Chrysovalantis Korfitis

Evaluation of the efficacy and safety of infliximab on psoriatic nails: an unblinded, nonrandomized, open‐label study

Background  Despite advances in the treatment of skin psoriasis during the last years, therapy of psoriatic nails remains a challenge.

Assigning new roles to topical tacrolimus

Tacrolimus is an ascomycin macrolactam derivative with immunomodulatory and anti-inflammatory activity that belongs to the class of calcineurin inhibitors. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis in two concentrations, 0.03 and 0.1%. In a thorough research of literature the authors review all of the available data regarding the off-label uses of the medication in other dermatoses. It seems that compared to pimecrolimus, tacrolimus has proved to be a more effective treatment. There is no causal relationship that has been established between tacrolimus and carcinogenesis. Furthermore, the authors believe that, without any evidence, the theoretical concerns are not enough to produce warnings. Tacrolimus ointment 0.1% may be recommended as a first-line choice for seborrheic dermatitis of the face and trunk, facial and intertriginous psoriasis and probably for allergic contact dermatitis and Zoons balanitis. It has been ineffective in numerous dermatoses such as alopecia areata, necrobiosis lipoidica, internal pruritus and in thick hyperkeratotic plaques of psoriasis when administered as the commercially available formulation without occlusion. There is yet unexploited therapeutic potential regarding the use of topical tacrolimus in dermatology. Isolated cases of successful administration of the medication in various cutaneous conditions require further large-scale studies to clarify the actual effectiveness.

Onset of palmoplantar pustular psoriasis while on adalimumab for psoriatic arthritis: A ‘class effect’ of TNF-α antagonists or simply an anti-psoriatic treatment adverse reaction?

Adalimumab is a human, recombinant IgG1 monoclonal antibody that specifically blocks the interaction of tumour necrosis factor (TNF)-α with the p55 and the p75 TNF-α cell surface receptors. We report the appearance of palmoplantar pustular psoriasis in a patient after 6 months of successful adalimumab administration for psoriatic arthritis. The development or worsening of psoriatic skin lesions is a known side effect of adalimumab and other TNF-α antagonists increasingly reported in the literature. Although it has been reported as a ‘class-effect’ of TNF-α antagonists, we believe that the deterioration or new onset of psoriasis is an adverse reaction seen mainly with drugs used for the treatment of psoriasis and not solely with anti-TNF agents. The latter is probably implying an existing gap in the understanding of the pathophysiology of psoriasis or of the anti-psoriatic drugs’ mechanisms of action.

Infliximab in dermatological treatment: beyond psoriasis

Infliximab is a chimeric monoclonal antibody of the IgG1 class. Experience from its use has been accumulated in rheumatology and gastroenterology by the treatment of rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and inflammatory bowel disease, respectively. Because of its TNF-α binding capacity it has been approved for the treatment of moderate-to-severe plaque psoriasis. Moreover, it has also been evaluated in other inflammatory dermatoses as well as systemic diseases involving the skin such as severe atopic dermatitis, pityriasis rubra pilaris, pyoderma gangrenosum and cutaneous sarcoidosis. The possible future uses of infliximab in dermatology are being reviewed herein.

Pimecrolimus versus topical corticosteroids in dermatology.

Pimecrolimus is an ascomycin macrolactam derivative with anti-inflammatory and immunomodulatory activity that belongs to the class of calcineurin inhibitors. It was developed after the attempt to discover alternatives to corticosteroids for the treatment of inflammatory skin diseases. Although pimecrolimus has been only approved for the treatment of atopic dermatitis, many clinical reports have proved its efficacy in a variety of skin conditions. However, corticosteroids remain the treatment of choice in inflammatory skin diseases. The possibility that pimecrolimus deserves a greater role in the long-term treatment of skin diseases is discussed herein by reviewing the published clinical studies that compare pimecrolimus and corticosteroids.

Should We Consider Hypohidrotic Ectodermal Dysplasia as a Possible Risk Factor for Malignant Melanoma

Background: Hypohidrotic ectodermal dysplasia (HED) is a rare multisystem disorder that typically affects hair, teeth, nails, and sweat glands in combination with abnormalities of ectodermal originated tissues. Objective: To raise the issue of whether heightened awareness is required in the follow-up of pigmented lesions in patients with HED. Methods/Results: Two patients with HED are reported. The first had a history of two malignant melanomas, whereas the second presented with a novel malignant melanoma. Conclusion: Although a prospective epidemiologic study to determine the incidence of malignant melanoma in patients with HED is virtually impossible and the probable pathogenesis warrants further investigation, these two case reports, in conjunction with other recent reports associating other ectodermal dysplasias with malignant melanoma, suggest that heightened awareness might be prudent in the follow-up of pigmented lesions in patients with HED.

Should novel psoriasiform eruptions be considered a paraneoplastic sign of invasion in patients with breast cancer

JEADV 2007, 21, 247–289

Trauma-induced bullous pemphigoid

Indian J Dermatol Venereol Leprol | November-December 2009 | Vol 75 | Issue 6 Both ELISA and WB results were consistent for different storage periods (up to 10 days), suggesting that antibodies from sera collected on filter paper can remain stable. Stability of antibodies reactive to viral antigens of diagnostic importance was further tested with two of these samples for a 15-days storage period. The ELISA and WB results were consistent over the period of 15-days storage of the filter paper. All diagnostically important serum antibodies against HIV antigens (p24, gp160, gp120) were detected in the WB results. Antibodies against other antigens (p55, p31, p51, p56 and gp41) were also found to be stable.

Skin biopsy in the context of dermatological diagnosis: a retrospective cohort study.

Background. Skin biopsy is an established method for allying the dermatologist in overcoming the diagnostic dilemmas which occur during consultations. However neither do all skin biopsies produce a conclusive diagnosis nor the dermatologists routinely perform this procedure to every patient they consult. The aim of this study was to investigate the favourable clinical diagnoses set by dermatologists when performing skin biopsy, the diagnoses reached by the dermatopathologists after microscopic examination, and the relationship between them and finally to comment on the instances that skin biopsy fails to fulfill the diagnostic task. Methods. Six thousand eight hundred and sixteen biopsy specimens were reviewed and descriptive statistics were performed. Results. The mean age of the patients was 54.58 ± 0.26 years, the most common site of biopsy was the head and neck (38.3%), the most frequently proposed clinical diagnoses included malignancies (19.28%), and the most prevalent pathological diagnosis was epitheliomas (21.9%). After microscopic examination, a specific histological diagnosis was proposed in 83.29% of the cases and a consensus between clinical and histological diagnoses was observed in 68% of them. Conclusions. Although there are cases that skin biopsy exhibits diagnostic inefficiency, it remains a valuable aid for the dermatology clinical practice.

Atypical Ofuji's disease exacerbated with pregnancy

© 2009 The Authors JEADV 2009, 23 , 1092–1115 Journal compilation