Dose reduction is a feasible strategy in patients with plaque psoriasis who achieve sustained response with secukinumab: a retrospective, multicenter cohort study in daily practice setting.

BACKGROUND: Biological therapy dose modification is a common practice in the long-term treatment of plaque psoriasis. OBJECTIVE: The objective of the study was to determine prevalence, characteristics of patients, effectiveness, treatment survival of secukinumab dose reduction (SEC-DR) strategy and assess its safety and cost implications. METHODS: A retrospective, observational, multicenter cohort study was conducted in patients with plaque psoriasis treated with secukinumab and up to 2 years of follow-up. RESULTS: In 63/347 patients with an initial standard dose regimen, SEC-DR was tried at any moment in 18.2% of them after sustained response. In 51 patients, the interval between administrations was increased while in 12 patients, monthly dose was reduced to 150 mg. Successful SEC-DR was achieved in 77.8% of the patients, with sustained PASI response to the end of the study. Survival of secukinumab treatment and safety profile were not compromised by DR. The use of DR saved 33% of the cost, including failures in which standard treatment was resumed. LIMITATIONS: The proper of the study designed and the arbitrary definition of "DR success." CONCLUSION: Off-label SEC-DR strategy was used in patients with sustained response to standard dose regimen; this strategy showed long-term efficacy without compromising treatment survival or worsening the safety profile while also being cost saving.

Evaluation of urinary selenium as a biomarker of human occupational exposure to elemental and inorganic selenium.

PURPOSE: Selenium (Se) is an essential trace element, which however, exhibits a narrow safe range of intake. Selenium also occurs at several workplaces, which results in an inhalative selenium exposure of the employees. Thus, an efficient exposure assessment strategy is demanded. The most established parameter, selenium in plasma, mostly consists of protein-bound selenium. This study aimed to investigate urinary total selenium (Se-U) as an additional biomarker of recent human occupational exposure to elemental and inorganic selenium. METHODS: Pre- and post-shift urine samples from employees with exposure to selenium-containing dust were analyzed to total selenium and compared with Se levels in urine samples from controls without occupational exposure to selenium as well as correlated with the recent ambient Se exposure by personal air monitoring. RESULTS: Se-U in post-shift samples was considerably increased compared to the levels in pre-shift samples as well as to the controls. However, Se-U in pre-shift urine was elevated compared to the Se-U in controls too. Se-U in post-shift urine and even better the shift increment in Se-U correlated with the air exposure of the present shift. A rough estimation by Se-U shift increment and external exposure accounted for an inhalative resorption rate of about 1%. CONCLUSION: Our data indicate that Se-U can display the exposure. Pre-shift Se-U levels may be based on previous exposure and indicate a slow urinary elimination kinetics. The results hint for a rather low resorption rate of selenium and inorganic selenium compounds via the lung.

Phototherapy in atopic dermatitis: a systematic review of the literature.

BACKGROUND: Phototherapy is a treatment option for atopic dermatitis recommended by several guidelines. OBJECTIVE: To perform a systematic review of the efficacy of different modalities of phototherapy and photochemotherapy in moderate to severe atopic dermatitis. MATERIAL AND METHODS: We considered all randomized clinical trials (RCTs) performed in patients with atopic dermatitis, and accepted all outcome measures. Articles were identified via an online search of the MEDLINE (via Ovid) and Embase databases and the Cochrane Central Register of Controlled Trials. We also searched for clinical trials registered in Current Controlled Trials and in the World Health Organization's International Clinical Trials Registry Platform. RESULTS: Twenty-one RCTs (961 patients) were included in the qualitative analysis. Two of the trials included children and adolescents (32 patients). The efficacy of narrow-band UV-B and UV-A1 phototherapy was similar for the different outcome measures contemplated. Two RCTs assessed the efficacy of psoralen plus UV-A therapy (PUVA). No serious adverse events were described. In general, the publications reviewed were characterized by a high risk of bias and poor reporting of methodology and results. CONCLUSIONS: There is evidence for the use of narrow-band UV-B and UV-A1 phototherapy in moderate to severe atopic dermatitis. Evidence supporting the use of PUVA in atopic dermatitis is scarce and there is little information on the use of phototherapy in childhood. For the purpose of future studies, it would be advisable to use comparable criteria and scales for the evaluation of disease severity and patients, to standardize radiation methods, and to establish a minimum follow-up time.

[Interferon-alpha and hepatitis C virus: the skin matters]. / Interferón alfa y virus hepatitis C: la piel importa.

Chronic hepatitis C virus infection (HCV) is classically associated with such dermatologic conditions as mixed cryoglobulinemia (MC), porphyria cutanea tarda (PCT) and lichen planus. This review focuses on the response of these entities to interferon alpha (IFN) therapy, which has an immunomodulatory activity and may modify their course. The presence of certain HCV-associated dermatologic disorders, as PCT, may predict the patients virological response to IFN therapy. On the other hand, the course of some dermatologic disorders, as MC, during treatment with IFN, may be an early indicator of virologic response. In any case, physicians should know how to handle the most common dermatologic side effects of IFN, which may affect the quality of life of patients, complicating the adherence to treatment.

Interferón alfa y virus hepatitis C: la piel importa / Interferon-alpha and hepatitis C virus: the skin matters

La infección crónica por el virus de la hepatitis C se asocia clásicamente con entidades dermatológicas como la crioglobulinemia mixta (CM), la porfiria cutánea tarda (PCT) o el liquen plano. Esta revisión se centra en la respuesta de estos trastornos cutáneos al tratamiento con interferón alfa (IFN), que posee una actividad inmunomoduladora y puede modificar su evolución. Parece que la presencia de ciertas manifestaciones dermatológicas por sí mismas, como la PCT, pueden predecir la respuesta virológica a IFN. Por otro lado, el curso de ciertos desórdenes dermatológicos, como la CM, durante el tratamiento con IFN puede ser un indicador precoz de la respuesta virológica. En cualquier caso, es importante que los facultativos conozcan los efectos cutáneos adversos del IFN, que pueden afectar de forma importante la calidad de vida de los pacientes, condicionando su adherencia al tratamiento(AU)

Chronic hepatitis C virus infection (HCV) is classically associated with such dermatologic conditions as mixed cryoglobulinemia (MC), porphyria cutanea tarda (PCT) and lichen planus. This review focuses on the response of these entities to interferon alpha (IFN) therapy, which has an immunomodulatory activity and may modify their course. The presence of certain HCV-associated dermatologic disorders, as PCT, may predict the patients virological aresponse to IFN therapy. On the other hand, the course of some dermatologic disorders, as MC, during treatment with IFN, may be an early indicator of virologic response. In any case, physicians should know how to handle the most common dermatologic side effects of IFN, which may affect the quality of life of patients, complicating the adherence to treatment(AU)

Urticaria de contacto localizada por calor / Localized heat contact urticaria

La urticaria de contacto localizada por calor es una enfermedad poco frecuente, de la que existen menos de 60 pacientes referidos. Presentamos el caso de una cocinera de 64 años con episodios de eritema y edema pruriginosos circunscritos a las zonas de contacto de la piel con el agua caliente. La positividad de la intradermo-reacción con suero autólogo a 55º C apoyaría la hipótesis que contempla la existencia de alguna molécula sérica, activada por el calor y responsable del cuadro clínico (AU)

Heat contact urticaria is an unusual disease, with nearly 60 cases reported. A 64 years old female, who works as a cook, and developed episodes of well-demarcated, reddish, itchy and edematous lesions, limited to areas of the skin exposed to hot water is reported. The autologous serum skin test(ASST) at 55ºC was performed and was positive, supporting the existing hypothesis of an unknown heat activated protein in serum, as responsible of the etiology of this disorder (AU)

Successful treatment of three cases of primary extramammary Paget's disease of the vulva with Imiquimod--proposal of a therapeutic schedule.

BACKGROUND/AIM: Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma of apocrine gland-bearing skin. Although surgery remains the mainstay of treatment, loss of tissue function and high recurrence rates have been reported. Recently, topical Imiquimod has been shown as a safe and effective treatment option for extramammary Paget's disease. METHODS: Three patients diagnosed of EMPD of the vulva were treated with a daily application of 5% Imiquimod cream for three weeks, followed by an every other day application for an additional three weeks. RESULTS: Complete clinical and histological remission of the disease was achieved in the three patients. Mild irritation and tenderness were observed as the only side effects. CONCLUSION: Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.

Linkage relationships between ALPL, ENO1, GPI, PGD, and TGFB1 on porcine chromosome 6.

A five-point linkage map has been established between the loci encoding liver/bone/kidney alkaline phosphatase (ALPL), enolase 1-alpha (ENO1), glucose-phosphate isomerase (GPI), phosphogluconate dehydrogenase (PGD), and transforming growth factor beta 1 (TGFB1) in swine. Linkage analysis was performed using the Meishan x Yorkshire three-generation reference pedigree at the University of Illinois (n = 91). Previously ENO1, GPI, PGD, and TGFB1 were mapped to porcine chromosome 6q by in situ hybridization but the linkage relations of TGFB1 and ENO1 with other loci in this group were not investigated. Based on mapping data from human chromosomes 1 and 19 and mouse chromosomes 4 and 7, it was postulated that ALPL should reside among or near these loci. Restriction fragment length polymorphisms were identified for ALPL, ENO1, and TGFB1. GPI (EC 5.3.1.9) and PGD (EC 1.1.1.44) phenotypes were determined by agarose gel electrophoresis of isozymes. Marker data were analyzed using the MLINK (two locus) and ILINK (multilocus) programs from LINKAGE (version 5.10). The most likely locus order between GPI-TGFB1-(PGD-ENO1)-ALPL with recombination rates of 0.049, 0.044, 0.000, and 0.156, respectively, could not be significantly determined. The maximum five-point lod score was the same to four decimal places irrespective of the order of ENO1 and PGD. This indicates that ENO1 and PGD are very closely linked and that ALPL is located telomeric to the established linkage group on pig chromosome 6.