Successful Response to a Combination of Intralesional Methotrexate and Fractional CO2 Laser in Refractory Alopecia Areata: Case Report.

Introduction: Refractory cases of alopecia areata (AA) may be considered a therapeutic challenge. Intralesional methotrexate (IL-MTX) has been used in other dermatological diseases rather than AA. Likewise, its topical use as an immunosuppressant drug may be of interest for the control of the lymphoid infiltrate in AA. On the other hand, the use of fractional ablative laser is supported in literature as an alternative or complementary treatment in AA, whilst the generation of columns of thermal damage may favour the migration of cells and cytokines that are beneficial. Case Presentation: In this paper, we present 2 cases in which IL-MTX and ablative fractional CO2 laser were combined with excellent outcomes. Conclusion: Previous research encompasses a total of 23 patients. Most patients presented with patchy AA. The doses administered ranged from 2.5 to 50 mg with an average frequency of 3 weeks. On average, most patients required a minimum of 3 sessions. One case employed 1% topical methotrexate ointment. Adverse local events were mild and transient. In conclusion, the concomitant application of these treatments has not been reported previously. Specific recommendations relating to the appropriate dosing of the drug, frequency of administration, and requirements for analytical control studies should be determined in further studies.

Treatment of primary follicular mucinosis with imiquimod 5% cream.

Follicular mucinosis can develop as a primary form or associated with other benign or malignant skin conditions. We present a case of primary follicular mucinosis in which complete clinical remission was achieved after treatment with topical imiquimod 5%. Primary follicular mucinosis (PFM), also called idiopathic alopecia mucinosa, is considered a distinct entity, the clinical course of which is usually benign, but its pathogenesis remains unclear. There is no standard treatment for PFM, and a wide variety of therapies have been described. There are no previous reports of treatment of PFM with imiquimod.

Cutaneous emboli of atrial myxoma: unusual case report and review of the literature.

Cardiac myxomas are difficult to diagnose, not only because of a lack of specific systemic symptoms but also because, even in those cases presenting with embolic disease, emboli are exceptional. The skin is one of the organs most frequently involved by myxomatous emboli. We report an extraordinary case in which emboli of a cardiac myxoma was present in the skin biopsy, but "camouflaged" among the normal Vater-Pacini corpuscles of the palm of the hand, We also review the existing literature on myxomatous emboli identified in skin biopsies.

Safe and successful treatment of acne vulgaris with isotretinoin in a patient with chronic granulomatous disease.

Isotretinoin for acne vulgaris in the setting of chronic granulomatous disease (CGD) is a controversial therapeutic option. In this inherited immunodeficiency, inefficient tissue responses to bacteria and fungi lead to chronic and recurrent infections. Isotretinoin is known to be associated with several mucocutaneous side effects that could worsen the immune response in individuals with CGD. We report the fourth published case of acne vulgaris treated with isotretinoin in an individual with CGD, with a safe and successful outcome.