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This article discusses a case of leprosy in an immunocompromised traveler. The patient, a 63-year-old man from the Netherlands, presented with symptoms including burning pain, swelling, fatigue, and weight loss. He had a history of allergic asthma and hypereosinophilic syndrome and was taking immunosuppressive medication. The patient had traveled to Indonesia and Southern Africa in the past. Physical examination revealed hypopigmented macules and swollen ankles and feet. A skin biopsy confirmed the diagnosis of leprosy, and the patient was started on multidrug therapy. However, he passed away from a myocardial infarction before further investigation could be conducted. The article highlights the rarity of leprosy in travelers and suggests that the patient's immunosuppressive medication and travel history may have contributed to his infection. [Extracted from the article]

Various dermatological conditions have been reported during tumor necrosis factor (TNF)-alpha-blocking therapy, but until now no prospective studies have been focused on this aspect. The present study was set up to investigate the number and nature of clinically important dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis (RA). RA patients starting on TNF-alpha-blocking therapy were prospectively followed up. The numbers and natures of dermatological events giving rise to a dermatological consultation were recorded. The patients with a dermatological event were compared with a group of prospectively followed up RA control patients, naive to TNF-alpha-blocking therapy and matched for follow-up period. 289 RA patients started TNF-alpha-blocking therapy. 128 dermatological events were recorded in 72 patients (25%) during 911 patient-years of follow-up. TNF-alpha-blocking therapy was stopped in 19 (26%) of these 72 patients because of the dermatological event. More of the RA patients given TNF-alpha-blocking therapy (25%) than of the anti-TNF-alpha-naive patients (13%) visited a dermatologist during follow-up (P < 0.0005). Events were recorded more often during active treatment (0.16 events per patient-year) than during the period of withdrawal of TNF-alpha-blocking therapy (0.09 events per patient-year, P < 0.0005). The events recorded most frequently were skin infections (n = 33), eczema (n = 20), and drug-related eruptions (n = 15). Other events with a possible relation to TNF-alpha-blocking therapy included vasculitis, psoriasis, drug-induced systemic lupus erythematosus, dermatomyositis, and a lymphomatoid-papulosis-like eruption. This study is the first large prospective study focusing on dermatological conditions during TNF-alpha-blocking therapy. It shows that dermatological conditions are a significant and clinically important problem in RA patients receiving TNF-alpha-blocking therapy.

The exact role of epidermal fatty acid binding protein (E-FABP) in skin is unknown. A restoration of the barrier function may be associated with an upregulation of E-FABP. Moreover, E-FABP is upregulated in a variety of cells in response to oxidative stress. A recent observation that dithranol induced irritation is not associated with skin barrier impairment prompted us to investigate the expression of E-FABP in this skin condition to elucidate the unknown function of this protein in skin. This study shows lack of E-FABP upregulation after a single application of dithranol on uninvolved skin of patients with psoriasis. The expression of E-FABP in dithranol irritation correlates with the unimpaired skin barrier function as assessed by measurements of TEWL. Furthermore, we did not find evidence for the recently introduced hypothesis that E-FABP functions as an antioxidant protein in the skin irritation induced by dithranol as oxidative stressor.