Journal of Cutaneous Immunology and Allergy最新文献

We report a case of 70-year-old woman with rectal malignant melanoma that recurred in the pelvic lymph node one year after surgery. Nivolumab was initiated and she achieved complete response after one year, but she discontinued nivolumab at her instance. At a follow-up 21 months after the discontinuation of nivolumab, a pelvic lymph node metastasis recurrence and a lung metastasis discovered. Nivolumab rechallenge was initiated, but it was not successful.

Erythema exudativum multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) are acute inflammatory diseases of the skin and mucous membranes. EM with mucosal eruptions is sometimes difficult to differentiate from SJS or TEN. This study aimed to understand the characteristics of these diseases by evaluating the backgrounds, clinical symptoms, and disease courses of EM/SJS/TEN patients treated at our hospital. It shows that persistent fevers and erosion are common in SJS/TEN. Therefore, we must pay attention to whether they become more severe.

Excipient allergies are rare and difficult to diagnose. Carboxymethylcellulose (CMC, carmellose sodium) is an anionic water-soluble polymer derived from native cellulose, that is, used as an excipient. Here, we report a case of urticaria caused by the CMC in lidocaine jelly and dimethicone drops, which had used for upper gastrointestinal endoscopy. CMC is widely used in pharmaceutical preparations, food additives, and other pharmaceuticals, and its use is increasing. However, there are few reports on immediate hypersensitivity reactions because substances containing CMC. Previous reports and our case suggest that excipients, such as CMC, can be potential hidden allergens.

We describe a 73-year-old patient who presented with marked hemifacial swelling secondary to herpes zoster. Magnetic resonance imaging (MRI) revealed hyperintensity of the spinal trigeminal nucleus. In the case presented here, stimulation of the spinal trigeminal nucleus owing to herpes zoster can cause vasodilation of the facial skin.

Immune checkpoint inhibitors are currently developed for the treatment of cancers showing high efficacy even in the cases of advanced and persistent malignancies. Psoriasis has been reported as a rare irAE in both the exacerbation of preexisting psoriasis and the novel onset psoriasis during immunotherapy. Herein, we report a case of pre-existence psoriasis, which was exacerbated following the administration of immune checkpoint inhibitors. We also summarize case reports and conducted a review of the literature.

A 4-year-old girl with refractory nummular eczema with atopic dermatitis (AD) was reported successfully treated with narrowband ultraviolet B (NB-UVB) once a week (400 mJ/cm²) and topical delgocitinib for 8 weeks. The treatment of NB-UVB and topical delgocitinib improved the severe nummular lesions and strong pruritus, resulting in only brown postinflammatory hyperpigmentation without pruritus. The combination of NB-UVB and topical delgocitinib can be an alternative treatment for refractory nummular eczema in children.

A 4-year-old girl presented with a 2-year history of AD. She had impetigo contagiosum throughout her body due to methicillin-resistant Staphylococcus aureus (MRSA) infection. Subsequently, nummular eczema with elevated erythema, erosion, and brown pigmentation occurred over the former impetigo lesions on the shoulders, buttocks (Figure 1A), and thighs with severe pruritus. She was treated with topical steroids, oral antihistamines, and antimicrobials. However, the patient did not respond to these treatments. Thus, NB-UVB therapy (400 mJ/cm²) once a week and topical delgocitinib twice a day were administered. After 8 weeks, the nummular eczema remarkably improved, resulting in flat brown pigmentation (Figure 1B). Laboratory findings showed eosinophilia (22%) and high immunoglobulin (Ig) E levels (853 IU/ml). Radioallergosorbent test (RAST) had a score of 6 (House dust 1 and dust mite). Bacterial culture from nummular eczema was negative.

Topical corticosteroids, antihistamines, and antimicrobials were ineffective in our case. NB-UVB therapy is a tolerant and effective treatment for children with AD.¹ NB-UVB inhibits immunological reactions and has anti-inflammatory and anti-bacterial effects. It also recovers skin barrier defects.² Therefore, NB-UVB therapy is a tolerant and economical treatment for children with AD. Moreover, it inhibits immune reactions, cytotoxic effects, cis-urocanic induction, and decreases Langerhans cells, antigen presentation, NK cell activity, and apoptosis of T cells and keratinocytes.³ However, the side effects of NB-UVB include erythema, reactivation of herpes simplex, and polymorphous light eruption.

Delgocitinib, a Janus kinase (JAK) inhibitor, is useful for treating AD.⁴ It is available for children with AD with ages more than 2 years old.⁵ It inhibits IL-4, IL-13, and IL-31,⁶ resulting in the relief of pruritus.

In our case, the patient did not respond to topical corticosteroids, antihistamines, or oral antimicrobials. We preferred NB-UVB and topical delgocitinib treatments. We speculated that the synergistic effects of NB-UVB and delgocitinib improved the refractory nummular eczema.

In our case, to reduce the risk, we should have tried to use topical delgocitinib alone at first. Additionally, the