Successful treatment of eosinophilic pustular folliculitis with topical tacrolimus

[A prospective study of the efficacy and safety of maintenance therapy with recombinant human thrombopoietin in patients with primary immune thrombocytopenia: a multicenter study]

Objective: To evaluate the efficacy and safety of maintenance therapy with reduced dose of rhTPO in the patients with primary immune thrombocytopenia (ITP) who attained stable platelet (PLT) counts after daily administration of rhTPO. Methods: Treatment was started with a daily administration of rhTPO (300 U/kg) for 2 consecutive weeks. Patients who attained stable PLT≥50×10(9)/L were enrolled to maintenance therapy starting with every other day administration of rhTPO, then adjusted dose interval to maintain platelet count (30-100) ×10(9)/L. Results: A total of 91 eligible patients were enrolled. Fourteen patients discontinued the study due to noncompliance (12/14) and investigator decision (2/14) . Among 77 patients who completed the study, 38 patients with the administration of rhTPO at every other day or less could maintain PLT≥30×10(9)/L for 12 weeks. The percentage of patients with a platelet response (PLT≥30×10(9)/L) at 4(th) week, 8(th) week and 12(th) week of maintain therapy was 92.6% (63/68) , 82.7% (43/52) and 85.0% (34/40) , respectively. Median platelet counts remained in the range of (70-124) ×10(9)/L. The overall incidence of rhTPO-related adverse events was 7.7%. All the adverse events were generally mild. Conclusion: Extending the dose interval of rhTPO is feasible to maintain stable platelet count in the patients with ITP, but the optimal dose interval is uncertain and might vary with individuals.

[Clinical analysis of recombinant human thrombopoietin for 92 adults with severe primary immune thrombocytopenia]

目的

评价重组人血小板生成素（rhTPO）治疗成人重型原发免疫性血小板减少症（ITP)的疗效及安全性。

方法

对2012年5月至2014年5月期间收治的92例成人重型ITP患者的临床资料进行回顾性分析。其中新诊断ITP 7例、持续性ITP 29例、慢性ITP 56例，男35例、女57例，中位年龄34 (18~65）岁。全部患者接受rhTPO 300 U·kg⁻¹·d⁻¹×14 d治疗，停药后观察7 d。

结果

全部92例患者rhTPO治疗的总反应率为60.9%(56/92)，新诊断ITP、持续性ITP、慢性ITP患者总反应率分别为71.4%、62.1%、58.9%。所有患者治疗第4、7、14天与停药第7天中位PLT分别为27(5~49)、65(16~138)、133 (28~208)、67(15~134)×10⁹/L。获完全反应的患者PLT达到100×10⁹/L的中位时间为6(5~7)d, PLT达峰值中位时间为11(5~17)d，中位PLT峰值为194(132~274)×10⁹/L。患者性别、年龄、疾病分期、血小板膜糖蛋白特异性抗体表达及外周血CD19⁺B、CD3⁺CD4⁺T、CD3⁺CD8⁺T淋巴细胞数量均与疗效无相关性(P>0.05)。少数患者出现低热、肌肉酸痛、乏力、头晕，均自行恢复。

结论

rhTPO治疗成人重型ITP具有较好的疗效和安全性。

[Efficacy and safety of rhTPO in the treatment of pediatric primary immune thrombocytopenia]

目的

观察重组人血小板生成素（rhTPO）治疗儿童原发免疫性血小板减少症（ITP）的疗效及安全性。

方法

回顾性分析2006年12月至2014年9月接受rhTPO治疗（rhTPO组）的41例儿童ITP患者临床资料，与同期接受长春地辛联合静脉丙种球蛋白治疗（对照组）的26例ITP患儿进行对比观察。

结果

全部67例ITP患儿中男31例、女36例，中位年龄10.0(1.6~17.0）岁；新诊断ITP 19例，持续性ITP 18例，慢性ITP 30例；重症ITP(PLT<10×10⁹/L) 43例。rhTPO组与对照组总有效率差异无统计学意义[68.29%（28/41）对65.38%（17/26），P=0.806]。rhTPO组与对照组新诊断ITP、持续性及慢性ITP患儿总有效率差异均无统计学意义（P值分别为0.320和0.763）。rhTPO组与对照组重症ITP患儿总有效率差异无统计学意义[56.67%（17/30）对61.54%（8/13），P=0.766]。rhTPO组与对照组治疗后PLT峰值、PLT>30×10⁹/L时间、PLT>50×10⁹/L时间差异均无统计学意义[52(7~608）×10⁹/L对40(3~152）×10⁹/L，P=0.05; 7(3~13) d对4(2~24) d，P=0.202; 7.5(4~15) d对5.5(4~23) d，P=0.557]。rhTPO组治疗后PLT升高值于对照组[43(3~605）×10⁹/L对32（−14~149）×10⁹/L，P=0.042]。两组患儿均无明显不良反应发生。

结论

rhTPO单药治疗儿童ITP的疗效与长春地辛联合静脉丙种球蛋白相当，安全性较好。

Eosinophilic pustular folliculitis (Ofuji's disease) without macroscopic pustules

BACKGROUND

Eosinophilic pustular folliculitis (EPF), first described by Ofuji et al. in 1970, is a rare dermatosis characterized by pruritic papules and pustules on circinate erythematous plaques with eosinophilic infiltration in and around the hair follicle.

METHODS AND RESULTS

We report three cases of EPF that showed no macroscopic pustules during the total observation period. Histopathological examination revealed eosinophilic infiltration in and around the hair follicle in the lower dermis and subcutis.

CONCLUSIONS

EPF consists of clinical variants, one of which lacks obvious pustules.

Assigning new roles to topical tacrolimus

Tacrolimus is an ascomycin macrolactam derivative with immunomodulatory and anti-inflammatory activity that belongs to the class of calcineurin inhibitors. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis in two concentrations, 0.03 and 0.1%. In a thorough research of literature the authors review all of the available data regarding the off-label uses of the medication in other dermatoses. It seems that compared to pimecrolimus, tacrolimus has proved to be a more effective treatment. There is no causal relationship that has been established between tacrolimus and carcinogenesis. Furthermore, the authors believe that, without any evidence, the theoretical concerns are not enough to produce warnings. Tacrolimus ointment 0.1% may be recommended as a first-line choice for seborrheic dermatitis of the face and trunk, facial and intertriginous psoriasis and probably for allergic contact dermatitis and Zoon's balanitis. It has been ineffective in numerous dermatoses such as alopecia areata, necrobiosis lipoidica, internal pruritus and in thick hyperkeratotic plaques of psoriasis when administered as the commercially available formulation without occlusion. There is yet unexploited therapeutic potential regarding the use of topical tacrolimus in dermatology. Isolated cases of successful administration of the medication in various cutaneous conditions require further large-scale studies to clarify the actual effectiveness.

Bullous eosinophilic cellulitis succession with eosinophilic pustular folliculitis without eosinophilia

Eosinophilic cellulitis is characterized clinically by an acute dermatitis resembling cellulitis with unknown etiology. Eosinophilic pustular folliculitis is also a rare inflammatory dermatosis characterized by recurrent crops of erythematous follicular papulopustules that coalesce to form annular plaques with unclear etiopathogenesis. We describe a 20-year-old white male who had vesiculobullous and plaque-like lesions on the hands and feet and was diagnosed with bullous eosinophilic cellulitis clinically and histologically without any etiological agents. Following therapy with oral corticosteroid and oral tetracycline capsules, the lesions disappeared. After a 2-month asymptomatic period, the patient developed pruritic follicular papules and pustules on the lower and upper extremities and upper back. Stool examination revealed Gierdia intestinalis eggs. The patient had complete clearance with treatment of ornidazol for 2 weeks and indomethacin for 2 months. This is the first report of bullous eosinophilic cellulitis coexisting with eosinophilic pustular folliculitis without eosinophilia in the English published work.