Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 205
Filter
Add more filters

Country/Region as subject
Publication year range
1.
Pediatr Dermatol ; 41(1): 34-40, 2024.
Article in English | MEDLINE | ID: mdl-38018272

ABSTRACT

BACKGROUND/OBJECTIVES: Itch is one of the hallmarks of atopic dermatitis (AD), which has a significant impact on the quality of life of pediatric patients with AD and their caregivers. We aimed to conduct a systematic review and meta-analysis to evaluate the antipruritic effects of systemic AD treatments in pediatric patients with AD. METHODS: PubMed, EMBASE, Cochrane, and Web of Science databases were searched, including studies providing original data on the effects of systemic treatment on pruritus in pediatric patients (<18 years) with AD. Placebo-controlled trials reporting a Peak Pruritus Numerical Rating Scale 4 (PP-NRS4) response were included in a meta-analysis. RESULTS: A total of 30 studies were included, with most evidence available for dupilumab. Overall, marked improvements of pruritus (50% or greater reduction in pruritus outcome measurements) were found for treatment with cyclosporin A (2-16 years), dupilumab (6 months-17 years), abrocitinib, and upadacitinib (both 12 and 17 years). Nemolizumab (12-17 years) may be promising in reducing pruritus in pediatric patients; however, data are limited. Only five randomized controlled trials could be included in our meta-analysis, in which dupilumab, abrocitinib, and upadacitinib showed a significantly higher probability of achieving a PP-NRS4 response compared with placebo. Our study was limited by a lack of homogeneity of included studies. CONCLUSIONS: Cyclosporin A, dupilumab, abrocitinib, and upadacitinib are all effective in decreasing pruritus and, therefore, in improving the quality of life in children with AD. As more systemic treatments for AD become available, it will be imperative to incorporate patient-oriented treatment goals such as reduction of pruritus into therapeutic decision-making.


Subject(s)
Dermatitis, Atopic , Pyrimidines , Sulfonamides , Humans , Child , Dermatitis, Atopic/complications , Dermatitis, Atopic/drug therapy , Cyclosporine/therapeutic use , Quality of Life , Treatment Outcome , Pruritus/etiology , Pruritus/complications , Severity of Illness Index , Double-Blind Method
2.
J Am Acad Dermatol ; 86(5): 1010-1019, 2022 05.
Article in English | MEDLINE | ID: mdl-34082036

ABSTRACT

BACKGROUND: Incorporating patient-related factors associated with treatment outcomes could improve personalized care in older patients with basal cell carcinoma (BCC). OBJECTIVE: To evaluate and identify predictors of treatment burden, treatment outcomes, and overall survival in patients aged ≥70 years, surgically treated for BCC in the head and neck area. METHODS: The data from the prospective, multicenter Basal Cell Carcinoma Treatment in Older Adults (BATOA) cohort study were extracted to evaluate the experienced treatment burden (visual analog scale, 0-10 cm; lower scores indicating higher treatment burden), treatment outcomes, and mortality. RESULTS: A total of 539 patients were included (median age, 78 years). The patients experienced a low overall treatment burden (median, 8.6) and good cosmetic results. The predictors of higher treatment burden were instrumental activities of daily living (iADL) dependency, female sex, complications, larger tumor diameter, and polypharmacy. Thirty-five patients (6.5%) died (none of the deaths were due to BCC) within the follow-up period; the predictors of mortality were increasing comorbidity index and iADL dependency. No difference in these outcomes was seen between Mohs micrographic surgery and conventional excision after correction for covariates. Age was not significantly associated with any outcome. LIMITATIONS: A selection bias may exist owing to the observational design. CONCLUSION: BCC management decisions based on chronological age alone should be avoided, whereas more attention is recommended for patient-related factors. Based on these data, early BCC intervention is beneficial for robust and fit patients or those experiencing symptoms.


Subject(s)
Carcinoma, Basal Cell , Skin Neoplasms , Activities of Daily Living , Aged , Carcinoma, Basal Cell/pathology , Cohort Studies , Female , Humans , Mohs Surgery/methods , Neoplasm Recurrence, Local/surgery , Prospective Studies , Skin Neoplasms/pathology
3.
Acta Derm Venereol ; 102: adv00805, 2022 Oct 31.
Article in English | MEDLINE | ID: mdl-36065742

ABSTRACT

Optimal selection of systemic therapy in older adults with psoriasis can be challenging, due to sparse evidence-based guidance. This multicentre retrospective study investigated the safety of systemic therapy with causality assessment in a real-world cohort of older adults (≥ 65 years) with psoriasis. Data from 6 hospitals on (serious) adverse events were collected, causality assessment performed and incidence rate ratios calculated. Potential predictors for adverse events-occurrence were studied using multivariable logistic regression analysis. In total, 117 patients with 176 treatment episodes and 390 patient-years were included, comprising 115 (65.3%) and 61 (34.7%) treatment episodes with conventional systemic therapy and biologics/apremilast, respectively. After causality assessment, 232 of 319 (72.7%) adverse events remained and were analysed further, including 12 serious adverse events. No significant differences in incidence rate ratios were found between the systemic treatment types. In regression analysis, increasing age was associated with causality assessed adverse events-occurrence (odds ratio 1.195; p=0.022). Comorbidity, polypharmacy, and treatment type were not associated with causality assessed adverse events-occurrence. In conclusion, increasing age was associated with a higher causality assessed adverse events-occurrence. Causality assessed serious adverse events were rare, reversible and/or manageable in clinical practice. In conclusion, the safety profile of systemic antipsoriatic therapy within this population is reassuring.


Subject(s)
Dermatologic Agents , Psoriasis , Humans , Aged , Retrospective Studies , Psoriasis/diagnosis , Psoriasis/drug therapy , Psoriasis/epidemiology , Dermatologic Agents/adverse effects , Cohort Studies , Incidence
4.
Acta Derm Venereol ; 100(19): adv00344, 2020 Dec 09.
Article in English | MEDLINE | ID: mdl-33236124

ABSTRACT

Patient-reported outcomes are valuable for assessing new psoriasis therapies. This study investigated patient-reported outcomes in patients with moderate-to-severe plaque psoriasis treated with ixekizumab or ustekinumab, dosed according to their respective labels, for 52 weeks (IXORA-S-NCT02561806). Patient-reported outcomes investigated included patient global assessment, pruritus, skin pain, health-related quality of life, and work productivity. Ixekizumab-treated patients reported greater improvements in patient-reported outcomes sooner after treatment compared with ustekinumab-treated patients, and maintained greater improvements in patient global assessment scores (ixekizumab 0.72, ustekinumab 1.19; p < 0.001), rates of Dermatology Life Quality Index (0, 1) (ixekizumab 71.3%, ustekinumab 56.6%, p < 0.01), and 36-item Short-form Health survey physical component summary score change from baseline (ixekizumab 5.53, ustekinumab 3.28; p < 0.05) at week 52. While clinically meaningful improvements in patient-reported outcomes resulted with either treatment, ixekizumab provided more rapid improvements in patient-reported outcomes and superior outcomes for some assessments through one year of treatment, while maintaining statistically superior improvements in skin severity, as assessed by either physicians or patients.


Subject(s)
Dermatologic Agents , Psoriasis , Antibodies, Monoclonal, Humanized , Dermatologic Agents/adverse effects , Humans , Patient Reported Outcome Measures , Psoriasis/diagnosis , Psoriasis/drug therapy , Quality of Life , Severity of Illness Index , Treatment Outcome , Ustekinumab/adverse effects
5.
Acta Derm Venereol ; 100(14): adv00215, 2020 07 28.
Article in English | MEDLINE | ID: mdl-32556353

ABSTRACT

Little is known about psoriasis in geriatric patients, whereas treating this growing population can be challenging due to comorbidities, comedication and physical impairments. To compare disease and treatment characteristics of psoriasis patients ≥ 65 years old with patients < 65 years old, a self-assessment survey was sent to all members of the Dutch Psoriasis Association (n = 3,310). In total, 985 (29.7%) patients returned the survey, 414 (43.6%) respondents were ≥ 65 years old. Patients ≥ 65 years old had experienced erythrodermic psoriasis significantly more frequently than patients < 65 years old, other disease characteristics were highly comparable. Despite a significantly higher prevalence of comorbidities and comedication use in patients ≥ 65 years old, no difference was seen between the age groups regarding systemic antipsoriatic treatment (38.3% in ≥ 65 years old vs 42.3% in < 65 years old; p = 0.219). Remarkably, treatment-related side-effects were reported more frequently by patients < 65 years old. In conclusion, age alone should not be a limiting factor in psoriasis management, and proper attention must be paid to additional patient-related factors.


Subject(s)
Dermatologic Agents , Psoriasis , Aged , Comorbidity , Humans , Middle Aged , Prevalence , Psoriasis/diagnosis , Psoriasis/drug therapy , Psoriasis/epidemiology , Surveys and Questionnaires
6.
Acta Derm Venereol ; 100(19): adv00340, 2020 Dec 01.
Article in English | MEDLINE | ID: mdl-33196101

ABSTRACT

A dose reduction strategy for adalimumab, etanercept and ustekinumab in patients with psoriasis who have stable and low disease activity has recently been compared with usual care in the CONDOR study (CONtrolled DOse Reduction) of biologics in patients with psoriasis with low disease activity. The aim of the current study was to perform a cost-utility analysis with a 12-month time horizon alongside this trial, using prospectively measured healthcare costs and quality-adjusted life years, based on Short-Form Six-Dimension utilities. Bootstrap analys-es were used to calculate the decremental cost-utility ratio and the incremental net monetary benefit. The dose reduction strategy resulted in a mean cost saving of €3,820 (95th percentile -€3,099 to -€4,509) per patient over a period of 12 months. There was an 83% chance that dose reduction would result in a reduction in quality adjusted life years (mean -0.02 (95th percentile -0.06 to 0.02). In conclusion, dose reduction of biologics resulted in substantial cost savings with an acceptable reduction in quality of life.


Subject(s)
Psoriasis , Ustekinumab , Adalimumab/adverse effects , Cost-Benefit Analysis , Drug Tapering , Etanercept/adverse effects , Humans , Psoriasis/diagnosis , Psoriasis/drug therapy , Quality of Life , Ustekinumab/adverse effects
7.
Acta Derm Venereol ; 100(1): adv00020, 2020 01 07.
Article in English | MEDLINE | ID: mdl-31742649

ABSTRACT

Psoriasis is a systemic, relapsing, inflammatory disease associated with serious comorbidities including mood problems and/or unhealthy lifestyle behaviours. Cutaneous and systemic abnormalities in innate and acquired immunity play a role in its pathogenesis. The exact pathogenetic mechanism remains elusive. Evidence is accumulating that TNF-alpha, IL-17 and IL-23 signalling are highly relevant as targeting these pathways reduces disease activity. Evidence suggests a strong link between psoriasis and depression in adults. The International Psoriasis Council (IPC) held a roundtable event, "Psoriasis and Mental Health", in Barcelona, Spain which focused on the presence of depression and suicidality, plus the role of neuroinflammation in psoriasis, sleep disruption and the impact of depression on cardiovascular disease outcomes. We summarize here the expert presentations to provide additional insight into the understanding of psychiatric comorbidities of psoriasis and of the impact of chronic, systemic inflammation on neuro- and cardiovascular outcomes. the associations between psoriasis and other psychiatric comorbidities are still controversial and warrant further attention.


Subject(s)
Cardiovascular Diseases/epidemiology , Inflammation/epidemiology , Mental Health/standards , Psoriasis/epidemiology , Adult , Humans , Risk Factors
8.
J Am Acad Dermatol ; 80(1): 70-79.e3, 2019 Jan.
Article in English | MEDLINE | ID: mdl-29969700

ABSTRACT

BACKGROUND: Biologics targeting interleukin 17A (IL-17A) allow for rapid clearance of psoriatic plaques, with a clinically favorable safety profile. OBJECTIVES: To compare the safety and efficacy of ixekizumab, an IL-17A antagonist, with the safety and efficacy of the IL-12/23 inhibitor ustekinumab through 52 weeks of treatment in the head-to-head trial IXORA-S. METHODS: Patients were randomized to ixekizumab (n = 136) or ustekinumab (n = 166) and dosed per the approved labels. After 1 year, efficacy was assessed via improvements in Psoriasis Area and Severity Index (PASI) score (with PASI 90 indicating a 90% or greater improvement from baseline PASI score) and a static Physician's Global Assessment (sPGA) response of either 0 or 0 or 1, with dropouts counted as nonresponders. Safety analyses included treatment-emergent adverse events (AEs). RESULTS: At week 52, significantly more ixekizumab-treated patients (P < .01) reported PASI 90 (104 [76.5%]), an sPGA response of 0 (72 [52.9%]), or an sPGA response of 0 or 1 (110 [82.1%]) responses than did ustekinumab-treated patients (PASI 90, 98 [59.0%]; sPGA response of 0, 60 [36.1%]; and sPGA response of 0 or 1, 108 [65.1%]). Treatment-emergent AEs, serious AEs, and discontinuation rates were not different between the treatment groups. Injection site reactions occurred more frequently in the ixekizumab-treated group (ixekizumab, 22 [16.3%]; ustekinumab, 2 [1.2%]) (P < .001). LIMITATIONS: This study was not designed to compare safety end points related to rare events. CONCLUSIONS: Compared with ustekinumab, ixekizumab showed superior efficacy and comparable safety outcomes through 52 weeks of treatment.


Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Dermatologic Agents/administration & dosage , Psoriasis/drug therapy , Ustekinumab/administration & dosage , Adult , Double-Blind Method , Female , Humans , Male , Time Factors , Treatment Outcome
9.
Acta Derm Venereol ; 99(3): 304-308, 2019 Mar 01.
Article in English | MEDLINE | ID: mdl-30521056

ABSTRACT

Treatment of chronic pruritus can be a challenge for clinicians. Several systemic treatments have been suggested to reduce itch, such as gabapentinoids and antidepressants. The aim of this study was to assess the current practice of dermatologists regarding systemic treatment in patients with chronic pruritus, and to identify possible barriers in the prescription of these treatments. An online survey was sent to all dermatologists and dermatology residents in the Netherlands between July 2017 and April 2018. A total of 193 physicians completed the questionnaire (response rate 27.0%). Overall, 61.7% prescribed gabapentinoids or antidepressants in patients with chronic pruritus. Amitriptyline was prescribed most frequently, followed by gabapentin, doxepin and mirtazapine. Reasons not to prescribe systemic treatment included lack of knowledge or experience, risk of side-effects, and lack of available evidence. As only a minority of respondents felt comfortable prescribing these drugs, more education on effective and safe dosing is needed.


Subject(s)
Antidepressive Agents/administration & dosage , Antipruritics/administration & dosage , Dermatologists , Gabapentin/administration & dosage , Practice Patterns, Physicians' , Pruritus/drug therapy , Adult , Antidepressive Agents/adverse effects , Antipruritics/adverse effects , Chronic Disease , Drug Prescriptions , Female , Gabapentin/adverse effects , Gabapentin/analogs & derivatives , Health Care Surveys , Humans , Male , Middle Aged , Netherlands , Pruritus/diagnosis
10.
Acta Derm Venereol ; 99(2): 152-157, 2019 Feb 01.
Article in English | MEDLINE | ID: mdl-30206638

ABSTRACT

Little is known about the relationship between nail psoriasis and psoriasis severity in children, and there has been no longitudinal assessment of psoriasis severity related to nail psoriasis. The aim of this study was to assess whether nail psoriasis could serve as a predictor for a more severe disease course. De-identified data were obtained from the ChildCAPTURE registry, a daily clinical practice cohort of children with psoriasis, from September 2008 to November 2015. Cross-sectional analyses were performed at baseline. Longitudinal data until 2-year follow-up were analysed by linear mixed models. Nail psoriasis was present in 19.0% of all 343 patients at baseline and cross-sectionally associated with higher Psoriasis Area and Severity Index (PASI) (p = 0.033). Longitudinal analysis demonstrated higher PASI (p <0.001) during 2-year follow-up in patients with nail involvement at baseline. These findings suggest that nail psoriasis is a potential clinical predictor for more severe disease course over time in paediatric psoriasis.


Subject(s)
Nails/pathology , Psoriasis/pathology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Disease Progression , Female , Humans , Longitudinal Studies , Male , Netherlands/epidemiology , Prognosis , Prospective Studies , Psoriasis/epidemiology , Registries , Severity of Illness Index , Time Factors
11.
Acta Derm Venereol ; 99(4): 386-392, 2019 Apr 01.
Article in English | MEDLINE | ID: mdl-30543381

ABSTRACT

Methotrexate (MTX) and biologics are frequently used treatments for psoriasis. Exploring patients' beliefs about their treatment may help to elucidate patients' attitudes towards these therapies. A cross-sectional survey was conducted using the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) in patients treated with methotrexate or biologics. BMQ-Specific scores (Necessity and Concerns scales) were calculated and patients were classified as "accepting", "indifferent", "ambivalent" or "sceptical" towards their treat-ment. Biologics users scored higher on the Necessity scale than did methotrexate users. Both groups had lower Concerns scores than Necessity scores. A high Necessity scale was associated with a low Psoriasis Area and Severity Index score in both groups and long treatment duration in the methotrexate group. Although this study cannot make a direct comparison, it was observed that most patients on biologics could be classified as "accepting" (59%), and most patients on MTX could be classified as "indifferent" (47%). In conclusion, the BMQ-Specific is useful to identify patients with a sceptical, ambivalent or indifferent profile. These profiles may negatively influence patient's attitude towards their medication.


Subject(s)
Biological Products/therapeutic use , Health Knowledge, Attitudes, Practice , Immunosuppressive Agents/therapeutic use , Medication Adherence , Methotrexate/therapeutic use , Psoriasis/drug therapy , Adult , Aged , Biological Products/adverse effects , Cross-Sectional Studies , Female , Humans , Immunosuppressive Agents/adverse effects , Male , Methotrexate/adverse effects , Middle Aged , Psoriasis/diagnosis , Psoriasis/immunology , Psoriasis/psychology , Surveys and Questionnaires , Treatment Outcome
12.
Skin Pharmacol Physiol ; 32(2): 81-93, 2019.
Article in English | MEDLINE | ID: mdl-30673682

ABSTRACT

BACKGROUND/AIMS: Aberrant skin barrier and intercorneocyte adhesion are potential contributors to the pathomechanism of sensitive skin (SS). Here we aimed to develop a novel and easy-to-apply method to analyze corneodesmosomes and to interrogate potential differences between corneocytes of subjects with SS and non-SS (NSS). METHODS: Corneocytes of the volar forearm and upper outer quadrant of the left buttock of SS (n = 10) and NSS (n = 8) subjects were extracted as a function of depth using adhesive tape and stained with anti-desmoglein 1 (DSG1) antibody. The total area of corneocytes and the number and average size of cells per tape was estimated using image processing. RESULTS: The total area of extracted corneocytes and the quantity of DSG1 decreased with depth. The level of decrease, total area of corneocytes, and average area of individual cells differed between anatomical locations. In SS, a larger total area of extracted corneocytes and a larger average cell size per tape was found at all inspected depths. CONCLUSION: The developed novel and easy-to-apply approach allows investigation of corneodesmosome components. We confirm a role of altered corneocytes in the pathomechanism of SS. The disclosed protocol can further be optimized in studies of skin conditions with strongly affected corneodesmosomes.


Subject(s)
Epidermal Cells/physiology , Skin Physiological Phenomena , Adhesiveness , Adult , Desmoglein 1/metabolism , Epidermal Cells/cytology , Epidermis/metabolism , Female , Humans , Male , Young Adult
13.
Acta Derm Venereol ; 98(10): 943-950, 2018 Nov 05.
Article in English | MEDLINE | ID: mdl-29856465

ABSTRACT

Nocebo effects, i.e. reduced treatment effects due to patients' negative expectations, play a role in itch. Recent studies have shown that nocebo effects can be induced experimentally on itch and also be minimized and even turned into the opposite direction, i.e. placebo effects. It is not known whether these effects generalize to itch-associated scratching behaviour. The aim of this study was to determine whether induction and reversal of nocebo effects on itch evoked by electrical and histamine stimuli generalized to scratching. Ninety-seven healthy participants were included in the study. The manipulation was successful, as during the nocebo learning phase, increased scratching responses were found for higher intensity compared with lower intensity itch stimuli. During the testing phase of induction or reversal of the nocebo effects, however, no significant nocebo effects or reversed nocebo effects, were found in scratching. Thus, no straightforward generalization of nocebo effects from itch to scratching was found in this laboratory setting. Further investigation into possible generalization is needed in different settings and in patients with chronic itch.


Subject(s)
Behavior , Nocebo Effect , Pruritus/psychology , Adolescent , Conditioning, Psychological , Cues , Electric Stimulation/adverse effects , Female , Healthy Volunteers , Histamine/adverse effects , Humans , Iontophoresis/adverse effects , Male , Placebo Effect , Pruritus/etiology , Young Adult
14.
Acta Derm Venereol ; 98(2): 225-233, 2018 Feb 07.
Article in English | MEDLINE | ID: mdl-28952654

ABSTRACT

Chronic somatic conditions, such as psoriasis, arthritis psoriatica and rheumatoid arthritis, have a large impact on patients' lives. Tailored therapist-guided internet-based cognitive-behavioural therapy (ICBT) has been shown to be effective in improving physical and psychological well-being in these patients. Two cases are presented here, in order to provide an in-depth illustration of the course and content of this novel treatment and to investigate the therapeutic alliance in an online treatment. After face-to-face intakes, both patients received therapist-guided ICBT tailored to their specific problems and treatment goals. The treatment resulted in improved physical and psychological well-being and these clinically significant improvements were maintained at 6-month follow-up. In addition, the therapeutic relationship was evaluated positively by both patients and increased further during treatment, indicating an adequate therapeutic working alliance in this online treatment. These case reports show that tailored ICBT may contribute to improved care for patients with chronic somatic conditions.


Subject(s)
Arthritis, Rheumatoid/therapy , Cognitive Behavioral Therapy/methods , Internet , Psoriasis/therapy , Therapy, Computer-Assisted/methods , Adaptation, Psychological , Adult , Affect , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/physiopathology , Arthritis, Rheumatoid/psychology , Cost of Illness , Female , Health Status , Humans , Male , Mental Health , Middle Aged , Psoriasis/diagnosis , Psoriasis/physiopathology , Psoriasis/psychology , Randomized Controlled Trials as Topic , Treatment Outcome
15.
Acta Derm Venereol ; 98(2): 212-217, 2018 Feb 07.
Article in English | MEDLINE | ID: mdl-28967977

ABSTRACT

Alopecia areata (AA) is an immune-mediated disease causing temporary or permanent hair loss. Up to 46% of patients with AA also have nail involvement. The aim of this study was to determine the presence, types, and clinical implications of nail changes in patients with AA. This questionnaire-based survey evaluated 256 patients with AA. General demographic variables, specific nail changes, nail-related quality of life (QoL), and treatment history and need were evaluated. Prevalence of nail involvement in AA was 64.1%. The specific nail signs reported most frequently were pitting (29.7%, p = 0.008) and trachyonychia (18.0%). Red spots on the lunula were less frequent (5.1%), but very specific for severe AA. Nail-related QoL was only minimally affected by nail changes. In conclusion, nail involvement is common in patients with AA and presents mostly with pitting and trachyonychia. The presence of these nail changes reflects the severity of the disease, with red spots on the lunula as a predictor for severe alopecia.


Subject(s)
Alopecia Areata/epidemiology , Nail Diseases/epidemiology , Nails, Malformed , Nails/pathology , Quality of Life , Adult , Aged , Alopecia Areata/pathology , Alopecia Areata/psychology , Alopecia Areata/therapy , Case-Control Studies , Cost of Illness , Female , Health Surveys , Humans , Male , Middle Aged , Nail Diseases/pathology , Nail Diseases/psychology , Nail Diseases/therapy , Netherlands/epidemiology , Prevalence , Prognosis
16.
Acta Derm Venereol ; 98(7): 648-654, 2018 Jul 11.
Article in English | MEDLINE | ID: mdl-29405245

ABSTRACT

Interleukin 17-antagonist secukinumab demonstrated high efficacy for treatment of psoriasis in randomized controlled trials. However, performance in daily practice may differ from trials. Drug survival is a comprehensive outcome covering effectiveness and safety, suitable for analyses of daily practice. The aim of this study was to evaluate drug survival of secukinumab in a daily practice psoriasis cohort. Data were collected from 13 hospitals. Drug survival was analysed using Kaplan-Meier survival curves, split for reason of discontinuation. In total, 196 patients were included (83% biologic experienced). Overall, 12 and 18 months drug survival of secukinumab was 76% and 67%, respectively, and was mostly determined by ineffectiveness. There was a trend towards shorter drug survival in women and in biologic experienced patients. Thirteen percent of patients experienced at least one episode of fungal infection. This is one of the first studies of drug survival of secukinumab in patients with psoriasis treated in daily practice.


Subject(s)
Antibodies, Monoclonal/therapeutic use , Dermatologic Agents/therapeutic use , Psoriasis/drug therapy , Adult , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Dermatologic Agents/adverse effects , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Netherlands , Proportional Hazards Models , Psoriasis/diagnosis , Psoriasis/immunology , Retrospective Studies , Time Factors , Treatment Outcome
17.
Photodermatol Photoimmunol Photomed ; 34(3): 184-193, 2018 May.
Article in English | MEDLINE | ID: mdl-29150968

ABSTRACT

BACKGROUND/PURPOSE: While growing evidence supports the therapeutic effect of 453 nm blue light in chronic inflammatory skin diseases, data on its effects on acutely perturbed human skin are scarce. In this study, we investigated the impact of 453 nm narrow-band LED light on healthy skin following acute perturbation. METHODS: Tape stripping and histamine iontophoresis were performed on the forearm of 22 healthy volunteers on 2 consecutive weeks. In 1 week, challenges were followed by irradiation for 30 minutes. In the other week (control), no light was administered. Reactions were evaluated up to 72 hours thereafter by transepidermal water loss (TEWL), diffuse reflectance spectroscopy, and skin surface biomarkers. RESULTS: Skin barrier disruption resulted in upregulation of IL-1α at 24 hours after tape stripping (P = .029). In contrast, irradiation abrogated this effect (P > .05). Irradiation also resulted in higher TEWL at 24 hours and in higher b* value at 72 hours after tape stripping compared to the control (P = .034 and P = .018, respectively). At 30 minutes following histamine iontophoresis and irradiation, a trend toward a higher a* value compared to the control was observed (P = .051). CONCLUSION: We provide the first in vivo evidence that blue light at 453 nm exerts biological effects on acutely perturbed healthy human skin.


Subject(s)
Dermatitis , Interleukin-1alpha/biosynthesis , Light , Skin , Up-Regulation/radiation effects , Adult , Dermatitis/etiology , Dermatitis/metabolism , Dermatitis/pathology , Dermatitis/therapy , Female , Humans , Male , Pilot Projects , Skin/metabolism , Skin/pathology
19.
J Am Acad Dermatol ; 77(6): 1068-1073.e7, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29033248

ABSTRACT

BACKGROUND: Chronic pruritus is a common skin symptom with marked impact on quality of life. Adequate treatment can be challenging for clinicians, demanding the exploration of new treatment options such as oral antidepressants. OBJECTIVE: To evaluate the use of oral antidepressants in chronic pruritus by a systematic overview of the available relevant literature. METHODS: The PubMed, EMBASE, Cochrane, and Web of Science databases were searched. Studies providing original data on the efficacy of oral antidepressants in patients with chronic pruritus were included. We assessed the risk for bias by using the Cochrane Risk of Bias tool for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. RESULTS: A total of 35 studies evaluating the oral use of fluoxetine, fluvoxamine, paroxetine, sertraline, amitriptyline, nortriptyline, doxepin, and mirtazapine were included. The majority of included articles showed a marked improvement of pruritus during treatment with oral antidepressants. LIMITATIONS: Recommendations are mainly based on open-label trials, case series, and case reports. CONCLUSION: Oral antidepressants should be considered in patients with chronic pruritus that is unresponsive to topical treatment and oral antihistamines, particularly in patients with uremic pruritus, cholestatic pruritus, or paraneoplastic pruritus. More evidence based on randomized-controlled trials is required.


Subject(s)
Antidepressive Agents/administration & dosage , Pruritus/drug therapy , Administration, Oral , Antidepressive Agents, Tricyclic/administration & dosage , Chronic Disease , Humans , Selective Serotonin Reuptake Inhibitors/administration & dosage
20.
Acta Derm Venereol ; 97(9): 1066-1073, 2017 Oct 02.
Article in English | MEDLINE | ID: mdl-28536733

ABSTRACT

Interleukin-1α (IL-1α) and its receptor antagonist IL-1RA play a pivotal role in skin homeostasis and disease. Although the use of biopsies to sample these cytokines from human skin is widely employed in dermatological practice, knowledge about less invasive, in vivo sampling methods is scarce. The aim of this study was to provide an overview of such methods by systematically reviewing studies in Medline, EMBASE, Web of Science and Cochrane Library using combinations of the terms "IL-1α", IL-1RA", "skin", "human", including all possible synonyms. Quality was assessed using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. The search, performed on 14 October 2016, revealed 10 different sampling methods, with varying degrees of invasiveness and wide application spectrum, including assessment of both normal and diseased skin, from several body sites. The possibility to sample quantifiable amounts of cytokines from human skin with no or minimal discomfort holds promise for linking clinical outcomes to molecular profiles of skin inflammation.


Subject(s)
Interleukin 1 Receptor Antagonist Protein/isolation & purification , Interleukin-1alpha/isolation & purification , Skin/metabolism , Specimen Handling/methods , Humans , Interleukin 1 Receptor Antagonist Protein/metabolism , Interleukin-1alpha/metabolism
SELECTION OF CITATIONS
SEARCH DETAIL