PMC4493649_01
Timeline of medical therapy. A graphic summary of the past 5 years of treatment for the patient reported in the case. Topical
corticosteroids (Top CS), Penicillin VK (Pen VK), Hydroxychloroquine (HCQ), Prednisone (Pred), Methotrexate (MTX), Minocycline
(MNC), Mycophenolate mofetil (MMF), Infliximab (IFX), Leflunomide (LEF), IV Methylprednisolone (MP) and No treatment (No Tx).
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F1
Oral treatment was initiated, though not considered as standard therapy, with penicillin VK and hydroxychloroquine (400mg daily) (Fig. 1). She received another course of monthly three consecutive days of 1000 mg daily IV methylprednisolone for 3 months prior to our evaluation in clinic (Fig. 1).
Pre- and Post-treatment photographs of the upper back. The initial back lesions (a, left panel) demonstrate yellow/white waxy
lesions with thick skin coalescing over her upper back. Post-treatment photographs (b, right panel) demonstrate decreased white/yellow waxy
appearance of lesions, with less uniform skin thickness and 'breaking up' of lesions.
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F2
Please see pre-treatment photographs in Figs. (2, 3) and pre- infliximab treatment durometer readings (skin hardness) and joint function in Table 1.
Pre- and Post-treatment photographs of the hands. (a) Pre-treatment photographs (left panel) demonstrate diffuse swelling of
fingers and limited range of motion. The patient was unable to make a fist. (b) Post-treatment photographs (right panel) demonstrated
marked decrease in swelling and the ability to close her fist.
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F3
Please see pre-treatment photographs in Figs. (2, 3) and pre- infliximab treatment durometer readings (skin hardness) and joint function in Table 1. The general edema of the distal upper and lower extremities greatly diminished and the overall ROM of large and small joints improved (see Table 1 and Fig. 3).