Aikaterini Kyriakou

Ustekinumab in nail psoriasis: an open-label, uncontrolled, nonrandomized study

Abstract Background: Ustekinumab has been most recently approved for psoriasis treatment and its efficacy on nail psoriasis is still underreported. Methods: Twenty-seven patients suffering from moderate-to-severe plaque psoriasis with nail involvement were enrolled in this open-label, uncontrolled, nonrandomized study to evaluate the therapeutic potential of ustekinumab. Participants were scheduled to receive subcutaneous injections of ustekinumab at a dose of 45 mg at baseline and week 4 and every 12 weeks thereafter. Nail Psoriasis Severity Index (NAPSI) and Psoriasis Area Severity Index (PASI) were assessed apart from baseline at weeks 16, 28, and 40. Results: NAPSI median score significantly decreased from 73.0 (range: 12.0–151.0) at baseline to 37.0 (range: 7.0–92.0) at week 16, to 9.0 (range: 0.0–32.0) at week 28, and to 0.0 (range: 0.0–12.0) at week 40. Median PASI score decreased from 23.9 (range: 10.6–45.5) at baseline to 0.0 (range: 0.0–5.2) at week 40. NAPSI median improvement was of 42.5% (range: 21.9–64.9%) at week 16, 86.3% (range: 75.0–100.0%) at week 28, and 100.0% (range: 91.0–100.0%) at week 40. PASI score showed a significant median improvement of 76.9% (range: 10.3–90.3%) and 100.0% (range: 71.7–100.0%), at weeks 16 and 40, respectively. Conclusion: Although this study may be considered as preliminary, data suggest that ustekinumab is very effective in nail psoriasis.

Detailed Analysis of Specific Nail Psoriasis Features and Their Correlations with Clinical Parameters: A Cross-Sectional Study

Background:Occurrence rates of specific features of psoriatic nails, as well as the influence of variable clinical parameters on nail involvement in psoriasis, are not determined. Objective:To evaluate the frequency and characteristics of nail involvement in patients with psoriasis and determine the relationship between nail psoriasis and clinical parameters (age, gender, family history, clinical type, age of onset, duration, joint involvement). Methods: 228 psoriatic patients, who had not received any systematic or topical antipsoriatic treatment for at least a year, were consecutively selected to participate in this cross-sectional study. Results: 66.7% of patients had nail psoriasis. A logistic regression model showed that none of the clinical covariates were statistically significant in predicting nail psoriasis. Conclusion: The majority of psoriatic patients presented nail psoriasis. The most common feature was oil drop. There was a difference in the prevalence of each feature between fingernails and toenails. In correlation with clinical parameters, nail psoriasis evolves independently.

Necrobiosis Lipoidica: Early Diagnosis and Treatment with Tacrolimus

We present a case of necrobiosis lipoidica (NL) with atypical early lesions and good response to topical tacrolimus. NL is a disease with clinical features that are seldom misinterpreted. Often histology just confirms the clinician’s diagnosis. Only in rare cases, the clinical presentation and the involved body sites may be misleading. A 67-year-old diabetic woman was admitted to our department with a well-defined, persistent plaque on her left arm and on her right shin. Histologic examination of both lesions revealed features of NL despite the dissimilar clinical presentation. The patient was treated with 0.1% topical tacrolimus ointment twice daily for 8 weeks and once daily for 8 weeks. A significant improvement and no further lesions were observed after 1 year of follow-up. A high index of suspicion regarding NL lesions with atypical clinical presentation on different body sites is advised in order to avoid misdiagnosis, wrong treatment decisions and ulceration. Additionally, it appears that topical tacrolimus treatment is an effective therapeutic option in patients with recent, non-ulcerated NL lesions.

Therapeutic efficacy of topical calcineurin inhibitors in plasma cell balanitis: case series and review of the literature.

Plasma cell balanitis of Zoon (PCBZ) and plasma cell vulvitis (PCV) are characterized as idiopathic, benign, chronic irritant mucositis. The clinical symptoms and signs usually persist or reappear after treatment withdrawal. Therefore, many therapies have been tried and are available. Recently, several reports of PCBZ and PCV treated with calcineurin inhibitors, tacrolimus and pimecrolimus, have been reported in the literature. We present 9 cases of PCBZ treated with tacrolimus 0.1% ointment (Protopic, Toyama, Japan) that showed good therapeutic results within 4 weeks of treatment, and we review the literature of PCBZ and PCV and their response to these topical immunomodulators. Based on the current literature and on the anecdotal experience, we believe that topical calcineurin inhibitors may serve as a therapeutic option in recalcitrant plasma cell balanitis and vulvitis.

Clinical Significance of Anti-desmoglein-1 and -3 Circulating Autoantibodies in Pemphigus Patients Measured by Area Index and Intensity Score

Detection of anti-desmoglein-1 (anti-DSG-1) and anti-DSG-3 autoantibodies is widely used in the diagnosis of pemphigus. Two validated scoring systems, Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS), are used for the evaluation of clinical severity. The aim of this cross-sectional study was to interpret the titres of pemphigus autoantibodies in correlation with either total or location-dependent PDAI scores and ABSIS. A total of 35 pemphigus patients were selected and evaluated at 3 time points. Total PDAI and ABSIS seemed useful in pemphigus with cutaneous lesions or in the mucocutaneous form, while location-dependent PDAI and ABSIS scores were useful in the mucosal form. Anti-DSG-1 autoantibodies titres better showed the disease extent in pemphigus with cutaneous only or with mucocutaneous lesions. Anti-DSG-3 autoantibodies titres did not correlate to disease activity.

Serum Levels of TNF-α, IL-12/23p40, and IL-17 in Plaque Psoriasis and Their Correlation with Disease Severity

A case-control study was performed to assess the serum levels of TNF-α, IL-12/23p40, and IL-17 in patients with plaque psoriasis, compare them with healthy controls, and correlate them with disease severity, as represented by Psoriasis Area Severity Index (PASI). 32 consecutively selected, untreated patients with active, chronic plaque psoriasis were recruited and compared to 32 age- and sex-matched healthy controls. Serum cytokine levels were determined by solid phase sandwich enzyme linked immunosorbent assay (R&D Systems Europe, Ltd.). The mean serum levels of TNF-α were significantly higher in psoriatic patients compared to those of controls (Mann-Whitney U test; P = 0.000). However, the median serum levels of neither IL-12/23p40 nor IL-17 differ significantly between the 2 groups (Mann-Whitney U test; P = 0.968 and P = 0.311, resp.). No significant correlations were found between PASI and any of the cytokine serum levels (Spearmans rank test; P > 0.05). Despite the well-evidenced therapeutic efficacy of biologic agents targeting TNF-α, IL-12/23p40, and IL-17, serum levels of TNF-α, IL-12/23p40, and IL-17 do not seem to correlate with the severity of psoriatic skin disease in untreated patients, as represented by PASI. Further investigation may add more data on the pathogenetic cascade of psoriasis.

Association of autoantibodies to BP180 with disease activity in Greek patients with bullous pemphigoid.

39 bullous pemphigoid (BP) patients were studied to assess the clinical significance of anti-BP180 and anti-BP230 circulating autoantibodies of BP and correlate their titers with the clinical scores of the BP Disease Area Index (BPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) as well as with the intensity of pruritus measured by the BPDAI pruritus component. All parameters were evaluated by the time of diagnosis (baseline), month 3, and month 6. Titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (r = 0.557, P  value < 0.0001) and ABSIS (r = 0.570, P  value < 0.0001) values, as well as with BPDAI component for the intensity of pruritus (rho = 0.530, P  value = 0.001) at baseline. At month 3, titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (rho = 0.626, P  value = 0.000) and ABSIS (rho = 0.625, P  value = 0.000) values, as well as with the BPDAI component for the intensity of pruritus (rho = 0.625, P  value = 0.000). At month 6, titers of anti-BP180 autoantibodies were strongly correlated with BPDAI (rho = 0.527, P  value = 0.001) and ABSIS (rho = 0.526, P  value = 0.001) values, as well as with the BPDAI component for the intensity of pruritus (rho = 0.525, P  value = 0.001). There was no statistically significant correlation between titers of anti-BP230 autoantibodies and the BPDAI, ABSIS, and BPDAI component for the intensity of pruritus at the same time points.

Treatment of male genital lichen sclerosus with clobetasol propionate and maintenance with either methylprednisolone aceponate or tacrolimus: a retrospective study

Objective: To assess the efficacy of clobetasol propionate 0.05% cream in male patients suffering from genital lichen sclerosus (GLS), as well as the efficacy of methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment as maintenance therapy. Methods: The study was conducted retrospectively. At baseline, male patients with GLS (n = 41) were treated with clobetasol propionate 0.05% cream applied twice daily for 8 weeks. Visual Analog Scale (VAS) score for pruritus, Investigators Global Assessment (IGA) score and Dermatology Life Quality Index (DLQI) were recorded at baseline, week 8 and week 20. At week 8, patients responsive to treatment (n = 37) were further treated with methylprednisolone aceponate 0.1% cream twice weekly (n = 17) or tacrolimus 0.1% ointment once daily (n = 20), as maintenance therapy until week 20. Results: VAS, IGA and DLQI median scores were significantly decreased from baseline to week 8 (p < 0.001). At week 20, patients treated with methylprednisolone aceponate 0.1% cream presented no significant difference in median IGA score (p = 0.865), median DLQI score (p = 0.853) or median VAS score (p = 0.474) compared with patients treated with tacrolimus 0.1% ointment. Conclusions: Clobetasol propionate 0.05% cream is effective as first-line treatment in male GLS. The data suggest that there is no difference between methylprednisolone aceponate 0.1% cream and tacrolimus 0.1% ointment in preventing the relapses.

Biologic agents in nail psoriasis: efficacy data and considerations

Introduction: Nail psoriasis plays a major role in the overall assessment of psoriatic disease. Four biologic agents are officially labeled for the treatment of moderate to severe, stable plaque psoriasis (adalimumab, etanercept, infliximab, ustekinumab) and have enriched subsequently the therapeutic armamentarium against psoriatic nails. However, evidence for the efficacy of these agents for nail psoriasis is under investigation. Areas covered: In this review an effort has been made to summarize evidence regarding the efficacy of biologics in nail psoriasis. A systemic search for reports of biologic agents in psoriatic patients with nail involvement was carried out (MEDLINE and CENTRAL in the Cochrane Library). Relevant data are thoroughly presented. Expert opinion: All four biologic agents have shown efficacy on psoriatic nail disease. However, published data are heterogeneous, based on studies assessing the therapeutic efficacy with different scoring indexes and at different time points, depending on the time table of each drug administration. Therefore, the need for consensus on core outcome to be used is mandatory. Additionally, optimization of the scoring systems and the conduction of further trials of high quality and validity could lead to more accurate conclusions on the efficacy of biologic agents in the treatment of nail psoriasis.

Cyclosporine in the Management of Impetigo Herpetiformis: A Case Report and Review of the Literature

A 27-year-old female, gravida 1, para 0, in week 22 of pregnancy, presented with an eruption consisting of annular erythematosquamous plaques with an active polycyclic elevated border comprised of superficial micropustules. Clinical and histological features were typical of impetigo herpetiformis (IH). Systemic steroids resulted in an unstable condition, with no resolution of lesions. Resistance to the above therapeutic scheme served as a stimulus to discuss the use of cyclosporine as a therapeutic option in this condition. Reviewing the limited literature, cyclosporine seems to serve not as a monotherapy in the management of IH but as an additional medication, in order to achieve a stable course of the disease and avoid high doses of systemic steroids.