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A case of unilateral neutrophilic dermatosis of the dorsal handsUm caso de dermatose neutrofílica do dorso das mãos unilateral

Erythroderma, or generalized exfoliative dermatitis, is a rare inflammatory disorder characterized by generalized erythema, involving more than 90% of the body surface area, accompanied by a variable degree of scaling. It may be the clinical presentation of several cutaneous or systemic diseases and it is frequently challenging to find the underlying cause. Our case focuses on a 76-year-old male patient that was referred to our department due to generalized erythroderma and diffuse alopecia, developing over the last 4 months. He presented with erythematous papules and nodules, some of them covered with sticky scales. Skin biopsy was compatible with drug eruption. Due to an inadequate response to treatment and typical B symptoms, further imagiologic studies were performed. Ultimately he was diagnosed with non-small cell lung cancer. This case shows the need to search for a neoplasm in patients presenting with erythroderma, particularly in the presence of systemic symptoms.

Introduction:Omalizumab is approved for the treatment of severe chronic spontaneous urticaria (CSU), unresponsive to quadruple doses of nonsedative H1 antihistamine. Few data are available to help predict the response to omalizumab in the Portuguese population. Objective: Characterize the population of CU patients treated with omalizumab in Hospital de Braga and identify variables that help predict a better response to omalizumab. Methods: Retrospective chart-review study of CU patients treated with omalizumab in Hospital de Braga. Statistical analysis was performed using the chi-square, odds ratio analysis and generalized linear models. Results: 21 patients were included (three men and 18 women). 16 patients had CSU, two had solar urticaria, two cholinergic urticaria, and one cold urticaria. They all had at least 6 months of treatment with omalizumab. Prior to omalizumab, they all had been treated with quadruple doses of nonsedating H1 antihistamines. Using generalized linear models, patients showed a significant reduction of the UAS and UAS7 scores. Women and patients with intermediate levels of immunoglobulin (Ig)-IgE presented a bigger reduction. Women had higher total serum IgE. Conclusion:The female gender and patients with intermediate levels of IgE had a better response to omalizumab. In this study, the female gender seems to have higher total serum IgE.

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