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1.
Purpose of Review
Compulsive sexual behavior (CSB) is widely regarded as a “behavioral addiction,” and is a major threat to quality of life and both physical and mental health. However, CSB has been slow to be recognized clinically as a diagnosable disorder. CSB is co-morbid with affective disorders as well as substance use disorders, and recent neuroimaging studies have demonstrated shared or overlapping neural pathologies disorders, especially in brain regions controlling motivational salience and inhibitory control.Recent Findings
Clinical neuroimaging studies are reviewed that have identified structural and/or function changes in prefrontal cortex, amygdala, striatum, and thalamus in individuals suffering from CSB. A preclinical model to study the neural underpinnings of CSB in male rats is discussed consisting of a conditioned aversion procedure to examine seeking of sexual behavior despite known negative consequences. Using this preclinical model, a role of the medial prefrontal cortex was identified, including neural plasticity during comorbidity of CSB and psychostimulant abuse.Summary
This review summarizes recent human behavioral and neuroimaging studies, in addition to preclinical models that can be used to study the underlying neurobiology of CSB.2.
Stephanie Both 《Current Sexual Health Reports》2017,9(4):192-199
Purpose of Review
This review summarizes the recent literature and empirical studies on psychopharmacological approaches to treating female sexual interest/arousal disorder (FSIAD).Recent Findings
Several new drugs for FSIAD that are intended to increase sexual responsiveness by influencing central excitatory and inhibitory neuromodulatory processes are under development. Studies on flibanserin resulted in the first approved medication for the treatment of low sexual desire in premenopausal women. New drugs under development are testosterone combined with sildenafil or buspiron, bremelanotide, BP101, and nasal testosterone (TBS-2).Summary
Although pharmacological enhancement of sexual responsiveness may be potentially helpful in the treatment of FSIAD, the observed effects of flibanserin and other new drugs under development seem limited in terms of clinical significance. Given the multifactorial character of FSIAD, it may be important to integrate psychopharmacological treatment with sex therapy for optimal treatment efficacy.3.
Background
Topical administration of ketoprofen to treat local subcutaneous pain significantly reduces gastrointestinal and cardiovascular adverse effects associated with oral delivery. However, this benefit must be weighed against the risk of photosensitisation/phototoxicity.Objective
To substantiate the safety and efficacy of topical ketoprofen delivery from a patch.Methods
Experiments were performed, and published information analysed, (a) to confirm the superior skin permeability and pharmacological activity of ketoprofen, and (b) to demonstrate the lower incidence of ketoprofen photosensitisation/phototoxicity when delivered from a topical patch.Results
Ketoprofen’s photodegradation products were more photoallergic than the drug itself. The period postketoprofen treatment that skin should be protected from UV radiation (while the drug is cleared from the application site) was estimated.Conclusions
Photosensitisation to ketoprofen can be mitigated by a patch formulation, which protects the drug from direct UV exposure during skin application, and reduces the formation of even more photoallergic photodegradation products.4.
Objective
A meta-analysis of 3 major German studies conducted between 1989 and 1994 with cyclosporine in severe psoriasis was performed to allow an integrated evaluation of the efficacy and tolerability of cyclosporine in this indication.Design and Setting
All 3 studies were prospective, randomized, parallel group studies. The studies were conducted in 61 dermatologic centers in Germany.Patients and Interventions
The studies involved 597 patients with severe plaque type psoriasis. Treatment consisted of cyclosporine (at a dosage of 1.25, 2.5 or 5 mg/kg/day), etretinate (at a mean daily dose of 0.53 mg/kg/day) or placebo in a total of 756 treatment cycles with a maximum duration of 12 weeks.Main outcome measures: The main outcome measures were the psoriasis area and severity index (PASI) and
serum creatinine level.Results
The meta-analysis revealed that cyclosporine given in a dosage of 2.5 and 5 mg/kg/day was significantly superior to etretinate. In addition cyclosporine 1.25 mg/kg/day proved to be significantly more effective than placebo. An increase in serum creatinine level that required intervention occurred in 3.4% of cyclosporine treatment cycles.Conclusion
Cyclosporine is highly effective and well tolerated in the short term treatment of severe psoriasis.5.
Annarita?Panebianco Francesca?Sampogna Maria?Luisa?Iemboli Luciano?Sobrino Elisabetta?Andreoli Valeria?Antinone Cinzia?Mazzanti Damiano?Abeni
Background
The psychosocial impact of skin conditions is usually evaluated in research settings.Objectives
To define predictors that can be used by dermatologists to refer patients for psychological consultation or psychotherapy using a simple screening instrument.Materials & Methods
A questionnaire to evaluate possible anxiety and depression (12-item General Health Questionnaire [GHQ-12]) was routinely used over a period of two months in an Italian dermatological reference centre.Results
Of 651 patients, 508 (78%) completed the GHQ-12. Of the total sample, 35.2% scored 4 or more (psychological consultation suggested), and 15.7% scored 7 or more (psychological consultation recommended). Probable depression or anxiety was more frequent in women than in men, in patients born in foreign countries, and in patients with leg ulcers, pemphigoid, and psoriasis.Conclusion
Our results indicate that a simple instrument may be useful for dermatologists to detect patients at risk of psychological problems and subsequently refer them for psychological consultation.6.
Background
The pathophysiology of primary burning mouth syndrome (BMS) is extensively debated but poorly understood.Objective
The aim of the study was to evaluate neuropathic and psychological components of BMS in patients with primary BMS.Methods
Subjects were recruited through a consultation dedicated to mouth diseases, during which a diagnosis of primary BMS was assessed. Patients answered the abbreviated Douleur Neuropathique 4 questionnaire (DN4i), the Hospital Anxiety and Depression Scale (HADS) and the questionnaire de la douleur de Saint-Antoine (QDSA), the French version of the McGill pain questionnaire.Results
Thirty-five patients with primary BMS were included in the study: 31 % of them had a DN4i score in favour of neuropathic pain and 34.3 % had a HADS overall score in favour of anxiety and depressive disorder.Conclusion
Both physiological and psychological aspects of BMS need to be actively investigated by clinicians to successfully manage these patients. The physiological and psychological aspects are not mutually exclusive. The DN4i and the HADS are easy-to-use tools and could be used in an initial assessment of BMS patients.7.
Background
Cutaneous lichen planus (CLP) is an inflammatory dermatosis. Its chronic relapsing course and frequently spontaneous regression hamper the assessment of treatment effectiveness.Objective
To evaluate the efficacy of available treatment modalities for CLP.Data Sources
PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov registry.Methods
We performed a systematic review of the current literature. All randomized controlled trials, nonrandomized case–control studies, and cohort studies with more than one treatment arm were included. The primary outcomes were complete response and time to complete response. The secondary outcomes were partial response, relapse, time to relapse, reduction of itch, the adverse event rate, and withdrawal due to adverse events.Data Synthesis
Sixteen studies met the inclusion criteria, of which 11 were randomized controlled trials. Most trials had a small sample size. In the rare studies in which variants other than generalized or classic lichen planus were included, they could not be analyzed separately. Body-of-evidence quality ranged from very low to moderate. Acitretin, sulfasalazine, and griseofulvin were associated with increased overall response rates in comparison with placebo. Narrow-band ultraviolet B radiation (NBUVB) was more effective than 6 weeks’ low-dose prednisolone in achieving a complete response, and prednisolone was more effective than enoxaparin. Hydroxychloroquine was more effective than griseofulvin in achieving an overall response. Betamethasone valerate 0.1 % ointment had comparable efficacy to calcipotriol ointment. Methotrexate was effective, with a nonsignificant difference in the complete response rate in comparison with oral betamethasone. In nonrandomized controlled trials, oral psoralen plus ultraviolet A photochemotherapy (PUVA) had comparable efficacy to a PUVA bath and NBUVB. Psoralen plus sunlight exposure (PUVASOL) and betamethasone dipropionate 0.05 % cream were effective relative to a short course of oral metronidazole.Conclusions
Several effective treatment options are available for CLP. Further well-designed studies are warranted to investigate the efficacy of topical glucocorticoids—the current first-line therapy—as well as other treatment modalities, and the treatment of different variants of CLP.8.
Jeffrey D. Campbell Uros Milenkovic Maarten Albersen Trinity J. Bivalacqua 《Current Sexual Health Reports》2018,10(3):169-176
Purpose of Review
Erectile dysfunction (ED) is a burden for the majority of men during their lifetime. Phosphodiesterase type-5 inhibitors are first-line treatment for men with ED; however, they are limited by on-demand dosing, short-term benefits, and reduced efficacy in difficult to treat populations such as men with diabetes mellitus or ED after radical prostatectomy.Recent Findings
Novel treatment options that offer a durable, tissue restorative approaches are being explored and potentially offer a long-term solution to this medical affliction. Medical therapies such as nanoparticles and botulinum neurotoxin, new technology including vibratory devices and low-intensity extracorporeal shockwave treatment, and regenerative medicine approaches that are undergoing human clinical trials.Summary
Although preclinical data surrounding novel ED therapies are intriguing, these studies are not yet robust enough to support these endeavors outside of clinical trials and further work is ongoing.9.
Background
Although acitretin has been widely used for the treatment of psoriasis, additional safer and more effective approaches, including traditional Chinese medicine, are needed.Objectives
To investigate the efficacy and safety of total glucosides of paeony (TGP) combined with acitretin in the treatment of moderate-to-severe plaque psoriasis.Materials & methods
A randomised, double-blind, placebo-controlled, multi-centre clinical study was conducted. In total, 108 patients with moderate-to-severe plaque psoriasis were randomly assigned to treatment with “TGP plus acitretin” (group A) or “placebo plus acitretin” (group B) for 12 weeks.Results
After 12 weeks of therapy, the percentage of patients achieving a 50% reduction in Psoriasis Area and Severity Index was 90% in group A and 70.5% in group B (p<0.05). The rate of serum alanine aminotransferase elevation was 6.25% in group A and 20.4% in group B (p<0.05).Conclusion
TGP is conducive to enhancing anti-psoriatic efficacy and reducing liver damage due to acitretin. TGP combined with acitretin is a safe and effective treatment approach for moderate-to-severe plaque psoriasis.10.
Background
Various phototherapy methods are used to treat vitiligo; however, the recent emergence of new devices has heightened debate concerning the best treatment method.Objective
We aimed to systematically review and meta-analyze published data comparing the efficacy and adverse effects of monochromatic excimer lamps versus excimer laser and narrowband ultraviolet B (NB-UVB) in treating vitiligo.Methods
A systematic search of PubMed, EMBASE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL), and clinical trials registries identified randomized controlled trials that included vitiligo patients, regardless of age, sex, or study language. We evaluated studies comparing excimer lamps with excimer laser or NB-UVB phototherapy.Results
The review included six studies (411 patients, 764 lesions). No study found significantly different efficacy between excimer lamps and excimer laser using the outcomes of ≥50 % repigmentation [risk ratio (RR) = 0.97, 95 % confidence interval (CI) 0.84–1.11] and ≥75 % repigmentation (RR = 0.96, 95 % CI 0.71–1.30). Likewise, no study found significant differences between excimer lamps and NB-UVB (RR = 1.14, 95 % CI 0.88–1.48 for ≥50 % repigmentation; RR = 1.81, 95 % CI 0.11–29.52 for ≥75 % repigmentation). Adverse effects were mild, including pruritus, burning sensation, and dryness, none of which interrupted treatment.Conclusions
To our knowledge, this is the first systematic review of the efficacy and safety of excimer lamp treatment for vitiligo. Excimer lamps, excimer laser, and NB-UVB are all safe and effective in repigmentation of vitiligo lesions. Safety, effectiveness, and cost are considerations when choosing treatment.PROSPERO Registration Number
CRD42014015237.11.
Yik Weng Yew Yi Chun Lai Robert A. Schwartz 《American journal of clinical dermatology》2016,17(2):113-123
Background
Laboratory and animals studies have suggested a possible protective effect of coffee consumption on the development of melanoma. However, the results of epidemiological studies investigating this association have been inconclusive.Objective
A systematic review and meta-analysis of published studies was conducted to evaluate any association between coffee consumption and melanoma.Methods
Observational studies were searched for in MEDLINE, EMBASE, and the Cochrane Central Register from inception to September 1, 2015. The Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines were followed in conducting this study.Results
We identified nine observational studies with a total of 927,173 study participants, of which 3787 had melanoma. With random-effects modeling, the pooled relative risks (RR) for melanoma among regular coffee drinkers was 0.75 (95 % confidence interval [CI] 0.63–0.89, p = 0.001) compared with controls. Visual inspection of a funnel plot suggested publication bias, although Egger’s test (p = 0.981) delineated no small-study effects. The pooled relative risks for melanoma among decaffeinated coffee drinkers was, however, not statistically significant at 0.92 (95 % CI 0.82–1.05, p = 0.215).Conclusion
There is some evidence for the beneficial effects of regular coffee consumption on melanoma. More prospective cohort studies with systematic quantification of coffee consumption would be necessary to further elucidate this association.12.
Lorena?Capriotti Biagio?Didona Stefania?Madonna Claudia?Scarponi Maria?Antonietta?Pilla Francesco?Facchiano Martina?Cordella Andrea?Cavani Cristina?Maria?Failla
Background
Eosin has been traditionally employed as a topical treatment for psoriasis, but the biological mechanism of its therapeutic action has not been fully elucidated.Objectives
To analyse eosin effects on psoriatic skin in vivo and keratinocytes and endothelial cells in vitro.Materials & Methods
Skin biopsies were taken from psoriatic plaques before and after a three-day eosin treatment and processed for histological analysis. Cultured human psoriatic keratinocytes and dermal endothelial cells were treated with eosin, and release of inflammatory chemokines was analysed by multiplexed bead-based immunoassay and ELISA.Results
In patients, the three-day eosin treatment significantly reduced the number of infiltrating T lymphocytes, neutrophilic granulocytes, and dermal dendritic cells.Areduction in VEGF-A expressionwas also observed. In vitro, eosin treatment significantly decreased the release of CCL2, CCL5, and VEGF-A by keratinocytes and angiopoietin-2 by endothelial cells.Conclusions
Eosin treatment impacts on psoriatic inflammatory infiltrates and dampens the release of proinflammatory chemokines and angiogenic factors.13.
Background and Objective
Topical cantharidin is routinely used for the treatment of molluscum contagiosum and warts. The objective of this systematic review is to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts.Methods
We performed a systematic review of studies assessing topical cantharidin treatment of molluscum contagiosum or warts. We searched the databases of Cochrane, EMBASE, GREAT, LILACS, MEDLINE, and Scopus. Two authors performed the study selection and data extraction.Results
Twenty studies (1958–2018) met inclusion/exclusion criteria. Twelve studies assessed warts, and eight studies assessed molluscum contagiosum. Overall, 1752 patients were included (range 0.3–62 years; specified in 15 studies). Clearance rates with topical cantharidin for molluscum contagiosum were variable (range 15.4–100%). Significant clearance of warts with maintenance of clearance was demonstrated with topical cantharidin alone. Topical cantharidin in combination with podophyllotoxin and salicylic acid demonstrated efficacy for plantar warts (pediatric and adult; clearance rate range 81–100%; four studies had 100% clearance), with the majority clearing after a single treatment. Satisfaction with cantharidin therapy was high, especially in molluscum contagiosum. Pain (7–85.7%), blistering (10–100%), and hyper-/hypopigmentation (1.8–53.3%) were the most commonly occurring adverse effects with cantharidin treatment.Conclusion
Topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.14.
Background
Pityriasis lichenoides (PL) is a dermatologic disorder that manifests in either the acute (pityriasis lichenoides et varioliformis acuta) or the chronic form (pityriasis lichenoides chronica, also known as parapsoriasis chronica). Traditional first-line therapy consists of corticosteroids or antibiotics; however, these treatments are often accompanied with multiple side effects and may be ineffective.Objective
The goal of this study was to review the use of phototherapy for treating PL in the pediatric population.Materials and methods
We performed a systematic review of the literature in the National Library of Medicine’s PubMed database and the SCOPUS database discussing phototherapy for treatment of PL in the pediatric population. The following search terms were used: ‘pityriasis lichenoides’, ‘pityriasis lichenoides chronica’, ‘pityriasis lichenoides et varioliformis acuta’, and ‘febrile ulceronecrotic Mucha-Habermann disease’.Results
The systematic search and screening of articles resulted in 14 articles including a total of 64 patients with PL treated with phototherapy. Three different modalities were utilized, with five studies using broadband ultraviolet B (BB-UVB) radiation, nine studies utilizing narrowband UVB (NB-UVB), and two studies employing psoralen with ultraviolet A (PUVA) therapy. Overall, the use of BB-UVB had an initial clearance rate of 89.6 % with 23.1 % recurrence, whereas NB-UVB cleared 73 % of the lesions with no recurrence, and PUVA therapy initially cleared 83 % of the lesions with 60 % recurrence. The side-effect profiles were similar and revealed limited toxicity.Conclusion
Phototherapy shows promising results and a favorable side-effect profile in the treatment of PL. Ultimately, large randomized controlled trials are needed to determine optimal treatments.15.
K. Herberger K. Heyer K. Protz A. Mayer J. Dissemond S. Debus T. Wild J. Schmitt M. Augustin Konsensusgruppe 《Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete》2017,68(11):896-911
Background
Standards in the assessment and documentation of disease processes are the basis of guideline-based care. For the treatment of chronic wounds, especially leg ulcers, no approved parameters are available.Objectives
Against this background, our aim was to develop standards for the documentation of leg ulcer in routine care. This article presents the recommendations for the classification and characteristics of the variables.Materials and methods
The development of the documentation standard was based on a systematic literature research and was performed in a Delphi-based consensus process. The national consensus process included meetings as well as web-based questionnaires. The Consensus Group is coordinated by the German Center for Health Services Research in Dermatology (CVderm).Results
The documentation standards and their variables for leg ulcer routine care were developed in seven meetings of the consensus group. The consensus group consists of 38 delegates of wound care societies, health insurances, wound networks and associations.Discussion
For each variable, recommended in routine care, a distinct response scheme (defined set of variable characteristics) was defined. As a next step, a structured implementation process is required, which was part of the resolutions of the consensus group.16.
Background
Information on the long-term efficacy of etanercept (ETN) treatment of moderate-to-severe psoriasis according to the Summary of Product Characteristics (SmPC) is scarce.Objectives
We report the efficacy results of an observational clinical trial including 202 patients treated for 12 months with ETN according to SmPC.Methods
Concomitant topical treatment was permitted throughout the study period. Efficacy assessment was done by intention-to-treat analysis with last observation carried forward.Results
Mean%Body Surface Area (BSA) and Psoriasis Area and Severity Index (PASI) decreased from 39.0% and 22.2% at baseline to 7.9% and 4.4%, respectively, at 12 months. Throughout the study duration, PASI 50, PASI 75 and PASI 90 response rates ranged from 72.8% to 95.7%, 55.6% to 84.3%, and 36.1% to 62.2%, respectively. Body mass index and body weight had minor effects on treatment efficacy.Conclusion
ETN treatment according to the SmPC provided sustained improvement of psoriasis throughout one year.17.
Background
Patients with advanced melanoma have a poor prognosis. Since the discovery of BRAF mutations in cutaneous melanoma, new pharmacological agents have been developed to inhibit this target. Although the survival of patients with advanced melanoma has improved with BRAF inhibitors, the emergence of drug resistance and the high incidence of cutaneous side effects represent important limitations.Objectives
The aim of our study was to compare the incidence of cutaneous side effects between BRAF inhibitor monotherapy and BRAF and MEK inhibitor combination therapy in our cohort of patients.Materials & methods
This studywas a longitudinal prospective observational study. The study population comprised 83 patients with advanced cutaneous melanoma presenting with BRAF V600 mutation. The inclusion criteria included: age above 18 years, metastatic cutaneous melanoma or melanoma with high risk of metastasis, the presence of BRAF V600 mutation, and treatment withBRAFinhibitors or a combination ofBRAF and MEK inhibitors.Results
The majority of patients developed skin toxicity during treatment. The most common cutaneous side effects were localized hyperkeratosis and verrucous keratosis. Other cutaneous side effects observed were photosensitivity, squamous cell carcinoma, and keratoacanthoma.Conclusion
Our results indicate that cutaneous side effects are generally observed during BRAF inhibitor monotherapy and are significantly different from those observed in patients treated with combination therapy.18.
19.
Background
Erosive oral lichen planus (OLP) is, at times, extremely difficult to treat and has a major impact on patients’ quality of life. There are only limited therapeutic options, such as topical and systemic glucocorticoids, retinoids, and immunosuppressants with considerable side effects and limited efficacy upon chronic use.Objectives
In the present individualised clinical trial, we assessed the efficacy of adjuvant intravenous immunoglobulins (IVIG; 2 g/kg/monthly cycle) in addition to the oral retinoid, acitretin, in three patients with refractory OLP over a period of two to six months.Materials & Methods
The efficacy of adjuvant IVIG treatment was evaluated using the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) which measures both extent of mucosal lesions and functional sequelae.Results
The three OLP patients showed mixed responses to adjuvant IVIG treatment, ranging from therapeutic efficacy to a lack of response to IVIG.Conclusions
In light of the observed therapeutic responses and a lack of good therapeutic options, adjuvant IVIG, although costly, warrants further investigation as a treatment option for OLP.20.