Bosentan treatment of digital ulcers related to autoimmune disorders

Endothelin 1, a powerful endogenous vasoconstrictor and mitogen, may be causal to pulmonary hypertension. Evidence also suggests that endothelin (ET) may have a fundamental role in scleroderma pathogenesis, including pulmonary arterial hypertension (PAH), a leading cause of death in patients with scleroderma. The development of a new class of drug, ET receptor antagonists, provides an improved outlook for patients with scleroderma and related diseases. Increasing vigilance toward early detection of PAH in scleroderma and a multidisciplinary approach to diagnosis and treatment may improve the clinical outcome for these patients. We describe the efficacy and safety of bosentan, an orally active dual ET-receptor antagonist, in patients with digital ulcers. Bosentan increases exercise capacity and improves hemodynamics in patients with pulmonary hypertension, suggesting that ET has an important role in pulmonary hypertension but in our experience also for refractory skin ulcers. Drug Dev Res 72:750755, 2011. (C) 2011 Wiley Periodicals, Inc

Efficacy of electrochemotherapy in ulcerated basal cell carcinoma

Basal cell carcinoma is the most common cutaneous malignant tumor, accounting for up to 80% of non melanoma skin cancers. Surgery, radiotherapy and chemotherapy have been for long time the main options for its treatment. Electrochemotherapy (ECT) is a novel local treatment successfully used in primary skin tumors. We report a case of a man affected by ulcerated basal cell carcinoma treated with ECT. In our case ECT was successful in the management of extensive basal cell carcinoma in clinical conditions whereas other approaches, would have been dangerous and inappropriate. To our knowledge, ECT must be considered as an alternative of traditional techniques when they are contraindicated in relation to the appearance of the lesions or the patient medical history. Clin Ter 2011; 162(5):443-44

Fusariosis and skin T cell lymphoma: concomitant more than a differential diagnosis.

Cytotoxic T cell lymphomas of the skin include a spectrum of a peripheral T cell and natural killer (NK) cell lymphomas with primary and secondary skin manifestation and had prognosis. Fusarium species have recently emerged as the second most common pathogenic fungi in immunocompromised patients, and they are moderately resistant to most anti fungal agents. We report a woman with concomitant cytotoxin T cell lymphomas of the skin and Fusarium spp infection. Patient was treated at the same time with antiblastic and anti fungal therapy. First line antifungal therapy was amphotericin B-lipid complex (3 mg/Kg iv/die) and then for clinical failure voriconazole (6mg/Kg bid, loading dose and 4 mg /Kg bid). Lymphoma was treated with a CHOEP 21 regiment without remission and after with gemcitabine and vinerolbine. Patient presented a partial remission of cutaneus and pulmonary lesions. Our case is intrinsically interesting because Fusarium infection was concomitant to cutaneus lymphoma and did non occur during neutropenic phases of chemoterapy. In a case with multiple ulcerated nodules of the skin is very important to discriminate from disseminated cutaneus Fusarium infection and neoplastic conditions such as cutaneus lymphoma. Early treatment of Fusarium infection in a patient with neoplastic disease could avoid a dissemination during immunosuppressive condition caused by antiblastic therapy. Clin Ter 2010; 161(3):265-26

Morphea, an unusual side effect of anti-TNF-alpha treatment

[No abstract available

Downregulation of circulating CD4+CD25(bright) Foxp3+ Tcells by cyclosporine therapy and correlation with clinical response in psoriasis patients: Report of three cases

[No abstract available

Gemcitabine-Induced Extensive Skin Necrosis

An 82-year-old woman presented with oedema and extensive necrotic ulcerative lesions on the back side of her lower limbs, emerging after the second cycle of chemotherapy consisting of Gemcitabine for metastatic pancreatic cancer. The absence of any convincing argument in favor of cardiovascular or autoimmune disease led us to attribute the onset of skin necrosis to chemotherapy administration. Although skin ischemia has also been described as a paraneoplastic syndrome, in this case we could observe a temporal and causal relationship to Gemcitabine infusion. Recently, this drug has been associated with important vascular side effects; its vascular toxicity is in fact higher than previously estimated. To our knowledge, careful attention should be reserved to neoplastic patients candidated to Gemcitabine administration, especially if previously affected by arterial vascular disease, venous thromboembolism, or collagenoses

Mutational profiling in melanocytic tumors: multiple somatic mutations and clinical implications.

In this study, we analyzed multiple somatic mutations in 10 genes relevant in melanoma tumorigenesis and targeted therapies. Overall, 45% of the tumors showed mutations and, in particular, 33% had multiple mutations. Based on our results, we conclude that the assessment of mutation status of multiple genes, including CDKN2A, could provide a genetic profile that can be useful as a prognostic and therapeutic marker in melanocytic tumors. © 2014 S. Karger AG, Basel

Facial superficial granulomatous pyoderma

facial pyoderm

Skin Ulcers In a Patient Afflicted With Microscopic Polyangiitis

Systemic vasculitis is a group of heterogeneous diseases characterized by inflammation and blood vessel walls necrosis. Usually the skin is one of the first organs involved, especially with damage of small to medium size vessels. The cutaneous patterns may help clinicians to diagnose these diseases at the beginning of their course, preventing complications due to internal organ involvement. The following case presents a patient with a microscopic polyangiitis that started with several skin ulcerations localized on the inferior limbs