Telogen effluvium following bivalent human papillomavirus vaccine administration: a report of two cases.

We describe two cases of telogen effluvium occurring in two 11-year-old children following bivalent human papillomavirus (HPV) vaccine administration. The two children began to lose their hair following the second HPV vaccine dose. Alopecia worsened following the third vaccine dose and then resolved spontaneously within a few months. In both cases, laboratory analysis and psychiatric evaluation excluded causes other than anti-HPV vaccine. Social discomfort and isolation were associated with alopecia in the two children. The clinical presentation was consistent with a pattern of telogen effluvium. The identification of specific vaccine components responsible for triggering the adverse event remains difficult. In similar cases, suspension of immunization is not recommended, as it provides health benefits that overcome the possible adverse effect of transient telogen effluvium. Caregivers should ensure psychiatric support to their patients to manage the social and emotional distress that might be associated with hair loss.

Lymphocytapheresis in the treatment of psoriasis vulgaris.

Psoriasis is a common autoimmune chronic inflammatory skin disease that affects approximately 2% of the world's population; fundamental for its immunopathogenic mechanism is secretion of type 1 (Th1) cytokines by T cells and their activation. Since cytapheresis has been widely applied to autoimmune disorders, emphasizing the recently reported results of granulocyte and monocyte adsorption apheresis in psoriasis, a small series of psoriasis vulgaris (PV) patients underwent lymphocytapheresis (LCA) with the aim to remove lymphocytes. Five patients were submitted to weekly LCA. The severity of the disease had been evaluated through psoriasis area and severity index (PASI) score before LCA and one week after the last apheresis. PASI score before: patient A: 66; patient B: 33; patient C: 50; patient D: 56; patient E: 29. All the patients showed improvement of skin lesions. PASI score after LCA: patient A: 24; patient B: 8; patient C: 5; patient D: 36; patient E: 2.1. No side effects linked to apheresis were reported. LCA seems to produce interesting results in PV, and PASI improvement related to apheresis is clinically significant. Further studies to address its mechanism of action and potential long-term side effects are needed. It could become a valuable therapeutic alternative or a complementary tool, which might even be used to reduce the dosages of conventional pharmacological therapies adopted for this chronic disease.