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Dermatol Ther ; : e14618, 2020 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-33263945


Sarcoidosis and sarcoid-like reactions (SLRs) may develop in association with various malignancies, as well as in association to certain oncologic drugs, including immune checkpoint inhibitors (ICIs). We aimed to perform a narrative review with regard to the development of ICIs-associated sarcoidosis or SLRs, and to discuss the corresponding diagnostic and therapeutic challenges raised in this scenario. Apropos of a melanoma patient developing SLRs while treated with ipilimumab and nivolumab, we searched for clinically evident, ICIs-associated sarcoidosis or SLRs in the English literature. We recorded the oncologic characteristics, including type of malignancy and type of ICI, the phenotypic characteristics of sarcoidosis/SLRs, as well as the impact on immunotherapy. Including our patient, we identified 80 ICIs-associated sarcoidosis or SLRs cases. Both sexes were equally affected (40 F/40 M) and the most common malignancy was melanoma (65/80, 81.3%). Concerning the oncologic treatment, there was a predilection for pembrolizumab (23/80, 28.7%), followed by the ipilimumab/nivolumab combination (21/80, 26.3%), ipilimumab (18/80, 22.5%), nivolumab (16/80, 20.0%). Although in the majority of the cases (52/80, 65.0%) there was no need for systemic prednisolone for the management of sarcoidosis, a significant proportion of patients finally discontinued ICIs treatment (44/80, 55.0%). Phenotypically, sarcoidosis and SLRs highly imitate oncologic progression posing diagnostic difficulties. A therapeutic dilemma is also raised when there is a need for systemic prednisolone, since the latter may jeopardize the therapeutic efficacy of immunotherapy. Sarcoidosis and SLRs, though rare, can present in oncologic patients treated with ICIs. Clinicians should be aware of this possibility and the related diagnostic and therapeutic challenges they have to face in this scenario.

Clin Cosmet Investig Dermatol ; 10: 305-310, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28848358


Rosacea is a chronic skin disease characterized by facial erythema and telangiectasia. Despite the fact that many hypotheses have been proposed, its etiology remains unknown. In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. A PubMed and Google Scholar search was performed using the terms "rosacea", "H.pylori", "gastrointestinal disorders and H.pylori", "microorganisms and rosacea", "pathogenesis and treatment of rosacea", and "risk factors of rosacea", and selected publications were studied and referenced in text. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea.

Int J Dermatol ; 54(9): 1105-8, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25557117


BACKGROUND: The incidence of non-infectious uveitis on a background of psoriasis is estimated to be 7-20%. The use of tumor necrosis factor-α (TNF-α) inhibitors as a treatment for refractory uveitis is emerging. METHODS: The psoriasis outpatient database at our referral center was searched for patients with concurrent diagnoses of psoriasis and uveitis. The medical records of the patients identified were reviewed for the use of TNF-α inhibitors. RESULTS: Five patients (three women and two men) were identified. All of them suffered moderate to severe psoriasis and chronic, bilateral uveitis. The patient with the most severe ocular inflammation was the only patient positive for human leukocyte antigen B27 (HLA-B27) and the only one to suffer from psoriatic arthritis. All patients had received treatment with adalimumab and had been evaluated at three and six months. Their psoriasis had responded excellently, and in four patients, uveitis had shown the complete remission of inflammation at six months. The fifth patient (HLA-B27+) exhibited improved uveitis activity but not complete remission at six months. CONCLUSIONS: Uveitis is an entity that should be considered when evaluating psoriasis patients with ocular complaints, even in the absence of arthritis. Anti-TNF-α monoclonal antibodies and adalimumab in particular seem to represent a promising therapeutic avenue for the treatment of refractory psoriatic uveitis. Larger randomized clinical trials are needed to confirm our conclusions.

Adalimumab/uso terapêutico , Psoríase/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Uveíte/complicações , Uveíte/tratamento farmacológico , Adulto , Anticorpos Monoclonais/uso terapêutico , Bases de Dados Factuais , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Seguimentos , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Psoríase/diagnóstico , Psoríase/tratamento farmacológico , Encaminhamento e Consulta , Estudos Retrospectivos , Amostragem , Índice de Gravidade de Doença , Resultado do Tratamento , Fator de Necrose Tumoral alfa/uso terapêutico , Uveíte/diagnóstico
Dermatol Pract Concept ; 4(2): 55-8, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24855576


Solitary trichoepithelioma (TE) is a rare, benign tumor of follicular origin that in certain cases is difficult to differentiate from basal cell carcinoma (BCC). We report the case of an 8-year-old girl with a pale pink, soft lesion on the neck. The clinical image of the lesion was equivocal, while some dermoscopic findings-blue-gray globules and arborizing vessels-could not exclude the presence of BCC from the differential diagnosis, although that would have been a very unlikely case considering the age of the patient. The histopathologic examination established the diagnosis of TE. Given the occasion of this challenging case we try to list the key clinical, dermoscopic and histopathological characteristics of TE and BCC in order to elucidate the differential diagnosis of these two entities.