Utilization of dapsone and hemoglobin in the epithelial skin regeneration therapy of cutaneous loxoscelism: A case report and integrative literature review

ABSTRACT BACKGROUND: Loxosceles spp are arthropods found worldwide. Its bite may produce cutaneous loxoscelism (necrotic or edematous) or cutaneous-visceral loxoscelism. Depending on their severity and location, cutaneous forms are managed with local cold application and systemic administration of antihistamines, corticosteroids, antibiotics, polymorphonuclear inhibitors, and analgesics. OBJECTIVE: This study aimed to report a case of cutaneous loxoscelism and to identify the main dermatological manifestations associated with the Loxosceles spp bite. DESIGN AND SETTING: This case report and literature review was conducted in a Mexican university. METHODS: A detailed report on the medical management of a patient with cutaneous loxoscelism treated at the emergency department of a public hospital was published. Scopus, PubMed, Web of Science, and Google Scholar databases were searched to identify articles reporting cutaneous loxoscelism. The following keywords were used during the database search: "loxoscelism" OR "spider bite," OR "loxosceles" OR "loxosceles species" OR "loxosceles venom" OR "loxoscelism case report" AND "cutaneous" OR "dermonecrotic arachnidism." RESULTS: A 62-year-old female patient with cutaneous loxoscelism was treated with systemic dapsone and local heparin spray. Eighteen studies with 22 clinical cases were included in this systematic review. Of the 22 patients, 12 (54.5%) were men. L. rufescens was the predominant spider species. CONCLUSIONS: The administration of dapsone and heparin for the management of cutaneous loxoscelism demonstrated success in this case, with no sequelae observed. In general, the literature review indicated favorable outcomes in patients treated with antimicrobials and corticosteroids, with continuous healing of skin lesions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO ID CRD42023422424 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023422424).

Acné conglobata familiar

El acné conglobata es una forma severa de acné que produce muchas lesiones inflamatorias y cicatrices, marcando la vida del paciente de manera negativa. Presentamos el caso de 2 hermanos con acné conglobata, ambos con lesiones en piel de 2 años de evolución con aparición de nódulos, quistes y fístulas en territorio corporal extenso. El primero con diagnóstico reciente de leucemia promielocítica aguda en planes de iniciar quimioterapia y, el segundo, sin patologías de base. El primer caso recibió tratamiento antibiótico sistémico por complicaciones infecciosas propias de la inmunodepresión, además recibió dexametasona y ácido transretinoico como quimioterapia, y es dado de alta con dichos medicamentos y antibiótico profiláctico. El segundo caso recibió tratamiento con antibiótico sistémico y dapsona. Ambos acuden a control a los 2 meses y se observó mejoría importante de las lesiones en piel. El primer paciente falleció por complicaciones inherentes a su patología de base y el segundo paciente abandonó el tratamiento.

Acne conglobata is a severe form of acne that produces many inflammatory lesions and scars, marking the patient's life in a negative way. We present the case of two brothers with acne conglobata, both with 2-year-old skin lesions with the appearance of nodules, cysts, and fistulas in extensive body territory. The first with a recent diagnosis of acute promyelocytic leukemia with plans to start chemotherapy and the second with no underlying pathologies. The first case received systemic antibiotic treatment due to infectious complications typical of immunosuppression, he also received dexamethasone and transretinoic acid as chemotherapy, and was discharged with the mentioned drugs and prophylactic antibiotic. The second case received treatment with systemic antibiotic and dapsone. Both cases returned for control at 2 months and significant improvement in skin lesions was observed. The first patient died due to complications inherent to his underlying pathology and the second patient abandoned treatment.

Dermatitis herpetiforme en mujer joven de la Amazonía peruana

La dermatitis herpetiforme es una enfermedad autoinmune que se caracteriza por la presencia de lesiones vesiculares y prurito en la superficie extensora de las extremidades, nalgas y parte baja de la espalda. Se presenta el caso clínico de una mujer de 21 años, natural y procedente de Iquitos, que presentó múltiples vesículas dolorosas, pruriginosas, de base eritematosa y purulentas en ambos codos durante un mes. Posteriormente, estas lesiones se diseminaron a ambas rodillas y se agregó prurito intenso. La paciente experimentó períodos alternantes de remisión y exacerbación. La correlación del cuadro clínico, resultados serológicos y de biopsia, junto con respuesta terapéutica a la dapsona confirmaron el diagnóstico de dermatitis herpetiforme, con una evolución favorable y remisión de la enfermedad.

Dermatitis herpetiforme is an autoimmune disease characterized by the presence of vesicular lesions and itching on the extensor surface of the limbs, buttocks, and lower back. The clinical case of a 21-year-old woman, a native of and from Iquitos, is presented. She presented multiple painful, itchy vesicles with an erythematous and purulent base on both elbows for a month. Subsequently, these lesions spread to both knees, and intense itching was added. The patient experienced alternating periods of remission and exacerbation. The correlation of the clinical picture, serological and biopsy results, along with the therapeutic response to dapsona, confirmed the diagnosis of dermatitis herpetiforme, with a favorable evolution and remission of the disease.

Metemoglobinemia como efeito adverso do tratamento para hanseníase: relato de caso / Methemoglobinemia as an adverse effect of the treatment for leprosy: case report / Metahemoglobinemia como efecto adverso del tratamiento de la lepra: informe de caso

Introdução: O tratamento da hanseníase consiste em um regime de poliquimioterapia com as seguintes drogas: Rifampicina, Dapsona e Clofazimina. Entre os efeitos colaterais, a metemoglobinemia decorre do uso da Dapsona e requer atenção especial, pois enseja a necessidade de suspensão da medicação e, em casos graves, de internação hospitalar. Trata-se de uma complicação rara, na qual ocorre uma anomalia da hemoglobina, que impossibilita a captação e a liberação de oxigênio. É provocada pela ação da Dapsona, quando administrada em quantidade e em duração além das recomendadas. Destacam-se como sinais e sintomas a presença de cianose, baixa saturação de oxigênio e dispneia aos esforços, embora a PaO2 esteja de acordo com os valores de referência. O diagnóstico da metemoglobinemia é realizado pela co-oximetria. Pacientes com cianose ou sintomas de hipoxemia, com PaO2 suficientemente alta, apresentam elevada suspeição. Apresentação do caso: Apresenta-se um caso de metemoglobinemia identificado na Atenção Primária à Saúde (APS) durante um tratamento de hanseníase, que exigiu condução minuciosa, culminando na suspensão da poliquimioterapia, com resolução do evento adverso. Conclusão: O acompanhamento clínico rigoroso pela APS durante o tratamento da hanseníase possibilita o reconhecimento precoce de eventuais efeitos adversos da poliquimioterapia, bem como a adoção das devidas medidas.

Introduction: Leprosy treatment consists of a multidrug therapy regimen with the following drugs: Rifampicin, Dapsone, and Clofazimine. Among the side effects, methemoglobinemia results from the use of Dapsone and requires special attention, as it leads to the need to discontinue the medication and, in severe cases, hospitalization. It is a rare complication, on which there is hemoglobin anomaly, which makes it impossible to capture and release oxygen. It is caused by the action of Dapsone when administered in doses and duration beyond the recommended ones. The presence of cyanosis, low oxygen saturation, and dyspnea on exertion stand out as signs and symptoms, although the PaO2 is within the reference values. The diagnosis of methemoglobinemia is performed by co-oximetry. Patients with cyanosis or symptoms of hypoxemia, with sufficiently high PaO2, are highly suspicious. Case presentation: A case of methemoglobinemia identified in Primary Health Care (PHC) during a treatment for leprosy is presented, which required meticulous management, culminating in the suspension of multidrug therapy, with resolution of the adverse event. Conclusions: The strict clinical follow-up by the PHC during the treatment of leprosy allows the early recognition of possible adverse effects of multidrug therapy as well as the adoption of the necessary measures.

Introducción: El tratamiento de la lepra consiste en un régimen de poliquimioterapia con los siguientes fármacos: Rifampicina, Dapsona y Clofazimina. Entre los efectos secundarios, la metahemoglobinemia resulta del uso de Dapsona y requiere atención especial, ya que conlleva la necesidad de suspender la medicación y, en casos graves, la hospitalización. Es una complicación rara, en la que existe una anomalía de la hemoglobina, que imposibilita la captación y liberación de oxígeno. Es provocada por la acción de la Dapsona, cuando se administra en cantidad y duración superiores a las recomendadas. Los signos y síntomas son cianosis, baja saturación de oxígeno y disnea a mínimos esfuerzos, aunque la PaO2 está dentro de los valores de referencia. El diagnóstico de metahemoglobinemia se realiza por cooximetría. Los pacientes con cianosis o síntomas de hipoxemia, con PaO2 suficientemente elevada, presentan alta sospecha. Presentación del caso: Se presenta un caso de metahemoglobinemia identificado en Atención Primaria de Salud (APS) durante un tratamiento por lepra, que requirió una conducta exhaustiva, culminando con la suspensión de la poliquimioterapia con resolución del evento adverso. Conclusiones: El estricto acompañamiento clínico por parte de la APS durante el tratamiento de la lepra permite el reconocimiento precoz de los posibles efectos adversos decurrentes de la poliquimioterapia, así como la adopción de las medidas necesarias.

Medications for the treatment of acne / 中华皮肤科杂志

Some progress has been made in pharmacological treatments for acne in recent years. Several new medications have been proven effective and safe in latest clinical trials, including sarecycline (a novel tetracycline-class antibiotic) , trifarotene (a new topical fourth-generation retinoid) , clascoterone (the first topical androgen receptor antagonist) , 4% SB204 (a nitric oxide-releasing gel) , 4% FMX101 (a topical minocycline foam) , etc. This review summarizes latest advances in drug therapy for acne.

Dermatosis ampollar por IgA lineal inducida por Vancomicina: reporte de un caso / Vancomycin-induced linear igabollous dermatosis: a case report

RESUMEN La dermatosis ampollar por IgA lineal del adulto (DLA) es una enfermedad autoinmune adquirida infrecuente, caracterizada por el depósito lineal de anticuerpos IgA en la membrana basal. La mayoría de los casos reportados son de causa idiopática, pero esta entidad también se ha visto asociada a ciertos fármacos, siendo la vancomicina el más frecuente. Se presenta un caso de DLA asociada a vancomicina, con extensa afectación cutánea y compromiso mucoso, tratado con dapsona y corticoides sistémicos con buena respuesta.

ABSTRACT Adult linear IgA bollous dermatosis (LABD) is a rare acquired autoimmune disease characterized by linear deposition of IgA antibodies on the basement membrane. Most of the reported cases are of idiopathic cause, but this entity has also been associated with certain drugs, vancomycin being the most frequent. We present a case of LABD associated with vancomycine, with extensive skin and mucosal involvement, treated with dapsone and systemic corticosteroids with a good response.

Erroneous reduction of HbA1c levels in patients with type 2 diabetes mellitus on dapsone treatment for Hansen’s disease - a single-center retrospective cohort study

Background: Dapsone treatment may reduce HbA1c levels in patients with diabetes. Aims: To assess the prevalence and characteristics of dapsone associated reduction of HbA1c in patients with Hansen’s disease. Methods: A retrospective data review of outpatient and inpatient charts of consecutive patients with Hansen’s disease and type 2 diabetes mellitus was conducted over two years from January 2014 to January 2016 at the Department of Dermatology, CMC Vellore, India. Results: Of the 245 patients with a confirmed diagnosis of Hansen’s disease who were on oral dapsone 100 mg/day as part of their treatment regimen, 49 patients had diabetes and were eligible for the study as per predetermined inclusion criteria. Of these, 35 subjects (71%) had an HbA1c discordantly lower than the corresponding mean plasma glucose levels. Patients with discordant HbA1c levels were more likely to be male and to have a higher RBC mean corpuscular volume (MCV). A greater reduction in HbA1c levels was seen during the initial 3 months of therapy of dapsone treatment. Limitations: The small sample size and retrospective design were limitations of this study. Also, we did not analyze the role of methemoglobinemia or the utility of alternative measures of glycemic control in these patients. Conclusion: We describe a high prevalence of dapsone associated inappropriate HbA1c lowering in type 2 diabetes mellitus patients. This may have serious implications for the management of diabetes in patients on therapy with dapsone.

Comparison of efficacy of two topical drug therapy of acne vulgaris – 1% clindamycin versus 5% dapsone: A split face comparative study

Background: Acne vulgaris is common skin problem for adolescents and young adults. Topical clindamycin is an established treatment modality effective in mild-to-moderate acne. Dapsone has been used orally for the treatment of acne but used less due to its systemic side effects. Topical dapsone may offer new treatment option for acne vulgaris due to its dual anti-inflammatory and anti-microbial effect. Aim and Objective: The aim of the study was to compare the efficacy of 1% clindamycin gel with 5% dapsone gel in the patient of Grade II acne vulgaris. Materials and Methods: It was a prospective interventional study with split face comparative study design. Each patient was received a pair of labeled tubes of medication – Right (Rt) side containing clindamycin 1% and left (Lt) side containing dapsone gel 5%. The assessment was done by calculating the change from baseline, after 4, 8, and 12 weeks of the total lesion count and both inflammatory and non-inflammatory lesions using repeated measures analysis of variance. Results: A total of 40 patients were included in the study. Both inflammatory and non-inflammatory lesion count reduce significantly at the end of 4, 8, and 12 weeks on both side (P < 0.05). Mean reduction in total count of lesions after 12 weeks of therapy by dapsone 5% was 5.4 ± 5.05 (50.0%), while by clindamycin 1% gel was 5.0 ± 2.76 (50.5%). Conclusion: Dapsone 5% gel monotherapy and clindamycin 1% gel monotherapy have almost equal efficacy when compared after 12 weeks of therapy, but dapsone 5% gel therapy is slightly better effect on inflammatory lesions than clindamycin 1% gel.

Dermatosis Pustulosa Subcórnea / Subcorneal pustular dermatosis

RESUMEN La dermatosis pustulosa subcórnea o enfermedad de Sneddon Wilkinson, es una enfermedad poco frecuente, caracterizada por lesiones pustulosas, recurrentes que suelen coalescer. Esta afección también se relaciona con enfermedades neoplásicas o inmunológicas. El propósito de este estudio es describir un caso clínico de ladermatosis referida en una paciente de 54 años de edad inicialmente tratada con dapsona, aunque,si bien, durante dos meses hubo mejoría, posteriormente se observa desarrollo de nuevas lesiones y alteración de las transaminasas. Por este motivo se procede a cambiar de tratamiento, por trimetoprima /sulfametoxazol.

Abstract Subcorneal pustular dermatosis or Sneddon Wilkinson's disease is a rare disease characterized by recurrent pustular lesions that often coalesce. This condition is also associated with neoplastic or immunologic diseases. The purpose of this study is to describe a clinical case of the referred dermatosis in a 54-year-old female patient initially treated with dapsone, although there was improvement for two months, subsequently new lesions developed and transaminase alteration was observed, for this reason the treatment was changed to trimethoprim/sulfamethoxazole.

Rhinosporidiosis of the lacrimal sac in a tertiary care hospital of India - A retrospective case study

Purpose: Though rhinosporidiosis of the lacrimal sac is a rare disease across the globe, the frequency with which these patients come to the outpatient department in western Odisha is quite alarming. This study was undertaken to upgrade the knowledge about the clinical profile and management of rhinosporidiosis of the lacrimal sac. Methods: This is a retrospective study comprising 32 clinically diagnosed and histopathologically proved cases of lacrimal sac rhinosporidiosis who were managed with dacryocystectomy with meticulous excision. Intraoperative copious irrigation with 5% povidone–iodine for 5 min and postoperative dapsone therapy for 3–6 months had been administered to all the patients. The mean follow?up period was 16.7 months. The study was conducted over 5 years from August 2015 to July 2020. Results: Rhinosporidium seeberi, an aquatic protistan parasite, was found to be the causative agent. Males and females were affected equally. Children less than 10 years of age comprised 56.2% (18 cases). History of pond bathing was found in 100% of cases. The most common presentation was boggy swelling over the lacrimal sac. The involvement was unilateral in all the cases. None of the patients were found to have nasal involvement. In 65.6%, the lesion was limited within the sac. Recurrence was noted in 25% of cases. Conclusion: Rhinosporidiosis of the lacrimal sac should be excluded in all patients presenting with boggy swelling of the lacrimal sac with a history of pond bath. The recurrence can be minimized by meticulous excision, intraoperative betadine, and postoperative dapsone therapy

Adverse effects of polychemotherapy for leprosy in 13 years of follow-up at a university hospital

Abstract Leprosy is one of the neglected diseases in the world and Brazil is the second country with more cases. A retrospective study was conducted based on the medical records of 196 leprosy patients diagnosed during the course of 13 years at a university hospital. The aim was to describe the adverse effects of polychemotherapy, as well the most prevalent and most vulnerable populations. In the study, dapsone was the most implicated drug, especially in women, and the risk increased with age. The authors conclude that with this patient profile, greater vigilance should be taken regarding possible adverse effects, especially anemia.

Granuloma Anular diseminado: a propósito de un caso / Disseminated annular granuloma: on the purpose of a case

RESUMEN El granuloma anular es un trastorno relativamente frecuente, se desconoce la prevalencia exacta, tiene mayor frecuencia en niños y adultos jóvenes. Se caracteriza por pequeñas pápulas agrupadas, en configuración anular, a menudo con distribución simétrica y acra. La mayor parte los casos se resuelve en forma espontánea dentro de los 2 años, pero la tasa de recidivas es del 40%. Presentamos el caso clínico de una paciente de 72 años de edad con granuloma anular diseminado, tratado con pentoxifilina, con buen resultado terapéutico.

ABSTRACT Annular granuloma is a relatively frequent disorder, the exact prevalence is unknown, it is more frequent in children and young adults. It is characterized by small grouped papules, in annular configuration, often with symmetric and acrid distribution. Most cases resolve spontaneously within 2 years, but the recurrence rate is 40%. We present the clinical case of a 72-year-old patient with disseminated annular granuloma, treated with pentoxifylline, with good therapeutic results.

Metahemoglobinemia, una entidad de diagnóstico complejo. Reporte de un caso

Methemoglobinemia is a rare condition with serious consequences if not diagnosed. We report the case of a 64-year-old woman with a history of allergy to sulfa drugs and a recent diagnosis of a small vessel vasculitis (ANCA-p) who started induction therapy with corticosteroids and rituximab. Due to the need for infectious prophylaxis, and considering her history, dapsone was administered instead of cotrimoxazole after ruling out glucose-6-phosphate dehydrogenase deficiency. During the admission to the hospital for her second dose of rituximab, and while being asymptomatic, she persistently presented a pulse oximetry ≪ 90% despite the administration of O2. Therefore, the infusion was postponed to study the patient. The arterial gasometric study by direct potentiometry revealed an O2 saturation of 98%, with a saturation gap > 5%. Considering the use of dapsone, a methemoglobinemia was suspected and confirmed by co-oximetry (methemoglobinemia 9%). Dapsone was suspended and one week later, her methemoglobinemia was absent.

Dapsone induced DRESS syndrome: a rare fatal complication

DRESS syndrome is a serious life threatening condition characterized by skin eruption, haematological abnormalities and multi organ involvement that can be fatal if unrecognized especially in patients with liver failure. Diagnosis may be difficult because it is rarely seen in children and it can mimic many different conditions. Author report a case of 12 year old female presented to this emergency department with moderate grade fever, skin rash and jaundice following dapsone ingestion. She was evaluated and was diagnosed as DRESS syndrome and successfully treated with steroids.

Urticária crônica espontânea de difícil tratamento: existiria um lugar para usar dapsona na falta de omalizumabe? / Spontaneous chronic urticaria of difficult treatment: is there a place to use dapsone in the lack of omalizumab?

Muitos estudos sugerem que a urticária crônica espontânea (UCE) seja uma doença autoimune. A primeira linha de tratamento consiste no uso de anti-histamínicos H1 de segunda geração, que podem ser empregados em até quatro vezes a dose recomendada. A Dapsona ­ diaminodifenil sulfona (DDS) ­ é um quimioterápico com propriedades antimicrobianas e anti-inflamatórias. Em dermatologia, a DDS é usada em doenças nas quais predominam neutrófilos. O omalizumabe é um anticorpo monoclonal, que se liga às moléculas de IgE na circulação e impede que estas IgEs se liguem aos seus receptores. Omalizumabe é recomendado como terceira linha de tratamento de pacientes com UCE, refratários a anti-histamínicos em doses quadriplicadas, na dose de 300 mg a cada quatro semanas. Paciente do sexo feminino, com 41 anos, com UCE sem períodos de remissão por mais de um ano, tratada sem sucesso, com diferentes anti-histamínicos. Existia uma extensa investigação laboratorial. Foi-lhe administrada Cetirizina (anti-histamínico H1 de segunda geração), em elevada dose (40 mg/dia) associada a antileucotrieno (10 mg/dia) por um período de duas semanas. No final do período, a UCE manteve-se completamente inalterada. Foi realizada biopsias das urticas com diagnóstico histopatológico "Dermatite neutrofílica com infiltrado intersticial neutrofílico, sem vasculite ativa e sem eosinófilos". Na falta de omalizumabe, a paciente continuou o tratamento com Cetirizina (40 mg/dia), agora associado a 100 mg/dia de DDS. Atualmente, após 16 semanas de observação, seu quadro mantém-se estável, com urticas ausentes, afora alguns surtos leves, intermitentes. Poder-se-ia usar a DDS na UCE refratária a anti-histamínicos? Alguns estudos bem conduzidos oferecem essa oportunidade.

Many studies suggest that chronic spontaneous urticaria (CSU) is an autoimmune disease. The first line of treatment consists of the use of second-generation H1 antihistamines, which can be used at up to four times the recommended dose. dapsone ­ diaminodiphenyl sulfone (DDS) ­ is a chemotherapeutic agent with antimicrobial and anti-inflammatory properties. In dermatology, DDS is used to treat diseases in which neutrophils predominate. Omalizumab is a monoclonal antibody that binds to IgE molecules in the circulation and prevents these IgEs from binding to their receptors. Omalizumab is recommended as a third-line treatment for patients with CSU refractory to antihistamines in quadruplicate doses, at a dose of 300 mg every four weeks. A 41 year-old female patient with CSU without remission periods for more than one year was unsuccessfully treated with different antihistamines. An extensive laboratory investigation was conducted. She was given a high dose (40 mg/day) of cetirizine (second-generation H1 antihistamine) associated with antileukotriene (10 mg/ day) for a period of two weeks. At the end of the period, CSU remained completely unchanged. Wheal biopsies were performed, with histopathological diagnosis: neutrophilic dermatitis with neutrophilic interstitial infiltrate, without active vasculitis and without eosinophils. In the absence of omalizumab, the patient continued treatment with cetirizine (40 mg/day), now associated with 100 mg/day of DDS. Currently, after 16 weeks of observation, her condition remains stable and the wheals disappeared, apart from some mild, intermittent outbreaks. Could DDS be used in the CSU refractory to antihistamines? Some well-conducted studies offer this opportunity.

A case report of drug rash with eosinophilia and systemic symptoms syndrome induced by dapsone

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a distinct, severe, idiosyncratic reaction to a drug characterized by a prolonged latency period. It is followed by a variety of clinical manifestations, usually fever, rash, lymphadenopathy, eosinophilia, and a wide range of mild-to-severe systemic presentations. Among sulfonamides, Dapsone, sulfamethoxazole-trimethoprim and sulfasalazine are the most common offending drugs. We report here a case of DRESS syndrome due to dapsone.

Rhinosporidiosis – A Clinical Survey

Background: Rhinosporidiosis is a chronic inflammatory granulomatous disease caused by the organism Rhinosporidiumseeberi. This causal organism was once believed to be a sporozoan, but is now considered to be a fungus. The disease ispresent all over the world except in Australia. However, it is endemic only in India and Sri Lanka; more than 95% of reportedcases are from these two countries. The most common site of manifestation of rhinosporidiosis in man is the nose accountingfor about 70% of cases. Surgical excision remains the mainstay of treatment today even though dapsone and ketoconazolehave been tried to some extent in preventing recurrence after surgery.Aim of the Study: The aim of the study was to study the prevalence, distribution, clinical behavior, results of various forms oftreatment and to provide a baseline clinical data and to supplement information for ongoing studies in the field of rhinosporidiosis.Materials and Methods: A total of 20 patients diagnosed as rhinosporidiosis, who attended the ENT Outpatient Department ofMedical College Hospital, Calicut, during the period from December 1998 to November 1999. Detailed history was recorded andpatients were subjected to thorough otolaryngological examination. Special attention was given to the site of lesions and type ofattachment. Details were also collected with particular reference to bathing habits, occupation, contact with animals, and occurrenceof similar illness in the family or in the neighborhood. Investigations included regular blood and urine and blood grouping. All thepatients underwent surgical excision of the lesions. The diagnosis was confirmed by histopathological examination of specimenobtained postoperatively. 100 mg of dapsone was administered daily (50 mg daily in children), 6 days a week, for a period of 6 months.All patients were reviewed for follow-up at the end of 1 month, 2, 4, and 6 and 9 months and on completion of a year after surgery.Observations and Results: In this study, the average age of patients suffering from rhinosporidiosis was 30.6 ± 2.80 years and theage varied between 8 and 52 years. The sex incidence was as follows: Males 17 (85%), females 3 (15%). Male predominance wasseen in this series and the male to female ratio was 5.66:1. Most of the subjects suffering from rhinosporidiosis were manual laborers7 (35%) out of 20, of which 2 (10%) were agricultural workers. The other major group was students accounting for 5 (25%) out of20 cases. The external appearance of the nose was normal in all patients. Partial nasal obstruction was seen in 13 cases (65%),on the left six, on the right five, and bilateral two cases. The total obstruction was seen in 5 cases (25%) – left two, right two, andbilateral one. Both nasal cavities were patent in only two cases. The vestibule showed the presence of mass in four cases (20%).Conclusions: Rhinosporidiosis is not an uncommon disease encountered in day-to-day ENT practice. The occurrence of thedisease does not bear any relation to the occupation of the patient. The maximum incidence of rhinosporidiosis is seen inthe age group of 21–30 years and males predominate. Rhinosporidiosis is more common in the rural population. There is asignificant association between dip baths in ponds and the occurrence of disease.

Effect of Three Chinese Herbs Processed with Different Proportions of Glycyrrhizae Radix et Rhizoma on Pharmacokinetics of Dapsone in Rats / 中国实验方剂学杂志

Objective::To investigate the processing purpose of Morindae Officinalis Radix (MO), Euodiae Fructus (EF) and Polygalae Radix (PR) processed by Glycyrrhizae Radix et Rhizoma (Gly). Method::The content of dapsone in rat plasma was determined by high performance liquid chromatography (HPLC), the mobile phase was acetonitrile (A)-water (B) for gradient elution (0-5 min, 10%-25%A; 5-20 min, 25%A) and detection wavelength was set at 292 nm. PK Solution 2.0 software was used to simulate pharmacokinetic parameters. Result::Within 300 min after dapsone was administrated, compared with the control (CTL) group, the elimination of dapsone was slowed down and its plasma concentration was increased in the unprocessed product of MO (UMO) group. The elimination of dapsone was accelerated and its peak concentration (Cmax) was decreased in the processed products of MO with Gly (GMO) groups, and they had positive correlation with proportion of Gly in GMO. Compared with the CTL group, the elimination of dapsone was slowed down, and its plasma concentration was increased and its peak time (Tmax) was postponed in the unprocessed product of EF (UEF) group, while their Cmax and Tmax were changed in the processed products of EF with Gly (GEF) groups. Compared with the CTL group, the elimination of dapsone was slowed down and its plasma concentration was increased in the unprocessed product of PR (UPR) group, while the elimination was accelerated and its plasma concentration was decreased in the processed products of PR with Gly (GPR) groups. Conclusion::The elimination of dapsone is slowed down in rats administered with UMO, UEF and UPR, while its elimination is accelerated in rats administered with the processed products of these three herbs with different proportions of Gly. Among the proportions, effect of processed products of these three herbs with 100∶6 (ratio of unprocessed product-Gly) on pharmacokinetics of dapsone is not significant.

Consensus on the diagnostic and therapeutic management of chronic spontaneous urticaria in adults - Brazilian Society of Dermatology

Abstract: Background: Urticarias are frequent diseases, with 15% to 20% of the population presenting at least one acute episode in their lifetime. Urticaria are classified in acute ( ≤ 6 weeks) or chronic (> 6 weeks). They may be induced or spontaneous. Objectives: To verify the diagnostic and therapeutic recommendations in chronic spontaneous urticaria (CSU), according to the experience of Brazilian experts, regarding the available guidelines (international and US). Methods: A questionnaire was sent to Brazilian experts, with questions concerning diagnostic and therapeutic recommendations for CSU in adults. Results: Sixteen Brazilian experts answered the questionnaire related to diagnosis and therapy of CSU in adults and data were analyzed. Final text was written, considering the available guidelines (International and US), adapted to the medical practices in Brazil. Diagnostic work up in CSU is rarely necessary. Biopsy of skin lesion and histopathology may be indicated to rule out other diseases, such as, urticarial vasculitis. Other laboratory tests, such as complete blood count, CRP, ESR and thyroid screening. Treatment of CSU includes second-generation anti-histamines (sgAH) at licensed doses, sgAH two, three to fourfold doses (non-licensed) and omalizumab. Other drugs, such as, cyclosporine, immunomodulatory drugs and immunosuppressants may be indicated (non-licensed and with limited scientific evidence). Conclusions: Most of the Brazilian experts in this study partially agreed with the diagnostic and therapeutic recommendations of the International and US guidelines. They agreed with the use of sgAH at licensed doses. Increase in the dose to fourfold of sgAH may be suggested with restrictions, due to its non-licensed dose. Sedating anti-histamines, as suggested by the US guideline, are indicated by some of the Brazilian experts, due to its availability. Adaptations are mandatory in the treatment of CSU, due to scarce or lack of other therapeutic resources in the public health system in Brazil, such as omalizumab or cyclosporine.

Bullous systemic lupus erythematosus ­ a case report

Skin involvement in systemic lupus erythematosus (SLE) occurs in more than 75% of patients with this condition. Vesicles and blisters in lupus erythematosus (LE) may be present in SLE secondary to interface vacuolar changes in the epidermis, in discoid LE also secondary to vacuolar epidermal changes, and in bullous LE secondary to antibodies anti-collagen VII deposits with neutrophilic aggregates. In addition, blisters can occur due to the association of SLE with other autoimmune blistering diseases (e.g. bullous pemphigoid). BSLE is a rare blistering disease that mainly occurs in females (30­40 years old), and less frequently in children and adolescents. The most common presentation is rapid and widespread development of tense vesicles and bullae over erythematous macules or plaques. Preferential sites are: superior trunk, proximal superior limbs, and face (lips) with symmetrical distribution. Mucosal involvement is common on perioral, pharyngeal, laryngeal, and genital areas. The involvement of sun-exposed areas is not mandatory. The lesions usually progress with no scarring, but hypo or hyperchromia may be present. We report an 18-year-old female patient with blistering lesions at admission, who was diagnosed with BSLE. She was initially treated with systemic prednisone and hydroxychloroquine. Her condition evolved with relapsing lesions, which required the introduction of Dapsone. The authors emphasize the relevance of recognizing BSLE­a rare presentation of SLE­which may evolve with marked clinical presentation