Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Conjuntivite/prevenção & controle , Dermatite Atópica/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Conjuntivite/induzido quimicamente , Conjuntivite/epidemiologia , Dermatite Atópica/complicações , Humanos , ItáliaRESUMO
Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory disease associated with a high physical and psychological burden. It is a disorder of the infundibular segment of the pilosebaceous unit, characterized by subcutaneous nodules, abscesses, sinus tracts and scar formation on the intertriginous and apocrine-bearing areas. HS is quite rare in young and prepubertal children. It usually begins after puberty, but several reports of prepubertal HS onset have been described. These cases are strongly linked to hormonal disorders and genetic susceptibility. Specific guidelines for prepubertal patients are still lacking, so further studies are warranted to better delineate a tailored approach. This paper aims to summarize the most significant aspects, as well as the most recent information about the epidemiology, pathogenesis, clinical features, diagnosis, comorbidities and treatment of paediatric HS. In addition, we report our clinical experience in managing HS in a group of eight prepubertal patients based on systemic antibiotics (azithromycin) and zinc oral supplementation.
Assuntos
Antibacterianos/uso terapêutico , Hidradenite Supurativa/tratamento farmacológico , Azitromicina/uso terapêutico , Criança , Clindamicina/uso terapêutico , Quimioterapia Combinada , Feminino , Predisposição Genética para Doença , Hidradenite Supurativa/complicações , Hidradenite Supurativa/epidemiologia , Hidradenite Supurativa/genética , Humanos , Hiperandrogenismo/complicações , Hiperinsulinismo/complicações , Guias de Prática Clínica como Assunto , Puberdade Precoce/complicaçõesRESUMO
Biologic treatments have modified the therapeutic armamentarium in the treatment of many dermatological and non- dermatological diseases and data on literature have widely focused on the efficacy and safety of TNF-alpha inhibitors in psoriasis. Although the etiopathogenesis has not completely elucidated, inflammation appears the lait motif unifying the immune-pathogenesis of diverse skin disease, as atopic dermatitis, alopecia areata and hidradenitis suppurativa. Actually, data on the off-label use of biologics in cutaneous immune-mediated inflammatory diseases are scarce and restricted to anecdotal cases and case series. The present review aims to evidence the major off- label use of TNF-alpha inhibitors in dermatology.
Assuntos
Terapia Biológica/métodos , Mediadores da Inflamação/imunologia , Uso Off-Label , Dermatopatias/tratamento farmacológico , Dermatopatias/imunologia , Adalimumab/uso terapêutico , Animais , Terapia Biológica/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/imunologia , Hidradenite Supurativa/diagnóstico , Hidradenite Supurativa/tratamento farmacológico , Hidradenite Supurativa/imunologia , Humanos , Mediadores da Inflamação/antagonistas & inibidores , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Psoríase/imunologia , Dermatopatias/diagnósticoRESUMO
During the last decades, the advent of biological therapies has revolutionized the management of several immune-mediated inflammatory disorders, as inflammatory bowel diseases, autoimmune arthritis and psoriasis, which significantly impact both quality of life and health care economics. Biological therapies currently available can be divided into two main categories: the tumor necrosis factor-α antagonists (infliximab, adalimumab, etanercept, golimumab, certolizumab pegol) and interleukin 12/23 monoclonal antibodies (ustekinumab). Biologics, reducing TNFα bioavailability or inhibiting proximal regulators of inflammatory cascade, represent an established therapeutic strategy of inflammatory autoimmune diseases, with remarkable efficacy and a safety profile that is extensively examined and monitored. The biology and the immunological effects of TNFα, IL-12, IL-23 and related signalling pathways are accurately summarized. The dosing regimens, methods of administration, pharmacodynamics profiles, and side effects of the currently licensed TNFα antagonists and IL12/IL23 inhibitor are discussed in detail.