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1.
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.2.
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.3.
Background
Administrative databases provide valuable patient data and are used to conduct population-based studies. However, no studies have been conducted to validate the codes for dermatological conditions.Objective
To evaluate the validity of ICD 9 code 706 for acne.Methods
This was a retrospective chart review of patients seen in dermatology clinics at Sunnybrook Health Sciences Centre between March 1 and May 31, 2013. The billing code for a clinic visit was compared to the diagnosis documented in the medical chart.Results
There were 4,248 participants; 201 with an ICD-9 code of acne. This code had a PPV and sensitivity with 95% confidence intervals (CI) of 84.58% (78.67–89.13%) and 86.29% (80.51–90.62%), respectively. The specificity was 99.20% (98.86–99.45%).Conclusions
We showed that ICD-9 code 706 can be used to accurately identify patients with acne in a dermatology setting. This information can be applied to future epidemiologic studies4.
Background
The use of skin puncture techniques may facilitate the delivery of topically applied drugs for photodynamic therapy (PDT).Objectives
The main aim of this prospective study was to evaluate the efficacy and cosmetic outcome of curettage, multiple needle puncture, and methyl-aminolaevulinate (MAL)-PDT in basal cell carcinoma (BCC).Materials and methods
All tumours received curettage and 15-20 needle punctures/cm2 before two sessions of MAL-PDT. The primary endpoint was clinically observed recurrence at follow-up. Overall, 284 patients with 299 histologically verified BCC (70 superficial, 190 nodular, 35 aggressive, and four not subtyped) were included. Following PDT, the mean follow-up period was 6.7 months.Results
After follow-up, 274 (92%) of 299 treatment sites showed no clinical signs of recurrence, with >90% complete response for each BCC subtype. The cosmetic outcome was rated as excellent/good in 81% of cases.Conclusion
Good short-term treatment results were shown following curettage, multiple needle puncture, and MAL-PDT for BCC of different subtypes.5.
Florence?Hacard Clemmie?Martin Virginie?Verdu Arlette?Montagnon Frédéric?Augey Marion?Braire-Bourrel Jean-Fran?ois?Nicolas Frédéric?Berard Audrey?Nosbaum
Background
Therapeutic patient education (TPE) allows patients to better understand their disease and cope with treatment. TPE programmes have not yet been evaluated for chronic spontaneous urticaria (CSU).Objectives
To investigate the cognitive and behavioural impact of TPE on CSU patients.Materials and methods
CSU patients were selected who completed a TPE programme. A pre-post comparison was performed using a skill/knowledge questionnaire, based on six educational objectives, before and after the intervention. The course of CSU was also analysed, according to daily hive count and itch intensity.Results
All of the 61 enrolled patients improved their knowledge and skills following TPE, with greatest improvement in itch management and use of alternatives to scratching. CSU activity was reduced at the end of the programme in 60% of patients.Conclusions
TPE improves knowledge and skills for CSU patients. Further research is needed to demonstrate the positive impact of TPE on CSU activity.6.
Background
Bullous pemphigoid (BP) is the most common autoimmune blistering disease of the skin requiring skin and serum tests for a precise diagnosis.Objectives
We analysed the sensitivity and specificity of BP-relevant parameters and the value of autoantibody titres during follow-up of BP patients.Materials & methods
In a retrospective single-centre study, we included 200 consecutive patients with BP and 400 non-BP patients, and evaluated the test results of patients’ serum and skin. In addition, we followed patients’ autoantibody titres and clinical characteristics.Results
BP180-ELISA revealed the highest sensitivity (85.0%; specificity: 93.9%), while BP230-ELISA demonstrated the lowest sensitivity (55.5%; specificity: 92.9%). Direct and indirect immunofluorescence showed comparable results for sensitivity (77.2%/72.7%) and specificity (94.9%/93.7%). The sensitivity for skin histology was 76.3% (specificity: 81.3%). Longitudinal analysis showed significant changes in autoantibody titres.Conclusions
BP diagnostics should include serum tests for BP autoantibodies and skin immunofluorescence. Skin histology is supportive for diagnosis. Autoantibody titres are markers for disease activity.7.
Background
The origin of worm-like bodies and their relationship with Birbeck granules is poorly understood.Objectives
To clarify the origin of worm-like bodies and their relationship with Birbeck granules.Materials and methods
Over 800 electron micrographs of histiocytic disorders and several appendage tumours were reviewed in order to check for worm-like bodies and Birbeck granules.Results
Worm-like bodies were most often encountered in mildly-to moderately-proliferative histiocytic tumours. Birbeck granules were observed in more malignant conditions. Narrow endoplasmic reticulum (Nrer), which resembles worm-like bodies, was abundant in worm-like body-rich cells and coexisted with Birbeck rods. Nrer is thought to be one of the candidates that gives rise to worm-like bodies. An ultrastructural similarity exists between worm-like bodies (and octopus body formation) and the so-called “lupus erythematosus virus”.Conclusion
The presence of Nrer is often concomitant with other organelle markers, and could be a candidate for the origin of worm-like bodies.8.
Background
Acne is a chronic inflammatory disease associated with scar development in many patients.Objectives
To check whether early inflammatory events in the epidermis via keratinocytes influence the development of scars in acne patients.Methods
We investigated several immunological markers involved in epidermal innate immunity in both clinically normal skin and inflammatory early papules in acne patients prone to scars or not.Results
In normal skin of acne patients prone to scars vs not prone to scars, TLR-4, IL-2, IL-10, TIMP-2 and JUN were significantly overexpressed and the MMP-9 protein level was decreased. Similar results were obtained in early inflammatory papules (no more than three days), except for TLR-4.Conclusion
These results suggest for the first time a link between the early events of inflammation with levels of activation of innate immunity in normal epidermis of acne patients and the development of scars. These markers could be a target for drugs in the field of scar prevention.9.
Background
Atopic dermatitis is a chronic disabling inflammatory skin disorder, typically characterized by intensely itching, oozing, crusted, eroded vesicles or papules developing on erythematous plaques. Conventional treatments, both topical and systemic, may produce unsuccessful and unsatisfactory results.Objectives
we aimed to assess the efficacy of apheretic treatments in patients with severe, recalcitrant AD, in particular, the pruritic component.Patients and methods
four patients affected by recalcitrant and debilitating atopic dermatitis, who had previously received conventional topical and systemic therapies with poor clinical improvement, were treated with extracorporeal photopheresis or therapeutic plasma exchange.Results
a satisfactory response to apheresis was observed with a reduction of pruritus and skin lesions.Conclusion
In our experience, apheretic therapies might be used as monotherapy but, more effectively, in combination with topical and/or systemic treatments. Indeed, they proved to be a safe “enhancer” for increasing the efficacy of conventional therapeutics.10.
Background
Adapalene has been previously evaluated as a treatment for actinic keratosis (AK) and solar lentigines and shown to improve signs of photoaging.Objectives
To evaluate whether adapalene 0.3% gel is non-inferior to tretinoin 0.05% cream as treatment for photoaged skin.Materials & Methods
An investigator-blinded, parallel-group comparison study was conducted in Brazil. Subjects were randomised in a 1:1 ratio to receive, once daily, adapalene 0.3% gel or tretinoin 0.05% cream. Subjects were evaluated at Weeks 1, 4, 8, 12, 16, 20 and 24, based on clinical signs of cutaneous photoaging, histopathological and digital morphometric findings, as well as safety and tolerability.Results
A comparison of clinical efficacy showed that both treatments did not differ significantly regarding clinical evaluation of the following criteria: global cutaneous photoaging, periorbital wrinkles, ephelides/melanosis, forehead wrinkles, and AK.Conclusion
Adapalene 0.3% gel showed non-inferior efficacy to tretinoin 0.05% cream as treatment for photoaged skin, with a similar safety profile. Adapalene 0.3% gel may therefore be considered a safe and effective option for the treatment of mild or moderate photoaging.11.
Background
High-throughput DNA sequencing has shown that the cutaneous microbiome varies due to different exogenous and endogenous factors.Objectives
To characterize the microbiome of cutaneous melanomas and melanocytic nevi.Material and Methods
Non-invasive swab specimens were taken from 15 cutaneous melanomas and 17 benign melanocytic nevi. Partial sequencing of the 16S ribosomal RNA gene was carried out on the 454 GS-FLX Titanium platform and the resulting sequence data was analysed by bioinformatics and statistical methods.Results
95% of the OTUs (Operational Taxonomic Units) belonged to four phyla: Firmicutes, Actinobacteria, Proteobacteria and Bacteroidetes. The genus Propionibacterium was overall the mostcommongenus, followed by Staphylococcus and Corynebacterium. Statistical analysis showed no significant differences in the relative abundances of bacterial genera or bacterial diversity between the patient groups. Melanoma samples showed a marginally decreased cutaneous microbial diversity.Conclusion
Our data suggests that the skin microbiome may not be a useful diagnostic tool for melanoma and melanocytic nevi.12.
Won?Joo?Kwon Joo?Yeon?Ko Young?Suck?Ro Myung?Hwa?Kim Byung?Soo?Kim Hye?One?Kim Jae?Hui?Nam Ga-Young?Lee Mi?Youn?Park Sang?Wook?Son Jun?Mo?Yang Dong?Hun?Lee Ai?Young?Lee Jun?Young?Lee Sung?Eun?Chang Hae?Young?Choi Eun?Joo?Park
Background
A comparison between responses to allergens based on the TRUE Test® (TT) and IQ® Chamber (IQC) in Europeans has been previously reported, however, no such study has been performed in Asians.Objectives
To compare allergen responses using the TT and IQC (using the Korean standard series) in order to gather more information regarding the positive response rates for each allergen and the clinical value of IQC.Materials & methods
Suspected contact dermatitis patients were enrolled and tested with 18 allergens using the TT and IQC.Results
The test was performed in 214 patients. Simultaneous positive results for both tests were recorded in 242 cases (positive concordance rate: 66.7%). IQC yielded more positive results. Allergens with a high positive concordance rate were nickel sulphate (82.1%), thimerosal (78.6%), and p-phenylenediamine (73.3%). IQC mostly showed similar or higher positive rates than TT, with high concordance.Conclusions
We recommend the IQC method as a screening test in patients with suspected contact dermatitis. To compensate for possible false positive results, careful history taking and a different patch test should be performed when appropriate.13.
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.14.
Background
Chronic spontaneous urticaria (CSU) is a skin disease characterised by wheal appearance, swelling, itching, and painful skin. Omalizumab has been used for CSU treatment demonstrating good efficacy.Objectives
To investigate the efficacy and safety of omalizumab treatment in CSU patients in real-life practice.Materials & methods
A retrospective analysis was performed on 38 patients suffering from CSU who received 300 mg of omalizumab every four weeks.Results
After omalizumab treatment, 68.4% of patients showed a complete response (UAS7 = 0). All the patients were able to stop treatment with corticosteroids, cyclosporine, and anti-leukotrienes, and only 39.5% of patients remained on anti-histamines. Omalizumab treatment led to a 96% and 65% decrease in emergency room and primary health care visits, respectively, as well as a reduction in the direct costs associated with the disease. No omalizumab-related adverse events were reported.Conclusion
Omalizumab exhibits good efficacy in alleviating the symptoms of CSU, leads to a decrease in concomitant medication use, restores patients’ quality of life, and has economic benefits by reducing disease-related health care costs.15.
Background
Peripheral T-cell lymphomas, not otherwise specified (PTCL-NOS), are a rare condition characterised by specific histology, nodal presentation, and a poor prognosis. In total, 10-18% of patients present with cutaneous involvement which is regarded as a poor prognostic marker. However, cutaneous PTCL-NOS lesions have been rarely reported in the literature.Objectives
We sought to describe PTCLNOS cases characterised by erythrodermic dissemination to the skin.Materials & methods
Three cases of PTCL-NOS were investigated; all male, with a mean and median age of 55 and 51 years, respectively.Results
All patients underwent aggressive chemotherapeutic protocols with only transient improvement of the disease, and died within two years of follow-up.Conclusions
Dermatologists should be reminded that erythroderma and lymph node enlargement do not represent an exclusive paradigm for erythrodermic cutaneous T-cell lymphoma, and that these features can be due to a systemic lymphoma that should be considered in the differential diagnosis.16.
Background
Systemic chemotherapy is the main treatment of diffuse and/or aggressive classic Kaposi’s sarcoma (KS) but there are no standard treatment guidelines and published literature regarding vinorelbine is lacking.Objective
To assess the safety and effectiveness of intravenous vinorelbine in the treatment of classic KS.Materials and Methods
We performed a retrospective study of a departmental database in histologically proven classic KS.Results
Twenty patients received intravenous vinorelbine as cycles of 20 mg/m2 once every two weeks for 5 cycles and subsequently at a dose of 30 mg/m2 once every three weeks. Of 19 assessable patients, three (16%) had a complete remission and 11 (58%) had a partial response, for an overall response rate of 74%. The remaining 5 patients had a stable disease (26%). Grade 3 or 4 toxicities were neutropenia (3/20 patients), deep vein thrombosis (1/20 patients) and constipation (1/20 patients). The median progression-free survival from the start of therapy until the development of progressive disease was 35.1 months.Conclusions
Vinorelbine is an effective and overall well tolerated treatment for classic KS.17.
Background
Rhinophyma is a deforming soft tissue hyperplasia of the nose and surgical removal represents the treatment of choice. Comprehensive data on surgical therapy and the impact of rhinophyma on patient quality of life are lacking.Objectives
Patients who received surgery for rhinophyma between 2006 and 2015 were retrospectively evaluated for postoperative complications, clinical outcome, recurrence of rhinophyma, and the impact of rhinophyma on daily life.Materials & Methods
A total of 143 patients were treated with superficial tumour decortication by scalpel under tumescent anaesthesia. Outcomes were determined by clinical review, clinical files, and a patient questionnaire.Results
Of 143 patients, 70 answered the questionnaire and were included in this study with a mean follow-up time of 54 months. Cosmetic results were evaluated as very good or good in 77% of patients. The majority of patients (87%) were very satisfied or satisfied with the postoperative result. Surgical treatment of rhinophyma improved patients’ quality of life in 67% of patients. Recurrence of rhinophyma was detected in 38% of patients.Conclusion
Surgery is an effective therapy for rhinophyma with excellent outcome.18.
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.19.
Mary?Nguyen-Nielsen Lisa?Wang Lars?Pedersen Anne?Braae?Olesen Jeannie?Hou Howard?Mackey Margaret?McCusker Nicole?Basset-Seguin Jon?Fryzek Mogens?Vyberg
Background
Few data exist on the occurrence of metastatic basal cell carcinoma (mBCC).Objective
To identify all cases of mBCC in Denmark over a 14-year period.Methods
We searched the Danish National Patient Registry covering all Danish hospitals, the Danish Cancer Registry, the National Pathology Registry and the Causes of Death Registry during the period 1997 to 2010 for potential cases of mBCC registered according to the International classification of diseases ICD-10 and the International Systemized Nomenclature of Medicine (SNOMED).Results
We identified 126,627 patients with a history of primary basal cell carcinoma (BCC) in the registries during the 14-year study period. Using case identifications from the four registries, a total of 170 potential mBCC cases were identified. However, after a pathology review, only five cases could be confirmed, of which three were basosquamous carcinomas. The 14-year cumulative incidence proportion of mBCC was 0.0039% (95% CI 0.0016–0.0083) among individuals with a history of previousBCC(n = 126,627) and 0.0001% (95% CI 0.0000–0.0002) in the general population.Conclusion
MBCCis a rare disease and only a small proportion of potential cases identified in automated clinical databases or registries can be confirmed by pathology and medical record review.20.