Indomethacin treatment of eighteen patients with Sweet's syndrome.

BACKGROUND: The standard treatment for Sweet's syndrome (acute febrile neutrophilic dermatosis) is oral corticosteroids. Despite a good initial response, the disease is characterized by frequent relapses. OBJECTIVE: Our purpose was to test the therapeutic effect of the nonsteroidal antiinflammatory drug indomethacin on Sweet's syndrome. METHODS: All patients with Sweet's syndrome observed during a 4-year period were given indomethacin, 150 mg/day for the first week and 100 mg/day for two additional weeks. The therapeutic response was assessed on days 4, 7, 14, 30, and 180. RESULTS: Seventeen of 18 patients had a good initial response; fever and arthralgias were markedly attenuated within 48 hours and eruptions cleared between 7 and 14 days. The remaining patient's cutaneous lesions continued to develop and were successfully treated with prednisone (1 mg/kg/day). The only side effect of indomethacin treatment was epigastric pain in two patients. No patient had a relapse after discontinuation of indomethacin (mean followup, 20.1 months). CONCLUSION: Indomethacin is a safe and effective treatment for Sweet's syndrome.

Cerebriform intradermal nevus. A clinical pattern resembling cutis verticis gyrata.

A clinical case resembling cutis verticis gyrata due to a cerebriform intradermal nevus (CIN) is reported. Such a lesion is diagnosed on clinical and histopathological grounds. Some aspects are particularly discussed, such as complications of CIN, including the potential development of malignant melanoma, prognosis and different possibilities in the therapeutic approach. It is stressed that early diagnosis, broad surgical excision and plastic reconstruction are major issues. Different techniques of surgical extirpation and scalpflap reconstruction are presented.