Metoprolol, a widely prescribed β - adrenergic receptor blocker, has occasionally been associated with a diversity of cutaneous reactions. We present a 79- year- old male patient with erosive lichen planus (LP) on th...Metoprolol, a widely prescribed β - adrenergic receptor blocker, has occasionally been associated with a diversity of cutaneous reactions. We present a 79- year- old male patient with erosive lichen planus (LP) on the feet and hands who was successfully treated with topical tacrolimus. Six months after the lesions had been cured the patient received the β - receptor blocker metoprolol for the treatment of hypertonus. Within only 2 weeks of metoprolol intake the erosive lesions on the palms and feet recurred. After discontinuation of the drug and repetitive topical treatment with tacrolimus a complete remission of the lesions could be achieved. The recurrence of erosive LP probably secondary to metoprolol and the therapeutic success of topical tacrolimus in the treatment of LP are discussed.展开更多
Aim:To report an unusual case of cutaneous presentation on the eyelid of systemic(or nodal),CD30+,anaplastic large-cell lymphoma(ALCL).Methods:A 39-year-old man presented with a rapidly growing exophytic mass on the l...Aim:To report an unusual case of cutaneous presentation on the eyelid of systemic(or nodal),CD30+,anaplastic large-cell lymphoma(ALCL).Methods:A 39-year-old man presented with a rapidly growing exophytic mass on the left upper eyelid,with a protuberant,ulcerated aspect and with discharge.The patient showed lymph node involvement 3 months after the appearance of the lesion on the eyelid(the lesion itself appeared 1 week before examination).Results:The histopathologic and immunohistoc hemical diagnosis was ALCL,T-cell phenotype,strongly positive for CD43 and CD30,and negative for CD3,anaplastic lymphoma kinase(ALK),and B-cell antigens.Treatment was by radiotherapy and,later,chemotherapy(cyclophosphamide,adriamycin,vincristine,and prednisolone,CHOP)for skin recurrences and lymphadenopathies over 5 years.There has been no recurrence for more than 6 years.Conclusions:Primary,systemic,CD30+,ALK-negative,ALCL presentations generally have a poor prognosis and tend to occur in older individuals,although the clinical outcome is highly variable and difficult to predict in individual cases.Only three cases of ALCL have been described in the ocular adnexae and none was ALK-negative.展开更多
Introduction: Total skin electron irradiation (TSEI) therapy is the treatment of choice for mycosis fungoides. However, conventional TSEI therapy is time cons uming as well as patient unfriendly. Therefore we used hig...Introduction: Total skin electron irradiation (TSEI) therapy is the treatment of choice for mycosis fungoides. However, conventional TSEI therapy is time cons uming as well as patient unfriendly. Therefore we used high-dose rate (HDR) mode TSEI in these patients. High-dose rate mode of TSEI is a technolog ical innovation attached to a Linear Accelerator (Philips, SL-20, Netherlands), which can deliver an electron beam of 30 Gy/min at the iso-center. The iso-center faces the patient, 100 cm away from the target of the linear accelerator. The patient is treated at a distance of 10 feet from the iso-center of the linear accelerator. The dose delivered to the skin was 1.13 Gy/min, making the treatm ent execution much easier and patient compliancemuch better. Methods: Seven male patients between 40 and 64 years in age having mycosis fungoides for 9-18 mont hs were treated by TSEI using high-dose rate mode between 1998 and 2000. The TS EI was performed according to the Stanford technique, delivering a total dose of 36 Gy. Each patient received a dose of 1.2 Gy/field/day. There were six fields, i.e. anterior, posterior, left and right anterior obliques, and left and right posterior obliques in both the upper and lower parts of the body. The eyes and n ails were shielded at each session of radiotherapy. The times taken at each sess ion of the therapy and radiation-associated side-effects were determined in ea ch patient. The patients were followed up to 26 months (median 9 months) to look for any relapse. Results: Three patients had early stage disease (IB) whereas f our patients had advanced disease (IIB). Six patients out of these had complete remission following TSEI while one patient died as a result of progression of th e disease during treatment. The treatment time taken at each treatment session i n each individual patient was approximately 15 min. Radiation-associated morbid ity was seen in all patients. Cutaneous lesions relapsed in two patients after 4 and 10 months, respectively, while four patients were alive without the disease at the end of 2 years. Conclusions: Total skin electron irradiation using high -dose rate mode delivery of electrons is an easy, better, compliant and effecti ve therapeutic modality for treatment of mycosis fungoides with an acceptable range of toxicities.展开更多
Though used occasionally,systemic therapies in severe childhood psoriasis have not been systematically investigated.CyclosporinA(CysA)is effective in adults with severe psoriasis but there are no extensive data regard...Though used occasionally,systemic therapies in severe childhood psoriasis have not been systematically investigated.CyclosporinA(CysA)is effective in adults with severe psoriasis but there are no extensive data regarding the efficacy and safety of its use in childhood psoriasis.In this paper,we describe six children aged between 11 months and 13 years(average:7.6 years)treated with CysA microemulsion formulation for severe psoriasis,who had been unresponsive to other treatments.The CysA dose ranged from 2 to 4 mg/kg/day,for periods varying from 8 to 105 weeks(mean:54 weeks).Dose tapering was gradual after lesion improvement and adjusted according to clinical response.Adjuvant therapy with topical steroids,vitamin D3 ointments,coal tar preparations or anthralin was used in all children.Acitretin was used in three patients for short periods.The children were regularly monitored for serum renal and liver function and blood pressure.Improvement of skin lesions was achieved after between 4 and 30(mean:12)weeks of treatment,with complete remission in three children.Relapse of lesions occurred in the other children during CysA reduction,but they responded to a dose increase.The treatment was found to be well tolerated and with no significant side-effects.CysA can be used in carefully selected and monitored patients and may represent an alternative tool for severe episodes of psoriasis in children,when other therapies are unsuccessful.展开更多
Background: Primary cutaneous marginal zone B- cell lymphoma (PCMZL) is a low- grade B- cell lymphoma that originates in the skin, with no evidence of extracutaneous disease. Studies focusing on the optimal treatment ...Background: Primary cutaneous marginal zone B- cell lymphoma (PCMZL) is a low- grade B- cell lymphoma that originates in the skin, with no evidence of extracutaneous disease. Studies focusing on the optimal treatment of PCMZL have not been published thus far. We describe 50 patients with PCMZL to Further characterize clinical characteristics and outcome and, in particular, to evaluate our current therapeutic approach. Observations: The majority of the patients (36/50 [72% ]) presented with multifocal skin lesions, and 14 patients(28% )presented with solitary or localized lesions. The initial treatment of patients with solitary lesions consisted of radiotherapy or excision, whereas patients with multifocal lesions received a variety of initial treatments, most commonly radiotherapy and chlorambucil therapy. Cutaneous relapses developed in 19(48% )of 40 patients who had complete remission and were more common in patients with multifocal disease. After a median period of follow- up of 36 months, 2 patients developed extracutaneous disease, but none of the patients died of lymphoma. Conclusions: Patients with PCMZL who have solitary lesions can be treated effectively with radiotherapy or excision. For patients with PCMZL who have multifocal lesions, chlorambucil therapy and radiotherapy are suitable therapeutic options. In case of cutaneous relapses, the beneficial effects of treatment should carefully be weighed against the potential adverse effects.展开更多
文摘Metoprolol, a widely prescribed β - adrenergic receptor blocker, has occasionally been associated with a diversity of cutaneous reactions. We present a 79- year- old male patient with erosive lichen planus (LP) on the feet and hands who was successfully treated with topical tacrolimus. Six months after the lesions had been cured the patient received the β - receptor blocker metoprolol for the treatment of hypertonus. Within only 2 weeks of metoprolol intake the erosive lesions on the palms and feet recurred. After discontinuation of the drug and repetitive topical treatment with tacrolimus a complete remission of the lesions could be achieved. The recurrence of erosive LP probably secondary to metoprolol and the therapeutic success of topical tacrolimus in the treatment of LP are discussed.
文摘Aim:To report an unusual case of cutaneous presentation on the eyelid of systemic(or nodal),CD30+,anaplastic large-cell lymphoma(ALCL).Methods:A 39-year-old man presented with a rapidly growing exophytic mass on the left upper eyelid,with a protuberant,ulcerated aspect and with discharge.The patient showed lymph node involvement 3 months after the appearance of the lesion on the eyelid(the lesion itself appeared 1 week before examination).Results:The histopathologic and immunohistoc hemical diagnosis was ALCL,T-cell phenotype,strongly positive for CD43 and CD30,and negative for CD3,anaplastic lymphoma kinase(ALK),and B-cell antigens.Treatment was by radiotherapy and,later,chemotherapy(cyclophosphamide,adriamycin,vincristine,and prednisolone,CHOP)for skin recurrences and lymphadenopathies over 5 years.There has been no recurrence for more than 6 years.Conclusions:Primary,systemic,CD30+,ALK-negative,ALCL presentations generally have a poor prognosis and tend to occur in older individuals,although the clinical outcome is highly variable and difficult to predict in individual cases.Only three cases of ALCL have been described in the ocular adnexae and none was ALK-negative.
文摘Introduction: Total skin electron irradiation (TSEI) therapy is the treatment of choice for mycosis fungoides. However, conventional TSEI therapy is time cons uming as well as patient unfriendly. Therefore we used high-dose rate (HDR) mode TSEI in these patients. High-dose rate mode of TSEI is a technolog ical innovation attached to a Linear Accelerator (Philips, SL-20, Netherlands), which can deliver an electron beam of 30 Gy/min at the iso-center. The iso-center faces the patient, 100 cm away from the target of the linear accelerator. The patient is treated at a distance of 10 feet from the iso-center of the linear accelerator. The dose delivered to the skin was 1.13 Gy/min, making the treatm ent execution much easier and patient compliancemuch better. Methods: Seven male patients between 40 and 64 years in age having mycosis fungoides for 9-18 mont hs were treated by TSEI using high-dose rate mode between 1998 and 2000. The TS EI was performed according to the Stanford technique, delivering a total dose of 36 Gy. Each patient received a dose of 1.2 Gy/field/day. There were six fields, i.e. anterior, posterior, left and right anterior obliques, and left and right posterior obliques in both the upper and lower parts of the body. The eyes and n ails were shielded at each session of radiotherapy. The times taken at each sess ion of the therapy and radiation-associated side-effects were determined in ea ch patient. The patients were followed up to 26 months (median 9 months) to look for any relapse. Results: Three patients had early stage disease (IB) whereas f our patients had advanced disease (IIB). Six patients out of these had complete remission following TSEI while one patient died as a result of progression of th e disease during treatment. The treatment time taken at each treatment session i n each individual patient was approximately 15 min. Radiation-associated morbid ity was seen in all patients. Cutaneous lesions relapsed in two patients after 4 and 10 months, respectively, while four patients were alive without the disease at the end of 2 years. Conclusions: Total skin electron irradiation using high -dose rate mode delivery of electrons is an easy, better, compliant and effecti ve therapeutic modality for treatment of mycosis fungoides with an acceptable range of toxicities.
文摘Though used occasionally,systemic therapies in severe childhood psoriasis have not been systematically investigated.CyclosporinA(CysA)is effective in adults with severe psoriasis but there are no extensive data regarding the efficacy and safety of its use in childhood psoriasis.In this paper,we describe six children aged between 11 months and 13 years(average:7.6 years)treated with CysA microemulsion formulation for severe psoriasis,who had been unresponsive to other treatments.The CysA dose ranged from 2 to 4 mg/kg/day,for periods varying from 8 to 105 weeks(mean:54 weeks).Dose tapering was gradual after lesion improvement and adjusted according to clinical response.Adjuvant therapy with topical steroids,vitamin D3 ointments,coal tar preparations or anthralin was used in all children.Acitretin was used in three patients for short periods.The children were regularly monitored for serum renal and liver function and blood pressure.Improvement of skin lesions was achieved after between 4 and 30(mean:12)weeks of treatment,with complete remission in three children.Relapse of lesions occurred in the other children during CysA reduction,but they responded to a dose increase.The treatment was found to be well tolerated and with no significant side-effects.CysA can be used in carefully selected and monitored patients and may represent an alternative tool for severe episodes of psoriasis in children,when other therapies are unsuccessful.
文摘Background: Primary cutaneous marginal zone B- cell lymphoma (PCMZL) is a low- grade B- cell lymphoma that originates in the skin, with no evidence of extracutaneous disease. Studies focusing on the optimal treatment of PCMZL have not been published thus far. We describe 50 patients with PCMZL to Further characterize clinical characteristics and outcome and, in particular, to evaluate our current therapeutic approach. Observations: The majority of the patients (36/50 [72% ]) presented with multifocal skin lesions, and 14 patients(28% )presented with solitary or localized lesions. The initial treatment of patients with solitary lesions consisted of radiotherapy or excision, whereas patients with multifocal lesions received a variety of initial treatments, most commonly radiotherapy and chlorambucil therapy. Cutaneous relapses developed in 19(48% )of 40 patients who had complete remission and were more common in patients with multifocal disease. After a median period of follow- up of 36 months, 2 patients developed extracutaneous disease, but none of the patients died of lymphoma. Conclusions: Patients with PCMZL who have solitary lesions can be treated effectively with radiotherapy or excision. For patients with PCMZL who have multifocal lesions, chlorambucil therapy and radiotherapy are suitable therapeutic options. In case of cutaneous relapses, the beneficial effects of treatment should carefully be weighed against the potential adverse effects.
