爱若华在皮肤科其他疾病的应用介绍.doc

Successful treatment of recalcitrant eczematous dermatitis with leflunomide. A. S. Boyd J Am Acad Dermatol. 2013; 69 3 : e148-149. Not all patients with eczematous dermatitis respond to conservative treatment, which means that systemic therapies or light therapy must be considered. Leflunomide may be of benefit in these patients. A 49-year-old healthy white woman presented with a 14-year history of eczematous dermatitis primarily affecting her hands and feet. Her condition fluctuated, with vesicles and bullae developing on the sides of her fingers and soles. Her plantar disease was variably incapacitating, with thickened, cracked, and painful skin, making walking difficult, leading to significant weight gain. She had been treated with high potency topical steroids, topical picrolimus, lactic acid and urea-containing creams, oral antibiotics, oral ketoconazole, and oral corticosteroids.None elicited more than temporary relief. A biopsy specimen of her left sole was obtained, and the histopathologic results were consistent with eczematous or atopic dermatitis. An intramuscular injection of triamcinolone 40 mg was unhelpful, as were topical coal tar and ichthammol.A patch test revealed allergies to fragrance mix, nickel sulfate, balsam of Peru, cobalt chloride, and cinnamaldehyde. Avoidance of these chemicals failed to result in improvement. The patient was prescribed mycophenolate mofetil 500 mg twice daily with only mild improvement. Because no relief had ensued after 4 months and the patient was anxious to pursue other options, the mycophenolate mofetil was discontinued and the patient was prescribed azathioprine 25 mg daily. Significant gastrointestinal upset ensued almost immediately, and she stopped taking azathioprine after 1 week. Because light therapy was impractical, leflunomide 20 mg daily was prescribed. After 1 month, her hands were largely disease-free and her feet had improved. After 2 months, her soles were essentially clear. After 5 months of therapy,