RESUMEN
BACKGROUND/OBJECTIVES: Patients with psoriasis experience higher rates of depression, anxiety and suicidal ideation than the general population. With effective treatment, there is evidence that with the initial decrease in the psoriasis area and severity index (PASI) score, patients' quality of life (QoL), measured by the dermatology life quality index (DLQI) improves. However, to date, there have been no studies demonstrating that patients' QoL remains improved. We investigated the association between the DLQI and PASI of patients with psoriasis on biologic agents for an extended period of time of up to 6.5 years. METHODS: The data for this longitudinal, retrospective study was collected from a large tertiary teaching hospital in South Australia. Data was collected from all patients with psoriasis who had been on biologic agents for 2 or more years (n = 54). RESULTS: PASI and DLQI were highly correlated over all time points (ρ = 0.50), P < 0.001. DLQI scores significantly decreased by 0.8 (95% CI: 0.30, 1.26) units per year from 12 months to 6.5 years, P = 0.002. After 12 months, PASI scores declined by 0.19 (95% CI: 0.13, 0.52) units per year, P = 0.24. CONCLUSION: This study demonstrates that DLQI and PASI remain low after 12 months, and, in fact, both gradually decline further with time. Patients on biologic agents for prolonged periods maintained their improvement in QoL for up to 6.5 years.
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Productos Biológicos/uso terapéutico , Psoriasis/diagnóstico , Psoriasis/tratamiento farmacológico , Calidad de Vida , Índice de Severidad de la Enfermedad , Adulto , Australia , Productos Biológicos/farmacología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Psoriasis/psicología , Estudios Retrospectivos , Medición de Riesgo , Perfil de Impacto de Enfermedad , Centros de Atención Terciaria , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND/OBJECTIVES: With the increase in rates of methicillin-resistant Staphylococcus aureus (MRSA) skin infections in the general population, there may be a similar increase of such infections in patients with atopic dermatitis (AD). There are few studies on MRSA prevalence in the AD population, and no previous studies in Australia. This study investigated the prevalence of MRSA and other organisms in the paediatric AD population over the previous 15 years. METHODS: Skin swab results and other significant data, including patients' characteristics and comorbidities, were collected on patients with AD aged 0-18 years, admitted to a large teaching hospital in South Australia from 1999 to 2014 (N = 298). This longitudinal, retrospective study investigated, using logistic regression, the change of prevalence of MRSA, methicillin-sensitive S. aureus (MSSA) and Streptococcus spp. in AD over the past 15 years. RESULTS: Compared with 1999-2002, in 2003-2006 patients were approximately threefold more likely (P = 0.350), in 2007-2010 they were approximately 13-fold more likely (P = 0.030) and in 2011-2014 they were approximately 24-fold more likely to test positive for MRSA (P = 0.008), despite low absolute MRSA numbers. There was a positive association between the number of previous hospital admissions per patient and MRSA (OR = 1.16 [1.08-1.25], P = 0.000). In contrast, there was no change in the prevalence of MSSA or Streptococcus spp. over time. CONCLUSION: The prevalence of MRSA in children with AD is clearly on the rise. This has negative consequences for individuals with AD and is also a major public health problem.
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Dermatitis Atópica/epidemiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Cutáneas Estafilocócicas/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus/aislamiento & purificación , Adolescente , Niño , Preescolar , Comorbilidad , Femenino , Hospitalización , Humanos , Lactante , Estudios Longitudinales , Masculino , Prevalencia , Estudios Retrospectivos , Piel/microbiología , Australia del Sur/epidemiología , Infecciones Cutáneas Estafilocócicas/microbiología , Infecciones Estreptocócicas/microbiologíaAsunto(s)
Antibacterianos/farmacocinética , Antifúngicos/farmacocinética , Interacciones Farmacológicas , Floxacilina/farmacocinética , Micosis/tratamiento farmacológico , Scedosporium/efectos de los fármacos , Voriconazol/farmacocinética , Antibacterianos/administración & dosificación , Antifúngicos/administración & dosificación , Floxacilina/administración & dosificación , Humanos , Micosis/microbiología , Voriconazol/administración & dosificaciónRESUMEN
We report a 20-year-old female with generalized, severe, recessive dystrophic epidermolysis bullosa who developed secondary chronic anal fissures. This resulted in anal sphincter spasm and severe, disabling pain. She was treated with five botulinum toxin A injections into the internal anal sphincter over a period of 2 years and gained marked improvement in her symptoms. This case demonstrates the successful use of botulinum toxin A injections to relieve anal sphincter spasm and fissuring, with long-term improvement.
RESUMEN
Ochronosis is a rare disease characterised clinically by bluish-grey skin discolouration and histologically by yellow-brown pigment deposits in the dermis. It occurs in endogenous and exogenous forms. Endogenous ochronosis, also known as alkaptonuria, is an autosomal recessive disease of tyrosine metabolism, resulting in the accumulation and deposition of homogentisic acid in connective tissue. We report a case of facial endogenous ochronosis and coexistent photodamage, which was successfully treated with erbium-doped yttrium aluminium garnet laser resurfacing and deep focal point treatment to remove areas of residual deep pigment.
Asunto(s)
Técnicas de Ablación , Alcaptonuria/complicaciones , Dermatosis Facial/cirugía , Láseres de Estado Sólido/uso terapéutico , Ocronosis/cirugía , Técnicas de Ablación/instrumentación , Dermatosis Facial/etiología , Femenino , Humanos , Persona de Mediana Edad , Ocronosis/etiologíaRESUMEN
We report two cases of adults with urticarial dermatitis who could not be managed by a variety of treatments but who obtained good control with mycophenolate mofetil (MMF). A clinical response was seen 6-8 weeks from treatment onset and they were maintained on MMF 1 g twice daily (case 1), and MMF 1 g omni mane and 500 mg omni nocte (case 2), with no major exacerbations for many years. MMF is an immunosuppressive agent, which is currently used off-label for many dermatological conditions. To date, there have been no studies investigating the use of MMF as a treatment for urticarial dermatitis. The cases we present suggest that MMF is an effective treatment for this condition, and we recommend that MMF be considered as a treatment option.