The impact of vitamin D supplementation on serum cathelicidin levels and the clinical course of atopic dermatitis in children.

BACKGROUND: Cathelicidin has been correlated with the pathophysiology of atopic dermatitis (AD). An indirect correlation of vitamin D with the course of the disease has already been reported as it directly affects the levels of cathelicidin. The purpose of the present article is to investigate the impact of vitamin D supplementation on the course of AD. METHODS: We conducted a prospective observational study. The severity of AD was assessed with the clinical tool SCORAD (SCORing Atopic Dermatitis) which is developed by the European Task Force on AD. RESULTS: Fifty children with AD were enrolled and stratified in two groups based on the severity of SCORAD. Children with severe AD (SCORAD Index >40) received higher doses of vitamin D in order to sufficiently reduce the disease (comparable SCORAD Index for children with mild atopic dermatitis). While the baseline SCORAD differed statistically significant level between the two groups of children with AD (P<0.001) this difference disappeared at 20 (P=0.649) days and remained statistically insignificant both at 45 days (P=0.610), and at the end of the administration of treatment (P=0.474). This effect was based on a significant downregulation of the severity of symptoms in the group of children that received 2400 IU of vitamin D. CONCLUSIONS: The findings of our study suggest that vitamin D may be accurately used in current clinical practice for the management of AD. However, the recommended dose should be titrated taking in mind the severity of the disease.

Deep Quality Assessment of a Solar Reflector Based on Synthetic Data: Detecting Surficial Defects from Manufacturing and Use Phase.

Vision technologies are used in both industrial and smart city applications in order to provide advanced value products due to embedded self-monitoring and assessment services. In addition, for the full utilization of the obtained data, deep learning is now suggested for use. To this end, the current work presents the implementation of image recognition techniques alongside the original the quality assessment of a Parabolic Trough Collector (PTC) reflector surface to locate and identify surface irregularities by classifying images as either acceptable or non-acceptable. The method consists of a three-step solution that promotes an affordable implementation in a relatively small time period. More specifically, a 3D Computer Aided Design (CAD) of the PTC was used for the pre-training of neural networks, while an aluminum reflector surface was used to verify algorithm performance. The results are promising, as this method proved applicable in cases where the actual part was manufactured in small batches or under the concept of customized manufacturing. Consequently, the algorithm is capable of being trained with a limited number of data.

Methotrexate: an effective monotherapy for refractory generalized morphea.

INTRODUCTION: Morphea is an inflammatory skin disorder characterized by excessive collagen deposition. Although treatment algorithms for morphea subtypes have been suggested, no consistent recommendations are available. This study attempts to evaluate the clinical efficacy of methotrexate (MTX) as monotherapy in refractory generalized morphea. METHODS: It is a retrospective study, including 20 patients who had already been treated with various topical and systemic therapies with minimal clinical improvement. Patients received orally MTX at a of dosage 15 mg once weekly. Duration of the use, dosage of MTX, and adverse events were recorded. Clinical assessment of skin lesions was performed and documented. RESULTS: The mean disease duration was 27 months before the initiation of MTX treatment. After 12 months of therapy, very good response was achieved in 6 patients (30%), good response in 10 patients (50%), and fair response in 2 patients (10%), while 2 patients (10%) had failed treatment. Patients were followed up for a mean time interval of 21 months. No serious adverse event was recorded. CONCLUSION: MTX has been already proved to be an effective and well-tolerated treatment in pediatric patients with morphea. The majority of the group of adult patients showed very good and good improvement when treated with MTX. Although this is an uncontrolled study, MTX monotherapy was considered a safe and effective treatment for the management of this specific clinical subset of morphea in adults.

An atypical case of pityriasis rosea gigantea after influenza vaccination.

Pityriasis rosea is a common erythematosquamous eruption, typically presenting along the cleavage lines of the skin. A wide spectrum of atypical manifestations may challenge even the most experienced physician. Here we report a rare case of a suberythrodermic pityriasis rosea with gigantic plaques after an influenza vaccination, and we discuss the possible triggers of atypical manifestations of such a common dermatological disease in the setting of an altered immunity.

Budget impact analysis of ustekinumab in the management of moderate to severe psoriasis in Greece.

BACKGROUND: The purpose of this study was to estimate the annual and per-patient budget impact of the treatment of moderate to severe psoriasis in Greece before and after the introduction of ustekinumab. METHODS: A budget impact model was constructed from a national health system perspective to depict the clinical and economic aspects of psoriasis treatment over 5 years. The model included drug acquisition, monitoring, and administration costs for both the induction and maintenance years for patients in a treatment mix with etanercept, adalimumab, infliximab, with or without ustekinumab. It also considered the resource utilization for non-responders. Greek treatment patterns and resource utilization data were derived from 110 interviews with dermatologists conducted in February 2009 and evaluated by an expert panel of 18 key opinion leaders. Officially published sources were used to derive the unit costs. Costs of adverse events and indirect costs were excluded from the analysis. Treatment response was defined as the probability of achieving a PASI 50, PASI 75, or PASI 90 response, based on published clinical trial data. RESULTS: The inclusion of ustekinumab in the biological treatment mix for moderate to severe psoriasis is predicted to lead to total per-patient savings of €443 and €900 in years 1 and 5 of its introduction, respectively. The cost savings were attributed to reduced administration costs, reduced hospitalizations for non-responders, and improved efficacy. These results were mainly driven by the low number of administrations required with ustekinumab over a 5 year treatment period (22 for ustekinumab, compared with 272 for etanercept, 131 for adalimumab, and 36 for infliximab). CONCLUSIONS: The inclusion of ustekinumab in the treatment of moderate to severe psoriasis in Greece is anticipated to have short- and long-term health and economic benefits, both on an annual and per-patient basis.

Treatment of autoimmune urticaria with low-dose cyclosporin A: A one-year follow-up.

Patients with autoimmune urticaria (AIU) and positive autologous serum skin test (ASST) represent a more serious type of chronic urticaria that does not respond to treatment with antihistamines, but responds completely to systemic corticosteroids. Because of the chronic course of the disease, there is a risk of side-effects. Cyclosporin A (CsA) is an alternative treatment for patients with AIU. In order to determine the efficacy of CsA at the lowest possible dose in patients with chronic idiopathic urticaria and positive ASST, 30 patients were included in a 5-month study with a follow-up one year after the end of treatment. All patients had positive ASST before treatment and autoantibodies were present in 73%. Twenty- three patients completed the study and responded to low-dose CsA treatment. Three patients did not respond to a dose of 2.5 mg/kg CsA, and 4 patients dropped-out due to side-effects. After the first month of treatment, an improvement of 31% was noted, reaching 88% after the fifth month of treatment. The mean dose of CsA was 2.16 mg/kg for the first month and 0.55 mg/kg for the fifth month. Three to 6 months after the end of the study, the ASST was repeated and was negative in 78.3% of patients. At the one-year follow-up, 20 patients were symptom-free (87%) and 3 had relapsed (13%). CsA, even in low-doses, can be an effective and short-term treat- ment with minimum side-effects in patients with AIU.

Assessment of cryotherapy for the treatment of verrucous epidermal naevi.

Epidermal naevi are hamartomas that are characterized by hyperplasia of the epidermis and adnexal structures and may be associated with serious disfiguration. Management of epidermal naevi is challenging. We present here our experience with cryosurgery in the treatment of verrucous epidermal naevi. The aim of this study was to determine the efficacy and safety of cryosurgery for the treatment of epidermal naevi. Nine patients with verrucous epidermal naevi and two with extensive unilateral epidermal naevus were treated with cryosurgery. Two cycles of open spray technique were used, 10-15 sec each, depending on the size and extent of the naevus. Ten patients had their naevi treated successfully in 2-5 sessions with two cycles of therapy, and the cosmetic result was excellent with no scarring. One patient showed a relapse within 8 months after the treatment. One patient with phototype IV developed hypochromic scarring, but repigmentation occurred after 6 months. Postoperative healing time was 10-20 days. Cryosurgery is an extremely effective therapeutic modality for the treatment of epidermal naevi. The low cost, the simplicity of the technique and the good cosmetic result makes cryosurgery an excellent therapeutic modality for the treatment of epidermal naevus.

Inosiplex for treatment of alopecia areata: a randomized placebo-controlled study.

Treatment of alopecia areata remains unsatisfactory. We decided to test if systemic therapy with inosiplex (Isoprinosine(R)), an immunomodulator could influence the disease. Thirty-two subjects with recalcitrant alopecia areata, aged 16-48 years (mean 30.3+/-5.1 years), were randomized into two treatment groups of 16 subjects each. They were assigned to receive either oral inosiplex (group 1), or placebo (group 2) on a double-blind basis. Inosiplex dosage was 50 mg/kg/day in five divided doses for 12 weeks. Of the 15 evaluable patients in group 1, 5 (33.3%) had full remission, 8 (53.3%) responded partially and 2 (13.3%) did not respond. Of the 14 evaluable patients in the placebo group, none had full remission, 4 (28.5%) responded partially and 10 (71.4%) did not respond. The therapeutic difference between patients receiving active and placebo therapy was statistically significant (?2=7.82, p<0.01). Compared with placebo, oral inosiplex showed considerable efficacy in alopecia areata with insignificant side-effects. Larger studies are required, however, before inosiplex may be recommended as an efficacious and safe alternative systemic form of therapy for recalcitrant alopecia areata.

Treatment of cutaneous leishmaniasis with cryosurgery.

BACKGROUND: The management of cutaneous leishmaniasis with topical methods, if effective, can spare patients from long and costly inpatient treatments. METHODS: Seventeen patients with cutaneous leishmaniasis were treated with cryosurgery using liquid nitrogen as the cryogen. Two cycles of 10-30 s freezing time were used and repeated at 3-week intervals. RESULTS: All patients responded well to therapy with excellent cosmetic results and no relapse in any case. Side-effects were rare. CONCLUSIONS: Cutaneous leishmaniasis can be successfully treated with a simple protocol of cryosurgery with minor side-effects.

Treatment of Pyoderma gangrenosum with low-dose colchicine.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown origin. Systemic agents occasionally administered provide either incomplete long-term control of the disease or have been associated with serious adverse side effects after chronic administration. We present two patients with PG successfully treated with low-dose colchicine. Antimitotic, anti-inflammatory and immunomodulating properties of colchicine might account for its beneficial effects in PG patients. Colchicine is effective and well tolerated in low doses by most patients. In addition, it is inexpensive and safer for long-term treatment than corticosteroids and other immunosuppressive agents. Colchicine may be proposed either as a single agent or as a corticosteroid-sparing agent for early treatment of PG.

A study on the environmental degradation of pesticides azinphos methyl and parathion methyl.

The effect of environmental parameters (temperature and relative humidity) on the degradation rate of azinphos methyl and parathion methyl was studied. Proprietary emulsifiable concentrates were diluted and added to each of 90 glass Petri dishes for each pesticide and were left overnight to dry. Petri dishes were placed in 18 air-tight containers (9 for each pesticide) in which were created environments with relative humidity (RH) of 60, 82, and 96%. The containers were stored at 0, 20, and 40 degrees C. From the experimental results best fit curves, kinetic equations, rate constants, and half-lives were calculated. Half-lives of azinphos methyl for the RH studied were, from 124 to 267 days at 0 degrees C, from 89 to 231 days at 20 degrees C, and from 25 to 71 days at 40 degrees C. Corresponding half-lives for parathion methyl were from 48 to 57 days at 0 degrees C, from 9.2 to 10.5 days at 20 degrees C and from 1.3 to 1.5 days at 40 degrees C. The results were correlated with relevant results from the decomposition of the same or similar pesticides on apples both, on the trees and during refrigerated storage. These correlations are suggesting that biological factors strongly affected the decomposition rate of azinphos methyl. On the contrary the decomposition of parathion methyl was mainly affected by environmental rather than biological factors.