Pregnancy outcomes in women with moderate‐to‐severe psoriasis

Background The association between psoriasis and pregnancy outcomes has not been adequately examined, although psoriasis onset is common in the reproductive period. Objective To evaluate the association between moderate‐to‐severe psoriasis and pregnancy complications. Methods A retrospective, matched cohort study of 68 deliveries in 35 women with moderate‐to‐severe psoriasis compared to 237 deliveries in 236 women without psoriasis randomly selected after matching for age, parity and gestational age. Results The psoriasis patients had higher mean of past spontaneous (0.42 ± 0.58 vs. 0.26 ± 0.63, P = 0.002) and induced (0.32 ± 0.60 vs. 0.06 ± 0.25, P = 0.001) abortions than controls. They had a higher percentage of pregnancy‐induced hypertensive diseases (7.4% vs. 2.1%, P < 0.05) and premature rupture of membranes (16% vs. 5.5%, P < 0.008). Newborns to women with psoriasis had higher birth weight (3375 ± 543 g vs. 3247 ± 460 g, P = 0.03), increased percentage of large‐for‐gestational age (24% vs. 12%, P = 0.02), and macrosomia (13% vs. 4.2%P = 0.02). In multivariate analysis, moderate‐to‐severe psoriasis was an independent risk factor for previous spontaneous abortions, induced abortions, premature rupture of membranes (PROM), and newborn macrosomia. Conclusion Moderate‐to‐severe psoriasis is associated with spontaneous and induced abortions, pregnancy‐induced hypertensive diseases, premature rupture of membranes, large‐for‐gestational age newborns, and macrosomia.     

Haplotype analysis in a 16‐year‐old boy with vancomycin‐induced DRESS syndrome

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare but life‐threatening multisystem adverse reaction to a medication, with vancomycin being one of the most common cause reported. We present the HLA analysis of a pediatric patient who developed DRESS related to vancomycin and compared the results with the available literature. With further data, the use of pretreatment HLA analysis to prevent vancomycin related DRESS may be a valuable option in the near future.     

Behavioral Characteristics in 18‐ to 36‐Month‐Old Toddlers with Atopic Dermatitis Compared with Healthy Children

Abstract: Some differences in behavioral characteristics have been attributed to atopic dermatitis (AD). In this study, AD patients compared with healthy toddlers had significantly higher scores in perceptual sensitivity and high pleasure in an early childhood behavior questionnaire (ECBQ). They tended to be more energetic and impulsive, and also showed more excitement when subjected to novel stimuli.     

Reduction in the appearance of facial hyperpigmentation by topical N‐undecyl‐10‐enoyl‐l‐phenylalanine and its combination with niacinamide

Objectives N‐undecyl‐10‐enoyl‐l ‐phenylalanine (Sepiwhite^®, N‐undecylenoyl phenylalanine), a reported alpha‐melanocyte‐stimulating hormone (MSH) receptor antagonist, has been observed to reduce melanin production in cultured melanocytes. In other testing, niacinamide has been found to inhibit melanosome transfer in cultured cells and to reduce the appearance of hyperpigmented spots in clinical studies. Since these two agents function by different mechanisms, we conducted two studies to determine if their combination is more effective than niacinamide alone in reducing facial hyperpigmentation. Methods  Two double‐blind, 10‐week (2‐week washout + 8‐week treatment), left‐right randomized, split‐face clinical studies were conducted. In one, two groups of Japanese women applied one of two pairs of test emulsion formulations: a vehicle control and a 5% niacinamide formulation (n= 40), or a 5% niacinamide and a 5% niacinamide plus 1%N‐undecylenoyl phenylalanine formulation (n = 40). Each formulation was applied to the randomly assigned side of the face. In the second study, Caucasian women applied one of three emulsions: vehicle control, 5% niacinamide formulation, or combination 5% niacinamide plus 1%N‐undecylenoyl‐phenylalanine formulation to the randomly assigned side of the face (n = ～60 treatment sites per formulation). In both studies, hyperpigmented spots were evaluated at weeks 4 and 8 by quantitative image analysis. Results  In both studies, the combination formulation was significantly more effective than the vehicle and the 5% niacinamide formulation in reducing the appearance of hyperpigmentation after 8 weeks. Conclusions  The combination of 5% niacinamide and 1%N‐undecylenoyl phenylalanine is an effective anti‐aging technology for use on facial skin.     

Elevation of serum KL‐6 in patients with psoriasis treated with anti‐tumour necrosis factor‐α therapy

We report three patients with psoriasis whose serum level of Krebs Von Den Lungen (KL)‐6 increased during therapy with anti‐tumour necrosis factor (TNF)‐α. A diagnosis of early‐phase or subclinical interstitial pneumonia was made in two patients, and their KL‐6 level decreased after anti‐TNF‐α discontinuation. The rise in KL‐6 in the other patient was attributed to methotrexate. We propose that serum KL‐6 should be monitored routinely in patients treated with anti‐TNF agents.     

Responses to ustekinumab in the anti‐TNF agent‐naïve vs. anti‐TNF agent‐exposed patients with psoriasis vulgaris

Background Approximately 20–30% of patients with psoriasis treated with anti‐tumour necrosis factor α (TNFα) agents will discontinue treatment within 2 years due to loss of efficacy or side‐effects. Switching to another anti‐TNFα agent produces clinical responses inferior to previously untreated patients. Ustekinumab binds to the p40 subunit of interleukin (IL)‐12 and IL‐23 and provides a mechanism of action independent of TNFα. Objective To investigate the efficacy of ustekinumab in a clinical practice setting and to compare treatment responses to ustekinumab in patients previously treated with TNFα inhibitors and anti‐TNFα‐naïve patients. Methods Patients receiving either ustekinumab (n = 71) or the subcutaneous TNFα inhibitors adalimumab or etanercept (n = 108) were identified through the registry of psoriasis patients in our Institutions. Efficacy effect outcome was a 75% improvement in the psoriasis area severity index (PASI75). Kaplan–Meier statistics evaluated the adherence to the treatments expressed as drug survival rate. Results PASI75 was achieved in 80% of the ustekinumab‐treated patients after a median time of 112 days. There was no difference in efficacy in anti‐TNFα‐naïve patients compared with anti‐TNFα unresponsive patients. Patients treated with ustekinumab showed a superior adherence to treatment in comparison with adalimumab and etanercept. Limitations Patients were non‐randomly assigned to treatment, which potentially may lead to biases. Observation time was short (1 year). Conclusion In clinical practice, the short‐term efficacy and patient adherence to ustekinumab are excellent and comparable to the data obtained in clinical trials. Lack of response to previous anti‐TNF treatment does not impair clinical response to ustekinumab.     

Effective anti‐programmed death‐1 therapy in a SUFU‐mutated patient with Gorlin–Goltz syndrome

We present the case of a 77‐year‐old male patient with more than 50 basal cell carcinomas on the head and upper trunk. The patient did not respond to several lines of treatment, including surgery, imiquimod, retinoids, itraconazole and therapy with the hedgehog inhibitor vismodegib. The patient responded well to off‐label therapy with the anti‐programmed death‐1 antibody pembrolizumab after four infusions.     

Autologous Graft‐Versus‐Host Disease in a Child with Stage IV Neuroblastoma

Graft‐versus‐host disease (GVHD) is an underappreciated complication of autologous hematopoietic stem cell transplantation (AHSCT) that can affect the skin, gastrointestinal tract, and liver. The development of this rare condition is probably due to an impairment of immunologic tolerance that can occur spontaneously through T‐cell dysregulation, possibly from intensive conditioning chemotherapy regimens, or intentionally through administration of cyclosporine in the hopes of promoting an antitumor response. We present the case of a 2‐year‐old boy with metastatic neuroblastoma who spontaneously developed autologous GVHD after AHSCT. Severe pruritus and an inability to taper his oral steroids without a disease flare marked his disease. Eventually partial relief was achieved with initiation of cyclosporine and a strict soak and smear protocol using topical triamcinolone 0.1% ointment.