Letter to the Editor e561 Table 1 Characteristics of 12 patients with atypical exanthemas and eosinophilia Case

Bullous pemphigoid (BP) is the most common autoimmune blistering disease of the skin and mucous membranes. 1,2 Although autoantibodies targeting proteins of the dermoepidermal junction (BP antigen 1 (BPAG1/ BP230) and BP antigen 2 (BPAG2/ BP180)) have been demonstrated as the physiopathological bases of BP, 1,3 the exact pathogenesis remains unknown.Reported annual incidence of BP varies 3-5 and ranges from 2.4 to 21.7 per million population. However, the tendency for BP incidence to increase is clear-cut. 4,[6][7][8] This increase has been attributed to population ageing, drug-induced cases and improvement in the diagnosis due to increasing awareness of non-bullous and atypical variants of BP. 1,3,8 Many studies have corroborated the potential association of medication use with BP. 9-12 Dipeptidyl peptidase-4 inhibitors

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Intralesional methotrexate (il-MTX) has been reported as a useful therapy in keratoacanthoma (KA) and cutaneous squamous cell carcinoma (cSCC). However, the data available on the histological changes induced by this therapy are very scarce. We conducted a single center, prospective study that included 65 cases of cSCC treated with il-MTX before surgical treatment. Two histological studies were conducted in all patients: before intralesional treatment and after surgical removal. Lesions were assessed longitudinally both clinically and histologically. 60 patients (92.3%) responded to il-MTX treatment. There were no differences regarding aggressive histological features of the cSCC between responder and non-responder patients. All cases showed a chronic inflammatory infiltrate after il-MTX. Intratumoral necrosis areas were frequently observed. All cases showed local fibrosis with fine thickening of collagen bundles. Il-MTX induces a chronic lymphohistiocytic inflammatory reaction in both clinical responder and nonresponder patients. Tumor involution after il-MTX is followed by a fine fibrosis that explains the great cosmetic results and improves the accuracy of the follow-up.