Post nirmatrelvir/ritonavir erythema multiforme in a patient with coronavirus disease infection

ABSTRACT Erythema multiforme (EM), an immune-mediated skin condition, can occur after infection or following the use of medications. In this study, we describe a patient who developed EM after nirmatrelvir/ritonavir administration. An 81-year-old woman presented with fever and dyspnea. Laboratory investigations showed positive coronavirus disease (COVID-19) based on polymerase chain reaction assay, and she received a 5-day regimen of nirmatrelvir/ritonavir. We observed development of EM after this treatment and initiated prednisone (1 mg/kg) therapy, which led to rapid improvement. Our study is the first to report EM in a patient with COVID-19, who received nirmatrelvir/ritonavir and showed a favorable response.

Daylight photodynamic therapy - Experience and safety in treatment of actinic keratoses of the face and scalp in low latitude and high brightness region

ABSTRACT Daylight photodynamic therapy has been used in countries with high latitudes during the summer for actinic keratoses treatment with reports of similar efficacy to conventional photodynamic therapy. We evaluate its safety in 20 patients in the city of Fortaleza, a local with low latitude and high brightness. Sixteen patients did not report any discomfort due to the procedure. Daylight photodynamic therapy is an easy application method with great tolerability by the patient and has the possibility of being performed throughout the year in these regions. It can mean a promising tool in the control of skin cancer.

Carcinoma basocelular desenvolvido sobre nevo sebáceo: tratamento com terapia fotodinâmica abordando campo de cancerização / Basal cell carcinoma growth over a nevus sebaceous: treatment of the field cancerization with photodynamic therapy

Nevo sebáceo de Jadassohn é hamartoma congênito que pode apresentar evolução para neoplasia cutânea maligna. A terapia fotodinâmica é utilizada para tratamento de ceratoses actínicas e carcinomas basocelulares superficiais ou nodulares, podendo-se observar o campo de cancerização cutâneo através da lâmpada de Wood, durante a realização da técnica. Relata-se um caso do uso da terapia fotodinâmica para o tratamento de um carcinoma basocelular, que se desenvolveu sobre nevo sebáceo, demonstrando-se o campo cancerizável através do uso da lâmpada de Wood. O procedimento consistiu em alternativa de tratamento não cirúrgico para o carcinoma basocelular, com excelente resultado estético. A paciente encontra-se em seguimento clínico, não apresentando recidiva da neoplasia 18 meses após o tratamento.

The sebaceous nevus of Jadassohn is a congenital hamartoma that may develop into a malignant cutaneous neoplasia. Photodynamic therapy is used to treat actinic keratoses and superficial or nodular basal cell carcinomas, and the cutaneous field cancerization can be observed using the Wood's lamp during the performance of the technique. This article describes a case of photodynamic therapy used in the treatment of a basal cell carcinoma, which developed on a sebaceous nevus, where the field cancerization was demonstrated through the use of Wood's lamp. The procedure is a non-surgical alternative for the treatment of the basal cell carcinoma, with excellent aesthetic outcome. The patient is on clinical follow-up, with absence of recurrence of the neoplasia 18 months after the treatment.

Terapia fotodinâmica com luz do dia: farmacoeconomia no uso do creme de metilaminolevulinato para ceratoses actínicas faciais / Daylight photodynamic therapy: pharmacoeconomics of methyl aminolevulinate cream use for facial actinic keratoses

Introdução: As ceratoses actínicas são as lesões pré-malignas de pele mais comuns, apresentando caráter crônico e recorrente. A terapia fotodinâmica com luz do dia tem sido utilizada no tratamento de ceratoses actínicas de face e couro cabeludo. Objetivo: Demonstrar a possibilidade da realização da terapia fotodinâmica com luz do dia em serviço público para o tratamento de ceratoses actínicas em face, utilizando um tubo de creme de metilaminolevulinato em até quatro pacientes. Métodos: Foram selecionados 10 pacientes para a realização de terapia fotodinâmica com luz do dia, realizando-se curetagem das ceratoses actínicas seguidas da aplicação de filtro químico e creme de metilaminolevulinato em toda a face. Resultados: um tubo de creme de metilaminolevulinato, foi suficiente para tratar até quatro pacientes com múltiplas ceratoses actínicas de face, enquanto os estudos sugerem o uso de pelo menos 1g para tratar uma face completa. Conclusões: O resultado nos leva a afirmar que na terapia fotodinâmica com luz do dia, a utilização de quantidade inferior a 1 grama de creme de metilaminolevulinato no tratamento de ceratoses actínicas de face é posologia factível para obtenção de efetiva resposta clínica.

Introduction: Actinic keratoses are the most common premalignant skin lesions, with a chronic and recurrent nature. Daylight photodynamic therapy has been used in the treatment of actinic keratoses of the face and scalp. Objective: To demonstrate the possibility of implementing daylight photodynamic therapy at a public service, for the treatment of facial actinic keratosis, using one tube of methyl aminolevulinate cream for up to four patients. Methods: Ten patients were selected to undergo daylight photodynamic therapy at the Centro de Dermatologia Dona Libânia, located in the city of Fortaleza (CE), Brazil. Curettage was performed on the actinic keratosis and a methyl aminolevulinate cream based chemical filter was applied across the face. Results: One tube of methyl aminolevulinate cream was enough for treating up to four patients with multiple facial actinic keratoses, whereas studies suggest the use of at least one gram to treat one face completely. Conclusion: It was possible to conclude when administering daylight photodynamic therapy, an amount of less than one gram of methyl aminolevulinate cream in the treatment of facial actinic keratoses is a dosage sufficient to obtain an effective clinical response.

Experiência na terapia fotodinâmica com cloridrato de aminolevulinato de metila para queratose actínica e neoplasia cutânea não melanocítica / Photodynamic therapy with methyl-aminolevulinate hydrochloride for actinic keratosis anda non-melanocytic cutaneous neoplasia

Introdução: A terapia fotodinâmica (TFD) é uma opção de tratamento baseada na utilização de substâncias fotoquímicas que, ao impregnarem seletivamente o tecido anormal, agem como sensibilizadores para a atuação de radiação luminosa. Objetivos: Avaliar a resposta clínica, o resultado estético e efeitos colaterais da aplicação de TFD utilizando o fotosensibilizante cloridrato de aminolevulinato de metila (MAL) em lesões de queratose actínica (QA), carcinoma basocelular (CBC) e doença de Bowen (DB). Métodos: Após remoção de escamas ou crostas e impregnação da lesão com MAL, foi realizada a exposição à radiação de luz vermelha de 632nm (37 j/cm2),por 8 minutos, entre 5 e 8 cm de distancia da pele. Resultados: Foram analisados 102 pacientes, sendo que 59 eram portadores de QAs, 32 de CBC e 11 de DB. Houve resposta completa na maioria dos pacientes após 12 semanas, excetuando-se 14 pacientes: 6 com QA, 2 com DB, 6 com CBC. O tratamento demonstrou excelente resultado estético. As principais complicações foram 1 caso de eritema severo e 1 de pústulas e edema importantes. Conclusões: O presente trabalho, em consonância com a literatura, confirma a eficácia da TDF-MAL no tratamento de lesões de QA e neoplasias cutâneas não melanocíticas (NCNM), com semelhantes taxas de recidiva e melhores resultados estéticos em comparação com as terapias convencionais.

Introduction: Photodynamic therapy uses photochemical substances that selectively impregnate abnormal tissue and act as a sensitizing agent for the light. Objective: To evaluate the clinical response, aesthetic results and side effects of applying photodynamic therapy using the photosensitizer methyl-aminolevulinate hydrochloride in actinic keratosis lesions, basal cell carcinomas, and Bowen’s disease. Methods: After removing scales or crusts and impregnating the lesion with methyl- aminolevulinate hydrochloride, 632 nm (37 j/cm2) red light radiation was applied, at a distance of 5 to 8 cm from the skin, for 8 minutes. Results: 102 patients (59 with actinic keratosis, 32 with basal cell carcinoma, and 11 with Bowen’s disease) were studied. After 12 weeks, only 14 patients (6 actinic keratosis, 6 basal cell carcinoma, and 2 Bowen’s disease) had incomplete results.The treatment yielded excellent aesthetic results. The main complications were 1 case of severe erythema and 1 case of important pustules and edema. Conclusions: Consistent with the literature, this study confirms the efficacy of photodynamic therapy with methyl-aminolevulinate hydrochloride in the treatment of actinic keratosis lesions and nonmelanocytic cutaneous neoplasias, with similar recurrence rates and better aesthetic results than conventional therapies.