When evaluating the patient who presents with a dermatitis and weight loss, it is important to exercise great caution. The differential diagnosis should be re-evaluated in a disease that is not responsive to first-line therapy before further treatment is considered.

With the increasing number of options for the treatment of moderate-to-severe atopic dermatitis, clinicians need guidance on a practical approach to selecting a systemic agent for specific patient populations. We convened an expert panel consisting of 12 members to conduct a literature review and summarize relevant data related to six scenarios of clinical interest: comorbid asthma, ocular surface disease, history of cancer, past and ongoing infections of interest (including herpes simplex virus, herpes zoster, hepatitis B, and tuberculosis), pregnancy and lactation, and the elderly. We performed a literature search and examined each clinical scenario with | 1143 ADAM et al.

Notes to Readers Disclaimer: As in the original guidelines, physicians should use their best clinical judgment when determining whether and how to apply treatment recommendations in the individualized care of patients. This document is not intended to replace the guidance found in the relevant Canadian product monographs or other official information available for the therapeutics discussed. Every reasonable effort has been made to ensure the accuracy of this document. Any errors made here will be corrected in the next edition of the guidelines. Drug recall: Please disregard all previous recommendations for alefacept, as it was withdrawn from the market in 2011. Drug names: As in the original guidelines document, generic names have been used throughout this document. Any new trade name or generic name used in the addendum has been has listed in Appendix I at the end of this document.

Levamisole is frequently added to crack/cocaine; we report three patients who developed vascular lesions and skin necrosis after using cocaine/levamisole. These improved with plasmapheresis and immunosuppression as well as abstention from the drugs; one patient with severe disease required débridement and skin grafting.