Objective The aim of this open-label study was to investigate the therapeutic effect and adverse reactions of oral ivermectin in scabies patients.Background There is much confusion over reports of efficacy, adverse reactions and relapses after oral treatment of scabies with ivermectin.Methods Nineteen patients, ten otherwise healthy outpatients with scabies, and nine inpatients with scabies and another skin disease (dermatomyositis, 3; pemphigus, 2; bullous pemphigoid, 1 ; pyoderma, I ; HIV, 1; Behqet's disease, 1) were treated with an oral dose of 0.2 mg/kg ivermectin ( I % water solution) on days 1 and 8. The presence of live mites and ova in the patient's skin was investigated before, during and after the treatment.Results None of the 19 patients with scabies had evidence of scabies after the second dose of ivermectin. In seven patients we noted the enhancement of pruritus 24-72 h after the first administration of ivermectin. In three patients the skin manifestation, vesicle-pustular rash increased between the second and the fourth day.Conclusion The advantages of oral ivermectin treatment in scabies patients are: high therapeutic efficacy against Sarcoptes scabiei, good tolerance and influence of the drug on the whole skin surface and on clinical symptoms. The administration of the drug is easy and quick. 0 An open-label study of 19 patients (1 3 males and 0926-9959/98/$ -see front matter P I I SO926-99.59(98)00075-0 0 1998 Elsevier Science B.V. All rights reserved
A 16-year-old girl with pyoderma gangrenosum (PG)-like skin lesions on the extremities, trunk and face developed Takayasu's arteritis (TA; pulseless disease). After 3 years under maintenance cyclosporin A therapy, the patient developed an ischaemic cerebral accident. Severe obstruction of both subclavian and left carotid arteries was found by Doppler sonography, angiography and computerised axial tomography. Evolution of this disease showed some characteristic findings: (a) PG-like lesions as the first cutaneous manifestation of pulseless disease; (b) methotrexate and cyclosporin A giving good results for the cutaneous lesions, but apparently not exerting an influence on the evolution of TA and the fatal outcome. This morphologic pattern may reflect underlying TA or Wegener's arteritis, and should be termed segmental ulcerative vasculitis.
Our patients with crusted scabies of the scalp and dermatomyositis prompted us to change our standard diagnostic and therapeutic regimens. Fascinating features included mimicry of scabies in patients with dermatomyositis, location of parasites on the scalp, suppressed cell-mediated immunity and successful cure of mange by ivermectin.
Lymphangiosarcoma is an uncommon vascular tumor that usually develops in chronic lymphedema. The etiology of lymphangiosarcoma remains unknown. It develops mainly after mastectomy, in association with chronic lymphedema (Stewart-Treves syndrome), or after radiotherapy. The early diagnosis of this aggressive tumor is important, as it has a high risk of local recurrence and metastasis. Stewart-Treves syndrome occurs in 0.5% of patients who survive mastectomy for more than 5 years. The mean age at appearance of the angiosarcoma is 62 years, and the mean interval between mastectomy and the appearance of the tumour is 10.5 years. Only two cases have been reported in men following mastectomy. We present a 70-year old male patient with lymphangiosarcoma which developed three and a half years after the diagnosis of breast carcinoma. The patient underwent mastectomy of the right mammary gland with ipsilateral axillary lymph node dissection and had postoperative chemo-and radiotherapy.
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