Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disease.
To review the literature on radiation therapy (RT)-associated BP.
A review of the English language literature on patients who ...developed BP during and up to 10 years post RT was performed.
29 patients were reported. 25 (86.2%) were women, 84% of whom had received RT for breast cancer. Three patients were male (10.3%). Gender was not mentioned in 1 (3.4%). 72% developed BP post RT; 28% developed BP while undergoing RT. BP was initially localized to irradiated sites in 25 patients and to non-irradiated sites in 2 patients. Two patients presented with generalized disease. Disease control was reported in 12 patients, partial remission in 7 and complete remission in 5.
The clinical profile, response to therapy and clinical outcome may indicate that RT-associated BP may be a specific subset of BP with a relatively benign course.
Reports describing the use of ablative fractional resurfacing (AFR) for cosmetic improvements in skin dyschromia, rhytides, and textural irregularities are becoming increasingly common in the ...literature. However, the is little mention of its functional impact on patients with traumatic scars and scar contractures. We present our experience treating scars with AFR, highlighting four illustrative cases and providing a review on possible mechanisms.
Up to three ablative fractional carbon dioxide laser treatments were performed at 1-month to 2-month intervals on four patients with functional deficits related to refractory scar contractures. Treatments were individualized and began as early as 2 months after injury or final reconstructive surgery. Cases were performed in the outpatient clinic using topical anesthetic supplemented by forced air cooling. Postprocedure care included diluted-vinegar compresses two to three times daily and application of ointment over the treatment area for approximately 3 days after the procedure. Postprocedure pain was minimal, and all patients were allowed to resume physical therapy as early as the day of treatment.
AFR was well tolerated without serious complications. Durable and cumulative improvements in range of motion or overall skin functionality were noted in all patients. AFR can be surgery sparing and facilitated earlier return to full or modified activities based on associated injuries.
AFR is a novel, well tolerated, and effective complement to traditional rehabilitative management for patients with traumatic scars and scar contractures. Potential paradigm shifts include earlier initiation of treatment and a focus on functional improvements.
Split-thickness skin grafts in the forearm can lead to motion restriction and disability through the dense scarring of the skin and formation of graft-tendon adhesions. Three patients were referred ...for laser treatment of motion-limiting scar-associated split-thickness skin grafts to the forearm. All patients had reached a plateau in range of motion despite aggressive hand therapy and underwent serial laser scar treatments at 6- to 8-week intervals. Treatments were performed in a clinic setting and were initiated 2 to 5 months after reconstructive surgery. Rapid subjective functional and objective improvements in range of motion were noted after laser therapy. Results were cumulative and durable at final follow-up ranging from 10 to 15 months after the initial treatment. No complications were noted. Fractionated carbon dioxide laser therapy is a promising adjunct to hand therapy when the main restraint to motion is superficial skin scarring and skin-tendon adhesions.
Psoriatic patients on tumor necrosis factor alpha inhibitors (TNFi) may be at increased risk for upper respiratory tract infections, including chronic rhino-sinusitis (CRS). Rarely, CRS can progress ...to orbital cellulitis (OC), an emergent ophthalmic complication wherein respiratory flora from paranasal sinus disease intrude the retro-orbital space.
Single case report.
We report the first case, to our knowledge, of an invasive sinusitis that rapidly evolved into OC in a patient receiving adalimumab treatment for plaque psoriasis and psoriatic arthritis. After TNFi withdrawal and appropriate medical and surgical intervention, the patient fully recovered. However, on resumption of TNFi therapy, symptoms of recalcitrant CRS returned.
More investigation is needed to explore how TNFi might predispose to chronic, refractory rhino-sinusitis and subsequent progression to OC. Military physicians and other medical providers should be aware of this proposed new disease entity and the potential for rapidly evolving and invasive infections in immunocompromised patients. Screening and monitoring for chronic infectious disease, such as CRS before initiating and during TNFi therapy is warranted.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Efalizumab, a humanized anti-CD11a monoclonal antibody, has been shown to treat plaque psoriasis. A known association between this drug and autoimmune thrombocytopenia has already been established. ...More recently publicized, however, is efalizumab's ability to affect another cell line—that of the erythrocyte—and cause an autoimmune hemolytic anemia that typically occurs 4 to 6 months after initiating therapy. In this article, we report the case of a patient who developed autoimmune hemolytic anemia after 8 months of successful treatment with efalizumab. His delayed presentation suggests that monitoring of blood cell counts longer than 6 months may be warranted.
BACKGROUND/OBJECTIVEAlthough the alexandrite 755-nm-wavelength laser is effective in the treatment of unwanted hair, there are no published studies gauging the efficacy of the variable long-pulse ...alexandrite laser in the treatment of superficial pigmented lesions.
STUDY DESIGN/METHODSEighteen patients underwent a single treatment session using a variable pulse-width alexandrite laser. Test sites were performed using a 10-mm spot size and up to four pulse widths (3, 20, 40, 60 ms) with and without epidermal cooling. Full treatments were performed 3 weeks later using optimum test parameters. The patients were evaluated at 3 and 6 weeks.
RESULTSPatients with darker lentigines had greater lesion clearance than those patients with lighter colored lentigines. Shorter pulse widths and treatment without cryogen cooling both, independently, lowered the fluence threshold for lentigo clearance.
CONCLUSIONA long-pulse alexandrite laser is effective in clearing solar lentigines in a single pass with minimal adverse effects.
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