Biological Therapies or Apremilast in the Treatment of Psoriasis in Patients with a History of Hematologic Malignancy: Results from a Retrospective Study in 21 Patients.

BACKGROUND: Few studies addressing the safety and efficacy of biological therapy (BT) or apremilast (APR) in patients with psoriasis with a history of hematologic malignancy (HM) exist. AIM: To describe the tolerance and efficacy of BT and APR in moderate-to-severe psoriasis in patients with a history of in-remission or evolving HM. METHODOLOGY: A retrospective, multicenter chart review of the tolerance and efficacy of BT or APR in patients with moderate-to-severe psoriasis and a clinical history of in-remission or evolving HM. RESULTS: Twenty-one patients with severe psoriasis and a history of HM were included in France by the GEM Resopso study group. Of the 16 patients treated with one or more BT lines, none showed recurrence of their HM which was considered as stable or in remission, and only 2 patients showed an evolution of their HM which had been considered as stable at the beginning of treatment. In the 10 patients treated with APR, the HM of one patient who also received BT worsened. The 3 evolutions did not impact the treatment with BT or APR. Tolerance was very satisfactory, with a low occurrence of infections. Regarding efficacy, only one patient treated with APR did not achieve any notable clinical improvement. CONCLUSION: Despite supportive data regarding tolerance, the heterogeneity of the analyzed population and limited available data, BT and APR should be used with caution in this patient population and investigations on larger cohorts should be conducted to further assess their tolerance in this patient population.

Higher Frequency of Dipeptidyl Peptidase-4 Inhibitor Intake in Bullous Pemphigoid Patients than in the French General Population.

Dipeptidyl peptidase-4 inhibitors have been suspected to induce bullous pemphigoid (BP). The objective of this study was to compare the observed frequency of gliptin intake in a large sample of 1,787 BP patients diagnosed between 2012 and 2015 in France, with the expected frequency after indirect age standardization on 225,412 individuals extracted from the database of the National Healthcare Insurance Agency. The secondary objective was to assess the clinical characteristics and the course of gliptin-associated BP, depending on whether gliptin was continued or stopped. The observed frequencies of intake of the whole gliptin class and that of vildagliptin in the BP population were higher than those in the general population after age standardization (whole gliptin class: 6.0%; 95% confidence interval = 4.9-7.1% vs. 3.6%, observed-to-expected drug intake ratio = 1.7; 95% confidence interval = 1.4-2.0; P < 0.0001; vildagliptin = 3.3%; 95% confidence interval = 2.5-4.1% vs. 0.7%, ratio = 4.4; 95% confidence interval = 3.5-5.7; P < 0.0001). The association of any gliptin+metformin was also higher than in the general population, ratio = 1.8 (95% confidence interval = 1.3-2.4; P < 0.0001). Gliptin-associated BP had no specific clinical characteristics. Gliptin was stopped in 48 (45.3%) cases. Median duration to achieve disease control, rate, and delay of relapse were not different whether gliptin was stopped or continued. This study strongly supports the association between gliptin intake, particularly vildagliptin, and the onset of BP.

[Interest of emergency dermatological consultation in a regional hospital]. / Intérêt d'une consultation dermatologique d'urgence dans un centre hospitalier régional.

INTRODUCTION: Dermatologists, both as hospital and as resident practitioners, are often requested to see emergencies of their discipline, although appointment planning are already fully booked months in advance. Orleans Regional Hospital (ORH) has opened a department of dermatological emergency consultation to try to help with this issue. A prospective, descriptive and consecutive study on patient characteristics was conducted during its first year operating. METHOD: In September 2011, we opened a department of dermatological emergency consultation. Reception is skin disorders evaluated by physicians or nurses as "emergencies", according to predefined criteria. Follow-up visits are performed in the afternoon. RESULTS: Within one year, 2209 medical visits were conducted, with an average of 8,7 emergency visits per day. The maximum numbers of patients treated by our dermatological emergency unit in one single morning was 19. Mondays were the busiest day of the week. The average age of a patient attending the department was 33 years, with 29% of pediatric patients (under 15 years old). The majority of patients presented spontaneously (43%), or were referred by general practitioners (25%). Adult and pediatric emergency departments sent 8% of patients. The two main reasons for consultation were rash (48%) and pruritus (16%). Diagnoses observed were mainly infections (24%) and eczema (14%). Scabies accounted for 9% of all diagnoses. In the aftermath of an emergency dermatological consultation, 84 patients were hospitalized, including 74 in the dermatology department of Orleans hospital totalling 505 days of hospitalization. CONCLUSION: The value of a dermatological emergency consultation is well demonstrated in areas where more medical services are available (such as cities with University hospitals available). It is even more justified in areas with a deficit of healthcare service availability such as Central France.

Enzyme-linked immunosorbent assay for the combination of bullous pemphigoid antigens 1 and 2 in the diagnosis of bullous pemphigoid.

OBJECTIVE: To assess the usefulness of enzyme-linked immunosorbent assay (ELISA) assessment of the combination of bullous pemphigoid antigen 1 (BPAG1) and BPAG2 in the diagnosis of bullous pemphigoid (BP). DESIGN: Retrospective study of serum samples from patients with BP. SETTING: Tertiary care center. PATIENTS: A total of 190 patients with newly diagnosed BP and 78 controls with other autoimmune bullous diseases. INTERVENTION: Serum samples were tested using commercialized BPAG1 and BPAG2 ELISA and indirect immunofluorescence (IIF). MAIN OUTCOME MEASURES: The sensitivity and specificity of ELISA for the combination of BPAG1 and BPAG2 in the diagnosis of BP were contrasted with ELISA for each of the antigens alone and with IIF. RESULTS: The sensitivity and specificity of ELISA for the combination of BPAG1 and BPAG2 were 87% and 88%, respectively, compared with 79% and 90% for BPAG2 ELISA, 61% and 96% for BPAG1 ELISA, and 81% and 63% for IIF. The combination of BPAG1 ELISA and BPAG2 ELISA permitted 8% and 16% gains in sensitivity compared with each of BPAG2 ELISA and BPAG1 ELISA alone, respectively. Anti-BPAG1 antibodies were detected in 15 of 40 BP serum samples with no anti-BPAG2 antibodies (38%) and in 8 of 13 serum samples from patients with BP and mucosal involvement (62%) compared with 2 of 22 samples of cicatricial pemphigoid (P = .002) and 0 of 16 epidermolysis bullosa acquisita serum samples (P < .001). The BPAG2 ELISA values were more closely correlated with initial extent of BP lesions (r = 0.44, P < .001) than BPAG1 ELISA values (r = 0.16, P = .03). CONCLUSION: Since the combination of BPAG1 and BPAG2 ELISA only slightly increases the sensitivity of BP diagnosis over BPAG2 ELISA alone, BPAG1 ELISA could be adequately proposed in a minority of BP cases with mucosal involvement and in those with no circulating anti-BPAG2 antibodies.