ABSTRACT
Woringer-Kolopp (WK) is a rare subtype of cutaneous T-cell lymphoma (CTCL) with limited treatment options. Bexarotene gel is a topical retinoid used in the treatment of CTCL. This report describes three female patients (mean age 66 years) with WK disease who had an effective treatment response to bexarotene 1% gel. This treatment could provide a safe alternative to other current treatment modalities which have higher risks of potential adverse effects and lack of access to other conventional treatments such as light therapy.
Subject(s)
Antineoplastic Agents/administration & dosage , Pagetoid Reticulosis/drug therapy , Skin Neoplasms/drug therapy , Tetrahydronaphthalenes/administration & dosage , Administration, Cutaneous , Aged , Aged, 80 and over , Bexarotene , Biomarkers, Tumor/analysis , Biopsy , Female , Gels , Humans , Immunohistochemistry , Middle Aged , Pagetoid Reticulosis/chemistry , Pagetoid Reticulosis/pathology , Remission Induction , Skin Neoplasms/chemistry , Skin Neoplasms/pathology , Treatment OutcomeABSTRACT
DRESS (drug rash with eosinophilia and systemic symptoms), also known as drug-induced hypersensitivity syndrome, is a severe, systemic drug reaction most commonly associated with aromatic anticonvulsants and sulfonamides. Patients typically present with fever, facial edema, cervical lymphadenopathy and a morbilliform eruption, which may progress to erythroderma. Hematologic abnormalities are a hallmark of the condition, including eosinophilia and atypical lymphocytosis. Visceral organ involvement typically manifests as hepatic dysfunction but may include lymphadenopathy, nephritis, interstitial pneumonitis, and myocarditis. Five to ten percent of patients with DRESS die from systemic complications, making timely recognition and treatment essential to prevent life-threatening manifestations. Myocarditis is a fatal and under-recognized manifestation of DRESS, which may occur long after the initial diagnosis. We review the literature of previously reported cases of DRESS and myocardial involvement, highlighting the presenting symptoms associated with cardiac involvement, treatments used, and the outcome for each patient. In addition, we offer an algorithm for early diagnosis, treatment, and subsequent monitoring of these patients.
Subject(s)
Drug Eruptions/complications , Myocarditis/etiology , Algorithms , Drug Eruptions/immunology , Eosinophilia/complications , Humans , Myocarditis/diagnosis , Myocarditis/therapyABSTRACT
Vulvodynia is a multifactorial chronic pain disorder that is distressing to the patient and exigent to the physician. Although the condition is common, it remains little understood, so patients remain undiagnosed and untreated or undertreated for many years. Although multiple therapies exist in the treatment of vulvodynia, few randomized controlled clinical trials have been performed. Thus, treatment should be individualized and tailored to a patient's diagnosis, symptoms, and psychosexual functioning. Patient education is also important and is facilitated by patient brochures providing assurance that vulvodynia is a real disease.
