Search

Background: Intravenous immunoglobulins (IVIG) have been increasingly used for various inflammatory dermatoses with success. Small case series and case reports suggest a role for IVIG in the management of refractory pyoderma gangrenosum (PG). Objective: The objective was to study the characteristics of PG patients treated with IVIG and the efficacy and safety of IVIG for patients with refractory PG. Methods: An analysis was performed of all patients with PG treated with IVIG from 2012 to 2022 at an Australian tertiary hospital seeing a high volume of PG patients. Results: We identified 12 patients, 9 females and 3 males, with median age of 61 years (29–77) at IVIG commencement. All patients were taking systemic corticosteroid therapy prior to IVIG treatment, and all had been treated with a steroid‐sparing agent—including ten patients who had been treated with a biologic agent. IVIG was used with corticosteroids in one patient, concurrently with a steroid‐sparing agent in nine patients and with a biologic agent in eight patients. Eleven patients demonstrated treatment response to IVIG—six with excellent response and five with good response. Three patients had complete healing of their most active ulcer. One patient did not respond to IVIG. Nine patients were able to wean their prednisolone dose and one patient was able to cease prednisolone. Four adverse events were recorded, and only one patient had to cease treatment due to aseptic meningitis and headaches. Conclusion: Our experience suggests that IVIG may be an efficacious treatment for patients with refractory PG due to its pleiotropic and immunomodulatory effects, particularly for patients with malignancy or other systemic conditions where high‐dose immunosuppressive agents are contraindicated. [ABSTRACT FROM AUTHOR]

Lymphocytic thrombophilic arteritis and Sneddon syndrome can have very similar clinical presentations with chronic persistent widespread blanchable livedo racemosa. Lymphocytic thrombophilic arteritis has only recently been described and generally is associated with a benign prognosis. Sneddon syndrome is associated with the development of multiple cerebrovascular accidents and progressive neurological impairment. We present three cases of Sneddon syndrome and compare them with lymphocytic thrombophilic arteritis to identify patients at risk of neurological events. [ABSTRACT FROM AUTHOR]

Abstract: We describe three patients who presented with a striking erythematous non‐blanching annular eruption and features of lymphocytic thrombophilic arteritis (LTA), with a prominent lymphocytic vasculitis involving deep dermal vessels. Lymphocytic inflammation was also evident in the superficial vessels and one patient had small superficial ulcers over the ankle area resembling livedoid vasculopathy (LV). Multiple biopsies demonstrated a persistent absence of neutrophils in the infiltrate consistent with a lymphocytic process. In addition to highlighting the annular morphology as a novel presentation of LTA, these cases suggest a possible relationship between LV and LTA and support the notion that they are distinct from neutrophilic vasculitides such as cutaneous polyarteritis nodosa. [ABSTRACT FROM AUTHOR]

Nodular vasculitis (NV) refers to a chronic relapsing lobular panniculitis that is thought to be a hypersensitivity reaction to antigenic triggers. While it is commonly associated with tuberculosis, in many cases no underlying cause is found and the condition is difficult to manage. Here, we report three patients with refractory idiopathic NV effectively treated with colchicine, leading to a significant improvement or complete resolution of their symptoms. Colchicine was successfully used as a steroid-sparing agent, and in one patient its cessation was associated with a flare of disease. [ABSTRACT FROM AUTHOR]

The article focuses on a study which sought the views by general practitioners (GPs), pharmacists, and consumers in Australia on pharmacists' integration into general practice. The study used a questionnaire to get their opinions on the issue. Results revealed that 92% of pharmacists, 67% of GPs, and 73 % of consumers agreed on the need for pharmacists to have an active role in general practice.

Political deviance is a broad concept, less frequently invoked than the concept of political crime. It can be perpetrated by those in power, in the name of the state or individually, or by those struggling to effect social change. The focus on the latter brings to the fore two types of movements, terrorism and civil disobedience, with their partial similarities in goals and their apparent dissimilarities in the means employed to achieve these goals. Both groups tend to assume responsibility for their acts, although for different reasons. The assumption of responsibility itself is a clouded and sometimes ambiguous notion, both linguistically and in its ramifications in the political arena. [ABSTRACT FROM AUTHOR]