Hyperthrofic lichen planus is considered a variant of lichen planus with marked epidermal hyperplasia in response to persistent itch. It is clinically, characterized by symmetric hyperkeratotic plaques, of purplish-grey color, often located in the pretibial region. Intense pruritus, refractoriness to conventional treatments and the possibility of association of the long-term injuries with squamous cell carcinoma requires an effective treatment. The first-line treatment is corticosteroids which can be applied either topically or systemically. Other therapeutic modalities proposed are: NB-UVB phototherapy or PUVA, immunosuppressive drugs and systemic retinoids, notably acitretin. We report a case with exuberant clinical presentation of hyperthrofic lichen planus with excellent response to acitretin after nine months of treatment. Keywords: Acitretin; Immunosuppressive drugs; Lichen planus; Prednisone Resumo: O líquen plano hipertrófico é uma variante do líquen plano, com pronunciada hiperplasia epidér-mica em resposta à coçadura persistente. Clinicamente, caracterizam-se por placas hiperceratósicas, simétri-cas, de coloração cinza-violácea, com predileção pela região pré-tibial. O prurido intenso, a refratariedade aos tratamentos convencionais e a possibilidade de associação de um carcinoma epidermoide às lesões de longa duração impõem um tratamento eficaz. Os corticoides são considerados o tratamento de primeira linha e podem ser aplicados topicamente ou empregados de forma sistêmica. Outras modalidades terapêu-ticas propostas são a fototerapia com UVB-NB ou PUVA, imunossupressores e retinoides sistêmicos, com destaque para a acitretina. Relatamos um caso com apresentação clínica exuberante e excelente resposta à acitretin, totalizando um seguimento de nove meses.

A male full‐term infant, who had been exclusively breast‐fed since birth, at 2 months of age developed an erythematous, scaling eruption involving the face (in a periorificial distribution, i.e. mouth, nose, ears, and eyes), hands, and feet, which did not respond to treatment with topical corticosteroids and oral antimicrobials. He was first seen at our institution at 5 months of age (Figs 1 and 2). He had been irritable for the last 2 weeks, but had no diarrhea, alopecia, or anogenital lesions. A clinical diagnosis of acrodermatitis enteropathica was confirmed with a serum zinc level of 41.2 µg/dL (normal, 70–120 µg/dL). His mother had low–normal serum (70.5 µg/dL; normal, 70–120 µg/dL) and normal milk (0.43 µg/mL; normal, 0.2–0.72 µg/mL) zinc concentrations. Within 7 days of starting therapy with zinc sulfate, 10 mg/kg/day, all cutaneous lesions had resolved (Fig. 3). 1 Infant at 5 months of age showing an erythematous, scaling eruption involving the face (periorificial distribution, i.e. mouth, nose, and eyes) and hands 2 Infant with dermatophytosis‐like lesions 3 Infant at 6 months of age after starting oral zinc supplementation. The lesions have resolved

Piloleiomyoma, a benign smooth-muscle tumor arising from the arrectores pilorum muscles of the skin, affects males and females in the third decade of life. It presents as asymmetrical, reddish-brown nodules or papules with a firm consistency, predominantly located on the limbs. When multiple lesions are present, they may be tender or painful. Their association with uterine fibroids, referred to as Reed syndrome or familial leiomyomatosis cutis et uteri, is rare and may be associated with renal cell carcinoma. The approach consists of surgical excision in cases presenting few lesions and pharmacological treatment if symptomatic. The present paper describes a case of Reed syndrome in which a decision was made to monitor the patient in view of the absence of symptoms.

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The use of TNF-α inhibitors for the treatment of moderate to severe psoriasis and psoriatic arthritis is increasingly more frequent. The authors report a case of Guillain-Barré syndrome as a late manifestation of the treatment with adalimumab. Although unusual, this is relevant for professionals who prescribe biologic drugs. We also stress the importance of investigating the past and family medical history regarding demyelinating diseases before starting treatment.