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While localized variants of granuloma annulare are typically self-limited, disseminated granuloma annulare tends to be chronic and often therapy-resistant. Treatment with fumaric acid esters is effective for severe forms of psoriasis. Disseminated granuloma annulare has also been reported to respond to fumaric acid esters. We treated 8 patients (mean age 64.2 years; 4 men, 4 women) with low-dose fumaric acid esters for 1-18 months. One patient showed complete clearance, 4 marked improvement, one slight to moderate improvement and one no response. One patient discontinued treatment due to nausea after one month and another stopped it after 18 months. Five out of 8 patients tolerated the treatment well. Six patients developed transient, mild leucopaenia and one eosinophilia. None of these blood abnormalities necessitated discontinuation of therapy. Low-dose fumanc acid esters significantly improve disseminated granuloma annulare in approximately 63% of patients. Larger, controlled, prospective studies are needed to evaluate its efficacy and safety in this setting. [ABSTRACT FROM AUTHOR]

A 69-year-old man presented with multiple livid maculae and infiltrated urticarial plaques, as well as elevated liver enzymes. Based on typical clinical picture, histopathology and positive PCR from a skin biopsy, we diagnosed an early disseminated infection with Borrelia afzelii presenting with multiple erythema migrans (erythemata migrantia) and a subclinical hepatitis. During antibiotic treatment with intravenous ceftriaxone, the maculae and plaques vanished almost completely and the liver enzymes decreased within 14 days. Dermatologists should keep in mind that early disseminated borreliosis can present with multiple erythema migrans and hepatitis. [ABSTRACT FROM AUTHOR]

The article offers information on a study related to the treatment of several severe skin disorders including acne vulgaris, acne conglobata and acne fulminas, with low dose of the drug Isotretinoin. The results of the study showed that low dose Isotretinoin helped in the improvement of skin lesions along with mild side effects like dryness on lips and skin.

The article presents case study of an 86-year-old woman who was reported to have purulent scalp lesions for approximately and was diagnosed with perifolliculitis capitis abdesce et suffodiens (PCAS). The administration of topical corticosteroids, and systematic amoxicillin and clavunalic acid produced no improvement in the patient. It further outlines the daily treatment with acitretin, prednisolone, tacrolimus, and oral zinc which proved total healing within 11 days.

The article presents a quiz which centers on the case of an 11 year old male subject who developed a facial butterfly rash and asks readers to develop a diagnosis for the rash.

The article presents a case study of a woman with brownish maculae on the tibial side of the left lower leg which was diagnosed as necrobiosis lipoidica (NL), a chronic granulomatous inflammatory disease of skin. The patient underwent skin biopsy showed granulomatous inflammation involving the entire corium and the upper subcutaneous fat tissue with homogenous necrobiosis lined by epithelioid histiocytes. The NL patient was treated with clofazimine, a rhinophenatine dye.

A letter to the editor is presented which discusses a medical case study of a 28-year-old woman, illustrating the diagnosis and treatment of her acquired haemophilia.

A letter to the editor is presented about a case of a 60-year-old man with pyoderma gangrenosum who developed septic shock during treatment with infliximab.

A letter to the editor is presented in response to the article "Metastasizing Squamous Cell Carcinomas in a Patient Treated With Extracorporeal Photopheresis for Cutaneous T-cell Lymphoma," that was published in the March 7, 2007 issue.

A letter to the editor is presented in response to the article on the treatment of keratosis lichenoides chronica with bath-PUVA, published in the previous issue.

A letter to the editor is presented in response to an article about the treatment of azole-resistant mucocutaneous candidosis with caspofungin.

A letter to the editor is presented in response to an article about the growth of dystrophic epidermolysis bullosa due to glycine susbtitution mutation in the COL7A1 gene.