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Efalizumab is an effective and safe treatment for psoriasis in most patients of a high need population in routine practice, and provides maintained improvement in 'responders'. Combination treatment was transiently used in 48.4% of patients to optimize therapeutic results. Special consideration must be given to possible rebound in patients with an inadequate response or after discontinuation of treatment.

Syphilis is a sexually transmitted disease caused by Treponema pallidum. Epidemiological studies show that rates have increased dramatically in recent y, especially in human immunodeficiency virus (HIV)-seropositive patients. Although lesions most frequently develop on the genital area, they are presently frequently detected in the oral cavity. We present an HIV-positive patient without antiretroviral treatment and immunologically stable, with firm nodules on the tongue. Following serological tests, clinical symptoms and histopathological findings, lesions were diagnosed as secondary syphilis. A spectacular improvement was achieved with specific treatment. To our knowledge this is the first case described in the literature of secondary syphilis presenting as nodular, painless lesions on the lingual mucosa.

The presence of acanthosis with a proliferation of bland spindle cells and entrapped hyaline collagen bundles, suggested the diagnosis of dermatofibroma. However, further examination revealed groups of macrophages with abundant blue-gray granular cytoplasm located at the periphery of the lesion. Wade-Fite stain revealed numerous acid-fast bacilli arranged in clumps within histiocytes, confirming the diagnosis of histoid leprosy (HL) (Figs. 1A, B).