Lupus miliaris disseminatus faciei (LMDF) is a rare inflammatory granulomatous dermatosis of unknown etiology, primarily affecting young adults. It presents as a symmetric papular eruption, predominantly on the mid-facial region, often leading to unsightly depressed scars. We report the case of a 28-year-old woman with persistent facial papules evolving into atrophic scars. Dermoscopy showed orange-brown globules, fine linear vessels, and scarred areas. Histology revealed epithelioid granulomas with fibrinoid necrosis and a lymphocytic infiltrate. The patient was treated with isotretinoin (20 mg/day for nine months) with partial improvement. Management of LMDF remains challenging due to the absence of standardized treatments. Therapeutic options include dapsone, oral corticosteroids, isotretinoin, biologic agents, and laser therapy. This case highlights the importance of early diagnosis and individualized treatment to minimize scarring and psychological impact.

Recurrent bullous pemphigoid is a rare autoimmune vesiculobullous disorder caused by bullous lesions on the body and areas of ruptured bullae that leave raw erythematous regions, resulting in a burning sensation in the oral cavity. The article enlightens the occurrence of bullous pemphigoid in a 68-year-old male who complained of a burning sensation in his oral cavity. The diagnosis was exclusively based on history and clinical examination without any intervention by histopathological or immunofluorescent tests.

Vanishing bile duct syndrome (VBDS) is a rare cholestatic liver disease often associated with drug-induced liver injury, yet systematic data on pharmaceutical triggers remain limited. Using WHO VigiBase, we applied Bayesian disproportionality analysis (IC0.25) to identify drug-event associations that may not be readily apparent in clinical trials or pre-marketing studies. Product labels approved by Swissmedic or the FDA, as well as LiverTox, were reviewed to determine whether VBDS was already acknowledged as an adverse event. Signal detection was deliberately restricted to reports naming a single suspect drug. Among these single-agent reports, 22 drugs demonstrated a positive IC0.25 signal, of which nevirapine, dapsone and azithromycin showed the strongest disproportionality signal. Only one of these agents (carbamazepine) explicitly labelled VBDS as an adverse event. These findings are based on spontaneous reporting data: disproportionality analysis is a hypothesis-generating signal-detection method that does not establish causality and requires further validation. This study expands the current understanding of drug-induced VBDS by reinforcing the associations with known drugs and generating pharmacovigilance signals for new potential VBDS triggers across several drug categories.

Background/Objectives: Neuropathic pain (NP) after traumatic spinal cord injury (SCI) is highly prevalent, markedly impairs quality of life, and remains difficult to treat because available therapies show limited efficacy and may cause relevant adverse effects. Because oxidative stress and glutamate-mediated excitotoxicity contribute to central sensitization after SCI, this study evaluated the antinociceptive and antioxidant effects of dapsone (DDS), N-acetylcysteine (NAC), and their combination in rats with SCI. An isobolographic analysis was also performed to determine the pharmacodynamic interaction between the two drugs. Methods: Female Wistar rats with SCI that developed stimulus-dependent hypersensitivity from day 15 after injury were treated once daily for 7 days with DDS (1.5-12.5 mg/kg, i.p.), NAC (9.3-75 mg/kg, i.p.), or 1:1 fixed-ratio combinations. Mechanical allodynia and hyperalgesia were assessed with Von Frey filaments, whereas lipid peroxidation (LP) and reduced glutathione (GSH) were quantified in injured spinal cord tissue. Results: DDS and NAC produced dose-dependent antinociceptive effects, with DDS being more potent than NAC in both endpoints. The individual ED50 values were 4.92 and 33.47 mg/kg for allodynia, and 4.06 and 27.74 mg/kg for hyperalgesia, for DDS and NAC, respectively. The DDS/NAC combination showed synergistic interactions in allodynia (ED50 = 7.45 mg/kg vs. Zadd = 19.19 mg/kg; γ = 0.388) and hyperalgesia (ED50 = 4.21 mg/kg vs. Zadd = 15.90 mg/kg; γ = 0.265), with stronger synergism in hyperalgesia. Combined treatment also improved LP and GSH levels. Conclusions: These findings indicate that DDS and NAC exert complementary actions and that their combination produces a synergistic antinociceptive effect associated with diminished oxidative stress after SCI.

Although in Romania an increase in migrant population has been reported in the last years, there are no screening programs for infectious diseases implemented for migrants. We report the first two cases of leprosy (Hansen's disease) since 1981 and the first imported ones in Romania, in two sisters originating from Indonesia, employed as massage therapists at a SPA center. Case one was diagnosed with multibacillary Hansen's disease of mid-borderline type, and case two with paucibacillary Hansen's disease borderline tuberculoid form based on epidemiological, clinical, histopathological and molecular diagnosis. Both patients have started multidrug therapy with dapsone, rifampicin and clofazimine provided by WHO. Both patients developed dapsone induced anemia under therapy, even though no G6PD deficiency was present, and dapsone was stopped. The clinical evolution of skin lesions was favorable under therapy, and the haemoglobin level started to increase after dapsone was stopped. This publication underlines the risk of importing rare diseases in Romania and in other European countries and the delay in diagnosis due to insufficient awareness among occupational medicine doctors. Improved strategies are needed at national level in order to increase awareness on rare imported infectious diseases and introduce screening programs in migrant population from high-risk areas.

Dapsone possesses anti-infective and anti-imflammatory properties, but its CYP-mediated metabolism to hydroxylamines causes dose-dependent haematological toxicity which impairs patient tolerance. In the 1990s cimetidine-mediated partial inhibition of the oxidative metabolism of dapsone was demonstrated clinically to lower methaemoglobin formation and subsequent case studies with fragile and immunosuppressed patients with multiple complex pathologies, showed cimetidine could minimize dapsone-mediated methaemoglobin formation in the place of methylene blue, when G6PD status is unknown, is deficient or there is prior sensitization. Pre-clinical and in vitro studies also suggest that prior administration of the antioxidant α-lipoic acid may potentially augment cimetidine's attenuation of dapsone-mediated methaemoglobin's formation through its conversion to dihydrolipoic acid which can restrict methaemoglobin formation within the erythrocyte. Overall, combined with novel buccal dapsone formulations which avoid first-pass metabolism, concomitant α-lipoic acid may augment cimetidine-mediated amelioration of dapsone's- haematological toxicity, potentially promoting the drug's patient tolerance and clinical utility.