Multiple maxillary and mandibular cysts are principle features of basal cell nevus syndrome (Gorlin-Goltz). We present cases from an affected family in which magnetic resonance imaging (MRI) was helpful in evaluation of the cystic lesions. A middle ear anomaly was identified which may represent an additional abnormality associated with the syndrome.
Conflicts of interest:None declared.To the Editor, Narrowband UVB or TL-01 phototherapy is an effective treatment for psoriasis (1). The emitted wavelength range (311-313 nm) is optimal for antipsoriatic activity (2). A rare side effect of TL-01 phototherapy is the development of blisters on psoriatic lesions, during a treatment course. Herein, we report four such cases which were identified in our institution over a 5-month period and review all reported cases in an effort to better understand the pathogenesis of this phenomenon.
CASE 1A 23-year-old female with guttate psoriasis had received 18 treatments of TL-01 phototherapy with 20% incremental dosing as per standard protocol. Six hours after her 19th treatment session, she noted blistering within the margins of a treated psoriatic plaque on her left forearm. Her next TL-01 treatment was deferred and the bullae resolved within 48 h following twice-daily application of a moderately potent topical steroid. Phototherapy was continued with a reduction in dose increments to 10% and no further adverse events.
CASE 2A 36-year-old male on his second course of TL-01 photototherapy developed a blistering eruption after his 28th treatment session. The blisters were mildly pruritic and occurred within psoriatic plaques on his right arm, left arm and back. Phototherapy was held until the bullae resolved and recommenced with dose increments decreased to 10%. After the 37th treatment session, two further blisters developed in psoriatic plaques on the upper limbs at which time treatment was discontinued.
CASE 3A 59-year-old female had a history of four previous uneventful courses of TL-01 phototherapy for psoriasis. She developed a single bulla on a psoriatic plaque on the right hip after the 19th treatment session of TL-01 which resolved quickly. Further blistering occurred following her 22nd and 27th treatments despite reduction in dose increments initially to 10% and then 5%.
CASE 4A 24-year-old male noted bullae within a psoriatic plaque on his left forearm after the 14th treatment of his 4th treatment course of TL-01 (Fig. 1). The bullae resolved with twice-daily application of a moderately potent topical steroid and emollients. Phototherapy was continued thereafter without further adverse events.No new medications preceded blistering in any of the four cases. Three of the four patients had prior, uneventful courses of TL-01. When the lesional blistering was noted by the patients, they did not have increased erythema or blistering in nonaffected skin.
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