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Background Clinical trials have shown the efficacy of omalizumabs efficacy in refractory chronic spontaneous urticaria ( CSU) and chronic inducible urticaria ( CIndU), but real-life management strategies are lacking. Aim To assess the long-term efficacy and safety of omalizumab, and to identify predictive factors and optimum dosage regimens. Methods This was a prospective study of 13 patients (11 women, 2 men) with severe CSU [weekly urticaria activity score ( UAS7) > 28] resistant to anti-H1 antihistamines. Patients were started on omalizumab 150 mg subcutaneously every 4 weeks. Dose and interval between administrations were adjusted according to clinical response (189 administrations; treatment duration range 2-38 months). Results Mean UAS7 was 36.3 ± 5.4. Of the 13 patients, all had experienced angio-oedema, while in addition, 7 had delayed pressure urticaria ( DPU) and 1 had solar urticaria ( SU). After omalizumab treatment, 4 (30.8%) of the 13 patients had complete response ( CR), and the remaining 8 (61.5%) had partial response. CR was achieved with a dose of 150 mg every 4 ( n = 2 patients) or 5 ( n = 2) weeks. One of these patients remained disease-free after stopping treatment. Partial responses were achieved with 150 mg every 4 weeks ( n = 4) and with 300 mg ( n = 4) at intervals of 5 weeks ( n = 1), 4 weeks ( n = 2) or 3 weeks ( n = 1). Only one patient (7.7%) did not show significant improvement, despite a dose of 300 mg every 4 weeks. There were no significant differences in epidemiological, clinical and laboratory data between the different response groups. Only two adverse events were observed: one was mild headache and the other was severe angio-oedema and aggravation of urticaria within 6 h of omalizumab administration. Conclusion Omalizumab dose and interval between administrations could be individualized for long-term management of CSU. [ABSTRACT FROM AUTHOR]

Background Inpatients with cutaneous adverse drug reactions ( CADR) with overlapping features between maculopapular exanthema ( MPE) and drug reaction with eosinophilia and systemic symptoms ( DRESS) were examined. Objectives To characterize patients with exanthema and few systemic symptoms not meeting the criteria for DRESS [overlapping MPE- DRESS ( MP/ DR)]. Methods We undertook a comparative analysis of clinical and laboratory features of patients with MPE, MP/ DR and DRESS (2008-12). Results We identified 132 inpatients (85 women/47 men, mean age 64·0 ± 17·7 years) with CADR, 37 with DRESS, 28 with MPE, 34 with MP/ DR and 33 with other patterns. There were no significant differences in sex, age or concomitant diseases. Allopurinol was the main cause of DRESS (40·5%) and MP/ DR (29·4%); antimicrobials were the main cause in MPE (35·7%). In MP/ DR the latency period (18·06 ± 13·17 days) was significantly longer than in MPE but shorter than in DRESS. Although hospitalization time was similar to DRESS (13·26 ± 7·41 days), duration of therapy and follow-up in MP/ DR was shorter. Exanthema/erythroderma were frequently associated with facial oedema in MP/ DR (73·5%) and DRESS (89·2%) but only in 42·0% of patients with MPE. MP/ DR histopathology showed keratinocyte vacuolization and perivascular and interstitial infiltrate of lymphocytes, eosinophils and neutrophils, similar but milder than in DRESS, with less interface dermatitis, exocytosis and spongiosis. DRESS was associated with liver involvement (78·4%) and eosinophilia (78·4%), but only in 64·7% and 11·8%, respectively, of patients with MP/ DR. Conclusions An overlapping pattern between MPE and DRESS was identified and characterized. There may be a continuum spectrum between MPE and DRESS. [ABSTRACT FROM AUTHOR]

The article describes the case of a 78-year-old man with spiradenocarcinoma, a rare, malignant, adnexal tumor, which arises on a background of a pre-existing benign spiradenoma. It notes on the histopathological examination of the excision specimen which showed a solid and cystic nodular lesion. It cites that the tumor was sharply circumscribed with no necrosis, inflitrative growth or high-grade nuclear atypia.

The article presents a case study of a 63 year old woman with a painless black-purple nail bed pigmentation on left first toe due to destruction of nail plate's distal border and showing melanonychia. Topics discussed include dermoscopic findings being suggestive of acral melanoma demanding a nail biopsy, histopathology examination confirming diagnosis of acral lentiginous melanoma and dermoscopy of the nail bed biopsy specimen immediately after excision preserving vascular elements.