Guidelines for the treatment of urticaria and angioedema have been prepared by the Japanese Dermatological Association. Subtypes of urticaria and angioedema have been classified into large three groups from the viewpoint of examinations and treatments; I. idiopathic urticaria, II. urticaria inducible by particular stimuli, and III. special types of urticaria and urticaria pigmentosa. The use of oral histamine H1-receptor antagonists is the first line treatment, regardless of the group, provided that sufficient efforts to eliminate the cause and/or aggravating factors are taken. Several options for treatment are suggested as second and/or third line treatments, but the aim of examinations and treatments should be determined by the type and severity of the disease.
We treated a younger case, 47-years-old, with malignant hemangioendothelioma (MHE) arising in the frontal region of the right ear as a rare subcutaneous type. The tumor was excised at another hospital but recurred and metastasized to the cervical lymph nodes immediately. In our hospital, he was then treated with radiotherapy accompanied with chemotherapy and achieved remission. However, seven months later, MHE recurred in the subcutaneous region behind the right ear and then broke through the skull and formed an inter-cranial tumor. He lost consciousness after a sign of the cerebellum. We treated him with a high-dose steroid hormone and X-ray radiation in a limited high dose accompanied with arterial infusion of paclitaxel. He recovered marvelously and returned to his social work for five months. Our results propose a new strategy for the treatment of serious MHE cases.
In this study, we examined antibody titers of desmoglein (Dsg) in serum, waste fluid, and saliva detected by enzyme-linked immunosorbent assay (ELISA) and serum IgG values during double filtration plasmapheresis (DFPP) treatment of three patients with persistant pemphigus. The first patient suffered from mucosal dominant pemphigus vulgaris, second one from pemphigus vegetans, and third from mucocutaneous pemphigus vulgaris; all were unresponsive to standard managements such as systemic steroid therapy and had to stop immunosuppressive drug because of the side effects. The DFPP treatment resulted in a highly successful removal rate of both anti-Dsg1 and anti-Dsg3 autoantibodies, 41.1±8.5% and 40.2±12.6%, respectively. The removal rate of serum IgG was lower (34.4±10.7%) than that of anti-Dsg autoantibodies. In order to avoid a rebound flare of the circulating anti-Dsg autoantibodies, three intravenous injections (i.v.) of methyl prednisolone sodium succinate (m-PSL) (40 mg/day) and three treatments either i.v. of m-PSL (1,000 mg/day) or per os (p.o.) of betamethasone were given after DFPP. The three treatments with m-PSL (1,000 mg/day) and the increased dose of betamethasone were very effective. The antibody titers of Dsg in their sera and waste fluids closely paralleled each other during DFPP treatment; thus we could check the effectiveness of removal of anti-Dsg autoantibodies. There were no anti-Dsg autoantibodies in the saliva. Our results suggest that various approaches are necessary in the high quality treatment of patients with pemphigus during DFPP.
Psoriasis arthropathica (PA) accounts for about 2～7% of total psoriasis patients, and it is often difficult to treat the associated arthritis. In this study, we epidemiologically evaluated the efficacy of variable treatments for arthralgia in patients with PA in our outpatient department during the past eight years. Our results found that our 25 patients (15 men and 10 women) had been treated with several drugs. Efficacy was reported in 60.0% patients treated with cyclosporin, 50.0% with acemetacin, 40.0% with diclofenac sodium, 31.6% with loxoprofen sodinm and 42.9% with prednisolone. The eight patients who did not show alleviation of arthralgia after treatment with the above-mentioned drugs, were treated with salazosulfapyridine. In six out of these eight cases, almost complete remission of arthralgia was achieved 8–15 weeks after the initiation of administration; nausea occurred in one case soon after the start of administration, and no response was seen in the other case. These results indicated that salazosulfapyridine can be one of the therapeutic options for arthralgia in PA patients that show resistance to various other types of other treatment.
We have previously reported that narrow-bandUVB (NBUVB) monotherapy and combination therapy using NBUVB plus topical calcipotriol are effective modalities for recalcitrant generalized vitiligo vulgaris. These NBUVB therapies are predicated on NBUVB minimal erythema dose (nMED). This report addresses how low dose NBUVB therapy without increments was an effective modality for a 59-year-old Japanese male with emphysema. We irradiated the patient with low dose NBUVB, which was under 0.7 nMED 13 times, to his cheeks and found pigmented macules in the vitiliginous lesions. Then we examined and compared the vitiliginous lesion with the newly pigmented macula histologically. After examining the clinical and histological findings, we believe this low dose NBUVB therapy was efficacious for his generalized vitiligo vulgaris with an underlying disease, emphysema and a high threshold nMED.