RESUMO
Phototherapy, classic systemic treatments (methotrexate, acitretin, and ciclosporin), and biologic agents (etanercept, infliximab, adalimumab, and ustekinumab) constitute a broad therapeutic arsenal that increases the likelihood of achieving control of severe and extensive disease in patients with psoriasis. Acitretin continues to be a very valuable tool in both monotherapy, in which it is combined with other systemic treatments (classic or biologic), and in sequential therapy. Thanks to its lack of a direct immunosuppressive effect and its ability to achieve a long-term response, acitretin has an important role in the treatment of psoriasis, although this has not always been acknowledged in relevant treatment guidelines. We present consensus guidelines for the use of acitretin in psoriasis drawn up by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. These guidelines provide a detailed account of acitretin, including pharmacological properties, indications and contraindications, adverse effects, and factors that should be taken into account to enhance the safe use of this drug. They also propose treatment strategies for use in routine clinical practice. The overall aim of these guidelines is to define the criteria for the use and management of acetretin in psoriasis.
Assuntos
Acitretina/uso terapêutico , Imunossupressores/uso terapêutico , Psoríase/tratamento farmacológico , Anormalidades Induzidas por Medicamentos/etiologia , Acitretina/administração & dosagem , Acitretina/efeitos adversos , Acitretina/farmacocinética , Biotransformação , Doenças Cardiovasculares/complicações , Comorbidade , Contraindicações , Esquema de Medicação , Interações Medicamentosas , Feminino , Regulação da Expressão Gênica/efeitos dos fármacos , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Imunossupressores/farmacocinética , Queratinócitos/efeitos dos fármacos , Queratinócitos/patologia , Síndrome Metabólica/complicações , Gravidez , Complicações na Gravidez , Psoríase/complicações , Psoríase/genética , Receptores do Ácido Retinoico/agonistas , Medição de Risco , Tetraciclinas/farmacocinéticaRESUMO
Psoriasis, a chronic multifactorial inflammatory disease that develops in genetically predisposed individuals, affects approximately 1.5% of the Spanish population. This disease has a negative impact on patients' quality of life, and long-term therapy is often required to control the symptoms. In addition to the classical systemic treatments (methotrexate, acitretin, cyclosporine, and ultraviolet light), the group of drugs known as biologics (etanercept, infliximab, adalimumab, and ustekinumab) provides the dermatologist with an expanded therapeutic armamentarium, thereby improving the likelihood of controlling psoriasis in patients with severe and/or extensive disease. Methotrexate, a classic antipsoriatic drug, is still very useful either as single-drug therapy or in combination with other systemic drugs, particularly as a rescue therapy or combined with biologics. This article aims to establish the role of methotrexate in the treatment of psoriasis. We considered it of interest to develop guidelines for using methotrexate in the management of psoriasis with a view to ensuring the safe and proper use of this drug in the management of psoriasis. This document was developed by consensus among members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology.
Assuntos
Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Psoríase/tratamento farmacológico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Humanos , Imunossupressores/efeitos adversos , Metotrexato/efeitos adversos , RegistrosRESUMO
Psoriasis, a chronic multifactorial inflammatory disease that develops in genetically predisposed individuals, affects approximately 1.5% of the Spanish population. This disease has a negative impact on patients' quality of life, and long-term therapy is often required to control the symptoms. In addition to the classical systemic treatments (methotrexate, acitretin, cyclosporine, and ultraviolet light), the group of drugs known as biologics (etanercept, infliximab, adalimumab, and ustekinumab) provides the dermatologist with an expanded therapeutic armamentarium, thereby improving the likelihood of controlling psoriasis in patients with severe and/or extensive disease. Methotrexate, a classic antipsoriatic drug, is still very useful either as single-drug therapy or in combination with other systemic drugs, particularly as a rescue therapy or combined with biologics. This article aims to establish the role of methotrexate in the treatment of psoriasis. We considered it of interest to develop guidelines for using methotrexate in the management of psoriasis with a view to ensuring the safe and proper use of this drug in the management of psoriasis. This document was developed by consensus among members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology.
RESUMO
Granulomatous sarcoidosis-like reactions affecting multiple organ systems at one time have infrequently been described within weeks to months after initiation of Ipilimumab. We present the first case of a 67-year-old man with isolated cutaneous granulomatous reaction involving the trunk, extremities, and face after eighteen months of treatment with ipilimumab for metastatic melanoma. This case documents the eruption of isolated cutaneous granulomatous reaction as a late treatment-related adverse effect of ipilimumab, highlighting the importance of adequate, prolonged follow-up.
Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Toxidermias/etiologia , Granuloma/induzido quimicamente , Ipilimumab/efeitos adversos , Melanoma/tratamento farmacológico , Dermatopatias/induzido quimicamente , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Antineoplásicos Imunológicos/uso terapêutico , Toxidermias/patologia , Granuloma/patologia , Humanos , Ipilimumab/uso terapêutico , Masculino , Melanoma/secundário , Dermatopatias/patologia , Neoplasias Cutâneas/patologiaAssuntos
Anticorpos Monoclonais/efeitos adversos , Toxidermias/etiologia , Hidradenite Supurativa/tratamento farmacológico , Psoríase/induzido quimicamente , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Anticorpos Monoclonais/uso terapêutico , Feminino , Humanos , Infliximab , Pessoa de Meia-IdadeAssuntos
Dermoscopia , Histiocitoma Fibroso Benigno/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adenocarcinoma Mucinoso , Idoso , Biópsia , Neoplasias do Endométrio , Feminino , Células Gigantes/patologia , Histiocitoma Fibroso Benigno/classificação , Histiocitoma Fibroso Benigno/patologia , Humanos , Neoplasias Primárias Múltiplas/patologia , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/patologia , Neoplasias Cutâneas/patologiaAssuntos
Antineoplásicos/efeitos adversos , Ácidos Borônicos/efeitos adversos , Toxidermias/etiologia , Antígeno Ki-1/imunologia , Mieloma Múltiplo/tratamento farmacológico , Pirazinas/efeitos adversos , Subpopulações de Linfócitos T/imunologia , Idoso , Bortezomib , Toxidermias/patologia , Humanos , Masculino , Mieloma Múltiplo/imunologiaRESUMO
INTRODUCTION: Although metastatic melanoma has a poor prognosis, cutaneous metastases represent a special case given their ready accessibility, making it possible for dermatologists to apply local treatment. We report our experience with intralesional treatment with interleukin (IL) 2 in 7 patients with cutaneous metastases from malignant melanoma. MATERIAL AND METHODS: A total of 244 lesions in 7 patients with satellitosis and/or cutaneous metastases from malignant melanoma were treated with intralesional IL-2 twice a week. The maximum dose in each patient ranged from 3 to 18 million units per session, according to the number and size of lesions. RESULTS: Complete or partial remission was achieved in almost all lesions (95.9 % and 3.7 %, respectively).Only 1 lesion (0.4 %) -the largest and located subcutaneously- did not respond to intralesional treatment and required alcoholization and subsequent surgical removal to achieve cure. All partial responses occurred in subcutaneous lesions larger than 2 cm. Treatment was well tolerated with only a few mild side effects (grade 1-2). CONCLUSIONS: IL-2 may be an effective and well-tolerated treatment option in patients with satellitosis and cutaneous metastases from melanoma. Lesions smaller than 2 cm and located in the epidermis or superficial dermis respond better than those larger than 2 cm or located in the subcutaneous cellular tissue. More studies are necessary to establish appropriate doses and regimens.
Assuntos
Antineoplásicos/administração & dosagem , Interleucina-2/administração & dosagem , Melanoma/tratamento farmacológico , Melanoma/secundário , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/secundário , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Injeções Intralesionais , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologiaRESUMO
Las reacciones granulomatosas "sarcoidosis-like" secundarias a ipilimumab afectarán simultáneamente a múltiples órganos y característicamente se presentarán semanas o meses después de haber iniciado el tratamiento. Paciente varón de 67 años, quien consulta por reacción cutánea granulomatosa a nivel de tronco, extremidades y rostro. Esta se presentó 18 meses después de haber iniciado tratamiento con ipilimumab, medicamento pautado por el diagnóstico de un melanoma metastásico. Reportamos reacción granulomatosa de presentación exclusivamente cutánea, como efecto adverso medicamentoso tardío secundario al tratamiento con ipilimumab. Así mismo resaltamos la necesidad de realizar en los pacientes tratados con ipilimumab un seguimiento prolongado
Granulomatous sarcoidosis-like reactions affecting multiple organ systems at one time have infrequently been described within weeks to months after initiation of Ipilimumab. We present the first case of a 67-year-old man with isolated cutaneous granulomatous reaction involving the trunk, extremities, and face after eighteen months of treatment with ipilimumab for metastatic melanoma. This case documents the eruption of isolated cutaneous granulomatous reaction as a late treatment-related adverse effect of ipilimumab, highlighting the importance of adequate, prolonged follow-up
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Melanoma/complicações , Melanoma/diagnóstico , Imunoterapia/métodos , Metástase Neoplásica/diagnóstico , Anticorpos Monoclonais/administração & dosagem , Sarcoidose/diagnóstico , Granuloma/diagnóstico , Antígeno CTLA-4/administração & dosagem , Prurido/diagnóstico , Radiografia Torácica , Granuloma/patologia , Corticosteroides/administração & dosagemRESUMO
INTRODUCTION: In the last times there has been an increased incidence of syphilis especially among homosexual men. In our department we have diagnosed 11 cases of early syphilis in 6 months during 2006, thus confirming an epidemic outbreak. MATERIAL AND METHODS: We carried out an epidemiological survey of patients with early syphilis. RESULTS: Syphilis was secondary in five cases and primary in six. All patients were men, 70 % homosexual with a mean age of 38.1 years. All patients had or have had other sexually transmitted diseases (STD), six were HIV positive. Ninety percent of the patients admitted having had promiscuous sexual contacts in the past year, and among these, 50 % never used protection, no protection was taken in cases of oral sex and only 25 % reported protection during anal sex. CONCLUSIONS: Currently, there is excessive slackening of protection practices as a method of STD prophylaxis, which leads to an increased number of cases. We consider relevant to insist in the use of barrier methods during oral sex as it is an important source of infection.
Assuntos
Surtos de Doenças , Sífilis/epidemiologia , Adulto , Ilhas Atlânticas/epidemiologia , Comorbidade , Preservativos/estatística & dados numéricos , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Sexualidade/estatística & dados numéricos , Infecções Sexualmente Transmissíveis/epidemiologia , Sífilis/transmissão , Sexo sem Proteção/estatística & dados numéricosAssuntos
Dermoscopia , Folículo Piloso/patologia , Púrpura/etiologia , Escorbuto/diagnóstico , Pigmentação da Pele , Idoso , Alcoolismo/complicações , Ácido Ascórbico/uso terapêutico , Eritrócitos , Fibrose , Frutas , Humanos , Ceratose/etiologia , Ceratose/patologia , Masculino , Desnutrição/complicações , Desnutrição/dietoterapia , Boca Edêntula/complicações , Púrpura/patologia , Indução de Remissão , Escorbuto/complicações , Escorbuto/dietoterapia , Escorbuto/tratamento farmacológico , Escorbuto/patologia , VerdurasRESUMO
La fototerapia y los tratamientos sistémicos clásicos (metotrexato, acitetrina, ciclosporina), junto con las denominadas terapias biológicas (etanercept, infliximab, adalimumab, ustekinumab), permiten al dermatólogo disponer de un arsenal terapéutico amplio que aumenta las posibilidades de control de pacientes con psoriasis grave y/o extensa. La acitretina sigue siendo de gran utilidad tanto en monoterapia como combinada con otros fármacos sistémicos (clásicos o «biológicos»), o en terapia secuencial. Se distingue por no ser inmunosupresor directo y mantener respuestas a muy largo plazo, lo que le confiere un papel relevante en el tratamiento de la psoriasis, que no siempre ha sido reconocido en las diversas guías terapéuticas de esta enfermedad. Se presenta una guía de uso de acitretina consensuada por los miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología, en la que se exponen de forma detallada aspectos de la farmacología del fármaco, sus indicaciones y contraindicaciones, su eficacia antipsoriásica, los efectos adversos asociados al fármaco, las acciones a tener en cuenta para aumentar la seguridad de su uso, y se propone diversas estrategias terapéuticas de aplicación en la práctica clínica habitual. El objetivo global es facilitar los criterios de indicación y manejo de la acitretina en pacientes con psoriasis (AU)
Phototherapy, classic systemic treatments (methotrexate, acitretin, and ciclosporin), and biologic agents (etanercept, infliximab, adalimumab, and ustekinumab) constitute a broad therapeutic arsenal that increases the likelihood of achieving control of severe and extensive disease in patients with psoriasis. Acitretin continues to be a very valuable tool in both monotherapy, in which it is combined with other systemic treatments (classic or biologic), and in sequential therapy. Thanks to its lack of a direct immunosuppressive effect and its ability to achieve a long-term response, acitretin has an important role in the treatment of psoriasis, although this has not always been acknowledged in relevant treatment guidelines. We present consensus guidelines for the use of acitretin in psoriasis drawn up by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. These guidelines provide a detailed account of acitretin, including pharmacological properties, indications and contraindications, adverse effects, and factors that should be taken into account to enhance the safe use of this drug. They also propose treatment strategies for use in routine clinical practice. The overall aim of these guidelines is to define the criteria for the use and management of acetretin in psoriasis (AU)
Assuntos
Humanos , Acitretina/uso terapêutico , Psoríase/tratamento farmacológico , Fototerapia , Terapia Biológica , Padrões de Prática MédicaRESUMO
No disponible
Assuntos
Humanos , Psoríase/diagnóstico , Hidradenite/complicações , Psoríase/etiologia , Hidradenite/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico , Anti-Inflamatórios/uso terapêuticoRESUMO
La psoriasis es una enfermedad inflamatoria crónica, de predisposición genética y origen multifactorial, que afecta aproximadamente al 1,5% de la población española, repercutiendo negativamente de forma importante en la calidad de vida de los pacientes, los cuales requieren frecuentemente tratamientos de larga duración, para controlar sus síntomas. Los tratamientos sistémicos clásicos (metotrexato, acitetrino, ciclosporina, luz ultravioleta), junto con las denominadas terapias biológicas (etanercept, infliximab, adalimumab, ustekinumab) permiten al dermatólogo disponer de un arsenal terapéutico más amplio y disponer, por lo tanto, de mayores posibilidades de control de pacientes con psoriasis severa y/o extensa. El metotrexato, un fármaco clásico en la terapia antipsoriásica, sigue siendo de gran utilidad tanto en monoterapia como asociado a otros fármacos sistémicos, en especial como rescate o combinación con los biológicos. El objetivo de este artículo es establecer el papel del metotrexato en el tratamiento de la psoriasis. Por ello hemos creído de interés elaborar una guía de uso de metotrexato en psoriasis, consensuada entre varios componentes del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología, que facilite la utilización segura y precisa de este fármaco en el manejo de pacientes con psoriasis (AU)
Psoriasis, a chronic multifactorial inflammatory disease that develops in genetically predisposed individuals, affects approximately 1.5% of the Spanish population. This disease has a negative impact on patients quality of life, and long-term therapy is often required to control the symptoms. In addition to the classical systemic treatments (methotrexate, acitretin, cyclosporine, and ultraviolet light), the group of drugs known as biologics (etanercept, infliximab, adalimumab, and ustekinumab) provides the dermatologist with an expanded therapeutic armamentarium, thereby improving the likelihood of controlling psoriasis in patients with severe and/or extensive disease. Methotrexate, a classic antipsoriatic drug, is still very useful either as single-drug therapy or in combination with other systemic drugs, particularly as a rescue therapy or combined with biologics. This article aims to establish the role of methotrexate in the treatment of psoriasis. We considered it of interest to develop guidelines for using methotrexate in the management of psoriasis with a view to ensuring the safe and proper use of this drug in the management of psoriasis. This document was developed by consensus among members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (AU)
Assuntos
Humanos , Metotrexato/farmacocinética , Psoríase/tratamento farmacológico , Leucovorina/uso terapêutico , Programas de Rastreamento/métodos , Doença Hepática Induzida por Substâncias e Drogas/epidemiologia , Ácido Fólico/uso terapêutico , Combinação de MedicamentosRESUMO
Introducción. A pesar del mal pronóstico del melanoma metastásico, las metástasis cutáneas constituyen un grupo especial por su fácil accesibilidad que lo hace susceptible al abordaje local por parte del dermatólogo. Describimos nuestra experiencia de tratamiento intralesional con interleucina 2 (IL-2) en 7 pacientes con metástasis cutáneas de melanoma maligno. Material y métodos. Un total de 244 lesiones en 7 pacientes con satelitosis y/o metástasis cutáneas de melanoma maligno han sido tratadas con IL-2 intralesional administrada dos veces a la semana. Las dosis máximas por pacientes variaron entre los 3 y 18 millones de unidades/sesión, en función del número y tamaño de las lesiones. Resultados. Se han obtenido remisiones completas (95,9 %) o parciales (3,7 %) en la gran mayoría de lesiones tratadas, una sola lesión (0,4 %), de localización subcutánea y de mayor tamaño, no respondió al tratamiento intralesional y precisó de alcoholización y posterior extirpación quirúrgica para su resolución. Todas las respuestas parciales se observaron en lesiones de localización subcutánea y mayores de 2 cm. El tratamiento fue bien tolerado, con escasos efectos secundarios de intensidad leve (grado 1-2). Conclusiones. La IL-2 puede ser una buena opción para el tratamiento de pacientes con satelitosis y metástasis cutáneas de melanoma con elevada eficacia y escasos efectos secundarios. Las lesiones menores de 2 cm y localizadas en epidermis o dermis superficial responden mejor que las mayores de 2 cm o localizadas en el tejido celular subcutáneo. Son necesarios más estudios para establecer las dosis y pautas de tratamiento adecuadas (AU)
Introduction. Although metastatic melanoma has a poor prognosis, cutaneous metastases represent a special case given their ready accessibility, making it possible for dermatologists to apply local treatment. We report our experience with intralesional treatment with interleukin (IL) 2 in 7 patients with cutaneous metastases from malignant melanoma. Material and methods. A total of 244 lesions in 7 patients with satellitosis and/or cutaneous metastases from malignant melanoma were treated with intralesional IL-2 twice a week. The maximum dose in each patient ranged from 3 to 18 million units per session, according to the number and size of lesions. Results. Complete or partial remission was achieved in almost all lesions (95.9 % and 3.7 %, respectively). Only 1 lesion (0.4 %)the largest and located subcutaneouslydid not respond to intralesional treatment and required alcoholization and subsequent surgical removal to achieve cure. All partial responses occurred in subcutaneous lesions larger than 2 cm. Treatment was well tolerated with only a few mild side effects (grade 1-2).Conclusions. IL-2 may be an effective and well-tolerated treatment option in patients with satellitosis and cutaneous metastases from melanoma. Lesions smaller than 2 cm and located in the epidermis or superficial dermis respond better than those larger than 2 cm or located in the subcutaneous cellular tissue. More studies are necessary to establish appropriate doses and regimens (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Melanoma/secundário , Interleucina-2/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Metástase Neoplásica/patologia , Infusões Intralesionais/métodos , Seleção de Pacientes , Resultado do TratamentoRESUMO
Introducción. En los últimos tiempos se ha detectado un aumento en los casos de sífilis, sobre todo en el colectivo de homosexuales masculinos. En nuestro Servicio hemos detectado 11 casos de sífilis precoz en 6 meses del 2006, constatando la presencia de un brote epidémico. Material y métodos. Pacientes con sífilis temprana a los que se realizó una encuesta epidemiológica. Resultados. Cinco casos eran de sífilis secundaria y 6 casos de primaria. Todos los pacientes eran varones, con un 70 % de homosexuales. La edad media era de 38,1 años. Todos los pacientes tenían o habían tenido otras enfermedades de transmisión sexual (ETS), 6 eran positivos para el virus de la inmunodeficiencia humana (VIH+). El 90 % reconocía haber tenido contactos sexuales promiscuos en el último año, y de ellos el 50 % nunca utilizaba preservativo, no lo usaban en el sexo oral, y sólo el 25 % lo empleaba en el sexo anal. Conclusiones. Existe en el momento actual una relajación excesiva en la protección como método de prevención de ETS, lo que conlleva el incremento de casos. Nos parece importante insistir expresamente en la utilización de métodos de barrera en el sexo oral, dado que es una fuente importante de contagio
Introduction. In the last times there has been an increased incidence of syphilis especially among homosexual men. In our department we have diagnosed 11 cases of early syphilis in 6 months during 2006, thus confirming an epidemic outbreak. Material and methods. We carried out an epidemiological survey of patients with early syphilis. Results. Syphilis was secondary in five cases and primary in six. All patients were men, 70 % homosexual with a mean age of 38.1 years. All patients had or have had other sexually transmitted diseases (STD), six were HIV positive. Ninety percent of the patients admitted having had promiscuous sexual contacts in the past year, and among these, 50 % never used protection, no protection was taken in cases of oral sex and only 25 % reported protection during anal sex. Conclusions. Currently, there is excessive slackening of protection practices as a method of STD prophylaxis, which leads to an increased number of cases. We consider relevant to insist in the use of barrier methods during oral sex as it is an important source of infection