Febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a severe form of pityriasis lichenoides et varioliformis acuta (PLEVA), featuring large, ulcerative, necrotic skin plaques, high fever, and other systemic symptoms, is a rare disorder of unknown etiology. No randomized controlled trials have established treatment guidelines and multiple modalities are often employed, making it difficult to assess the efficacy of any single agent. We report two cases of this condition in which treatment with methotrexate plus antibiotic treatment for superinfection led to rapid improvement.

Comparative tolerability and efficacy of daylight, conventional, and combination aminolevulinic acid photodynamic therapy for treatment of actinic keratosis To the Editor: The drawbacks to photodynamic therapy (PDT) for actinic keratoses (AK) include pain during illumination and patient access to a light source that is approved by the US Food and Drug Administration. To address this, dermatologists are exploring daylight PDT. 1 Clinical studies in Europe and South America provide initial evidence that daylight exposure is efficacious. 2,3 This randomized, single-blind trial investigated the tolerability and safety of daylight PDT for AK on the face and scalp in Northern California.Participants with 4 to 20 face/scalp AKs were randomly selected (1:1:1) to 3 treatment groups (NCT03322293). Patients underwent topical application of aminolevulinic acid HCl (ALA) solution 20%. Group A had conventional treatment of 1 hour of incubation and 16 minutes, 40 seconds of 417-nm Blue Light Photodynamic Therapy (BLU-U; Sun Pharmaceutical Industries, Inc.). Group B received combination therapy of 15 minutes of incubation, 16 minutes 40 seconds BLU-U, and 45 minutes of daylight. Group C received daylight therapy of 15 minutes of incubation and

Herpes simplex virus infections in HIV-infected individuals can be clinically unusual and difficult to treat due to underlying problems with cell-mediated immunity and the occurrence of antiviral resistance. Additionally, partial or incomplete restoration of immune function may result in chronic ulcerations that require rotational treatments. In this report, we describe the case of a 38-year-old HIV-positive woman who developed the ulcerative form of chronic herpes simplex infection despite highly active antiretroviral therapy and valacyclovir prophylaxis. Repeated intravenous courses of foscarnet and topical cidofovir finally controlled her erosions as her cell-mediated immunity was slowly restored. This case highlights the challenges that still exist in diagnosing and managing this rare presentation of herpes simplex virus

No abstract