{'fraction_non_alphanumeric': 0.02197802197802198, 'fraction_numerical': 0.010582010582010581, 'mean_word_length': 4.966019417475728, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Subacute cutaneous lupus erythematosus precipitated by leflunomide

pustule on the palm showed spongiform pustules in the upper part of the malpighian layer of the epidermis. We treated the lesionwith topicalALA-PDTanda632-nm diode laser. An ointment containing 20% ALA was applied topically to both palms and soles 5 h before irradiation. The light intensity was 30 mW ⁄ cm, and the light dose was 15 J ⁄ cm. The treatment was performed once weekly. The lesion was almost completely cleared after the 11th irradiation with a cumulative dose of 165 J ⁄ cm (Fig. 1b). Maintenance treatment was performed on three occasions every other week and on two occasions every third week, then the treatment was stopped. The patients has remained almost clear of skin lesions for 3 months. The only side-effect was a slight burning sensation during treatment, which subsided shortly after the end of light application. The mechanisms of action of PDT in psoriasis are not well known. It has been demonstrated that PDT in vitro reduces the secretion of cytokines involved in the pathogenesis of inflammation, altering the cytokine secretion pattern of mononuclear cells of patients with psoriasis in a manner similar to PUVA. Shick et al. showed that PDT inhibits proliferation of keratinocytes in vitro, suggesting a mechanism for effectiveness in psoriasis. Recently, Bissonnette et al. showed that blue-light exposure of psoriatic plaques after oral administration of ALA induced apoptosis in lesional T lymphocytes under erythematous conditions. T lymphocytes play a central role in the pathogenesis of psoriasis, therefore this group suggested that induction of apoptosis in lesional T lymphocytes may be indicative of longer remission time following treatment of psoriasis with systemic ALA-PDT. The therapeutic protocols used differ, and, at present, the optimum regimen for topical PDT for psoriasis has not been established. We chose a light dose of 15 J ⁄ cm because psoriasis had been treated with PDT using a light dose of 5–25 J ⁄ cm in the previous reports. In view of the treatment course stretching over 11 weeks, it might be questioned whether a natural improvement in our patient’s disease had occurred. However, spontaneous improvement was not typical of the patient’s normal persistent manifestation of disease, noting the resistance even to second-line therapy. Moreover, a sequential improvement was evident throughout the course of treatment. 1,2