INTENSE PULSED LIGHT (IPL) TREATMENT FOR DUPILUMAB INDUCED OCULAR SURFACE DISEASE (DIOSD)

PurposeTo report a case of dupilumab induced ocular surface disease (DIOSD) managed with intense pulsed light (IPL) as an effective adjunct therapy to topical steroids and topical immunomodulator lifitegrast.MethodsDiscussion of a patient’s case with accompanying anterior segment and meibography photos with diagnosed DIOSD for which adjunct therapy with IPL was an effective treatment after limited relief from and difficulty with adherence to traditional treatment with topical steroids and lifitegrast ophthalmic solutions. ConclusionThis case demonstrates the complexity of management required to treat patients with DIOSD and its chronic nature. IPL as a nonpharmaceutical adjunct therapy to topical steroids and immunomodulators in the treatment of DIOSD showed improved signs and symptoms of DIOSD.

EBV Reactivation in A Case of DRESS Syndrome Associated with Lamotrigine – A Case Report

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, T-cell mediated hypersensitivity reaction that develops secondary to a drug reaction. Several drugs have been associated with DRESS syndrome, most commonly carbamazepine. The mechanism is not clearly understood. It is a life-threatening condition that can present with skin rash, hematologic abnormalities, lymphadenopathy, and organ failure. Case Presentation: The authors report a case of 43-year-old gentleman who developed DRESS syndrome secondary to lamotrigine and was found to have EBV reactivation. Patient was managed with supportive care; topical steroids and the culprit drug were discontinued. He had full recovery almost 2 weeks following treatment. DRESS syndrome can occur 2 weeks following exposure to an offending drug in susceptible individuals. Conclusion: Lamotrigine and EBV reactivation are not frequently reported in patients with DRESS syndrome. Therefore, physicians should be vigilant about this rare drug related hypersensitivity reaction in order to prevent life threatening complications.

Epidemiology, Comorbidities, and Prescription Patterns of Korean Prurigo Nodularis Patients: A Multi-Institution Study

Prurigo nodularis (PN) is a chronic dermatosis typified by extraordinarily itchy nodules. However, little is known of the nature and extent of PN in Asian people. This study aimed to describe the epidemiology, comorbidities, and prescription pattern of PN in Koreans based on a large dermatology outpatient cohort. Patients with PN were identified from the Catholic Medical Center (CMC) clinical data warehouse. Anonymized data on age, sex, diagnostic codes, prescriptions, visitation dates, and other relevant parameters were collected. Pearson correlation analysis was used to calculate the correlation between PN prevalence and patient age. Conditional logistic regression modeling was adopted to measure the comorbidity risk of PN. A total of 3591 patients with PN were identified at the Catholic Medical Center Health System dermatology outpatient clinic in the period 2007–2020. A comparison of the study patients with age- and sex-matched controls (dermatology outpatients without PN) indicated that PN was associated with various comorbidities including chronic kidney disease (adjusted odds ratio (aOR), 1.48; 95% confidence interval (CI), 1.29–1.70), dyslipidemia (aOR, 1.88; 95% CI, 1.56–2.27), type 2 diabetes mellitus (aOR, 1.37; 95% CI, 1.22–1.54), arterial hypertension (aOR, 1.50; 95% CI, 1.30–1.73), autoimmune thyroiditis (aOR, 2.43; 95% CI, 1.42–4.16), non-Hodgkin’s lymphoma (aOR, 1.95; 95% CI, 1.23–3.07), and atopic dermatitis (aOR, 2.16, 95% CI, 1.91–2.45). Regarding prescription patterns, topical steroids were most favored, followed by topical calcineurin inhibitors; oral antihistamines were the most preferred systemic agent for PN. PN is a relatively rare but significant disease among Korean dermatology outpatients with a high comorbidity burden compared to dermatology outpatients without PN. There is great need for breakthroughs in PN treatment.

Microsporidia-induced stromal keratitis: a new cause of presumed immune stromal (interstitial) keratitis

Background and objectiveTo describe the clinical features, diagnosis and management of immune stromal keratitis/interstitial keratitis (IK) associated with microsporidial epithelial keratitis.MethodsBetween October 2020 and January 2021, medical records of IK patients microbiologically proven as microsporidia from samples collected from corneal epithelium on smear examination, and/ or molecular analysis were reviewed. Demography, clinical profile and treatment were analysed. Real-time PCR (RT-PCR) for adenovirus (ADV), Epstein-Barr virus (EBV), herpes simplex virus (HSV) and varicella-zoster virus (VZV) was done.ResultsTwenty of 152 (13%) microbiologically proven cases of microsporidial keratitis were diagnosed as IK during the study period, the mean age and duration of symptoms were 35.7±11.4 years and 46.3±27.7 days, respectively. Half had predisposing risk factors, like trauma; and 30% had prior recurrences. One-fourth of patients were using antivirals on presentation. Characteristic presentations included disciform keratitis(n=12), incomplete/complete ring(n=5), and combination(n=3), along with variable subepithelial infiltrates (n=14). All cases had stromal oedema, with an intact epithelium and fine pigment dusting on endothelium. Corneal epithelial scrapings had scanty microsporidia spores in smears of 17/20 (85%), and pan-microsporidial DNA was identified in 14/20 (70%), with Vittaforma corneae by sequencing in 11/20 (55%). Other viruses detected were ADV (14,70%), VZV (2,10%), EBV (1,5%) and HSV (1,5%). Rapid resolution of inflammation and oedema within 2 weeks of starting steroids was seen in all cases.ConclusionMicrosporidia epithelial keratitis induced stromal inflammatory keratitis; is distinguished from microsporidial keratoconjunctivitis and stromal keratitis, by characteristic clinical features, and response to topical steroids.

Local immunosuppression in WZS-pig to rhesus monkey Descemet’s stripping automated endothelial keratoplasty: An innovative method to promote the survival of xeno-grafts

Corneal xenotransplantation is an effective solution for the shortage of human corneas. We investigated the feasibility and efficacy of different postoperative protocols on xeno-Descemet's stripping automated endothelial keratoplasty (DSAEK) grafts. Thirty rhesus monkeys were randomly divided into three groups: control group (C), only Descemet's membrane (DM) stripping; DSAEK 1 (D1) and DSAEK 2 (D2) groups, DM stripping followed by endothelial keratoplasty. Betamethasone 3.5 mg was subconjunctival injected in groups control and D1 postoperatively, while animals in group D2 were treated with topical 0.1% tacrolimus and topical steroids. All groups were evaluated by slit-lamp microscopy, anterior segment OCT and LSCM for at least nine months. A total of 24 monkeys (24 eyes) met the inclusion criteria. Nine months after DSAEK surgery, all xenografts showed good attachment, and most corneas were transparent. Graft rejection occurred in 25% of the cases in group D1 and 28.57% of those in group D2 (P > 0.05). The corneal endothelium density in the DSAEK groups was 2715.83±516.20/mm² (D1) and 2220.00 ± 565.13/mm² (D2) (P > 0.05). Xenogeneic corneal endothelial grafts can survive and function in rhesus monkey eyes for a long time with subconjunctival steroid or topical tacrolimus and steroid treatment.

What do Patients Use for Treating Their Oral Ulcers? And How do these Treatments Affect Their Quality of Life?

Objectives: Oral ulceration forms a major category of oral lesions. Due to its effect on the quality of life, the patients seek treatment using various substances. This study investigated the types of treatments used by a sample of patients having all types of oral ulcers and its positive and negative effects on the patients' lives. Methods: This cross-sectional study included patients having different types of oral ulcers. Participants provided information about their previous treatments, the source of recommendation of its use and side effects linked to them. They filled the oral health impact profile-14 questionnaire to report the change in their quality of life after treatment. The patients' educational and social levels were tested as predictors for the use of non-conventional treatments. Results: Correct pharmaceutical treatments were administered y 34% of the participants; the most effective of which were systemic and topical steroids by ulcerative oral lichen planus patients; and vitamin supplements in recurrent aphthous stomatitis patients. The majority (64.2%) of the previously treated patients used non-conventional treatments, the most widely used of which was Tahini. Half of the patients using non-conventional treatments suffered side effects. The source of information of the self-medication was attributed mainly to the patients themselves, followed by friends and family members. Conclusion: This study reflects the widely spread habit of self-medication in our sample of patients having oral ulcers. It highlights the negative influence of these remedies.

Review of Corticosteroid Use in Pediatric Cataract Surgery

Introduction: Following pediatric cataract surgery, an intense inflammatory response is related to various complications, including posterior capsule opacification (PCO), which is a visually threatening incidence that can lead to visual axis opacification (VAO). Although corticosteroids are essentially effective in reducing inflammation, potential ocular side effects are a remaining concern. Objective: This study aimed to review the efficacy and safety of corticosteroid drugs and their administration routes in pediatric patients who underwent cataract surgery Methods: A literature search was conducted from four electronic databases using keywords selected a priori. Identified articles were sorted according to the type of corticosteroid used, route of administration, and outcome measures, including inflammatory response and ocular side effects. Results: Five studies were included with one case series, one retrospective case-control, and three clinical trials. The total number of subjects was 311 patients, with an age range of six weeks to 15 years old. Four studies analyzed the use of triamcinolone acetonide intracamerally, which was superior to topical steroids. Most of the studies reported a decrease in inflammatory parameters. The outcome of PCO and VAO varied between studies. Nearly all the studies observed elevated intraocular pressure (IOP) as an ocular side effect. Conclusion: Various corticosteroids and different delivery routes can be used to ameliorate inflammation in pediatric cataract surgery. However, there is promising evidence suggesting intracameral steroids as substantially beneficial in reducing inflammatory parameters. Due to the limited number of studies reviewed, no firm conclusion regarding the superior steroid preparation or route of administration can be inferred. This review highlights the need for further studies.

Mentha arvensis Essential Oil Exerts Anti-Inflammatory in LPS-Stimulated Inflammatory Responses via Inhibition of ERK/NF-κB Signaling Pathway and Anti-Atopic Dermatitis-like Effects in 2,4-Dinitrochlorobezene-Induced BALB/c Mice

The mechanism of atopic dermatitis (AD) is modulated by the release of cytokines and chemokines through the mitogen-activated protein kinase (MAPK)/nuclear factor-kappa B (NF-κB) signaling pathway. Topical steroids are used to treat AD, but some people need safer anti-inflammatory drugs to avoid side effects. Mentha arvensis has been used as a herbal plant with medicinal properties, but its anti-inflammatory effects have not been elucidated in an AD model. In this study, we investigated the anti-inflammatory effects of M. arvensis essential oil (MAEO) and its underlying molecular mechanism in lipopolysaccharide (LPS)-stimulated RAW 264.7 macrophages and HaCaT cells (human epidermal keratinocyte). Additionally, we examined the ameliorating effects of the MAEO in a dinitrochlorobenzene (DNCB)-induced murine model of AD. We found, in both RAW 264.7 cells and HaCaT cells, MAEO inhibited LPS-stimulated inflammatory mediators such as nitric oxide (NO) and prostaglandin E2 and proinflammatory cytokines, including IL-1β and IL-6, due to the suppression of COX-2 and iNOS expression. In LPS-stimulated macrophages, we also observed that MAEO inhibited the phosphorylation of ERK and P65. Furthermore, MAEO treatment attenuated AD symptoms, including the dermatitis score, ear thickness, epidermal thickness and infiltration of mast cells, in a DNCB-induced animal model of AD. Overall, our findings suggest that MAEO exerts anti-inflammatory and anti-atopic dermatitis effects via inhibition of the ERK/NF-κB signaling pathway.

Symmetrical Drug-related Intertriginous and Flexural Exanthema (Baboon Syndrome)

Baboon syndrome, also called symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), is an erythematous maculopapular rash that presents in skin folds in a symmetrical pattern. This condition may develop after the patient starts a particular agent. Treatment consists of stopping the associated trigger and medicating with topical or systemic corticosteroids. A 30-year-old man with odynophagia, otalgia and fever was prescribed amoxicillin. He developed erythematous and pruriginous lesions in the cubital fossa and inguinal regions. He attended the emergency department (ED) where he was prescribed penicillin. Lesions continued to progressively worsen with a bilateral symmetrical pattern in the axillary region and later in the nape folds, popliteal regions, and on the perineum and buttocks. The patient presented to the ED for a second time, where he was diagnosed with baboon syndrome and prescribed topical steroids with clear improvement.