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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Lichen Planus &#40;LP&#41; pemphigoides was first described by Kaposi in 1892&#46; It is characterized by widespread bullae formation over the normal skin with preexisting LP&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Autoantibodies IgG formed against BPAg2&#44; BPAg1 and 200kd antigen leads to the development of LP pemphigoides&#46; Treatment includes dapsone&#44; systemic steroids&#44; cyclosporine&#44; azathioprine&#44; and more recently biologics including ustekinumab with variable success rates&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> We report a case of LP Pemphigoides successfully treated by mesalamine as novel use of an older drug&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 58-year-old male presented with multiple violaceus&#44; pruritic papules&#44; and plaques over dorsal surface of hands and feet for the last 5 years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; along with oral-genital involvement&#46; Recurrent crops of multiple vesiculobullous lesions were noticed over non-lesional normal skin predominantly over extremities and a few over the trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; for 6 months&#46; No vesiculobullous lesions were seen over preexisting hyperpigmented plaques&#46; He was a known patient with Diabetes mellitus on treatment with oral Metformin&#46; Tzanck smear from bullae revealed predominant polymorphonuclear neutrophils&#46; Biopsy from the hypertrophic plaque showed hyperkeratosis&#44; basal cell vacuolation and lymphocytic infiltrate &#40;Fig&#46; 1B&#41; whereas biopsy from bullous lesion revealed subepidermal split with neutrophils and few eosinophils &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46; Direct immunofluorescence study showed a linear C3 deposit at the dermo-epidermal junction &#40;Fig&#46; 3B&#41;&#46; ELISA for BP180 or immunoblotting were not available&#44; so they could not be performed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A diagnosis of LP pemphigoides was made based on the above findings and he was treated with oral Mesalamine &#40;800<span class="elsevierStyleHsp" style=""></span>mg thrice daily&#41;&#46; The bullous lesions resolved within 2 weeks with no recurrence after 6 months of follow-up&#46; Topical betamethasone dipropionate &#40;0&#46;05&#37;&#41; was used as adjuvant therapy for hypertrophic plaques with gradual regression of lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">LP pemphigoides should be differentiated from bullous LP where the bullae arise over preexisting lesions of LP&#46; In contrast to BP which occurs in the elderly&#44; LP pemphigoides are seen to have a younger age of onset&#44; with short-lived bullae&#44; and more neutrophils in subepidermal vesicle on histological examination&#46; DIF study reveals fine&#44; linear&#44; continuous pattern of IgG and C3 deposit at the basement membrane zone &#40;similar to BP&#41; but immune-electron microscopic studies reveal these deposits to be localized to the base of bullae as contrasted to the roof as in BP&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Mesalamine &#40;5 Amino-salicylic acid&#41; is a drug structurally related to salicylates and is used primarily as an anti-inflammatory agent &#40;for ulcerative colitis&#41; and Disease Modifying Anti-Rheumatic Drug for the treatment of Rheumatoid arthritis and other seronegative arthritis&#46; To the best of our knowledge&#44; Mesalamine has not been used for the treatment of LP&#44; bullous pemphigoid&#44; or LP pemphigoides&#46; <a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> No major adverse reaction was seen in our patient&#44; although lichenoid eruptions had been reported during sulfasalazine therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Because of Diabetes Mellitus in our patient&#44; we decided to use Mesalamine as it has a favorable effect on the metabolic milieu&#46; We propose Mesalamine as an alternative drug in LP pemphigoides&#44; especially in patients with metabolic syndrome due to its favorable anti-inflammatory effects&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Vijay Gandhi&#58; Concepts&#59; design&#59; definition of intellectual content&#59; literature search&#59; clinical studies&#59; manuscript preparation&#59; manuscript editing&#59; manuscript review&#59; guarantor&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pradeep Kumar&#58; Concepts&#59; definition of intellectual content&#59; clinical studies&#59; manuscript editing&#59; manuscript review&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ankita Chauhan&#58; Concepts&#59; definition of intellectual content&#59; clinical studies&#59; manuscript editing&#59; manuscript review&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Treatment of lichen planus pemphigoides with mesalamine: novel use of this drug
Vijay Gandhi, Pradeep Kumar
Autor para correspondência
drprdp007@yahoo.in

Corresponding author.
, Ankita Chauhan
Department of Dermatology & STD, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India
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pruritic papules&#44; and plaques over dorsal surface of hands and feet for the last 5 years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; along with oral-genital involvement&#46; Recurrent crops of multiple vesiculobullous lesions were noticed over non-lesional normal skin predominantly over extremities and a few over the trunk &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; for 6 months&#46; No vesiculobullous lesions were seen over preexisting hyperpigmented plaques&#46; He was a known patient with Diabetes mellitus on treatment with oral Metformin&#46; Tzanck smear from bullae revealed predominant polymorphonuclear neutrophils&#46; Biopsy from the hypertrophic plaque showed hyperkeratosis&#44; basal cell vacuolation and lymphocytic infiltrate &#40;Fig&#46; 1B&#41; whereas biopsy from bullous lesion revealed subepidermal split with neutrophils and few eosinophils &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41;&#46; Direct immunofluorescence study showed a linear C3 deposit at the dermo-epidermal junction &#40;Fig&#46; 3B&#41;&#46; ELISA for BP180 or immunoblotting were not available&#44; so they could not be performed&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">A diagnosis of LP pemphigoides was made based on the above findings and he was treated with oral Mesalamine &#40;800<span class="elsevierStyleHsp" style=""></span>mg thrice daily&#41;&#46; The bullous lesions resolved within 2 weeks with no recurrence after 6 months of follow-up&#46; Topical betamethasone dipropionate &#40;0&#46;05&#37;&#41; was used as adjuvant therapy for hypertrophic plaques with gradual regression of lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">LP pemphigoides should be differentiated from bullous LP where the bullae arise over preexisting lesions of LP&#46; In contrast to BP which occurs in the elderly&#44; LP pemphigoides are seen to have a younger age of onset&#44; with short-lived bullae&#44; and more neutrophils in subepidermal vesicle on histological examination&#46; DIF study reveals fine&#44; linear&#44; continuous pattern of IgG and C3 deposit at the basement membrane zone &#40;similar to BP&#41; but immune-electron microscopic studies reveal these deposits to be localized to the base of bullae as contrasted to the roof as in BP&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Mesalamine &#40;5 Amino-salicylic acid&#41; is a drug structurally related to salicylates and is used primarily as an anti-inflammatory agent &#40;for ulcerative colitis&#41; and Disease Modifying Anti-Rheumatic Drug for the treatment of Rheumatoid arthritis and other seronegative arthritis&#46; To the best of our knowledge&#44; Mesalamine has not been used for the treatment of LP&#44; bullous pemphigoid&#44; or LP pemphigoides&#46; <a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> No major adverse reaction was seen in our patient&#44; although lichenoid eruptions had been reported during sulfasalazine therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Because of Diabetes Mellitus in our patient&#44; we decided to use Mesalamine as it has a favorable effect on the metabolic milieu&#46; We propose Mesalamine as an alternative drug in LP pemphigoides&#44; especially in patients with metabolic syndrome due to its favorable anti-inflammatory effects&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Vijay Gandhi&#58; Concepts&#59; design&#59; definition of intellectual content&#59; literature search&#59; clinical studies&#59; manuscript preparation&#59; manuscript editing&#59; manuscript review&#59; guarantor&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pradeep Kumar&#58; Concepts&#59; definition of intellectual content&#59; clinical studies&#59; manuscript editing&#59; manuscript review&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Ankita Chauhan&#58; Concepts&#59; definition of intellectual content&#59; clinical studies&#59; manuscript editing&#59; manuscript review&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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