clobetasol and Fibrosis

Dear Editor, cutaneous chronic graft versus host disease (cGVHD) is a pathological process consisting of donor-derived T-cells aimed at the antigens of the recipient. It exhibits a large range of clinical presentations resembling morphea and deep sclerosis/fasciitis, all characterized by both inflammation and progressive dermal and hypodermic fibrosis (1). Although classic scleroderma-like lesions in cGVHD are nummular or irregular plaques and linear bundles associated with hypo- or hyperpigmentation (2), we report an atypical case with ulcerative presentation. No other case-reports of morphea-like or scleroderma-like cGVHD with an ulcerated appearance after liver transplantation (LT) and magnetic resonance imaging (MRI) correlation have been found in the literature. CASE REPORT Ten months after LT due to an end-stage cirrhosis associated with multifocal hepatocarcinoma (HCC), a 61-year-old man on immunosuppressive therapy with Tacrolimus (1 mg) and Everolimus (10 mg) presented to our clinic for a skin lesion in the right scapular region. We observed a flat ulcerated plaque with areas of sclerosis, minimal necrosis, and well-defined slightly erythematous margins (Figure 1, a). On palpation, the plaque had a hard consistency and was slightly painful. The skin lesion had been preceded by subjective discomfort with stinging sensation for seven months before its onset. Gradually lesion developed starting from a small, flat, oval purplish plaque associated with a progressive increase in pain. Patient denied dysphagia, retrosternal heartburn, Raynaud's phenomenon, arthralgia, and dyspnea. A previous MRI (Figure 2, a,b) showed subcutaneous and muscle edema. Blood tests showed abnormal liver function indexes due to extrahepatic cholestasis, while C-reactive protein, erythrocyte sedimentation rate, and leukocytes were within normal ranges. Self-reactive antibodies were negative. Histological examination (Figure 1, b) identified rare dyskeratotic keratinocytes and basal lymphocyte infiltrate, a dermal dense fibrosis with the disappearance of the skin appendages, and large fibrous septa in the adipose panniculus. It led to the diagnosis of scleroderma/morphea, based on the patient's clinical history. The diagnosis of graft versus host disease scleroderma-like post liver transplant was established. The lesion was treated by topical application of 0.05% clobetasol once a day. We did not use systemic immunosuppressive therapy in order to prevent HCC recurrence. The pat

Topics: C-Reactive Protein; Clobetasol; Everolimus; Fibrosis; Graft vs Host Disease; Humans; Inflammation; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Scleroderma, Localized; Sclerosis; Skin Diseases; Tacrolimus; Ulcer

Topics: Adult; Aged; Alopecia; Clobetasol; Dermoscopy; Disease Progression; Drug Therapy, Combination; Dutasteride; Female; Fibrosis; Follow-Up Studies; Hair Follicle; Humans; Inflammation; Middle Aged; Prospective Studies; Severity of Illness Index; Skin; Treatment Outcome; Triamcinolone

Frontal fibrosing alopecia is a distinctive form of scarring alopecia presenting with frontal and temporoparietal recession of the hairline. Its etiology remains unknown, and there are no universal treatment guidelines. We conducted a retrospective cohort study to define the clinical findings and treatment outcomes of 62 patients with frontal fibrosing alopecia, one of the largest cohorts to date.. Data analysis from case notes was performed on 62 patients with a diagnosis of frontal fibrosing alopecia seen from January 2004 to March 2012.. Except for one male, all patients in this cohort were females (80% post-menopausal) and mostly Caucasians (81%). Age at onset was between 18 and 81 years. While 35% reported no symptoms, the majority (65%) had itching, pain, or burning sensations. All patients had frontal hairline recession, and 81% had complete or partial loss of eyebrows. Perifollicular erythema and perifollicular hyperkeratosis occurred in 73% and 31%, respectively. Associated autoimmune connective tissue diseases were observed in 14% of patients. Reduction in symptoms and hairline stabilization were achieved in 97% of treated patients with intralesional corticosteroids. Thirty-one percent of patients were able to stop treatments and remained in remission for six months to six years.. Frontal fibrosing alopecia is increasingly seen in postmenopausal women and rarely in men. Despite the limitations of a retrospective study, we conclude early intervention and treatment with intralesional triamcinolone acetonide may halt the progression of the disease; however, further controlled prospective studies are needed to establish treatment guidelines for frontal fibrosing alopecia.

Topics: 5-alpha Reductase Inhibitors; Adolescent; Adult; Aged; Aged, 80 and over; Alopecia; Anti-Bacterial Agents; Anti-Inflammatory Agents; Azasteroids; Clobetasol; Drug Therapy, Combination; Dutasteride; Female; Fibrosis; Finasteride; Follow-Up Studies; Forehead; Humans; Male; Middle Aged; Retrospective Studies; Skin; Time Factors; Triamcinolone Acetonide; Young Adult

Morphoea, or localised scleroderma, is a disease entity with poorly understood pathogenesis. Early diagnosis of the condition is crucial in order to prevent permanent morbidity. However, initial presentations of morphoea can be nonspecific and easily mistaken for other conditions, resulting in late treatment and permanent disability. We report a case of linear morphoea in a 22-year-old man who was initially diagnosed with reflex sympathetic dystrophy. By the time the diagnosis of morphoea was confirmed, the patient had already developed contractures.

Topics: Clobetasol; Collagen; Diagnosis, Differential; Disease Progression; Fibrosis; Humans; Male; Phototherapy; Reflex Sympathetic Dystrophy; Scleroderma, Localized; Young Adult

Topics: Administration, Cutaneous; Aged; Alopecia; Clobetasol; Eyebrows; Female; Fibrosis; Follow-Up Studies; Glucocorticoids; Humans; Treatment Outcome