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Methylenetetrahydrofolate reductase (MTHFR) is a key enzyme in folate and homocysteine metabolism. Genetic polymorphisms are associated with thrombophilia and vasculopathy, which result in cutaneous ulceration. In this case series, New et al describe 2 patients who were found to have MTHFR polymorphisms during hypercoagulable evaluation for cutaneous ulceration on the lower extremities. Both patients showed rapid improvement following oral B-vitamin supplementation and local wound care. MTHFR polymorphisms should be part of a comprehensive laboratory evaluation when performing a hypercoagulable workup.
Lichen planus is a common inflammatory autoimmune condition that commonly affects the skin and mucous membranes. Ocular involvement is rare, but isolated conjunctival lichen planus is a rare cause of cicatricial conjunctivitis. In this case report, Muñoz et al describe a 79-year-old man with chronic refractory keratoconjunctivitis in the absence of any other skin or mucosal lesions. Biopsy specimens analyzed under direct immunofluorescence revealed changes suggestive of lichen planus. The patient's clinical findings improved following treatment with oral corticosteroids and azathioprine, demonstrating how early anti-inflammatory treatment can avoid irreversible visual loss.
This Month in Archives of Dermatology. Arch Dermatol. 2011;147(4):382. doi:10.1001/archdermatol.2011.61
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