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FIG 2: Histology of a splenic hamartoma, showing the exclusive presence of red pulp tissue on the left hand side, without associated white pulp follicles, as can be seen on the right hand side, which shows normal adjacent splenic tissue. Haematoxylin and eosin. x 100 FIG 1: Splenic hamartomas, identified during laparotomy as several discoloured nodules protruding above the capsular surface of the slightly enlarged spleen FIG 3: Immunohistochemistry of a splenic hamartoma, showing positive staining for antibody CD31 in the endothelial cells of the vessels. Avidin-biotin complex method. x 100

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Allergic contact dermatitis (ACD) is a type IV, delayed‐type reaction caused by skin contact with low‐molecular‐weight organic chemicals and metal ions that activate antigen‐specific T cells, primarily T‐helper 1 (Th1), in a sensitized individual, leading to skin eczema.First‐line treatments are based on avoidance of causal agents and topical corticosteroids/immunomodulators. In recalcitrant cases, chronic oral immunosuppressive agents may be used, but they may have serious adverse effects and do not address the immunological disfunction. We report a case of severe ACD, unresponsive to topical or oral immunosuppressive therapy, which resolved itself after treatment with teriflunomide (TF) 14 mg/daily used for multiple sclerosis. TF is a once‐daily, oral selective and reversible dihydroorotate dehydrogenase inhibitor, revealing a new treatment option for ACD.

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