ABSTRACT
Systemic treatment options for moderate to severe pediatric psoriasis are limited. Due to uncertainties regarding severe adverse events the majority of established systemic therapeutic drugs for adult psoriasis are not administered to children. In 2011 the TNF-α-inhibitor etanercept (Enbrel(®)) was approved as the first biological agent for the treatment of plaque psoriasis in pediatric patients. It is available for children from the age of 6 years and constitutes an effective and safe treatment option during childhood. Our report is based on the successful treatment of three boys with etanercept each at the age of 11 years.
Subject(s)
Etanercept/administration & dosage , Psoriasis/drug therapy , Psoriasis/pathology , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Child , Humans , Immunosuppressive Agents/administration & dosage , Male , Treatment OutcomeABSTRACT
Juvenile systemic lupus erythematosus (JSLE) is a rare multisystem autoimmune disease with broad heterogeneity of clinical manifestations. Diagnosing JSLE is often very challenging. This life-threatening, unpredictable, and relapsing disease, which may affect various organ systems, requires interdisciplinary, lifelong care. Here, we report the case of a 13-year-old patient with JSLE suffering from recurrent arthralgia, lupus panniculitis, and rashes that were successfully treated with hydroxychloroquine and prednisolone.
Subject(s)
Hydroxychloroquine/administration & dosage , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Panniculitis, Lupus Erythematosus/diagnosis , Panniculitis, Lupus Erythematosus/drug therapy , Prednisolone/administration & dosage , Adolescent , Anti-Inflammatory Agents/administration & dosage , Diagnosis, Differential , Drug Therapy, Combination/methods , Humans , Lupus Erythematosus, Systemic/complications , Male , Panniculitis, Lupus Erythematosus/etiology , Recurrence , Treatment OutcomeABSTRACT
Acquired angioedema due to C1 inhibitor deficiency (C1-INH-AAE) is characterized by recurrent edema of the subcutaneous and/or submucosal tissue without wheals and negative family history of angioedema. Here, we present the case of a patient with a chronic lymphatic B cell leukemia who suffered from both C1-INH-AAE and chronic spontaneous urticaria. Oral corticosteroids, antihistamines, and the anti-IgE antibody omalizumab were applied to treat the chronic urticaria in combination with the plasma-derived C1 esterase inhibitor concentrate Berinert® and the bradykinin B2 receptor antagonist icatibant, but the symptoms did not improved significantly. Thus, polychemotherapy targeting the slow-growing lymphoproliferative disease including rituximab was initiated, which resulted in remission of both the urticaria and the angioedema.
Subject(s)
Angioedema/complications , Complement C1 Inactivator Proteins/deficiency , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy , Urticaria/drug therapy , Urticaria/etiology , Angioedema/diagnosis , Angioedema/drug therapy , Antineoplastic Agents/administration & dosage , Chronic Disease , Diagnosis, Differential , Drug Therapy, Combination/methods , Humans , Immunosuppressive Agents/administration & dosage , Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis , Male , Middle Aged , Omalizumab/administration & dosage , Rituximab/administration & dosage , Treatment Outcome , Urticaria/diagnosisABSTRACT
The BRAF inhibitor vemurafenib was approved in 2011 for the treatment of inoperable or metastatic melanoma. Vemurafenib therapy is associated with several side effects, such as arthralgia, secondary skin tumors or inflammatory rashes. In particular cutaneous toxicities represent a serious threat to patients' adherence. Here, we present the case of a successful drug desensitization in a patient that presented with a vemurafenib-induced rash. Lymphocyte activation tests failed to detect drug-specific T cells, suggesting that the development of the rash was based upon a nonallergic drug hypersensitivity reaction. A program of slow desensitization was initiated and subsequently, vemurafenib was tolerated at the full effective and recommended dosage.
Subject(s)
Drug Eruptions/etiology , Drug Eruptions/prevention & control , Exanthema/chemically induced , Indoles/administration & dosage , Indoles/adverse effects , Sulfonamides/administration & dosage , Sulfonamides/adverse effects , Desensitization, Immunologic/methods , Dose-Response Relationship, Drug , Drug Eruptions/diagnosis , Exanthema/diagnosis , Exanthema/prevention & control , Female , Humans , Middle Aged , Treatment Outcome , VemurafenibABSTRACT
As a rare antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome) is characterized by asthma, severe peripheral eosinophilia and the presence of extravascular granulomas. Cutaneous involvement usually includes palpable purpura or cutaneous to subcutaneous nodes. We present the case of a 43-year-old woman with EPGA and the unusual cutaneous manifestation of livedo racemosa.
Subject(s)
Churg-Strauss Syndrome/diagnosis , Granulomatosis with Polyangiitis/diagnosis , Livedo Reticularis/diagnosis , Adult , Anti-Inflammatory Agents/therapeutic use , Churg-Strauss Syndrome/drug therapy , Diagnosis, Differential , Female , Granulomatosis with Polyangiitis/drug therapy , Humans , Livedo Reticularis/drug therapy , Treatment OutcomeABSTRACT
Various dermatological disorders require treatments with immunosuppressive or immunomodulatory agents. Nevertheless, several studies demonstrate low prescription rates for systemic treatments. This low usage may be a result of physicians' low levels of confidence in administering systemic treatments. However, immunosuppressive treatments represent safe options when potential side effects as well as pharmacological interactions are considered. This review overviews the most important oral immunosuppressive or immunomodulatory agents and summarizes their mode of actions, indications, and adverse effects. Biologics that require intravenous or subcutaneous application are not included, but novel and new agents likely to be released soon are considered.
