Incapacitating solar urticaria: successful treatment with omalizumab

Abstract: Solar urticaria is a rare form of physical urticaria mediated by immunoglobulin E. The lesions appear immediately after the sun exposure, interfering with the patient's normal daily life. Omalizumab, a monoclonal anti-IgE antibody, has been recently approved for the treatment of chronic spontaneous urticaria, and the latest reports support its role also in the treatment of solar urticaria. Hereby, we report a case of solar urticaria refractory to conventional treatment strategies, with an excellent response to treatment with omalizumab and phototesting normalization.

Risk factors associated with actinic prurigo: a case control study

Abstract: Background: Actinic prurigo (AP) is an idiopathic photodermatosis. Although its initial manifestations can appear in 6 to 8-year-old children, cases are diagnosed later, between the second and fourth decades of life, when the injuries are exacerbated. Objective: To identify risk factors associated with clinical manifestations of AP such as skin and mucosal lesions. Methods: Thirty patients with AP and 60 controls were included in the study, the dependent variable was the presence of skin or labial mucosal lesions, the independent variables were age, sex, solar exposure, living with pets or farm animals, exposure to wood smoke, smoking habit, years smoking, and hours spent per day and per week in contact with people who smoke. Results: Of the 30 diagnosed AP patients, 66.7% were female. Patients age ranged from 7 to 71 years and the mean age was 35.77 ± 14.55 years. We found significant differences with the age and cohabitation with farm animals. Those who lived with farm animals presented 14.31 times higher probability of developing AP (95% CI 3-78.06). Study limitations: This is a case-control study; therefore, a causal relationship cannot be proven, and these results cannot be generalized to every population. Conclusions: The identification of factors related to the development of AP increases our knowledge of its physiopathology. Moreover, identifying antigens that possibly trigger the allergic reaction will have preventive and therapeutic applications in populations at risk of AP.

Cutaneous manifestations of systemic lupus erythematosus - an experience from Bahawal-Victoria Hospital, Bahawalpur

To document the frequency of cutaneous manifestation of systemic lupus erythematosus [SLE]. It was a case-series collected from Dermatology Department and all four Medical Units of Bahawal-Victoria Teaching Hospital of Quaid-e-Azam Medical, Bahawalpur. A total of 100 patients with diagnosis of SLE and fulfilling the inclusion criteria were included in the study. All the patients were evaluated for the cutaneous manifestations of SLE. All the information was collected in a specially designed proforma and analyzed with the help of SPSS version 10. The mean age of the patients was 25.97 +/- 4.64 years. 92% patients were female and 8% were male. Out of 100 patients, 85% patient presented with cutaneous manifestations. Photosensitivity was seen in 40 [40%] patients, discoid rash in 35 [35%], malar rash in 25 [25%], and oral ulcers in 24 [24%]. SLE is predominantly seen among female patients of young age. Photosensitivity is most common presentation, followed by discoid rash

Reações tegumentares adversas relacionadas aos agentes antineoplásicos: parte II / Adverse mucocutaneous reactions related to chemotherapeutic agents: part II

Os eventos e reações envolvendo quimioterapia são frequentes na prática oncológica. Agentes quimioterápicos são uma modalidade de tratamento amplamente utilizada. Efeitos colaterais podem variar de frequência e também ser confundidos com outras manifestações tegumentares do tratamento oncológico. Este artigo objetiva expor as informações sobre reações cutâneas à quimioterapia, em especial, aqueles para os quais o dermatologista é requisitado a emitir parecer e a comentar sobre a segurança e a viabilidade da readministração de uma droga específica. Os autores descrevem os aspectos associados a esses eventos, fazendo uma análise detalhada de cada um deles.

Events and reactions involving chemotherapy are common in clinical oncology. Chemotherapeutic agents are widely used in therapy. Side effects range from the common to the rare and may be confused with other mucocutaneous manifestations resulting from the oncological treatment. The objective of this paper was to present data on skin reactions to chemotherapy, particularly those cases in which the dermatologist is requested to issue a report and asked to comment on the safety and viability of readministration of a specific drug. The authors describe aspects associated with these events, presenting a detailed analysis of each one of them.

Kindler syndrome.

Kindler syndrome is a rare autosomal recessive disorder associated with skin fragility. It is characterized by blistering in infancy, photosensitivity and progressive poikiloderma. The syndrome involves the skin and mucous membrane with radiological changes. The genetic defect has been identified on the short arm of chromosome 20. This report describes an 18-year-old patient with classical features like blistering and photosensitivity in childhood and the subsequent development of poikiloderma. The differential diagnosis of Kindler syndrome includes diseases like Bloom syndrome, Cockayne syndrome, dyskeratosis congenita, epidermolysis bullosa, Rothmund-Thomson syndrome and xeroderma pigmentosum. Our patient had classical cutaneous features of Kindler syndrome with phimosis as a complication.

Fitodermatitis: aspectos epidemiológicos en Temuco-Chile / Phytophotodermatitis: epidemiological aspects in Temuco-Chile

La fitodermatitis provocadas por ruda (Ruta graveolens) son un motivo de consulta frecuente para los dermatólogos que ejercen en Temuco. Estas consultas predominan durante el período estival y sus manifestaciones clínicas pueden ser variadas y en algunas circunstancias presentarse de un modo severo. Se estudian 107 pacientes con diagnóstico de fitodermatitis que asisten a la consulta privada del autor desde mayo de 1990 a abril del 2003. En más de la mitad de los casos la planta involucrada era la ruda. La mayoría de los pacientes consultaron durante los meses de primavera y verano. La patología afecta a cualquier edad, incluyendo los lactantes, aunque predomina en personas de la segunda década de la vida. Este estudio muestra una alta incidencia de fitofotodermatosis por ruda en la IX Región de Chile, a diferencia de la literatura internacional, donde los casos publicados son escasos. Esta conclusión puede ser relevante desde el punto de vista epidemiológico para la región y avala la importancia de advertir a la población sobre el cuidado que se debe tener en la manipulación de la planta.

Fotossensibilizaçäo hepatógena em bovinos no Sul do Rio Grande do sul / Hepatogenous photosensitization in cattle in southern Rio Grande do Sul, Brazil

Säo descritos aspectos epidemiológicos e patológicos de 19 surtos de fotossensibilizaçäo observados em bovinos na regiäo sul do Rio Grande do Sul, no período entre 1984 e 1997. A doença, ocorre, principalmente, nos meses de outono e primavera com morbidade de 0,08 por cento a 64 por cento e mortalidade de 0 a 14 por cento. Todas as categorias säo afetadas e as áreas onde ocorrem os surtos se caracterizam por campos planos e baixos, freqüentemente utilizados para o plantio de arroz irrigado ou pastagens de azevém, trevo e aveia ou, ainda, em áreas similares com vegetaçäo nativa. A enfermidade caracteriza-se, clinicamente, por depressäo, anorexia, salivaçäo intensa e fotossensibilizaçäo observada nas áreas de pele despigmentadas e desprovidas de pêlos como o focinho, ao redor dos olhos, virilha, úbere e vulva. Nos casos severos, observam-se lesöes caracterizadas por ressecamento, rachaduras e desprendimento da pele, principalmente do dorso e membros, deixando à mostra superfície ulcerada. As lesöes macroscópicas säo características de insuficiência hepática, observando-se icterícia, fígado aumentado de tamanho com coloraçäo amarelada, aumento de tamanho da vesícula biliar, presença de líquido nas cavidades e, em alguns casos, edema do tecido subcutâneo e peritônio. As lesöes histológicas caracterizam-se, principalmente, por lesöes degenerativas do parênquima hepático, observando-se tumefaçäo e vacuolizaçäo difusa ou zonal dos hepatócitos. Observa-se, também, apoptose ou focos de necrose destribuídos aleatoriamente pelo parênquima, presença de megalócitos e, ainda, fibroplasia dos espaços porta e proliferaçäo de células de ductos biliares. A enfermidade é caracterizada como fotossensibilizaçäo hepatógena relacionada a dano primário ao parênquima hepático, de etiologia näo determinada, uma vez que foram descartadas as principais causas conhecidas de fotossensibilizaçäo de origem hepática em bovinos.

A clinical analysis of 11 patients with chronic actinic dermatitis in Korea

Chronic actinic dermatitis is a rare disease worldwide and also in Korea. However there has been no clinicohistologic and photobiological analysis of chronic actinic dermatitis in Korea. We examined 11 patients who were diagnosed as chronic actinic dermatitis and the results of this study were compared with previous reports. Most patients were elderly men who had erythematous papules or lichenified plaques on sun-exposed areas such as the face, neck, and dorsum of the hands with severe itching sensation. All patients had severe sensitivity to UVB and biopsied specimens showed findings of chronic eczema. Five patients had positive photopatch test materials. The patients were treated with systemic and topical steroid, cyclosporine and antihistamine.

Enfermedad de Günter / Günter's disease

La enfermedad de Günter o porfiria eritropoyética congénita es el resultado de la deficiente actividad de la enzima uroporfirinógeno III cosintetasa, siendo una afección de transmisión autosómica recesiva. Las manifestaciones clínicas comunicadas comprenden fotosensibilidad, con hipertricosis y una erupción ampollar de evolución mutilante. Presentamos un caso de enfermedad de Günther en un varón de 28 años cuyas manifestaciones clínicas y de laboratorio son características de la enfermedad

Experimental porphyria cutanea tarda and photosensitivity

FUNDAMENTOS - A porfiria cutânea tardia é uma doença metabólica da via porfirina-heme, resultante da deficiência da enzina uroporfirinogênio descarboxilase, que induz ao acúmulo de porfirinas, principalmente no fígado e na pele, responsáveis por lesöes cutâneas em áreas expostas ao sol. OBJETIVOS - Determinar a espécie animal que melhor corresponda ao modelo experimental da PCT, para o estudo de lesöes cutâneas relacionadas à fotossensibilidade. MÉTODO - Ratos, cobaias e camundongos foram submetidos a uma dieta contendo um dos fatores desencadeantes da PCT, o hexaclorobenzeno (HCB), na concentraçäo de 0,25 porcento. Após o surgimento da PCT, os animais foram expostos à radiaçäo ultravioleta, as porfirinas uninárias dosadas e as manifestaçöes cutâneas de fotossensibilidade anotadas, e, comparadas ao grupo controle. RESULTADOS - Somente os ratos apresentaram aumento da excreçäo de porfirinas urinárias, principalmente de uroporfirinas: 60,81ug/24h, comparados aos controles: 0,9ug/24h, neurotoxicidade e lesöes cutâneas em àreas fotoexpostas. CONCLUSÄO - Considerando-se as três espécies de animais estudadas, os ratos apresentaram quadro semelhante à PCT encontrada no homem. Em relaçäo às cobaias, sugere-se administrar dieta contendo menor concentraçäo de HCB e prolongar o tempo do experimento. Os camundongos näo se adequaram ao modelo experimental

Síndrome de Dubowitz / Dubowitz syndrome

Apresentaçäo de dois casos de síndrome de Dubowitz em gêmeas monozigóticas, rara emfermidade congênita cujos principais aspectos clínicos incluem retardo de crescimento pré e pós-natal, microcefalia, face peculiar e erupçäo eczematosa, resultante de fotssensibilidade em áreas expostas aos raios solares

Fotodermatitis al piroxican / Photosensitivity by piroxicam

El número de reacciones a la fotosensibilización ha aumentado en los últimos años. De los 16 casos estudiados que presentaron fotodermatitis posterior a la medicación con piroxicam, el mayor porcentaje pertenecía al sexo femenino, con antecedentes familiares de alergia a los medicamentos en un 25%. La localización de lesiones de eritema-pápula-vesícula se registraron en zonas expuestas al sol predominantemente en verano. En todos los casos se inicia la sintomatología durante las primeras tomas, con una duración mayor de 10 días a pesar de la medicación, y sin exposición solar. Se debe agregar la familia de los oxicams a la lista de los medicamentos potencialmente fotosensibilizantes

Corneal involvement in acrodermatitis enteropathica: a case report.

A case of acrodermatitis enteropathica occurred with corneal changes consisting of superficial punctate lesions, nebulous subepithelial opacities and linear epithelial erosions. These manifestations exacerbated intermittently whenever the patient ran out of her oral zinc sulphate therapy, but regressed and disappeared when she resumed her medication.