RESUMO
"Reactive erythemas" is an umbrella term grouping several different conditions, all of which have in common the fact of being stereotypical inflammatory clinical patterns of the skin in response to disparate infectious, immune, or toxic factors. Typically, such eruptions are symmetrical or disseminated. The here reported cases are different. An elderly man underwent recurrent infections of an epidermoid cyst, accompanied by a typical erythema annulare centrifugum near the infectious focus. His grandson, aged ten months, presented with an infectious conjunctivitis, during the resolution of which two small annular lesions, compatible with annular erythema of infancy, appeared on the face. A man aged 42, respectively son and father of the two former patients, presented with an erythema multiforme target lesion proximally to an infected wound. There were no detectable predisposing factors in all cases. Familial cases of reactive erythemas have been reported. However, such limited distributions have not yet been described.
Assuntos
Eritema/patologia , Adulto , Idoso , Eritema/classificação , Eritema/genética , Humanos , Lactente , MasculinoRESUMO
Hepatorenal syndrome (HRS) is a peculiar form of progressive renal failure complicating the course of cirrhosis and ascites. The renal impairment of HRS is merely functional and potentially reversible. Notwithstanding, in spite of several encouraging attempts, a satisfactory medical treatment for HRS is still expected. Several pathophysiological mechanisms are active in HRS. Arachidonate metabolism derangements are among these, and prostaglandins and thromboxane antagonists have been tried with variable outcomes. Also leukotrienes (LT) appear to be involved in HRS. Three drugs (zileuton, montelukast and zafirlukast) interfering with LT synthesis and receptor binding are currently available, but they have not yet been tried in HRS. Accordingly, the author would like to suggest physicians engaged in care of these critical patients to consider a trial with these drugs-as well as with any future innovative agent active on the arachidonate-derived metabolic pathways.
Assuntos
Síndrome Hepatorrenal/tratamento farmacológico , Síndrome Hepatorrenal/prevenção & controle , Hidroxiureia/análogos & derivados , Antagonistas de Leucotrienos/farmacologia , Leucotrienos/química , Acetatos/farmacologia , Ácido Araquidônico/metabolismo , Ciclopropanos , Humanos , Hidroxiureia/farmacologia , Indóis , Leucotrienos/metabolismo , Fígado/efeitos dos fármacos , Fenilcarbamatos , Estrutura Terciária de Proteína , Quinolinas/farmacologia , Sulfetos , Sulfonamidas , Tromboxanos/farmacologia , Compostos de Tosil/farmacologiaRESUMO
We report a case of tinea corporis caused by a cattle-derived strain of Trichophyton mentagrophytes in a 44-year-old male affected by cutaneous T-cell lymphoma (CTCL, so-called mycosis fungoides). Fungal colonization of glabrous skin was strictly confined within pre-existing lymphomatous plaques. Either oral itraconazole or griseofulvin, or topical terbinafine were ineffective until the patient, who was treated with systemic retinoids and interferon-alpha for his CTCL, was shifted from leucocyte to lymphoblastoid interferon. The hypothesis that a local immunodisturbance could be responsible for the selective superimposition of tinea on CTCL lesions ('mycosis on mycosis'), and that such an immunodisturbance could be partially corrected by the interferon switch is discussed.
Assuntos
Linfoma Cutâneo de Células T/microbiologia , Micose Fungoide/microbiologia , Neoplasias Cutâneas/microbiologia , Tinha/etiologia , Antineoplásicos/uso terapêutico , Humanos , Interferon-alfa/uso terapêutico , Linfoma Cutâneo de Células T/complicações , Linfoma Cutâneo de Células T/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Micose Fungoide/complicações , Micose Fungoide/tratamento farmacológico , Micose Fungoide/patologia , Retinoides/uso terapêutico , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Tinha/tratamento farmacológico , Tinha/patologiaRESUMO
Leukotriene receptor antagonists are recommended for the treatment of asthma, and have proved anecdotally successful even in atopic dermatitis. Standard treatments of atopic dermatitis are often unsatisfactory. Accordingly, we compared montelukast, 10 mg/day, with a combined regimen (orally administered cetirizine and clarythromycin, topical corticosteroids and hydrating preparations) for treatment of moderate-to-severe atopic dermatitis of adults. The trial was designed as a randomized single-blind study. SCORAD, eosinophilic cationic protein (ECP), eosinophilic protein X (EPX) serum levels were assessed at baseline and after 6 weeks in 32 adult patients with atopic dermatitis (16 treated with montelukast; 16 treated with the combined regimen). Similar improvements, evaluated in term of SCORAD reductions, were detected in both groups (Mann-Whitney, p < 0.05), while ECP and EPX levels significantly reduced within each group (Welch's approximate t, p < 0.05). We conclude that montelukast is as effective as the comparison combined regimen to treat atopic dermatitis of adults.
Assuntos
Acetatos/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Antagonistas de Leucotrienos/uso terapêutico , Quinolinas/uso terapêutico , Ribonucleases , Acetatos/sangue , Acetatos/imunologia , Acetatos/farmacologia , Administração Tópica , Adolescente , Adulto , Antialérgicos/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios , Proteínas Sanguíneas , Cetirizina/uso terapêutico , Claritromicina , Ciclopropanos , Dermatite Atópica/classificação , Dermatite Atópica/imunologia , Quimioterapia Combinada , Proteínas Granulares de Eosinófilos , Feminino , Glucocorticoides , Humanos , Antagonistas de Leucotrienos/imunologia , Antagonistas de Leucotrienos/farmacologia , Masculino , Pessoa de Meia-Idade , Quinolinas/sangue , Quinolinas/imunologia , Quinolinas/farmacologia , Índice de Gravidade de Doença , Método Simples-Cego , Sulfetos , Resultado do TratamentoAssuntos
Alilamina/uso terapêutico , Alternaria , Antifúngicos/uso terapêutico , Dermatomicoses/tratamento farmacológico , Naftalenos/uso terapêutico , Alilamina/análogos & derivados , Dermatomicoses/etiologia , Feminino , Humanos , Terapia de Imunossupressão/efeitos adversos , Pessoa de Meia-Idade , TerbinafinaAssuntos
Fármacos Dermatológicos/administração & dosagem , Ceratose/tratamento farmacológico , Líquen Plano/tratamento farmacológico , Psoríase/tratamento farmacológico , Fármacos Dermatológicos/normas , Aprovação de Drogas , Humanos , Ceratose/diagnóstico , Líquen Plano/diagnóstico , Psoríase/diagnóstico , Sensibilidade e Especificidade , Resultado do Tratamento , Estados Unidos , United States Food and Drug AdministrationAssuntos
Ciclosporina/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Imunossupressores/uso terapêutico , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/tratamento farmacológico , Pioderma Gangrenoso/complicações , Pioderma Gangrenoso/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-IdadeAssuntos
Doença de Darier/diagnóstico , Adulto , Diagnóstico Diferencial , Eritema/diagnóstico , Sobrancelhas , Feminino , HumanosAssuntos
Antineoplásicos/uso terapêutico , Interferon Tipo I/uso terapêutico , Interferon-alfa/uso terapêutico , Linfoma Cutâneo de Células T/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Resistencia a Medicamentos Antineoplásicos , Humanos , Masculino , Pessoa de Meia-Idade , Proteínas RecombinantesRESUMO
Here we present the case of a patient affected with a unique association of Sweet's syndrome, idiopathic myelofibrosis, spindle-cell thymoma, myasthenia gravis and Good's syndrome (a rare form of thymoma-related, combined immunodeficiency presenting with recurrent respiratory infections). Conventional therapies (corticosteroids, colchicine, DDS, clofazimine) were ineffective or were contraindicated. Treatment with etretinate (50 mg/day) proved effective on skin lesions. Moreover, the patient's general condition unexpectedly improved, with long-lasting (11 months) suppression of respiratory infections and a slight but consistent improvement of hematological parameters such as Hct, MCV, Hb level, RBC, WBC and lymphocyte absolute counts.