Our study supports earlier findings reporting the efficacy of low-dose MTX in CLE lesions, particularly in recalcitrant clinical courses. MTX treatment appears to be safe if patients are carefully selected and monitored, with particular attention to side-effects and contraindications.
Patch tests with an expanded European standard series and 20 different wound dressings revealed sensitization in 78% of all (36) patients. The charts of allergens were headed by ointment bases (wool wax alcohols sensitization in 33% of all patients; Amerchol L-101 19.4%; cetearyl alcohol 13.9%; propylene glycol 8.3%), followed by plant resins/ethereal oils (balsam of Peru 22.2%; colophony 13.9%, fragrance mix 8.3%; propolis 5.6%) and topical antibiotics (neomycin sulfate 16.7%, chloramphenicol 13.9%), while usually common sensitizers like metal salts were not found as often (nickel sulfate 16.7%; potassium dichromate 13.9%; cobalt chloride 5.6%). Sensitization to modern wound dressings was found in 8.3% (3 cases) and was caused by propylene glycol as an ingredient of hydrogels; no sensitization was found to hydrocolloids, alginates or polyurethane foams. The overall sensitization rate in 2nd degree CVI was nearly as high as in 3rd degree CVI, but sensitization to ointments, their additives and topical antibiotics was significantly higher in 3rd degree CVI. Significant differences in sensitization frequencies to individual allergens were found between male and female patients. Our investigation points out the high risk of sensitization in 2nd as well as 3rd degree CVI, especially to ointment bases and active principles of topical drugs. Even wound dressings may cause allergic contact reactions.
There is no consensus about an effective and safe treatment for patients with cutaneous lupus erythematosus (LE) who are refractory to antimalarials and/or low-dose oral glucocorticosteroids. Therefore, we retrospectively analyzed the clinical data and laboratory findings of 12 patients who received weekly administrations of 10-25 mg methotrexate (MTX). Previous treatment with antimalarials and/or glucocorticosteroids was not effective or had to be withdrawn because of side effects. Of 12 patients, ten showed improvement of their skin lesions; two patients did not respond to low-dose MTX; two patients cleared rapidly, and five other patients had long-lasting remissions of 5-24 months after stopping MTX treatment. A reduction of circulating autoantibodies was detected in five patients. In all patients, MTX was well tolerated subjectively and objectively. Weekly low-dose MTX is useful for the treatment of cutaneous LE, particularly in those cases which need long-term treatment and/or do not respond to standard therapeutic regimens.
Langerhans cell histiocytosis (LCH) can be a difficult therapeutic problem. We present a 40-year-old woman with a 4-year history of LCH who was successfully treated with low-dose methotrexate (20 mg weekly).
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