Dermatitis Exfoliative Publications (2840)
Dermatitis Exfoliative Publications
There were also cervical, axillary, and inguinal lymphadenopathy. Laboratory studies revealed a high white blood cell count of 125×10(9)/L (reference range: 4-10×10(9)/L), hemoglobin level of 11.9 g/dL (reference range: 12-16 g/dL), and normal platelet level of 396×10(9)/L (reference range: 140-440×10(9)/L). Results from direct Coombs test were negative and lactate dehydrogenase levels were normal.
The patient developed a pruritic, morbiliform eruption, which slowly progressed over 3 months to a tender, exfoliative dermatosis. Histology initially showed interface dermatitis and subsequently revealed full thickness epidermal necrosis. The diagnosis of TEN was made. From initial biopsy to TEN presentation, there was an increase in the number of CD8+ lymphocytes within the dermal-epidermal junction and an increase of programmed death ligand 1 (PD-L1) expression in both lymphocytes and keratinocytes. Despite treatment with infliximab, high-dose steroids and intravenous immunoglobulin, the patient expired. Herein we describe what we believe is the second case of TEN associated with anti-PD1 therapy reported in the literature. Increased expression of PD-L1 by immunohistochemistry was observed as the eruption progressed to TEN. Early diagnosis and treatment is necessary in these fatal TEN reactions secondary to the anti-PD-1 antibody therapies.
Management of this condition is largely based on aggressive supportive care and the use of anti-inflammatory immunosuppressive and biologic agents. We describe a case of psoriatic erythroderma which was triggered by withdrawal from systemic steroids and successfully treated with apremilast and cyclosporine. Apremilast induced atrial fibrillation limited its continued use after the initial response period.
In total, 281 dogs were randomly selected from Nicosia (n=80), Trikomo (n=58), Famagusta (n=60), Morphou (n=30), and Kyrenia (n=53), consistent with a statistically representative number of the regional dog population.
Ten (3.55%) out of 281 dogs were found to be seropositive by the IFA test. CanL seropositivity differed between cities as follows: 1.72% (1/58) in Trikomo, 13.20% (7/53) in Kyrenia, 1.67% (1/60) in Famagusta, and 3.33% (1/30) in Morphou. No seropositive dog was found in Nicosia. The symptoms in 37 out of 281 dogs were generalized lymphadenopathy, weight loss, alopecia, exfoliative dermatitis, and epistaxis. Four out of 10 seropositive dogs showed at least one clinical symptom that could be related with CanL.
CanL seroprevalence was found to be 3.55% (10/281) in Northern Cyprus. Seropositive dogs, in particular, had lived in areas that exhibited rural as well as urban characteristics.
On histopathologic findings, diagnosis of ESFA was confirmed. Our unusual and interesting case emphasizes the first report described one case in which multiple cobblestone like ESFAs arising from long-standing exfoliative dermatitis.
Since manifestations of dermatophytosis are highly variable, particularly in the cat, dermatophytosis should be considered in case of any annular, papular, nodular or pustular dermatoses, alopecic or not, sometimes pruritic, and nodular dermatoses as well.
We diagnosed this patient as having exfoliative cheilitis (EC). A patch test using the toothpaste containing sodium lauryl sulfate (SLS) was positive and the patient discontinued using it. Instead, she started using a toothpaste not containing SLS. One year after treating her lesions with hydrogen peroxide mouthwash 1% and glycerin borax, a gradual improvement was observed until returning to normal. Glycerin borax was safe, low cost and simple to use in treatment of refractory exfoliative cheilitis. SLS may have been a precipitating factor in EC in this case.
The reintroduced imatinib dosage was stepped up every week starting from 10 mg/d and increasing to 25, 50, 75, 100, 150, 200, and 300 mg/d until the target dose of 400 mg/d was achieved. Prednisolone of up to 30 mg/d was allowed if allergic reactions recurred. The percentages of CD4(+)CD25(+)CD134(+) T cells present after incubating peripheral blood mononuclear cells with imatinib, at baseline and after successful desensitization, were analyzed using flow cytometric analysis.
By using a slow desensitization technique, all patients were able to receive 400 mg/d of imatinib, and prednisolone was gradually tapered off. The percentages of imatinib-induced CD4(+)CD25(+)CD134(+) T cells decreased from a mean (SD) of 11.3% (6.5%) and 13.4% (7.3%) at baseline to 3.2% (0.7%) and 3.0% (1.1%) after successful desensitization, when stimulating peripheral blood mononuclear cells with 1 and 2 μM of imatinib, respectively.
Slow desensitization is a helpful procedure in treating patients with imatinib-induced nonimmediate reactions other than simple maculopapular exanthema. The reduced percentages of imatinib-induced CD4(+)CD25(+)CD134(+) T cells in these patients may be associated with immune tolerance.