Palliative Therapy for Recalcitrant Cutaneous T-Cell Lymphoma of the Hands and Feet With Low-Dose, High Dose-Rate Brachytherapy.

IMPORTANCE: Cutaneous T-cell lymphoma (CTCL) of the hands and feet can be challenging to treat and cause significant disability for patients. Although CTCL is a highly radiosensitive tumor, the complex topography of acral surfaces presents challenges to achieving homogeneous superficial dosing of traditional electron beam therapy. In addition, traditional dosing may result in substantial acute cutaneous toxic effects. Recent reports demonstrate that low-dose palliative radiotherapy may be as effective as traditional regimens in CTCL. High dose-rate (HDR) brachytherapy allows for control of the depth of radiation penetration over complex curved surfaces. This study investigated the role of low-dose HDR brachytherapy for acral CTCL lesions. OBSERVATIONS: Six patients with a total of 8 acral CTCL lesions received low-dose HDR brachytherapy during a 3-year period. Rapid improvement and clinical clearance were observed in all treated lesions with minimal to no acute cutaneous toxic effects. During a mean follow-up period of 15.8 months, 1 lesion recurred locally; the remaining 7 lesions had sustained clinical remission. No long-term sequelae were observed. CONCLUSIONS AND RELEVANCE: This case series demonstrates that low-dose HDR brachytherapy provides excellent palliation for local control of acral CTCL lesions, offering homogeneous, controlled dosing for complex topographic sites with minimal to no cutaneous toxic effects.

Alternative, Complementary, and Forgotten Remedies for Atopic Dermatitis.

Atopic dermatitis, perhaps more than other dermatologic diseases, has garnered much attention in the realm of alternative medicine. This may be because its etiopathogenesis is incompletely understood, it is increasingly common, and it waxes and wanes often without clear precipitants, opening up many opportunities for misinterpretation. Herein we explore the evidence for a number of different alternative and complementary therapies, from textiles to vitamin supplements. By definition, none have enough data to be deemed "effective" in a conventional sense, but it is hopeful that some show promising evidence that may one day lead to mainstream acceptance with further research.

Drug-associated dermatomyositis following ipilimumab therapy: a novel immune-mediated adverse event associated with cytotoxic T-lymphocyte antigen 4 blockade.

IMPORTANCE: Ipilimumab, a human monoclonal antibody targeted against cytotoxic T-lymphocyte antigen 4, has shown promise in the treatment of metastatic melanoma. However, given its mechanism of action, immune-related adverse effects have been reported with this therapy. Despite increasing reports of immune-related adverse effects related to ipilimumab therapy, dermatomyositis associated with this agent has not previously been reported. OBSERVATIONS: We describe a woman undergoing treatment with ipilimumab for metastatic melanoma who developed classic cutaneous findings of dermatomyositis along with proximal muscle weakness and elevated muscle enzymes. CONCLUSIONS AND RELEVANCE: This case adds to the expanding literature regarding immune-related adverse events associated with ipilimumab. To our knowledge, drug-induced dermatomyositis from ipilimumab has not previously been reported. Physicians should be aware of these potential immune-related adverse events and consider drug-associated dermatomyositis in the differential diagnosis in patients receiving ipilimumab who present with a cutaneous eruption or muscle weakness.

Diffuse large B-cell lymphoma associated with the use of biologic and other investigational agents: the importance of long-term post-marketing safety surveillance.

This case report describes a patient who developed diffuse large B-cell lymphoma (DLBCL) after receiving courses of two investigational biologic agents and cyclosporine followed by more than four years of subcutaneous efalizumab for the treatment of extensive chronic plaque psoriasis. Three years later, the patient remains free of lymphoma and his psoriasis is well controlled with thrice-weekly narrow-band ultraviolet phototherapy. This case emphasizes the importance of continued long-term post-marketing safety surveillance and the early reporting of all possible serious side effects, including cancers, related to the use of any newly available product. In particular, surveillance should focus on the immunomodulating biologic agents in order to identify possible dangerous sequelae.

Treatment of vulvovaginal lichen planus.

Vulvovaginal lichen planus is a chronic condition characterized by complex mucocutaneous findings. Patients may be asymptomatic or may have severe pain and itching. Findings vary from erythema, erosions, and white striae to severe scarring. Goals of treatment are to relieve symptoms and to minimize potential scarring. A multidisciplinary approach is advised for patients with widespread involvement to maximize treatment success (dermatologists, gynecologists, dentists, physical therapists, ophthalmologists, gastroenterologists, urologists, neurologists, anesthesiologists, psychologists, and psychiatrists).

Herpetic geometric glossitis in an immunocompetent patient with pneumonia.

Herpetic geometric glossitis is an uncommon, clinically distinctive presentation of oral herpes simplex virus infection that affects the tongue. All published reports have been in patients who are immunocompromised. We present an immunocompetent woman with viral pneumonia who developed painful linear fissures on the back of the tongue suggestive of herpetic geometric glossitis. The diagnosis was confirmed by both biopsy specimen and immunohistochemistry. As in other cases, the patient promptly responded to treatment with antiviral therapy. The morphology, laboratory findings, and similarities to herpetic corneal dendrites are discussed. Herpetic geometric glossitis should no longer be considered as a diagnosis only in immunosuppressed individuals, but in immunocompetent persons as well.

Inferior alveolar nerve canal position: a clinical and radiographic study.

PURPOSE: To document a clinically relevant position of the inferior alveolar nerve (IAN) in dentate patients and identify patient factors associated with IAN position. MATERIALS AND METHODS: The investigators used a cross-sectional study design and a study sample of subjects who had a radiographically identifiable IAN canal and at least 1 mandibular first molar was enrolled. Predictor variables were age, gender, and race. Outcome variables were the linear distances between the buccal aspect of the IAN canal and the outer buccal cortical margin of the mandible, and the superior aspect of the IAN canal and the alveolar crest. Appropriate uni-, bi-, and multivariate statistics were computed. RESULTS: The study sample was composed of 50 patients with a mean age of 42 years, 42.0% were male, and 73.2% were white. On average, the buccal aspect of the canal was 4.9 mm from the buccal cortical margin of the mandible. The superior aspect of the IAN canal was 17.4 mm inferior from the alveolar crest. Age and race were statistically associated with IAN position relative to the buccal cortical mandibular margin (P<.05). None of the demographic variables were associated with vertical position. CONCLUSIONS: The IAN canal was 4.9 mm and 17.4 mm from the buccal and superior cortical surfaces of the mandible, respectively. The bucco-lingual IAN canal position was associated with age and race. Older patients and white patients, on average, have less distance between the buccal aspect of the canal and the buccal mandibular border. To minimize the risk of IAN injury, these variables should be considered when planning mandibular osteotomies or using monocortical plates.