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This Month in Archives of Dermatology
July 2005

This Month in Archives of Dermatology

Arch Dermatol. 2005;141(7):819. doi:10.1001/archderm.141.7.819
Histiocytoid Sweet Syndrome

Acute febrile neutrophilic dermatosis (Sweet syndrome) is a reactive disorder characterized by painful, erythematous, cutaneous plaques and nodules, the onset of which is accompanied by fever, leukocytosis, and neutrophilia. In this multicenter study, Requena et al describe a series of 41 patients with Sweet syndrome in whom histopathologic analysis revealed an inflammatory infiltrate composed mainly of histiocytoid mononuclear cells that were revealed to be immature myeloid cells. The lesions showed a benign biological behavior and responded promptly to low doses of corticosteroids or nonsteroidal anti-inflammatory drugs.

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Pulsed High-Dose Corticosteroids Combined With Low-Dose Methotrexate in Severe Localized Scleroderma

Localized scleroderma (LS) is characterized by hardening and thickening of the dermis, subcutis, and even underlying soft tissue and bone. There are numerous therapeutic options for LS, but none has proven consistently effective. In this nonrandomized open pilot study, Kreuter et al examined the effects of pulsed intravenous high-dose corticosteroids combined with orally administered low-dose methotrexate therapy in severe LS. Fifteen consecutive patients were treated, and most markedly improved as demonstrated by clinical and ultrasonographic evaluation.

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Sarcoidosis Associated With Pegylated Interferon Alfa and Ribavirin Treatment for Chronic Hepatitis C

Chronic hepatitis C affects at least 170 million people worldwide. Antiviral treatment regimens that include interferon alfa are often effective in eradicating the virus. Adverse cutaneous reactions are fairly common, and in this case report, Hurst and Mauro describe the third case of cutaneous sarcoidosis associated with these regimens. Cutaneous sarcoidosis that arises in patients undergoing immunomodulatory treatment regimens that include interferon alfa often follows a benign course, and the hepatitis treatment may often be continued with close monitoring for pulmonary compromise.

Right elbow and forearm. The patient had multiple violaceous dermal papules that coalesced into plaques. A biopsy site is present superiorly.

Right elbow and forearm. The patient had multiple violaceous dermal papules that coalesced into plaques. A biopsy site is present superiorly.

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Combination Antimalarials in the Treatment of Cutaneous Dermatomyositis

Cutaneous symptoms of dermatomyositis are often treated with antimalarials, usually as monotherapy. Although combination antimalarial therapy has been proven effective in other autoimmune skin diseases, there have been no formal studies documenting the efficacy of these regimens in dermatomyositis. In this retrospective case series, Ang and Werth demonstrate that a significant subgroup of patients with dermatomyositis exist for whom antimalarial monotherapy is ineffective, but combination therapy with either hydroxychloroquine and quinacrine or chloroquine and quinacrine provides excellent therapeutic effect.

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No Evidence for Increased Risk of Cutaneous Squamous Cell Carcinoma in Patients With Rheumatoid Arthritis Receiving Etanercept for Up to 5 Years

Etanercept is a solubilized tumor necrosis factor antagonist that is seeing increased use as an antipsoriatic agent. Tumor necrosis factor plays an essential role both in inflammation and cellular immunity, and there remain concerns regarding the potential for pathologic immunosuppression with this medication, including impaired tumor surveillance. In this retrospective analysis of the clinical trials and postmarketing surveillance databases, Lebwohl et al demonstrate no increase in the observed incidence of cutaneous squamous cell carcinoma in patients with rheumatoid arthritis who had used etanercept for up to 5 years.

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