Intravenous immunoglobulins (IVIGs), a mixture of variable amounts of proteins (albumin, IgG, IgM, IgA, and IgE antibodies), as well as salt, sugar, solvents, and detergents, are successfully used to treat a variety of dermatological disorders. For decades, IVIGs have been administered for treatment of infectious diseases and immune deficiencies, since they contain natural antibodies that represent a first-line defense against pathogens. Today their indication has expanded, including the off-label therapy for a variety of autoimmune and inflammatory diseases. In dermatology, IVIGs are administered for treatment of different disorders at different therapeutic regimens, mostly with higher doses then those administered for treatment of infectious diseases. The aim of this prospective review is to highlight the indications, effectiveness, side effects, and perspectives of the systemic treatment with IVIGs for patients with severe, life-threatening, and resistant to conventional therapies autoimmune or inflammatory dermatoses.
Acute generalized exanthematous pustulosis (AGEP) is a rare drug-induced pustular cutaneous reaction. The clinical course is characteristic with a sudden onset of multiple sterile pustules on an erythemantous base with fever and neutrophilia, followed by a spontaneous resolution within two weeks. Drug-specific T cells play the main role in the pathogenesis, but the exact cytokine cascade and genetic background are yet to be elucidated. Timely and exact recognition is important in order to prevent confusion with infections and psoriasis and hence institution of unnecessary and wrong treatments. The diagnosis may be confirmed by typical history, identification of a culprit drug, histopathology and patch testing. The purpose of this review is to present the current knowledge on AGEP and its association with various drugs in the context of a drug allergic reaction.
Although toxoplasmosis is one of the most widely spread infections in the world, types that involve the skin are extremely rare. However, skin lesions are not specific; moreover, they are quite diverse, which makes the diagnosis of cutaneous toxoplasmosis rather difficult. Thus, differential diagnosis should include a number of other diseases. We present a case of a 43-year-old immunocompetent man with multiple livid erythematous papules and nodules with yellowish discharge that involved the skin of the body and the extremities. By using electro-chemiluminescence immunoassay, immunoglobulin G antibodies to Toxoplasma gondii were detected in the serum, confirming the diagnosis of toxoplasmosis. The treatment with pyrimethamine and trimethoprim-sulfamethoxazole led to complete resolution of skin lesions. In conclusion, although rare in the dermatological practice, cutaneous toxoplasmosis should be considered in all patients presenting with lymphadenopathy, non-specific skin eruptions, especially nodular and colliquative, blood eosinophilia and histological findigs revealing abundant eosinophilic inflitrations.
hemolytic crises in patients with hemoglobinopathies. 7,8 Few data about the lupus therapy with antimalarial drugs in children are available but there is not enough information about its prescription in patients with comorbidities, especially haemopaths. 4,5,9 Our experience showed that hydroxychloroquine has excellent clinical response and a good tolerance from pediatric patients, although β-thalassemia is a relative contraindication for it.
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