Annabelle Levy

Poor Reporting of Quality of Life Outcomes in Dermatology Randomized Controlled Clinical Trials

Background: Because many dermatological diseases are chronic but not life-threatening, consideration of their impact on health-related quality of life (QOL) seems essential. Objective: To analyze the use of QOL as an evaluation endpoint in randomized clinical trials concerning skin diseases. Methods: Studies identified by computerized search of 3 bibliographical databases were selected, and their data on QOL as an evaluation endpoint were collected and analyzed. Results: Among the 67 studies retained, 87% did not adequately describe the questionnaires; 75% did not address handling of missing data; 95% did not calculate the number of subjects needed to obtain the desired statistical power; 95% did not disclose before-and-after results as means of overall scores and each dimension. Conclusion: Our analysis highlighted methodological weaknesses in the use of QOL questionnaire and poor reporting of QOL outcomes in randomized clinical trials.

Severe neutrophilia induced by infliximab for psoriasis.

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Efficacy of infliximab for severe recalcitrant psoriasis after 6 weeks of treatment

Infliximab treatment has been shown to be effective for moderate‐to‐severe psoriasis in several large clinical trials. Nonetheless, experience with this new treatment is still needed to evaluate its efficacy and tolerance in everyday practice. In this follow‐up study, we report our experience with infliximab for recalcitrant psoriasis. Nineteen patients with recalcitrant psoriasis were treated between July 2004 and December 2006 with 5 mg/kg infliximab i.v. at weeks 0, 2 and 6 followed by maintenance every 8 weeks. In three patients resistant to treatment, methotrexate was added at a 15–25 mg dose weekly after the sixth week of infliximab therapy. Pretreatment evaluations included chest X‐ray, tuberculin test (5 units), full blood count, kidney and liver function tests, antinuclear antibodies and patient weight. Response to treatment, using the Psoriasis Area and Severity Index (PASI) score, and adverse effects were prospectively assessed at weeks 0, 6 and 22. At week 6, after only two infusions, 78.9% (15/19) of patients showed at least 75% improvement in baseline PASI (PASI 75). At week 22, 73.6% (14/19) patients had reached PASI 75. Three patients had a relapse. Four developed adverse effects that required suspension of infliximab therapy. No tuberculosis or lymphoproliferative disease was observed. Four patients (21%) showed apparition of positive antinuclear antibody during the course of treatment and 57.8% (11/19) of patients showed an increase in weight at week 22. Our experience shows that infliximab is a very rapidly effective treatment of severe, treatment‐resistant psoriasis as soon as the sixth week of treatment.

Liquen plano y dermatosis liquenoides

El liquen plano es una dermatosis cronica frecuente que se observa, sobre todo, en el adulto de mediana edad. En su forma tipica, se presenta como papulas escamosas poligonales violaceas pruriginosas sobre las caras de extension de los miembros. La afectacion de la mucosa oral y genital suele ir asociada. Desde el punto de vista histologico, se observa un infiltrado linfocitico en banda en la dermis superficial, junto con necrosis de los queratinocitos en las capas basales. Las formas atipicas son comunes. La evolucion de las formas cutaneas suele ser favorable en 6 meses a 1 ano. Existe un riesgo debil de malignizacion, sobre todo en las formas cronicas y erosivas bucales. La etiologia se desconoce; en ella intervienen principalmente mecanismos inmunologicos. El tratamiento se basa en los dermocorticoides, los retinoides y el PUVA. La corticoterapia oral no se ha evaluado, aunque se prescribe a menudo.