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INTRODUCTION: Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness. It may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are redness and oedema, typically followed by whitening of the genital skin; sometimes fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES: The guideline intends to provide guidance on the diagnostic of LS, highlight important aspects in the care of LS patients (part 1), generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS: The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS: Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS: LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.
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INTRODUCTION: Lichen sclerosus (LS) is an inflammatory skin disease affecting all ages. LS typically involves the anogenital site where it causes itching and soreness; it may lead to sexual and urinary dysfunction in females and males; however, it may be asymptomatic. First signs of LS are usually a whitening of the genital skin, sometimes preceded by redness and oedema; fissuring, scarring, shrinkage and fusion of structures may follow in its course. LS is associated with an increased risk of genital cancer. LS has a huge impact on the quality of life of affected patients, and it is important to raise more awareness of this not uncommon disease in order to diagnose and treat it early. OBJECTIVES: The guideline intends to provide guidance on the diagnostic of LS (part 1), highlight important aspects in the care of LS patients, generate recommendations and treatment algorithms (part 2) on topical, interventional and surgical therapy, based on the latest evidence, provide guidance in the management of LS patients during pregnancy, provide guidance for the follow-up of patients with LS and inform about new developments and potential research aspects. MATERIALS AND METHODS: The guideline was developed in accordance with the EuroGuiDerm Methods Manual v1.3 https://www.edf.one/de/home/Guidelines/EDF-EuroGuiDerm.html. The wording of the recommendations was standardized (as suggested by the GRADE Working Group). The guideline development group is comprised of 34 experts from 16 countries, including 5 patient representatives. RESULTS: Ultrapotent or potent topical corticosteroids in females and males, adults and children remain gold standard of care for genital LS; co-treatment with emollients is recommended. If standard treatment fails in males, a surgical intervention is recommended, complete circumcision may cure LS in males. UV light treatment is recommended for extragenital LS; however, there is limited scientific evidence. Topical calcineurin inhibitors are second line treatment. Laser treatment, using various wave lengths, is under investigation, and it can currently not be recommended for the treatment of LS. Treatment with biologics is only reported in single cases. CONCLUSIONS: LS has to be diagnosed and treated as early as possible in order to minimize sequelae like scarring and cancer development. Topical potent and ultrapotent corticosteroids are the gold standard of care; genital LS is often a lifelong disease and needs to be treated long-term.
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INTRODUCTION: It remains unclear whether multiple primary melanoma (MPM) patients have a worse survival prognosis compared with single primary melanoma (SPM) patients. OBJECTIVES: To investigate the demographics, histological features, and survival of MPM versus SPM patients. METHODS: Cox regression analyses compared survival between SPM and MPM patients. Furthermore, demographics and histological features of the MPM cohort were compared with the SPM patients retrieved from dermatopathology files between 2000 and 2019. RESULTS: Out of 3853 melanoma patients, 95 MPM patients were retrieved: 81 with two primary melanomas (85.2%) and 14.8% with three or more. Mean Breslow of the first melanoma was 0.84 mm [minimum (min): 0 mm, maximum (max): 16 mm, standard deviation (SD) 1.77] versus 0.37 mm (second MPM) (min: 0 mm, max: 2.5 mm, SD 0.50) and 0.33 mm (third MPM) (min: 0 mm, max: 0.6 mm, SD 0.22). The mean Breslow for the second MPM was significantly higher for men than women (0.59 mm versus 0.27 mm). First and second melanoma in MPM patients developed on preexisting melanocytic nevi in 13% and 12%, respectively. In contrast with the mean age of primary melanoma in Belgium for women (58.2 years) and men (63.3 years), MPM patients developed their first melanoma earlier, at 44.8 years and 54.6 years, respectively. The mean distribution of anatomical localization of primary and secondary melanoma was highly similar in women, whereas in men a shift towards lower extremities was observed (19% versus 28%). The thicker the primary melanoma was, the sooner the second appeared. Follow-up (2-4/year) versus (1/year) yielded a mean Breslow of 0.29 mm and 0.55 mm, respectively. Cox regression analysis with time-varying covariate revealed a tendency for a worse prognosis in 5-year survival rates, but this was not statistically significant (p = 0.09). Patient phenotypes were not available on the histological reports. CONCLUSION: A closer follow-up regimen of MPM versus SPM patients is probably justified.
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Mycosis fungoides (MF) is the most frequent form of cutaneous lymphomas. MF is known as the great mimicker. The tumour d'emblee form is an exceptional presentation, for which there is no precise treatment guidance. A 45-year old man presented with tumoral MF on the dorsal side of his right hand with an extension to the forefinger. After the histological, immunohistological and the TCR monoclonality proof of MF, different topical and systemic treatments have been administered. As none of these treatments provided satisfying clinical responses, a surgical excision was finally proposed, with a very good clinical outcome and no recurrence observed after 2 months. Although exceptional in the event of an MF in general, localized tumoral forms of MF could readily benefit from a surgical excision.
: Le mycosis fongoïde (MF) est le lymphome cutané le plus fréquent. Il est notamment connu pour pouvoir se manifester sous différentes formes cliniques, dont une forme tumorale d'emblée et uniloculaire, rarissime. La prise en charge spécifique de cette forme n'est pas codifiée et se base sur les mêmes principes que pour le traitement d'un MF classique. Un homme de 45 ans s'est présenté avec un MF tumoral d'emblée et uniloculaire de la face dorsale de la main droite, avec une extension vers l'index. Après confirmation du diagnostic par histologie, immunohistochimie et biologie moléculaire en 2015, il a reçu différents traitements topiques et systémiques, sans résultats probants. Devant l'échec des multiples options thérapeutiques, une excision chirurgicale a été proposée en deux temps, avec une rémission complète à 2 mois. Quoique exceptionnelle pour cette pathologie, la chirurgie reste une option devant un MF d'emblée tumoral et uni- voire pauci-loculaire, avec une excellente réponse dans ce cas-ci.
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Linfoma Cutâneo de Células T , Micose Fungoide , Neoplasias Cutâneas , Masculino , Humanos , Pessoa de Meia-Idade , Linfoma Cutâneo de Células T/diagnóstico , Linfoma Cutâneo de Células T/terapia , Linfoma Cutâneo de Células T/patologia , Micose Fungoide/diagnóstico , Micose Fungoide/terapia , Micose Fungoide/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologiaRESUMO
Mucinous nevus is an exceptional entity and presents as flesh-colored to brownish papules or plaques, coalescing to form a pigmentary or verrucous lesion with either a blaschkoid, linear, grouped or zosteriform disposition. It usually appears at birth or during early childhood, but late onset has also been described. Mucinous nevus does not require additional work-up as no internal pathologies have been described. Abstention of any therapeutic intervention is usually preferred.
: Le naevus mucineux est une entité exceptionnelle, se présentant par des papules ou des plaques de couleur chair à brunâtre qui confluent sous la forme d'une lésion pigmentaire ou verruqueuse de distribution blaschkoïde, linéaire, groupée ou zostériforme. Il est le plus souvent congénital ou d'apparition précoce, mais des formes tardives ont également été rapportées. Le naevus mucineux n'est jamais associé à une pathologie interne et ne nécessite pas d'exploration complémentaire. Au vu du caractère bénin, l'abstention thérapeutique est généralement la règle.
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Nevo , Anormalidades da Pele , Neoplasias Cutâneas , Pré-Escolar , Humanos , Recém-Nascido , Nevo/diagnóstico , Nevo/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/terapiaRESUMO
Monkeypox (MPX), is a rare endemic zoonotic disease of certain areas of Central and West Africa. Nevertheless, in recent years, several outbreaks have occurred outside the African continent. Monkeypox usually presents with a flu-like prodromal period (fever, headache, chills, sweating) associated or followed by the appearance of lymphadenopathy and a typical skin rash. Transmission is suspected to be direct or indirect via contact with saliva, respiratory droplets or skin lesions of infected animals or more rarely of humans. The gold standard for diagnosis is the detection of MPX virus (MPXV) by PCR on skin lesion fluid. The evolution is usually favourable in 2 to 5 weeks but severe complications and sequelae are possible. In the absence of a specific treatment, the management is essentially supportive: appropriate local care, rehydration, analgesia and management of eventual complications.
La variole du singe (monkeypox, MPX), ou orthopoxvirose simienne, est une zoonose rare et endémique de certains pays d'Afrique Centrale et de l'Ouest. Néanmoins, ces dernières années, plusieurs épidémies sont survenues en dehors du continent africain. La MPX se manifeste, habituellement, par un prodrome pseudogrippal (fièvre, céphalées, frissons, sudations), associé ou suivi par l'apparition d'une lymphadénopathie et d'un rash typique. La transmission serait directe ou indirecte, via contact avec la salive, les gouttelettes respiratoires ou les lésions cutanées d'animaux ou, plus rarement, d'humains contaminés. Le gold standard du diagnostic est la mise en évidence du virus monkeypox (MPXV) par «polymerase chain reaction¼ (PCR) sur lésion cutanée. L'évolution est habituellement favorable en 2 à 5 semaines, mais des complications et des séquelles sévères sont possibles. En l'absence d'un traitement spécifique, le traitement de soutien comporte: soins locaux adaptés, réhydratation, antalgie et prise en charge des éventuelles complications.
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Mpox , Animais , Surtos de Doenças , Humanos , Mpox/diagnóstico , Mpox/epidemiologia , Mpox/terapia , Monkeypox virus/genética , Reação em Cadeia da PolimeraseRESUMO
The therapeutic prospects for patients with moderate to severe atopic dermatitis completely changed in 2017 with the arrival of the first targeted therapy, dupilumab. Achieving important clinical improvement scores are now possible with this monoclonal antibody directed against interleukins 4 and 13. Since that time, other agents such as tralokinumab arrived on the market, but also the small molecules called «JAK inhibitors¼ (upadacitinib, baricitinib, etc.). This article provides an inventory of the existing or imminent therapeutic options for atopic dermatitis.
: Les perspectives thérapeutiques pour les patients atteints de dermatite atopique modérée à sévère ont été complètement bouleversées en 2017 avec l'arrivée sur le marché de la première thérapie ciblée, le dupilumab. Cet anticorps monoclonal dirigé contre les interleukines 4 et 13 permet d'atteindre des scores d'amélioration clinique encore inespérés il y a quelques années. Depuis, d'autres biothérapies comme le tralokinumab sont arrivés sur le marché européen, mais également des petites molécules appelées «inhibiteurs JAK¼ (upadacitinib, baricitinib, etc.). Cet article présente un état des lieux des options thérapeutiques existantes ou imminentes pour la prise en charge de la dermatite atopique.
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Dermatite Atópica , Dermatite Atópica/tratamento farmacológico , Humanos , Resultado do TratamentoRESUMO
Postherpetic neuralgia is the most feared complication of herpes zoster (HZ). The incidence increases with age. Nevertheless, around 5 % of HZ patients will experience a motor deficiency known as segmental zoster paresis (SZP) according to the affected dermatome. Abdominal pseudohernia is an exceptional clinical presentation of SZP, involving the T6-L1 dermatomas. The recognition of this rare complication of HZ prevents unnecessary explorations and interventions. There is no specific treatment but in general the evolution is favorable and spontaneous healing is observed within several months.
La névralgie post-zostérienne est la complication la plus redoutée du zona, et son incidence augmente avec l'âge. Néanmoins, environ 5 % des patients peuvent également présenter une atteinte motrice appelée parésie segmentaire zostérienne (PSZ) et dont la clinique dépend du dermatome affecté. La pseudohernie abdominale est une forme exceptionnelle de PSZ, dépendant des dermatomes T6-L1. Reconnaître cette complication rare permet d'éviter des explorations et des interventions inutiles. Il n'y a pas de traitement spécifique et, en règle générale, l'évolution est spontanément favorable en quelques mois.
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Parede Abdominal , Herpes Zoster , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Humanos , ParesiaRESUMO
Köbner's phenomenon and its related phenomena are dermatological curiosities that are still partially misunderstood. The Köbner phenomenon is by far the best known and the most studied. It is characterized as the appearance of an inflammatory or infectious dermatosis in an area of healthy skin after skin trauma. The dermatoses most frequently concerned are psoriasis, lichen planus and vitiligo. The inverse Köbner phenomenon and the Renbök phenomenon are two very similar phenomena. The first represents the disappearance of a skin lesion after skin trauma. The second is characterized by a skin trauma that is more specifically induced by another dermatosis. Finally, the Wolf's isotopic phenomenon corresponds to the appearance of a new dermatosis on an area of the skin that was previously the site of another healed dermatosis.
Le phénomène de Köbner et les phénomènes qui lui sont apparentés sont des curiosités dermatologiques, encore partiellement incomprises. Le phénomène de Köbner est de loin le plus connu et le plus étudié. Il correspond à l'apparition d'une lésion cutanée caractéristique d'une dermatose en zone de peau saine après traumatisme cutané. Parmi les dermatoses concernées, on peut citer le psoriasis, le lichen plan et le vitiligo. Le phénomène de Köbner inverse et le phénomène de Renbök sont deux phénomènes très similaires. Il s'agit de la disparition d'une lésion cutanée après traumatisme cutané pour le phénomène de Köbner inverse. Ce traumatisme cutané est induit plus spécifiquement par une autre dermatose dans le phénomène de Renbök. Enfin, le phénomène isotopique de Wolf correspond à l'apparition d'une nouvelle dermatose sur une zone cutanée qui a précédemment été le siège d'une autre dermatose guérie.
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Dermatologia , Psoríase , Dermatopatias , Humanos , Dermatopatias/epidemiologia , Dermatopatias/etiologiaRESUMO
The management of melanoma is a typical example of a pluridisciplinary approach, in order to provide the patient with a rapid and adequate treatment plan after the initial diagnosis. Both in the domains of dermatology, pathology and oncology, enormous progress has been made. Recent advances permit a rapid access to diagnostic techniques using teledermoscopy, an improved diagnostic accuracy using dermoscopy, pre-interventional high-frequency ultrasound and optical coherence tomography, a determination of risk factors using immunohistochemistry and genetic analyses on the pathology samples. Furthermore, the development of immunotherapies, in particular the anti-PD1 antibodies, and the directed therapies, therapies permitting an increased number of patients to experience an increased survival with an acceptable tolerance profile in the event of metastatic lesions. This article describes the patient's care pathway, from the initial diagnosis, staging, to an eventual treatment and follow-up.
Le traitement du mélanome est un exemple type de collaboration multidisciplinaire, afin de pouvoir garantir au patient une prise en charge rapide dès le moment de la détection de la lésion. Tant au niveau dermatologique, anatomopathologique et oncologique, d'énormes progrès ont eu lieu ces dernières années. Ils permettent un accès au diagnostic de plus en rapide par la télédermoscopie, une précision diagnostique accrue par la dermoscopie, l'ultrason à haute fréquence et la tomographie par cohérence optique, une détermination des facteurs de risque immunohistochimiques et génétiques sur les analyses anatomo-pathologiques ainsi que le recours à des immunothérapies, notamment les anti-PD1, et à des traitements ciblés. Ces nouveaux traitements permettent souvent une plus longue survie du patient, avec un profil de tolérance acceptable en cas de lésions métastatiques. Cet article reprend le trajet de soins du patient, du diagnostic initial et du staging au traitement éventuel avec son suivi.
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Melanoma , Neoplasias Cutâneas , Dermoscopia , Humanos , Imuno-Histoquímica , Imunoterapia , Melanoma/diagnóstico , Melanoma/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapiaRESUMO
Recently, brentuximab vedotin (BV) (Adcetris®) obtained the reimbursement in Belgium for the treatment of the primary cutaneous NKT-cell lymphomas mycosis fungoides (MF), large cell anaplastic lymphoma and lymphomatoid papulosis type A. BV is a monoclonal antibody directed against the CD30 expressed on tumoral T cells. The inhibition of this pathway releases the process of apoptosis leading to the cell death of the tumoral cells. BV is reimbursed after the use of another systemic treatment without success and if the number of CD30 positive atypical T-cells is larger than 10 %. BV is administered intravenously every 3 weeks with a dosing of 1,8 mg/kg with a maximum of 16 courses. The response rates exceed 75 %. In some instances, interesting treatment responses have been observed with BV in CD30 negative patients. The principal adverse effects are neutropenia and peripheral neuropathy. Two patients are presented with longstanding multi-resistant MF that were successfully treated with BV.
Récemment, le brentuximab védotine (BV) (Adcetris®) a obtenu le remboursement en Belgique pour le traitement du lymphome cutané primitif de type mycosis fongoïde (MF), du lymphome anaplasique à larges cellules et de la papulose lymphomatoïde de type A. Le BV est un anticorps monoclonal dirigé contre le CD30 exprimé par les cellules T tumorales. L'inhibition de cette voie de signalisation induit un processus d'apoptose et conduit à la mort cellulaire. Le BV est remboursé après l'échec d'un autre traitement systémique et lorsque le nombre de cellules T atypiques exprimant le CD30 en immunohistochimie excède 10 % de la population totale sur une biopsie cutanée. Le BV est administré par voie intraveineuse toutes les 3 semaines à la posologie de 1,8 mg/kg, avec un maximum de 16 cures. Les taux de réponse globale excèdent 75 %. Certains patients négatifs pour le CD30 ont également montré une réponse thérapeutique intéressante. Les principaux effets indésirables du BV sont la neutropénie et la neuropathie périphérique. Les cas de deux patients avec un MF de longue date et multi-résistant, ayant répondu favorablement au BV, sont présentés dans cet article.
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Imunoconjugados , Micose Fungoide , Neoplasias Cutâneas , Bélgica , Brentuximab Vedotin , Humanos , Imunoconjugados/uso terapêutico , Micose Fungoide/tratamento farmacológicoRESUMO
Androgenic alopecia is a genetically determined and leads to a progressive hair loss of the vertex, affecting both men and women. It is related to an important psychological and social distress. Medical therapies include topical minoxidil, oral 5?-reductase inhibitors and oestroprogestative drugs with anti-androgen effects for women. The surgical option is autograft hair transplantation. Recently, phototherapy with low-level energy lasers became available. All these treatments may present adverse effects and their effectiveness is questionable. Subcutaneous injections of autologous platelet-rich plasma into the scalp represent an interesting alternative treatment for androgenetic alopecia, as monotherapy or as an adjuvant treatment. The methodology, the possible mechanisms of action and some initial clinical results of this treatment are presented.
L'alopécie androgéno-génétique se manifeste par une perte progressive des cheveux du sommet du cuir chevelu, touchant aussi bien l'homme que la femme. Ses impacts sociaux et psychologiques négatifs sont souvent très importants. Elle peut se traiter par des médicaments (minoxidil topique, inhibiteurs de la 5?-réductase per os, oestroprogestatifs à visée anti-androgénique chez la femme), par des techniques chirurgicales d'autogreffes capillaires, ou encore, par photothérapie avec des lasers de basse énergie. Tous ces traitements ne sont pas dénués d'effets indésirables et leur efficacité n'est pas constante. Les injections sous-cutanées de plasma riche en plaquettes autologue dans le cuir chevelu peuvent constituer un traitement efficace de l'alopécie androgéno-génétique, en monothérapie ou comme adjuvant. Les modalités techniques, les modes d'action potentiels et les principaux résultats cliniques obtenus à ce jour sont présentés.
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Alopecia , Plasma Rico em Plaquetas , Alopecia/terapia , Feminino , Humanos , Masculino , Minoxidil , Couro Cabeludo , Resultado do TratamentoRESUMO
Besides the principal respiratory symptoms, the COVID-19 has been associated with an important array of dermatological manifestations. However, it is not always easy to distinguish whether these skin manifestations are the result of a direct action of the virus on epidermal and/or dermal cell populations, represent a paraviral phenomenon or are a rather fortuitous association. In this review the principal cutaneous manifestations associated with COVID-19 are described as well as their eventual value in terms of diagnostic aid or as prognostic factor. The palmoplantar ischemic pseudo-chilblains lesions are the most frequently observed and are useful for epidemiological purposes. The disseminated vesicular eruptions affect about 23 % of the patient and may witness an initial COVID-19 infection, whereas the vasculitic lesions are rather rare but are currently considered as a factor of bad prognosis.
Outre les symptômes principaux respiratoires, la COVID-19 a été associée avec toute une série de manifestations cutanées. Néanmoins, dans de nombreuses publications, il est assez difficile de discerner si la COVID-19 est directement causale des lésions cutanées, s'il s'agit plutôt d'un phénomène cutané paraviral ou si l'association est fortuite. Dans cette revue, les manifestations cutanées associées à la COVID-19 sont décrites ainsi que leur éventuelle valeur diagnostique et/ou pronostique. Les lésions de type acral (pseudo-engelure) sont les plus fréquentes et surtout utiles pour des données épidémiologiques. Les éruptions vésiculeuses disséminées touchent environ 23 % des patients et peuvent suggérer une infection récente par la COVID-19. Les lésions de type vasculite sont plutôt rares, mais peuvent être considérées comme un facteur de mauvais pronostic.
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Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Humanos , Pneumonia Viral/epidemiologia , SARS-CoV-2RESUMO
BACKGROUND: Impressive progress in new therapeutic options has been made for psoriasis. Treatments include topical steroids, phototherapy, conventional, synthetic disease-modifying drugs and an expanding list of biologics. OBJECTIVE: The primary objective of this work was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis). METHODS: Evidence-based recommendations were formulated using a quasi-Delphi methodology after a systematic search of the literature and a consensus procedure involving 8 psoriasis experts. RESULTS: In this part, the use of systemic treatment in different age groups, during pregnancy, in metabolic syndrome, in patients with mental health problems, in different psoriasis subtypes and in previously systemically treated patients treatment is discussed. CONCLUSION: Guidance on therapeutic choice in specific clinical situations in psoriasis is provided in order to facilitate the decision-making in clinical practice.
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Síndrome Metabólica , Psoríase , Bélgica , Feminino , Humanos , Saúde Mental , Fototerapia , Gravidez , Psoríase/tratamento farmacológicoRESUMO
BACKGROUND: Psoriasis patients carry an increased risk for associated comorbidities. Dermatologists have to be aware of the effects of systemic treatments not only on psoriasis but also on co-occurring diseases. In case of other coexisting inflammatory diseases, the right psoriasis treatment may improve both disorders. For infectious and malignant disorders, some treatments have to be avoided as they may be harmful. OBJECTIVE: The primary objective of this project was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis). METHODS: Evidence-based recommendations were formulated using a quasi-Delphi methodology after a systematic search of the literature and a consensus procedure involving eight psoriasis experts. RESULTS: Recommendations are given on the use of systemic treatment in psoriatic arthritis, inflammatory bowel disease, demyelinating disorders, hepatitis B and C, HIV and cancer. CONCLUSION: This expert opinion is a practical guide for dermatologists when handling psoriasis patients with these specific conditions.
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Artrite Psoriásica , Neoplasias , Psoríase , Artrite Psoriásica/epidemiologia , Bélgica , Comorbidade , Humanos , Neoplasias/epidemiologia , Psoríase/complicações , Psoríase/tratamento farmacológico , Psoríase/epidemiologiaRESUMO
Psoriasis is a chronic inflammatory skin disease affecting around 2-3 % of the population. The disease spectrum evolves from to the knees and elbows limited disease to erythrodermic psoriasis. The impact on the quality of life, the pruritus, the pain from palmo-plantar disease, arthropathic psoriasis and the comorbidities are the major complaints of the patients. The treatment relies on topical treatments with dermocorticosteroids with or without vitamin D derivatives, UVA or UVB phototherapy, conventional treatments including methotrexate, ciclosporin and acitretin, and, since around 15 years, biological treatments. The biological treatments for moderate to severe psoriasis progressed in a spectacular way with an improvement of clinical results and an amelioration of the safety profile at every step. This article discusses these developments from the TNF? antagonists, including etanercept, adalimumab and infliximab to the newly arrivals, the anti-IL17 and anti-IL23 antagonists, the anti-PDE-4 antagonists and the JAK inhibitors.
Le psoriasis est une maladie chronique inflammatoire cutanée qui affecte environ 2 à 3 % de la population. Le spectre varie d'une atteinte limitée aux coudes et genoux jusqu'à l'érythrodermie psoriasique. L'impact sur la qualité de vie, le prurit, les douleurs des atteintes palmo-plantaires, l'atteinte articulaire et les comorbidités constituent les plaintes majeures des patients. La prise en charge repose sur des traitements locaux à base de dermocorticoïdes, avec ou sans dérivés de vitamine D, la photothérapie UVA ou UVB, les traitements conventionnels comme le méthotrexate, la ciclosporine et l'acitrétine, et, depuis une bonne dizaine d'années, les traitements biologiques. Les traitements biologiques pour les psoriasis modérés à sévères ont spectaculairement progressé avec, à chaque avancée, de meilleurs résultats thérapeutiques et des profils de sécurité de plus en plus sûrs. Cet article discute des avancées des traitements biologiques du psoriasis en démarrant avec les antagonistes du TNF? comme l'étanercept, l'adalimumab et l'infliximab, jusqu'aux derniers arrivés, les antagonistes anti-IL17 et anti-IL 23, les anti-PDE-4 et les inhibiteurs JAK.
Assuntos
Imunossupressores , Psoríase , Qualidade de Vida , Adalimumab/uso terapêutico , Etanercepte/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Infliximab/uso terapêutico , Psoríase/tratamento farmacológicoRESUMO
BACKGROUND: Limited options are available for treatment of paediatric psoriasis. OBJECTIVES: To evaluate the efficacy and safety of ustekinumab in paediatric patients with psoriasis (≥ 6 to < 12 years of age). METHODS: CADMUS Jr, a phase III, open-label, single-arm, multicentre study, evaluated ustekinumab in paediatric patients with moderate-to-severe plaque psoriasis. Patients received weight-based dosing of ustekinumab (< 60 kg: 0·75 mg kg-1 ; ≥ 60 to ≤ 100 kg: 45 mg; > 100 kg: 90 mg) administered by subcutaneous injection at weeks 0 and 4, then every 12 weeks through week 40. Study endpoints (all at week 12) included the proportions of patients achieving a Physician's Global Assessment score of cleared/minimal (PGA 0/1) and ≥ 75%/90% improvement in Psoriasis Area and Severity Index (PASI 75/90), and change in Children's Dermatology Life Quality Index (CDLQI). Serum ustekinumab concentrations, antidrug antibodies and cytokine levels were measured through week 52. Safety was evaluated through week 56. RESULTS: In total, 44 patients (median age 9·5 years) received at least one dose of ustekinumab. Three patients discontinued the study agent through week 40. At week 12, 77% of patients achieved PGA 0/1, 84% achieved PASI 75 and 64% achieved PASI 90 response. The mean change in CDLQI was -6·3. Trough serum ustekinumab concentrations reached steady state at weeks 28-52. The incidence of antidrug antibodies was 10% (n = 4). Mean serum concentrations of interleukin-17A/F and interleukin-22 were significantly reduced at weeks 12 and 52. Overall, 34 patients (77%) had at least one adverse event and three (7%) had a serious adverse event. CONCLUSIONS: Ustekinumab effectively treated moderate-to-severe psoriasis in paediatric patients, and no new safety concerns were identified. What is already known about this topic? Ustekinumab is approved for use in adolescents (≥ 12 to < 18 years of age) and adults (≥ 18 years) with moderate-to-severe psoriasis. What does this study add? Ustekinumab effectively treats moderate-to-severe psoriasis in paediatric patients (≥ 6 to < 12 years of age), with no new safety concerns. Linked Comment: Reich. Br J Dermatol 2020; 183:606-607.
Assuntos
Psoríase , Ustekinumab , Adolescente , Adulto , Anticorpos Monoclonais , Biomarcadores , Criança , Método Duplo-Cego , Humanos , Psoríase/tratamento farmacológico , Índice de Gravidade de Doença , Resultado do Tratamento , Ustekinumab/efeitos adversosRESUMO
The molecular weight of methotrexate (MTX) makes cutaneous penetration difficult. Oxygen flow could enhance the skin permeation of MTX diluted in the proprietary LP3 carrier system. This pilot study aims to assess the efficacy, safety, and tolerance of oxygen flow-assisted LP3-MTX3% for treating superficial skin cancers. Patients with superficial basal cell carcinoma (n = 12), extramammary Paget disease (n = 5), classic mycosis fungoides (MF; n = 10), and folliculotropic MF (n = 6) were included in the study and were treated with four weekly applications of oxygen flow-assisted LP3-MTX3%. Photographs and biopsies were performed before and one month after treatment. At one month after treatment, the mean superficial basal cell carcinoma erythema-crusting-thickness clinical score, the extramammary Paget disease erythema-oozing-scaling/hyperkeratosis-pain/pruritus clinical score, and the modified composite assessment of index lesion severity classic MF and folliculotropic MF scores were improved by 77.5% ± 17.1% (P < 0.0001), 66.7% ± 22.9% (P = 0.011), 51.3% ± 32.2% (P = 0.0007), and 27.8% ± 32.0% (P = 0.086), respectively. At one month after treatment, histology revealed partial and total clearances for superficial basal cell carcinoma (1/12, 11/12), extramammary Paget disease (4/5, 1/5), classic MF (8/10, 2/10), and folliculotropic MF (6/6, 0/6). Tolerance was excellent and no pain was observed. MTX was never detectable in serum at baseline and 1, 2, 3, 8, 24, 48, and 72 hours post-treatment. In conclusion, the interesting therapeutic efficacy of oxygen flow-assisted LP3-MTX3% for treating superficial basal cell carcinoma, extramammary Paget disease, and MF lesions prompts further studies on a larger scale.
Assuntos
Carcinoma Basocelular/tratamento farmacológico , Portadores de Fármacos/química , Metotrexato/administração & dosagem , Micose Fungoide/tratamento farmacológico , Oxigênio/administração & dosagem , Doença de Paget Extramamária/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Feminino , Humanos , Masculino , Metotrexato/efeitos adversos , Metotrexato/farmacocinética , Pessoa de Meia-Idade , Micose Fungoide/diagnóstico , Micose Fungoide/patologia , Doença de Paget Extramamária/diagnóstico , Doença de Paget Extramamária/patologia , Permeabilidade , Projetos Piloto , Índice de Gravidade de Doença , Pele/metabolismo , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Distribuição Tecidual , Resultado do TratamentoRESUMO
Since decades the incidence of skin cancer is clearly rising. This alarming trend also applies to melanoma. It represents the 4th most common cancer in women and 6th in men in 2015. Early recognition and treatment reduce both morbidity and mortality. Screening is the cornerstone of secondary prevention. However, access to reliable and rapid diagnosis is hampered by several factors, including accessibility to specialized medicine. One of the solutions to this problem is to collaborate with the first-line medical care through a teledermatology system. The TeleSPOT project, Teledermoscopy Smartphone-based Pigmented lesion diagnosis Online Taskforce, aims to provide a remote diagnostic aid by dermatologists to distinguish suspect pigmented skin lesions and accelerate their management.
Depuis des décennies, l'incidence des cancers cutanés est en nette augmentation. Cette tendance alarmante s'applique également au mélanome. Il représente le 4ème cancer le plus fréquent chez la femme en 2015. Une prise en charge précoce permet de réduire la morbidité et la mortalité. Le dépistage représente la pierre angulaire de la prévention secondaire. Néanmoins, l'accès au diagnostic fiable et rapide est entravé par plusieurs facteurs limitants, notamment l'accessibilité à une Médecine spécialisée. Une des solutions à cette problématique est de collaborer avec la Médecine de première ligne par le biais de la télédermatologie. Le projet TeleSPOT, acronyme de Teledermoscopy Smartphone-based Pigmented lesion diagnosis Online Taskforce, a pour objectif de fournir une aide diagnostique à distance par des dermatologues afin de trier les lésions cutanées pigmentées suspectes et d'en accélérer la prise en charge.