KAPOSI S SARCOMA General Considerations in Objective-C

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KAPOSI S SARCOMA General Considerations
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Before 1980 in the United States, this rare malignant skin lesion was seen mostly in elderly white men, had a chronic clinical course, and was rarely fatal Kaposi s sarcoma occurs endemically in an often aggressive form in young black men of equatorial Africa, but it is rare in American blacks Kaposi s sarcoma continues to occur largely in homosexual men with HIV infection as an AIDS-defining illness Kaposi s sarcoma may complicate immunosuppressive therapy, and stopping the immunosuppression may result in improvement Human herpes virus 8 (HHV8), or Kaposi s sarcoma-associated herpes virus (KSHV), is universally present in all forms of Kaposi s sarcoma Red or purple plaques or nodules on cutaneous or mucosal surfaces are characteristic Kaposi s sarcoma commonly involves the gastrointestinal tract, but in asymptomatic patients these lesions are not sought or treated Pulmonary Kaposi s sarcoma may be life-threatening and is managed aggressively The incidence of AIDS-associated Kaposi s sarcoma is diminishing
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Lichen planus must be distinguished from similar lesions produced by medications (see above) and other papular lesions such as psoriasis, lichen simplex chronicus, graftversus-host disease, and syphilis Lichen planus on the mucous membranes must be differentiated from leukoplakia Erosive oral lesions require biopsy and often direct immunofluorescence for diagnosis since lichen planus may simulate other erosive diseases
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For Kaposi s sarcoma in the elderly, palliative local therapy with intralesional chemotherapy or radiation is usually all that is required In the setting of iatrogenic immunosuppression, the treatment of Kaposi s sarcoma is primarily reduction of doses of immunosuppressive medications In AIDS-associated Kaposi s sarcoma, the patient should first be given effective anti-HIV antiretrovirals because in most cases this treatment alone is associated with improvement Other therapeutic options include cryotherapy or intralesional vinblastine (01 05 mg/mL) for cosmetically objectionable lesions; radiation therapy for accessible and spaceoccupying lesions; and laser surgery for certain intraoral and pharyngeal lesions Systemic therapy is indicated in patients with rapidly progressive skin disease (more than ten new lesions per month), with edema or pain, and with symptomatic visceral disease or pulmonary disease Liposomal doxorubicin is highly effective in controlling these cases and has considerably less toxicity and greater efficacy than anthracycline monotherapy or combination chemotherapeutic regimens -Interferon may also be used
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Bursics A et al HHV-8 positive, HIV negative disseminated Kaposi s sarcoma complicating steroid dependent ulcerative colitis: a successfully treated case Gut 2005 Jul;54(7):1049 50 [PMID: 15951561] Fardet L et al Treatment with taxanes of refractory or lifethreatening Kaposi sarcoma not associated with human immunodeficiency virus infection Cancer 2006 Apr 15;106 (8):1785 9 [PMID: 16534786] Gutman-Yassky E et al Classic Kaposi sarcoma Which KSHVseropositive individuals are at risk Cancer 2006 Jan 15; 106(2):413 9 [PMID: 16353205]
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Superpotent topical corticosteroids applied twice daily are most helpful for localized disease in nonflexural areas Alternatively, high-potency corticosteroid cream or ointment may be used nightly under thin pliable plastic film Topical tacrolimus appears effective in oral and vaginal erosive lichen planus, but long-term therapy is required to prevent relapse If tacrolimus is used, lesions must be observed carefully for development of cancer If the erosive lichen planus lesions are adjacent to a mercury containing amalgam, removal of the amalgam may result in clearing of the erosions
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B Systemic Therapy
Corticosteroids (see 26) may be required in severe cases or in circumstances where the most rapid response to treatment is desired Unfortunately, relapse almost always occurs as the corticosteroids are tapered, making systemic corticosteroid therapy an impractical option for the management of chronic lichen planus UV phototherapy may also be effective treatment
Prognosis
Lichen planus is a benign disease, but it may persist for months or years and may be recurrent Hypertrophic lichen planus and oral lesions tend to be especially persistent, and neoplastic degeneration has been described in chronically eroded lesions
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