P6938Conservative treatment of chondrodermatitis nodularis chronica heliciswith topical nitroglycerin

Joana Cabete, Dermatology Department, Hospital de Santo Ant�onio dosCapuchos - Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Andr�eLencastre, Dermatology Department, Hospital de Santo Ant�onio dos Capuchos- Centro Hospitalar de Lisboa Central, Lisbon, Portugal; Maria Jo~ao Paiva Lopes,Dermatology Department, Hospital de Santo Ant�onio dos Capuchos - CentroHospitalar de Lisboa Central, Lisbon, Portugal; Sara Lestre, DermatologyDepartment, Hospital de Santo Ant�onio dos Capuchos - Centro Hospitalar deLisboa Central, Lisbon, Portugal; Vasco Serr~ao, Dermatology Department,Hospital de Santo Ant�onio dos Capuchos - Centro Hospitalar de Lisboa Central,Lisbon, Portugal

Background: Chondrodermatitis nodularis chronica helicis (CNCH) is a benign,painful, indurated inflammatory nodule arising on the pinna. Different treatmentmodalities have been used with varying efficacy rates. Despite lower efficacy,conservative methods are most desirable.

Case reports: Three patients diagnosed with CNCH were treated with 0.4% topicalnitroglycerin ointment, twice daily. These included 2 women and 1 man, aged 66,86, and 60 years old, respectively. Two painful nodules were located on theantihelix, and 1 on the helix. One patient had been previously treated withintralesional corticosteroids, and another with intralesional corticosteroids, CO2

laser and photodynamic therapy. All 3 patients experienced significant clinical andsymptomatic improvement with topical nitroglycerin. No side effects werereported.

Discussion: The etiology of CNCH is uncertain. Dermal and chondral ischemiaarising from perichondrial arterial narrowing has been recently described as apossible cause for this benign condition, hence the potential of nitroglycerin as asmooth muscle relaxant and vasodilator. A previous report described significantimprovement in 12 patients treated with 2% topical nitroglycerin.

Conclusion: Topical nitroglycerin ointment appears to be a noninvasive alternativefor the treatment of CNCH. A lower concentration (0.4%) may be as effective andwith fewer side effects, but more studies are warranted.

APRIL 20

cial support: None identified.

Commer

P6203Cost effectiveness analysis of botulinum toxin versus sympathectomy forpalmar hyperhidrosis

Maria Alvarez, MD, Department of Dermatology, Reina Sofia University Hospital,Cordoba, Spain; Angel Salvatierra, MD, PhD, Department of Thoracic Surgery,Reina Sofia University Hospital, C�ordoba, Spain; Beatriz Isla, PharmD, MS,Department of Pharmacy, Reina Sofia University Hospital, C�ordoba, Spain;Ennrique Casas, MD, Department of Dermatology, Reina Sofia UniversityHospital, C�ordoba, Spain; Jose-Carlos Moreno-Gim�enez, MD, PhD, Departmentof Dermatology, Reina Sofia University Hospital, C�ordoba, Spain; Juan Ruano,MD, PhD, Department of Dermatology, Reina Sofia University Hospital, C�ordoba,Spain; Manuel C�ardenas, DPharm, Department of Pharmacy, Reina SofiaUniversity Hospital, C�ordoba, Spain

Background: Local botulinum toxin injections and endoscopic thoracic sympathec-tomy (ETS) have shown clinical effectiveness for the treatment of palmar hyperhi-drosis in several studies. Although both strategies cause considerable costs for healthcare systems, at the moment there are no studies examining directly their costeffectiveness performance.

Objective: To assess the incremental cost effectiveness of botulinum toxin whencompared to ETS for palmar hyperhidrosis.

Methods: Costs, effectiveness, and incremental cost effectiveness ratio (ICER) werecalculated. Costs were assessed from a Spanish National Health System perspectivein a historical cohort of patients with palmar hyperhidrosis attending a terciaryreferral hospital. Effectiveness was evaluated by using the Hyperhidrosis DiseaseSeverity Scale (HDSS). A responderwas defined as a patient who reported at least a 2-grade improvement on the HDSS scale with respect to the baseline value. Thehorizon of time was 1 year.

Results: Effectiveness was greater for ETS (n ¼ 128) when compared to botulinumtoxin (n ¼ 100) for the treatment of palmar hyperhidrosis (92% vs 68%; OR ¼ 6.22[2.80, 13.8]; ARR ¼ -0.24 [-0.45, -0.14]; NNT ¼ -4 [-2, -11]). Botulinum toxin had anICER of 125 Euros when compared with ETS during the first year of treatment.

Conclusion: In this retrospective real-world observational sample of patients withpalmar hyperhidrosis, treatment with ETS appears to be more effective and lesscostly when compared to botulinum toxin during the first year of treatment. Thisanalysis may help physicians to choose a better treatment option which is bothhighly effective yet and has a low cost.

cial support: None identified.

Commer

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P6849Danazol-induced StevenseJohnson syndrome in a patient with systemiclupus erythematosus

Mark Jean-Aan Koh, MD, Changi General Hospital, Singapore; Koh Wei-Liang, MD,Changi General Hospital, Singapore; Yong-Kwang Tay, MD, Changi GeneralHospital, Singapore

Case report: A 19-year-old Malay lady, with a 5-year history of systemic lupuserythematosus (SLE), presented with 2 days of facial rashes and oral ulcers. This rashwas significantly different from themalar erythema that characterized her earlier SLEflares. Her SLE was controlled with oral tacrolimus and prednisolone. Significantly,she had been started on oral danazol 200mg/day for autoimmune hemolytic anemia,2 weeks before her current admission. On examination, the patient was febrile.There were discrete to confluent, dusky purpuric macules, papules and targetoidlesions, over the forehead, bilateral cheeks, neck and arms. Similar lesions withcentral bullae were noted on the palms. Erosions were noted on the lips, hard palateand vulvae. The conjunctiva were normal. The cutaneous lesions affected approx-imately 3% of her total body surface area. Systemic examination was unremarkableexcept for mild pallor. Joint tenderness and alopeciawere not present. Punch biopsyof lesional skin showed a subepidermal blister with full thickness epidermalnecrosis and interface change. Alcian blue was negative for dermal mucin. Thesechanges were consistent with Stevens-Johnson syndrome (SJS). Direct immunoflu-orescence was negative. In view of the history, clinical and histologic findings, adiagnosis of danazol-induced SJS was made and the culprit drug was discontinued.She was treated with increased doses of systemic steroids. Progression of the rasheswas halted with reepithelization noted 10 days later.

Discussion: Danazol is an attenuated androgen indicated for treating endometriosis,fibrocystic breast disease, and hereditary angioedema. It has been used for thetreatment of SLE-associated haematological abnormalities. Its mechanism of action isunknown, but androgens appear to display potent immunoregulatory and antiin-flammatory properties in modulating the development of SLE. The mechanism ofaction of danazol in haemopoiesis remains unclear. Main reported side effectsinclude weight gain, virilization, hepatitis, and rashes. Although SJS has been listedas a rare reaction, causal relation has not been confirmed nor refuted. We report arare case of danazol-induced SJS.

cial support: None identified.

Commer

P6717Dupuytren’s contractures secondary to BRAF kinase inhibitor therapy

Lindsay Taylor Morgan Bicknell, University of Texas Medical School at Houston,Houston, TX, United States; Ana Ciurea, MD, Department of Dermatology, TheUniversity of Texas Medical School at Houston/M.D. Anderson Cancer Center,Houston, TX, United States; Lucia Diaz, MD, Department of Dermatology, TheUniversity of Texas Medical School at Houston/M.D. Anderson Cancer Center,Houston, TX, United States; Sharon Hymes, MD, Department of Dermatology,The University of Texas Medical School at Houston/M.D. Anderson CancerCenter, Houston, TX, United States

Selective BRAF kinase inhibitors are used to treat patients with BRAF V600Emutation-positive metastatic melanoma. Presence of this mutation leads todysregulation of the MAP kinase pathway, and subsequent cancer cell proliferationand dysregulation. As with most chemotherapeutic agents, BRAF inhibitors maycause an array of adverse effects. Cutaneous side effects include various rashes,follicular cysts, verrucae, keratoacanthomas, and squamous cell carcinomas. In thisreport, we describe a patient with a BRAF mutation-positive metastatic papillarythyroid carcinoma treated with BRAF inhibitor on clinical trial who developedDupuytren’s contractures of the bilateral hands, palmar hyperkeratosis, a keratosispilaris-like eruption, and erythema nodosum. To our knowledge, this is the firstreported case of Dupuytren’s contractures secondary to BRAF kinase inhibitortherapy.

cial support: None identified.

Commer

J AM ACAD DERMATOL AB179