BACKGROUND: sirolimus (formerly rapamycin) is an immunosuppressive agent that interferes with T-cell activation. After 2 individuals with psoriasis developed a capillary leak syndrome following treatment with oral sirolimus lesional skin cells and activated peripheral blood cells were analyzed for induction of apoptosis. OBSERVATIONS: A keratome skin specimen from 1 patient with sirolimus-induced capillary leak syndrome had a 2.3-fold increase in percentage of apoptotic cells (to 48%) compared with an unaffected sirolimus-treated patient with psoriasis (21%). Activated peripheral blood T cells from patients with psoriasis tended to exhibit greater spontaneous or dexamethasone-induced apoptosis than did normal T cells, particularly in the presence of sirolimus. CONCLUSIONS: Severe adverse effects of sirolimus include fever, anemia, and capillary leak syndrome. These symptoms may be the result of drug-induced apoptosis of lesional leukocytes, especially activated T lymphocytes, and possibly release of inflammatory mediators. Because patients with severe psoriasis may develop capillary leak from various systemic therapies, clinical monitoring is advisable for patients with inflammatory diseases who are treated with immune modulators. ( info) |
12/925. psoriasis associated with human immunodeficiency virus in an infant. psoriasis is commonly reported in association with hiv in adults. A 3-month-old girl with hiv presented with a widespread eruption and was diagnosed with psoriasis. This is the first infant reported with psoriasis in association with hiv infection. The relationship between the two entities is discussed, as is the role of treatment with zidovudine. ( info) |
13/925. Laugier-Hunziker syndrome: case report and treatment with the Q-switched Nd-Yag laser. We report the case of a 46-year-old Caucasian female presenting with mucocutaneous pigmentation on the lips, oral mucosa, hands, feet and nails, as well as on a psoriatic plaque. She was successfully treated with Q-switched Nd-Yag laser, with double frequency, for both the mucosal and cutaneous lesions. ( info) |
We report the case of an elderly woman who had been on hydroxyurea for long-standing widespread psoriasis. After approximately 5 years's treatment with hydroxyurea, she developed a symmetrical dermatomyositis-like eruption on her hands, together with bilateral leg ulceration. Although similar skin eruptions have been reported after long-term hydroxyurea treatment, all of the previous patients were being treated for myeloproliferative disorders. A dermatomyositis-like eruption has not previously been reported to occur as a consequence of hydroxyurea treatment for psoriasis. Its recognition is important to prevent unnecessary investigation or treatment withdrawal. ( info) |
15/925. Allergic and irritant contact dermatitis to calcipotriol. Calcipotriol (Daivonex R; Leo Pharmaceuticals, Zurich, switzerland) may cause irritation of the skin, whereas allergic reactions are less common. In the present study we describe two patients with different types of reaction patterns, one presenting as an allergic, the other as an irritant contact dermatitis. Irritative skin reactions were observed only at higher testings doses, in contrast to the allergic type of reaction, which occurred at a lower testing dose. The present observation suggests, that a batch of different testing doses, including lower testing doses may help to differentiate between an allergic type of contact dermatitis and an irritant type of reaction after treatment with calcipotriol. ( info) |
16/925. Remission of psoriasis after treatment with interferon-alfa and 2-chlordeoxyadenosine for hairy cell leukemia. 2-Chlordeoxyadenosine (2-CdA) is an antineoplastic/immunosuppressive agent used to treat hairy cell leukemia (HCL), chronic lymphocytic leukemia, and low-grade lymphomas. Its immunomodulatory properties, however, may allow its future use in the treatment of psoriasis. We report a patient with psoriasis and HCL who was treated for 1 week with continuous intravenous infusion of 2-CdA for recurring HCL. Both the psoriasis and the HCL cleared. Four years after 2-CdA treatment, the patient has psoriasis on only 1% of his body surface area. 2-CdA induces lymphocytopenia, which may explain the improvement in this patient's psoriasis. ( info) |
17/925. Widespread plaque psoriasis responsive to mycophenolate mofetil. A woman with a long history of widespread plaque psoriasis unresponsive to and/or intolerant of phototherapy, retinoids, methotrexate and cyclosporin was successfully treated with mycophenolate mofetil. Remission was maintained on doses between 1 and 1.5 g/day for 18 months without adverse effects. ( info) |
18/925. The peripheral corneal melting syndrome and psoriasis: coincidence or association? The peripheral corneal melting syndrome (PCMS) is a rare disease consisting of marginal corneal thinning that can progress to perforation. The PCMS carries a grave prognosis and it is of vital importance that dermatologists are aware that this may be responsible for a painful red eye in a patient with psoriasis. We highlight the features of the PCMS developing in an elderly woman with long-standing psoriasis to increase awareness of its significance, and hypothesize that an association may exist between the two conditions. Only one previous report has been published in which the authors speculate on the possible association of this syndrome with psoriasis. That few other cases have been described is either a consequence of under-reporting by both ophthalmologists and dermatologists unaware of a link or because the relationship between the syndrome and psoriasis is genuinely coincidental. ( info) |
19/925. Clinical response of psoriasis to low-energy irradiance with the Nd:YAG laser at 1320 nm report of an observation in three cases. BACKGROUND: psoriasis is a perplexing disease for which we have no definitive therapy. many types of lesions and clinical forms exist, from the small, localized indolent papule, to the persistent intractable plaque, to the disabling palmo-plantar involvement to the erythrodermic form. This wide variety of clinical manifestations has made it difficult to apply therapies such as lasers, which can reportedly produce an improvement. Although they have been shown to work, the carbon dioxide laser needs local injection for anesthesia along with healing by second intention, lasting for 3 to 6 weeks, while the flashlamp-pumped dye laser needs to be delivered in individual pulses of 5 to 10 mm in diameter each and repetition rates of only 1 to 2 pulses per second (1-2 Hz). These factors have made both lasers impractical for widespread use given the extensive skin involvement, which is often present. OBJECTIVE: To report on the beneficial effects of this new apparatus in some psoriatic lesions as observed in 3 out of 3 individuals tested. methods: Three patients who had lesions ranging from the small indolent papule to the persistent plaque, resistant to conventional treatment, to plantar involvement, underwent focal treatment with low-energy continuous emission of laser light below the threshold of pain for a total of 4 treatments in a span of 2 weeks. RESULTS: A clinical response was observed in all 3 cases. Improvement was noticed at a 4-week follow-up visit and continued for 3 months. Early recurrence in 1 case was noted at the end of this period. Partial response in a case of plantar involvement was seen. CONCLUSIONS: These findings are not only encouraging to undertake a study in a larger number of patients, with several different fluences and treatment frequencies, but are also intriguing regarding the possible mechanism or mechanisms of action. ( info) |
A 24-year-old man with down syndrome presented with prominent ichthyosiform skin on his extremities and psoriatic plaques on his chest, back and scalp. The late onset of his ichthyosis without family history suggested that it was not a heritable form but was associated down syndrome. Such an association with ichthyosis and psoriasis has not been described previously. ( info) |