Cases reported "Recurrence"

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1/15. quality of life improvement in a patient with severe atopic dermatitis treated with photopheresis.

    Atopic dermatitis is a common skin disease characterized by severely pruritic eczematous patches, papular and lichenified plaques, excoriations, cracks, and erosions. photopheresis has been shown to ameliorate the signs and symptoms of atopic dermatitis in some patients. We describe successful results with photopheresis for refractory disease in a patient who chronicled his quality of life weekly for more than 15 years before and during extracorporeal photochemotherapy.
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2/15. Treatment of resistant discoid lupus erythematosus of the palms and soles with mycophenolate mofetil.

    Mycophenolate mofetil is an immunosuppressive drug that has recently been used to treat a variety of autoimmune and inflammatory skin diseases. Expanding the use of this agent in dermatology, we describe 2 patients with both systemic lupus erythematosus and discoid lupus erythematosus whose recalcitrant palmoplantar lesions were successfully treated with mycophenolate mofetil.
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3/15. Bortezomib-induced Sweet's syndrome.

    Sweet's syndrome is an uncommon acute skin disease, associated with a variety of medical problems. The drug-induced variant is even rarer. We describe two cases of this syndrome associated with the administration of the proteasome inhibitor bortezomib. The diagnostic criteria for drug-induced Sweet's syndrome as proposed by Walker and Cohen were fulfilled. vasculitis and neutrophilic eccrine hidradenitis were excluded.
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4/15. A case of recurrent Sweet's syndrome in an 80-year-old man: a clue to an underlying malignancy.

    An 80-year-old man presented with multiple erythematous papules on the trunk and extremities of a few weeks' duration. He had no past medical or family history of skin diseases or any other medical diseases. A biopsy showed a perivascular lymphohistiocytic infiltrate and sparse neutrophils with several atypical lymphocytes in the deeper dermis. With an initial diagnosis of T-cell pseudolymphoma or unspecified neutrophilic dermatosis, he showed a brisk response to an intramuscular injection of triamcinolone acetonide (40 mg/mL). After 1 month, his skin lesion recurred. Steroid was given with a good clinical response. One month later, however, his skin lesion relapsed. At this time, he presented with disseminated pustulopapular lesions on the trunk and extremities. Examination revealed multiple, variable-sized, erythematous plaques with central pustules on the extremities (Fig. 1). The mucous membranes were not involved. He had no pain or tenderness. He had no systemic symptoms. Laboratory tests showed a hemoglobin level of 10.3 g/dL, a leukocyte level of 6,900/mm(3), with an increased proportion of segmented nuclear neutrophils (83%), and an elevated c-reactive protein. A skin biopsy revealed a dense perivascular and interstitial infiltrate composed of neutrophils with marked dermal edema (Fig. 2). Sweet's syndrome was the final diagnosis and he was treated with oral prednisolone (30-40 mg/day) and dapsone (50 mg/day) for 2 months. As this 80-year-old patient had a recurrent history of similar skin lesions and anemia, an underlying hematologic malignancy was suspected. A bone marrow biopsy showed typical myelodysplastic syndrome (MDS). The hemoglobin level was decreased to 5.3 g/dL during a follow-up period of 5 months. The skin lesions recurred despite oral steroids and dapsone. The patient received only symptomatic treatment, such as a transfusion, for the underlying malignancy MDS.
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5/15. Recurrent injection site reactions from interferon beta 1-b.

    Recombinant human interferon beta-1b is an immune-modulatory drug used for a variety of conditions including multiple sclerosis (MS). Skin reactions to therapeutic use of injectable interferon beta-lb are relatively common, including injection site reactions and exacerbation of underlying skin disease. Injection site reactions are seen much more frequently in females. We discuss a case of prolonged susceptibility to injection site reaction with over a decade of use of interferon beta 1-b for MS. Given the prevalence of such reactions, the dermatologist should be aware of the phenomenon and that it frequently does not necessitate discontinuation of therapy.
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6/15. Pituitary granuloma and pyoderma gangrenosum.

    pyoderma gangrenosum is a rare chronic and recurrent skin disease characterized by progressing lesions from papulopustules to large necrotic sterile ulcers. Its definite etiology remains unknown. In a 40-year-old woman with typical pyoderma gangrenosum an intrasellar mass with suprasellar extension was diagnosed and removed by transsphenoidal surgery. Histopathological features of the lesion were those of a nonspecific granulomatous hypophysitis. Five months postoperatively the patient experienced visual defects and hypopituitarism demonstrated by endocrine evaluation. Computerized tomography showed the recurrence of the intrasellar expanding mass. Extensive and repeated evaluation failed to find any evidence of sarcoidosis, tuberculosis or histiocytosis. Corticosteroid therapy was preferred to surgery and 80 mg daily prednisone produced a dramatic shrinkage of the pituitary pseudotumor. Long-term follow-up studies did not disclose any recurrence of the pituitary granulomatous process nor objective evidence of underlying disease even after steroid dosage has been tapered. The hypothesis of a pituitary localization of pyoderma gangrenosum is suggested by the similarity between the histopathologic findings of the two conditions and the excellent response to steroid therapy.
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7/15. Pustular psoriasis of v. Zumbusch type associated with recurring cholestatic jaundice.

    A 46-year-old man with pustular psoriasis and recurring episodes of severe cholestatic liver disease is described. Six icteric periods have occurred parallelling high activity of the skin disease.
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8/15. Relapsing linear acantholytic dermatosis.

    A 5-year-old girl with a unilateral linear systematized skin lesion showing the clinical, histological and ultrastructural features of Hailey-Hailey disease is described. We suggest that this relapsing linear acantholytic dermatosis represents a new distinct entity within the spectrum of unilateral linear skin diseases.
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9/15. Skin grafting herpetic ulcers.

    Recurrent and chronic herpetic skin ulcers are associated with the persistence of virus in the dorsal root ganglia serving the respective dermatomes. Descriptions of surgical approaches to control herpetic skin disease have recently appeared in the medical literature. We report the successful excision and skin grafting of chronic genital ulcers. Our subsequent animal studies support our expectations that potential seeding and reinfection of the grafted skin can occur following graft reinnervation. This problem must be watched for following grafts of herpetic ulcers in humans.
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10/15. Bullous dermatoses of pregnancy.

    Eight women had a bullous skin disease that occurred during pregnancy. One patient had clinical, histopathologic, and immunopathologic features of pemphigus. The other seven patients showed the features of herpes gestationis. Oral contraceptives reproduced the disease in the pemphigus patient and in one of the others. When the pemphigus patient was free of active disease, local intraepidermal acantholytic blister formation with deposition of IgG and C3 in the intercellular substance of the epidermis was induced by intradermal injection of progesterone.
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