Alessandra Ventura

Golimumab in Patients Affected by Moderate to Severe Psoriatic Arthritis: An Open-Label Study in Thirty-Two Patients Previously Treated with Other Biologics

Background: Clinical trials have demonstrated the efficacy of golimumab (GLB) in improving the signs and symptoms of psoriatic arthritis (PsA). Objective: The aim of this study was to evaluate the efficacy of GLB in monotherapy in patients affected by PsA with cutaneous involvement unresponsive to other anti-tumor necrosis factor-α (TNF-α) agents. Methods: This study included 32 patients treated with GLB as monotherapy, at a dosage of 50 mg, subcutaneously, every 4 weeks. Patients were divided into 3 groups (A, B, and C) according to their number of previous anti-TNF-α treatments (1, 2, or 3). Clinical and laboratory evaluations were performed at weeks 0, 12, and 24. Results: All patients showed significant improvement of their clinical, inflammatory, and quality of life indexes. Conclusion: Data suggest that GLB can be successful and safe in patients affected by PsA with skin involvement previously treated with other anti-TNF-α agents.

Treatment of Multiple Actinic Keratosis and Field of Cancerization with Topical Piroxicam 0.8% and Sunscreen 50+ in Organ Transplant Recipients: A Series of 10 Cases

Organ transplant recipient (OTR) subjects are at high risk of skin cancer such as squamous cell carcinoma and basal cell carcinoma. Actinic keratosis (AK) is considered the precursor of these non-melanoma skin cancers. Sun protection is mandatory in subjects with AK and this preventive strategy is very important in OTR. Treatment of the field of cancerization is also crucial to reduce the risk of recurrence of skin lesions in AK and non-melanoma skin cancer patients. Activation of cyclooxygenase 1 and 2 enzymes plays an important role in the pathogenesis of skin cancers. Topical application of cyclooxygenase inhibitors such as diclofenac and, more recently, piroxicam has shown to reduce AK lesions in immunocompetent subjects. A medical device containing piroxicam and SPF 50+ sunscreen filters (P+SS) has been demonstrated to be effective in reducing AK lesions and improving the field of cancerization. We report the effect of P+SS, applied for 16 weeks, in a case series of 10 OTR subjects with multiple AK lesions. P+SS treatment was associated with a relevant AK lesion reduction (>75%) in 7 patients (with a complete clearance in 3 subjects) with an improvement in the field of cancerization. This medical device could be considered a promising long-term curative and preventive treatment in OTR patients at high risk of non-melanoma skin cancers.

New insight into the pathogenesis of nail psoriasis and overview of treatment strategies

Psoriasis is a chronic inflammatory disease affecting up to 3% of the general population. The prevalence of nail involvement in psoriasis patients varies between 15% and 79%. While the nails represent a small portion of the body surface area, psoriasis in these areas can have a disproportionate influence on a patient’s physical and psychosocial activities. Differential diagnosis between an onychomycosis and a psoriatic nail could be challenging; nevertheless, coexistence of onychomycosis and nail psoriasis also occurs and both are common disorders in the general population. Nail psoriasis can be difficult to treat. Treatment of nail psoriasis should consider the body surface area of skin disease, psoriatic arthritis, severity of nail disease, and the impairment in the quality of life. All patients should be tested for onychomycosis before starting a therapy. This recommendation is underlined by the fact that nail psoriasis is mostly treated by immunosuppressive drugs, like steroids, methotrexate, or biologics, which may aggravate mycotic nail infections. Conventional systemic therapy, such as use of steroids, cyclosporine, methotrexate, and retinoid in the long term, can cause organ toxicities. Currently, use of apremilast and tofacitinib favors an early healing of nail psoriasis because they act directly on the pathogenic targets, distressing the inflammatory signals associated with the initiation and maintenance of the disease activity, and as with several conventional synthetic disease modifying antirheumatic drugs, they are characterized by the convenience of oral administration. The number of treatment options has increased considerably in recent years; however, given the heterogeneity of the disease, the therapy should be personalized to individual cases.

Behandlung der multiplen aktinischen Keratose und Feldkanzerisierung mit topischem Piroxicam 0,8% und Sonnenschutz (LSF 50+) bei Organtransplantat-Empfängern: Eine Serie von 10 Fällen

Empfänger von Organtransplantaten (organ transplant recipients, OTR) haben ein hohes Risiko, Hautkrebs wie z.B. ein Plattenepithelkarzinom und ein Basalzellkarzinom zu entwickeln. Die aktinische Keratose (AK) wird als Vorstufe dieser nicht-melanozytären Hautkrebsarten angesehen. Sonnenschutz ist für Patienten mit AK unerlässlich und eine wichtige vorbeugende Maßnahme bei Organtransplantat-Empfängern. Die Behandlung der Feldkanzerisierung ist außerdem entscheidend, um das Risiko für ein Rezidiv der Hautläsionen bei AK und bei Patienten mit nicht-melanozytärem Hautkrebs zu reduzieren. Bei der Pathogenese von Hautkrebserkrankungen spielt die Aktivierung von Cyclooxygenase-1- und -2-Enzymen eine wichtige Rolle. Die topische Anwendung von Cyclooxygenase-Inhibitoren wie Diclofenac und, seit Kurzem, Piroxicam hat sich bei der Verringerung der AK-Läsionen bei immunkompetenten Patienten als wirksam erwiesen. Es wurde gezeigt, dass ein Medizinprodukt, das Piroxicam und Sonnenschutz (LSF 50+) (P+SS) enthält, die AK-Läsionen reduziert und die Feldkanzerisierung verbessert. Wir berichten über den Effekt der Anwendung von P+SS über 16 Wochen in einer Fallserie mit 10 Patienten mit multiplen AK-Läsionen. Die Behandlung mit P+SS führte bei 7 Patienten zu einem klinisch relevanten Rückgang der AK-Läsionen (>75%) (mit vollständiger Abheilung bei 3 Patienten) und zu einer Besserung der Feldkanzerisierung: Dieses Medizinprodukt kann als Erfolg versprechende kurative und präventive Langzeittherapie bei OTR-Patienten mit hohem Risiko für nicht-melanozytären Hautkrebs angesehen werden. Übersetzung aus Case Rep Dermatol 2017;9:211-216 (DOI: 10.1159/000481770)

Spotlight on ixekizumab for the treatment of moderate-to-severe plaque psoriasis: design, development, and use in therapy

Psoriasis is a chronic inflammatory disease affecting up to 3% of the general population, associated with discomfort and impaired quality of life. In recent years, the pathogenic cytokine network of psoriasis has been extensively studied leading to the development of new treatments that provide greater efficacy. Interleukin 17A (IL-17A) has been recognized as a crucial cytokine that mediates immunopathogenesis of psoriasis. Ixekizumab – indicated for the treatment of adults with moderate-to-severe plaque psoriasis – is a subcutaneously administered humanized monoclonal antibody that targets IL-17A. A large percentage of patients affected by psoriasis achieved consistent benefits in terms of disease control and rapid onset of action during clinical trials. Overall, ixekizumab brought clinical improvement and a favorable safety profile in phase III trials. Ixekizumab is characterized by consistent efficacy and rapid onset of response; it is not influenced by previous exposure to biologics and has shown good results in areas that are difficult to treat and in severe clinical variants of psoriasis. Ixekizumab has shown significant improvements in the activity of the disease and in those physical functions that inhibit radiographic progression in patients with concomitant involvement of joints. Our data support ixekizumab as a successful therapeutic option for patients affected by moderate-to-severe plaque-type psoriasis.

The efficacy and tolerability of 5-aminolevulinic acid 5% thermosetting gel photodynamic therapy (PDT) in the treatment of mild-to-moderate acne vulgaris. A two-center, prospective assessor-blinded, proof-of-concept study

Acne vulgaris is a chronic inflammatory skin disease, commonly treated with topical or systemic drugs, according to the severity of the condition. Retinoids and antibiotic compounds are considered cornerstone approaches in this condition. However, low adherence to the therapy and the issue of bacterial resistance undermine the efficacy in the long term. Photodynamic therapy (PDT) with 20% aminolevulinic acid (ALA) has shown to be effective in the treatment of inflammatory acne. Skin tolerability, however, could be a limiting factor for a widespread use of this approach. A new formulation of 5% ALA in thermosetting gel has been recently available. This formulation allows a more convenient application procedure without occlusion and better and more efficient release of the active compound in comparison with traditional ALA formulations like creams or ointments.

Current developments in pharmacotherapy for actinic keratosis

ABSTRACT Introduction: Actinic keratosis (AK) is a superficial squamous cell carcinoma (SCC) where chronic sun exposure playing central role in its pathogenesis. UVB causes direct damage to DNA, producing pyrimidine dimers, and suppressing the protective role of p53. The stepwise progression of AK, with increased expression of anti-apoptotic Bcl-2, favors progression to SCC. Moreover, the dermal response characterized by inflammation and mediated by prostaglandins is a critical component of tumorigenesis that promotes tumor growth, tissue invasion, angiogenesis and metastasis. Other risk factors are represented by age, gender, phototype and drugs. Areas covered: In this review, the authors document the recent developments of different therapies used to treat AK and provide their perspectives on current and future treatment strategies. Expert opinion: The usefulness of long-term treatment with piroxicam and sun filters or diclofenac targeting the inflammation phases of skin tumorigenesis favors AK’s healing and provides greater control of the cancerization field. Nonsteroidal anti-inflammatory drugs can be safely used in patients who use photosensitizing drugs and, therefore, are more at risk of developing skin tumors. Immunomodulatory therapies, which require shorter treatment, are characterized by more common local side effects, and need more attention by the dermatologist in the concern of patient education, resulting essential to improve adherence and outcomes.

Oral Lichen Planus: Novel Acquisitions in the Pathogenesis and Treatment

Lichen planus (LP) is a mucocutaneous disease of chronic inflammatory nature, commonly seen in dermatological and dental clinics; it is a relatively common disorder of stratified squamous epithelia, frequently exclusively involving the oral cavity. Oral Lichen Planus (OLP) is often asymptomatic, the atrophic-erosive form can cause symptoms ranging from burning sensation to severe pain, interfering with speaking, eating, and swallowing. Lichen planus is regarded as a premalignant lesion. This review discusses the role of hepatitis C virus (HCV), bacterial and fungal infection in LP. Analysing the seroprevalence of HCV infection in LP patients and patients with oral OLP in particular, which was the case in the vast majority of studies, the association varied from 0% to 62% and seemed to be connected to the high HCV seroprevalence in the general population. Candida albicans is present in about 37% of oral LP lesions. The aim of this review is to summarize what is new in the pathogenesis and treatment of OLP.

Contents Vol. 227, 2013

G. Argenziano, Reggio Emilia M. Augustin, Hamburg W.H. Boehncke, Geneve L. Borradori, Bern R.P. Braun, Zürich R. Cerio, London L. Cerroni, Graz O. Chosidow, Créteil A. Dupuy, Rennes J.W. Fluhr, Berlin L. French, Zürich F. Furukawa, Wakayama M. Gilliet, Lausanne A.K. Gupta, London, Ont. R. Happle, Freiburg R.J. Hay, London P. Itin, Basel G. Kaya, Geneva R.G.B. Langley, Halifax, N.S. J.M. Mascaro, Jr., Barcelona K. Matsunaga, Nagoya Y. Miyachi, Kyoto L. Naldi, Bergamo F. Nestle, London C. Paul, Toulouse T. Shiohara, Tokyo Th. Simonart, Brussels H.P. Soyer, Brisbane L. Thomas, Lyon R.M. Trueb, Zürich T.J. Yoon, Jinju Ch.C. Zouboulis, Dessau International Advisory Board