Wet‐wrap therapy combined with compound glycyrrhizin and oral antihistamines as a therapy option for two cases of papuloerythroderma of ofuji

Abstract

Papuloerythroderma of Ofuji (PEO) is a rare erythroderma with "deckchair" sign, and there is no specific treatment yet. Here, we present two cases of PEO, which are responsive to wet-wrap therapy (WWT) combined with Compound Glycyrrhizin and oral antihistamines.Case one, a 72-year-old Chinese male who had generalized pruritic rashes for 1 month. He had cerebrovascular stenosis for 4 years.Dermatological examination showed a wide range of erythema, covering more than 80% of the body surface, which was characterized by the solid and flat-topped papules except for the skin folds, presented as the "deck-chair" sign (Figure 1A), combined with palmoplantar keratoderma (Figure 1D). Laboratory tests showed leucocytosis (15.34 Â 10 9 /L), eosinophilia (18.3%; 2.8 Â 10 9 /L), and IgE (466.6 IU/ml). The complete screening for internal malignancy was unrevealing. Skin biopsy showed epidermal hypertrophy, and infiltration of perivascular inflammatory cells in the superficial dermis, consisting of lymphocytes, histiocytes, and eosinophils (Figure 1F,G).Case two, an 85-year-old Chinese male who had generalized pruritic rashes on the trunk after a liver cancer operation 2 years ago, and the lesions spread to the whole body for 3 months. He had hypertension and hyperlipemia for 20 years. The clinical manifestation (Figure 1H) was similar to case one. Laboratory tests showed eosinophilia (11.5%, 0.76 Â 10 9 /L), IgE (763.0 IU/ml), and ANA (1:80). The patient was followed up for more than 2 years without recurrence. They all denied medical history of skin diseases and lymphadenopathy.Treatment protocol: patients were treated with WWT (2 h, BID) for 1 week (Figure 1J). From day 8, the patients used topical halometasone (BID) without WWT. Compound Glycyrrhizin (40 ml, ivgtt, QD) F I G U R E 1 Skin lesions of the trunk (A) and the palm (D) before the treatment of case one, showed a wide range of erythema with the "deckchair" sign and palmoplantar keratoderma. Skin lesions of case one at 3 days after the treatment (B) and 21 days after the treatment (C). Dermoscopic examination of papules of case one showed multiple red dots, surrounded by whitish halos (E). Histopathology of skin lesions of case one: epidermal hyperplasia; some inflammatory cells, including lymphocytes, histiocytes, and eosinophils were present in the dermis, with prominent perivascular infiltration (HE staining, F: 100Â; G: 400Â). Clinical manifestations of case two before the treatment (H) and 7 days after the treatment (I). Case one with WWT (J). WWT used 0.05% Halometasone cream (Ao Neng ® . Batch No. 1601508). Patients applied Halometasone cream (Daily dose: 30 g) on the lesions first, and then used Vaseline jelly (Daily dose: 100 g). After that, a set of the cotton longsleeved sweatshirts and pants, were soaked in warm water, squeezed dry, and worn by the patients. This set of damp clothing was overlaid with a second, dry set of cotton clothing, lasting for 2 h, and adjusted the course of treatment was according to the condition. WWT, Wet-wrap therapy.

Efficacy and safety of compound glycyrrhizin in combination with conventional therapy in treatment of vitiligo: A systematic review and meta-analysis of randomized controlled trials

“…After remove of duplicates, title and abstract screening, and full-text assessment, 39 eligible RCTs enrolling 3994 participants with vitiligo were evaluated in our meta-analysis. [26–64] The selection process is shown in Figure 1. The included trials were carried out in China and published in the Chinese language from 2005 to 2021, except one published in English.…”

“…A meta-analysis including 7 trials [47][48][49][50][51][52][53] revealed that combination therapy of CG and TCM was better than TCM alone in terms of repigmentation > 50% (RR = 1.38, 95% CI: 1.21-1.57, P < .001), there was no heterogeneity (I 2 = 0%), as shown in Figure 5.…”