The effect of anxiety, psychopathological symptoms and personality traits on response to treatment in male patients with anogenital warts: a prospective study.

BACKGROUND: In the era of precision medicine, identification of possible predictive factors of clinical response to treatment is fundamental. This need is particularly strong for anogenital warts (AGW), because there are several treatment modalities with different clearance and recurrence rates. However, data regarding the effect of mental health parameters on response to treatment in patients with AGW are lacking. OBJECTIVES: The purpose of the present study was to evaluate the association between patients' mental health parameters and AGW treatment outcomes. METHODS: This was a single-centre, prospective study that included newly diagnosed male patients with AGW. At their initial visit, all patients completed the State-Trait Anxiety Inventory (STAI), the Symptom Checklist-90-Revised (SCL-90-R) and the Eysenck Personality Questionnaire (EPQ) questionnaires, which evaluate anxiety, psychopathological manifestations and personality traits, respectively. All patients received cryotherapy until clearance of lesions and were followed up for 18 months for detection of recurrences. RESULTS: The study included 167 male patients. The mean number of days for AGW clearance was 89 ± 65. During the 18-month follow-up, 28% of participants showed a recurrence, after a mean number of 150 ± 132 days. No statistically significant association was detected between questionnaires scores and (a) time needed for AGW clearance, (b) time until 1st recurrence and (c) number of recurrences. CONCLUSION: If confirmed, our findings indicate that we may not need to modify our AGW treatment plan according to a patient's mental health profile.

Acitretin for severe lichen sclerosus of male genitalia: a randomized, placebo controlled study.

PURPOSE: Genital lichen sclerosus is a chronic inflammatory and fibrosclerotic disease associated with substantial morbidity. Acitretin has been reported to be of benefit in many dermatological indications including lichen sclerosus. We evaluated the efficacy and tolerability of acitretin for biopsy confirmed, severe lichen sclerosus of the male genitalia. MATERIALS AND METHODS: A randomized, double-blind, placebo controlled study was performed in which 52 male patients with severe, long-standing lichen sclerosus were randomized in a 2:1 ratio to receive daily acitretin (35 mg) or placebo for 20 consecutive weeks. Followup lasted for 36 weeks from baseline. The primary end point was complete response of active lichen sclerosus as well as improvement of patient quality of life. Secondary end points were partial response and recurrence rates after treatment discontinuation. RESULTS: A total of 49 patients completed the study and were eligible for statistical analysis. Complete response was achieved by 36.4% (12 of 33) of the acitretin group vs 6.3% (1 of 16) of the controls, while 36.4% (12 of 33) vs 12.5% (2 of 16) achieved partial resolution, respectively. Mean total clinical score of the acitretin group was significantly lower than that of the controls at week 20 [t (47) = -4.146, p = 0.00 < 0.5], which was also accompanied by a significant improvement in mean Dermatology Life Quality Index score [t (32) = 6,441, p = 0.000 < 0.05]. Acitretin was well tolerated and only minimal transient side effects were recorded. CONCLUSIONS: Acitretin is safe and effective for the management of severe, long-standing lichen sclerosus of the male genitalia. Study limitations included bias during clinical evaluation considering the expected side effects of acitretin.

Evaluation of the efficacy and safety of infliximab on psoriatic nails: an unblinded, nonrandomized, open-label study.

BACKGROUND: Despite advances in the treatment of skin psoriasis during the last years, therapy of psoriatic nails remains a challenge. Objectives The objective of this unblended, nonrandomized, open-label study was to evaluate the efficacy and safety of infliximab on nail psoriasis. PATIENTS/METHODS: Eighteen psoriatic patients with nail involvement, consecutively selected among patients scheduled to start infliximab infusions were included in the study. Thirteen of these patients had psoriatic arthritis and five had severe plaque type psoriasis. Outcome measures were assessed at baseline and at weeks 14, 22, 30 and 38 using the nail psoriasis severity index (NAPSI). Patients also filled in a Greek translation of the international onychomycosis-specific questionnaire to assess improvement in quality of life after improvement of psoriatic nail signs. RESULTS: All 18 patients completed the study. Significant improvement was noted in most patients after the third infusion as shown by the reduction of mean NAPSI (NAPSIm) from 55.8 at baseline to 29.8 at week 14. Evaluation after six infusions, at week 38, showed an almost complete resolution of psoriatic nail involvement (NAPSIm: 3.3). No adverse event was observed. All patients reported satisfaction with the results and significant improvement in their quality of life with reduction of the score of the international quality of life questionnaire from 66.3 at baseline to 19.1 at week 38. CONCLUSIONS: Alphalthough there is no control group, this data suggests that infliximab is effective for psoriatic nail disease in the context of severe skin and joint involvement.

Hyperpigmentation and melasma.

Facial and neck pigmentations are significant cosmetic problems. They are common in middle-aged women, related to endogenous (hormones) and exogenous factors (cosmetics, perfumes, sun exposure), and often represent paramount causes of emotional distress. Although melasma is the most common cause of facial pigmentation, there are many other forms including drug-induced and postinflammatory hyperpigmentation. We review pathogenesis, clinical and histopathological data, effect on quality of life, and treatment options in facial hyperpigmentation disorders.

Coping with acne: beliefs and perceptions in a sample of secondary school Greek pupils.

BACKGROUND: Information on the understanding of acne in adolescents has only occasionally been reported in the medical literature. OBJECTIVE: To evaluate the perceptions of Greek high school students regarding acne causation, exacerbating factors, sources of information, and effect on their daily life and school performance. PATIENTS AND METHODS: Three-hundred and forty-seven students (aged 13-18) of four Athenian high schools completed a self-reported questionnaire. RESULTS: Self-reported acne was present in 59.2% (187/316). Popular sources of information were parents (31.6%), dermatologists (26.7%), magazines and television (17.5%), pharmacists (16.2%), friends (5.3%), beauticians (1.6%) and other doctors (1.1%). Fifty-two per cent considered the information received as inadequate. Reported causal or exacerbating acne factors included: diet (62.3%), hormones (55.1%), poor hygiene (42.4%), stress (31.9%), infection (14.9%) and genetics (5.7%). Reported ameliorating factors included frequent washing (80.7%), sunbathing (38.6%) and adequate hours of sleep (32%). These notions did not differ among pupils with and without acne or among pupils receiving information from different sources (P < 0.05 in all comparisons). Smoking habits, school performance, hours of sleep, sleep disturbances and self-assessment of stress status were not statistically significantly different between pupils with and without acne. Among pupils with acne 48.6% believed that acne was compromising interpersonal relations while 64.4% believed that acne was compromising their self-image. Fifteen per cent of adolescents reported pruritus associated with their acne lesions. CONCLUSION: Beliefs of Greek adolescents about acne were shown to be similar to those of pupils in other developed countries.

Randomized placebo-controlled trial of a flavonoid-rich plant extract-based cream in the treatment of rosacea.

BACKGROUND: Biological research suggests that vascular changes may play a major role in rosacea pathogenesis. Chrysanthellum indicum is a plant-based extract containing a unique combination of phenylpropenoic acids, flavonoids and saponosids, and has a well-documented effect on vascular wall permeability and increase of the mechanical resistance of capillaries. OBJECTIVE: To determine the efficacy and safety of a cream containing 1%C. indicum extract with vitamin P properties in the treatment of rosacea. METHODS: This study included 246 patients diagnosed clinically as having moderate rosacea. Patients were randomly allocated to C. indicum extract-based cream (n = 125) and placebo (n = 121) groups. Patients were advised to apply the products on their face twice a day for a 12-week period. The patients were examined at the end of each 4-week period. Severity of erythema (graded by reference to six photographs), surface of erythema and rosacea overall severity scores were recorded at each visit on days 0, 28, 56 and 84. Investigators carried out a final efficacy assessment at the end of week 12. Volunteers' final overall efficacy assessment was recorded in a self-administered questionnaire. Adverse events were identified through examination, interview and collection of comments in patients' questionnaires. RESULTS: Treatment with the C. indicum extract-based cream resulted in significant improvement (P < 0.05) in severity of erythema, overall rosacea severity compared to baseline and placebo, and investigator and patient overall efficacy assessment scores (P = 0.046 and P = 0.001, respectively) compared with placebo scores. Adverse reactions were mild, and did not differ between the C. indicum extract-based cream and the placebo groups. CONCLUSION: Chrysanthellum indicum extract-based cream is an effective and well-tolerated topical agent for the treatment of moderate rosacea. The mode of action of the active ingredient suggests that additional efficacy might be expected from combination with other topical treatments.