Aikaterini Patsatsi

Pharmacogenetic analysis of TNF, TNFRSF1A, and TNFRSF1B gene polymorphisms and prediction of response to anti-TNF therapy in psoriasis patients in the Greek population.

AbstractBackground: Although biologic therapies have revolutionized the treatment of psoriasis, patients exhibit a substantial heterogeneous response that could be due to complex genetic heterogeneity. Objective: The aim of this study was to investigate the possible influence of tumor necrosis factor-α (TNF), TNF receptor I (TNFRSF1A), and TNF receptor II (TNFRSF1B) gene polymorphisms on anti-TNF treatment responsiveness in psoriasis patients. Methods: A Greek multicenter collaboration was established to recruit a cohort of patients (n = 80) with psoriasis treated with anti-TNF drugs. Single nucleotide polymorphisms (SNPs) in TNF -238G>A, -308G>A, -857C>T), TNFRSF1A (36A>G), and TNFRSF1B (676T>G) were genotyped by PCR-restriction fragment length polymorphism assays. SNPs and haplotypes, including stratification by comorbidity status, were analyzed for association with treatment response after 6 months of therapy, defined as a reduction in the Psoriasis Area and Severity Index (PASI) score by >75% (responders) or ≤50% (nonresponders). Results: Sixty-three patients (78.8%) were defined as responders (PASI score reduction >75%) and 17 patients (21.2%) were defined as nonresponders (PASI score reduction ≤50%). Carriage of TNF -857C or TNFRSF1B 676T alleles was associated with positive response to drug treatment in patients treated with etanercept (p = 0.002 and p = 0.001, respectively). None of the genotyped SNPs were associated with responsiveness to treatment with infliximab or adalimumab. Additionally, when patients were stratified by comorbidity status, none of the genotyped SNPs were alone associated with responsiveness to drug treatment. Conclusion: This study is the first in the field of psoriasis demonstrating a strong association between genetic markers and positive response to drug treatment. Validation of this result in larger studies, as well as analysis of other drug treatments, could provide the basis for individually tailored treatment, along with increased cost effectiveness and reduced unnecessary exposure to toxicity.

Febrile ulceronecrotic Mucha-Habermann disease: a case report and review of the literature.

Febrile ulceronecrotic Mucha-Habermann disease is a severe variant of pityriasis lichenoides et varioliformis acuta characterized by the sudden onset of ulceronecrotic skin lesions and associated with high fever and systemic symptoms. We report here a case of a 20-year-old woman in whom the disease started as pityriasis lichenoides et varioliformis acuta and evolved to febrile ulceronecrotic Mucha-Habermann disease. Almost 90% of the body surface was involved, together with high fever and malaise. Steroids alone proved to be an insufficient therapeutic procedure. The remission achieved was attributed to the use of methotrexate. To our knowledge, only 39 cases of febrile ulceronecrotic Mucha-Habermann disease have been reported in the literature to date.

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.

Extrinsic aging: UV-mediated skin carcinogenesis

Age-associated skin lesions linked to UV radiation (UVR) include actinic keratosis, non-melanoma skin cancer—such as basal cell carcinoma and squamous cell carcinoma—lentigo senilis and lentigo maligna. Their incidence is increasing worldwide, mainly due to exaggerated UV exposure and to an aging population. Early diagnosis and therapy of pre-malignant cutaneous lesions is crucial for the secondary prophylaxis of invasive and highly aggressive skin cancers. Combined efforts to increase public awareness, patient education about self-examination, prophylactic modalities, such as consistent and sufficient UV protection, and rigorous follow-up of high-risk groups are of highest importance.

Photodermatoses with onset in the elderly.

Photodermatoses are a group of skin disorders induced by ultraviolet radiation (UVR) and, in some cases, visible light. To establish a diagnosis it is important to carefully take a history, physical examination and perform phototesting as well as other testing when appropriate (patch and photopatch tests, antinuclear antibodies, porphyrin profile). This article focuses on the photodermatoses that affect the elderly, which with the ageing of population, particularly in the industrialized societies, are becoming an increasingly important group for the healthcare systems. The most common photodermatoses with onset in the elderly are chronic actinic dermatitis and drug induced photosensitivity.

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.

5-Aminolevulinic acid-photodynamic treatment for dermatophytic tinea pedis of interdigital type: a small clinical study

© 2008 The Authors JEADV 2009, 23, 169–243 Journal compilation

Applicability of dermoscopy for evaluation of patients' response to nonablative therapies for the treatment of superficial basal cell carcinoma

Applicability of dermoscopy in evaluation of outcome and monitoring of superficial basal cell carcinoma (sBCC) after nonablative therapies has not been sufficiently assessed.

Recalcitrant vulvar lichen sclerosis treated with aminolevulinic acid‐photodynamic therapy: a report of five cases

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