnosis of melanoma is fundamental to ensure a good prognosis, although an important proportion of stage I–II patients may still develop metastasis during follow‐up. The aim of this work was to discover serum biomarkers in patients diagnosed with primary melanoma that identify those at a high risk of developing metastasis during the follow‐up period. Proteomic and mass spectrophotometry analysis was performed on serum obtained from patients who developed metastasis during the first years after surgery for primary tumors and compared with that from patients who remained disease‐free for more than 10 years after surgery. Five proteins were selected for validation as prognostic factors in 348 melanoma patients and 100 controls by ELISA: serum amyloid A and clusterin; immune system proteins; the cell adhesion molecules plakoglobin and vitronectin and the antimicrobial protein dermcidin. Compared to healthy controls, melanoma patients have high serum levels of these proteins at the moment of melanoma diagnosis, although the specific values were not related to the histopathological stage of the tumors. However, an analysis based on classification together with multivariate statistics showed that tumor stage, vitronectin and dermcidin levels were associated with the metastatic progression of patients with early‐stage melanoma. Although melanoma patients have increased serum dermcidin levels, the REPTree classifier showed that levels of dermcidin <2.98 μg/ml predict metastasis in AJCC stage II patients. These data suggest that vitronectin and dermcidin are potent biomarkers of prognosis, which may help to improve the personalized medical care of melanoma patients and their survival.

Cutaneous Reactive Angiomatosis Associated With Chronic Lymphoid Leukemia

Cutaneous reactive angiomatosis is an unusual benign vascular disorder of the skin usually associated to systemic diseases. It is characterized by lobular or diffuse proliferation of small blood vessels with hyperplasia of endothelial cells, pericytes, and sometimes histiocytes. We report a 59-year-old man with asymptomatic erythematous-violaceous patches on back, palms, and elbows for 9 months. Laboratory examination revealed changes consistent with B-chronic lymphocytic leukemia. Cutaneous biopsy showed a predominantly lobular small blood vessel proliferation in dermis with pericytic hyperplasia and mild perivascular lymphoplasmacytic infiltrate. Spontaneous involution of lesions occurred after 6 months. A second biopsy performed at the beginning of clinical involution showed a less prominent vascular component with perivascular giant cells with coexpression of CD68 and CD 31. To our knowledge, this is the first case of cutaneous reactive angiomatosis with documented histopathological findings of clinical involution.

Trasplante autólogo de progenitores hematopoyéticos seguido de bexaroteno oral en paciente con micosis fungoide avanzada

We describe the case of a 17-year-old patient with rapidly progressing and aggressive mycosis fungoides, with multiple cutaneous tumors and large cell transformation. She was initially treated with 3 cycles of high-dose chemotherapy with mega-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) without response, leading to the decision to undertake autologous hematopoietic stem cell transplantation. Partial remission of the disease was achieved with this treatment and subsequent introduction of oral bexarotene led to complete remission, which has been maintained for more than 3 years with good tolerance of oral therapy. We discuss the advantages and disadvantages of autologous hematopoietic stem cell transplantation and the use of oral bexarotene.

Autologous Hematopoietic Stem Cell Transplantation Followed by Oral Bexarotene in a Patient With Advanced Mycosis Fungoides

We describe the case of a 17-year-old patient with rapidly progressing and aggressive mycosis fungoides, with multiple cutaneous tumors and large cell transformation. She was initially treated with 3 cycles of high-dose chemotherapy with mega-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) without response, leading to the decision to undertake autologous hematopoietic stem cell transplantation. Partial remission of the disease was achieved with this treatment and subsequent introduction of oral bexarotene led to complete remission, which has been maintained for more than 3 years with good tolerance of oral therapy. We discuss the advantages and disadvantages of autologous hematopoietic stem cell transplantation and the use of oral bexarotene.