- Infectious risk of biological drugs versus traditional systemic treatments in moderate to severe psoriasis: a cohort analysis in the French insurance database. [Journal Article]
- FCFundam Clin Pharmacol 2018 Feb 15
- The aim of this study was to compare the infectious risk between a group of psoriasis patients treated by Biological Drugs (BD) and a group treated by Traditional Systemic Treatments (TST). We built ...
The aim of this study was to compare the infectious risk between a group of psoriasis patients treated by Biological Drugs (BD) and a group treated by Traditional Systemic Treatments (TST). We built a retrospective observational cohort study from the French health insurance database in the Midi-Pyrénées area (2.9 million inhabitants, South West of France) using data from 01/01/2010 to 12/31/2013. We compared the infectious risk between 'exposed' patients treated with BD (adalimumab, etanercept, infliximab or ustekinumab) and 'unexposed' patients treated by TST (phototherapy, acitretin, methotrexate or cyclosporine). We realized a survival analysis on the first infectious event, defined as an anti-infective drug delivery or a hospital diagnosis of infection. We selected 101 « exposed » and 788 « unexposed » patients. In our multivariate Cox model, « exposure » did not seem to decrease the time frame of the first infectious event compared with « non-exposure » (HR = 0.94, p = 0.62). Among all treatment, the safest seemed to be ustekinumab while the least safe was etanercept. We found factors statistically associated with the risk of infection: gender (female versus male), economic deprivation, chronic hepatitis B or C, history of cancer, at least one infectious event and the number of different drugs during the 6 months period before the study. We did not find any difference of infective risk between the BD and the TST. This result enhances the recent PSONET registries conclusions. This article is protected by copyright. All rights reserved.
- A Case of Disseminated Hypopigmented Keratoses Improved with Oral Acitretin. [Journal Article]
- CRCase Rep Dermatol Med 2017; 2017:1617375
- Disseminated hypopigmented keratosis is a distinct clinical entity and only few cases have been reported so far. Here, we present a 21-year-old man with almost 10-year history of hypopigmented, nonfo...
Disseminated hypopigmented keratosis is a distinct clinical entity and only few cases have been reported so far. Here, we present a 21-year-old man with almost 10-year history of hypopigmented, nonfollicular, keratotic lichenoid papules occurring on the extensor surfaces of the extremities, back and lumber region. Histopathological examination showed orthohyperkeratosis, irregular acanthosis, and sporadic papillomatosis with a normal amount of melanin and number of melanocytes. In addition, no marked inflammation or melanophages were seen. In order to exclude other possible causes, we performed laboratory tests and radiological examination which were all found to be normal. As the clinical and histopathological features of our patient were taken into account, it was considered to be compatible with the diagnosis of disseminated hypopigmented keratoses. So far, only topical therapies have been used with failure in the previously reported cases except one patient. Considering the extensive lesions, we treated the present patient with 5% salicylic acid in addition to oral acitretin and significant regression in all lesions was achieved, particularly on the keratosis.
- Doppler versus Histopathology in the Assessment of Egyptian Patients with Psoriasis Treated with Acitretin. [Journal Article]
- JCJ Clin Aesthet Dermatol 2017; 10(11):33-38
- Psoriasis is one of the most common chronic inflammatory skin diseases, characterized by erythema and the formation of plaques. The diagnosis of psoriasis is based on clinical examination, and its se...
Psoriasis is one of the most common chronic inflammatory skin diseases, characterized by erythema and the formation of plaques. The diagnosis of psoriasis is based on clinical examination, and its severity is assessed by the Psoriasis Area and Severity Index. Histologic examination is still the standard method for the final diagnosis. Sonography has proved to be a suitable noninvasive imaging method for studying soft tissue in dermatologic diseases such as psoriasis. This study evaluated the effect of Doppler sonography in the assessment of psoriasis in comparison with histopathology. Clinical, multifrequency sonography, and histological examinations were completed in 30 patients with chronic plaque psoriasis before and after acitertin treatment. After a 12-week treatment period, there was a notable decrease of psoriatic plaques in 28 patients with Psoriasis Area and Severity Index-1 severity and in two patients with Psoriasis Area and Severity Index-2 severity. Multifrequency sonography results after treatment of the same plaques showed normal finding in five patients, mild sonographic changes in 24 patients, and moderate sonographic changes in one patient. Histopathology findings after treatment were normal epidermis and dermis in six patients, mild histopathological changes in 22 patients, and moderate changes in two patients. In conclusion, there were significant correlations between sonography and histopathology in the diagnosis and evaluation of a psoriatic skin treatment regimen.
- Drug-induced psoriasis: clinical perspectives. [Review]
- PPsoriasis (Auckl) 2017; 7:87-94
- Exposure to certain drugs can elicit an induction or exacerbation of psoriasis. Although well-conducted systematic studies on drug-related psoriasis are mostly lacking, traditionally strong associati...
Exposure to certain drugs can elicit an induction or exacerbation of psoriasis. Although well-conducted systematic studies on drug-related psoriasis are mostly lacking, traditionally strong associations have been documented for beta-blockers, lithium, antimalarial drugs such as (hydroxy)chloroquine, interferons, imiquimod, and terbinafine. More recently, new associations have been reported for monoclonal antibody- and small-molecule-based targeted therapies used for oncological and immunological indications, such as tumor necrosis factor-alpha antagonists and anti-programmed cell death protein 1 immune checkpoint inhibitors. Recognizing potential drug-related psoriasis is of clinical relevance to allow an optimal management of psoriasis. However, in clinical practice, identifying medication-related exacerbations and induction of psoriasis can be challenging. The clinical and histopathological features of drug-provoked psoriasis may differ little from that of "classical" nondrug-related forms of psoriasis. In addition, the latency period between start of the medication and onset of psoriasis can be significantly long for some drugs. Assessment of the Naranjo adverse drug reaction probability scale could be used as a practical tool to better differentiate drug-related psoriasis. The first step in the management of drug-related psoriasis is cessation and replacement of the offending drug when deemed clinically possible. However, the induced psoriasis skin lesions may persist after treatment withdrawal. Additional skin-directed treatment options for drug-related psoriasis follows the conventional psoriasis treatment guidelines and includes topical steroids and vitamin D analogs, ultraviolet phototherapy, systemic treatments, such as acitretin, methotrexate, and fumaric acid esters, and biological treatments.
- Xanthoma Disseminatum Presenting with Hoarseness. [Journal Article]
- IJIran J Otorhinolaryngol 2017; 29(95):365-368
- CONCLUSIONS: Xanthoma disseminatum is a very rare form of non-Langerhans cell histiocytosis that classically presents with cutaneous xanthomas, mucosal xanthomas, and diabetes insipidus. Hoarseness of voice due to lesions involving the larynx is a rare symptom. Because the disease has punctated, numerous relapses and causes morbidity to the patient, its multisystem manifestations have to be known. Therefore, xanthoma disseminatum has to be kept in mind as a differential diagnosis for hoarseness of voice.
- A prospective 52-week randomised controlled trial of patient-initiated care consultations for patients with psoriasis. [Journal Article]
- BJBr J Dermatol 2018 Jan 24
- CONCLUSIONS: PICC offers additional clinical benefits compared to routine care, making patients less dependent on clinical visits. The intervention adds no harm to monitoring systemic treatment and patients report high quality of life and satisfaction with healthcare. This article is protected by copyright. All rights reserved.
- Combined acitretin and Candida antigen versus either agent alone in the treatment of recalcitrant warts. [Journal Article]
- JAJ Am Acad Dermatol 2018 Jan 12
- Severe ectropion in lamellar ichthyosis managed medically with oral acitretin. [Case Reports]
- PDPediatr Dermatol 2018 Jan 15
- Congenital ectropion is commonly associated with lamellar ichthyosis. Severe eyelid ectropion may cause corneal exposure, keratopathy, and permanent corneal scarring. We report a neonate with severe,...
Congenital ectropion is commonly associated with lamellar ichthyosis. Severe eyelid ectropion may cause corneal exposure, keratopathy, and permanent corneal scarring. We report a neonate with severe, bilateral, congenital ectropion and eclabium managed using oral retinoids. Both corneas were protected with topical antibiotics and lubricating eyedrops and eye ointments. At 12-month follow-up, the child was doing well, with no ectropion or corneal opacity.
- Cutaneous squamous cell carcinoma: Management of advanced and high-stage tumors. [Review]
- JAJ Am Acad Dermatol 2018; 78(2):249-261
- While the majority of cutaneous squamous cell carcinomas (cSCCs) can be treated surgically, the additional work-up and treatments indicated for high-risk cSCC remain undefined. In recent years, impro...
While the majority of cutaneous squamous cell carcinomas (cSCCs) can be treated surgically, the additional work-up and treatments indicated for high-risk cSCC remain undefined. In recent years, improvements in tumor staging systems have allowed for the more accurate stratification of tumors into high- and low-risk categories. This insight, along with the publication of cSCC guidelines, brings us closer to the development of a consensus approach. The second article in this continuing medical education series addresses in question and answer format the most common questions related to advanced and high-stage cSCCs, with a simplified flowchart. The questions include the following: 1) Does my patient have high-risk cSCC?; 2) What is the next step for patients with cSCC and palpable lymphadenopathy?; 3) In patients with no clinically evident lymphadenopathy, who are candidates for lymph node staging?; 4) What forms of radiologic imaging can help detect subclinical lymph node metastases?; 5) What is the role of sentinel lymph node biopsy in cSCC?; 6) Which patients with cSCC need adjuvant radiation therapy?; 7) Is adjuvant chemotherapy an option for patients with high-stage cSCC after surgery?; 8) Are targeted and immunologic therapies an option for advanced cSCC?; 9) How often should I follow up with my patient after he/she has been diagnosed with a high-risk cSCC?; 10) What are the options for chemoprophylaxis in a patient with an increased risk of cSCC?; and 11) What chemopreventive measures can be started in coordination with medical oncology or transplant physicians?
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- Cutaneous squamous cell carcinoma: Incidence, risk factors, diagnosis, and staging. [Review]
- JAJ Am Acad Dermatol 2018; 78(2):237-247
- Cutaneous squamous cell carcinoma (cSCC), a malignant proliferation of cutaneous epithelium, represents 20% to 50% of skin cancers. Although the majority of cSCCs are successfully eradicated by surgi...
Cutaneous squamous cell carcinoma (cSCC), a malignant proliferation of cutaneous epithelium, represents 20% to 50% of skin cancers. Although the majority of cSCCs are successfully eradicated by surgical excision, a subset of cSCC possesses features associated with a higher likelihood of recurrence, metastasis, and death. The proper identification of these aggressive cSCCs can guide additional work-up and management. In the first article in this continuing medical education series, we discuss the incidence, recurrence rates, mortality rates, and risk factors associated with cSCC and review the staging systems used to stratify patients into high- and low-risk groups. The second article in this series reviews the treatment options for cSCC, with focused attention on the management of high-stage tumors.