Infections in Moderate to Severe Psoriasis Patients Treated with Biological Drugs Compared to Classic Systemic Drugs: Findings from the BIOBADADERM Registry.

Information regarding the safety of biological drugs prescribed to psoriasis patients on daily and long-term bases is insufficient. We used data from the BIOBADADERM registry (Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases) to generate crude rates of infection during therapy with systemic drugs, including biological drugs (infliximab, etanercept, adalimumab, and ustekinumab) and nonbiological drugs (acitretin, cyclosporine, and methotrexate). We also calculated unadjusted and adjusted risk ratios (RRs) (with propensity score adjustment) of infection, serious infections, and recurrent infections of systemic therapies compared with methotrexate, using Poisson regression. Our study included records of 2,153 patients (7,867.5 person-years). The adjusted RR of overall infection was significantly increased in the groups treated with adalimumab with methotrexate (adjusted RR = 2.13, 95% confidence interval [CI] = 1.2-3.7), infliximab (adjusted RR = 1.71, 95% CI = 1.1-2.65), cyclosporine (adjusted RR = 1.58, 95% CI = 1.17-2.15), ustekinumab with methotrexate (adjusted RR = 1.56, 95% CI = 1.08-2.25), and etanercept (adjusted RR = 1.34, 95% CI: 1.02-1.76) compared with methotrexate alone. Cyclosporine had a significant risk of serious infection (adjusted RR = 3.12, 95% CI = 1.1-8.8), followed by adalimumab combined with methotrexate (adjusted RR = 3.28, 95% CI = 0.8-13.5). Adalimumab in combination with methotrexate had the highest risk of infection recurrence (adjusted RR = 4.33, 95% CI = 2.27-8.24).

Long-Term Cost-Effectiveness Analysis of Etanercept and Adalimumab for Plaque Psoriasis not Associated with Arthritis.

INTRODUCTION: Pharmacoeconomic studies examining the cost-effectiveness of biological agents to treat moderate-to-severe psoriasis in real-life clinical practice are scarce. The aim of this study was to assess the efficiency, in terms of incremental cost-effectiveness, of etanercept and adalimumab in a real clinical setting. METHODS: Direct and indirect costs were assessed from a Spanish societal perspective in a historical hospital cohort of patients with moderate-to-severe psoriasis attending a tertiary referral hospital over a 1-year period. The data examined included drug-related variables, use of health-care resources, transportation and work productivity losses. Effectiveness was measured as the proportion of patients achieving a reduction of at least 75% with respect to the baseline value for the Psoriasis Area Severity Index (PASI 75) during the first 52 weeks of treatment. RESULTS: No statistically significant differences in effectiveness between etanercept (n = 135) and adalimumab (n = 48) were found (PASI 75 80% vs. 85.7%; RR = 1.07 [0.90, 1.27]; RRA = 5.7 [-8.9, 20.2]; p = 0.943). There were no significant differences in total cost per patient with etanercept as compared to adalimumab (14,843.73 ± 6,178.98  vs. 15,405.91 ± 9,106.50 ; p = 0.768). CONCLUSION: Under conditions of daily clinical practice in our hospital, total health-care costs associated with the treatment of moderate-to-severe psoriasis with etanercept appear to be equivalent to those with adalimumab in the first year of treatment.

Therapeutic Hotline: Topical glycopyrrolate: a successful treatment for craniofacial hyperhidrosis and eccrine hidrocystomas.

Eccrine hidrocystoma is a benign tumor derived from eccrine sudoriparous glands. Most eccrine hidrocystomas are solitary and asymptomatic lesions. Multiple hidrocystomas are unusual and have been associated with Graves' disease, Parkinson's disease, and idiopathic craniofacial hyperhidrosis. This report describes the successful treatment of multiple center facial eccrine hidrocystomas associated with craniofacial hyperhidrosis with 0.5% glycopyrrolate aqueous solution applied locally for 1 week. The present authors obtained a very significant improvement without leaving any trace of clinical examination. Multiple eccrine hidrocystomas are a rare condition and, to date, no effective treatment has been reported. Topical glycopyrrolate is a very good first-line treatment option.

Extensive tinea in a patient with severe combined immunodeficiency.

Severe combined immunodeficiency (SCID) is a heterogeneous group of disorders characterized by a defect of T and B cell immunity with a genetic origin in most cases. Although the X-linked recessive form is most common (60-70%), there are autosomal recessive forms (20%) and spontaneous mutations. While SCID may present with many nosocomial infections, dermatophyte infections are not common. We reported a case of SCID which was associated with a widespread skin infection with Trichophyton mentagrophytes.

LEOPARD syndrome: what are café noir spots?

Lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, and deafness syndrome (multiple lentigines syndrome) is most often characterized by multiple lentigines and cardiac conduction defects. Café noir spot is a term proposed, by analogy to café au lait spots, for the larger and darkly pigmented patches that are frequently observed in patients with this syndrome. Although presumed by some authors to represent lentigines, the histologic features of café noir spots have not been well documented in the literature. Only two previous cases have been reported in which a biopsy of the café noir spots than melanocytic nevi. We describe the histologic characteristics of seven café noir spots in six patients with lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, and deafness syndrome. Three lesions represented melanocytic nevi (one with dysplastic features), and four were compatible with lentigo simplex. These findings help our understanding of the histologic spectrum of pigmented lesions in lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormalities of genitalia, retarded growth, and deafness syndrome.

[Angiosarcoma in chronic lymphedema]. / Angiosarcoma sobre linfedema crónico.

Angiosarcoma that develops on a limb with chronic lymphedema is called Stewart-Treves syndrome. This typically appears as a complication of a long course lymphedema located on the arm, after mastectomy and/or radiotherapy due to breast cancer. There are cases of Stewart-Treves syndrome in chronic lymphedema in the upper limb contralateral to the breast treated for cancer and in chronic lymphedema of the leg. We present two cases of this syndrome. The first corresponds to a typical syndrome of Stewart-Treves in an 83-year-old woman who was diagnosed of angiosarcoma in a chronic lymphedema territory secondary to mastectomy and radiotherapy due to breast cancer. The second case is much rarer, since it is a case of diffuse angiosarcoma of the leg in a 42-year-old man with a history of lymphedema. Due to the aggressive nature of this syndrome, knowledge and research on its treatment are necessary.

Angiosarcoma sobre linfedema crónico / Angiosarcoma in chronic lymphedema

El angiosarcoma que se desarrolla sobre una extremidad con linfedema crónico se denomina síndrome de Stewart-Treves. Éste aparece típicamente como una complicación de un linfedema de larga evolución localizado en el brazo, tras mastectomía y/o radioterapia por un cáncer de mama. Existen casos de síndrome de Stewart-Treves sobre linfedema crónico en la extremidad superior contralateral al cáncer de mama tratado y sobre linfedema crónico de pierna. Presentamos dos casos de este síndrome. El primero corresponde a un típico síndrome de Stewart-Treves en una mujer de 83 años, que fue diagnosticada de angiosarcoma en el territorio de un linfedema crónico secundario a mastectomía y radioterapia por un cáncer de mama. El segundo caso es mucho más raro, ya que se trata de un caso de angiosarcoma difuso de pierna, en un hombre de 42 años e historia de linfedema. La naturaleza agresiva de este síndrome precisa de su conocimiento e investigación de tratamientos para prevenirlo

Angiosarcoma that develops on a limb with chronic lymphedema is called Stewart-Treves syndrome. This typically appears as a complication of a long course lymphedema located on the arm, after mastectomy and/or radiotherapy due to breast cancer. There are cases of Stewart-Treves syndrome in chronic lymphedema in the upper limb contralateral to the breast treated for cancer and in chronic lymphedema of the leg. We present two cases of this syndrome. The first corresponds to a typical syndrome of Stewart-Treves in an 83-year-old woman who was diagnosed of angiosarcoma in a chronic lymphedema territory secondary to mastectomy and radiotherapy due to breast cancer. The second case is much rarer, since it is a case of diffuse angiosarcoma of the leg in a 42-year-old man with a history of lymphedema. Due to the aggressive nature of this syndrome, knowledge and research on its treatment are necessary

[Diffuse cutaneous reticulohistiocytosis]. / Reticulohistiocitosis cutánea difusa.

The reticulohistiocytoses make up a heterogeneous group of diseases whose origin lies in an accumulation of cells of histiocytic lineage in different tissues and primarily in the skin. Three main clinical forms have been described (multicentric, solitary, diffuse cutaneous), which present with identical histological, ultrastructural and immunohistochemical characteristics. We present a case of diffuse cutaneous reticulohistiocytosis, which is the least common clinical pattern in the spectrum of this disease.

Reticulohistiocitosis cutánea difusa / Diffuse cutaneous reticulohistiocytosis

Las reticulohistiocitosis constituyen un grupo heterogéneo de enfermedades que tienen su origen en la acumulación de células de estirpe histiocitaria en diferentes tejidos y fundamentalmente en la piel. Se han descrito tres formas clínicas principales (multicéntrica, solitaria, cutánea difusa) que presentan idénticas características histológicas, ultraestructurales e inmunohistoquímicas. Presentamos un caso de reticulohistiocitosis cutánea difusa que constituye el patrón clínico menos común dentro del espectro de esta enfermedad

The reticulohistiocytoses make up a heterogeneous group of diseases whose origin lies in an accumulation of cells of histiocytic lineage in different tissues and primarily in the skin. Three main clinical forms have been described (multicentric, solitary, diffuse cutaneous), which present with identical histological, ultrastructural and immunohistochemical characteristics. We present a case of diffuse cutaneous reticulohistiocytosis, which is the least common clinical pattern in the spectrum of this disease

Hidradenitis ecrina neutrofílica secundaria a tioguanina en paciente neutropénico / Neutrophilic eccrine hidradenitis secondary to thioguanine in a neutropenic patient

La hidradenitis ecrina neutrofílica (HEN) es una dermatosis inflamatoria poco frecuente y autolimitada, caracterizada por un infiltrado neutrofílico alrededor de las glándulas ecrinas y que se presenta clínicamente con diferentes tipos de lesiones. La HEN ocurre con más frecuencia en pacientes tras recibir quimioterapia por neoplasias hematológicas. Se presenta un caso de HEN en un paciente neutropénico varón de 70 años que recibió tioguanina por una leucemia aguda mieloide. Las placas eritematosas desaparecieron en 3-4 semanas. Los hallazgos histológicos fueron compatibles con HEN. Los cultivos cutáneos excluyeron causas infecciosas

Neutrophilic eccrine hidradenitis (NEH) is an infrequent, self-limited inflammatory dermatosis characterized by a neutrophilic infiltrate around the eccrine glands. Clinically, it presents with different types of lesions. NEH occurs most frequently in patients who have undergone chemotherapy for hematologic neoplasms. We present a case of NEH in a 70-year-old neutropenic male who received thioguanine for acute myeloid leukemia. The erythematous plaques disappeared in 3-4 weeks. The histological findings were compatible with NEH. Skin cultures ruled out infectious causes

Tratamiento de las úlceras crónicas / Treatment of chronic ulcers

Las úlceras crónicas suponen un reto en la terapia dermatológica. Lo esencial en su tratamiento es establecer su etiología, pero en muchas ocasiones la terapia local es muy beneficiosa. El tratamiento de las úlceras crónicas se basa actualmente en la llamada cura húmeda y contempla un doble aspecto: el de la enfermedad de base y el tratamiento local. El tratamiento local es siempre necesario e incluye: limpieza, desbridamiento, control de la infección, si existe, y la aplicación de diversos agentes tópicos, tanto desde el punto de vista de la medicación como del uso de apósitos. Recientemente se establecen nuevas estrategias terapéuticas, algunas en vías de valoración, que incluyen: reemplazamiento de piel a través de sustitutos biológicos de la misma, factores de crecimiento, láser, oxígeno hiperbárico, estimulación eléctrica o curas con sistema de presión negativa. En el presente trabajo se revisan los avances terapéuticos de esta enfermedad, sin olvidar la validez de terapias clásicas

Chronic ulcers are a challenge in dermatological therapy. It is essential to establish their etiology in order to treat them, but on many occasions local therapy is of great interest. Treatment of chronic ulcers is currently based on so-called moist wound healing, and it takes two aspects into consideration: the underlying pathology and local treatment. Local treatment is always necessary and includes: cleaning, debridement, the control of any infection, and the application of different topical agents, both medication and dressings. Recently, new therapeutic strategies are being established, some of which are still being assessed, and which include: skin replacement using biological skin substitutes, growth factors, laser, hyperbaric oxygen, electrical stimulation and negative pressure dressings. In this work, we review the therapeutic advances in this pathology, without neglecting the validity of classic treatments

[Neutrophilic eccrine hidradenitis secondary to thioguanine in a neutropenic patient]. / Hidradenitis ecrina neutrofílica secundaria a tioguanina en paciente neutropénico.

Neutrophilic eccrine hidradenitis (NEH) is an infrequent, self-limited inflammatory dermatosis characterized by a neutrophilic infiltrate around the eccrine glands. Clinically, it presents with different types of lesions. NEH occurs most frequently in patients who have undergone chemotherapy for hematologic neoplasms. We present a case of NEH in a 70-year-old neutropenic male who received thioguanine for acute myeloid leukemia. The erythematous plaques disappeared in 3-4 weeks. The histological findings were compatible with NEH. Skin cultures ruled out infectious causes.

[Treatment of chronic ulcers]. / Tratamiento de las úlceras crónicas.

Chronic ulcers are a challenge in dermatological therapy. It is essential to establish their etiology in order to treat them, but on many occasions local therapy is of great interest. Treatment of chronic ulcers is currently based on so-called moist wound healing, and it takes two aspects into consideration: the underlying pathology and local treatment. Local treatment is always necessary and includes: cleaning, debridement, the control of any infection, and the application of different topical agents, both medication and dressings. Recently, new therapeutic strategies are being established, some of which are still being assessed, and which include: skin replacement using biological skin substitutes, growth factors, laser, hyperbaric oxygen, electrical stimulation and negative pressure dressings. In this work, we review the therapeutic advances in this pathology, without neglecting the validity of classic treatments.