Biologics are often used to treat patients with moderate to severe psoriasis, but some patients develop secondary loss of response to biologics. Granulocyte and monocyte adsorption apheresis (GMA) is considered a safe treatment for elderly patients, children with body weight ≥ 25 kg, pregnant women, and patients receiving immunosuppressive therapy. We report two cases of generalized pustular psoriasis with secondary loss of response to biologics (infliximab and brodalumab, respectively), in whom response was regained after combined GMA sessions. Following 5 GMA sessions, the patients' lesions rapidly diminished, and maintenance therapy was continued without changing the biologics. The inclusion of GMA therapy is a viable option for ensuring that treatment with biologics remains effective in cases with secondary loss of response to biologics.
Beta blockers inhibit the proliferation and migration of vascular endothelial cells. They have been reported to have a tumor-reducing effect on infantile hemangiomas, and their use has also been covered by Japanese health insurance since 2016. Further, it has been shown that beta blockers have a recurrence-suppressing effect on angiosarcomas. We performed a retrospective study involving 19 cases of cutaneous angiosarcomas of the scalp, treated between April 2009 and March 2019 at the hospital of the University of Occupational and Environmental Health, Japan. Eight cases were initially treated with chemoradiotherapy. Four of these 8 cases received beta-blockers to treat complications. An extensive evaluation revealed that treatment with combination chemoradiotherapy and beta blockers may prolong the overall survival as well as the metastasis-free survival in the affected subjects compared with chemoradiotherapy without beta blockers. Our results suggest that beta blockers may have a suppressing effect on tumor recurrence when administered alone or in conjunction with standard treatment protocols.
A 26-year-old Japanese man presented with a black macule on the lower right abdomen; it was clinically diagnosed as Clark nevus. Dermoscopic findings showed a peripheral brown regular pigment network and a central brown-black homogeneous pattern with a blue-white veil, consistent with Clark nevus. Histopathological examination revealed remarkably thick dermal lamellar fibrosis with architecturally atypical melanocytic nests and junctional proliferation of slightly atypical melanocytes.
Our pathological diagnosis is Sclerosing nevus; this type is still not well known in Japan. Our report discusses this case and presents a review of the literature.