Safety and reactogenicity of the recombinant zoster vaccine after allogeneic hematopoietic cell transplantation.

Allogeneic hematopoietic cell transplantation (HCT) recipients are at increased risk for varicella zoster virus (VZV) reactivation and associated complications. A nonlive adjuvanted recombinant zoster vaccine (RZV) has been developed to prevent herpes zoster (HZ), but there are no recommendations for use in this population. In this single-center prospective observational cohort study, we assessed the safety and reactogenicity of RZV, as well as incidence of graft-versus-host disease (GVHD) and confirmed cases of HZ after vaccination. Between December of 2018 and June of 2020, patients aged ≥18 years received 2 doses of RZV between 9 and 24 months after HCT, with the doses separated by ≥8 weeks. One hundred and fifty-eight patients (mean age, 55 years; 42% women) received ≥1 dose (total vaccinated cohort), and 150 patients (95%) received 2 doses (modified total vaccinated cohort). Solicited reactions occurred in 92.1% of patients (grade 3, 32.5%), owing mostly to injection site pain, which occurred in 86% (grade 3, 16%). The cumulative incidence of GVHD in the peri-vaccination period was no different than in historical controls (adjusted incidence rate ratio, 1.05; 95% confidence interval, 0.8-1.38). There were 4 cases of HZ in the total vaccinated cohort (2.5%) and 3 cases in the modified total vaccinated cohort (28.3/1000 person-years). Among recipients of allogeneic HCT, RZV was safe, tolerable, and did not increase rates of GVHD. Future clinical trials are needed to determine the immunogenicity and efficacy of RZV in this population.

Safety and efficacy of nonsteroid pimecrolimus cream 1% in the treatment of atopic dermatitis in infants.

OBJECTIVE: The safety and efficacy of a 1% cream formulation of pimecrolimus, a selective, nonsteroid immunomodulator, was studied in infants with atopic dermatitis (AD). METHODS: During a 6-week double-blind phase, 186 infants with mild/moderate AD were randomly assigned to twice-daily pimecrolimus cream 1% or vehicle. All patients were subsequently treated with open-label pimecrolimus for 20 weeks. RESULTS: At the end of the double-blind phase, 54.5% and 23.8% of patients in the pimecrolimus and vehicle groups, respectively, were clear or almost clear of AD (P <.001). Similar improvements were observed in the Eczema Area and Severity Index, pruritus assessment, and the care giver's assessment. By the first return visit, 69.9% and 36.5% of pimecrolimus and vehicle-treated patients, respectively, achieved absent or mild pruritus. Efficacy during the double-blind phase was maintained throughout the open-label phase. Vehicle-treated patients transferring to open-label pimecrolimus rapidly achieved disease control comparable to those receiving continuous pimecrolimus. There were no significant differences between groups in application site reactions or skin infections. Most adverse events were mild or moderate and unrelated to treatment. CONCLUSIONS: Pimecrolimus was safe in infants with AD, with rapid and sustained efficacy. Pimecrolimus holds promise as a valuable new treatment option for the youngest patients with AD.

Cutaneous manifestations of gastrointestinal disorders. Part I. Part II

PART I - This article reviews the cutaneous manifestations of gastrointestinal tract diseases. In part I, the gastrointestinal tract polyposis syndromes and gastrointestinal tract malignancies will be discussed. The cutaneous manifestations of inflammatory bowel disorders, vascular disorders of the gastrointestinal tract, celiac disease and bowel-associated dermatosis-arthritis syndrome will be discussed in part II. For each entity, a brief summary of the gastrointestinal tract (and other extracutaneous) manifestations is given. This is followed by a detailed discussion of the cutaneous signs. Current guidelines for the investigation and management of these diseases are presented.

Therapy for cutaneous melanoma: an update

This article reviews the current therapy for cutaneous melanoma. Diagnosis, staging, and prognostic evaluation, which are crucial to proper management, are discussed. Surgical excision is the treatment of choice for primary melanoma. The resection margins should be tailored to tumor thickness. Guidelines for surgery are presented. The controversy about elective regional lymph node dissections is discussed. Limb perfusion, chemotherapy, immunotherapy, radiotherapy, and hormonal therapy as adjuvant treatments of primary melanomas as well as the treatment of disseminated melanomas are reviewed and new developments are highlighted. Guidelines for the management of metastatic melanoma at various sites are given. Special issues such as "pregnancy/estrogen and melanoma" and "borderline melanoma" are discussed and approaches to these problems are suggested. Recommendations are given for the follow-up and counseling of patients with melanoma.