A retrospective observational study on biological drug treatment in a daily practice serving patients with psoriasis in Japan.

BACKGROUND: In Japan, more than five years have passed since emergence of the first three biologics, infliximab, adalimumab, and ustekinumab, became available in daily practice; however, no data for drug survival was reported from Japan. OBJECTIVE: To study the long-term drug survival of infliximab, adalimumab, and ustekinumab used for Japanese psoriatic patients. METHODS: We retrieved data on all patients treated with biological agents and calculated the long-term drug survival for infliximab, adalimumab, and ustekinumab using our psoriasis registry (Kurume Psoriasis Registry: KURUPR) consisted of 343 patients by the end of March 2017. We analyzed 103 treatment courses of 83 patients with all types of psoriasis, as well as 79 treatment courses of 62 patients with psoriasis vulgaris using the Kaplan-Meier method. RESULTS: Drug survival was higher for ustekinumab than infliximab and adalimumab in both settings, although there were no statistical differences. CONCLUSIONS: Previous studies of long-term drug survival in patients with psoriasis vulgaris showed significantly higher drug survival for ustekinumab than infliximab, and adalimumab. Our data showed similar tendency. Besides randomized clinical trials, drug survival data is useful because it reflects real-world management.

Adenodermatofibroma possessing dilated glandular structures with eccrine features: A case study.

Adenodermatofibroma is a newly recognized variant of dermatofibroma characterized by dense proliferation of fibroblasts and histiocytes admixed with dilated glandular structures showing apocrine secretion. Only five cases of adenodermatofibroma have been reported to date. We report an additional case of adenodermatofibroma on the back of a 67-year-old female. In addition to the dilated glandular structures, nondilated eccrine units were present at the upper periphery of the lesion, above which the normal eccrine glands reside. Although decapitation secretion was observed in the nondilated eccrine units at the upper periphery of the lesion, this was not observed in the dilated glandular structures. The inner cells of the dilated glandular structures were S-100 positive, similar to those of the secretory portion of eccrine glands. We considered the glandular structures in our patient were derived from the entrapped eccrine units. We suggest that the term "apocrine metaplasia" be applied to eccrine units showing decapitation secretion.

Combination therapy of fexofenadine and montelukast is effective in prurigo nodularis and pemphigoid nodularis.

In this study, we report on the efficacy of combination therapy of second-generation antihistamine antagonist, fexofenadine hydrochloride, and leukotriene receptor inhibitor, montelukast sodium, for the treatment of 15 prurigo nodularis or pemphigoid nodularis patients, in whom conventional therapy was ineffective. All patients received 10 mg montelukast once a day and 240 mg fexofenadine twice a day for 4 weeks in addition to other medications they had been taking. We assessed the manifestations of the lesions and itching intensity before and after the therapy, and we evaluated each patient as (i) markedly improved, (ii) improved, (iii) slightly improved, (iv) no change, (v) worse. Two patients (13.3%) were evaluated as markedly improved, and the lesions of one patient completely disappeared. Three patients (20.0%) were evaluated as improved, and six patients (40.0%) as slightly improved. Thus, 11 of 15 cases (73.3%) improved by combination therapy of fexofenadine and montelukast, in which nine cases (75.0%) of prurigo nodularis and two cases (66.7%) of pemphigoid nodularis were involved. No patients revealed any side effects. This study revealed that combination therapy of fexofenadine and montelukast was effective for some patients with conventional therapy-resistant prurigo nodularis and pemphigoid nodularis.