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J Dermatolog Treat [journal]
- A retrospective chart review of the clinical efficacy of Nd:YAG 1064 nm laser for toenail onychomycosis. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Oct 20.:1-9.
Abstract Cosmetic improvement in nail appearance is a great concern to patients with onychomycosis. Although oral and topical treatments for onychomycosis can potentially eradicate the infection, unsightly nails may remain despite negative mycology. Laser-based devices have been approved for the temporary clearance of nails with onychomycosis, thus providing a means of improving the aesthetic appearance of the nails. A retrospective chart review of patients treated with a Nd:YAG 1064 nm laser and debridement for onychomycosis, and terbinafine 1% cream for associated tinea pedis, between July 2012 and February 2014 was performed to ascertain the proportion of patients who achieved clinical outcomes. A temporary improvement in the appearance of the target nail was observed in 78% of patients and the affected area of the nail plate was reduced by at least 50% from baseline in 46% of patients. It appears that patients whose great toenails are potentially infected with non-dermatophyte molds may particularly benefit from laser therapy. Higher clinical outcome rates were observed with administration of four or more treatments, but additional observations and/or studies are needed to optimize the regimen of laser therapy to improve the cosmetic appearance of infected nails.
- Recommended surgery of Kaposi's sarcoma nodules. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Oct 20.:1-3.
Abstract Background: Classic Kaposi's sarcoma [KS] is a chronic, multifocal, vascular proliferation, which commonly presents purplish nodules on the distal extremities of elderly men. Excisional surgery is one of the traditional therapies, but is generally time consuming and costly. Objective: To evaluate the safety and efficacy of curettage for the treatment of KS nodules. Methods: A single arm, prospective study in patients with at least one KS nodule removed by curettage. Hemostasis was obtained using 130-volume hydrogen peroxide [H2O2] and the wound was left to heal by secondary intention. Follow-up was done after 15 days, 1, 3, 6 and 12 months. Results: Ninety patients [88 male, 2 female] with mean age of 75.8 years were enrolled. Eighty-two of the curetted nodules were localized on the lower limbs, five on the face, and three on the upper limbs. No postoperative complications were encountered, and cosmetic outcome was rated excellent by 87 patients and good by the remaining 3 patients. After 3 months, we noticed only minimal hypo-/hyperpigmentation in 59 cases, while in the remaining 31 patients the scar appeared imperceptible. Recurrence after 12 months was null. Conclusion: Curettage followed by the application of H2O2 is a safe, effective and simple technique for the treatment of KS nodules in elderly patients.
- A pilot study on the Psoriasis Area and Severity Index (PASI) for small areas: presentation and implications of the Low PASI score. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Oct 2.:1-15.
Abstract Background: The Psoriasis Area and Severity Index (PASI) is not able to measure small affected areas in a body region which is important for assessing the performance of high-effective treatment. Objective: To present the Low PASI score, show the difference between the classic PASI and the Low PASI, evaluate the inter-observer-agreement of both scores, and compare the two scores within investigators. Methods: Cross-sectional study. Two investigators independently assessed the classic PASI and the Low PASI in 10 patients with mild-to-moderate plaque psoriasis. Differences in outcome between the two scores were calculated. Intra-class correlation coefficients (ICC) were used to determine the inter-observer-agreement, and to compare measurements of the two scores within both investigators. Prediction limits of 95% for the errors in measurements were provided. Results: In both investigators Low PASI were mean 1.71 and 1.76, whereas the classic PASI were mean 4.14 and 4.33. The inter-observer-agreement (ICC) was excellent for both investigators in both scores (ICC classic PASI = 0.95, and Low PASI = 0.87). Conclusion: The Low PASI score allows more possible scores at lower levels of psoriasis extent (affected areas lower than 10% in a body region) compared to the classic PASI. This new score may lead to a more precise analysis of treatment responses, and may have important clinical implications.
- Efficacy, tolerability and safety of switching from etanercept to infliximab for the treatment of moderate-to-severe psoriasis: A multicenter, open-label trial (TANGO). [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Sep 18.:1-8.
Abstract Biologic anti-tumor necrosis factor-α (anti-TNF-α) therapies have revolutionized the management of psoriasis. However, despite similar mechanisms of action, inter-patient variability in the clinical responses to therapy remain unexplained. Possible differences between agents include stability or bioavailability and anti-drug antibody development, and patient factors such as compliance may play a role. As a result, it is not uncommon for physicians to switch a patient from one anti-TNF-α agent to another when initial response is inadequate. This multicenter, single-arm, observational, Phase IV study assessed the efficacy and safety of infliximab therapy in patients with moderate-to-severe psoriasis who had not responded to 24 weeks' etanercept treatment. Drug efficacy was assessed using specific psoriasis indexes; health-related quality of life (HRQoL) was measured using the Dermatology Life Quality Index and the Skindex-29. A total of 48 patients were screened, 38 were treated with infliximab and 31 completed the study. Of these, 71% achieved Psoriasis Area and Severity Index 75 after 10 weeks, and improvement in HRQoL was documented. The results of this study showed that patients with moderate-to-severe psoriasis could be successfully switched from etanercept to infliximab, with improvements in both clinical parameter and HRQoL.
- Frequent office visits for injections may reduce adalimumab survival rate in patients with psoriasis. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Sep 15.:1-9.
Abstract Background: Adalimumab is an anti-tumor necrosis factor-? agent, and is widely used to treat moderate to severe psoriasis in Japan. The drug survival rate of adalimumab is shorter than that of other biological agents used for psoriatic patients in Europe. Objective: To study the long-term drug survival rate of adalimumab used for Japanese psoriatic patients. Methods: We studied 36 patients with moderate to severe psoriasis for whom adalimumab was administered between February 2010 and April 2013. Results: Thirty three patients had psoriasis vulgaris, and 3 patients had psoriatic arthritis. At the end of the observational period, 16 patients continued adalimumab therapy, while 20 patients discontinued. Six patients had adverse events, and 14 patients self-injected adalimumab. The mean probability of drug survival was 20.0 months (median, 18 months); it was shorter than the previously reported data from European countries. Gender, age, and the Psoriasis Area and Severity Index at baseline were not significant predictors of drug survival rates. Frequent visits for biweekly adalimumab injections were a burden for 40% of drop-out patients. Conclusion: The shorter drug survival rate of adalimumab in the present study may be attributed to the lower rate of self-injection than that in European patients.
- Treatment of vitiligo with NB-UVB: a systematic review. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Aug 8.:1-27.
Abstract Objective: To assess the effect and safety of NB-UVB for vitiligo using an evidence-based approach. Methods: Randomized controlled trials (RCTs) on the treatment of vitiligo with NB-UVB were identified by searching PubMed and the Cochrane Library. The primary outcome was re-pigmentation degree. Results: A total of 7 RCTs involving 232 participants with vitiligo were included in this systematic review. The methodological qualities of included studies were generally moderate. Two trials compared narrow-band ultraviolet B (NB-UVB) with UVA control, showing no significant differences between two methods on the number of patients who achieved >60% re-pigmentation (RR=2.50, 95%CI: 0.11-56.97, P>0.05). Two trials compared NB-UVB with psoralens plus UVA (PUVA) control, and no difference was seen between the two treatments on the number of patients who achieved >50 re-pigmentation (RR=1.16, 95%CI: 0.64-2.11, P>0.05) or >75% re-pigmentation (RR=2.00, 95%CI: 0.89-4.48, P>0.05). Three trials compared NB-UVB with 308-nm excimer light/laser (EL) control, and again no significant difference was found between the two methods (P>0.05). The adverse events of NB-UVB in the included studies were slight and tolerated. Conclusion: NB-UVB showed equivalent efficacies to UVA, PUVA, or 308-nm EL control in the treatment of vitiligo. Side effects of NB-UVB were acceptable. More RCTs were needed to validate the results.
- Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Aug 8.:1-12.
Abstract Introduction Acitretin is a retinoid approved for the treatment of psoriasis that has good efficacy for palmo-plantar psoriasis. The safety and efficacy of acitretin in severe chronic hand dermatitis (CHD) is unknown. Methods A total of 9 patients with severe CHD were enrolled and treated with acitretin 10 mg once daily which could be increased to 30 mg daily if well tolerated. Patients were treated for up to 24 weeks or 12 weeks if the physician global assessment was clear or almost clear at that time. CHD severity was evaluated using a 5-grade physician global assessment (PGA) scale and the modified total lesion symptom score (mTLSS). Results The proportion of patients achieving PGA of clear or almost clear was 33.3% (95% CI: 9-69%) and the proportion achieving PGA of clear, almost clear or mild was 44% (95% CI:15-77%). The mTLSS decreased by 45% (-6.3±4.7; p=0.02). Three patients did not complete the study: one due to an increase in facial dermatitis, one due to lack of efficacy and one who withdrew consent. Conclusions This pilot study suggests that acitretin could improve severe CHD. Further studies are needed to better assess the efficacy and safety of acitretin in patients with severe CHD.
- Risk of myocardial infarction in psoriasis patients: a retrospective cohort study. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Aug 8.:1-19.
Abstract Background: Psoriasis may or may not be associated with a higher risk for myocardial infarction (MI). We sought to assess differences in MI incidence between control, mild psoriasis, and severe psoriasis patients. Methods: We performed a retrospective cohort study of Kaiser Permanente Southern California members with psoriasis between 1-JAN-04 and 30-JUN-12, assessing the risk and incidence rates of MI. Results: There were 50865 control patients matched to 10173 patients with mild psoriasis and 19205 control patients matched to 3841 patients with severe psoriasis. The MI incidence per 1000 person-years for mild psoriasis controls, mild psoriasis, severe psoriasis controls, and severe psoriasis were 4.9, 6.7, 3.7, and 5.1 respectively. Upon multivariable analysis, mild psoriasis patients had a significantly higher risk of MI compared to matched control patients (hazard ratio (HR) 1.31 [95% CI: 1.14, 1.51]) and severe psoriasis patients had a significantly higher risk of MI compared to matched control patients (HR 1.28 [95% CI: 1.02, 1.60]). Conclusion: Patients with psoriasis are at higher risk for MI compared to control patients.
- Use of Opioid Analgesics in Skin Disorders: Results from a Nationally Representative US Sample. [JOURNAL ARTICLE]
- J Dermatolog Treat 2014 Aug 4.:1-19.
Abstract Introduction: Increasing and inappropriate use of opioid analgesics (OA) have been declared a public health concern in the US. There are no epidemiologic studies of OA use in skin disorders. We examined OA use in a nationally representative sample of US patient visits with only physician-diagnosed skin disorders. Methods: Retrospective cross-sectional study of 56,751 patient visits from 1995-2010 (ICD9-CM codes 680-709 denoting 'Diseases of the Skin and Subcutaneous Tissue';172,173, 216 and 232 denoting malignant and benign skin neoplasms). Results: An estimated 3.1% ± 0.2% of skin disorders visits were associated with OA use; 52.7% ± 5.4% were Schedule III opioids; 11.4% ± 1.4% of OA visits involved skin neoplasms, and 45.4% ± 2.3% cellulitis and abscess. OA use increased from 1995-2010 (adjusted OR=1.82, 95% CI 1.49-2.22), even after controlling for increase in the frequency of skin infections from 1995-2010. Discussion: The most frequent use OA for cellulitis and abscess is entirely consistent with their FDA-approved indications for pain management. The almost two-fold increase in OA use in skin disorders from 1995-2010 may suggest that OA are being considered for pain management earlier in therapy. Conclusions: Only a minority of patient visits with OA had primary dermatologic disease. OA are being used in dermatology primarily for FDA-approved indications.