Current Issue : October - December Volume : 2015 Issue Number : 4 Articles : 7 Articles
Background: Psoriasis prevalence and characteristics in Asia, Central Europe, and Latin America have not been\nthoroughly investigated and there are no large trials for biologic treatments for patients from these regions. The\ngoal of this analysis was to report clinical response to anti-tumor necrosis factor-alpha treatment in these patients.\nMethods: Patients from Argentina, Czech Republic, Hungary, Mexico, Taiwan, and Thailand (N = 171) were included\nin this subset analysis of the PRISTINE trial. Patients with stable moderate-to-severe plaque psoriasis were blinded\nand randomized to receive etanercept 50 mg once weekly (QW) or biweekly (BIW) for 12 weeks, followed by 12 weeks\nof open-label QW treatment with etanercept 50 mg through week 24 (QW/QW vs. BIW/QW). Concomitant methotrexate\n(?20 mg/week) and mild topical corticosteroids or other agents were permitted at the physician�s discretion, in\naccordance with therapeutic practice.\nResults: As early as week 8, 26.7 % in the etanercept QW group and 44.0 % in the BIW group achieved Psoriasis\nArea and Severity Index (PASI) 75. At weeks 12 and 24, respectively, PASI 75 increased to 39.5 % and 62.8 % in the\nQW/QW group and 66.7 % and 83.3 % in the BIW/QW group. PASI 75 was significantly different between treatment\ngroups from week 8 through the end of study (p < 0.05). The Kaplan-Meier estimate of the proportions achieving PASI\n75 in QW/QW and BIW/QW groups, respectively, was 27.4 % and 45.8 % through week 8; 41.9 % and 68.7 % through\nweek 12; and 72.5 % and 95.2 % through week 24.\nConclusions: Treatment with etanercept 50 mg provided rapid relief of psoriasis symptoms in patients from Asia,\nCentral Europe, and Latin America. A more rapid response was observed in patients who received BIW treatment for\nthe first 12 weeks which was sustained after reducing to QW dosing for the subsequent 12 weeks. Response rates were\nsimilar to those observed in the overall PRISTINE population....
Background: Plaque psoriasis is a debilitating skin condition that affects approximately 2% of the adult population\nand for which there is currently no cure. Tofacitinib is an oral Janus kinase inhibitor that is being investigated for\npsoriasis.\nMethods: The design of this study has been reported previously (NCT00678210). Patients with moderate to severe\nchronic plaque psoriasis received tofacitinib (2 mg, 5 mg, or 15 mg) or placebo, twice daily, for 12 weeks.\nLymphocyte sub-populations, cytomegalovirus (CMV) and Epstein-Barr virus (EBV) DNA were measured at baseline\nand up to Week 12.\nResults: Tofacitinib was associated with modest, dose-dependent percentage increases from baseline in median B\ncell count at Week 4 (24ââ?¬â??68%) and Week 12 (18ââ?¬â??43%) and percentage reductions from baseline in median natural\nkiller cell count at Week 4 (11ââ?¬â??40%). The proportion of patients with detectable CMV and EBV DNA (defined as\n>0 copies/500 ng total DNA) increased post-baseline in tofacitinib-treated patients. However, multivariate analyses\nfound no relationship between changes in CMV or EBV viral load and changes in lymphocyte sub-populations or\ntofacitinib treatment.\nConclusions: Twelve weeks of treatment with tofacitinib had no clinically significant effects on CMV or EBV viral load,\nsuggesting that lymphocyte sub-populations critical to the response to chronic viral infections and viral reactivation\nwere not significantly affected. Replication of these findings during long-term use of tofacitinib will allow confirmation\nof this observation....
PHACE syndrome is a neurocutaneous disorder characterized by large cervicofacial infantile hemangiomas and associated\nanomalies: posterior fossa brain malformation, hemangioma, arterial cerebrovascular anomalies, coarctation of the aorta\nand cardiac defects, and eye/endocrine abnormalities of the brain. When ventral developmental defects (sternal clefting or\nsupraumbilical raphe) are present the condition is termed PHACE. In this report, we describe three PHACE cases that presented\nunique features (affecting one of the organ systems described for this syndrome) that have not been described previously. In the\nfirst case, a definitive PHACE association, the patient presented with an ipsilateral mesenteric lymphatic malformation, at the age\nof 14 years. In the second case, an anomaly of the posterior segment of the eye, not mentioned before in PHACE literature, a\nretinoblastoma, has been described. Specific chemotherapy avoided enucleation. And, in the third case, the child presented with\nan unusual midline frontal bone cleft, corresponding to Tessier 14 cleft. Two patients� hemangiomas responded well to propranolol\ntherapy.The first one was followed and treated in the pre-propranolol era and had amoderate response to corticoids and interferon....
The objective of this paper is to report a case of extramammary Paget disease of the vulva, to describe its diagnosis, surgical\ntreatment, and outcome, and to discuss the general characteristics of this pathology. This is a rare neoplasm, found principally\nin areas in which apocrine and eccrine glands are numerous. This case report is relevant to the literature since the differential\ndiagnosis of extramammary Paget disease is difficult to be done only with the macroscopic appearance of the lesion and even\nwith the microscopic characteristics, requiring further studies, immunohistochemistry, as to differentiate pathologies. The present\nreport describes the case of a 63-year-old patient at the Santa Casa de Miseric�´ordia Hospital in Vit�´oria, Esp�´?rito Santo, Brazil, who\npresented with a hardened, ulcerated, and purplish lesion with hyperchromic and hypochromic spots, measuring 4 cm in diameter,\nlocated on the lower third of right labium majus, close to the vaginal fourchette. A right hemivulvectomy was performed, leaving\nwide margins all around.The patient progressed satisfactorily following surgery. Although extramammary Paget disease is rare, its\nincidence increases as a function of the patientâ��s age. Patients should be followed up closely because of the risk of persistence and/or\nrecurrence of the disease....
We described a case of Staphylococcal Scalded Skin Syndrome in infant age of 21 days by discussing clinical and management\nissues. This newborn presented large erythematous, eroded, and oozing areas covered by epidermal skin flap. The average surface\nof cutaneous unsticking on admission was 31.35% of body surface area corresponding to lesions of superficial second-degree burns.\nAn important biological inflammatory syndrome including positive C-reactive protein was found. Under treatment, erythroderma\ndecreased within 7 to 10 days and the newborn was completely healed after 3 weeks of followup, with the disappearance of the\ninflammatory syndrome and total body surface restored. This clinical case report showed that SSSS remains a major dermatological\nproblem in neonates. Therefore, its diagnosis should be made without doubt and its care should start earlier in a neonate emergency\nunit in order to have good prognosis. And the rigorous ââ?¬Å?search and destroyââ?¬Â policy based on screening of staff and patients and\nisolation of identified patients advocated in the United Kingdom should be applied in neonate units in CÃ?â? ote dââ?¬â?¢Ivoire...
Background: Stress or psychological distress is often described as a causative or maintaining factor in psoriasis.\nPsychological traits may influence the appraisal, interpretation and coping ability regarding stressful situations.\nDetailed investigations of psychological traits in relation to stress reactivity in psoriasis are rare. The aim of this\nstudy was to examine whether patients with psoriasis who report an association between psychological distress\nand exacerbation, ââ?¬Å?stress reactorsââ?¬Â (SRs), differ psychologically from those with no stress reactivity ââ?¬Å?non-stress\nreactorsââ?¬Â (NSRs).\nMethods: This cross-sectional study was conducted among 101 consecutively recruited outpatients with plaque\npsoriasis. A psychosocial interview was performed including questions concerning stress reactivity in relation to\nonset and exacerbation. Three validated self-rating scales were used: Spielberger State-Trait Anxiety Inventory (STAI,\nForm-Y), Beck Depression Inventory (BDI-II) and Swedish Universities Scales of Personality (SSP). Independent samples\nt-tests, Chi-square tests and one-way ANOVA analyses were used for group comparisons when appropriate. A logistic\nregression model was designed with SR as the dependent variable.\nResults: Sixty-four patients (63%) reported a subjective association between disease exacerbation and stress (SRs).\nPatients defined as SRs reported significantly higher mean scores regarding state and trait anxiety, depression, and also\nfive SSP scale personality traits, i.e. somatic trait anxiety, psychic trait anxiety, stress susceptibility, lack of assertiveness\nand mistrust, compared with NSRs. In multivariate analysis, SSP-stress susceptibility was the strongest explanatory\nvariable for SR, i.e. OR (95% CI) = 1.13 (1.02 ââ?¬â?? 1.24), p = 0.018.\nConclusion: According to our results, patients who perceive stress as a causal factor in their psoriasis might have a\nmore vulnerable psychological constitution. This finding suggests important opportunities for clinicians to identify\npatients who may benefit from additional psychological exploration and support...
Background: Public health nurses report on effects of fresh human milk as treatment for conjunctivitis, rhinitis and\natopic eczema (AE), the latter being highly prevalent in early childhood. Emollients and topical corticosteroids are\nfirst line treatment of AE. As many caregivers have steroid phobia, alternative treatment options for mild AE are of\ninterest. The aim of this small pilot study was to assess the potential effects and risks of applying fresh human milk\nlocally on eczema spots in children with AE.\nMethods: This was a split body, controlled, randomized and physician blinded pilot study, of children with AE with\ntwo similar contralateral eczema spots having a mother breastfeeding the child or a sibling. Fresh expressed milk\nand emollient was applied on the intervention spot and emollient alone on the control area, three times a day for\nfour weeks. The severity and area of the eczema spots was evaluated weekly, and samples from milk and the spots\nwere analysed weekly with respect to bacterial colonisation.\nResults: Of nine patients included, six completed the study. Mean age at inclusion was 18.5 months. The spots\nexamined were localized on the arms, legs or cheeks. The spots were similar in severity, but differed in area. In one\npatient the eczema ceased after inclusion. In four patients both control and intervention areas increased during the\nintervention. The relative change in eczema area compared to baseline showed less increase in the intervention\nspots in two patients, whereas the opposite was observed in three. In four children Staphylococcus aureus was\nfound in their eczema once or more. In three of the 28 human milk samples, Staphylococcus aureus, alfa haemolytic\nstreptococci or coagulase negative staphylococci were detected. Staphylococcus aureus was found once both in\nhuman milk and in the eczema spots, no clinical signs of infection were however observed. No secondary infection\ndue to milk application was detected.\nConclusion: In this small pilot study, no effect was found on eczema spots treated with topical application of fresh\nhuman milk. (ClinicalTrials.gov Identifier, NCT02381028)....
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