Clinical management with efalizumab of a patient with psoriasis and comorbid vitiligo.

Although the precise pathogenesis is not known, vitiligo appears to be an autoimmune disease involving T cell-mediated melanocyte destruction. Efalizumab, a recombinant, humanized monoclonal antibody, targets T cells, the key mediators of the immunopathogenesis of psoriasis. Although a concomitant presentation of vitiligo with psoriasis is uncommon, several cases have been reported previously in the literature. A case of a patient with vitiligo and psoriasis who was treated with efalizumab to alleviate the symptoms of psoriasis is described. Over the course of the diseases, the patient had been treated unsuccessfully with numerous therapies. The patient initiated efalizumab with a 0.7 mg/kg conditioning dose and then continued on 1 mg/kg weekly. After 2 months of efalizumab therapy, the psoriasis symptoms were reduced, and the vitiligo had visibly improved in some areas. The patient has remained on efalizumab therapy with no evidence of an exacerbation of vitiligo. The management of acute flares is also discussed. This case is illustrative of a patient with psoriasis and vitiligo who was treated successfully with efalizumab.

Current use of anti-infectives in dermatology.

Dermatologic diseases encompass a broad category of pathologic situations. Infection remains a significant aspect of the pathology faced in patient encounters, and it is natural to expect that anti-infectives play a major element in the armamentarium utilized by dermatologists. Aside from the treatment of the classic bacterial and fungal infections, there are now new uses for antiviral agents to help suppress recurrent disease, such as herpes simplex. There is also the novel approach of using anti-infectives, or agents that have been thought to have antimicrobial activity, to treat inflammatory diseases. This review describes anti-infectives, beginning with common antibiotics used to treat bacterial infections. The discussion will then cover the current use of antivirals. Finally, the description of antifungals will be separated, starting with the oral agents and ending with the topical antimycotics. The use of anti-infectives in tropical dermatology has been purposefully left out, and perhaps should be the subject of a separate review. Cutaneous bacterial infections consist chiefly of those microorganisms that colonize the skin, such as species of staphylococcus and streptococcus. Propionibacterium acnes and certain other anaerobes can be involved in folliculitis, pyodermas and in chronic conditions such as hidradenitis suppurativa.