Development of cutaneous sarcoidosis in a patient with chronic hepatitis C treated with interferon alpha 2b

BACKGROUND: Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology that most commonly affects young adults. A probable induction of sarcoidosis by interferons (IFN) has been published. To this date, few cases of cutaneous sarcoidosis inpatients with chronic hepatitis C under interferon treatment have been reported. OBJECTIVE: We describe a 50-year-old woman with chronic hepatitis C who developed lesions of cutaneous sarcoidosis three months after IFN treatment. CONCLUSIONS: The possible role of INF therapy in the development of cutaneous sarcoidosis in a patient with chronic hepatitis C should be considered.     

Psoriasis treatment with etanercept and efalizumab: clinical strategies influencing treatment outcome

BACKGROUND: Multiple trials have been conducted in which the safety and efficacy of different biological therapies for psoriasis have been studied. However, the treatment course in clinical practice is different from the setting in which trials are conducted. OBJECTIVES: The evaluation of the efficacy, safety and adverse events of etanercept and efalizumab treatment in daily practice and the investigation of interfering clinical strategies that could be of influence on treatment outcome. METHODS: A prospective cohort consisting of 101 patients with high-need psoriasis was followed for 2 years and analysed. Patients were treated with etanercept or efalizumab between February 2005 and May 2007. Efficacy, safety and adverse events were investigated. Furthermore, all accompanying factors of which an influence on treatment efficacy outcome was suspected were registered, including treatment interruptions, dosage adjustments and combinations of therapies. RESULTS: Etanercept and efalizumab treatment was effective and safe in most patients. However, in many cases the treatment course was characterized by unsatisfactory efficacy (83%), necessitating combination therapies or dosage adjustments. Treatment interruptions occurred in 56% (etanercept 2x50 mg group), 84% (etanercept 2x25 mg group) and 10% (efalizumab-treated patients). CONCLUSIONS: Treatment of high-need psoriasis patients in daily practice is highly different from treatment courses in clinical trials. Frequently applied clinical strategies such as treatment interruptions, dosage adjustments and combinations of treatments influence treatment outcome in routine treatment in comparison with randomized controlled trials. Information about treatment with these new drugs in daily clinical practice is important for adjusting treatment schedules and guidelines.     

Toxic epidermal necrolysis successfully treated with etanercept

Toxic epidermal necrolysis (TEN) is a rare and acute severe adverse reaction to drugs, characterised by massive apoptosis and widespread epidermal and mucosal detachment. Although no gold standard therapy exists, human i.v. immunoglobulins have recently been described as an effective treatment for this disease. We report a case of phenobarbital-induced TEN in a 59-year-old white woman where the epidermal detachment stopped 48 h after beginning the etanercept treatment with complete healing after 20 days. To the best of our knowledge, this is only the second reported case of TEN successfully treated with etanercept.     

Recalcitrant palmoplantar pustular psoriasis treated with etanercept

We report a 10-year-old boy presenting with palmoplantar pustular psoriasis, resistant to topical and systemic treatments, who was successfully treated with subcutaneous etanercept (0.4 mg/kg) twice a week for 1 month. Maintenance therapy was extended for 18 months in combination with near ultraviolet light therapy without any adverse effect. Etanercept may be a safe and effective alternative for severe palmoplantar pustular psoriasis in children.     

Psoriasis therapy with biologicals

"Biologicals" represent a new group of compounds which are produced by using methods of biotechnology. They mainly include monoclonal antibodies, fusion proteins and recombinant proteins. The development of biologicals is based on the knowledge derived from pathogenetic studies in psoriasis which have focussed on targeting cell- or mediator-systems relevant for the disease. In this regard, the inactivation of soluble mediators such as tumor-necrosis-factor alpha, the blockade of receptors for cytokines such as interleukin 2, and the interference with T cell activation by antigen presenting cells are all of increasing importance. Recombinant cytokines such as interleukins 4 or 10 are able to modulate the immunological balance. Blockade of adhesion molecules to prevent extravasation of inflammatory cells is a new strategy under development. This article reviews about the current knowledge of psoriasis therapy with biologicals.     

Juvenile generalized pustular psoriasis treated with etanercept

An 8‐year‐old boy with general pustular psoriasis (GPP) and iatrogenic secondary Cushing syndrome was treated successfully with etanercept after he had failed on acitretin, methotrexate, and methylprednisolone therapy. GPP is a severe and very rare variant of psoriasis in children often accompanied by life‐threatening complications. Retinoids, cyclosporine, methotrexate, or dapsone used in a small number of case series and case reports were effective. Etanercept is a recombinant human tumor necrosis factor‐alpha (TNF‐alpha) receptor protein fused with Fc portion of IgG1 that binds to TNF‐alpha, approved by Food and Drug Administration for the treatment of moderate‐to‐severe plaque psoriasis in children and teens who have not responded to other psoriasis treatments. In our patient, etanercept demonstrated significant clinical response associated with long‐term efficacy without acute exacerbation, excellent tolerability, and good safety profile.     

Psoriasis treated with clobetasol propionate and photochemotherapy

Comparable lesions in 16 patients with chronic plaque psoriasis were treated with clobetasol propionate or placebo ointments for 1 week before beginning photochemotherapy. The greater improvement of the steroid treated lesions was maintained after the ointment was withdrawn and there was a mean period of 31 days before those treated with placebo showed a comparable response to photochemotherapy. By the end of the study 8 patients were completely free of psoriasis, healing being achieved after a mean of 7.2 photochemotherapy treatments on the steroid treated lesions compared with 13.5 where a placebo ointment was used. No patient had any adverse reaction to treatment.