ABSTRACT
Sclerodermic or scleroderma-like lupus erythematosus panniculitis (SLEP) shares both clinical and histopathological features between lupus panniculitis and localized scleroderma. It is exceedingly rare. We herein report a case of SLEP manifested with a solitary, firm-to-hard, erythematous plaque in an Asian woman. This patient responded well to intralesional corticosteroid and antimalarials. We have reviewed the pathogenesis of fibrosis in patients with chronic cutaneous lupus erythematosus as well as documented cases of SLEP in the literature.
ABSTRACT
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are mucocutaneous conditions associated with high mortality and morbidity. Although several prognostic factors have been proposed, some may have yet to be identified. A 14-year retrospective cohort study of patients with SJS/TEN was conducted at a university-based hospital in Bangkok, Thailand, to explore additional prognostic factors for mortality of patients with SJS/TEN. Medical records of all patients aged ≥18 years who were diagnosed with SJS, SJS-TEN overlap, or TEN between 2007 and 2020 were reviewed. Univariate and multivariate analyses were performed to examine associations between death and potential prognostic factors. A total of 76 patients with a mean age of 52 years were enrolled. Among them, 46, 15, and 15 patients were diagnosed with SJS, SJS-TEN overlap, and TEN, respectively. Overall, 10 patients deceased, marking a mortality rate of 13.2%. Based on an algorithm for assessment of drug causality for epidermal necrolysis, drug was the major cause of disease (96.1%). Allopurinol and trimethoprim/sulfamethoxazole were the most frequent culprit drugs. Univariate analysis revealed nine prognostic factors related to death, i.e., age, malignancy, chronic kidney disease (CKD), coronary artery disease, heart rate >120 beats/min, diagnoses of SJS-TEN overlap and TEN, blood urea nitrogen (BUN) >10 mmol/L, hemoglobin <10 g/dL, and serum albumin <2 g/dL. Causality with regard to drug, drug notoriety, time interval from drug intake to onset of reaction, and timing of culprit drug withdrawal were not significantly associated with death. Four independent prognostic factors for mortality were identified from multivariate analysis, i.e., TEN (risk ratio [RR] 8.29, 95% confidence interval [CI]: 2.71-25.38), malignancy (RR 3.34, 95% CI: 1.68-6.69), BUN >10 mmol/L (RR 3.02, 95% CI: 1.28-7.14), and early-stage CKD (RR 4.81, 95% CI: 2.49-9.28). Our findings suggest that CKD is an independent prognostic factor for mortality of patients with SJS/TEN besides those from the SCORTEN.
ABSTRACT
Ultraviolet C (UVC), or ultraviolet germicidal irradiation (UVGI), is known for its effective air, water, and surface disinfectant properties. With the rise of global awareness about public sanitation and personal hygiene due to the emergence of the current coronavirus disease 2019 pandemic, several applications of UVC were introduced to the commercial market. The present experimental study aimed to evaluate the effectiveness of commercial household UVC germicidal devices for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) inactivation. Ten UVC devices were included in the study comprising of 7 low-pressure mercury lamps (LPMLs) and 3 UVC- light-emitting diodes (LEDs). Considering applications, 3 were handheld UVGI surface disinfection equipment, 4 were UVGI disinfection chambers, and 3 were movable UVGI air and surface purifiers. To determine SARS-CoV-2 inactivation performance, UVC irradiance (mW/cm2) was measured 3 times repeatedly at distance and duration corresponding to manufacturers' usage instructions. The required UVC dosage could not be achieved by either of UVC-LED devices (1 handheld UVGI surface disinfection equipment and 2 UVGI disinfection chambers). Five of seven LPMLs can sufficiently emit UVC irradiance for SARS-CoV-2-inactivation. A lack of standardization in the distance and cycle duration for each UVC application was observed. Standard usage guidelines for UVC devices are required to improve the effectiveness of UVC irradiance for SARS-CoV-2 inactivation as well as to minimize the potential side effects of UVC.
ABSTRACT
BACKGROUND: The use of methotrexate-acitretin (MTX-ACI) combination therapy in treating psoriasis has been limited due to concerns related to hepatic fibrosis. However, in vitro evidence revealed a protective effect of acitretin in methotrexate (MTX)-induced liver fibrosis. OBJECTIVE: This study aimed to compare the real-life incidence of hepatic fibrosis in patients with psoriasis receiving MTX-ACI and MTX monotherapy and to investigate factors associated with hepatic fibrosis in MTX-exposed patients. METHODS: A retrospective cohort study was conducted based on a real-life registry containing data on patients with psoriasis who were administered MTX-ACI or MTX between 2008 and 2019 and underwent transient elastography according to cumulative MTX dose of 1.0-1.5 g and/or 3.5-4.0 g. Time-to-event analysis was performed to determine the cumulative incidence, incidence rate, and factors potentially affecting the occurrence of hepatic fibrosis. RESULTS: Of the 160 patients, 32 (20%) were treated with MTX-ACI, and 128 (80%) with MTX alone. Four patients (12.5%) in MTX-ACI group and 21 (16.4%) in MTX group developed hepatic fibrosis (p = 0.59). There was no statistically significant difference in cumulative incidence (16% in MTX-ACI vs 17% in MTX, p = 0.89) and incidence rate (37 cases per 1000 person-year in MTX-ACI vs 23 cases per 1000 person-year in MTX; hazard ratio [HR] = 1.07; p = 0.90) of hepatic fibrosis between the two groups. Diabetes and obesity were identified as significant factors associated with hepatic fibrosis (adjusted HR = 2.40, 95% confidence interval [CI]: 1.05-5.51; p = 0.04 and adjusted HR = 3.28, 95% CI: 1.18-9.16; p = 0.02, respectively) regardless of the cumulative MTX dose. CONCLUSION: The incidence of hepatic fibrosis in a real-life clinical situation, determined by transient elastography in patients with psoriasis receiving MTX-ACI, was not increased compared to those receiving MTX monotherapy. Type 2 diabetes mellitus and obesity were identified as risk factors of hepatic fibrosis; hence, patients with these factors receiving long-term MTX therapy should be regularly monitored for this particular event.
