Impact of Single Nucleotide Polymorphisms of the Promoter of the TNF Gene on Adalimumab Treatment Responses in Hidradenitis Suppurativa.

BACKGROUND: Results of randomized clinical trials show great variation in response to treatment with adalimumab (ADA) in hidradenitis suppurativa (HS). This varied response may be associated with genetic polymorphisms. OBJECTIVES: The aim of the study was to study the association between carriage of single nucleotide polymorphisms (SNPs) in the promoter of the tumor necrosis factor (TNF) gene and their response to ADA. METHODS: Patients with moderate to severe HS who received ADA treatment for at least 12 weeks were enrolled. SNPs were analyzed with PCR-restriction fragment length polymorphism. Hidradenitis Suppurativa Clinical Response (HiSCR) score, International Hidradenitis Suppurativa Severity Scoring System 4 (IHS4) score, inflammatory lesion (AN) count, and draining tunnel (dT) count were collected at weeks 0, 12, 24, 36, and 48. RESULTS: HiSCR response after 12 weeks of ADA treatment was 71.8% among carriers of the common GGG haplotype and 50.0% among carriers of minor frequency SNP haplotypes (p: 0.031; odds ratio: 0.39). This significant difference persisted until week 36. Carriers of minor frequency SNP haplotypes also had a lower relative decrease of the AN count at weeks 12 and 24; the dT count and IHS4 were not statistically different between the two groups. CONCLUSIONS: Carriage of at least one minor frequency SNP haplotype of the promoter of the TNF gene is associated with a decreased response to ADA. This association may have an impact on treatment decision-making.

The Association Between Oral Health and Skin Disease.

OBJECTIVE: Oral health and mucocutaneous inflammation might play an important role in the etiopathogenesis of many skin diseases, especially those that also involve the oral mucosa. This review examines the relationship between skin conditions and various oral health metrics to better understand how oral diseases, especially periodontitis, might influence the development or prognosis of several conditions, including aphthous stomatitis, atopic dermatitis, lichen planus, pemphigus, pemphigoid, and psoriasis. METHODS: Using the PubMed search engine between Summer 2017 and Summer 2018, searches were performed for: oral health OR oral hygiene AND psoriasis, eczema, dermatitis, hidradenitis suppurativa, acne inversa, pyoderma gangrenosum, Sweet's syndrome, neutrophilic dermatosis, subcorneal pustular dermatosis, hives, urticaria, cutaneous lupus, pemphigoid, pemphigus, or lichen planus OR aphthous stomatitis. The abstract of articles written in English were reviewed by the investigators and selected for inclusion if the study involved a correlation between oral health/hygiene and skin disease. After studies were included, the references were reviewed for additional relevant studies. Diseases listed in the search terms that were not ultimately discussed in this review did not produce any articles of relevance. RESULTS: Aphthous stomatitis is correlated with poor periodontal health and greater plaque accumulation. Atopic dermatitis shows an association with gingivitis, toothaches, and oral infections. Heavier enamel plaque burden and reduced oral care are implicated in the exacerbation of lichen planus. Mucous membrane pemphigoid and pemphigus are intimately influenced by oral health, underscoring the important role of good oral health and hygiene. Psoriasis presents a strong connection with oral streptococcal bacterial burden, has been shown to be improved or even cured with tonsillectomy, and has treatment outcomes that are generally associated with periodontal disease. CONCLUSION: Comorbid disease associations are frequently being reported in dermatology, spurring collaboration between multiple specialists and dermatologists. This review emphasizes a need for closer collaboration between dermatologists and dentists to treat several common skin diseases.

The frequency of low-risk morbilliform drug eruptions observed in patients treated with different classes of antibiotics.

Antibiotics are among the most commonly prescribed medications worldwide but can lead to numerous cutaneous adverse events. Cutaneous adverse drug reactions can range from a common and low-risk morbilliform eruption to severe cutaneous adverse reactions (SCARs) such as toxic epidermal necrolysis. In the hospital setting, patients often start a myriad of new drugs and may be on multiple antibiotics when the dermatologist is consulted. With the current lack of commercially available testing for delayed-type hypersensitivity reactions, etiologic confirmation is challenging. While the Naranjo and other standardized assessment criteria are available, complete scoring is often impossible in hospitalized patients. Further, multiple drugs may have been initiated at the same time point. Therefore, the prevalence of antibiotic-associated drug eruptions often is required to facilitate causality assessments. This review summarizes the prevalence of morbilliform eruptions for the most frequently prescribed antibiotics based upon systematic reviews, retrospective, and prospective analyses, with case series and reports providing other salient details.

Nodular Demodicosis in a Pregnant Woman Treated with Oral Ivermectin and Metronidazole.

A 32-year-old woman presented at 12 weeks' gestation with a severe nodulopustular reaction involving the central region of the forehead and the right cheek (Figures 1 and 2). This had progressively worsened over a several-week period despite use of topical metronidazole. A Demodex preparation revealed numerous Demodex mites from each pustule that was sampled. Based on the clinical findings and the positive Demodex preparations, the woman was diagnosed with nodular demodicosis.

The impacts of oral health symptoms, hygiene, and diet on the development and severity of psoriasis.

Numerous studies have suggested a correlation between oral health, the oral microbiome, and various dermatologic conditions, particularly psoriasis. In this study, we utilize a specially designed questionnaire administered to 265 patients at The Ohio State University's dermatology clinics to explore the relationship between psoriasis and a combination of factors that included dietary habits, oral health, and oral hygiene practices. Age, family history of psoriasis, previous diagnosis of strep throat or rheumatoid arthritis, and oral pain or discomfort experienced within the last 12 months were all found to be significant predictors of psoriasis. Additionally, higher body mass index scores, poor gum health, and speech difficulties related to dental problems were all correlated with more severe psoriasis symptoms. Conversely, patients who reported consuming fresh fruit at least once a day experienced milder symptoms. Our goal is to develop a better understanding of how and why psoriasis incidence is correlated with some of the oral health factors under review.