Systemic Therapy

Bleomycin Tattooing as a Promising Therapeutic Modality in Large Keloids and Hypertrophic Scars

“…Bleomycin is a polypeptide antibiotic with antitumor, antibacterial, and antiviral activity. It has no immunosuppressive action, and its toxicity is confined to the skin and the lungs 18 It is effective against squamous cell carcinoma and induces remission in mycosis fungoid and other lymphomas. It has been used intralesionally for treatment of intractable warts.…”

Bilateral recurrent facial primary cutaneous nodular amyloidosis (PCNA)

“… 2 , 3 , 4 The fibrils of amyloid in PCNA are composed of immunoglobulin light chains of either kappa and/or lambda type, called “protein AL” and do not differ from those seen in primary systemic amyloidosis and in multiple myeloma. 5 , 6 Unlike in the more common forms such as macular and lichen amyloidosis where the amyloid is formed by degenerating keratinocytes, monoclonal plasma cells in PCNA produce and secrete the immunoglobulin kappa and lambda light chains through an unknown mechanism. 2 , 4 , 7 …”

“…There is extensive and diffuse amyloid deposit in deeper parts of the dermis, subcutaneous tissue, and the small dermal blood vessels unlike in the more common forms such as macular amyloidosis and lichen amyloidosis. 2 , 4 , 5 , 8 , 10 All of the amyloid material appears as homogenous and eosinophilic in hematoxylin-eosin stain and shows up as a pinkish amorphous mass in more specific stains such as Congo red.…”

“…It is imperative to rule out systemic involvement because morphologically identical lesions are found both in primary and systemic amyloidosis. 2 , 5 , 6 There is a strong body of evidence to suggest a genetic basis to development and progression of amyloidosis. Mutations such as oncostatin M receptor-beta on chromosome 5p13.1 and/or interleukin-31 receptor A on the same chromosome have also been documented.…”

The importance of accurate dosage of topical agents: a method of estimating involved area and application to calcipotriol treatment failures

“…This may be because the doctor is unsure of the quantities of ointment or cream required. The standard British Dermatology reference book 19 recommends 100 g /week of 'a topically applied drug' as the quantity needed to treat the whole body for 1 week with a 'sparing' application and 250 -500 g for 'liberal' application, although no mention is made of the frequency of treatment. The British National Formulary (BNF) 20 suggests suitable quantities of ointment and cream for specific body sites, which can be calculated to amount to 605 -805 g for a whole body treatment twice daily for 1 week.…”