Medication history of a series of patients with bullous pemphigoid from northern Greece - observations and discussion.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune bullous disease that mainly affects elderly patients. In this retrospective study, in a series of patients with BP, data on systemic medications were collected in order to investigate a possible association with active BP. METHODS: Thirty-four patients with BP were studied in two groups. Group A contained patients who were receiving systemic medications and group B contained patients receiving no medications. All sera were examined by immunoassay for the possible existence of anti-BP180NC16a and anti-BP230, prior to the initiation of steroid treatment. RESULTS: Patients were of a similar age in both groups (P = 0.07). Anti-BP180NC16a autoantibodies were detected in 80% of patients in group A and in 14% of patients in group B. Anti-BP230 autoantibodies were detected in 25% of patients in group A and in 50% of patients in group B. Levels of circulating anti-BP180NC16a autoantibodies were statistically significantly higher in group A than in group B (P = 0.04). CONCLUSIONS: Patients who were receiving systemic medications seemed to be more susceptible to the development of BP. Should we consider drug exposure as one of the reasons for the increased prevalence of BP in the elderly? It is important to be more vigilant with this category of patients in order to provide an early diagnosis of the disease.

Acrodermatitis continua of Hallopeau on toes successfully treated with a two-compound product containing calcipotriol and betamethasone dipropionate.

OBJECTIVE: To investigate the efficacy of treating acrodermatitis continua of Hallopeau (ACH) with a new two-compound ointment. BACKGROUND: ACH is a rare pustular eruption on the distal portions of the fingers and less often, on the toes. It is nowadays classified as a form of acropustular psoriasis that tends to be resistant to treatment. METHODS: A 75-year old woman presented with pustules and hyperkeratotic erythematous papules, coalescing in plaques on the dorsal aspect of both great toes and on the perionychium of their nails. Diagnosis of ACH was based on clinical and histologic findings. We treated the patient with application of an ointment containing calcipotriol and betamethasone dipropionate twice daily for a month. RESULTS: Therapeutic effect of the applied agent was impressively rapid with complete recovery of the lesions CONCLUSION: In our patient, calcipotriol/ betamethasone dipropionate ointment was an efficacious regimen in the treatment of ACH. In the era of biologics, old topical agents in combined forms remain valuable. Although calcipotriol alone or its combination with betamethasone have been reported to aggravate the disease in some cases, their beneficial role is important and they are worth considering as first line therapeutic agents in the management of various forms of pustular psoriasis.

Plasma exchange in patients with toxic epidermal necrolysis.

We describe our experience with plasma exchange (PE) therapy in 13 patients with drug-induced toxic epidermal necrolysis (TEN), 4 of whom had malignant disorders. Skin lesions covered 17% to 100% of total body surface area and 1 to 4 mucous membranes were involved. None of the patients was hospitalized in a burn unit. The patients underwent from 2 to 5 PE sessions (mean 3.4 +/- 0.2 standard error of mean [SEM], median 3) exchanging 6.6 to 17.6 L of plasma (mean 10.1 +/- 0.7 SEM, median 10). PE sessions were carried out every other day in 8 patients and daily in 5. Three patients died (23%) while the remaining 10 (77%) had a full recovery. Plasmapheresis may be an effective treatment in patients with drug-induced TEN hospitalized outside a burn unit.