Erythema nodosum leprosum (ENL) may uncommonly present before treatment in patients with multibacillary leprosy. Atypical manifestations are known in ENL and may be clinically misleading. Such wide variations in the clinical presentation of leprosy in reaction make histopathology an important tool for supporting clinical diagnosis. We report bullous ENL presenting as the first manifestation of leprosy in a 30-year-old Indian man diagnosed using histopathology.
Background and Objectives The emergence of resistant strains of Cutibacterium acnes can limit the efficacy of currently approved antibiotics for acne. VB-1953 is a next-generation antibiotic that exerts a bactericidal effect on resistant C. acnes. In this study, we investigated the safety, tolerability, and efficacy of VB-1953 topical gel in patients with moderate to severe acne having clindamycin-resistant C. acnes. Methods An investigator-initiated, open label, single-arm clinical study was conducted in patients with moderate to severe facial acne vulgaris showing poor or no response to previous clindamycin treatment. Nineteen subjects were enrolled in the study based on laboratory screening for the presence of clindamycin-resistant C. acnes in acne swab samples collected from patients. VB-1953 2% gel was applied on the entire face twice daily over 12 weeks. The primary efficacy endpoints were absolute changes in inflammatory and noninflammatory lesion counts from baseline at week 12, while the secondary efficacy endpoint was the proportion of subjects achieving Investigator Global Assessment success (score of 0 or 1) or a grade 2 or higher improvement from baseline at week 12. The presence and severity of local skin reactions (erythema, edema, scaling/ dryness, burning/stinging, pruritus) were evaluated for safety. Additionally, the detection and quantification of drug-resistant C. acnes strains were performed in the laboratory using acne swab samples collected from patients. Results The occurrence of treatment-emergent adverse events or changes in vital signs, physical examinations, and urinalysis for any of the patients during the course of the entire study were clinically insignificant. Topical application of 2% VB-1953 topical gel resulted in a significant reduction of mean absolute inflammatory and noninflammatory lesion counts by 53.1% and 52.2%, respectively (p < 0.0001 for both), with an Investigator Global Assessment success of 26.3% at week 12 compared with baseline. Resistant bacteria were reduced by (94.3 ± 1%; p < 0.05) within 12 weeks of treatment with VB-1953. Conclusion These results indicate that VB-1953 topical gel can be a safe and effective therapy for moderate to severe acne with underlying resistant C. acnes in subjects who had not responded to previous antibiotic treatments. Key PointsThe efficacy and safety of the bactericidal antibiotic VB-1953 (2%) topical gel was evaluated for acne treatment in an investigator-initiated, open-label, single-arm study in acne patients who did not respond to or showed poor response to previous clindamycin treatment and had clindamycin-resistant Cutibacterium acnes.In the era of emerging antimicrobial resistance, the selection of VB-1953 for acne treatment can play a key role in improving clinical outcomes in acne patients and in public health.
We present a series of three kidney transplant patients developing epidermoid cysts after receiving oral tacrolimus for long‐term prevention of rejection of the allograft. Cyclosporin A has been known to show this cutaneous adverse drug reaction, but this is the first series of patients with epidermoid cysts following tacrolimus to the best of our knowledge.
Objective: To observe the clinical efficacy and evaluate the safety of using minocycline in the treatment of non-segmental vitiligo. Methods: A total of 48 patients with non-segmental vitiligo were divided randomly into two groups. The combination therapy group (23patients) were treated with minocycline capsule, compound glycyrrhizin capsule in oral administration and 308-nm excimer light local irradiation, and conventional therapy group (25patients) were treated with compound glycyrrhizin capsule in oral administration and 308-nm excimer light local irradiation. Both treatments were given for 24 consecutive weeks, and follow-up 6 months after completion of treatment. Then, Mean Vitiligo Area Scoring Index (VASI), repigmentation rate as well as Mean Vitiligo Disease Activity Score (VIDA) were used to comparatively asses the tested patients before and after the treatment in the form of photos. Results: Both groups showed a significant decline in mean VASI , mean VIDA and a obvious increase in repigmentation rate. The difference between the mean VASI and repigmentation rate in the two groups is statistically significant (P<0.05). However, mean VIDA scores was not statistically significant (P >0.05) at the end of treatment period. Conclusion: The combination therapy with minocycline reduced the mean VASI and increased the repigmentation rate of patients with unstable vitiligo. What's more, it was safe, effective and had a low adverse reaction. However, the combination therapy with minocycline failed to inhibit disease progression. 605Efficacy and safety of dupilumab in adolescent patients with moderate-to-severe atopic dermatitis Dupilumab (DPL) is approved for adults with moderate-to-severe atopic dermatitis (AD) inadequately controlled with topical therapy or when such treatment is inadvisable. Here, DPL safety and efficacy in adolescents are reported. In a phase 2a study (NCT02407756; n¼40), adolescents (12 to <18 years) received a single dose of DPL (2mg/kg or 4mg/kg) followed by 4 weekly doses. In a subsequent phase 3, open-label extension trial (OLE) (NCT02612454; n¼36), patients (pts) continued DPL (2mg/kg or 4mg/kg) weekly. Topical corticosteroids were allowed. Primary endpoints were concentrationetime profile (phase 2a) and rate of adverse events ([AEs] OLE). Secondary endpoints were % change in Eczema Area and Severity Index (EASI), and Peak Pruritus Numerical Rating Scale (PP-NRS); proportion of pts achieving !75% reduction in EASI (EASI-75); and Investigator's Global Assessment (IGA) score 0/1. In the OLE, DPL steady-state concentrations were consistent with those seen in adults. DPL was generally well tolerated. The most common AE was nasopharyngitis; there were no discontinuations due to AEs. Mean % changes in EASI were e66% and e70% for 2mg/kg and 4mg/kg at Week (Wk)12 (phase 2a) and e85% and e84% at Wk52 (OLE). Mean % changes in PP-NRS were e31% and e38% at Wk12, and e68% and e66% at Wk52. At Wk12, 55% and 40% of pts in the 2mg/kg and 4mg/kg groups achieved EASI-75, and 88% and 78% at Wk52. 10% and 3...
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