Papuloerythroderma of Ofuji is an uncommon dermatological disorder of unknown etiology and is characterized by a pruritic eruption of widespread confluent papules in vast sheets over the skin, but spares the skin folds (the so-called 'deck-chair' effect). We present a case of a patient with papuloerythroderma of Ofuji of unknown cause. Treatment with oral and topical corticosteroids, antihistamines, and narrow-band UVB phototherapy proved to be ineffective in helping the condition but considerable clinical improvement was obtained with cyclosporine.
Adrenal Cortex Hormones ; Cyclosporine* ; Histamine Antagonists ; Humans ; Phototherapy ; Skin

BACKGROUND: The efficacy and safety of cyclosporine for the treatment of chronic idiopathic urticaria (CIU) have been studied in numerous trials, but there have been few studies on the long-term effect of cyclosporine. OBJECTIVE: This study was aimed to assess the efficacy and safety of low-dose cyclosporine for treating CIU. Furthermore, its long-term effect on the natural course of CIU was investigated. METHODS: Thirty patients who suffered from persistent CIU despite conventional treatments received 2~3 mg/kg/day of cyclosporine for 12 weeks. The severity score was assessed by means of the urticaria activity score and the visual analogue score at baseline and at weeks 2, 4, 8 and 12. The safety assessments consisted of reporting the side effects and monitoring the laboratory parameters. After a follow-up period of at least 1 year, the patients were asked whether they had any remaining or new symptoms and whether they still used antihistamines or any other drugs. RESULTS: Twenty seven patients completed the trial medication, and the respective symptom scores significantly improved after 12 weeks. Four (14.8%) patients reported adverse events during the trial period, but the events were not severe enough to require withdrawal from the study. Of the twenty one patients who were followed for at least 1 year (range: 12~45 months) after the completion of cyclosporine administration, eight patients (38.1%) were symptom free, and seven patients (33.3%) used only antihistamines. CONCLUSION: This study shows that low-dose cyclosporine is an efficacious and safe treatment option for treating CIU. In addition, the preliminary results suggest that low-dose cyclosporine might be helpful for the long-term control of this disease.
Cyclosporine ; Follow-Up Studies ; Histamine Antagonists ; Humans ; Urticaria

BACKGROUND: The efficacy and safety of cyclosporine for the treatment of chronic idiopathic urticaria (CIU) have been studied in numerous trials, but there have been few studies on the long-term effect of cyclosporine. OBJECTIVE: This study was aimed to assess the efficacy and safety of low-dose cyclosporine for treating CIU. Furthermore, its long-term effect on the natural course of CIU was investigated. METHODS: Thirty patients who suffered from persistent CIU despite conventional treatments received 2~3 mg/kg/day of cyclosporine for 12 weeks. The severity score was assessed by means of the urticaria activity score and the visual analogue score at baseline and at weeks 2, 4, 8 and 12. The safety assessments consisted of reporting the side effects and monitoring the laboratory parameters. After a follow-up period of at least 1 year, the patients were asked whether they had any remaining or new symptoms and whether they still used antihistamines or any other drugs. RESULTS: Twenty seven patients completed the trial medication, and the respective symptom scores significantly improved after 12 weeks. Four (14.8%) patients reported adverse events during the trial period, but the events were not severe enough to require withdrawal from the study. Of the twenty one patients who were followed for at least 1 year (range: 12~45 months) after the completion of cyclosporine administration, eight patients (38.1%) were symptom free, and seven patients (33.3%) used only antihistamines. CONCLUSION: This study shows that low-dose cyclosporine is an efficacious and safe treatment option for treating CIU. In addition, the preliminary results suggest that low-dose cyclosporine might be helpful for the long-term control of this disease.
Cyclosporine ; Follow-Up Studies ; Histamine Antagonists ; Humans ; Urticaria

The treatment of chronic spontaneous urticaria begins with antihistamines; however, the dose required typically exceeds that recommended for allergic rhinitis. Second-generation, relatively non-sedating H1-receptor blockers are typically employed up to 4 times a day. First-generation antihistamines, such as hydroxyzine or diphenhydramine (Atarax or Benadryl), were employed similarly in the past. Should high-dose antihistamines fail to control symptoms (at least 50%), omalizumab at 300 mg/month is the next step. This is effective in 70% of antihistamine-refractory patients. H₂-receptor blockers and leukotriene antagonists are no longer recommended; they add little and the literature does not support significant efficacy. For those patients who are unresponsive to both antihistamines and omalizumab, cyclosporine is recommended next. This is similarly effective in 65%–70% of patients; however, care is needed regarding possible side-effects on blood pressure and renal function. Corticosteroids should not be employed chronically due to cumulative toxicity that is dose and time dependent. Brief courses of steroid e.g., 3–10 days can be employed for severe exacerbations, but should be an infrequent occurrence. Finally, other agents, such as dapsone or sulfasalazine, can be tried for those patients unresponsive to antihistamines, omalizumab, and cyclosporine.
Adrenal Cortex Hormones ; Blood Pressure ; Cyclosporine ; Dapsone ; Diphenhydramine ; Histamine Antagonists ; Humans ; Hydroxyzine ; Leukotriene Antagonists ; Omalizumab ; Rhinitis, Allergic ; Sulfasalazine ; Urticaria*

BACKGROUND: Chronic idiopathic urticaria (CIU) has a major impact on patients' quality of life. However the management of CIU has sometimes been challenging to physicians, with little response to conventional therapy like antihistamines. OBJECTIVE: This study was aimed to determine the effectiveness and safety of low-dose cyclosporine for the treatment of recalcitrant CIU with a positive autologous serum skin test (ASST). METHODS: Thirty CIU patients who were unresponsive to conventional antihistamine therapy were treated for 3 consecutive months with low-dose cyclosporine (2~3 mg/kg/day) and fexofenadine (180 mg/day). The clinical efficacy was measured at baseline, week 1, 2, and month 1, 2 and 3. CIU sign and symptom scores were assessed using 4-point scales for pruritus, number of hives, size of largest hive, interference with sleep, and interference with daily activities. Global assessment of the severity by patients and any side effects were also measured at every visit. RESULTS: Low-dose cyclosporine significantly improved the total CIU scores. In addition, the interference with sleep was reduced and the performance of daily activities improved in accordance with patient's global assessment of urticaria severity after 3 month of treatment. Moreover there were no significant side effects to suggest stopping cyclosporine administration. CONCLUSION: These results show that low-dose cyclosporine therapy might be a good therapeutic alternative in CIU patients who are unresponsive to conventional treatments.
Cyclosporine* ; Histamine Antagonists ; Humans ; Pruritus ; Quality of Life ; Skin Tests ; Urticaria* ; Weights and Measures

Posttransplant erythrocytosis (PTE) is a common complication of renal transplantation, which can occur in approximately 10% to 15% of renal transplant patients and usually affects males with relatively good renal function. It is also associated with an increased incidence of thromboembolic events. Clinical manifestations of PTE include malaise, headache, plethora, lethargy, and dizziness. It is correlated with use of cyclosporin, gender, posttransplant renal function, and type of antihypertensive medication. The angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor is preferred as an initial treatment for PTE because these agents are effective and reasonably safe in the majority of patients with PTE, and can also provide a necessary antihypertensive effect for kidney transplant patients. We report here on a 35-year-old male who had erythrocytosis after renal transplantation. After renal transplantation, his level of hemoglobin was 21 g/dL. We treated this patient with ARB and his symptoms and signs have been completely relieved.
Adult ; Angiotensin Receptor Antagonists ; Angiotensins ; Cyclosporine ; Dizziness ; Headache ; Humans ; Incidence ; Kidney Transplantation ; Kidney* ; Lethargy ; Male ; Polycythemia

Urticaria is a relatively common condition that if chronic can persist for weeks, months or years and affect quality of life significantly. The etiology is often difficult to determine, especially as it becomes chronic. Many cases of chronic urticaria are thought to be autoimmune, although there is no consensus that testing for autoimmunity alters the diagnostic or management strategies or outcomes. Many times, urticaria is easily managed with antihistamines and/or short courses of oral corticosteroids, but too often control is insufficient and additional therapies must be added. For years, immune modulating medications, such as cyclosporine and Mycophenolate Mofetil, have been used in cases refractory to antihistamines and oral corticosteroids, although the evidence supporting their efficacy and safety has been limited. Omalizumab was recently approved for the treatment of chronic urticaria unresponsive to H1-antagonists. This IgG anti-IgE monoclonal antibody has been well demonstrated to safely and effectively control chronic urticaria at least partially in approximately 2/3 of cases. However, the mechanism of action and duration of treatment for omalizumab is still unclear. It is hoped that as the pathobiology of chronic urticaria becomes better defined, future therapies that target specific mechanistic pathways will be developed that continue to improve the management of these often challenging patients.
Adrenal Cortex Hormones ; Angioedema ; Autoimmunity ; Consensus ; Cyclosporine ; Diagnosis ; Histamine Antagonists ; Hope ; Humans ; Immunoglobulin G ; Omalizumab ; Quality of Life ; Urticaria*

Papuloerythroderma of Ofuji isa rare and unique form of erythroderma and usually affects elderly Asian men. Various therapeutic approaches have been tried and both systemic corticosteroids and PUVA have been reported to be most effective. A 57-year-old man presented with itchy erythematous papules forming erythroderma that did not affect skin folds. His lesion did not respond to topical corticosteroids and antihistamines for 2 weeks. We used cyclosporine and topical tacrolimus. He completely recovered several days later and there has been no sign of recurrence for nearly 1 year.
Adrenal Cortex Hormones ; Aged ; Asian Continental Ancestry Group ; Cyclosporine ; Dermatitis, Exfoliative ; Histamine Antagonists ; Humans ; Male ; Middle Aged ; Recurrence ; Skin ; Tacrolimus

BACKGROUND: Chronic actinic dermatitis comprises a spectrum of chronic photosensitivity disorders. Treatment includes avoidance of UV light, application of broad-spectrum topical sunscreens, PUVA therapy, corticosteroid, azathioprine and cyclosporine. OBJECTIVE: Our purpose was to determine the efficacy of cyclosporine in the treatment of chronic actinic dermatitis. METHODS: Six patients with chronic actinic dermatitis refractory to conventional treatment were treated with cyclosporine 100-200mg a day for four to eighteen weeks. RESULTS: In all six patients improvement of the skin lesions and itching were dramatic, but in three of them hyperterision developed during the cyclosporine treatment. After stopping the cyclosporine therapy, their blood pressures normalized within two to five weeks. Other side effects of cyclosporine were not found. Although the skin lesions of all of the six patients were aggravated more or less after stopping the cyclosporine therapy, we could maintain their improved states with topical corticosteroids and oral antihistamines. CONCLUSION: 1. Cyclosporine is a good alternative in treating chronic actinic dermatitis patients who are suffering from severe symptoms refractory to conventional therapy. 2. Hypertension is the frequent side effect of cyclosporine.
Adrenal Cortex Hormones ; Azathioprine ; Cyclosporine* ; Histamine Antagonists ; Humans ; Hypertension ; Photosensitivity Disorders* ; Pruritus ; PUVA Therapy ; Skin ; Sunscreening Agents ; Ultraviolet Rays

BACKGROUND: Since the treatment guidelines for atopic dermatitis (AD) were issued by the Korean Atopic Dermatitis Association (KADA) work group in 2006, there have been further advances in the systemic treatment of AD. OBJECTIVE: We aimed to establish updated evidence- and experience-based systemic treatment guidelines for Korean AD. METHODS: We compiled a database of references from relevant systematic reviews and guidelines regarding the systemic management of AD, including antihistamines, antimicrobials, systemic immunomodulators, allergen-specific immunotherapy, phototherapy, adjunctive treatment, and complementary and alternative medicines. Evidence for each statement was graded and classified based on the strength of the recommendation. Thirty-nine council members of KADA participated in the three rounds of votes and expert consensus recommendations were established. RESULTS: The use of antihistamines is recommended to relieve pruritus and to prevent exacerbation due to scratching in AD patients. Infection should be controlled as needed and long-term medication should be avoided. For moderate to severe AD patients, concomitant active treatments with systemic immunomodulators are indicated. Cyclosporine is the first choice among systemic immunomodulators and others should be considered as second-line alternatives. Allergen-specific immunotherapy could be effective in AD patients with aeroallergen hypersensitivity. Phototherapy can be useful for moderate to severe AD patients and narrow-band ultraviolet B is the most effective option. Complementary and alternative medicines cannot be recommended for treating AD. CONCLUSION: We expect these recommendations to be a reference guide for physicians and AD patients in choosing the appropriate treatment to improve quality of life and decrease unnecessary social medical costs.
Consensus* ; Cyclosporine ; Dermatitis ; Dermatitis, Atopic* ; Histamine Antagonists ; Humans ; Hypersensitivity ; Immunologic Factors ; Immunotherapy ; Korea* ; Phototherapy ; Pruritus ; Quality of Life