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We describe a patient with a generalized bullous form of Fixed Drug Eruption (FDE) induced by bromhexine, a commonly used drug for respiratory symptoms. This is a rare association and generalized bullous FDE is also very rare. We emphasize the importance of patch tests in identifying the culprit drug.

The structure of lignosulphonates (LS) from acidic magnesium-based sulphite pulping of Eucalyptus globulus wood has been studied. LS from thin and thick spent liquors were purified by dialysis and characterised by 1D/2D Nuclear Magnetic Resonance (NMR) and Electrospray Ionization Mass Spectrometry (ESI-MS). It was suggested that major part of LS is comprised of partially sulphonated low molecular weight oligomers formed via extensive cleavage of β-O-4 bonds in eucalypt lignin upon sulphite pulping. More than ten types of LS structures derived from different lignin structural units have been identified. A significant proportion of LS (> 20%) is comprised by monomeric compounds, mainly 4-allyl-2,6-dimethoxyphenyl-α -sulphonic and 4-propyl-2,6-dimethoxyphenyl-α,γ -disulphonic acids. LS revealed partial degradation during the thin liquor evaporation leading to cleavage of ether and carbon-carbon linkages in the side chain and to the increasing of the condensation degree. [ABSTRACT FROM AUTHOR]

The major components of industrial thin (SSL) and thick (THSL) liquors from acidic magnesium-based sulphite pulping of Eucalyptus globulus wood have been characterized. The analysis of sugars in SSL revealed the predominance of xylose, which was present in the form of sugar monomer (ca. 70%) and as xylo-oligosaccharides (ca. 30%). Lignosulphonates (LS) were the most abundant organic fraction of spent liquor (ca. 50% of liquor dry matter) consisting of sulphonated oligomers (SO3H ≈ 20% w/w) of low molecular weight (Mw ≈ 1000-1300 Da) and constituted mainly by syringyl units (syringyl:guaiacyl ratio = 81:19). The major phenolic extractives of THSL were pyrogallol (93 g/ton) and gallic acid (1020 g/ton), and the most abundant fatty acid and sterol were tetracosanoic acid (6 g/ton) and β -sitosterol (45 g/ton), respectively. The structural changes of macromolecular components during the liquor evaporation were discussed. [ABSTRACT FROM AUTHOR]

An 86-year-old man presented with a painful reddish tumour on the scalp with a 3-month history, mental confusion with recent onset and lymphadenopathies. Histological examination of the lymph node and cutaneous lesion revealed a dense infiltrate of atypical and large B cells. There was no evidence of bone marrow invasion. According to REAL (Revised European–American Classification of Lymphoid Neoplasms), this lymphoma was considered as a diffuse large B-cell lymphoma with concurrent cutaneous and nodal involvement. Cerebral computerized tomography (CT) scan showed bone and dura mater invasion in the right parieto-occipital region with collapse of lateral ventricle. The patient was submitted to systemic chemotherapy with cyclophosphamide, vincristine and prednisolone (CVP). There was a good response with regression of the cutaneous lesion, but the patient died after the third cycle. We point out the unusual clinical presentation and aggressive behaviour of this lymphoma. [ABSTRACT FROM AUTHOR]

Examines the treatment of epidermal necrolysis with intravenous immunoglobulin. Effects of corticosteroids; Treatment of patient with cotrimoxazole for sinusitis; Production of reactive metabolites.

Objectives: Generalized pustular psoriasis (GPP) is a rare, life-threatening skin inflammatory disorder. This study aimed to describe the disease course, treatment strategies, and healthcare utilization among patients with GPP in Portugal., Methods: This multicentric, observational, retrospective study included consecutive adult patients with GPP undergoing a dermatology evaluation in different reporting institutions by experienced dermatologists between 2002 and 2023., Results: A total of 59 patients were assessed. Most of the cohort had a previous history of plaque psoriasis (71%) and 83% presented at least one comorbidity. At the initial encounter, 64% of the cohort needed hospitalization. Systemic involvement was common, including fever (37%), and elevated white blood cell count and erythrocyte sedimentation rate/C-reactive protein (49%). Nearly, 73% of patients initiated systemic drugs, and 70% had to discontinue the first treatment. During the study, 98% of patients experienced at least one flare. At the last visit, 3.4% of patients had died, and 71.2% exhibited signs of active disease despite undergoing treatment., Conclusions: Our study demonstrates that GPP is a chronic, debilitating condition associated with systemic involvement, frequent flares, and hospitalizations, despite receiving multiple systemic treatments. Improved disease awareness and new treatments are needed to improve patient care and decrease the burden of the disease.

(1) Background: Psoriasis is a common chronic inflammatory skin disease with different manifestations, affecting the quality of life at social, emotional, and professional dimensions and requiring long-term treatment. This study aimed to investigate the effect of psychosocial and clinical factors on adherence to topical treatment in psoriasis. (2) Methods: Self-reported measures and weighing the medicines were used to assess adherence. Psychopathological symptoms were measured using the Brief Symptoms Inventory (BSI). Social and clinical factors were assessed by a sociodemographic and clinical questionnaire. Adherence to treatment with topical medication was assessed using a sample of 102 psoriasis patients. (3) Results: The explanatory models of adherence to topical treatment in psoriasis translated into positive associations between adherence and the education level (higher education) ( p = 0.03; φ = 0.23), the single-family household ( p = 0.01; φ = 0.44), active employment status ( p = 0.05; φ = -0.19), familiar history of psoriasis ( p = 0.04; φ = -0.21), and the presence of obsessive-compulsive symptoms ( p = 0.01; d = 0.29). (4) Conclusions: In patients who present the characteristics identified that influence non-adherence, instructions should be reinforced to increase adherence. The experimental mortality (39.6%) reduced the sample size, representing a limitation of the study.

Background: Real-world evidence plays a pivotal role in validating the efficacy of biologic drugs beyond the controlled environment of randomized trials. This study aimed to evaluate the effectiveness of tildrakizumab in treating moderate-to-severe psoriasis within a real-world setting over a 52-week period in Portugal., Methods: This multicentric, prospective, observational study included adult patients with moderate-to-severe psoriasis. All participants received tildrakizumab 100 mg at weeks 0 and 4, followed by a maintenance dose every 12 weeks, and were monitored for 52 weeks. Primary endpoints were determined based on Psoriasis Area and Severity Index (PASI) assessments at baseline, 16 (±2) weeks, 28 (±2) weeks and 52 (±2) weeks., Results: A total of 54 patients were enrolled in the study (56% men, mean age of 50.3 ± 14.4 years). Half of the sample ( n =27) had no prior experience with biologic treatments. About 74% of patients ( n =40) presented at least one comorbidity during the study, with psoriatic arthritis being the most prevalent (29.6%). By week 52, there was a significant decrease in the mean PASI from 17.8±10.3 at baseline to 1.3±1.9 ( p <0.001), indicating an overall improvement of 93%. By week 52, more than 85% of patients attained PASI ≤5, more than 80% reached PASI ≤3, and nearly 60% achieved PASI ≤1. Infections were observed in 9.3% of patients, and one patient required hospitalization (1.9%). The cumulative proportion of patients continuing treatment at 52 weeks was 88.9%., Conclusions: This study demonstrates that tildrakizumab is an effective and safe agent for the treatment of moderate-to-severe psoriasis in a diverse, real-world setting., Competing Interests: Disclosure and potential conflicts of interest: TT has received consultancy and/or speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Amgen, Almirall, Arena Pharmaceuticals, Biocad, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Fresenius-Kabi, Janssen, LEO Pharma, Eli Lilly, MSD, Mylan, Novartis, Pfizer, Samsung-Bioepis, Sanofi-Genzyme, Sandoz and UCB. He is also Associate Editor for Drugs in Context. PV has received consultancy and/or speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Boehringer Ingelheim, Janssen, Leo, Lilly, Novartis, Pfizer, Sanofi and Sandoz. PM-B has received honoraria for acting as a consultant and/or speaker for AbbVie, Pfizer, Janssen, LEO Pharma, Novartis, Sanofi, Teva, Bayer and L’Oreal. SM has no conflicts to disclose. MH has received consultancy and/or speaker’s honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Janssen, LEO Pharma, Novartis, Pfizer and Sanofi-Genzyme. PF has received honoraria for acting as a consultant and/or speaker for AbbVie, Janssen, LEO Pharma, Eli Lilly, Novartis and Pfizer. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2024/02/dic.2023-12-5-COI.pdf, (Copyright © 2024 Torres T, Varela P, Mendes Bastos P, Magina S, Henrique M, Ferreira P.)