RESUMO
BACKGROUND: Real-world data in patients with moderate psoriasis treated with apremilast is limited. OBJECTIVES: To evaluate the effectiveness and safety of apremilast in bio-naïve patients with moderate psoriasis in real-world clinical settings. METHODS: This was a 52-week multicenter, observational, prospective study of adult outpatients with moderate psoriasis {[10% < body surface area < 20% or 10 < psoriasis area severity index (PASI) < 20] and 10 < dermatology quality of life index (DLQI) < 20} initiated on apremilast ≤7 days before enrollment. Missing data were imputed using the last observation carried forward method. RESULTS: A total of 287 eligible patients (median age: 54.2 years; median psoriasis duration: 9.8 years) were consecutively enrolled. At baseline, the median DLQI and PASI scores were 12.0 and 11.8, respectively. The 52-week DLQI ≤ 5 and PASI75 response rates were 68.3% and 61.0%. At 52 weeks, 70.8% and 72.7% of the patients shifted from moderate/severe/very severe to clear/minimal scalp and palmoplantar psoriasis involvement, respectively; the pruritus severity state improved in 67.2%. The 52-week Kaplan-Meier estimated drug continuation rate was 85.3%. The adverse drug reaction rate was 19.9%. CONCLUSIONS: Apremilast is a safe and effective treatment for bio-naïve patients with moderate psoriasis and specific psoriasis manifestations.
Assuntos
Psoríase , Qualidade de Vida , Adulto , Grécia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Psoríase/tratamento farmacológico , Índice de Gravidade de Doença , Talidomida/análogos & derivados , Resultado do TratamentoRESUMO
BACKGROUND: Apremilast is an oral phosphodiesterase-4 inhibitor indicated for patients with moderate-to-severe chronic plaque psoriasis and active psoriatic arthritis. OBJECTIVES: To examine the effectiveness of apremilast on Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI) and nail, scalp and palmoplantar involvement, when administered prior to biologics. METHODS: This 52-week real-world study included biologic-naive adults with moderate psoriasis (psoriasis-involved body surface area 10% to <20%, or PASI 10 to <20 and DLQI 10 to <20). Apremilast was initiated ≤7 days before enrolment. Data from the first 100 eligible patients who completed 24 weeks (W24) of observation (or were prematurely withdrawn) are presented in this interim analysis using the last-observation-carried-forward imputation method. RESULTS: Eligible patients (mean age: 49.9 years; 71.0% males; median disease duration: 8.0 years) were consecutively enrolled between April and October 2017, by 18 dermatology specialists practising in hospital outpatient settings in Greece. Baseline DLQI (median: 12.0) and PASI (median: 11.7) scores improved (P < 0.001) at all postbaseline timepoints (Weeks 6, 16 and 24; W24 median decreases: 9.0 and 9.4 points respectively). At W24, DLQI ≤5, DLQI 0 or 1, and PASI-75 response rates were 63.0%, 25.0% and 48.0% respectively. The Nail Psoriasis Severity Index score in patients with baseline nail involvement (n = 57) decreased at all postbaseline timepoints (P < 0.001; W24 median decrease: 20.0 points). At W24, 50.0% and 51.7% of patients with baseline scalp (n = 76) and palmoplantar (n = 29) involvement respectively achieved postbaseline Physician's Global Assessment (PGA) score of 0 or 1 if baseline score was ≥3, or 0 if baseline score was 1 or 2. The adverse drug reaction rate was 21.0% (serious: 2.0%). CONCLUSIONS: These interim results indicate that through 24 weeks, apremilast improved quality of life and reduced disease severity in biologic-naive patients with moderate plaque psoriasis, while demonstrating safety consistent with the known safety profile.
Assuntos
Produtos Biológicos , Psoríase , Adulto , Feminino , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/tratamento farmacológico , Qualidade de Vida , Índice de Gravidade de Doença , Talidomida/análogos & derivados , Resultado do TratamentoRESUMO
BACKGROUND: Obesity has been associated with moderate-to-severe plaque psoriasis severity and PASI 75 response attainment of biologic therapies, but findings are inconsistent. OBJECTIVE: This study aimed to examine the association of body mass index (BMI) and waist circumference (WC) on disease severity, to identify potential patient characteristics associated with response attainment and to assess the impact of infliximab on the patients' health-related quality of life (HRQoL) among infliximab-treated patients in the routine care setting of Greece. METHODS: This was a multicenter, prospective, observational study of adult moderate-to-severe plaque psoriasis patients who had initiated treatment with originator infliximab within 2 weeks prior to enrolment. Postenrolment visits occurred at 14 ± 4, 30 ± 4 and 54 ± 4 weeks following treatment onset. RESULTS: Between October 2012 and June 2014, 136 eligible patients (62.5% males) with a median age of 48.6 years, BMI of 29.6 kg/m2 and WC of 107.0 cm at enrolment were recruited by 21 dermatology hospital/private offices. All patients had received prior psoriasis treatment(s); 62.5% were biologic-naïve. Mean baseline psoriasis area severity index (PASI) and Dermatology Quality of Life Index (DLQI) scores were 23.4 ± 13.6 and 15.0 ± 8.3, respectively. A low correlation was observed between WC at enrolment and baseline PASI [ρ = 0.324 (P < 0.001)]. Over a median 48.4 weeks of infliximab exposure, 89.3% of the per protocol set achieved a PASI 75 response. At 14, 30 and 54 weeks, the PASI 75 attainment rate was 66.4%, 74.8% and 76.6%, respectively; the clinically meaningful DLQI improvement (≥5 point decrease) rate was 68.9%, 75.7% and 69.8%, respectively. BMI category and abdominal obesity at enrolment did not impact PASI 75 or DLQI improvement rate attainment. CONCLUSION: In the routine care of Greece, infliximab reduced disease activity and improved the quality of life of moderate-to-severe psoriasis patients through 1 year of treatment, independent of their BMI and WC.
Assuntos
Índice de Massa Corporal , Fármacos Dermatológicos/uso terapêutico , Infliximab/uso terapêutico , Psoríase/tratamento farmacológico , Qualidade de Vida , Circunferência da Cintura , Adulto , Superfície Corporal , Fármacos Dermatológicos/efeitos adversos , Feminino , Grécia , Humanos , Infliximab/efeitos adversos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/complicações , Estudos Prospectivos , Psoríase/complicações , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
Generalized pustular psoriasis (GPP) is a severe type of psoriasis accompanied by systemic and often life-threatening manifestations. The efficacy of the interleukin (IL)-1 antagonist anakinra in cases of GPP underscores the role of IL-1 in disease pathogenesis. We present a case of a middle-aged man who developed an abrupt and severe form of GPP with severe eosinophilia and cholestatic hepatitis. The patient received salvage treatment with a combination of glucocorticoids, hydroxyurea and imatinib, while administration of the IL-1 inhibitor anakinra resulted in remission of hepatitis and a significant skin improvement. However, due to persistent hypersensitivity skin reactions, anakinra was withdrawn and replaced with the anti-IL-1ß antagonist canakinumab. As a result of canakinumab, the patient's skin completely cleared, while no systemic manifestations recurred. After 1 year of continuous canakinumab therapy, the patient remained virtually free of symptoms, while the drug was well tolerated.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Interleucina-1beta/antagonistas & inibidores , Psoríase/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/induzido quimicamente , Resultado do TratamentoRESUMO
BACKGROUND: Applicability of dermoscopy in evaluation of outcome and monitoring of superficial basal cell carcinoma (sBCC) after nonablative therapies has not been sufficiently assessed. OBJECTIVES: Certain dermoscopic criteria, namely pigmented structures, ulceration and arborizing vessels, have been suggested to predict the presence of residual disease [residual disease-associated dermoscopic criteria (RDADC)]. We aimed to assess this hypothesis. PATIENTS AND METHODS: Lesions exhibiting RDADC 3 months after treatment were biopsied and in the case of histopathological confirmation were excised. Lesions characterized by white/red structureless areas, superficial fine telangiectasias, or lacking any dermoscopic criterion, were monitored for 12 months. RESULTS: At the 3-month evaluation, one or more of the RDADC were detected in 25/98 (25·5%) sBCCs, in which histology confirmed tumour persistence. In 45 (61·6%) of the 73 remaining lesions, dermoscopy showed white/red structureless areas and/or superficial fine telangiectasias. Twenty-eight lacked any dermoscopic criterion of sBCC. The two latter groups entered follow-up. In total, disease recurred in 13 (17·8%) of the 73 lesions. CONCLUSIONS: RDADC accurately predict residual disease. Absence of dermoscopic criteria of sBCC safely predicts complete histopathological clearance. Detection of white/red structureless areas and/or superficial fine telangiectasias warrants close monitoring to recognize early recurrence.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Basocelular/patologia , Dermoscopia/métodos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/administração & dosagem , Ácido Aminolevulínico/análogos & derivados , Aminoquinolinas/administração & dosagem , Carcinoma Basocelular/tratamento farmacológico , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/patologia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/administração & dosagem , Neoplasias Cutâneas/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Dermoscopy is useful in evaluating skin tumours, but its applicability also extends into the field of inflammatory skin disorders. Discoid lupus erythematosus (DLE) represents the most common subtype of cutaneous lupus erythematosus. While dermoscopy and videodermoscopy have been shown to aid the differentiation of scalp DLE from other causes of scarring alopecia, limited data exist concerning dermoscopic criteria of DLE in other locations, such as the face, trunk and extremities. OBJECTIVE: To describe the dermoscopic criteria observed in a series of patients with DLE located on areas other than the scalp, and to correlate them to the underlying histopathological alterations. METHODS: DLE lesions located on the face, trunk and extremities were dermoscopically and histopathologically examined. Selection of the dermoscopic variables included in the evaluation process was based on data in the available literature on DLE of the scalp and on our preliminary observations. Analysis of data was done with SPSS analysis software. RESULTS: Fifty-five lesions from 37 patients with DLE were included in the study. Perifollicular whitish halo, follicular keratotic plugs and telangiectasias were the most common dermoscopic criteria. Statistical analysis revealed excellent correlation between dermoscopic and histopathological findings. Notably, a time-related alteration of dermoscopic features was observed. CONCLUSIONS: The present study provides new insights into the dermoscopic variability of DLE located on the face, trunk and extremities.
Assuntos
Dermoscopia , Lúpus Eritematoso Discoide/patologia , Adulto , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Estudos Prospectivos , Fatores de TempoRESUMO
BACKGROUND: Early stage mycosis fungoides (MF) is difficult to be clinically differentiated from chronic dermatitis (CD) in a high proportion of patients. Dermoscopy is a rapid, cheep, non-invasive and widely used method for the evaluation of skin tumours and, recently, of inflammatory skin diseases, as well. OBJECTIVE: To describe the dermoscopic pattern of early stage MF and compare it with the dermoscopic features observed in CD. METHODS: This was a retrospective study. Dermoscopic images of lesions that were clinically equivocal between MF and CD were evaluated for the presence of predefined morphologic criteria. Diagnosis had been histopathologically and immunohistochemically confirmed in all cases. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for predefined dermoscopic criteria in relation to the diagnosis of mycosis fungoides. RESULTS: A total of 67 dermoscopic images were selected for dermoscopic evaluation. Mycosis fungoides lesions exhibited a characteristic dermoscopic pattern consisting of fine short linear vessels (sensitivity 93.7%, specificity 97.1%) and orange-yellowish patchy areas (sensitivity 90.6%, specificity 99.7%). A characteristic vascular structure resembling spermatozoa was also found to be highly specific for the diagnosis of mycosis fungoides. CD was typified by a different dermoscopic pattern, usually consisting of dotted vessels. CONCLUSIONS: These observations provide a first indication that early stage MF exhibits a characteristic dermoscopic pattern which is different from CD. Prospective studies with long term follow-up are needed to determine the value of these dermoscopic criteria in the differentiation between the two entities in the daily routine.
Assuntos
Dermoscopia , Micose Fungoide/diagnóstico , Humanos , Micose Fungoide/patologia , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Dermoscopy is useful in evaluating skin tumours, but its applicability extends also to the field of inflammatory skin disorders. Plaque psoriasis (PP), dermatitis, lichen planus (LP) and pityriasis rosea (PR) are common inflammatory skin diseases, but little is currently known about their dermoscopic features. OBJECTIVES: To determine and compare the dermoscopic patterns associated with PP, dermatitis, LP and PR and to assess the validity of certain dermoscopic criteria in the diagnosis of PP. METHODS: Patients with PP, dermatitis, LP and PR were prospectively enrolled. The single most recently developed lesion was examined dermoscopically and histopathologically. Variables included vascular morphology, vascular arrangement, background colour, scale colour, scale distribution and presence of Wickham striae. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot receiver-operator characteristic curves. RESULTS: Eighty-three patients with PP and 86 patients with either dermatitis, LP or PR were included in the study. Dotted vessels in a regular arrangement over a light red background and white scales were highly predictive for the diagnosis of PP, whereas dermatitis more commonly showed yellow scales and dotted vessels in a patchy arrangement. PR was characterized by yellowish background, dotted vessels and peripheral scales; whitish lines (Wickham striae) were seen exclusively in LP. CONCLUSIONS: PP, LP, PR and dermatitis show specific dermoscopic patterns that may aid their clinical diagnosis. Certain combinations of dermoscopic features can reliably predict the diagnosis of PP.
Assuntos
Dermatite/patologia , Dermoscopia/normas , Líquen Plano/patologia , Pitiríase Rósea/patologia , Psoríase/patologia , Humanos , Análise Multivariada , Estudos ProspectivosRESUMO
Background Patients with a previous medical history of nonmelanoma skin cancers (NMSCs) often develop multiple or recurrent malignant lesions around the site of the primary tumour. This finding led to the field cancerization theory, which suggests that the entire epithelial surface of the regional skin has an increased risk for the development of malignant lesions. Management of field change is challenging, taking into account the high impact of NMSCs on public health and healthcare costs. Objectives We sought to investigate whether field-photodynamic therapy (PDT) of extreme photodamaged skin would prevent new NMSCs, in comparison with a control area receiving placebo-PDT, in patients with clinical and histological signs of field cancerization. Methods Forty-five patients, previously diagnosed as having NMSCs of the face or scalp, with actinic keratoses symmetrically distributed over the same regions, were randomized for field treatment with 20% aminolaevulinic acid (ALA)-PDT on one side and placebo-PDT on the other. During the next 12-month period of follow up, patients were clinically evaluated for new NMSCs. Results A significant delay in the mean time of appearance and a reduction in the total number of new lesions were observed in the field-PDT protocol, when compared with the control. Conclusions The results obtained showed that field therapy with ALA-PDT confers a significant preventive potential against the formation of new NMSCs in patients with field changes.
Assuntos
Neoplasias Faciais/prevenção & controle , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Segunda Neoplasia Primária/prevenção & controle , Fotoquimioterapia , Couro Cabeludo , Neoplasias Cutâneas/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/uso terapêutico , Carcinoma Basocelular/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Feminino , Humanos , Ceratose Actínica/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológicoAssuntos
Aminoquinolinas/uso terapêutico , Antineoplásicos/uso terapêutico , Dermatoses Faciais/tratamento farmacológico , Ceratoacantoma/tratamento farmacológico , Lúpus Vulgar/complicações , Idoso , Quimioterapia Adjuvante , Dermatoses Faciais/patologia , Humanos , Imiquimode , Ceratoacantoma/patologia , Masculino , Resultado do TratamentoRESUMO
Trichoepitheliomas are benign skin tumors with follicular differentiation that present most commonly as solitary lesions. They can also present as multiple centrofacial papules due to several mutations in the CYLD gene. Multiple unilateral trichoepitheliomas in a linear or dermatomal distribution may rarely be seen. Herein, we report a case of multiple unilateral trichoepitheliomas on the face of a healthy 34-year-old woman of Caucasian origin.
Assuntos
Conservadores da Densidade Óssea/efeitos adversos , Dermatomiosite/induzido quimicamente , Difosfonatos/efeitos adversos , Imidazóis/efeitos adversos , Idoso , Anti-Inflamatórios/uso terapêutico , Feminino , Humanos , Prednisolona/uso terapêutico , Resultado do Tratamento , Ácido ZoledrônicoRESUMO
Bowen's disease (BD) is a squamous cell carcinoma in situ. Recent studies suggest that human papilloma virus plays an important role in the development of BD. We investigated whether imiquimod 5%, a topical immune response modifier, is an effective treatment for BD in five immunocompetent patients. The lesions were one genital and four extragenital. The frequency of application varied from three times weekly up to twice daily, and treatment duration ranged from 8-24 weeks. Four patients achieved clinical and histological cure. The patient with the genital lesion gained an important reduction in size and infiltration, which enabled surgical removal of the remaining lesion with good functional and cosmetic result. Our results suggest that topical imiquimod 5% is an effective treatment for BD through its viral and antitumor effects.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Aminoquinolinas/uso terapêutico , Antivirais/uso terapêutico , Doença de Bowen/tratamento farmacológico , Carcinoma de Células Escamosas/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Administração Tópica , Idoso , Antineoplásicos/farmacologia , Biópsia , Epiderme/patologia , Feminino , Humanos , Imiquimode , Masculino , Pessoa de Meia-Idade , Papillomaviridae/metabolismo , Infecções por Papillomavirus/tratamento farmacológico , Fatores de Tempo , Resultado do TratamentoRESUMO
In severe papulopustular and in nodulocystic/conglobate acne, oral isotretinoin is the treatment of choice. It is also required for patients with moderate to severe acne, especially when acne scars start to occur A new therapeutic approach consists of a low-dose regimen of isotretinoin. We performed a comparative study of high- and low-dose schemas of isotretinoin per os for the treatment of acne. The purpose of this study was to assess the therapeutic effect and tolerability of low doses of isotretinoin in the treatment of acne vulgaris and compare low-dose with high-dose regimens. Sixty-four patients (35 women and 29 men) with different types and grades of acne vulgaris were divided into two treatment groups of 32 patients, in a trial that compared a low dose of 0.15-0.40 mg/kg per day with a high dose of 0.5-1.0 mg/kg per day. These regimens were analyzed with reference to clinical history of acne, baseline investigations, dose and response to isotretinoin, clinical and laboratory adverse effects, relapses and cost of therapy. The mean success rate of the low-dose schema was 69%. The total dose up to 120 mg/kg should be followed for optimal results (success rate of 91%) and avoidance of relapses. The low-dose schema produced fewer adverse effects and offered a very beneficial effect on pre-existing scarring. Our results confirm the beneficial effect of the low-dose schema. We recommend a total dose > or = 120 mg/kg, as this therapeutic regimen of isotretinoin has proven to be the most successful in preventing relapses and scarring.
Assuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Isotretinoína/uso terapêutico , Administração Oral , Adolescente , Adulto , Análise Custo-Benefício , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/efeitos adversos , Fármacos Dermatológicos/economia , Relação Dose-Resposta a Droga , Feminino , Humanos , Isotretinoína/administração & dosagem , Isotretinoína/efeitos adversos , Isotretinoína/economia , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do TratamentoRESUMO
INTRODUCTION: Perforating necrobiosis lipoidica is a rare clinical form of necrobiosis lipoidica and is almost always associated with diabetes. Necrotized tissue is usually eliminated via transfollicular perforations. CASE REPORT: We report two cases of perforating necrobiosis lipoidica associated with type II diabetes mellitus. The characteristic clinical feature was the presence of keratotic plugs around the periphery of the lesions. Transfollicular perforation predominated in the first case. The second also presented epidermal perforation. DISCUSSION: There have been only 6 cases of perforating necrobiosis lipoidica in the literature. To our knowledge, this is the first case report of transepidermal elimination. We confirmed the constant association between this perforation type and diabetes mellitus.
Assuntos
Dermatoses da Mão/diagnóstico , Dermatoses da Perna/diagnóstico , Necrobiose Lipoídica/diagnóstico , Diabetes Mellitus/patologia , Feminino , Dermatoses da Mão/terapia , Humanos , Dermatoses da Perna/terapia , Pessoa de Meia-Idade , Necrobiose Lipoídica/terapiaRESUMO
Impetigo herpetiformis (IH) is a rare pustular dermatosis that shares striking clinical and histological similarities to generalized pustular psoriasis. The case of a 26-year-old primigravida with IH progressing in the 30th week of her pregnancy is presented. The peculiarity of our presentation relies on the reappearance of the disease postpartum. Monthly exacerbations during menstruation lasted for 7 years. Some probable clues regarding the pathogenesis of IH are suggested.