Clinical and radiological outcomes of infantile hemangioma treated with oral propranolol: A long‐term follow‐up study

Infantile hemangiomas (IH) undergo rapid growth during early infancy followed by gradual involution. After involution, a part of IH remain as residual lesions. Since 2008, oral propranolol has been widely used in the treatment of IH. However, long‐term outcome of IH treated with propranolol remains unknown. This study aimed to investigate the sequelae of IH treated with propranolol. In this study, propranolol was given at a dose of 2 mg/kg per day at the age of 3.8 ± 2.5 months and follow‐up visits were arranged to continue at least through the age of 4 years. Types of sequela were recorded and classified as four degrees (“none”, “minimal”, “significant” and “severe” at last visit), then subsequent therapy was evaluated with the help of magnetic resonance imaging (MRI). A total of 73 patients with complete follow up were enrolled in the study. The most common types of sequela were telangiectasia, fibrofatty tissue and erythema. Significant and severe sequelae were observed in 72.4% of treated IH; superficial IH led to more but not significantly significant and severe sequelae than mixed IH (P > 0.05). Despite propranolol treatment, surgery was still needed in 37.5% of IH at a mean age of 70.3 months, and for the main reason of surgery, fibrofatty or hemangioma residua, MRI was useful for us to choose an appropriate surgical procedure.     

Slow‐growing melanoma: a dermoscopy follow‐up study

Background Recent evidence suggests that melanoma is a family of different tumours with varying abilities to grow and metastasize. Trends in melanoma epidemiology show a strong increase in the incidence of thin melanoma, with no corresponding increase in mortality or incidence of thick melanoma. We initially evaluated five cases and found that none had baseline features suggestive of melanoma; excision was performed based on slight changes visible only in side‐by‐side comparisons of dermoscopic images. Objectives To assess the clinico‐dermoscopic features and the growth patterns of melanomas that were excised after a follow‐up of 1 year or more due to their inconspicuous features at the baseline consultation. Methods In a multicentre, retrospective study of histopathologically confirmed melanomas excised after follow‐up, we analysed dermoscopic images obtained at the initial consultation and compared them with images obtained at the last follow‐up consultation. Images were analysed and graded using standard algorithms and scored for changes in size, symmetrical or asymmetrical structural change, and development of new melanoma‐specific criteria. An overall score reflecting the amount of change was calculated for each lesion. Results Our series consisted of 103 melanomas. After a median follow‐up of 20 months, most lesions were still in situ or early invasive (median Breslow thickness of 0·48 mm), with only three lesions showing tumour thickness of 1 mm or more. The most frequent baseline characteristics were asymmetrical pigmentation (78·6% of lesions), reticular overall pattern (62·1%), and regression features (35·9%). Most melanomas (58·3%) showed minor to moderate changes over time, with < 2 mm size increase, with asymmetrical structural change, and without development of new melanoma‐specific criteria. Major changes were visible only after a mean follow‐up of 33 months. Conclusions This study provides evidence for the existence of a subgroup of slow‐growing melanomas, which may explain the increase in the incidence of thin melanoma, despite stable rates of thick melanoma and melanoma‐associated mortality.     

Livedoid vasculopathy: Clinical course and long‐term outcome in Asian patients with a review of the literature

Livedoid vasculopathy (LV) is an uncommon, chronic, and recurrent thrombo‐occlusive vascular disorder. Data specific to LV in Thai population remains scarce. This study aimed to evaluate the clinical course and treatment outcomes of LV in Thai patients, and to perform a literature review for studies that reported on anticoagulant treatment in LV. Seventy‐four patients with a mean age of 37.6 ± 14.7 years were included. The female to male ratio was 5.2:1, and the median follow‐up was 10.5 months. Most patients had primary LV disorder. Forty‐eight patients were improved with treatments, with a median duration of 11.4 months. Combination treatments were commonly used, including anti‐inflammatories, antiplatelets, and immunosuppressants. Add‐on therapy with anticoagulant or psoralen plus ultraviolet‐A (PUVA) led to disease improvement in a majority of the patients treated. Kaplan‐Meier analysis demonstrated that 38.5%, 53.7%, and 57.9% would have disease improvement at 1, 2, and 3 years, respectively. Of 39 studies (n = 219) that reported on anticoagulant treatment in LV, anticoagulant drug was used as monotherapy in 104 patients. The mean duration of anticoagulant treatment was 7.2 ± 3.8 months, which led to disease improvement in 97 patients (93.3%). Bleeding side effect was found in 9 patients (8.7%). The highest incidence of LV was found among females aged 30 to 40 years. Combination therapy with anti‐inflammatory drugs, antiplatelet drugs, and immunosuppressants led to disease improvement. The observed efficacy of add‐on PUVA or anticoagulant is promising and should be further investigated. Further studies are needed to guide the development of an LV management guideline.     

Long‐term follow‐up study of occupational hand eczema

Background Long‐term follow‐up studies on the prognosis and consequences of occupational hand eczema (OHE) and the prognostic risk factors for persistent OHE are sparse. Objectives To determine the medical and occupational outcome after a follow‐up of 7–14 years in 605 patients diagnosed with OHE and to identify the prognostic risk factors for the continuation of hand eczema. Methods Patients examined at the Finnish Institute of Occupational Health in 1994–2001 completed a follow‐up questionnaire 7–14 years after diagnosis. Results The hand eczema had healed (no eczema during the last year) in 40% of patients with OHE. The duration of hand eczema before diagnosis was strongly associated with the continuation of eczema. Age, sex and diagnosis (allergic or irritant contact dermatitis) were not associated with the prognosis, but skin atopy, and especially respiratory atopy, were correlated with the continuation of hand eczema. Contact allergies in general were not risk factors for persistent OHE, but the presence of a work‐related chromate allergy was associated with poor healing. A total of 34% of patients had changed their occupation due to OHE, and their long‐term prognosis was better than those who had not. The hand eczema of patients originally in food‐related occupations continued on an unfavourable course. Conclusions In the logistic model, risk factors for the continuation of OHE were a long duration of hand eczema before diagnosis, respiratory atopy, skin atopy, and continuation in the same occupation. Those who ended up changing occupation due to their OHE had a better medical and economic prognosis.     

A case of guttate psoriasis following Kawasaki disease

We report a case of guttate psoriasis following Kawasaki disease, in a patient with Staphylococcus aureus demonstrated in a throat swab. We suggest that preceding staphylococcal infection can play a key role in the pathogenesis of some cases of guttate psoriasis, possibly by the production of superantigens.     

Sirolimus therapy for kaposiform hemangioendothelioma with long‐term follow‐up

Mammalian target of rapamycin inhibitors have shown promising results in the management of kaposiform hemangioendothelioma (KHE). The purpose of this study was to present our experience involving sirolimus therapy for KHE. A retrospective study was conducted to review the medical documents of 26 patients with KHE who were treated with sirolimus at our hospital between March 2012 and December 2016. Fifteen males and 11 females manifested KHE in infancy with an average age of 2.9 ± 1.8 months. Multiple anatomical sites were involved. Four patients had multifocal lesions, while 22 patients had solitary lesions. Twenty‐five patients had Kasabach–Merritt phenomenon (KMP). Twenty patients completed sirolimus therapy in 28.3 ± 12.5 months. Nineteen KHE lesions reduced to small residuals with platelet counts reaching normal levels 3.7 ± 2.8 weeks after treatment; one KHE lesion had no response to therapy. One patient with multifocal lesions died due to a severe infection, although the patient had previously responded to sirolimus. Five patients remained in treatment and had good responses with normal platelet counts. Nineteen patients with anemia had normal hemoglobin levels after 3.5 ± 1.9 weeks of treatment. Mild side effects were observed. The median follow‐up time was 32 months (26–60 months), with no evidence of recurrences. Sirolimus was shown to be efficacious in the management of KHE with an average course of 28 months. The time‐to‐response was variable, with an average of 1 week. After 4 weeks of treatment, the platelet count and hemoglobin level had normalized. Multifocal KHE with KMP is more severe than solitary KHE.     

Long‐term efficacy follow‐up on two cryolipolysis case studies: 6 and 9 years post‐treatment

Cryolipolysis is a noninvasive esthetic procedure that utilizes controlled cooling to reduce subcutaneous fat. Clinical studies have established its safety, efficacy, and tolerability for fat reduction in a variety of areas including the abdomen, flanks, thighs, submental area, arms, back, and chest. Because of obvious esthetic concerns, long‐term unilateral studies leaving an untreated flank, thigh, or arm are not performed, but serve as ideal controls for weight gain or loss or re‐distribution of fat for other reasons. This article follows two patients previously documented in a case report to demonstrate their ongoing treatment efficacy at 6 and 9 years after treatment. Clinical photographs of the treated flanks and untreated contralateral controls demonstrate long‐term durability in these two subjects.     

Efficacy and safety of fumaric acid esters in the long‐term treatment of psoriasis – A retrospective study (FUTURE)

Background: This study collected data on the safety and efficacy of fumaric acid esters (FAE; Fumaderm^®) in the long‐term treatment of psoriasis. Patients and Methods: Patients were included at 163 dermatological centers if they either had been treated continuously with FAE for at least 24 months, or for 36 months with interruptions of no longer than 6 months. Data were reported from baseline, after 3, 6, 12, 24, and 36 or more months of therapy. Safety parameters were monitored and the severity of skin symptoms was assessed by “Physician's Global Assessment” (PGA) and “Psoriasis Area and Severity Index” (PASI). Results: 984 patients were included with a mean duration of 44 months of continuous treatment. The percentage of patients documented as markedly improved or clear was 67 % after six months, 78 % after 24 months, and 82 % after 36 months of therapy. Improvement was similar in patients with moderate and severe disease. Changes of laboratory parameters were usually insignificant and did not require a modification of FAE treatment in more than 90 % of the cases. Conclusions: In the long‐term treatment of patients with moderate and severe psoriasis FAE show a good and sustained clinical efficacy combined with a favorable safety profile.     

Three years dermoscopic follow‐up of atypical nevi

Atypical nevi are dynamic lesions and may progressively transform into more or less atypical lesions. We aimed to investigate the dermoscopic features of atypical nevi and dynamic changes in these lesions over a period of 3‐years. Patients with 3‐year dermoscopic follow‐up records were enrolled in the study. We compared the dermatoscopic features of the nevus recorded in the first dermoscopic examination and at the end of the third year. Changes in size (mm), pattern, and color were investigated. The most common dermoscopic patterns were reticular (18 patients; 34%), reticular‐homogeneous (17 patients; 32.1%), and reticular‐globular (7 patients; 13.2%). The most common pigmentation patterns were central hyperpigmentation (28 patients; 52.8%), regular pigmentation (nine patients; 17.0%), and multifocal hypo/hyperpigmentation (eight patients; 15.1%). Twenty‐one (39.6%) patients showed changes in pattern. The transformation from reticular‐homogeneous pattern to the homogeneous pattern was the most frequent change in pattern (7 of 21 patients; 33.3%). The transformation from reticular pattern to reticular‐homogeneous pattern was the second most common change in pattern (5 of 21 patients; 23.8%). Fourteen (26.4%) patients experienced symmetrical enlargement. Symmetrical enlargement was statistically more frequent in patients who showed dermoscopic changes in pattern than in those who did not show any changes in the pattern (p: .038). In this study, we did not observe any new dermoscopic clues for the diagnosis of melanoma during the follow‐up. The nevi tended to turn into a homogeneous (structureless) pattern. We observed that the most common dermoscopic change in pattern was the transformation from reticular‐homogeneous pattern to homogeneous pattern, and the lesions had symmetrical enlargement during this transformation. In conclusion, despite the known association between atypical nevi and the risk of developing melanoma, most atypical nevi do not transform into melanoma. Therefore, our study suggests that the excision of atypical nevi is not necessary and dermatoscopic follow‐up can reduce the number of unnecessary excisions.     

Cost‐effectiveness of reduced follow‐up in malignant melanoma

Background: Considerable variability exists in the extent and frequency of follow‐ up examinations for melanoma patients between different countries, generating significantly different total costs and uncertain clinical benefits. Patients and Methods: We have analyzed the follow‐up of melanoma patients under clinical and economic aspects based on the latest recommendations of the American Joint Committee on Cancer (AJCC) and the German Dermatologic Society (DDG) in the Düsseldorf cohort of 526 patients (stage IIII) during a 5‐year follow‐up period. Outcome measures were frequency of metastasis detection, most effective detection method, costs per detected metastasis and cost per quality‐adjusted life year. Results: Structured follow‐up detected 17 recurrences in stages I‐III. Physical examination and lymph node ultrasound were the only cost‐effective methods at all stages, while laboratory studies were generally not cost‐effective. The implementation of a reduced, yet medically adequate follow‐up reducing chest X‐rays, abdominal ultrasound examinations and eliminating blood tests in early stages yielded savings of more than 100,000 € (120,000 $) annually at a tertiary care university hospital. Conclusion: The implementation of a reduced follow‐up for melanoma patients seems not only medically justified but also economically required without adversely affecting patient outcome.     

丹参酮治疗点滴型银屑病68例的疗效观察

目的评价丹参酮治疗点滴型银屑病的疗效。方法将122例点滴型银屑病随机分成两组。治疗组68例,口服丹参酮6~8w;对照组予青霉素静滴7d,同时口服复方青黛丸6~8w。统计治疗前症状积分和治疗后第4w、第8w的症状积分及疗效,并进行统计学比较。结果治疗组与对照组在治疗4w时,症状积分和疗效差异无显著性;在治疗8w时疗效差异无显著性,但症状积分差异有显著性。结论丹参酮治疗点滴型银屑病症状改善明显,疗效与复方青黛丸相似,使用方便。     

A systematic review of treatments for guttate psoriasis

BACKGROUND: Many different therapies are available for treating guttate psoriasis; however, there appears to be little objective evidence for their efficacy OBJECTIVES: This review aims to assess the evidence for the effectiveness of treatments for guttate psoriasis. Antistreptococcal interventions for guttate psoriasis are addressed in a separate review. METHODS: Studies were identified by searching the Cochrane Clinical Trials Register (Cochrane Library, Issue 3, 1999), Medline (1966-September 1999), Embase (1988-September 1999), Salford Database of Psoriasis Trials (to November 1999) and the European Dermato-Epidemiology Network (EDEN) Psoriasis Trials Database (to November 1999) for terms GUTTATE and PSORIASIS. We also searched 100 unselected randomized controlled trials of psoriasis therapy and all 112 randomized controlled trials of phototherapy for psoriasis in the Salford Database of Psoriasis Trials for separate stratification of guttate psoriasis. RESULTS: No published report could be found to support or to challenge current commonly used methods of management. Only one trial that met the selection criteria was identified. In this small study of 21 hospitalized patients with guttate psoriasis, intravenous infusion of an n-3 fatty acid rich lipid emulsion was compared with placebo emulsion containing n-6 fatty acids. The n-3 preparation appeared to be of some benefit for patients with guttate psoriasis. CONCLUSION: There is currently no firm evidence on which to base treatment of acute guttate psoriasis. Studies comparing standard treatment modalities, including phototherapy and topical regimens, are required to enable informed decisions on treatment choices to be made.     

Clinical long‐term studies: data collection and assessment

Short‐term randomized controlled clinical trials often provide the basis of regulatory approval for a new drug application, while long‐term clinical studies are essential for monitoring the (long‐term) effectiveness and safety of a drug. As the duration of a study increases and the number of patients continuing in the study declines, missing data become more of a problem, as they may bias the results. Therefore, standard analytical strategies used in short‐term trials (intention‐to‐treat, per‐protocol) may not always be appropriate for data generated in long‐term studies. In this article, commonly used analytical approaches in the assessment of clinical trial data will be reviewed. Given their specific characteristics, regulatory authorities and expert guidelines suggest to use several of these approaches in parallel to correctly interpret the data of long‐term clinical studies and to come to better informed decisions.     

Adalimumab treatment optimization for psoriasis: Results of a long‐term phase 2/3 Japanese study

The tumor necrosis factor‐α inhibitor, adalimumab, is approved to treat moderate‐to‐severe plaque psoriasis (40 mg every‐other‐week or 80 mg every‐other‐week following inadequate response at 40 mg in Japan). This open‐label extension (OLE) trial evaluated the optimal adalimumab dose for long‐term efficacy and safety in Japanese patients with moderate‐to‐severe plaque psoriasis following a prior 24‐week, phase 2/3, randomized, double‐blind study. Of the 169 patients from the phase 2/3 trial, 147 entered the OLE on 40 mg (n = 89) or 80 mg (n = 58) adalimumab every‐other‐week. Patients on 40 mg with Psoriasis Area and Severity Index (PASI) of less than 50 could escalate to 80 mg. At week 52 (28 of OLE), patients entering the OLE on 80 mg were reduced to 40 mg, with the option to re‐escalate. For patients entering the OLE on 40 mg, final PASI 50/75/90 response rates were 85.1%/73.3%/60.4%, respectively, including effects of dose escalation. Among patients whose dose was escalated, final PASI 50/75/90 response rates were 70.0%/53.3%/36.7%, respectively. For patients entering the OLE on 80 mg, final PASI 50/75/90 response rates were 92.5%/84.9%/73.6%, respectively, including effects of dose re‐escalation. Overall incidence rates of adverse events (AE) and injection‐site reaction AE declined over time; rates for serious AE and infections were generally stable. Clinically meaningful efficacy of adalimumab was sustained to 4 years. Dose escalation to 80 mg every‐other‐week for patients with suboptimal response to 40 mg every‐other‐week, and dose reduction to 40 mg every‐other‐week for patients satisfactorily controlled on 80 mg every‐other‐week, are viable strategies for adalimumab optimization.     

A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis

BACKGROUND: Guttate psoriasis is closely associated with preceding or concurrent streptococcal infection. Some authorities have claimed that chronic plaque psoriasis may also be made worse by infection. In view of this many dermatologists have recommended using antibiotics for psoriasis, particularly guttate type. Some dermatologists have also recommended tonsillectomy for psoriasis in patients with recurrent streptococcal pharyngitis. OBJECTIVES: This review aims to assess the evidence for the effectiveness of antistreptococcal interventions, including antibiotics and tonsillectomy in the management of acute guttate and chronic plaque psoriasis. METHODS: Studies were identified by searching the Cochrane Clinical Trials Register (Cochrane Library, Issue 3, 1999), Medline (1966-September 1999), Embase (1988-September 1999), the Salford Database of Psoriasis Trials (to November 1999) and the European Dermato-Epidemiology Network (EDEN) Psoriasis Trials Database (to November 1999) for terms (STREPTOCOCC* or ANTIBIOTIC* or TONSIL*) and PSORIASIS using the Cochrane Skin Group search strategy. RESULTS: Only one trial met the selection criteria. This compared the use of two oral antibiotic schedules in 20 psoriasis patients, predominantly of guttate type, who had evidence of beta-haemolytic streptococcal colonization. Either rifampicin or placebo was added to the end of a standard course of phenoxymethylpenicillin or erythromycin. No patient in either arm of the study improved during the observation period. No randomized trials of tonsillectomy for psoriasis were identified. CONCLUSIONS: Although both antibiotics and tonsillectomy have frequently been advocated both for patients with guttate psoriasis and for selected patients with chronic plaque psoriasis, there is to date no good evidence that either intervention is beneficial.     

Delay in medical attention to hand eczema: a follow‐up study

Background Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis. Objectives To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis. Methods Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6‐month follow up using a self‐administered photographic guide. Additional information was obtained by self‐administered questionnaires. Results Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1·5–8·0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1–8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1·11 [95% confidence interval (CI) 1·02–1·21] per month of patient delay and by 1·05 (95% CI 1·00–1·10) per month of healthcare delay. Conclusions A poorer prognosis of hand eczema was associated with longer delay before medical attention.