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INTRODUCTION: Solid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors. METHODS: In a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases. RESULTS: Of 514 SOTRs who presented with 623 primary cSCCs, metastases developed in 37 with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size > 2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9%-68.4%). CONCLUSIONS: SOTRs have a high risk of cSCC metastases and well-established clinical and histologic risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.
Subject(s)
Carcinoma, Squamous Cell , Organ Transplantation , Skin Neoplasms , Humans , Skin Neoplasms/epidemiology , Skin Neoplasms/pathology , Carcinoma, Squamous Cell/epidemiology , Prospective Studies , Incidence , Middle Aged , Male , Female , Europe/epidemiology , Organ Transplantation/adverse effects , Risk Factors , Aged , Adult , Transplant Recipients/statistics & numerical data , Neoplasm Invasiveness , Head and Neck Neoplasms/epidemiology , Head and Neck Neoplasms/pathology , Neoplasm Staging , Neoplasm Recurrence, Local/epidemiologyABSTRACT
Cutaneous collagenous vasculopathy (CCV) is an extremely rare acquired microangiopathy of unknown etiology. The authors describe a case of a 68-year-old man, a carrier of a heterozygous pathogenic variant of the glucocerebrosidase (GBA) gene, who was diagnosed with CCV, revealing uncommon fibrinogen positivity in direct immunofluorescence. The patient was subsequently diagnosed with multiple myeloma. Treatment of the myeloma with combined chemotherapy including bortezomib, followed by autologous stem cell transplantation, led to significant reduction of cutaneous lesions. To the best of the authors' knowledge, this is the first published case of CCV in a carrier of a pathogenic variant of the GBA gene, associated with multiple myeloma and with significant regression of CCV after myeloma treatment. Direct immunofluorescence examination revealed an unusual fibrinogen deposition. Hypothetical causative role of bortezomib treatment was proposed regarding significant regression of CCV.
Subject(s)
Hematopoietic Stem Cell Transplantation , Multiple Myeloma , Skin Diseases, Vascular , Telangiectasis , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bortezomib/therapeutic use , Fibrinogen/therapeutic use , Glucosylceramidase/therapeutic use , Humans , Male , Multiple Myeloma/complications , Multiple Myeloma/drug therapy , Multiple Myeloma/genetics , Skin Diseases, Vascular/pathology , Telangiectasis/pathology , Transplantation, AutologousABSTRACT
Bimatoprost is a synthetic prostaglandin structural analogue used among other indications to increase eyelash growth. The aim of this prospective, open-label study was to evaluate the safety and efficacy of topical bimatoprost in the treatment of eyelash loss in alopecia areata totalis (AT) and universalis (AU). Study subjects applied ophthalmic bimatoprost (0.3 mg/ml) solution to the eyelid margins once nightly for at least 12 weeks (mean treatment period was 30.6 weeks). A total of 16 out of 17 subjects completed the study. Only the subjects with eyelashes present at baseline experienced an increase in eyelash length and thickness. No new eyelash regrowth was induced. In patients with AT and AU topical bimatoprost affected existing eyelashes, but failed to induce regrowth of new eyelashes.
Subject(s)
Alopecia Areata , Eyelashes , Alopecia/diagnosis , Alopecia/drug therapy , Bimatoprost/adverse effects , Humans , Prospective StudiesABSTRACT
The IL-17 cytokine family encompasses six different homodimers and heterodimers referred to as IL-17A-F. Due to some differences in the mechanism of IL-17 inhibition, aninsufficient effect of one IL-17 inhibitor does not necessarily imply lack of efficacy of the other agent of the same class. Aim of study was analysis of the success rate of switches among IL-17 inhibitors (secukinumab, ixekizumab, and brodalumab) in patients treated in the Czech Republic. Data were obtained from the Czech nationwide registry of psoriatic patients receiving biological/targeted therapy (BIOREP). Our analysis involved data of a total of 90 patients with severe chronic plaque psoriasis and baseline PASI scores >10 both prior to first-line biological therapy initiation and after switch to another agent of the class of IL-17 inhibitors. The most effective switch was that from secukinumab to brodalumab, with PASI 90 reached by 64.7% and 73.3% of patients at weeks 12 and 24. Among patients switched from secukinumab to ixekizumab target PASI 90 responses were achieved (at weeks 12 and 24) by 41.2% and 55.2% of patients. Among patients switched from ixekizumab to brodalumab target PASI 90 responses were achieved, at the above time points, by 30.8% and 38.5% of patients. Our analysis showed a high success rate of switches from secukinumab to ixekizumab and brodalumab, followed by the ixekizumab-to-brodalumab switch. Importantly, the therapeutic response and success rates of individual switches are independent of the patient's body weight and presence of psoriatis arthritis.
Subject(s)
Interleukin-17 , Psoriasis , Antibodies, Monoclonal/therapeutic use , Biological Therapy , Cytokines , Czech Republic , Humans , Psoriasis/chemically induced , Psoriasis/drug therapy , Registries , Severity of Illness Index , Treatment OutcomeABSTRACT
BIOREP is a Czech registry of patients with psoriasis undergoing biological treatment. The objective of the study was to compare differences in demographic data, previous therapy, comorbidities, severity of psoriasis, quality of life, drug survival rates, and reasons for discontinuation between men and women. We analyzed a cohort of patients from the registry treated between May 2005 and January 2020. The total study population of 2472 patients (4051 treatment series) included 913 females and 1559 males. Women were significantly older than men at the onset of the biological treatment (47.8 vs 45.4 years, P < .0012) and the mean durations of psoriasis and that from its diagnosis until initiation of biological therapy, were longer in women (29.6 vs 27.2 years and 23.2 vs 20.6 years, P < .0012). Women as compared with men were also more often diagnosed with psoriatic arthritis (43.5% vs 33.0%, P < .0012). The prevalence rate of comorbidities was equivalent for both sexes except for that of depression (11.4% females vs 3.7% males, P < .0012). Both the DLQI and PASI scores were significantly different at baseline (DLQI = 16.0 and PASI = 19.5 for men vs DLQI 17.6 = and PASI = 17.7 for women, P < .0012). The survival probability with biological therapy was significantly lower in women for both biologically naïve and non-naïve patients, and there was more evidence of adverse effects in women. Our research demonstrates significant differences relative to multiple factors associated with psoriasis between men and women.
Subject(s)
Psoriasis , Quality of Life , Biological Therapy , Czech Republic/epidemiology , Female , Humans , Male , Probability , Psoriasis/diagnosis , Psoriasis/drug therapy , Psoriasis/epidemiology , Severity of Illness IndexABSTRACT
Dupilumab is a monoclonal antibody against interleukin 4 (IL-4) receptor α that blocks signaling from IL-4 and IL-13, essential mediators of T helper 2 (Th2) pathway. To date, all clinical trials investigating the use of dupilumab excluded patients with human immunodeficiency virus. Herein, we describe the safe and successful use of dupilumab in a patient with atopic dermatitis, severe therapy resistant asthma, and HIV infection.
Subject(s)
Asthma , Dermatitis, Atopic , HIV Infections , Adult , Antibodies, Monoclonal, Humanized , Asthma/diagnosis , Asthma/drug therapy , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/drug therapy , HIV Infections/complications , HIV Infections/diagnosis , HIV Infections/drug therapy , Humans , Interleukin-13 , MaleABSTRACT
A case is described of severe acute hepatitis in 47-year-old woman with chronic psoriasis and psoriatic arthritis treated with infliximab. Although clinical, serological and laboratory results were compatible with acute EBV hepatitis, it was difficult to differentiate between EBV infection and other non-infectious causes of hepatitis. The patient gradually developed chronic hepatitis with liver steatosis and efficient treatment with adalimumab had to be stopped. This case presents an uncommon complication that may arise from the use of biologic therapy and calls for caution in long-term management of psoriatic patients with internal comorbidities.
Subject(s)
Epstein-Barr Virus Infections/virology , Hepatitis, Chronic/virology , Hepatitis, Viral, Human/virology , Immunocompromised Host , Immunologic Factors/adverse effects , Infliximab/adverse effects , Opportunistic Infections/virology , Psoriasis/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Alcohol Drinking/adverse effects , Antiviral Agents/therapeutic use , Biopsy , Epstein-Barr Virus Infections/diagnosis , Epstein-Barr Virus Infections/drug therapy , Epstein-Barr Virus Infections/immunology , Female , Hepatitis, Chronic/diagnosis , Hepatitis, Chronic/drug therapy , Hepatitis, Chronic/immunology , Hepatitis, Viral, Human/diagnosis , Hepatitis, Viral, Human/drug therapy , Hepatitis, Viral, Human/immunology , Humans , Middle Aged , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Psoriasis/diagnosis , Psoriasis/immunology , Remission Induction , Risk Factors , Severity of Illness Index , Treatment Outcome , Tumor Necrosis Factor-alpha/immunologyABSTRACT
Immunoglobulin A (IgA) pemphigus is a clinically distinct variant of pemphigus characterized by intercellular IgA deposition in the epidermis. Recently, an IgA/Immunoglobulin G (IgG) subset of pemphigus with IgA and IgG anti-keratinocyte cell surface antibodies has been described. Both IgA and IgA/IgG pemphigus have been associated with internal malignancies. Above all, monoclonal IgA gammopathy in patients with IgA pemphigus has been reported, and lung cancers in association with IgA/IgG pemphigus have been described. IgA pemphigus can be successfully treated with dapsone, whereas therapeutic management of IgG/IgA pemphigus is not well established yet. We report a rare case of a patient, who developed atypical pemphigus with both IgA and IgG autoantibodies and an underlying lung cancer, successfully treated with corticosteroids and dapsone.
Subject(s)
Immunoglobulin A/immunology , Immunoglobulin G/immunology , Lung Neoplasms/pathology , Pemphigus/drug therapy , Aged , Autoantibodies/immunology , Dapsone/administration & dosage , Dapsone/therapeutic use , Drug Therapy, Combination , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Male , Pemphigus/immunology , Treatment OutcomeABSTRACT
INTRODUCTION: Psoriasis is a chronic, immune-mediated inflammatory skin disease. Despite the availability of several therapies, many patients affected by this disease remain untreated, do not have adequate response, or suffer from treatment-related toxic effects. It has been shown that the interleukin (IL)-17 pathway plays a key role in the immunopathogenesis of psoriasis. Brodalumab, the first human monoclonal IgG2 antibody that selectively binds to subunit A of the human IL-17 receptor, blocking interactions with a number of cytokines of the IL-17 family, has confirmed fast onset of action, high complete clearance rates, and sustained efficacy. Nevertheless, there is only a limited amount of published real-world evidence (RWE) data. METHODS: This was an open-label, multicenter, real-world, prospective, non-interventional, non-controlled (single-arm) observational study (LIBERO-CZ) assessing the management of moderate to severe psoriasis with brodalumab in daily practice for up to 52 weeks of treatment. RESULTS: Fifty-four patients (70.4% male, mean age 46.9 ± 13.4 years, weight 95.6 ± 22.7 kg, disease duration 18.6 ± 12.7 years) were enrolled and included in the final analysis. Forty-nine of the patients completed the study and five discontinued prematurely; 51.8% of all the enrolled patients were biologic-naïve. At baseline, 28% patients were classified as severe (psoriasis area severity index (PASI) ≥ 20). Overall, the mean PASI decreased by 15.6 from 16.1 (± 5.0) at baseline to 0.5 (± 1.2) at the last visit. The primary endpoint of an absolute PASI ≤ 3 at week 12 (as observed analysis) was achieved by 95.9% of patients. The static Physician's Global Assessment (sPGA) success (defined as clear = 0 and almost clear = 1) at week 52 was achieved by 92.1% of patients. PASI 75, PASI 90, and PASI 100 were achieved by 98.0%, 87.8%, and 75.5% of patients, respectively, after approximately 52 weeks of treatment. The study also recorded very positive results concerning patient-reported outcomes. CONCLUSIONS: LIBERO-CZ confirms the fast onset and high clearance rates of brodalumab in real life in both biologic-naïve and biologic-experienced patients.
ABSTRACT
We describe a case of a patient with severe generalized psoriasis treated with etanercept, who developed deep vein thrombosis and 1 year later developed solid lung cancer. Anti-tumor necrosis factor therapies have been a powerful addition to the therapy of psoriasis; nevertheless, the treatment might be associated with adverse events, such as venous thromboembolism or malignancies. Available data regarding these specific adverse reactions are rather conflictive; therefore, more observational studies and registry reports for long-term risk assessment are needed.
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INTRODUCTION: The broad and sustained efficacy of apremilast for psoriasis has been demonstrated in randomized and real-world observational studies. Data from Central and Eastern Europe (CEE) are lacking. Moreover, apremilast use in this region is limited by country-specific reimbursement criteria. This is the first study to report data on the real-world use of apremilast in the region. METHODS: APPRECIATE (NCT02740218) was an observational, retrospective, cross-sectional study assessing psoriasis patients 6 (± 1) months after apremilast treatment initiation. The study aimed to describe the characteristics of patients with psoriasis receiving apremilast, estimate treatment outcomes, including Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI), and assess dermatologists' and patients' perspectives on treatment using questionnaires including the Patient Benefit Index (PBI). Adverse event reports were taken from the medical records. RESULTS: Fifty patients (Croatia: 25; Czech Republic: 20; Slovenia: 5) were enrolled. In patients continuing apremilast at 6 (± 1) months, mean (± SD) PASI score was reduced from 16.2 ± 8.7 points at treatment initiation to 3.1 ± 5.2 at 6 (± 1) months; BSA from 11.9% ± 10.3% to 0.8% ± 0.9%; DLQI from 13.7 ± 7.4 points to 1.6 ± 3.2. PASI 75 was reached by 81% of patients. Physicians reported that the overall treatment success fulfilled their expectations in more than two thirds of patients (68%). At least three-quarters of patients reported apremilast had a quite or very high benefit on the needs they identified as being most important. Apremilast was well tolerated; no serious or fatal adverse events were identified. CONCLUSION: Apremilast was effective in reducing skin involvement and improving quality of life in CEE patients having severe disease. Treatment satisfaction among physicians and patients was very high. These data add to the growing body of evidence showing consistent effectiveness of apremilast across the continuum of psoriasis disease severity and manifestations. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT02740218.
Subject(s)
Psoriasis , Quality of Life , Humans , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cross-Sectional Studies , Europe, Eastern , Psoriasis/drug therapy , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
BACKGROUND: Real-world data on the use of interleukin-17 (IL-17) inhibitors for the treatment of psoriasis are limited. OBJECTIVE: To evaluate and compare the efficacy, safety, and drug survival of IL-17 inhibitors. METHODS: This retrospective study analyzed the BIOREP registry data of patients treated with at least one IL-17 inhibitor (secukinumab, ixekizumab, and brodalumab). RESULTS: In total, 949 patients were included. The improvement in PASI score was significant for all drugs, and the proportion of patients achieving PASI 75, 90, and 100 after both 3 and 24 months of therapy was highest for brodalumab, followed by ixekizumab and secukinumab. The Dermatology Life Quality Index score decreased to Ë3 after 3 months and to Ë2 after 24 months of therapy for all inhibitors. Loss of effectiveness was the major reason for discontinuation in 17.2% of patients, followed by adverse events in 3.2% of patients. The drug survival probability was the highest for brodalumab, followed by ixekizumab and secukinumab. Negative predictors for treatment discontinuation were obesity and the number of treatment lines, whereas a positive predictor was the presence of concomitant psoriatic arthritis; sex had no influence. CONCLUSION: This real-life study demonstrated the effectiveness and good safety profile of all currently available IL-17 inhibitors.
Subject(s)
Interleukin-17 , Psoriasis , Humans , Retrospective Studies , Czech Republic , Antibodies, Monoclonal/adverse effects , Psoriasis/drug therapy , Psoriasis/chemically induced , Registries , Treatment Outcome , Severity of Illness IndexABSTRACT
BACKGROUND: Dupilumab has been approved to treat moderate-to-severe atopic dermatitis; however, the data in a real-world setting are still limited. OBJECTIVE: To analyze the effectiveness and safety of dupilumab. METHODS: This was a real-life Czech multicenter retrospective study from patients treated with dupilumab for severe AD. RESULTS: A total of 360 patients were included. At 16 weeks, 66.6, 34.1, and 5.5% of patients achieved EASI75/90 and EASI100, respectively. Improvement continued with the time, and the proportion of patients with EASI75/90 and EASI100 increased to 89.5, 55.6, and 12.9% after one year of treatment and reached 95.8, 60.4, and 27.1% in the second year of therapy, respectively. A significant reduction was observed in the DLQI scores. The most common adverse events were infections in 5.8% of patients, followed by ocular complications in 2.5% of patients. Persistence rates were 98.2% at four months to 93.1% at month 24, and lack of effectiveness was the most common reason for discontinuation. CONCLUSION: This real-life study confirmed the effectiveness and safety of dupilumab in a real-life setting during the COVID-19 pandemic. Our study revealed a higher frequency of infections and a lower conjunctivitis frequency than other real-life studies and clinical trials.
Subject(s)
COVID-19 , Dermatitis, Atopic , Antibodies, Monoclonal, Humanized , Czech Republic , Dermatitis, Atopic/drug therapy , Humans , Pandemics , Registries , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
INTRODUCTION: The study aimed to evaluate the real-world effectiveness of adalimumab as well as investigate the persistence of treatment and identify factors, which may affect it. METHODS: More than 1150 patients (4363.1 patient-years) with psoriasis who had been treated with adalimumab since the start of the BIOREP registry in the Czech Republic were included in this analysis. Treatment effectiveness was defined as improvement in Psoriasis Area and Severity Index (PASI). The analysis was performed during the years 2005 and 2018. Patients were on on-label dose. RESULTS: After 12 and 96 months of therapy, 84% and 88% of patients had a 75% reduction in PASI score from baseline, respectively. Drug survival was analyzed according to the number of previous biological therapies, and results showed 75% and 58.1% survival rate for biologically naïve patients in the 20th and 80th month of treatment, respectively. The negative predictors of adalimumab survival were the female gender, obesity, baseline PASI score and the number of previous biological therapies. CONCLUSIONS: Baseline factors including PASI, number of previous biological therapies, and sex were associated with shorter adalimumab survival. This long-term study shows that adalimumab is effective and has high treatment persistence.
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INTRODUCTION: Risankizumab has been approved for the treatment of moderate-to-severe plaque psoriasis; however, real-life data are limited. Our objectives were to evaluate the effectiveness and safety of risankizumab and its impact on the quality of life of patients with psoriasis in a real-world setting. METHODS: We retrospectively analyzed 154 patients from 18 centers in the Czech Republic who had undergone biologic therapy with risankizumab for moderate-to-severe plaque psoriasis. Baseline characteristics included data on comorbidities, demographics, previous therapies, Dermatology Life Quality Index (DLQI) score, and Psoriasis Area and Severity Index (PASI) score. The proportion of patients achieving a 90% improvement in their PASI score from baseline (PASI 90) and complete resolution (PASI 100) after 16, 28, and 52 weeks was analyzed. RESULTS: A total of 95 men and 59 women with mean body mass index (BMI) of 29.6 were enrolled in our analysis. The mean age of the patients was 48.5 years and the mean time from diagnosis until initiation of risankizumab therapy was 22.5 years. After 16 weeks, 63.8 and 44.7% patients achieved PASI 90 and PASI 100 responses, respectively. Improvement continued with time, and the proportion of patients with PASI 90 and PASI 100 responses increased to 82.4 and 67.6%, respectively, at week 52. A significant reduction was observed over time in the DLQI. Patients achieving PASI 100 response at week 16 had a higher reduction in the DLQI score than those with PASI 90 response (- 15.9 vs. - 11.8). PASI 90 and PASI 100 responses were independent of the BMI and previous biologic therapy. No new safety issues were identified. CONCLUSIONS: In this patient population, risankizumab was effective and safe in a real-world setting, and a high number of patients achieved PASI 90 and PASI 100 responses. A higher reduction in the DLQI was seen in patients with PASI 100 response, which supports the evidence that this value should be the new therapeutic goal.
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BACKGROUND: Seafood allergy is among one of the common food allergies. Decrease in consumption of omega-3 polyunsaturated fatty acids (PUFAs), prevalent especially in oily fish, has been proposed to contribute to the increased prevalence of allergic diseases. AIM: The aim of this study was to evaluate, in atopic dermatitis (AD) patients, the relation between the occurrence of food hypersensitivity reaction (FHR) to seafish and the occurrence of other atopic diseases and parameters. METHODS: Complete dermatological and allergological examination was performed in patients included in the study; 332 patients were examined, with the average age 26.8 years (SD 9.2 years). RESULTS: The FHR to seafish was confirmed in 11% of patients. Patients suffering from FHR to seafish suffered significantly more from sensitization to fungi (in 46%), from reactions to celery (in 34%), and from persistent eczematic lesions (in 82%). CONCLUSION: FHRs to seafish in AD patients are associated with persistent eczematic lesions and with the higher occurrence of sensitization to fungi and reactions to celery. The occurrence of bronchial asthma, rhinitis, positive family history, and onset of AD under 5 years of age is higher in patients with reactions to seafish, but the difference is not statistically significant.
ABSTRACT
The patient, a 30-year-old man with numerous genital condylomata acuminata (CA), has had unsuccessful treatment with liquid nitrogen, 20% podophyllin, and repeated 0.5% podophyllotoxin solution with 5% imiquimod (Figure 1). Before the appearance of CA, he experienced acute orchiepididimitis and a Candida infection. The patient was immunologically examined, and the lower level of lymphocytes, slightly reduced level of IgM, and C4 complement were revealed. Results from a human immunodeficiency virus examination were negative. After the therapeutic failure mentioned above, photodynamic therapy (PDT) was initiated using 20% aminolevulinic acid (5-ALA) in a gel. The photosensitizer was applied to lesions and 10 mm of surrounding skin in a 1-mm-thick layer under occlusive dressing for 3 hours and then removed with saline and nonwoven gauze. The site was immediately irradiated with noncoherent red light with an emission spectrum of 580 to 680 nm wavelength (Medeikonos PDT-Model 200, Medeikonos AB, Sweden). The total light dose was 50 J/cm(2); light intensity ranged from 70 to 90 mW/cm(2). Because of persistent fluorescence during photodynamic therapy, the treatment was repeated 10 times in 2-week intervals with a follow-up of 1, 3, and 6 months after its completion. After the last PDT treatment, the persistent fluorescence disappeared completely. The absence of fluorescence corresponded with a healed clinical finding without scarring and pigmentation (Figure 2). The period from the initiation of PDT to the consolidation of CA was 22 weeks. During PDT treatment, the patient felt only mild burning, which disappeared after the illumination stopped. Six months after the therapy, there were no signs of recurrent disease.
Subject(s)
Aminolevulinic Acid/therapeutic use , Condylomata Acuminata/drug therapy , Photochemotherapy , Photosensitizing Agents/therapeutic use , Adult , Humans , Male , Penis/virology , Skin/virologyABSTRACT
BACKGROUND: BIOREP is a Czech registry of psoriatic patients on biological treatment in a clinical setting. We describe the characteristics of patients with psoriasis at the time of enrollment and present comparisons with published data from other national registries. METHODS: We analyzed the cohort of patients treated with biologics between May 2005 and May 2015. Demographic data, previous therapies, comorbidities, and severity of psoriasis were compared with data from other registries - DERMBIO, BIOBADADERM, BADBIR, and PSOBEST. RESULTS: A total of 1412 psoriatic patients initiating biological treatment were included with a predominance of males (63.4%). The mean patient age was 50.2 years, and approximately 70.5% of patients were either overweight or obese. The mean baseline Psoriasis Area and Severity Index was 19.8, and the Dermatology Life Quality Index was 16.6. More than one-third of patients (41.0%) reported a history of psoriatic arthritis, and a high proportion of patients (49.5%) with cardiovascular risk factors (hypertension [35.2%], hyperlipidemia [27.7%], diabetes mellitus [11.4%], coronary heart disease [4.9%], and obesity [15.2%]) were observed. Most of the patients had been previously treated with phototherapy (85.4%), acitretin (74.0%), methotrexate (65.7%), or cyclosporine (53.1%). CONCLUSION: BIOREP is one of the first registries of patients with psoriasis treated with biologics in Central and Eastern Europe. Our results found a similar or higher prevalence of comorbidities, long disease duration, and high impact on the quality of life among patients included in Western European registries.
Subject(s)
Biological Products/therapeutic use , Obesity/epidemiology , Psoriasis/drug therapy , Psoriasis/epidemiology , Acitretin/therapeutic use , Adult , Body Mass Index , Comorbidity , Coronary Disease/epidemiology , Cyclosporine/therapeutic use , Czech Republic/epidemiology , Dermatologic Agents/therapeutic use , Diabetes Mellitus/epidemiology , Female , Humans , Hyperlipidemias/epidemiology , Hypertension/epidemiology , Keratolytic Agents/therapeutic use , Male , Methotrexate/therapeutic use , Middle Aged , Phototherapy , Prevalence , Psoriasis/therapy , Quality of Life , Registries , Retreatment , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
Dysplastic naevi (DN) are a known risk factor for malignant melanoma. Their occurrence is closely connected with the degree of skin pigmentation. People with a light complexion are more likely to develop DN than dark-skinned individuals. We examined the proposition that DN exhibit altered melanin formation, which may be involved in their malignant transformation. X-ray microanalysis was used to study the composition of melanosomes from DN and to compare the results with those obtained from melanomas, banal (dermal) naevi and normal cutaneous melanocytes. We analysed sulphur (an indicator of phaeomelanin) and two metals, iron and calcium, involved in oxidative stress. FACS analysis of dihydrorhodamine-123-labelled cells was employed to quantify differences in the production of radical oxygen species in DN cells and normal skin melanocytes. A significantly higher sulphur content was found in melanosomes from DN cells and melanoma cells when compared with normal melanocytes and naevus cells from banal naevi. In addition, melanosomes of DN cells and melanoma cells contained higher amounts of iron and calcium. In the case of calcium, this was associated with a significantly elevated cytoplasmic concentration. FACS analysis showed that DN cells exhibited higher concentrations of radical oxygen species than normal skin melanocytes from the same individuals. We propose that increased phaeomelanogenesis in DN cells is connected with oxidative imbalance, which is reflected by increased intracellular concentrations of reactive oxygen species and raised calcium and iron concentrations. We show that the metabolic alterations in DN cells resemble those found in melanoma cells. Our findings provide support for the idea that DN cells are true precursor lesions of melanoma.