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  • ISSN: 2373-9371
    Volume 5, Issue 4
    Case Report
    Nurşen Düzgün*, Ender Kalacı, Ilyas Ercan Okatan, and Aylin Heper Okçu
    In this case report, we present a patient with systemic lupus erythematosus who has both refractory discoid lupus erythematosus lesions and refractory cytopenia under antimalarial, glucocorticoid and untarget immunosuppressant drugs. Rituximab, a monoclonal antibody directed against the CD20 antigen on the surface of B-lymphocytes has been used as an additional therapy in systemic lupus erythematosus. Cytopenia has resolved and clinical response continues over two years but discoid lesions did not respond rituximab therapy within the same time.
    Manas Bajpai*and Nilesh Pardhe
    Mucous membrane pemphigoid (MMP) is an autoimmune blistering disorder of mucosa, characterized by subepithellial bullae. The involvement of skin is only seen in one quarter of the patients with MMP. We report a case of 37 years old male presented with painful erosions involving gingiva, tongue and palatal mucosa without any skin involvement. Hisopathological features and direct immunofluroscene l to the final diagnosis of MMP.
    Joseneide Viana de Almeida* and Reginaldo Peçanha Brazil
    American Cutaneous Leishmaniasis (ACL) is among the neglected and reemerging diseases with outbreaks around the world. In Brazil, the northern region presents the highest incidence, presenting cases in all states of the Amazon region, and specifically the State of Roraima center of attention of our study. This communication brings a bibliographic review about the epidemiological behavior of American Cutaneous Leishmaniasis (ACL) in the State of Roraima, through a retrospective study in the period 2011 to 2015 of the cases reported with diagnoses confirmed for ACL observed in the Notification Disease Information System of the Ministry of Health of Brazil. We found 2,238 reports of confirmed cases and explored according to the variables: number of cases reported, sex, age, race, clinical form and case evolution. The majority of the patients were male (80.83%), cutaneous form of the disease (97.32%) was predominant among the reported cases. The main age group in the number of cases was people aged 20-39 years. Regarding race, we highlight an increasing number of cases (287) of ACL among Amerindians, and we still emphasize a high number (86) of abandonment of treatment. This study shows the predominance of cutaneous form of ACL in Roraima and suggests the activity of forest exploitation, leisure, mining, agriculture and residential environment as important predictive factors for infection. However, there is a lack of publications on the identification of the species of Leishmania responsible for ACL, their vectors and distribution in the state.
    Elia Samaniego-Gonzalez and Gonzalez - Moran
    Subungual melanoma is among the rarest forms of melanoma and diagnostic delay is common. Even once the diagnosis of melanoma is confirmed and the lesion excised special difficulties exist to determine the histological peripheral margins, which can lead to later recurrences. Mohs micrographic surgery has been advocated as a treatment for melanoma, especially for melanomas with poorly defined clinical margins and those on the hands and feet. Several cases of recurrent melanoma into the skin graft have been published, though selective invasion of the graft has rarely been reported. We report the case of a recurrent subungual melanoma in situ with a selective spread into the skin graft that was successfully treated with slow Mohs surgery.
    Short Communication
    Lauren Anderson*, Helena Lolatgis, Raymond Martyres, Danny Liew, Jemma Gillard1, Gayle Ross, and George Varigos
    Whilst most cases of atopic dermatitis respond to topical treatments, moderate to severe cases often require systemic therapy. The time to drug discontinuation, or ‘drug survival,' of these therapies is often limited by multiple side effects and ineffectiveness over time.
    Our study included 44 adult patients with moderate or severe atopic dermatitis who were receiving systemic immunosuppressive therapy (cyclosporine, azathioprine, methotrexate and mycophenolate mofetil) through the department of dermatology outpatient clinic at The Royal Melbourne Hospital. Patients were reviewed every 3-6 months for clinical assessment of disease and to record SCORAD, DLQI, side effects, and toxicity.
    Our final data set consisted of a total of 94 treatment series. When excluding the cases of remission, 59 of these regimens (63%) had been terminated due to side effects, toxicities, and non-compliance. The mycophenolate mofetil group demonstrated the greatest success at long-term survival. 61% of patients who tried treatment with mycophenolate mofetil have remained on mycophenolate mofetil thus far, compared to 20%, 10%, and 30% for cyclosporine, azathioprine, and methotrexate, respectively.
    Our data supports recent trends in management, which have seen an increase in the use of mycophenolate mofetil, likely due to improved access and a lower side effect profile.
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