1/15. Low-dose oral methotrexate treatment for recalcitrant palmoplantar pompholyx. We describe 5 patients with severe pompholyx who did not respond to conventional therapy or who had debilitating side effects from corticosteroids. Low-dose methotrexate was added to their treatment regimens and led to significant improvement or clearing with a favorable side-effect profile. In all 5 patients the need for oral corticosteroid therapy was substantially decreased or eliminated, thus decreasing potential corticosteroid-induced morbidity. In this uncontrolled series of patients with recalcitrant palmoplantar pompholyx, methotrexate was an effective treatment and acted as a steroid-sparing agent. ( info) |
2/15. Complete remission of refractory dyshidrotic eczema with the use of radiation therapy. Dyshidrotic eczema is a chronic, enigmatic condition that usually affects the hands and feet. Modern-technique radiation therapy using megavoltage equipment for the treatment of dyshidrotic eczema has not been described in the literature before. A dramatic clinical response to low-dose external beam radiation therapy was observed in a patient refractory to multiple forms of topical and systemic agents. Complete resolution of this severe presentation of dyshidrosis occurred within 1 month following therapy, with a durable response at 6 months. Withdrawal of oral steroids, without flare of disease, was possible after 6 weeks, with the patient remaining free of medication at the 6-month interval. Complete remission of severe dyshidrotic eczema is achievable using low-dose external beam megavoltage therapy in situations where other forms of conventional therapies have failed. Lasting remission may allow for the complete withdrawal of oral or topical agents, which may become harmful with chronic use. ( info) |
3/15. Resolution of dyshidrotic dermatitis of the hand after treatment with continuous positive airway pressure for obstructive sleep apnea. eczema of the palm and obstructive sleep apnea (OSA) are common disorders. Proinflammatory cytokines and cell adhesion molecules are elevated in both of these disorders. We describe an unusual patient with OSA who had recurrent free remission of dermatitis after treatment with continuous positive airway pressure. We speculate that the resolution of the patient's skin condition may reflect the effects of increased tissue oxygenation during sleep, reduced sleep fragmentation, and/or a reduction in sympathetic tone associated with successful sleep apnea treatment. ( info) |
4/15. Dyshidrotic-like spongiotic dermatitis after intravenous immunoglobulin therapy. Intravenous immunoglobulin (IVIG) therapy has been used to treat a variety of immune mediated disorders. Cutaneous reactions to IVIG are rare and have only been anecdotally described. We describe three cases with dyshidrotic-like biopsy proven spongiotic dermatitis after administration of IVIG. These three cases may highlight an uncommon and rarely reported side effect of IVIG. ( info) |
5/15. Dyshidrosiform pemphigoid: report of a case. A Japanese woman had bullous eruptions on her palms and soles for two months, histopathologic examination, immunofluorescence microscopy, and ELISA for BP180 antigen led to the definitive diagnosis of dyshidrosiform pemphigoid (DP). This paper also includes a study of 15 other cases of DP. ( info) |
6/15. Photoinduced pompholyx: a report of 5 cases. We describe 5 patients whose histories and investigation findings point toward a diagnosis of photo-induced hand pompholyx, a previously unreported condition. Several factors have been associated with the exacerbation of pompholyx, but no direct relationship with sunlight exposure has been reported. ( info) |
7/15. Acropustulosis of infancy. Acropustulosis of infancy (Al) is a syndrome consisting of pruritic pustules that are found primarily on the extremities of infants. It is uncommon, but not rare, and persists about two years. In two infants in whom Al began at birth, there was a striking response to sulfones. There was no response to other therapy. Laboratory findings are not diagnostic for Al. Similar histopathologic changes (subcorneal pustules) can be found in other eruptions of infancy. ( info) |
8/15. Annular pompholyx. The common manifestation of pompholyx is easily recognized by the clinician. Morphologic variants are known in which the predominant lesions are pustules or desquamation with or without erythema. A patient is described herein whose eruption was composed mainly of arciform, annular, and target-like vesicles. Pompholyx (bubble) is a preferred term because "dyshidrosis" denotes a dysfunction of sweating, which does not occur in this condition. The causes of this eruption have not been determined, but it is likely that a certain genetic predisposition and multiple environmental factors are responsible. Pompholyx should be considered in the differential diagnosis of eruptions with annular pattern. ( info) |
9/15. Severe dyshidrosis in two patients with hiv infection shortly after starting highly active antiretroviral treatment. The use of highly active antiretroviral therapy (HAART) is the gold-standard treatment for hiv infected patients. We here describe two hiv positive patients whose histories are suggestive for dyshidrosis as an immune reconstitution inflammatory syndrome (iris). Several factors have been associated with the exacerbation of dyshidrosis lesions but no direct relationship with HAART has been reported until now. ( info) |
10/15. Linear IgA disease with haemorrhagic pompholyx and dapsone-induced neutropenia. A case of haemorrhagic pompholyx occurring in a 29-year-old man with linear IgA disease is described. There were several features in our patient that are usually seen in chronic bullous disease of childhood. Treatment with dapsone cleared the eruption but induced a progressive yet reversible neutropenia. ( info) |