Comparison of Intralesional Sodium Stibogluconate versus Intralesional Meglumine Antimoniate for the Treatment of Leishmania major Cutaneous Leishmaniasis.

Israel is endemic for Old-World cutaneous leishmaniasis. The most common species is Leishmania major. However, the available treatment options are limited. This study's objective was to compare the authors' experience with different antimony intralesional treatments of Leishmania major cutaneous leishmaniasis. A retrospective evaluation was undertaken for cases of Leishmania major cutaneous leishmaniasis treated by pentavalent antimony in a university-affiliated medical centre in Israel. The previous treatment of intralesional sodium stibogluconate (Pentostam®) was compared with the current treatment of meglumine antimoniate (Glucantime®). One hundred cases of cutaneous leishmaniasis were treated during the study period, of whom 33 were treated with intralesional sodium stibogluconate and 67 were treated with intralesional meglumine antimoniate. The patients were 78 males and 22 females, mean age 24 (range 10-67) and there was a total of 354 skin lesions. Within 3 months from treatment, 91% (30/33) of the intralesional sodium stibogluconate group and 88% (59/67) of the intralesional meglumine antimoniate group had complete healing of the cutaneous lesions after an average of 3 treatment cycles (non-statistically significant). In conclusion, the 2 different medications have the same efficacy and safety for treating cutaneous leishmaniasis. Pentavalent antimoniate intralesional infiltration treatment is safe, effective, and well tolerated with minimal side effects for Old-World cutaneous leishmaniasis.

Frequency of skin cancer among psoriasis, vitiligo, and mycosis fungoides patients treated with narrowband ultraviolet B phototherapy.

BACKGROUND: Narrowband ultraviolet B (NB-UVB) phototherapy is a popular and relatively contemporary treatment option. However, only a few studies to date have explored the potential risk of skin cancer following NB-UVB treatment. OBJECTIVE: This study aimed to investigate the potential long-term risk of skin cancer in patients treated with NB-UVB. METHODS: This cohort study included patients with psoriasis, vitiligo, and mycosis fungoides treated with NB-UVB at two university hospitals in Israel in 2000-2005. Patients were followed up for skin cancer for at least 10 years. Data were extracted from the hospital and community medical records. RESULTS: A total of 767 patients were included in this study: 509 with psoriasis, 122 with vitiligo, and 136 with mycosis fungoides. The mean follow-up duration was 13 years. Among these patients, 4.43% developed skin cancer during the follow-up (3.93% had psoriasis, 2.46% had vitiligo, and 8.09% had mycosis fungoides). Old age and fair skin type were the only significant independent risk factors for skin cancer. There was no significant difference in the mean number of NB-UVB treatments among patients who developed skin cancer and those who did not (99.09 vs. 94.79, respectively). CONCLUSION: No association was observed between the number of NB-UVB treatments and carcinogenesis in any study group. Age is a significant risk factor, and older patients treated with NB-UVB should be followed up carefully.

Bullous pemphigoid and dipeptidyl peptidase-4 inhibitors: evaluation of clinical course and treatment response.

BACKGROUND: Dipeptidyl peptidase-4 inhibitors (DPP4is), drugs used to treat type 2 diabetes mellitus (DM2), show a significant association with bullous pemphigoid (BP) development. OBJECTIVES: To evaluate the clinical course and development of BP among patients with DM2 treated with DPP4is. METHODS: This retrospective cohort study included all the patients with BP and comorbid DM2 who visited Sheba Medical Center during 2015-2020. RESULTS: Among 338 patients with BP, 153 were included in our study. In 92 patients, BP diagnosis was attributed to the use of DPP4is. The patients with DPP4i-associated BP had fewer neurological and cardiovascular comorbidities and higher blistered body surface area (BSA) at first presentation, with noticeable upper and lower limb involvement. These patients were younger and more responsive to treatment, with a greater reduction in their BSA score after 2 months of treatment. CONCLUSIONS: The clinical features of patients with BP treated with DPP4is were initially more severe; however, during follow-up, a marked clinical improvement was noticed, especially among patients who had ceased the drug. Therefore, although withdrawal of the drug may not impose disease remission, it can alleviate the disease course and avert the need for treatment escalation.

Predictors of adherence to Narrowband ultraviolet B first-month treatment dosage plan.

BACKGROUND: The adherence to a narrowband ultraviolet B (NB-UVB) treatment plan is derived, in large part, from the patient's skin tolerance to the phototherapy dose. At present, the initial and first-month incremental phototherapy doses are determined prior to treatment initiation based on the patient's Fitzpatrick skin phototyping. OBJECTIVES: To identify variables that predict adherence to NB-UVB first-month treatment dosage plan. METHODS: Charts of 1000 consecutive patients receiving NB-UVB at a hospital-based phototherapy unit were retrospectively analyzed. We included patients receiving NB-UVB for atopic dermatitis, psoriasis, vitiligo, and mycosis fungoides. The first-month NB-UVB treatment plan was determined based on the patient's Fitzpatrick phototype. Adherence to treatment was defined as receiving at least 80% of the planned first-month cumulative dose. We compared adherent vs. non-adherent patient groups for age, sex, Fitzpatrick phototype, presence of freckles, nevus count category, and type of dermatological disease. RESULTS: The study included 817 eligible patients, mean age 40 (2-95) years; 54% men; 32% had Fitzpatrick phototype I-II. Distribution by diagnosis was atopic dermatitis (29%), psoriasis (27%), vitiligo (23%), and mycosis fungoides (21%). Adherence to NB-UVB treatment plan was observed in 71% of patients. Adherence decreased with age, with 7% decrease per year (P = 0.03) and was higher among mycosis fungoides patients (77.3%) compared to all other diagnoses (69.8%; P = 0.02). CONCLUSIONS: Adherence to NB-UVB treatment may be related to age and diagnosis. Fitzpatrick phototype-based first-month treatment plans should be modified accordingly.

The risk for severe COVID 19 in patients with autoimmune and/or inflammatory diseases: First wave lessons.

Data regarding the risk for severe COVID19 in patients with autoimmune or inflammatory diseases are scarce. To estimate the risk of those patients to develop a more severe COVID19 infection All active patients and those with dermatologic and/or rheumatologic autoimmune/inflammatory diseases were identified in a single tertiary center. The charts of those tested positive for COVID19 between 1 March 2020 and 31 May 2020 reviewed including demographics, co-morbidities, and medications. COVID19 outcome of those with dermatologic and/or rheumatologic autoimmune/inflammatory diseases were compared to COVID19 infected matched controls without an autoimmune/inflammatory background. Overall, 974 of 381 268 active patients were tested positive for COVID19, including 35 out of 13 225 with dermatologic and/or rheumatologic autoimmune/inflammatory diseases. No statistically significant difference in severity of COVID19 infection or mortality rate was found. The rate of asymptomatic, mild, moderate, severe/critical and fatal COVID19 infection was 11.4%, 37.1%, 22.8%, 11.4%, and 17.1%, respectively, for the patients with autoimmune diseases and 17.8%, 45.8%, 10.9%, 6.8%, and 18.4%, respectively for the controls . Patients with autoimmune/inflammatory diseases seem not to develop a more severe COVID19 infection than controls.

The effect of narrow-band ultraviolet B radiation on sleep, happiness, and appetite: A prospective cohort study.

BACKGROUND: The health benefits of sunlight are well documented, including the effects on happiness and sleep. However, only a few studies have investigated the benefits of artificial narrow-band ultraviolet B (NB-UVB) radiation. OBJECTIVES: To investigate the effect of NB-UVB on sleep quality, happiness, and appetite. METHODS: Patients from a single phototherapy unit were selected, and their epidemiological characteristics were documented. Subjects were asked to complete questionnaires including the Pittsburg Sleep Quality Index (PSQI), Subjective Happiness Scale (SHS), and the Simplified Nutritional Appetite Questionnaire (SNAQ) 4 weeks before and after the initiation of the NB-UVB therapy. The sample consisted of 52 patients. RESULTS: Four weeks after the initiation of NB-UVB sessions, sleep quality was significantly improved (the PSQI decreased from 6.5 to 5.23 (t = -3.52, P < .01). In contrast, subjective happiness did not improve (the SHS decreased from baseline 5.5 to 5.2, P > .05). Similarly, appetite did not change (the SNAQ score increased from baseline 14.75 to 15.05, P > .05) and body mass index was not affected by phototherapy. In general, men were found to have better sleep quality before and after UV light therapy. CONCLUSION: Our data suggest that NB-UVB exposure over 4 weeks improves sleep quality; however, it does not influence happiness or appetite.

Efficacy of Repeated Courses of Rituximab as Treatment for Pemphigus Vulgaris.

Rituximab targets the B-lymphocyte antigen CD20, providing pemphigus vulgaris patients with long-term remissions. However, the effects of repeated courses have not yet been established. This study aimed to evaluate the effect of repeated rituximab courses on remission length in pemphigus vulgaris. A total of 73 patients with pemphigus vulgaris treated with rituximab at a single centre were retrospectively analysed. Of 73 study participants (28 men, 45 women), 42 (58%) received a 2nd course of rituximab, 24 (33%) received a 3rd course, 4 (6%) received a 4th course, and one (1%) received a 5th course. Rituximab remained efficacious in each course, irrespective of previous treatments (complete remission 75-81%). Following the 2nd and 3rd courses, the results indicated longer remissions with reduced flare-ups, and the remission length increased with each subsequent course. We conclude that rituximab serves as a disease-modifying agent, notably for patients with moderate-to-severe pemphigus vulgaris.

[XANTHOTRICHIA (YELLOWING OF THE HAIR) DUE TO MINOXIDIL TREATMENT].

INTRODUCTION: Different drugs can affect the hair. Among the various types of drug-induced hair changes, hair colour change is a rare phenomenon which is less reported in the literature. Hair colour changes include lightening of the hair, whitening or returning to the original colour and even change to a new colour. In this article we report a patient presenting with hair yellowing due to topical treatment with minoxidil and discuss the phenomenon of drug-induced hair colour changes.

Potential of narrow-band ultraviolet B to induce sustained durable complete remission off-therapy in patients with stage I mycosis fungoides.

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) is a first-line therapy for stage I mycosis fungoides (MF), with a complete response in 75%-85% of patients. However, data on long-term disease-free survival (DFS) after therapy are scarce. OBJECTIVE: To assess the long-term DFS after NB-UVB treatment of stage I MF. METHODS: We used a historic cohort of all stage I MF patients achieving a complete response with NB-UVB who discontinued treatment before 2011. Age at the beginning of phototherapy, sex, stage, skin phototype, number of treatments, total dose, and the length of DFS was collected. RESULTS: Of the 117 patients who started NB-UVB, 93 patients (80%) had a complete response and 56 (60%) were disease free as of March 2017. In a multivariate analysis, DFS was affected independently by age and disease stage only. DFS was longer for patients <50 years old (124 months) than those ≥50 years old (91 months, P = .01) and longer for stage IA patients (131 months) than stage IB patients (87.6 months, P = .001). LIMITATIONS: The study was retrospective in nature. CONCLUSION: After a single course of NB-UVB, over a half of stage I MF patients achieved >5 years of DFS and were potentially cured. Thus, NB-UVB can be considered a disease-modifying therapy.

Role of bath psoralen plus ultraviolet A in early-stage mycosis fungoides.

BACKGROUND: Psoralen plus ultraviolet (UV) A (PUVA) radiation is the preferred treatment for folliculotropic mycosis fungoides (MF) and MF refractory to narrowband (NB) UVB radiation. However, systemic PUVA has many unfavorable side effects and contraindications. Bath PUVA has been found to be a suitable alternative in patients with psoriasis, but data on MF are sparse. OBJECTIVE: The purpose of the study was to evaluate the effectiveness of bath PUVA in the treatment of folliculotropic MF and NB-UVB-refractory early-stage MF. METHODS: The study group included 26 patients of average age 44 years attending a tertiary medical center in 2004 through 2012, 14 with folliculotropic type and 12 with NB-UVB-refractory early-stage MF who were not amenable for oral PUVA. Treatment consisted of 0.2 mg/L 8-methoxypsoralen bath 3 times weekly followed by UVA irradiation at 0.3 J/cm(2) with fixed increments every second session. RESULTS: A complete clinical response was achieved in 62% of patients after an average of 33 weeks and a cumulative radiation dose of 158 J/cm(2). LIMITATIONS: This was a relatively small series. CONCLUSION: Bath PUVA is a good treatment option for superficial folliculotropic MF and NB-UVB-refractory early-stage MF.

Leishmania tropica in children: a retrospective study.

BACKGROUND: Limited data are available regarding topical and systemic therapies for Leishmania tropica in children. OBJECTIVE: We sought to characterize the clinical presentation and evaluate the efficacy and safety of topical and systemic treatments in pediatric patients infected with L tropica. METHODS: A retrospective study was performed on 47 children with L tropica cutaneous leishmaniasis. Treatments included topical or systemic therapy with liposomal amphotericin B or pentavalent antimony. RESULTS: Seventy patients with L tropica cutaneous leishmaniasis were treated at our center between 2008 and 2012, of which 47 (67%) were children. The average age of the pediatric population was 8.8 years, and the face was the most common site of involvement (76%). The average number of lesions was 2.6. 24 children (51%) required systemic therapy. The patients were treated with 3 to 5 mg/kg/d of intravenous liposomal amphotericin B, and a response was observed in 83% of the patients within 3 months. LIMITATIONS: This was a retrospective study. CONCLUSION: The disease burden of L tropica in children is high, and because of facial involvement and a low response to topical therapies, systemic therapy is often required. In our experience, liposomal amphotericin B treatment in children is safe and effective and is required for a considerably shorter duration than treatment with pentavalent antimony.

Juvenile mycosis fungoides: cutaneous T-cell lymphoma with frequent follicular involvement.

BACKGROUND: The literature on mycosis fungoides (MF) in children/adolescents is sparse. OBJECTIVE: We sought to evaluate the characteristics of juvenile MF in a large cohort. METHODS: Data were collected on all patients with MF, aged 18 years or younger at the time of clinicopathologic diagnosis, who attended the Rabin Medical Center Dermatology Department, Petach Tikva, Israel, between 1994 and 2012 and were followed up prospectively. RESULTS: There were 50 patients (30 male; mean age 11.4 years at diagnosis); 18 (36%) had Fitzpatrick skin type IV or higher. All were given a diagnosis of early-stage disease (IA-IIA) except 1 (tumor stage, IIB). Eight had classic MF lesions only and 42 had other variants, alone or in combination; these were mainly hypopigmented MF (n = 29) and cases with subtle but clear clinicopathologic features of folliculotropic MF (FMF) (n = 18). Among the various skin-targeted therapies, psoralen plus ultraviolet A (systemic/bath) proved beneficial for FMF. During a follow-up period of 0.25 to 15 years (mean 4.5), 2 patients progressed from stage IA to IB or IIA. LIMITATIONS: Relatively short follow-up is a limitation. CONCLUSIONS: This case series shows that FMF is not uncommon in children and adolescents. It is characterized by more superficial clinical features and less heavy perifollicular lymphocytic infiltrates than adult FMF, and responds well to psoralen plus ultraviolet A. The prognosis of childhood FMF remains unclear.

Bath psoralen-UVA photochemotherapy for localized scleroderma: experience from a single institute.

BACKGROUND: Localized scleroderma (LS) comprises a spectrum of sclerotic autoimmune diseases primarily affecting the dermis. Various treatment modalities have been recommended for the management of LS, but only a few studies exist regarding the efficacy of bath PUVA photochemotherapy in the treatment of LS. OBJECTIVES: To evaluate the efficacy of bath PUVA photochemotherapy in the management of LS in a retrospective study. METHODS: Twenty-eight patients (23 women and five men) with a diagnosis of LS, confirmed by histology, were included in the study. Patients were treated with a thrice-weekly regimen of bath immersion in 0.2 mg/1 water solution of 8-methoxypsoralen, followed by irradiation with UVA. RESULTS: Eleven patients (39%) showed complete remission (complete softening of the sclerotic plaques with or without postinflammatory hyper- or hypopigmentation) after a mean of 71 treatments (range 33-170) and a mean cumulative dose of 115 J/cm(2) (range 11-232). Partial softening and regression of the sclerotic plaques was observed in 14 patients (50%). Three patients (10.7%) showed no effect, and in none of the patients was worsening noted during treatment. CONCLUSIONS: In our experience, bath PUVA photochemotherapy is an effective and well-tolerated treatment option for LS and should be considered as one of the first-line treatment modalities.

Psori Silk in Mild to Moderate Psoriasis: A Randomized Phase I-II Trial Study.

In patients with mild to moderate psoriasis, topical corticosteroids are usually the first-line of treatment; however, they are not suitable for long-term use. The purpose of this study was to assess the efficacy and safety of a multi-fruit-and-vegetable compound, Psori Silk, in the treatment of patients with psoriasis. This was a randomized double-blind trial comprising 12 weeks of treatment with Psori Silk versus a vehicle, and a 4-week follow-up. The primary endpoint was 50% reduction in the modified Psoriasis Area and Severity Index (MPASI 50) score at week 12, while the secondary endpoint was quality of life assessment using the Dermatology Life Quality Index (DLQI). The Psori Silk group consisted of 23 patients with 34 lesions to be treated versus 22 patients in the vehicle group with 36 lesions. The MPASI 50 score was observed in 59% patients in the active group versus 22.7% patients in the vehicle group (P < 0.001). A mean 33% DLQI improvement was observed in 65.2% patients in the active group versus 27.2% patients in the vehicle group (P < 0.001). Mild and temporary discomfort at the site of application was reported in 39% patients in the active group versus 23% patients in the vehicle group. Psori silk appears to be an effective and safe treatment option for mild to moderate plaque psoriasis.

Bath psoralen plus ultraviolet-A photochemotherapy for chronic graft-versus-host disease: a retrospective cohort study.

BACKGROUND: Chronic graft-versus-host disease is a severe complication of allogeneic stem cell and bone marrow transplantation. First-line immunosuppressive agents, such as steroids, are used to prevent this disease; however, they have multiple side effects. Therefore, bath psoralen plus ultraviolet-A (PUVA) is an alternative second-line treatment. This study aimed to evaluate the clinical efficacy of bath PUVA for managing chronic graft-versus-host disease. METHODS: This retrospective, case-control study included 14 patients with extensive cutaneous chronic graft-versus-host disease, resistant to systemic corticosteroid, treated with bath PUVA. Major and partial responses were defined as clinical improvements of >70% and 50-70%, respectively. We analyzed the graft-versus-host disease clinical presentation and timing after allogeneic stem cell and bone marrow transplantation, bath PUVA doses, background diseases, additional treatments, and adverse effects. RESULTS: We observed eight major (three lichenoid and five sclerodermatoid) and six partial (three lichenoid and three sclerodermatoid) responses after a mean of 28 treatment sessions. After 6 to 25 months, four of the eight patients with sclerodermatoid lesions and all those with lichenoid lesions experienced relapse but responded to additional treatment cycles. CONCLUSIONS: Bath PUVA is well-tolerated and effective for extensive cutaneous chronic graft-versus-host disease. It allows rapid tapering of adjuvant immunosuppressants; however, most patients require prolonged maintenance phototherapy.

Pediatric Psoriasis with or without Arthritis: Does It Make a Difference?

BACKGROUND: Psoriasis and psoriatic arthritis can present simultaneously or separately in children and may pose a diagnostic challenge. OBJECTIVE: To compare the dermatological manifestations in pediatric psoriatic patients with and without arthritis. METHODS: A retrospective case-control study of psoriatic patients ≤ 18 years old at Sheba Medical Center was conducted between 2011 and 2021. Patients with psoriatic arthritis versus psoriasis-only were compared according to body surface area (BSA) involvement, cutaneous distribution, severity of skin disease, response to treatment and related side effects. RESULTS: The study cohort included 29 psoriatic arthritis and 64 psoriasis-only patients matched by age and sex. The psoriasis-only group had a significantly higher mean BSA (19.7%, SD ± 18.7) than the psoriatic arthritis group (6.1%, SD ± 11.4), (p = 0.029). The skin distribution differed with the psoriasis group showing more involvement of the extremities, scalp, trunk, and genitals. Both groups primarily experienced partial responses to methotrexate, whereas the psoriasis group mainly saw complete responses to biologics. Adverse events were rare, with a higher incidence in the psoriasis group. CONCLUSION: This retrospective study highlights the differences in cutaneous disease characteristics, severity, and treatment response in pediatric patients with psoriasis and psoriatic arthritis, providing valuable insights for diagnosis and disease course in the pediatric population.

Long-Term Narrowband UV-B Efficacy in Moderate to Severe Atopic Dermatitis.

BACKGROUND: Narrowband (NB) UV-B is known as an effective and safe treatment for atopic dermatitis (AD). However, there is a lack of studies regarding prognostic factors for favorable response and its duration. OBJECTIVE: The aim of the study was to evaluate the efficacy of NB-UV-B for AD, in a large cohort and "real-life" setting. METHODS: This is a retrospective cohort study based on the medical records of patients with moderate to severe AD treated with NB-UV-B therapy between 2000 and 2017 with a long-term follow-up (≥3 years) after completing therapy. RESULTS: A total of 390 of 555 AD patients who were scheduled for NB-UV-B were included; among them, 55.4% responded well to treatment. Facial involvement, presence of adverse effects, lower number of treatments, and pretreatment immunoglobulin E levels greater than 4000 were related to poorer response. There was an overall median response duration of 12 months with a greater relapse rate among the patients younger than 18 years. CONCLUSIONS: Narrowband UV-B phototherapy shows high and long-lasting efficacy in AD. Patients with facial involvement and patients with high immunoglobulin E levels respond less to treatment. Response duration seems to be shorter for patients younger than 18 years.

Narrowband Ultraviolet B Radiation for Lichen Planus: Long-term Follow-up of 192 Patients.

Background: Narrowband UVB (NB UVB) has been suggested as an option for lichen planus control. However, the literature is lacking in reports of long-term results. OBJECTIVE: We sought to evaluate the long-term results of NB UVB therapy in lichen planus. Methods: This was a prospective, retrospective analysis of patients with lichen planus treated with NB UVB at our institution since 2004. The clinical response and relapse rate were recorded according to age, sex, mouth involvement, skin phototype, number of treatments, and total radiation dose. Results: One hundred thirty-seven of 192 (71%) eligible patients had a major response (MR) and 102 (74%) patients had no recurrence after an average follow-up period of 58.7 months. MR was achieved in 66 percent and 75 percent of men and women, respectively (p=0.021) and 76 percent and 68 percent of patients with Fitzpatrick Skin Types I and II and Skin Types IV and V, respectively (p=0.017). Age at the onset of the disease, number of treatments, and total UVB dose had no effect on the MR rate. The disease-free periods were 131 and 101 months for male and female patients, respectively (p=0.06), and 128 and 103 months for patients 40 years or younger and older than 40 years of age, respectively (p=0.07). Conclusion: Based on our results, female patients and patients with lighter skin phototypes appeared to have higher MR rates. However, female and older patients appear to be at increased risk of recurrence.

Illness perception, coping, and quality of life in early-stage Mycosis fungoides.

BACKGROUND: Mycosis fungoides is the most common type of cutaneous T-cell lymphoma. Most early-stage mycosis fungoides cases follow an indolent course, hence considered by doctors a relatively easy condition. However, since mycosis fungoides bears the title of cancer, patients might perceive it differently. OBJECTIVE: To investigate patients' illness perception, and its relationships to quality of life, depression, anxiety, and coping among early-stage mycosis fungoides patients. METHODS: A cross-sectional questionnaire-based study was conducted. Patients from a single tertiary medical center completed the Revised Illness Perception Questionnaire, the MF/SS-CTCL Quality of Life scale, the Hospital Anxiety and Depression Scale, and The Mental Adjustment to Cancer Scale. RESULTS: Thirty patients (25 males, five females, mean age 51.60) with stage I mycosis fungoides were enrolled. Mycosis fungoides had a little impact on patients' daily life, quality of life, and levels of depression and anxiety, and they generally coped well. Disease understanding was low and was negatively correlated with impairment to quality of life and depression. Patients felt that stress and worry were features of the disease's etiology. STUDY LIMITATIONS: A small sample of patients was included. CONCLUSION: Patients with early-stage mycosis fungoides adapt well to their disease. Psychological interventions should be aimed at improving patients coping style and enhancing illness understanding, in order to maintain high quality of life.