ABSTRACT
Molluscum contagiosum (MC) is a common, self-limited cutaneous infection in immunocompetent individuals. However, in immunocompromised individuals the infection often has an atypical presentation and can be difficult to eradicate, making both the diagnosis and treatment challenging. Due to advancements in the management of patients with human immunodeficiency virus (HIV) and cancer, there is a growing population of immunosuppressed individuals, signaling the need for dermatologists to recognize and manage related skin diseases. We present a case of an atypical MC eruption in a patient on biologic therapy for psoriasis and an unrecognized underlying HIV infection, followed by a current review of the presentation and treatment of MC in various immunosuppressed states. With a growing population of immunosuppressed patients, it is important to recognize MC as a potential indicator of underlying immunosuppression. Testing for HIV should be offered to any patient starting immunosuppressive therapy such as biologic agents.
Subject(s)
Acquired Immunodeficiency Syndrome/diagnosis , Acquired Immunodeficiency Syndrome/immunology , Biological Therapy/adverse effects , Immunocompromised Host , Molluscum Contagiosum/etiology , Psoriasis/therapy , AIDS-Related Opportunistic Infections/etiology , Adult , Humans , Male , Molluscum Contagiosum/immunologyABSTRACT
We present two pediatric patients with pityriasis lichenoides et varioliformis acuta fulminans whose admitting diagnosis was Stevens Johnson Syndrome. The patients were successfully treated with methotrexate and prednisone. These cases highlight the importance of early recognition and treatment of this disease to prevent further morbidity and a potentially fatal prognosis.
Subject(s)
Herpes Simplex/diagnosis , Pityriasis Lichenoides/diagnosis , Skin Ulcer/diagnosis , Stevens-Johnson Syndrome/diagnosis , Anti-Bacterial Agents/therapeutic use , Clindamycin/therapeutic use , Dermatologic Agents/therapeutic use , Drug Therapy, Combination , Female , Herpes Simplex/drug therapy , Humans , Infant , Methotrexate/therapeutic use , Pityriasis Lichenoides/drug therapy , Prednisone/therapeutic use , Skin Ulcer/drug therapy , Treatment Outcome , Vancomycin/therapeutic useABSTRACT
BACKGROUND: Acne vulgaris is a chronic disease with several pathogenic factors. Multiple medications are typically used that can lead to nonadherence and treatment failure. Combination medications target multiple pathways of acne formation and may offer therapeutic benefit. PURPOSE: To explore the efficacy and tolerability of combination retinoid plus antimicrobial treatments in acne vulgaris. METHODS: A PubMed and Google search was conducted for combination therapies of clindamycin and tretinoin, with secondary analysis of related citations and references. Similar searches were completed for the combination medications of benzoyl peroxide plus clindamycin or erythromycin, and for the combination therapy of adapalene and benzoyl peroxide. RESULTS: Combination clindamycin phosphate and tretinoin gel was found to be more efficacious than monotherapy of either drug or its vehicle for acne, including inflammatory acne, and has a greater onset of action than either drug alone. Clindamycin phosphate and tretinoin gel was well-tolerated, and adherence to its use exceeded that of using both medications in separate formulations. Benzoyl peroxide-containing combination medications with clindamycin or erythromycin were both more effective in the treatment of acne than either drug alone. Both medications were well-tolerated, with dry skin being the most common adverse effect. CONCLUSIONS: Combination medications have superior efficacy and adherence, and have a similar tolerability profile compared with monotherapy of its components. Several studies have found antibiotic-containing combination products with a retinoid effective for acne. The use of antibiotic-containing combination medications for acne can lead to bacterial resistance. Due to this potential for bacterial resistance, benzoyl peroxide treatments are also recommended in combination with a retinoid.
