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Artículos Científicos Edición 226

Drug induced subacute cutaneous lupus erythematos…..
Cordialmente enviado por Jairo Mesa

Update on skin repigmentation therapies in vitiligo
Cordialmente enviado por Rafael Falabella

Hidradentis suppurative. Manager with Adalimumab
Cordialmente enviado por Rolando Hernández

Drug-induced subacute cutaneous lupus erythematosus: a paradigm for bedside-to-bench patient-oriented translational clinical investigation
Richard D. Sontheimer, Clifford L. Henderson, Renee H. Grau

At least 71 patients have been reported in which their otherwise typical subacute cutaneous lupus erythematosus (SCLE) skin lesions were felt to have been temporally associated with the systemic administration of a drug. The mean age of this cohort of drug-induced SCLE (DI-SCLE) patients was 59 years of age which is somewhat older than the mean age of previously reported idiopathic SCLE patient cohorts. Patients had been taking the suspected triggering drug for weeks to years before the onset of SCLE skin lesions. In addition, it was not unusual for 2–3 months to be required for resolution of the SCLE skin lesions following discontinuation of the triggering drug. A relatively large number of drugs representing different pharmacological classes have been implicated in the induction of SCLE. The drug classes that were more frequently encountered were those used for the treatment of cardiovascular disease, especially hypertension. Calcium channel blockers were especially common in this regard.
Elderly individuals being treated for hypertension are often taking multiple classes of drugs that have been implicated in triggering SCLE (thiazide diuretics, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, beta-blockers). An approach to the management of DISCLE is presented. Ro/SS-A autoantibodies tended to remain present in the blood after resolution of drug-induced SCLE skin lesions. A common link between the disparate group of drug structures implicated in triggering SCLE is their tendencies to produce photosensitivity and lichenoid drug reactions. This leads to the speculation that DI-SCLE could represent a photo-induced isomorphic/Ko¨ebner response in an immunogenetically predisposed host.

Update on skin repigmentation therapies in vitiligo
Rafael Falabella and Maria I. Barona

Treatment for vitiligo is difficult and prolonged. Nevertheless, at present considerable knowledge accumulated during several decades on the pathogenic mechanisms, revealed important clues for designing new strategies to improve vitiligo depigmentation. With available medical therapies, high repigmentation percentages mostly on facial and neck lesions are achieved, although they are less effective on trunk and limbs and poor on the acral parts of the extremities. Narrow band UVB and psoralens and UVA are the two most important treatments for generalized vitiligo affecting more than 10–20% of the cutaneous surface, and topical corticosteroids, or calcineurin inhibitors are the most valuable treatments for localized vitiligo. Persistence of achieved regimentation is variable and an undefined percentage of patients may have variable recurrence.
When vitiligo becomes refractory, surgical methods may improve depigmentation as effectively as with medical therapy; in segmental (unilateral) or long standing, non-segmental (bilateral) stable vitiligo, repigmentation with surgical methods is usually permanent.

Hidradenitis suppurativa Managed with Ada1imumab
Paul S. Yamauchi MD PhD, Nicole Mau BS

Hidradenitis suppurativa (HS) is a chronic, inSammatory, relapsing, suppurative, cicatri2ing disease of the apocrine glands in the skin, which is characteri2ed by multiple abscesses and scaling in the axilla, groin, perineum, perianal region, buttocks, and submammary region. The disease commonly occurs in women aged 2O to 4O years.
Patients typically present with discomfort and/or itching associated with papules or nodules that may recur and lead to abscess formation and sinus tracts in advanced disease. Healing lesions may result in fbrosis, dermal contractures, and scarring.
Recent reports have shown that adalimumab, a fully human immunoglobulin monoclonal antibody directed against tumor necrosis factor (TNF), may be effective in the treatment of HS. 2-6 It is also convenient for patients to use, as it may be administered at home and is available in an autoinjection pen device. 7 The authors describe 3 patients with moderate to severe HS who were effectively treated with adalimumab after conventional therapy failed.


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