Dermatology
An observational study to evaluate the long-term outcomes of treatment with etanercept in patients with plaque-type psoriasis
T. Luger, R.e. Schopf, A. Schwanke, S. Langhammer, T. Meng, P.a. Löschmann ·Tuesday, June 14, 2016, 14:48
Abstract
Background
There is an unmet need for long-term, real-life data on the effect of a drug-free interval between treatment cycles in patients with plaque psoriasis being treated with etanercept, which is licensed for intermittent and continuous treatment.
Objective
The aim of this study was to determine the average duration of the drug-free interval between etanercept treatment cycles in patients with plaque psoriasis.
Methods
This was a non-interventional, open-label, multicentre, prospective study in patients for whom the decision had already been made to initiate treatment with etanercept during routine practice in German centres. Clinical outcomes were documented over 36 months with study visits every 12 weeks. The primary endpoint was the duration of the treatment-free interval between etanercept treatment cycles (24 weeks/cycle). Secondary endpoints assessed efficacy [Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), static Physician's Global Assessment (sPGA)], health-related outcomes [EuroQol-5 Dimensions (EQ-5D), Dermatology Life Quality Index (DLQI)] and safety.
Results
A total of 955 patients were enrolled from 224 centres; 926 of these were included in the safety analyses and 720 patients from the safety population were included in the efficacy analysis. The mean duration of drug-free intervals was 12.9 ± 12.8 weeks. Efficacy and health-related quality of life outcomes measures showed consistent improvement that occurred within 12 weeks of treatment with etanercept. There was a descriptive difference between the continuous and intermittent treatment subgroups, as subjects in the latter showed a deterioration at the first visit following an interval. However, retreatment with etanercept resulted in a clinical efficacy identical to the initial effect. The incidence of physician-assessed, drug-related adverse events and serious adverse events was 13.1% and 1.9%, respectively.
Conclusion
The mean duration of drug-free intervals was relatively short, most patients experienced improvements in disease activity and health-related quality of life within 12 weeks of either continuous or intermittent treatment with etanercept, and there were no new safety signals. ClinicalTrials.gov identifier: NCT00708708.
Tags: Dermatology
Dermatology
A Rare Presentation of a Dermoid Cyst with Draining Sinus in a Child: Case Report and Literature Review
Chen Yan, David W. Low · Tuesday, June 14, 2016, 14:48
Abstract
Orbitofacial dermoid cysts in children are treated using surgical excision. Dermoid cysts of the frontotemporal region usually present as superficial, slow-growing masses without deep extension. We report a rare case wherein a frontotemporal dermoid in a 21-month-old girl presented with a draining sinus tract to the skin and extended intracranially through the sphenoid bone. It was removed surgically and a dermoid cyst was removed from the frontotemporal region, extending superficially from the skin sinus tract through the sphenoid bone and attaching to the dura of the anterior temporal lobe. In addition to our case presentation, a literature review was performed to identify the few reported similar cases in the published literature, the combination of which suggests that frontotemporal dermoid cysts with associated draining sinus tracts may require preoperative imaging with computed tomography or magnetic resonance imaging before surgical intervention because of the high likelihood of intracranial extension.
Tags: Dermatology
Dermatology
Catastrophic cryofibrinogenaemia associated with chronic lymphocytic leukaemia and salvage therapy using plasmapheresis and cyclophosphamide
M. Algain, R. Damade, F. Aucouturier, J. Rivet, M. Jachiet, M. Malphettes, G. Hickman, R. Szalat, A. Saussine, A. De Masson, A. Petit, M. Rybojad, M. Bagot, B. Arnulf, J.d. Bouaziz · Tuesday, June 14, 2016, 14:48
Tags: Dermatology
Dermatology
Histopathology and reflectance confocal microscopy features of photodamaged skin and actinic keratosis
J.m. Tan, D. Lambie, S. Sinnya, A. Sahebian, H.p. Soyer, T.w. Prow, M. Ardigò ·Tuesday, June 14, 2016, 14:48
Abstract
Background
Actinic keratosis (AK) usually co-exists in areas of severe photodamage, but the clinical applicability of reflectance confocal microscopy (RCM) in diagnosing AK currently depends on a set of parameters yet to be defined in comparison to photodamaged skin (PD).
Objective
To correlate the RCM features of PD and AK with histopathology.
Methods
Twenty participants with a mean age of 64 years and skin phototype I and II were studied. RCM was performed on two PD and one AK within a field of 25 cm2 on the left dorsal forearm, followed by shave biopsies. Blinded evaluation of the histopathological and RCM images using established parameters in AK were performed retrospectively in consensus with an expert confocalist, correlated with the histopathological diagnosis by a board-certified dermatopathologist.
Results
A total of 57/60 areas were included. There were 43/57 (75%) and 14/57 (25%) histopathologically confirmed PD and AK respectively. Individual corneocytes, stratum corneum disruption, dermal inflammatory cells, increased vascularity/dilated vessels and solar elastosis were detected in PD and AK upon histopathology and RCM. The features in favour of AK were parakeratosis, hyperkeratosis, more severe keratinocyte pleomorphism and architectural disruption, and the presence of epidermal inflammatory cells. PD also demonstrated keratinocyte pleomorphism and architectural disruption though this was generally less severe than AK. A small subset of PD exhibited a comparable degree of keratinocyte pleomorphism and architectural disruption to the AKs in the cohort.
Conclusions
The viable epidermis demonstrates PD and AK to be part of a disease continuum corresponding to field cancerization. Individual corneocytes, stratum corneum disruption, dermal inflammatory cells, increased vascularity/dilated vessels and solar elastosis may be present in PD; whereas, parakeratosis and hyperkeratosis may represent the key to distinguishing AK from PD using RCM. The significance of epidermal inflammatory cells in the RCM diagnosis of AK remains to be elucidated.
Tags: Dermatology
Dermatology
Dermatology
Entwicklungen der Immunmodulation nach Transplantation im Hinblick auf De-novo-Malignome und Tumorrezidive
Tuesday, June 14, 2016, 14:48
Zusammenfassung
Hintergrund
Organtransplantierte Patienten haben ein erhöhtes Risiko, maligne Tumoren zu entwickeln. Im langfristigen Verlauf nach Organtransplantation stellen maligne Tumoren nach den kardiovaskulären Erkrankungen die zweithäufigste Todesurasche dar. Ziel dieses Reviews ist eine überblickende Darstellung der Zusammenhänge zwischen Immunmodulation und Tumorentstehung nach Organtransplantation.
Ergebnisse und Schlussfolgerung
Neben individuellen Risikofaktoren werden die immunologischen Veränderungen nach Organtransplantation als Ursache des erhöhten Krebsrisikos angesehen. Histokompatibilität, HLA-Status, die kumulative Immunsuppressionsdosis in der Induktions-, Erhaltungs- und Abstoßungsbehandlung, das mit spezifischen Immunsuppressiva assoziierte Malignitätsrisiko sowie eine erhöhte Inzidenz onkogener viraler Infektionen scheinen zum erhöhten Krebsrisiko nach Organtransplantation beizutragen. Ein gründliches Tumorscreening vor und nach Transplantation, antivirale Prophylaxen und eine so niedrig wie möglich dosierte Immunsuppression sind gegenwärtige Strategien, um das Risiko für die Entstehung maligner Tumore nach Transplantation zu senken. Die Entwicklung neuer Immunsuppressiva und Protokolle zur Toleranzinduktion und klinische Erfahrungen mit systemischen und lokalen immunbasierten Tumortherapien können zukünftig ebenso dazu beitragen wie ein besseres Verständnis der Pathomechanismen der Kanzerogenese unter Immunsuppression.
Tags: Dermatology
Dermatology
New treatment offers hope for children with debilitating skin and muscle disease
Tuesday, June 14, 2016, 14:48
Patients who have failed multiple drug treatments show significant improvements.
Tags: Dermatology
Dermatology
Triple paradoxical reaction due to adalimumab
J.f. Mir-bonafe, A. Lopez-ferrer, A. Laiz, L. Puig · Tuesday, June 14, 2016, 14:48
Tags: Dermatology
Dermatology
Next-generation sequencing identified a novel mutation of COL7A1 in a Chinese pedigree of dystrophic epidermolysis bullosa
S. Zheng, X.g. Xu, Y. Lv, X.-h. Gao, H.d. Chen · Tuesday, June 14, 2016, 14:48
Tags: Dermatology
Dermatology
Sentinel lymph node biopsy versus PET-CT in AJCC stages I and II of melanoma
M.a. Chessa, E. Dika, A. Patrizi, P.a. Fanti, B.m. Piraccini, G. Veronesi, S. Diodato, S. De Vivo, S. Fanti · Tuesday, June 14, 2016, 14:48
Tags: Dermatology
Dermatology
Atypical Forms of Hand, Foot, and Mouth Disease: A Prospective Study of 47 Italian Children
Iria Neri, Arianna Dondi, Andreas Wollenberg, Lorenza Ricci, Giampaolo Ricci, Giulia Piccirilli, Tiziana Lazzarotto, Annalisa Patrizi · Tuesday, June 14, 2016, 14:48
Abstract
Background
Atypical forms of hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 have been reported in recent years. High fever and severe cutaneous lesions are common, whereas neurologic complications are rare. Eczematous areas of patients with atopic dermatitis show more lesions. The goal of the current study was to describe the clinical characteristics of children with atypical HFMD and to investigate the involvement of the different enterovirus serotypes associated.
Methods
All patients referred to our service for atypical HFMD from January 2012 to February 2014 were enrolled and classified as having the diffuse form (lesions extended to the trunk), the acral form (lesions with a mainly acral distribution), or eczema coxsackium (lesions on preexisting eczematous areas).
Results
Data from 47 patients were analyzed (median age 22 months [range 4–84 mos]); viral genotyping was performed in 11 cases. Sixty-two percent of the subjects developed the acral form, 23% eczema coxsackium, and 15% the diffuse form. Most patients had a nonclassical vesicular eruption and moderate to severe extent of cutaneous involvement. Approximately 80% of patients had palmoplantar purpuric macules. Most children younger than 2 years old had the acral form, most patients with eczema coxsackium were age 2 years and older, and the diffuse form was similarly distributed between the two age groups. Coxsackievirus A6 was detected in 9 of 11 genotyped cases.
Conclusion
Our prospective study allowed the identification of three HFMD phenotypes differing from the classical form. Clinical care of these patients should include symptomatic treatment of extracutaneous features and, if necessary, hospitalization for complications.
Tags: Dermatology
Dermatology
Ultrasound Diagnosis and Staging in Pediatric Hidradenitis Suppurativa
Ximena Wortsman, Carolyn Rodriguez, Carolina Lobos, Gonzalo Eguiguren, Maria Teresa Molina · Tuesday, June 14, 2016, 14:48
Abstract
Hidradenitis suppurativa (HS) can affect children, and ultrasound has been proven to be useful in diagnosis and staging. The sonographic characteristics of HS in children have not been reported. We studied color Doppler ultrasound images of children (≤15 years old; n = 12) with clinically and sonographically positive criteria for HS. Sonographic scoring of hidradenitis suppurativa (SOS-HS) was used to stage the cases sonographically. Subclinical pseudocysts were found in 92% of the cases, fluid collections in 83%, and fistulous tracts in 58%. Retained hair tracts in the fluid collections and fistulous tracts were present in 100% of patients; 67% of cases were SOS-HS stage II. In 92% of cases, management was modified after the ultrasound examination. In conclusion, ultrasound can be a reliable and safe imaging tool to support diagnosis and staging and may help in the noninvasive monitoring of treatment in children.
Tags: Dermatology
Dermatology
Prognosis and Management of Congenital Hair Shaft Disorders without Fragility—Part II
Gaurav Singh, Mariya Miteva · Tuesday, June 14, 2016, 14:48
Abstract
Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective of this study was to review the literature regarding the prognosis and treatment options for hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in English related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, woolly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati, improve with minoxidil. Oral retinoids have been found to improve hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Furthermore, any inherited or congenital disorder requires genetic counseling as part of management.
Tags: Dermatology
Dermatology
Prognosis and Management of Congenital Hair Shaft Disorders with Fragility—Part I
Gaurav Singh, Mariya Miteva · Tuesday, June 14, 2016, 14:48
Abstract
Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective was to review the literature regarding the prognosis and treatment options of hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in the English language related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, wooly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati improve with minoxidil. Oral retinoids have improved hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Any inherited or congenital disorder requires genetic counseling as part of management.
Tags: Dermatology
Dermatology
Late-Onset Nail Changes Associated with Hand, Foot, and Mouth Disease: A Clinical Analysis of 56 Cases
Dong-ling Long, Shi-yuan Zhu, Cai-zi Li, Cui-yan Chen, Wan-tao Du, Xi Wang · Tuesday, June 14, 2016, 14:48
Abstract
Objectives
To investigate the development and clinical characteristics of nail changes in hand, foot, and mouth disease (HFMD).
Methods
A telephone survey was conducted with the parents of patients diagnosed with HFMD in the Fourth General Hospital of Nanhai from June to August 2013 to document nail changes within 3 months of diagnosis of HFMD.
Results
Valid survey results were obtained from 273 cases. Definitive nail changes were identified in 56 patients (20.5%). More boys (25.8%) than girls (10.6%) (p < 0.01) showed changes. The age distribution ranged from 1 to 5 years, and nail changes were rare in children younger than 1 year of age (p < 0.01). Nail changes were usually seen 1 to 2 months after the onset of HFMD and lasted for 1 to 8 weeks, most for approximately 4 weeks. Toenails or fingernails could be affected and the changes were more likely to occur synchronously. Fingernails were more commonly involved than toenails. When both fingernails and toenails were involved, this typically occurred synchronously. Although there were cases with all toenails and fingernails involved (16.1%), we did not encounter any instances involving 13 to 19 nails. The nail changes mainly presented as onychomadesis. Spontaneous recovery without special treatment was the course for all patients. No relapse or new nail involvement was identified.
Conclusions
Nail change associated with HFMD usually occurs within 1 to 2 months after onset, mainly presents as onychomadesis, and is a self-limited process. Possible mechanisms are discussed.
Tags: Dermatology
Dermatology
Risk Factors for Premature Hair Graying in Young Turkish Adults
Asli Akin Belli, Fatma Etgu, Seyran Ozbas Gok, Bilge Kara, Gursoy Dogan · Tuesday, June 14, 2016, 14:48
Abstract
Background
Premature hair graying (PHG) is a common condition resulting in loss of self-esteem. Studies investigating PHG risk factors for both sexes with a large number of patients are scarce. We sought to investigate the socioclinical risk factors for PHG in young Turkish men and women and the differences between the sexes.
Methods
A cross-sectional study was conducted in 1,119 participants who answered a survey about PHG and some socioclinical characteristics between February and July 2015. The number of gray hairs, onset age of hair graying, and family history of PHG were asked about, as well as demographic characteristics, anthropometric measures, body mass index, smoking, alcohol consumption, sports life, diet, medical history, educational status, occupation, marital status, monthly income, and Fitzpatrick skin type.
Results
Of 1,119 participants, 315 (28.1%) had PHG and 804 did not. Maternal and paternal PHG, alcohol consumption, presence of chronic disease, educational status, hair loss, perceived stress scale (PSS) score, age, and height were significantly higher in subjects with PHG. Rates of maternal and paternal PHG were high in women with PHG, and the rate of paternal PHG was high in men with PHG. According to the multivariate ordinal regression analysis, PSS score, age, hair loss, and family history of PHG were correlated with the severity of PHG.
Conclusion
PHG is closely related to factors causing oxidative stress, such as emotional stress, alcohol consumption, and chronic diseases in genetically predisposed men and women.
Tags: Dermatology
Dermatology
Asymmetrical proliferative pattern loss linked to cyclin D1 overexpression during malignant transformation of the lip epithelium
N.g. Garcia, M.a. González-moles, I. Ruiz-ávila, M. Bravo, P. Ramos-garcía, E.m. Minicucci, M.a.c. Domingues, D.t. Oliveira · Tuesday, June 14, 2016, 14:48
Abstract
Background
There is inadequate knowledge on the involvement of oncogenic mechanisms linked to the cyclin (CCND1) gene in lip squamous cell carcinoma (LSCC).
Objective
The aim of this study was to analyse the implication of cyclin D1 in the malignant transformation of lip lesions.
Methods
We immunohistochemically studied 45 actinic cheilitis cases (15 mild dysplasia, 15 moderate dysplasia, 15 severe dysplasia/carcinoma in situ), 30 LSCC cases with adjacent non-tumour epithelium and 15 normal oral epithelium samples for detection of cyclin D1, β-catenin and Ki-67.
Results
Cyclin D1 and Ki-67 expressions were significantly increased in the basal layer of premalignant epithelia and peripheral layers of tumour nests vs. controls. Premalignant epithelia had lost their asymmetrical proliferative pattern.
Conclusion
Lip carcinogenesis was associated with loss of the asymmetrical proliferative pattern, a preventive mechanism against lip oncogenesis, and with cyclin D1 overexpression.
Tags: Dermatology
Dermatology
Short-term efficacy and safety of new biologic agents targeting IL-23/Th17 pathway for moderate to severe plaque psoriasis: a systematic review and network meta-analysis
F. Gómez-garcía, D. Epstein, B. Isla-tejera, A. Lorente, A. Vélez García-nieto, J. Ruano ·Tuesday, June 14, 2016, 14:48
Abstract
A new generation of biologics targeting IL-23/Th17 pathway has been developed. This study aimed to assess the short-term effectiveness and safety of these new agents using a network meta-analysis. Twenty seven randomized clinical trials (n=10,629) were identified by a comprehensive systematic literature review (PROSPERO 2015:CRD42015025472). Quality of evidence was assessed following Cochrane compliant rules and GRADE approach. Efficacy and safety outcomes at weeks 10-16 were compared using a random-effects network meta-analysis within a frequentist framework to estimate pooled odds ratios (OR) of direct and indirect comparisons among the therapeutic options. There were 6 direct drug-to-drug comparisons in the network, with a high degree of consistency between the direct and the indirect evidence. From the available evidence, infliximab 5mg.kg-1 every eight weeks (OR: 118.89; 95%CI: 60.91-232.04) and secukinumab 300mg every four weeks (OR: 87.07;95%CI: 55.01-137.82) are shown as among the most effective short-term treatment, but are ranked as the biologic most likely to produce any adverse event (AE) or an infectious AE, respectively. Ustekinumab 90mg every twelve weeks, the third most efficacious (OR: 73.67; 95%CI: 46.97-115.56), was the only agent that did not show increased risk of adverse events when compared with placebo. Treatment recommendations should also consider long term outcomes and costs.
This article is protected by copyright. All rights reserved.
Tags: Dermatology
Dermatology
Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the UK Clinical Research Practice Datalink
A. Matthews, M. Turkson, H. Forbes, S.m. Langan, L. Smeeth, K. Bhaskaran · Tuesday, June 14, 2016, 14:48
Abstract
Background
Statins are commonly prescribed worldwide and recent evidence suggests they may increase the risk of herpes zoster.
Objective
To quantify the effect of statin exposure on the risk of zoster in the UK.
Methods
A matched case-control study was conducted using data from UK primary care and hospital records. Patients >18 years with an incident diagnosis of zoster were matched to up to four controls on age, sex and general practice. Exposures were: ever use of a statin; daily dosage of most recent statin prescription; time since most recent statin prescription. The primary outcome was an incident diagnosis of zoster. Odds ratios were estimated from conditional logistic regression and adjusted for potential confounders.
Results
A total of 144,959 incident cases of zoster were matched to 549,336 controls. Adjusted analysis suggested strong evidence for an increase in risk of zoster related to statin exposure (OR:1.13, 95% CI:1.11,1.15). There was also an increasing risk with increasing dose in current and recent users (p-trend<0.001), and an attenuation of excess risk in previous users as time since last exposure increased (p-trend<0.001).
Conclusion
These findings are consistent with the hypothesis that statin therapy leads to an increase in the risk of zoster.
This article is protected by copyright. All rights reserved.
Tags: Dermatology
Dermatology
The SCAR Scale (Scar Cosmesis Assessment and Rating Scale): Development and validation of a new outcome measure for postoperative scar assessment
J. Kantor · Tuesday, June 14, 2016, 14:48
In order to effectively discriminate between various surgical interventions, it is critical to utilize a valid and feasible outcome measure for postoperative scar quality. Despite the large number of studies published in the dermatology, general surgery, and plastic surgery literature on the relative merits of various surgical techniques, no ideal scar scale exists to effectively assess the quality of postoperative scars. Until now, studies have relied on one of several scales for scar rating,1-5 many of which were developed for burn, rather than linear, scars. Moreover, none of these scales were developed or validated by dermatologists, none were developed expressly for tracking the evolution of linear postoperative scars, and none rigorously included input from patients in its development.
This article is protected by copyright. All rights reserved.
Tags: Dermatology
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from #Med Blogs by Alexandros G.Sfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/1ZNLF7e
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