ABSTRACT
BACKGROUND AND OBJECTIVES: Bexarotene has been approved to treat advanced stage cutaneous T-cell lymphomas (CTCL) since 1999. However, very few data have been published on its long-term safety and efficacy profile. The aim of this study is to determine the tolerability to bexarotene and outcomes by collecting the 2nd largest case series to date on its long-term use vs CTCL. MATERIAL AND METHOD: This was a multicenter retrospective review of 216 patients with mycosis fungoides (174), or Sézary syndrome (42) on a 10-year course of bexarotene alone or in combination with other therapies at 19 tertiary referral teaching hospitals. RESULTS: A total of 133 men (62%) and 83 women (38%) were included, with a mean age of 63.5 year (27-95). A total of 45% were on bexarotene monotherapy for the entire study period, 22% started on bexarotene but eventually received an additional therapy, 13% were on another treatment but eventually received bexarotene while the remaining 20% received a combination therapy since the beginning. The median course of treatment was 20.78 months (1-114); and the overall response rate, 70.3%. Complete and partial response rates were achieved in 26% and 45% of the patients, respectively. Treatment was well tolerated, being the most common toxicities hypertriglyceridemia (79%), hypercholesterolemia (71%), and hypothyroidism (52%). No treatment-related grade 5 adverse events were reported. CONCLUSIONS: Our study confirms bexarotene is a safe and effective therapy for the long-term treatment of CTCL.
Subject(s)
Bexarotene , Mycosis Fungoides , Sezary Syndrome , Skin Neoplasms , Tetrahydronaphthalenes , Humans , Bexarotene/therapeutic use , Male , Female , Aged , Retrospective Studies , Middle Aged , Aged, 80 and over , Skin Neoplasms/drug therapy , Adult , Tetrahydronaphthalenes/therapeutic use , Tetrahydronaphthalenes/adverse effects , Mycosis Fungoides/drug therapy , Sezary Syndrome/drug therapy , Spain , Lymphoma, T-Cell, Cutaneous/drug therapy , Treatment Outcome , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effectsABSTRACT
BACKGROUND AND OBJECTIVES: Bexarotene has been approved to treat advanced stage cutaneous T-cell lymphomas (CTCL) since 1999. However, very few data have been published on its long-term safety and efficacy profile. The aim of this study is to determine the tolerability to bexarotene and outcomes by collecting the 2nd largest case series to date on its long-term use vs CTCL. MATERIAL AND METHOD: This was a multicenter retrospective review of 216 patients with mycosis fungoides (174), or Sézary syndrome (42) on a 10-year course of bexarotene alone or in combination with other therapies at 19 tertiary referral teaching hospitals. RESULTS: A total of 133 men (62%) and 83 women (38%) were included, with a mean age of 63.5 year (27-95). A total of 45% were on bexarotene monotherapy for the entire study period, 22% started on bexarotene but eventually received an additional therapy, 13% were on another treatment but eventually received bexarotene while the remaining 20% received a combination therapy since the beginning. The median course of treatment was 20.78 months (1-114); and the overall response rate, 70.3%. Complete and partial response rates were achieved in 26% and 45% of the patients, respectively. Treatment was well tolerated, being the most common toxicities hypertriglyceridemia (79%), hypercholesterolemia (71%), and hypothyroidism (52%). No treatment-related grade 5 adverse events were reported. CONCLUSIONS: Our study confirms bexarotene is a safe and effective therapy for the long-term treatment of CTCL.
Subject(s)
Bexarotene , Mycosis Fungoides , Sezary Syndrome , Skin Neoplasms , Tetrahydronaphthalenes , Humans , Bexarotene/therapeutic use , Male , Female , Aged , Retrospective Studies , Middle Aged , Aged, 80 and over , Skin Neoplasms/drug therapy , Adult , Tetrahydronaphthalenes/therapeutic use , Tetrahydronaphthalenes/adverse effects , Mycosis Fungoides/drug therapy , Sezary Syndrome/drug therapy , Spain , Lymphoma, T-Cell, Cutaneous/drug therapy , Treatment Outcome , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/adverse effectsABSTRACT
Protein S deficiency is rare in systemic lupus erythematosus (SLE) and is generally associated with the presence of antiphospholipid (APL) antibodies. Lack of protein S can cause skin necrosis, but when it does it is generally in response to warfarin exposure. In this article, we describe the case of a patient who had not received warfarin and without APL antibodies who developed extensive skin necrosis due to protein S deficiency. It is important to investigate protein S deficiency in patients with lupus and extensive skin ulcers as it is a sign of arterial thrombosis and venous thromboembolism.
Subject(s)
Lupus Erythematosus, Systemic/complications , Protein S Deficiency/diagnosis , Skin/pathology , Female , Humans , Necrosis/pathology , Thrombosis/pathology , Venous Thromboembolism/pathology , Young AdultABSTRACT
Neurofibromatosis type 2 is an autosomal dominant hereditary disease with complete penetrance. It gives rise to multiple central and peripheral nervous system tumors, ocular alterations, and various types of skin lesion. In general, neither dermatologists nor other specialists have in-depth knowledge of the clinical manifestations of neurofibromatosis type 2. In some cases, this can lead to delayed diagnosis, which can increase morbidity and mortality. We describe the less well known clinical manifestations of NF2, focusing particularly on skin lesions specific to this disease. Identification of these lesions, when present, can facilitate diagnosis.
Subject(s)
Neurofibromatosis 2/pathology , Skin/pathology , Cafe-au-Lait Spots/etiology , Cataract/genetics , Child , Early Diagnosis , Genes, Neurofibromatosis 2 , Humans , Hyperpigmentation/genetics , Hypertrichosis/genetics , Molecular Diagnostic Techniques , Neurilemmoma/genetics , Neurilemmoma/pathology , Neurofibromatosis 2/diagnosis , Neuroma, Acoustic/diagnostic imaging , Neuroma, Acoustic/genetics , Prognosis , Skin Diseases/genetics , Skin Diseases/pathologyABSTRACT
INTRODUCTION: When co-administered with interferon and ribavirin, the prescription drug telaprevir significantly improves treatment response in patients with chronic hepatitis C virus (HCV) infection. Its use, however, also increases the likelihood of adverse effects that may lead to discontinuation of treatment. Cutaneous adverse effects are particularly common. OBJECTIVE: To determine the frequency and clinical characteristics of drug eruptions induced by telaprevir in patients receiving HCV treatment and to analyze the clinical course of lesions and response to treatment. MATERIAL AND METHODS: We performed a prospective observational study of all patients who started a treatment regimen that included telaprevir between May 2012 and July 2013. We recorded the demographic characteristics of the patients who developed telaprevir-induced eruptions, and analyzed the clinical characteristics of the lesions and their clinical course following the application of guideline-based treatment recommendations. RESULTS: Twenty (46%) of the 43 patients who received triple therapy with interferon, ribavirin, and telaprevir during the study period developed drug reactions attributable to telaprevir. The reaction was classified as mild or moderate (grades 1 or 2) in 90% of cases and consisted of an exanthem with erythematous-edematous scaling plaques and papules. The rash worsened, mainly by spreading, in about one-third of cases. The skin lesions led to discontinuation of treatment in 2 patients (4.6%). Sustained viral response was achieved in 34 patients (79%). CONCLUSIONS: Telaprevir-induced eruptions are common and often progress, but they rarely require patients to discontinue treatment.
Subject(s)
Drug Eruptions/etiology , Hepacivirus/isolation & purification , Hepatitis C, Chronic/drug therapy , Oligopeptides/adverse effects , Serine Proteinase Inhibitors/adverse effects , Adult , Aged , Disease Progression , Drug Eruptions/epidemiology , Drug Therapy, Combination , Female , Genotype , Hepacivirus/genetics , Hepatitis C, Chronic/virology , Humans , Interferons/therapeutic use , Male , Middle Aged , Oligopeptides/therapeutic use , Prospective Studies , Ribavirin/therapeutic use , Serine Proteinase Inhibitors/therapeutic use , Severity of Illness IndexABSTRACT
Antimalarial drugs have been in common use in dermatology since the 1950s. Their mechanism of action is complex, and it is now known that they act through various pathways. We review the indications for antimalarials in dermatology, their adverse effects, and some less well-known effects, such as their antithrombotic and hypolipidemic action. The most recent recommendations concerning ophthalmological screening in patients on antimalarials are also reviewed.
Subject(s)
Antimalarials/pharmacology , Antimalarials/therapeutic use , Skin Diseases/drug therapy , Antimalarials/adverse effects , HumansSubject(s)
Anti-Allergic Agents/administration & dosage , Chronic Disease/drug therapy , Omalizumab/administration & dosage , Urticaria/drug therapy , Adult , Age Factors , Dose-Response Relationship, Drug , Drug Resistance , Female , Humans , Middle Aged , Retrospective Studies , Treatment Outcome , Urticaria/pathologyABSTRACT
Morphea or localized scleroderma is a distinctive inflammatory disease that leads to sclerosis of the skin and subcutaneous tissues. It comprises a number of subtypes differentiated according to their clinical presentation and the structure of the skin and underlying tissues involved in the fibrotic process. However, classification is difficult because the boundaries between the different types of morphea are blurred and different entities frequently overlap. The main subtypes are plaque morphea, linear scleroderma, generalized morphea, and pansclerotic morphea. With certain exceptions, the disorder does not have serious systemic repercussions, but it can cause considerable morbidity. In the case of lesions affecting the head, neurological and ocular complications may occur. There is no really effective and universal treatment so it is important to make a correct assessment of the extent and severity of the disease before deciding on a treatment approach.
Subject(s)
Scleroderma, Localized/classification , Scleroderma, Localized/drug therapy , Algorithms , Aminoquinolines/therapeutic use , Clinical Trials as Topic , Eosinophilia/classification , Fasciitis/classification , Glucocorticoids/therapeutic use , Humans , Imiquimod , Immunosuppressive Agents/therapeutic use , Methotrexate/therapeutic use , Photochemotherapy , Physical Therapy Modalities , Recurrence , Scleroderma, Localized/pathology , Severity of Illness IndexSubject(s)
Chorioretinitis/etiology , Oral Ulcer/etiology , Syphilis/complications , Biopsy , Diagnostic Errors , Herpes Genitalis/diagnosis , Humans , Immunocompetence , Male , Middle Aged , Ophthalmoscopy , Oral Ulcer/microbiology , Oral Ulcer/pathology , Palate/microbiology , Palate/pathology , Palatine Tonsil/microbiology , Palatine Tonsil/pathology , Retinal Pigment Epithelium/pathology , Syphilis/diagnosis , Syphilis Serodiagnosis , Treponema pallidum/isolation & purificationABSTRACT
BACKGROUND AND OBJECTIVE: Pivotal trials with omalizumab for treatment of chronic spontaneous urticaria (CSU) are generally run over 12 to 24weeks. However, in clinical practice, many patients need longer treatment. In this article, we present an algorithm for treatment with omalizumab. MATERIAL AND METHODS: The consensus document we present is the result of a series of meetings by the CSU working group of "Xarxa d'Urticària Catalana i Balear" (XUrCB) at which data from the recent literature were presented, discussed, compared, and agreed upon. RESULTS: Treatment with omalizumab should be initiated at the authorized dose, and is adjusted at 3-monthly intervals according to the Urticaria Activity Score Over 7days, the Urticaria Control Test, or both. CONCLUSIONS: The algorithm proposed is designed to provide guidance on how to adjust omalizumab doses, how and when to discontinue the drug, and how to reintroduce it in cases of relapse.
Subject(s)
Algorithms , Anti-Allergic Agents/therapeutic use , Omalizumab/therapeutic use , Urticaria/drug therapy , Anti-Allergic Agents/administration & dosage , Chronic Disease , Humans , Omalizumab/administration & dosageSubject(s)
Humans , Male , Child , Noonan Syndrome , LEOPARD Syndrome , Hypertelorism , Pulmonary Valve Stenosis , Hearing Loss, SensorineuralSubject(s)
Humans , Male , Child , Noonan Syndrome , LEOPARD Syndrome , Hypertelorism , Pulmonary Valve Stenosis , Hearing Loss, SensorineuralABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Hypereosinophilic Syndrome/diagnosis , Hypereosinophilic Syndrome/drug therapy , Brain Ischemia/diagnostic imaging , Biopsy , Hypereosinophilic Syndrome/pathology , Cytokines/analysis , Brain Ischemia/pathologyABSTRACT
Antecedentes y objetivo: Los ensayos pivotales de omalizumab en urticaria crónica espontánea (UCE) tienen un periodo de tratamiento de entre 12 y 24 semanas. Sin embargo, muchos pacientes en práctica clínica requieren periodos de tratamiento más prolongados. Por ello el objetivo es presentar un algoritmo de manejo del fármaco. Materiales y métodos: El documento de consenso que detallamos nace de la puesta en común, aceptación, revisión y confrontación de la literatura reciente del grupo de trabajo de UCE "Xarxa d'Urticària Catalana i Balear" (XUrCB). Resultados: Se inicia el tratamiento a dosis autorizada y se ajusta la dosis en intervalos trimestrales en función del Urticaria Activity Score de los últimos 7 días (UAS7) y/o el Urticarial Control Test (UCT). Conclusiones: El algoritmo propuesto pretende servir de guía respecto a cómo ajustar dosis, cómo y cuándo parar el fármaco y el modo de reintroducirlo en casos de recaída
Background and objective: Pivotal trials with omalizumab for treatment of chronic spontaneous urticaria (CSU) are generally run over 12 to 24weeks. However, in clinical practice, many patients need longer treatment. In this article, we present an algorithm for treatment with omalizumab. Material and methods: The consensus document we present is the result of a series of meetings by the CSU working group of "Xarxa d'Urticària Catalana i Balear" (XUrCB) at which data from the recent literature were presented, discussed, compared, and agreed upon. Results: Treatment with omalizumab should be initiated at the authorized dose, and is adjusted at 3-monthly intervals according to the Urticaria Activity Score Over 7 days, the Urticaria Control Test, or both. Conclusions: The algorithm proposed is designed to provide guidance on how to adjust omalizumab doses, how and when to discontinue the drug, and how to reintroduce it in cases of relapse
Subject(s)
Humans , Urticaria/drug therapy , Omalizumab/administration & dosage , Algorithms , Consensus , Dosage/methods , Histamine H1 Antagonists/administration & dosage , Dose-Response Relationship, DrugABSTRACT
No disponible
Subject(s)
Humans , Autoimmune Diseases/complications , Skin Diseases/immunology , Connective Tissue Diseases/immunology , Systemic Vasculitis/immunology , Specialization/trends , Hereditary Autoinflammatory Diseases/immunologyABSTRACT
La neurofibromatosis tipo 2 es una enfermedad hereditaria, autosómica dominante, con penetrancia completa, que ocasiona la aparición de múltiples tumores en el sistema nervioso central y periférico, afectación ocular y lesiones cutáneas de distinta índole. La clínica de la neurofibromatosis tipo 2 es, en general, poco conocida, tanto por los dermatólogos como por el resto de los especialistas, lo que deriva, en algunos casos, en un retraso en el diagnóstico que favorece un aumento de la morbilidad y la mortalidad. En este artículo se expondrán las manifestaciones clínicas menos conocidas, haciendo especial hincapié en las lesiones dermatológicas propias de la enfermedad, las cuales en caso de presentarse y ser identificadas, pueden facilitar el diagnóstico de la misma (AU)
Neurofibromatosis type 2 is an autosomal dominant hereditary disease with complete penetrance. It gives rise to multiple central and peripheral nervous system tumors, ocular alterations, and various types of skin lesion. In general, neither dermatologists nor other specialists have in-depth knowledge of the clinical manifestations of neurofibromatosis type 2. In some cases, this can lead to delayed diagnosis, which can increase morbidity and mortality. We describe the less well known clinical manifestations of NF2, focusing particularly on skin lesions specific to this disease. Identification of these lesions, when present, can facilitate diagnosis (AU)