Successful treatment of ulcerated pyoderma gangrenosum with baricitinib, a novel JAK inhibitor.

Pyoderma gangrenosum manifests as an ulceration of the skin often associated with several systemic diseases. The diagnosis is usually made by exclusion criteria with suggestions made by clinical findings and histological features. It can occur any site but more common in the legs. Advances in translational medicine led to the development of new forms of therapy in chronic inflammatory diseases by the oral administration of Janus kinase inhibitors. We report two cases of chronic ulceration of the skin consistent with the diagnosis of Pyoderma Gangrenosum that went into complete remission after the use of baricitinib.

Unveiling atopic dermatitis burden in Brazil: a report from clinical assistance perspective / Revelando a dermatite atópica no Brasil: um relato da perspectiva da assistência clínica

Objective: Atopic dermatitis (AD) or atopic eczema is a chronic skin inflammatory disease that involves the interaction between immune, genetic and environmental triggers. AD affects 15%-20% of infants and 1%-4% of adults worldwide although prevalence varies per country. The main objective is to raise the awareness of AD impact on patients' quality of life (QoL) in Brazil. Methods: Interviews were carried out with key Therapeutic Area Experts (TAEs) throughout the country to gain information about disease management, treatment efficacy and patient's QoL. For disease cost estimation, private health costs from public sources was used. Results: AD prevalence in adults was estimated at 7% in Brazil, of which 35% was moderate and 30% severe AD. Overall, 41% of patients have undergone 5 or more different treatments. However, 17% and 29% of patients with moderate and severe AD, respectively, fail to control their disease. Emollients and topical steroids are the main first-line (1L) treatments for all AD patients, although in the case of moderate and severe AD, a rapid 2-week treatment transition from 1L to 2L has been reported. In terms of economic burden, for severe and moderate AD patients, direct medical costs (medical appointments, treatments, hospitalizations and others) are between 94% and 93%. Regarding indirect costs, absenteeism was estimated to be responsible for 6% and 7% of total cost in moderate and severe AD patients, respectively. Conclusion: There is a need for AD treatments that can be used in the long term without severe side effects and with a positive impact on QoL.

Objetivo: A dermatite atópica (DA) ou eczema atópico é uma doença inflamatória que envolve a interação entre fatores imunológicos, genéticos e ambientais. A DA afeta 15% a 20% das crianças e 1% a 4% dos adultos. O objetivo é conscientizar sobre o impacto da DA na qualidade de vida (QdV) dos pacientes no Brasil. Métodos: Entrevistas foram conduzidas com Especialistas dessa Área Terapêutica (EATs) em todo o país para obter informações sobre o manejo da doença, eficácia do tratamento e QdV dos pacientes. Para estimativa dos custos da doença, utilizamos custos da saúde privada de fontes públicas. Resultados: A prevalência de DA em adultos foi estimada em 7% no Brasil, dos quais 35% possuem DA moderada e 30%, severa. No geral, 41% dos pacientes foram submetidos a cinco ou mais tratamentos diferentes. No entanto, 17% e 29% dos pacientes com DA moderada/grave, respectivamente, não conseguem controlar sua doença. Emolientes e esteroides tópicos são os principais tratamentos de primeira linha (1L) para todos os pacientes. No caso de DA moderada/grave, a transição rápida do tratamento de 1L para 2L em duas semanas é relatada. Em termos de carga econômica, para pacientes com DA grave e moderada, entre 94% e 93% são custos médicos diretos (consultas médicas, tratamentos, hospitalizações e outros). Considerando custos indiretos, o absenteísmo é responsável por 6% e 7% do custo total em pacientes com DA moderada e grave, respectivamente. Conclusão: Em conclusão, há necessidade de tratamentos de DA que possam ser usados a longo prazo sem efeitos colaterais graves e com impacto positivo na qualidade de vida.

An excellent response to tofacitinib in a Brazilian adolescent patient with alopecia areata: A case report and a review of the literature.

Alopecia areata is a common autoimmune disease, with a negative impact in health-related quality of life, especially when affecting children and adolescents. Current medical therapies, mainly for severe disease, are not effective. There are no FDA (Food and Drug Administration)- or ANVISA (Agência Nacional de Vigilância Sanitária)-approved therapy for children with alopecia areata. JAK inhibitors are emerging as a promising therapy.

Brazilian Experience of the Treatment of Alopecia Universalis with the Novel Antirheumatic Therapy Tofacitinib: A Case Series.

INTRODUCTION: Alopecia universalis is an autoimmune disorder for which there is no known effective therapy. Tofacitinib-a novel antirheumatic therapy for rheumatoid arthritis-has been shown in some reports to induce sustained hair growth in patients with alopecia universalis. CASE SERIES: Here, we review the experiences of four different rheumatologists across the country regarding four Brazilian patients with alopecia universalis who were treated with tofacitinib . Two of these four patients had idiopathic alopecia and the other two had rheumatoid arthritis; in each case, the alopecia universalis was apparently induced by etanercept. CONCLUSION: Tofacitinib should be considered for the treatment of severe alopecia areata, but the optimal dose and duration of therapy should be defined in randomized controlled trials.

Recovery of nail dystrophy potential new therapeutic indication of tofacitinib.

Nail dystrophy is a heterogeneous skin condition and in some subtypes, is associated with autoimmune diseases in particular psoriasis and psoriatic arthritis. In this report, we show that tofacitinib, a novel therapy for rheumatoid arthritis, appears to be beneficial in patients with nail disease refractory to other conventional modes of therapy.

Remarkable Improvement of Nail Changes in Alopecia Areata Universalis with 10 Months of Treatment with Tofacitinib: A Case Report.

Alopecia areata (AA) is a chronic, autoimmune disease. The main symptom is massive hair loss, localized or diffuse, in the scalp and the whole body. However, nails may also be involved, and brittleness, fragility and pitting can be signs of nail dystrophy in AA patients. Here, we report the case of a male patient with AA refractory to various treatments, including oral, topical and intralesional corticosteroids, immunosuppressants, cyclosporin and PUVA (oxoralen plus ultraviolet light), all interrupted due to side effects. The patient's nails had erythematous blotches (striated lunulae) with regular and superficial pitting as well as fragility (trachyonychia), and he could no longer play the guitar because of these symptoms. With patient consent, we introduced tofacitinib (5 mg twice daily), which resulted in remarkable improvements not only regarding hair regrowth but also nail changes, with function recovery within 10 months.