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Using modern Q-switched lasers, tattoos are removed successfully with minimal risk of scarring and permanent pigmentary alterations. Even multicoloured tattoos can be treated successfully and with a low rate of side-effects.

Summary:Adverse reactions to iodinated contrast media are varied and known to develop in patients with asthma and a history of allergy. We describe three successful allogeneic bone marrow transplantation (BMT) patients, who all developed dermal graft-versus-host disease (GVHD) after receiving contrast media. Cutaneous GVHD triggered by contrast media has not been reported to date and has implications for the assessment, monitoring and treatment of patients during the post-transplant period. Bone Marrow Transplantation (2002) 29, 899-901. DOI: 10.1038/sj/bmt/1703564 Keywords: bone marrow transplantation; graft-versushost disease; contrast media Graft-versus-host disease (GVHD) is a singularly important threat to the successful outcome of allogeneic stem cell transplantation and prevention and treatment of GVHD are of critical importance for transplant physicians and patients. Prophylactic use of cyclosporin A (CsA) and methotrexate (Mtx) successfully reduces the incidence of acute GVHD. Some studies suggest a reduction in chronic GVHD with prolonged CsA prophylaxis. [1][2][3] Additional studies have shown, that random red cell transfusions given shortly before transplantation may be associated with a decreased risk of chronic GVHD, whereas unirradiated donor buffy coat or marrow reinfusions are associated with an increased risk for development of chronic GVHD. 4,5 Splenectomy appeared to increase the risk for development of chronic GVHD, possibly due to increased rates of infection in splenectomized patients. 6 As another possibility, which could be of prophylactic importance, we report three allogeneic BMT patients who experienced contrast mediainduced cutaneous GVHD. Case reports Case 1A 49-year-old patient underwent allogeneic BMT from his HLA-identical brother for AML M4 in first CR. He received GVHD prophylaxis with CsA beginning with 10 mg/kg/day, adjusted to provide serum levels of 150-250 g/l, Mtx (15 mg/m 2 on day 1 and 10 mg/m 2 on days 3, 6 and 11), and IvIgG (0.5 g/kg/week). No serious complications occurred and rapid engraftment was achieved. Pre-existing pulmonary aspergillosis was treated with intravenous amphotericin B. Acute GVHD occurred on day +43 (grade 2, skin) without other organ involvement. The skin rash settled after 4 months. Six months after BMT the patient was still receiving CsA (5 mg/kg/day p.o.). Computed thoracoabdominal tomography was performed for evaluation of the aspergillosis infection. As contrast medium, 120 ml of iodixanolum 550 mg (Visapaque 270) was used. Six hours after application of the contrast medium, the patient developed generalized erythroderma with a pruritic and painful skin rash. Therapy with prednisone 50 mg p.o. and cetirizin 10 mg p.o. was begun. The initial changes were limited to the more superficial skin layers, with formation of new lichen planus-like papules and scaling erythematous plaques involving facial skin, palms and soles. These findings were associated with dryness of mouth and conjunctivae. A skin biopsy showed chronic GVHD with typical epide...

Background Vedolizumab is an α4β7 integrin monoclonal antibody indicated for moderately to severely active Crohn’s disease (CD) and ulcerative colitis (UC). There are limited data on how vedolizumab impacts extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD). The aim of the study was to analyse the effect of vedolizumab on EIM in a real-world cohort of IBD patients. Methods A multicentre retrospective study was conducted in Belgium, Denmark, Israel, the Netherlands and Switzerland. Adult patients with moderately to severely active IBD and concurrent active EIM with at least 6 months follow-up after vedolizumab initiation (index date) were enrolled. Improvement of EIM was defined as absence of symptoms (resolution) or partial response (reduction of symptoms). Results 99 patients were included (UC: 44, CD: 55); the majority of active EIM at index were musculoskeletal (Table 1). Median disease duration at index was 9 (IQR: 3-19) years and 77% of patients had been exposed to 1+ biologic. Overall, after 6 and 12 months of vedolizumab, 37% and 50% of EIM respectively were reported as improved, 22%, 25% as stable (no change) and 1% and 3% as worsened (Table 2), missing values were 5% and 4%, respectively. Median time since first EIM improvement was 0.5 months (Figure 1). At 6 and 12 months, 48% (10/21) and 33% (6/18) of patients experienced clinical response/remission of their IBD, respectively. Vedolizumab treatment persistence at 12 months was 83% overall (Figure 2). Adverse Events were reported for 18% patients; 96% of them non-serious. Conclusion Vedolizumab treatment was associated with an improvement in 37% and 50% of EIM at 6 and 12 months, respectively, in a real-world IBD cohort.

This study emphasizes the relevance of standardized written guidelines for the therapy of acute hyperglycemic crises in diabetic patients.