Rana Anadolu

Dermatomal lichenoid graft-versus-host disease within herpes zoster scars

Case 1 A 23‐year‐old woman was diagnosed with chronic myelogenous leukemia in 1997. In 1999, she underwent allogeneic bone marrow transplantation (BMT) from a human leukocyte antigen (HLA)‐matched sibling donor after induction chemotherapy with cyclophosphamide and busulfan. At day 46 after BMT, she was discharged with a medication regimen which included cyclosporine, fluconazole, acyclovir, and trimethoprim/sulfamethoxazole. Five months later she developed clusters of vesicles and pain over the right inframammary and right infrascapular areas corresponding to the T5–T6 dermatomes. Herpes zoster infection was diagnosed clinically and acyclovir therapy (3 × 10 mg/kg/day) was started. All lesions healed within 2 weeks leaving atrophic cicatrices and postinflammatory hyperpigmentation.

Mycosis fungoides and Sezary syndrome: therapeutic approach and outcome in 113 patients

Backgroundu2002 Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common forms of cutaneous T‐cell lymphoma (CTCL). Various topical and systemic therapeutic alternatives are available, but there is no standard or definite curative treatment regimen. When making a decision about the appropriate treatment modality, the age and compliance of the patient, stage of the disease, treatment accessibility, and previous treatment history should be considered.

Remission of severe autoimmune bullous disorders induced by long-term extracorporeal photochemotherapy

Pemphigus vulgaris (PV) and epidermolysis bullosa acquisita (EBA) sometimes resist treatments. In drug-resistant cases, adjuvant treatment with extracorporeal photochemotherapy (ECP) has been reported to induce remission. However, limited numbers of patients have been reported up to date. Eleven patients with drug-resistant autoimmune bullous diseases have been treated with ECP (8 patients with PV, 3 patients with EBA). The introduction of ECP to systemic therapies of the patients with PV resulted in complete response (CR) after a limited cycle (2-6 cycles) in all, except one patient. Prednisolone doses could be tapered in all patients. ECP resulted in CR in two patients while improvement was partial in one patient with EBA after 3-6 cycles. Our patients demonstrate the efficacy of long-term ECP to be tried in the treatment of aggressive autoimmune bullous disorders. The treatment has produced a remarkable corticosteroid-sparing effect while inducing clinical remission.

Giant keratoacanthoma-type low-grade squamous cell carcinoma of the upper lip: Response to intralesional interferon alpha-2B

Giant aggressive keratoacanthoma (KA) is a rare destructive subset of KA that grows rapidly to a large size, and often recurs after surgical management. Here, we present a patient with a solitary giant KA of the upper lip and philtrum that was successfully treated by intralesional injections of interferon alpha-2b (IFN-a-2b). A 43-year-old male presented with a rapidly growing mass on the upper lip for 4 months. The patient had previously been treated in another center with the diagnosis of KA with intralesional triamcinolone acetonide and intralesional methotrexate without any significant clinical response. Thus, the neoplasm continued to enlarge and cover both the philtrum and nasal orifices. Dermatological examination revealed a 7 5 cm verrucoid, firm, painless mass on the upper lip and philtrum extending towards both nasal cavities (Figure 1). A KOH preparation of a skin scraping for fungi, a giemsa-stained touch smear for Leishmania tropica, smears for acid-fast mycobacteria and cultures were all negative. His physical examination and laboratory results were insignificant. A skin biopsy revealed giant solitary KA-type low-grade squamous cell carcinoma (SCC). Total surgical removal of the lesion was refused by the patient. IFNa-2b, 3 1 million international units (MIU)/week was initiated. At the end of the second week, a 50% clinical regression was achieved. Then dosage was increased to 3 3 MIU/week. The treatment was discontinued after 12 injections, with complete resolution of the neoplasm (Figure 2). The disease is in complete resolution without recurrence after 17 months of follow-up. Giant solitary KA is a variant of low-grade SCC (1,2). Although spontaneous regression is common in solitary KA, the giant variant may express aggressive, destructive behavior. Complete surgical excision remains the treatment of choice followed by intralesional methotrexate, 5-fluorouracil, bleomycin, IFNa, triamcinolone acetonide and radiotherapy. Radiotherapy, although efficient in the treatment of KAs, is today used with some caution owing to its carcinogenic potential. In the present case, we consider intralesional IFNa-2b as a therapeutic option due to the patient’s refusal of surgical excision. Successful treatment of KA with intralesional IFNa-2a was first reported in 1989 by Wickramasinghe et al. (3). Since then, few studies had evaluated the efficacy of IFNa in the treatment of KA. The total amount of IFNa needed

A giant mass on the scalp: an unusual presentation of lupus vulgaris

Lupus vulgaris (LV) is a paucibacillary form of cutaneous tuberculosis (TB) that may arise in case of slight immunosuppression which results in moderate to high immunity against the pathogen. Predilection sites are buttocks and trunk. TB reemerges to be a serious medical problem due to HIV infection, organ transplants, and thus increase in the number of immunocompromised patients. Cutaneous TB comprises only less than 1–2% of the cases. Mycobacterium TB and unusually Mycobacterium bovis cause cutaneous TB. LV is the most common form of cutaneous TB which may lead to disfigurement if not diagnosed and treated properly. LV arises in patients with slight immunosuppression and the bacilli count in the lesions is low because of the immune response. Here, we describe a neglected atypical case of LV with complete clinical and histopathological response to antituberculous treatment (ATT) in an immunocompetent woman.