Annalisa Arcese

Improvement of psoriatic onychodystrophy by a water-soluble nail lacquer

Background  There is a strong need for effective products, simple to use and safe for a chronic use in the management of nail psoriasis. Recently, a non‐drug, water‐soluble nail lacquer became available, containing hydroxypropyl chitosan (HPCH), horsetail extract (Equisetum arvense) and methylsulphonyl‐methane (DMSO2). This product was effective in strengthening the nails and reducing fragility and roughness in brittle nails. A clinical trial was performed to verify whether this product was able to improve nail psoriatic signs and appearance.

Treating psoriasis with etanercept in Italian clinical practice: Prescribing practices and duration of remission following discontinuation

AbstractBackground: Conventional antipsoriatic therapies are often administered until remission, with treatment resumed in the case of relapse, in order to reduce the likelihood of cumulative, dose-dependent toxicities. Biological agents have been safely used in continuous therapy. Objective: To assess the use of etanercept for psoriasis in clinical practice in Italy. Methods: This was an observational study carried out in 13 dermatological centres across Italy in patients with plaque psoriasis (with a Psoriasis Area and Severity Index [PASI] score ≥10) treated with etanercept. The study comprised a treatment and subsequent discontinuation period. Patients were eligible if they had plaque psoriasis and had begun treatment with etanercept between 1 September 2007 and 1 April 2008. Patients were evaluable for the duration of discontinuation analysis if they achieved a PASI reduction ≥50% (PASI50) and a PASI score <10 at the end of treatment. Etanercept treatment was restarted if the PASI score reached ≥10 or the patient had a clinical relapse. Data were collected retrospectively up to June 2008 and prospectively between July 2008 and January 2009. Patients received etanercept during the treatment period, followed by no etanercept treatment (other psoriasis treatment permitted) during the discontinuation period, and etanercept again during re-treatment. The main outcome measures were: PASI scores (type A responders: PASI reduction ≥75% [PASI75]; type B responders: PASI50 and PASI final score <10), Dermatology Life Quality Index (DLQI) scores and body surface area (BSA) involvement. Time from discontinuation to retreatment was evaluated. Use of other antipsoriatic medications was recorded throughout. Results: Eighty-five patients were evaluable for the treatment period. Overall, 55 (64.7%) of these patients were prescribed etanercept 50 mg twice weekly. The mean treatment duration was approximately 25 weeks. In total, 79 patients (92.9%) were considered type B responders and 77 of these patients were evaluable for the duration of discontinuation analysis. Overall, 68/85 (80%) were type A responders. During the treatment period, 7/85 (8.2%) patients received other antipsoriatic therapies. Improvements in mean DLQI score (−71.5%) and mean BSA involvement (−79.2%) were also observed. Etanercept was well tolerated. During the discontinuation period, 40/77 (51.9%) patients used other antipsoriatic medications (group 1) and 37/77 (48.1%) did not (group 2). The mean duration of discontinuation was significantly longer in group 1 (174 days) than in group 2 (117 days, log-rank test: p = 0.0013). Conclusion: In clinical practice, the duration of discontinuation from etanercept was in accordance with previously reported data, and was longer in patients who received other antipsoriatic drugs during discontinuation of etanercept than in those who did not. High rates of PASI50 and PASI75 response were obtained with etanercept, and these rates were higher than those observed in controlled clinical studies. Etanercept treatment was flexible, effective and well tolerated, and was associated with improved quality of life.

Psychiatric comorbidity and suicidal ideation in psoriasis, melanoma and allergic disorders

Abstract Objective: Psychiatric disorders and suicide risk (especially in psoriasis) are frequent and disabling conditions in patients with skin diseases. The aim of this study was to examine the risk of suicide and stressful life events in a sample of patients with skin disease. Methods: A sample of 242 dermatological patients (142 women and 100 men), 112 of which had psoriasis, 77 had melanoma, and 53 were suffering with chronic allergic diseases. Patients were administered the MINI International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients were also asked about their experiences with stressful life events. Results: Patients with psoriasis were more likely to have a history of psychiatric disorders (36.6% vs. 13.2% χ2(1) = 9.55; p = 0.002) compared to patients with allergies. Specifically, patients with psoriasis more likely had a diagnosis of a mood disorder (16.1% vs. 3.9% χ2(1) = 6.85; p = 0.009; 16.1% vs. 0% χ2(1) = 9.56; p = 0.002) and reported past suicidal ideation (33.9% vs. 15.6% χ2(1) = 7.89; p = 0.005; 33.9% vs. 18.9% χ2(1) = 3.96; p = 0.047) as compared to those with melanoma and allergy. Conclusions: The results from this study suggest that patients affected by psoriasis have an increased risk of psychiatric comorbidities and suicidal ideation compared to those who have other dermatological disorders.

Long-term treatment with adalimumab in psoriatic arthritis: serum adalimumab concentration, immunogenicity and the link with clinical response

Objectives An observational study to evaluate the relationship between serum concentrations of adalimumab and disease activity in patients receiving long-term adalimumab treatment for psoriatic arthritis. Methods Serum adalimumab and adalimumab antidrug antibodies were quantified by enzyme linked immunosorbent assay. Disease activity was assessed using Disease Activity Score (44 joint measures). Serum C-reactive protein was quantified using standard methods. Results A total of 30 patients were recruited. There were significant inverse correlations between serum adalimumab concentration and serum C-reactive protein (CRP) concentration [r = −0.43], the number of tender joints (r = −0.4), and Disease Activity Score (DAS44)-CRP (r = −0.36). Mean serum adalimumab levels were significantly higher in patients with DAS44-CRP <1.6 than in patients with DAS44-CRP ≥1.6. Conclusions Serum adalimumab could be an important tool that may improve the management of psoriatic arthritis in patients responding to long-term treatment.

Nodular melanoma arising in a patient treated with anti-tumor necrosis factor alpha antagonists.

Figure 1 The neoplasm is asymmetric (a, ·20), with a junctional component (b, ·200) and involvement of the hair follicle (c, ·200). There are dermal mitoses (d, ·400) and confluence of the dermal nests e, ·200). The tumor cell populations are different: some large with abundant cytoplasm while others are small and spindle-shaped with little cytoplasm. Histological examination reveals a brisk tumor infiltrating lymphocytes (f, ·200)

Transient acantholytic dermatitis and Parkinson's disease

© 2008 The Authors JEADV 2009, 23, 441–496 Journal compilation

Long-term safety of etanercept in psoriasis: Retrospective study focused on infections

Objective Retrospective study to evaluate the incidence of infectious adverse events in patients with psoriasis treated with etanercept. Methods Patients with psoriasis or psoriatic arthritis who were treated with etanercept (50 mg, administered weekly via subcutaneous injection) for ≥48 weeks were retrospectively enrolled. Patients were screened for occult infections before treatment commenced, and then every 12 months thereafter. Minor (not requiring hospitalization and/or discontinuation of treatment) and major (requiring hospitalization and/or discontinuation of treatment) infectious events were recorded. Results The study included 50 patients. Minor infectious events included self-limiting upper respiratory tract infections (six patients), lower urinary tract infections (one patient) and recurrent herpes simplex labialis (two patients). Major infections occurred in only two cases. Conclusion These data support the good safety profile of etanercept in patients with psoriasis or psoriatic arthritis.

Efficacy of acitretin in the treatment of squamous cell carcinoma of the oral cavity.

A 50-year-old woman presented in April 2009 with ulcerative lesions of the oral cavity and a reddish nodular lesion, in correspondence to the left oropharyngeal tract, clinically suggestive of a malignant one (Fig. 1). She was referred with a 7-year history of leukoplakia and erosive oral lichen planus (OLP), and 2 years before she was treated with laser CO2 resection and radiotherapy for a squamous cell carcinoma of the palate with a good clinical response.