Topical Steroid Application Research Articles

Postoperative complications (early and late) after pediatric cataract surgery in Sohag University Hospital

Introduction: Glaucoma is a recognized complication of pediatric cataract surgery. Despite improved surgical techniques, the incidence of glaucoma following successful cataract removal remains high. A significant number of surgeons regard aphakia as a cause of glaucoma. This glaucoma, however, may be better described as ‘glaucoma in aphakia and pseudophakia’. Other complications, retinal detachment. It was found that retinal detachment is infrequent following aphakia in pediatric cataract surgery, at least at short term follow-up. Corneal astigmatism is recognized as a problem arising from cataract surgery. Aim of the work: To evaluate postoperative complications (early and late) after pediatric cataract surgery in Sohag University Hospital Patients and Methods: A prospective, randomized study, were divided into 3 groups based on the surgical technique they had undergone. Group A 25 patients : who have undergone Lensectomy anterior vitrectomy (LAV). GroupB24patients: who have undergone Extracapsular cataract extraction, primary posterior capsulorhexis or capsulotomy, anterior vitrectomy, and IOL implantation (ECCE/PPC/AV/IOL). Group C26patients: who have undergone Extracapsular Cataract Extraction and IOL Implantation (ECCE/IOL) Results: Early postoperative complications were diagnosed in 34 eyes (35.1%). Postoperative iritis occurred in 7 eyes (7.2%) with mild inflammatory reaction. Striate keratopathy was found in 4 eyes (4.12 %) and cleared after frequent topical steroid application. Postoperative endophthalmitis: occurred in one eye in group A in the second postoperative day. Twenty-four hours later, 3 ports pars plana vitrectomy was done but unfortunately the eye passed into atrophia. Early IOL capture occurred in 2 eyes (2.1%) with PMMA IOL. Both belonged to group C. Both occurred in the second postoperative day. Postoperative retinal detachment (RD) occurred in one eye (1%) in group B, Posterior capsule opacification (PCO) occurred in 30 eyes (31%) during the first 3 months of follow up. Seven eyes (7.2%) belonged to group A. In group B, 5 eyes (5.1%) had PCO, Late IOL capture occurred in 9 eyes (9.3%). These included 5 eyes (5.2%) in group B; among them 4 eyes (4.1%) had been implanted PMMA IOL. Conclusion: Complications after cataract surgery in children are often associated with a robust inflammatory reaction or secondary opacity and, in infants, glaucoma

Aire-deficient mice provide a model of corneal and lacrimal gland neuropathy in Sjögren's syndrome.

Sjögren’s syndrome (SS) is a chronic, autoimmune exocrinopathy that leads to severe dryness of the mouth and eyes. Exocrine function is highly regulated by neuronal mechanisms but little is known about the link between chronic inflammation, innervation and altered exocrine function in the diseased eyes and exocrine glands of SS patients. To gain a better understanding of neuronal regulation in the immunopathogenesis of autoimmune exocrinopathy, we profiled a mouse model of spontaneous, autoimmune exocrinopathy that possess key characteristics of peripheral neuropathy experienced by SS patients. Mice deficient in the autoimmune regulator (Aire) gene developed spontaneous, CD4+ T cell-mediated exocrinopathy and aqueous-deficient dry eye that were associated with loss of nerves innervating the cornea and lacrimal gland. Changes in innervation and tear secretion were accompanied by increased proliferation of corneal epithelial basal cells, limbal expansion of KRT19-positive progenitor cells, increased vascularization of the peripheral cornea and reduced nerve function in the lacrimal gland. In addition, we found extensive loss of MIST1+ secretory acinar cells in the Aire -/- lacrimal gland suggesting that acinar cells are a primary target of the disease, Finally, topical application of ophthalmic steroid effectively restored corneal innervation in Aire -/- mice thereby functionally linking nerve loss with local inflammation in the aqueous-deficient dry eye. These data provide important insight regarding the relationship between chronic inflammation and neuropathic changes in autoimmune-mediated dry eye. Peripheral neuropathies characteristic of SS appear to be tightly linked with the underlying immunopathological mechanism and Aire -/- mice provide an excellent tool to explore the interplay between SS-associated immunopathology and peripheral neuropathy.

EASI p-EASI: Utilizing a combination of serum biomarkers offers an objective measurement tool for disease severity in atopic dermatitis patients

EASI p-EASI: Utilizing a combination of serum biomarkers offers an objective measurement tool for disease severity in atopic dermatitis patients

Blepharitis and Demodex spp. infection

According to the latest reports Demodex mites appear to play an important role in the pathogenesis of chronic blepharitis. Demodex mites are cosmopolitan and are present in many species of mammals. In this paper we describe two species that are found in humans: Demodex folliculorum and D. brevis . Infection occurs during direct contact with an affected person and also through contact with dust containing eggs of the parasite, through contact with bed linen, as well as cosmetics used together with an affected person. Treatment of chronic blepharitis caused by D. folliculorum and D. brevis is difficult and time consuming. Some improvement can be achieved after topical application of yellow mercury ointment, sulphuric ointment, camphor oil, crotamiton, cholinesterase inhibitors, sulfacetamide, steroids, antibiotics and antifungal drugs. Good results have been achieved with oral ivermectin and permethrin cream. However, the best results were observed after treatment with metronidazole.

Understanding application of topical steroids and emollients

Advice must be clear so patients understand what to do and then do it, writes David Voegeli

A Challenge to Diagnose Amalgam Associated Lichenoid Reaction in Elderly Patient

<p class="AbstractContent"><strong>Introduction:</strong> Several studies reported the association between erosive oral lichenoid reaction (OLR) and amalgam which often arises without symptoms and rarely becomes chief complaint of patient in contrast with its local inflammatory reaction. Amalgam filling was popular in elderly patients. A decline in the protective functions of the oral mucosa could expose elder people to a variety of chemicals and put them in the higher risk to suffer from OLR.</p><p class="AbstractContent"><strong>Case Report</strong>: A 70-year-old female patient has chief complaints of taste loss and dry mouth. In the next scheduled visit, operator found a non-scrapable reticular with a reddish inflamed area on buccal mucosa adjacent to amalgam fillings which was painful when being stretched. The Amalgam filling associated OLR diagnosis was established. The lesion was reduced significantly after replacing amalgam filling followed by topical application of steroid. Many factors may contribute as the challenging factors for undetected OLR lesion during the first visit such as elderly altering mental status and pain perception.</p><strong>Conclusion:</strong> Although the Amalgam filling associated OLR was a relatively common lesion in the elderly, factors that contribute as challenging factors to diagnose OLR must be comprehended by the dentist, in order to have a precise diagnosis.

Cortisol homeostasis in the epidermis is influenced by topical corticosteroids in patients with atopic dermatitis

Background:The skin produces cortisol by itself and regulates its own proliferation and differentiation. There is a possibility that topical corticosteroids (TCSs) influence the cortisol homeostasis in the skin.Aims and Objectives:The author described the density and distribution of cortisol and its parties in the epidermis after application of topical steroids immunohistologically.Materials and Methods:The forearm skin was biopsied before and after 2 weeks’ application of clobetasol propionate 0.05% two times a day in one healthy volunteer. The biopsied skin was stained immunohistologically by ant-MLN64, StAR, CPY11A1, cortisol, HSD11B1, HSD11B2, glucocorticoid receptor alpha, glucocorticoid receptor beta (GRB), and mineralocorticoid receptor (MCR) antibodies. The skin biopsy was performed similarly in 19 adult patients with atopic dermatitis who had used TCS for a considerable period. They were 4 TCS present users (TCS+), 12 TCS nonusers with skin manifestation on the biopsied site (TCS-E+) and 3 TCS nonusers without skin manifestation on the biopsied site (TCS-E−).Results:The staining density increased during TCS application in MLN64, cortisol and HSD11B2 in a healthy volunteer. The staining density was stronger in HSD11B2 of the basal layer and MCR of the spinous layer in the TCS-E+ patients than in the TCS+ and TCS-E− patients. The staining density was weaker in MLN64 of the basal and granular layers, HSD11B1 of the basal layer and GRB of the whole layer in the TCS-E+ patients than in the TCS+ and TCS-E− patients.Conclusion:The hypertrophy of the epidermis and insufficient keratinization recognized in the TCS-E+ patients might be caused by the decreased cortisol synthesis regulated by MLN64 and the increased cortisol inactivation by HSD11B2. Decreased GRB and increased MCR might enhance the reactivity of cortisol in the keratinocytes.

A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD)

Soak and smear (SS), a technique whereby a bath is followed by topical corticosteroid (TCS) application to wet skin, is reported to be a beneficial adjunctive therapy for patients with recalcitrant atopic dermatitis (AD). We evaluated whether SS is of greater benefit than application of TCS to dry skin for the treatment of childhood AD. A randomized, investigator-blinded, controlled study was performed in children with AD. Patients were randomized to apply TCS either via SS (n=22) or to dry skin (n=23) for 14days. Theprimary outcome was an improvement in the Eczema Area and Severity Index score. Secondary outcomes included assessments of disease burden, pruritus, and sleep; morning cortisol levels; and adverse effects. Patients with AD severity who applied TCS via SS or to dry skin improved 84.8% (95% confidence interval 77.5-92.1) and 81.4% (95% confidence interval 70.3-92.4) by Eczema Area and Severity Index score, respectively. There was no statistical difference between the 2 groups (P value=.85). Small sample size limited the power of our study. We did not find that application of TCS to presoaked skin works better than application to dry skin for the treatment of AD in children.

Conservative and surgical management of chronic Rhinosinustitis

Chronic rhinosinusitis is a common complex medical condition associated with high therapy costs and quality of life impairment. The European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS) 2012 delineates the current standard of management of the patient with chronic rhinosinusitis for both defined disease forms: with and without polyps. Medical history and endoscopic or CT findings are needed for the correct diagnosis. Therapy of chronic rhinosinusitis aims at achieving a local disease control and reducing patients' symptoms. The center point of conservative therapy of both forms is the topical application of steroids together with nasal saline irrigations. In case of persistence of symptoms or in severe chronic rhinosinusitis with polyps, different local application methods of steroids or short systemic steroid cures should be considered. In case of insufficient disease control with conservative treatment, functional endoscopic sinus surgery is the accepted as “gold standard”. Purpose of the surgical management is opening of the sinus ostia in order to improve sinus ventilation and mucociliary clearance as well as to facilitate a wide distribution of topical drugs. Due to technical advances, endoscopic sinus has been reported to be a safe and effective procedure.

Basal Serum Cortisol and Adrenocorticotropic Hormone Levels in Patients with Atopic Dermatitis

Background: Atopic dermatitis (AD) is an inflammatory skin disease with eczematous pruritic lesions. Topical corticosteroids are the most widely used and the mainstay of treatment for AD. There are some studies that percutaneous systemic absorption of topical steroids may occur and lead to suppression of hypothalamic-pituitaryadrenal axis (HPAA). However, almost in all of these studies, “basic” HPAA function (before application of topical steroids) was not evaluated. Aim: The aim of this study was to investigate basal serum cortisol, adrenocorticotropic hormone (ACTH), and IgE levels in patients with AD and their correlation with disease severity. Methods: Levels of basal serum cortisol, ACTH, and IgE were assessed by ELISA in 31 patients with AD and 31 control subjects. Clinical severity of AD was evaluated by the SCORAD (SCORing Atopic Dermatitis) index. Results: Data analysis showed no statistical difference for basal serum cortisol and ACTH levels between two groups. The serum IgE level was significantly higher in AD group (P=0.02). The SCORAD index was correlated with serum IgE level, but not with the basal serum cortisol level and ACTH level. Conclusions: Basal serum cortisol and ACTH levels are normal in AD patients. Serum IgE level is significantly higher in AD patients and correlated with disease severity.

Aspirin Exacerbated Respiratory Disease.

Aspirin exacerbated respiratory disease (AERD) has been defined as a non-steroidal anti-inflammatory drug (NSAID)-triggered hypersensitivity, non-allergic bronchial asthma and chronic rhinosinusitis (CRS) with nasal polyps. The underlying pathophysiology of AERD is not completely understood so far. An altered arachidonic acid metabolism and dysregulated enzyme activity are regarded to be causal. AERD is characterized by recalcitrant CRS with recurrent nasal polyps after sinus surgery, accompanied by difficult to treat bronchial asthma and adverse reaction after NSAID ingestion such as nasal blockage, itching, laryngospasm and severe asthma attacks. Affected individuals suffer from poor quality of life. Besides functional endoscopic sinus surgery, the application of topical and systemic steroids and symptomatic therapy, aspirin desensitization is the only causative treatment option. The diagnostic approach to AERD, the ideal desensitization protocol and especially the following daily maintenance dose is part of an ongoing debate. This article summarizes the current knowledge about the pathophysiology, focuses on modern diagnostic approaches of AERD and discusses various aspirin desensitization protocols with respect to efficacy as well as to undesirable side effects.

Amniotic membrane transplantation in bacterial and herpetic stromal keratitis.

The aim of this study was to describe the results of amniotic membrane transplantation (AMT) in patients with bacterial and herpetic stromal keratitis. This was a retrospective chart review study including 42 patients with herpetic keratitis (group 1) and 42 patients with bacterial keratitis (group 2). AMT was performed in addition to antimicrobial therapy. Topical steroids were administered after surgery. The outcome parameters evaluated were epithelialization time, decrease of stromal inflammation, and uncorrected visual acuity (UCVA). The average age of our patients was 55.85 ± 19.07 years, and average follow-up was 14.70 ± 11.75 months. The period of epithelialization was 19.23 ± 7.32 days in the herpetic group and 19.31 ± 6.30 days in the bacterial group. Descemetocele developed in 2 patients of the herpetic group. Other patients in both groups completed epithelialization after AMT procedures with varying amounts of corneal scarring. The bacterial group showed an improvement in UCVA, but the herpetic group showed no improvement in UCVA. AMT is a convenient approach for the treatment of corneal keratitis resistant to conventional treatment and allows the use of early topical steroid application. It provides patients with corneal scarring an opportunity for subsequent keratoplasty by arresting the inflammatory response.

A Case of Cutaneous Protothecosis in an Immunocompetent Patient.

Dear Editor: Protothecosis is a rare infection, caused by the genus Prototheca, achlorophyllous algae which are saprophytes in soil, and occasionally affect dogs and cats1. It is believed that they may infect humans by traumatic inoculation2. A 74-year-old woman visited our clinic with prickling erythematous umbilicated papules on the anterior neck and upper chest which developed 2 months prior on top of an erythematous telangiectatic patch which had been present for 2 years (Fig. 1A, B). She had been treated at another clinic. with topical corticosteroids for 2 years for suspected eczema aggravated by rubbing. She had no history of trauma or other medical disease. She had lived with a pet dog for 18 years. Fig. 1 (A) Several crusted papules on an erythematous telangiectactic patch on the anterior neck and upper chest. (B) Close-up view. (C) Improved skin lesion with fibrotic scar after treatment with oral itraconazole 200 mg/day and topical sertaconazole application ... The patient's complete blood count, renal and liver function, and chest X-ray study were all normal. The HBs Ag, HCV Ab, HIV Ab, and anti-nuclear Ab tests were negative. The venereal disease research laboratory test (VDRL) was nonreactive. The histopathology revealed a granulomatous inflammation with necrosis in the dermis (Fig. 2A), containing many non-budding spherical organisms. Multiple sporangia containing endospores were observed with the morula appearance that is the characteristic feature of the Prototheca species (Fig. 2B). The Periodic acid-Schiff staining was positive and showed characteristic internal septation and thick cell walls (Fig. 2C). Treatment with oral itraconazole (200 mg/day) and topical sertaconazole for 12 weeks resulted in marked improvement of the skin lesions (Fig. 1C). Fig. 2 (A) Granulomatous inflammation with necrosis in the dermis (H&E, ×12.5). (B) Multiple sporangia with in morula-like or cartwheel-like appearance (arrow) (H&E, ×400). (C) Multiple morula-like appearances highlighted by Periodic ... Cutaneous protothecosis mainly involves the extremities and its presentation is variable2. It can manifest as an erythematous plaque, or less commonly, in ulcerative or purulent forms3,4,5. Our patient presented with erythematous umbilicated papules on chest, which is a less common3,4. Prototheca have low virulence; hence, systemic or local predisposing factors are commonly found in affected patients, such as steroid use, malignancy, diabetes mellitus, and organ transplantation3. Our patient had intact immunity but was predisposed to local immunosuppression by long-term topical steroid application, skin damage by frequent rubbing, and the presence of a pet dog, which may have been the source of the algae. Prototheca wickerhamii and P.zopfii can mainly cause human protothecosis, and P.wickerhamii is the most commonly responsible3,4. The sporangia of P.wickerhamii are round with symmetrical morula formation and a diameter of 7~ 13 µm, while the sporangia of P.zopfii are oval with relatively asymmetric random septation and a diameter of 14~16 µm. P.wickerhamii is susceptible to antifungal agents and is easily treated, but P.zopfii is resistant to treatment. In Korea, 11 cases of cutaneous protothecosis have been reported2. Most of the reported cases involved patients who were over the age of 60 years. The most commonly involved sites were the extremities, except one patient whose cheek was affected. Most patients had systemic predisposing factors and 2 patients had local predisposing factors (long-term topical steroid use). All of these cases were confirmed with diagnostic tests; P.wickerhamii was identified in 10 cases and P.zopfii was identified in 1 case2. We report a rare case of cutaneous protothecosis in an immunocompetent patient who presented with erythematous umbilicated papules on the chest after long-term topical corticosteroid use, traumatic rubbing, and exposure to a pet dog.

A clinical approach to diagnose patients with localized telangiectasia

Telangiectasia, or dilated blood vessels, may represent a benign condition or a marker of a much more serious internal or cutaneous malignancy (e.g., mycosis fungoides). They can be generalized or localized in distribution. 'Localized telangiectasia? can be macular or papular. Macular ones can be further divided into two major categories: primary and secondary. They can occur on their own (primary), after skin injury (e.g., sun damage, post-radiation therapy, after prolonged topical steroid application), or may arise due to an underlying condition (secondary). While telangiectases can spring from a multitude of possible causes, the location of the lesions, in combination with a careful history and exmination, often helps in elucidating the correct diagnosis. A patient with localized telangiectasia as a manifestation of malignancy may be difficult to diagnose, however the diagnosis is one of exclusion, and a thorough evaluation should be performed before diagnosing this condition. This article reviews possible conditions to consider in these patients and suggests an approach to their evaluation.

Retour d’expérience d’une nouvelle technique de préputioplastie comme alternative à la circoncision

Surgery is required for phimosis with a contracted fibrous ring or when the medical treatment with steroids has been unsuccessful. Surgical teams often opt for circumcision when a conservative technique can be used. This surgery could have some psychologic consequences, and when the circumcision in not according to religious convictions, it cannot be live well for the patient and his family. Furthermore, some surgery procedures for prepuce conservation seem to give some unaesthesics aspects with cutaneous excess. The objective of this study was to evaluate our new preputioplasty technique according to the initial diagnosis (phimosis with scarred foreskin or long and narrow foreskin), in situation where circumcision is required currently. Outcome evaluated was: easy and painless foreskin retraction, absence of postoperative phimosis as well as cosmetic aspects of the penis. In this study, 90 children benefited from this technique and subsequent follow-up. The mean age was 7.9 years for the 32 children in the sclerotic phimosis group and 6.8 years for the 58 children in the long and narrow foreskin group. We observed complete foreskin retraction without any recurrence in 100% of children with a phimosis resistant to medical treatment which consisted of progressive foreskin retraction and application of topical steroids, with a mean postoperative follow-up of 1.4 years. Results showed an excellent cosmetic aspect of the penis with absence of enlarged foreskin in all our subjects. This study underlines the relevance of this surgical technique.

Surface Ablation with 0.02% Mitomycin C for Retreatment after LASIK and LASEK

Purpose: To evaluate the efficacy and safety of surface ablation with mitomycin C (MMC) for the retreatment of refractive errors following laser-assisted in-situ keratomileusis (LASIK) and laser-assisted sub-epithelial keratectomy (LASEK). Methods: In this retrospective clinical study conducted at a single center, we evaluated 23 eyes that received surface ablation with MMC (0.02%, 20 seconds) between 2009 and 2013 for the treatment of residual refractive errors following myopic LASIK and LASEK. All eyes were evaluated for corneal thickness, initial refractive error, time interval to retreatment, amount of retreatment, duration of postoperative topical steroids use as well as uncorrected vision, spherical equivalent and corneal haziness preoperatively and 1, 3, 6 and 12 months postoperatively. Results: Initially corrected myopia in the LASIK group was -6.47 ± 2.17 D and -5.68 ± 2.51 D in the LASEK group. Mean time between initial and retreatment by surface ablation was 11.88 ± 5.59 months for LASIK and 14.07 ± 10.10 for LASEK. Retreat amount was 1.49 ± 0.36 D after LASIK and -1.65 ± 0.41 D after LASEK. At postoperative 12 months, uncorrected visions were -0.061 ± 0.886 (log MAR) in the LASIK group and -0.004 ± 0.745 (log MAR) in the LASEK group and spherical equivalents were -0.55 ± 0.56 D in the LASIK group and 0.36 ± 0.33 D in the LASEK group. Postoperative hazes developed in 1 of 8 LASIK eyes and 3 of 15 LASEK eyes which resolved with application of topical steroid for 2-3 months postoperatively. Conclusions: Surface ablation with 0.02% MMC is safe and highly effective for treating myopic regression following LASIK or LASEK. Application of 0.02% MMC for 20 seconds was effective in preventing postoperative haze formation and maintaining stable vision and spherical equivalent at 12 months after retreatment. J Korean Ophthalmol Soc 2015;56(7):992-997

The reservoir effect of topical steroids in vitiliginous skin: A cross-sectional study.

Prolonged and frequent use of topical steroids may lead to decrease in efficacy as well as many local adverse effects. Stratum corneum has a unique property of reservoir effect. To study the reservoir effect of topical steroids in a steroid-responsive condition which may enable a decrease in the dosing frequency of topical steroids. A cross-sectional study design was used. Patients with at least three vitiliginous patches of more than 2 cm 2 present over the trunk or limbs were included. Exclusion criteria were topical or systemic corticosteroid use within the previous 4 weeks, antihistamine use within the previous 7 days, history of any allergy in the past and immunosuppression. Clobetasol propionate cream was applied on the first vitiliginous area (site A) and fluticasone propionate ointment was applied on the second vitiliginous area (site B). The third vitiliginous area, site C (control site) was left without applying any medication. Histamine-induced wheal suppression test was performed on each site, at the same time of the day, on every consecutive day following steroid application, until the values obtained at sites A and B approached those obtained at site C. SPSS software for Windows, version 16.0 was used for statistical analysis. The mean and standard deviation of the various studied parameters were calculated for various treatment groups and compared using analysis of variance (ANOVA) test. Forty patients were included in the study. The average wheal volumes and average erythema sizes at sites A and B were significantly smaller than the corresponding values at site C for up to 5 days after applying medication (P < 0.001). The presence of a cutaneous reservoir of topical steroid was confirmed based on its suppressive effect on the wheal and flare response to histamine. It is not certain that the concentration that suppresses histamine-induced wheal and flare is sufficient for therapeutic efficacy in vitiligo. The reservoir effect of topical clobetasol propionate and fluticasone propionate persisted for 5 days in vitiliginous skin. Hence, it may be possible to reduce the frequency of topical steroid application in vitiligo.

PO-0353 Lichen Striatus – Case Report

Background Lichen striatus is an common dermatosis that follows the lines of Blaschko. Aetiology of this eruption is unknown, its features are less known to paediatricians. Objective We attempted to characterise the clinical, pathologic features and evolution of one case presented to the paediatric departament in our clinic. Materials and methods A 2-year-old girl, atopic, presented with fever and upper respiratory tract infection. Clinical examination: one month long dull-red papulo-squamous dermatosis arranged in a Blaschko line. The eruption appeared suddenly a month ago. The skin lesions were asymmetrically distributed linearly unilateral along the left arm, arranged in a Blaschko line pattern. Intense itching was present in this case. Laboratory results: Hb = 12,6 g/dl, Ht = 35,2%, WBC = 9400/µL, S = 25%, Eo = 2,5%, Ba = 0,745%, Ly = 71,1%, RBC = 4,38 × 10 mil/µL, PLT = 336000 µL, ALT = 23 U/L, AST = 31 U/L, CRP = 0,6 mg/dL; Creatinin, Immunogram, Glucose –normal; HIV 1 + 2, Ag HBs, Anti HCV-negative Histopathology revealed features consistent with lichen striatus. Tratament for itchy lichen striatus consisted in topical steroid application (mometasone furoate 1% cream once daily for two weeks). Five months later, complete resolution of the skin lesions occurred without any other treatment, leaving only slightly hypopigmented macules on the left arm. Conclusion That lesions of lichen striatus may have a prolonged active phase, the differential diagnosis includes other inflammatory diseases that can assume a linear pattern, paediatrician and dermatologist must team up in these cases; Post-inflammatory hypopigmentation can be a cause for concern for the parents and their children.

Prurigo nodularis: retrospective study of 13 cases managed with methotrexate.

Prurigo nodularis (PN), or nodular prurigo, is a chronic, debilitating, inflammatory skin disease. It can be very difficult to manage, and represents a challenge for the physician. Methotrexate (MTX) is a safe folic acid antagonist widely used in the management of inflammatory skin diseases such as psoriasis. Weekly administration of 7.5-20mg methotrexate (low-dose methotrexate, LD-MTX) represents an attractive treatment option, and could therefore find a place in the management of PN. To evaluate the efficacy of LD-MTX as a treatment option for PN. Thirteen patients who had failed to respond to conventional therapies such as topical steroids, phototherapy and antipruritic agents were treated with LD-MTX. The mean age of the patients was 75.83. Objective symptoms (Prurigo Nodularis Area and Severity Index; PNASI) and subjective symptoms (Pruritus Numeric Rating Scale; PNRS) were recorded. Treatment consisted of one subcutaneous injection of MTX 7.5-20mg once weekly for a minimum of 6months. Adjuvant application of emollients and topical steroids was maintained where needed. There was remission or marked improvement (decrease in both PNRS or PNASI of >75%) in 10 cases, a trend to improvement in 2 cases and relapse in 1 case after treatment discontinuation. LD-MTX may allow improvement of PN in some patients, with long-lasting remission.

Pompholyx of the Hands after Intravenous Immunoglobulin Therapy for Clinically Isolated Syndrome: A Paediatric Case

Pompholyx is a common eruption of small vesicles on the palms, soles, and/or lateral aspects of the fingers. It has a multifactorial etiology, including genetic determinants, allergy to metals, and id reaction; rarely it is a drug-related side effect. We report a paediatric case of pompholyx of the hands related to the intravenous immunoglobulin (IVIG) therapy for Clinically Isolated Syndrome (CIS). A 10-year-old boy, received an IVIG therapy (Venital, Kedrion Spa, Italy) at a dose of 400 mg/kg daily for five days. The fifth day of IVIG infusion, a symmetrical vesicular eruption appeared on the palms of the hands and on lateral aspects of the fingers. The lesions improved with application of topical steroids in few days. The mechanism of induction of pompholyx by IVIG therapy is unknown. A review of the Literature suggests the hypothesis that dyshidrotic eczematous reactions may be related not only to the type of IVIG, to the dose and the rates of infusion, but also to an allergic response to excipients and preservatives contained in the drug, probably elicited by an underlying neurological disease in some cases.