Pityriasis rubra pilaris post-infection due COVID-19: case report / Pitiriasis rubra pilaris post-infección por COVID-19: reporte de un caso

Abstract Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.

Resumen Descripción del caso: Niño 32 meses de vida, con IgG positivo para SARS-CoV-2, acude al servicio de emergencia por presentar lesiones dermatológicas. Hallazgos clínicos: Cuatro días antes del ingreso presentó erupciones en la piel, con enrojecimiento y prurito en manos y pies. Se evidenció eritema papular generalizado, extremidades superiores con placas eritematoescamosas difusas, queratodermia palmo-plantar por lo que es evaluado por dermatólogo quien diagnostica pitiriasis rubra pilaris. Tratamiento y resultado: Crema rehidratantes, cetirizina 0.5 mg/kg/día cada 2 días y prednisolona 2 mg/kg/día por la mañana. Fue dado de alta a los 14 días, el paciente presenta mejora clínica, pero aún persiste la lesión eritematosa en tronco y extremidades. En la evaluación a los tres meses el paciente no mostró las lesiones descritas, evidenciando una mejoría y resolución clínica de los problemas dermatológicos. Relevancia clínica: Se reporta un paciente con afectación por pitiriasis rubra piloris asociado a una post-infección por SARS-CoV-2 que no se había descrito antes.

A randomized controlled trial of cetirizine plus pseudoephedrine versus loratadine plus pseudoephedrine for perennial allergic rhinitis.

The purpose of this study was to compare the safety and efficacy of cetirizine plus pseudoephedrine (C+P) with loratadine plus pseudoephedrine (L+P) in the treatment of perennial allergic rhinitis. This was a double blind, randomized, parallel trial with an active control. Subjects aged 12 to 70 years with perennial allergic rhinitis for at least 2 years were enrolled and randomized to receive either of the active study medications plus a placebo resembling the other, twice daily for 4 weeks. Nasal total symptom scale (NTSS) including sneezing, rhinorrhea, nasal itching and nasal stuffiness is evaluated by subjects daily and at baseline, 2 weeks, and 4 weeks by the investigator as efficacy measurement. A total of 51 eligible patients were enrolled and 45 patients completed the treatment course. Both groups had significant reductions in NTSS after 4 weeks of treatment as assessed by the subjects, but there was no significant difference between the two groups (mean +/- SD) reduction of 4.25 +/- 2.45 with C+P vs. 3.52 +/- 2.41 with L+P, p = 0.215. As assessed by the investigator, sneezing was significantly better at 2 weeks (-1.13 vs. -0.52, p = 0.028) and nasal congestion at 4 weeks (-1.71 vs. -1.19, p = 0.031) in subjects treated with C+P compared to those treated with L+P. There were 37 treatment-related adverse events (5 in 4 subjects in the C+P group and 32 in 16 subjects in the L+P group). It was concluded that both cetirizine plus pseudoephedrine and loratadine plus pseudoephedrine are efficacious for perennial allergic rhinitis in Taiwanese subjects. Relief of sneezing and nasal congestion may be marginally better with the cetirizine preparation, which also seemed to be slightly better tolerated, although the incidence of side effects did not differ significantly.

Serum sickness and hepatitis B vaccine including review of the literature.

HB vaccine is one of the most widely administered vaccines in the world. Its efficacy approaches 95 per cent. The majority of adverse reactions are generally mild, although there have been individual case reports of serious reactions since the vaccine has become commercially available. Here, a patient with a serum sickness-like reaction after her second HB immunization is reported. Review of the literature for reports of serious adverse reactions to the vaccine was also carried out.

Efficacy of nimesulide alone and in combination with cetirizine in acute allergic rhinitis.

OBJECTIVE: To study the effect of cetirizine and nimesulide given alone and in combination in allergic rhinitis. METHOD: A double blind, double dummy, randomised, parallel controlled clinical study in three groups consisting of 18 patients each suffering from allergic rhinitis was conducted. Group A was given nimesulide alone (100 mg BD), Group B received combination (nimesulide 100 mg + cetirizine 10 mg) and Group C was given cetirizine alone (10 mg) for one week. The efficacy of each treatment in reducing nasal stuffiness, nasal discharge, itching nose and watery eyes was assessed at base line (day 0), on days four and eight of treatment. Patients used diary cards twice daily to rate symptom severity on a four point scale. RESULTS: Nimesulide and cetirizine alone could decrease nasal discharge, nasal stuffiness and sneezing significantly in allergic rhinitis patients by day four. Cetirizine was more effective in relieving nasal discharge and sneezing compared to nimesulide. By combining cetirizine and nimesulide four symptoms of allergic rhinitis, i.e., nasal discharge, nasal stuffiness, sneezing and watery eyes decreased significantly. CONCLUSION: Present study has shown that nimesulide alone could decrease three symptoms of allergic rhinitis like certirizine and combination of cetirizine (anti-histaminic) and nimesulide (anti-inflammatory) exerts synergistic action in reducing symptoms in patients of allergic rhinitis.

Foliculitis eosinofílica relacionada con VIH: tres casos clínicos y revisión de la literatura / Eosinophilic folliculitis related to HIV: 3 clinical cases and literature review

Entre 1993 y 1997, en el Centro de Control de ETS se diagnosticaron tres casos de varones VIH positivos que presentaban lesiones papulares eritematosas generalizadas, con predominio en tronco, muy pruriginosas. La biopsia de piel mostró infiltrado eosinofílico, ausencia de gérmenes y tinción negativa para hongos. De manera concomitante se observó eosinofilia en sangre superior al 10 por ciento y CD4 inferior a 100 cel/mm elevado a 3. Los pacientes fueron tratados con antihistamínicos H1 y corticoides tópicos; un paciente recibió además itraconazol por onicomicosis. En nuestro medio es usual que la foliculitis eosinofílica asociada a VIH se confunda con escabiosis debido a la presencia de erupción papular y prurito intenso. Se presentan tres casos clínicos y la revisión de los estudios sobre el tema

Estudo clínico comparativo entre cetirizina e placebo no tratamento de pacientes com rinite alérgica perene / Comparative clinical study between cetirizine and placebo in the treatment of patients with perennial allergic rhinitis

O estudo teve como objetivo avaliar a tolerabilidade, a eficácia clínica e a segurança do uso da cetirizina (CTZ) no tratamento da rinite alérgica perene. O estudo foi comparativo contra placebo (PLB), duplo-cego, randomizado, cruzado. Os pacientes receberam um período de 15 dias com CTZ (10 mg em dose única di ria), seguido de outro período de 15 dias com PLB, ou vice-versa de acordo com lista de aleatorizaçäo. Setenta e dois pacientes foram admitidos e 52 deles completaram os dois períodos de tratamento previstos. A CTZ mostrou superioridade nos seguintes sintomas de rinite alérgica: coriza, obstruçäo nasal, crises de espirro, prurido nasal e conjuntivite. O sintoma tosse näo foi modificado por qualquer dos tratamentos. Os sinais físicos de rinite alérgica, como coloraçäo da mucosa, hipertrofia de cornetos, secreçäo nasal e inflamaçäo faríngea, mantiveram-se inalterados com os dois tratamentos. O mesmo ocorreu com os sinais vitais: pressäo arterial, frequência cardíaca, frequência respiratória e peso. Durante o período de tratamento com a CTZ foram observados eventos adversos em sete pacientes (12,3 por cento) e no período PLB foram observados eventos adversos em oito pacientes (14 por cento). Os eventos adversos mais frequentes no período de tratamento com CTZ foram sonolência e aumento subjetivo de peso (nÝo confirmado ao exame físico); no período PLB foram tontura, aumento de apetite e cefaléia. Durante o período de tratamento com a CTZ nove pacientes interromperam o tratamento, sendo oito pacientes por abandono ou falta de colaboraçäo do paciente e um por evento adverso (urticária ao frio näo controlada). Durante o período PLB 11 pacientes interromperam o tratamento, sendo dez pacientes por abandono ou falta de colaboraçäo do paciente e um por evento adverso (tontura e calafrios). Concluímos que a CTZ se mostrou clinicamente superior ao PLB em efic cia, proporcionando alívio dos sintomas da rinite alérgica perene e sintomas conjuntivais. A incidência de eventos adversos com CTZ nÝo diferiu da observada com PLB. A cetirizina é um anti-histamínico eficaz e bem tolerado, com posologia cômoda em relaçäo aos anti-histamínicos clássicos, podendo ser utilizada para tratamento da rinite alérgica.