mycophenolic-acid and Skin-Diseases--Vascular

One month after the onset of immunosuppressive treatment with corticosteroids and mycophenolate mofetil for a newly diagnosed pemphigus vulgaris, a 50-year-old female patient developed a new eruption clinically and histomorphologically consistent with eruptive pseudoangiomatosis (EP). Its self-limited course further confirmed this diagnosis. Although initially described as a paediatric eruption, meanwhile more adult cases of EP (30 out of a total of 53 cases identified by a Medline search) are reported in the literature. The review of adult cases of EP disclosed some common clinical and epidemiological characteristics: adult EP cases tend to cluster in the Mediterranean region of Europe, develop during the summer months, sometimes in the form of limited micro-epidemics, affect immunocompromised individuals and have lesions confined to the exposed skin sites. These characteristics, together with the exanthematic nature of the disease in children, point to some vector-transmitted infectious agent as the cause of this probably underdiagnosed disease.

Topics: Angiomatosis; Biopsy, Needle; Child, Preschool; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Immunocompromised Host; Immunohistochemistry; Methylprednisolone; Middle Aged; Mycophenolic Acid; Pemphigus; Risk Assessment; Severity of Illness Index; Skin Diseases, Vascular; Treatment Outcome

Topics: Humans; Immunosuppressive Agents; Male; Middle Aged; Mycophenolic Acid; Skin Diseases, Vascular; Vasculitis

Cutaneous polyarteritis nodosa (CPAN) is a self-limited cutaneous vasculitis characterized by painful nodules, affecting mostly the lower limbs, and livedo reticularis. Despite its benign course, CPAN may display a chronic relapsing evolution with repeated exacerbations. Ulcerative CPAN has a more prolonged evolution and is associated with peripheral neuropathy. We report on a patient with a 20-year history of ulcerative and painful CPAN, refractory to multiple immunosuppressive treatments, treated successfully by mycophenolate mofetil and pentoxifylline.

Topics: Aged; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Mycophenolic Acid; Pentoxifylline; Polyarteritis Nodosa; Skin Diseases, Vascular

Apheresis has been effective as rescue therapy in patients with severe, therapy-resistant, systemic lupus erythematosus (SLE). Its benefit in patients with less severe but therapy-resistant SLE is not known. Dextran sulfate apheresis was applied as a rescue therapy for therapy-resistant vasculitic skin lesions in a 30 year old female patient with a 9 year history of SLE in combination with antiphospholipid syndrome and Raynaud's phenomenon. Partial remission was achieved after 9 immunoadsorption sessions, as documented by marked improvement of skin lesions and an increase of capillary density in the nailfold area. Further improvement was noted with maintenance therapy using mycophenolate mofetil. Dextran sulfate apheresis can be applied safely in patients with moderate therapy-resistant SLE disease activity when severe immunodeficiency and cytotoxic adverse effects should be avoided.

Topics: Adsorption; Adult; Antibodies, Antinuclear; Blood Component Removal; Complement System Proteins; Dextran Sulfate; Female; Fingers; Humans; Immunoglobulins; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Microscopic Angioscopy; Mycophenolic Acid; Plasmapheresis; Skin Diseases, Vascular