Sarcoidosis exclusion criteria: the “simple truth” for a “complicated diagnosis”.

The differentiation between sarcoidosis and sarcoid-type reactions remains a clinical and histopathologic diagnostic dilemma. A definitive distinction is yet to be determined according to the current literature data. Sarcoid-like tissue reactions with identifiable infectious or other immunogenic antigens, should be classified as non-specific clinical manifestations of a specific disease. The current assignment of this type of reaction under the generic umbrella of “sarcoidosis” is incorrect and may result in the subsequent misinterpretation of the definition of the disease in general. On the other hand, this may lead to clinical studies with incorrectly selected inclusion criteria and, therefore, contradictory statements regarding the epidemiology and pathogenesis of the disease. Thus we propose the introduction of new criteria for exclusion of sarcoidosis as an autonomous disease. Recent trials on patients with probable sarcoidosis have focused on ideal criteria, or have provided information about the genetic and immunological profile of patients with specific infections or other diseases, which manifest themself as sarcoidal granulomas. This could explain the heterogeneous clinical and/or genetic profiles of the reported patients, who in fact were not affected by the autonomous disease “sarcoidosis”. The simplification of the current available data regarding this issue will be of fundamental importance for the correct direction of future studies, whose aim is to unravel the pathogenesis of the immunological cascade in patients with sarcoidosis and sarcoid-like type of reaction. It is expected that the introduction of exclusion criteria will inevitably lead to a change in the approach to diagnosis as well as the fundamental understanding of this mysterious disease, known as sarcoidosis.

Polyamide hair implant (biofibre®): evaluation of efficacy and safety in a group of 133 patients.

One of the greatest challenges in medicine is treatment of both feminine and masculine baldness. Among several surgical treatments available, artificial hair implantation has to be listed. We report the efficacy and safety of hair fibre implants, (Biofibre®), through the follow-up of 133 patients in three years. One-hundred-and-thirty-three patients, 98 male and 38 female, with alopecia or baldness, were treated with the hair implant (Biofibre®) which is made from a mixture of polyamides. The patients included had good state of health, healthy scalp and they were diligent in scalp cleaning. Patients with atopic dermatitis, lupus, seborrhoeic dermatitis and other skin diseases were excluded. Patients' scalps had to be normalized in case of local diseases. A clinical evaluation was carried out after 1 month, 4 months, and every other 4 months after the implant. Efficacy and safety of the product were evaluated in each patient. The most represented group consisted of men aged between 30 and 60, belonging to a scale of Hamilton III to IV. They underwent implants of up to 6000 fibres (average of 5-6 implants in three months). The fibre loss was of no more than 10% per year in 91.4% of the cases, 15% in 7.8% of the cases and 20% in 0.8% of the cases. 96.2% of patients declared to be satisfied from the result of the implant while 3.8% declared to not be satisfied. As for post-implantation tolerability and complications, 90.3% of patients recorded no pathology after surgery/ies. The 5.9% presented mild infection pathologies and the 3.8% presented inflammation pathologies (mainly from the use of wrong chemical substances). The resolution of the septic and chemical pathologies occurred in 97.9% of the cases within an average of 15 days with the use of systemic antibiotic and/or steroid local therapy. In 2.1% of the cases it was necessary to remove the fibres which took place without leaving any lasting scar. The implant of polyamide hairs (Biofibre®) can be considered an efficient surgical technique that allows immediate aesthetic results. In our study, hair implant technique demonstrated to be safe and well tolerated by patients.

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study.

BACKGROUND: It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease. METHODS: Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed. RESULTS: The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus. CONCLUSION: Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.