Demetrios Ioannides

Botulinum toxin A in postherpetic neuralgia: a parallel, randomized, double-blind, single-dose, placebo-controlled trial.

Objectives:Cumulative evidence support a beneficial effect of botulinum toxin A (BTX-A) in postherpetic neuralgia (PHN). We aimed to assess efficacy, safety, and tolerability of BTX-A in the management of PHN, performing a randomized, double-blind, single-dose, placebo-controlled trial. Methods:Thirty adults with PHN were randomized either to BTX-A or placebo. Severity of pain was evaluated by patients using a visual analogue scale (VAS) and quality of sleep was assessed using a 5-item questionnaire. Primary outcome was reduction in VAS score, with a greater than 50% reduction being considered clinically significant. Secondary outcomes were reduction in sleep score and maintenance of VAS score after treatment, with over 50% maintenance considered clinically meaningful. Results:Thirteen patients from the experimental arm achieved an at least 50% reduction in VAS score, compared with none of the placebo patients (NNT=1.2, 95% CI, 2-1; ARR=0.87, 95% CI, 055-096; P<0.001). BTX-A patients showed significant reduction in VAS pain scores between baseline and week 2, which persisted for a median period of 16 weeks. BTX-A patients showed significant reduction in sleep scores between baseline and week 2, which remained unchanged until 16th week (P<0.001). Treatment was well tolerated. Discussion:Data confirm that BTX-A is effective and well tolerated in the treatment of PHN.

Spontaneous abortion during ustekinumab therapy

BACKGROUNDnPsoriasis affects a considerable proportion of women in their reproductive years. Limited published data exist about the possible negative impact of the disease itself in the prognosis of pregnancy. On this background, the emergence of newer biologic agents for psoriasis treatment - such as ustekinumab - raises safety issues concerning the exposure to the drug during pregnancy. To our knowledge this is the first report in the literature describing a pregnancy outcome under ustekinumab treatment.nnnOBSERVATIONnWe report a 35-year-old female psoriasis patient who was under treatment with ustekinumab for a year when she inadvertedly became pregnant. The drug was discontinued immediately and the patient did not opt for termination. During the 12th week of gestation she experienced a spontaneous abortion.nnnCONCLUSIONnAlthough the patients profile fulfilled 2 general risk factors for spontaneous abortion - she was a smoker and this was her third pregnancy - one could not underestimate the possible role of the drug and of psoriasis per se in this adverse pregnancy outcome. Pregnancy registries and large prospective studies are needed in order to determine whether poorer pregnancies outcomes in psoriatic women are due to the disease itself, associated comorbidities or side-effects of new therapies such as ustekinumab.

Management of psoriasis in adolescence

Psoriasis is a chronic inflammatory cutaneous disorder affecting 2%–4% of the world’s population. The prevalence of the disease in childhood and adolescence ranges between 0.5% and 2%. The management of psoriasis in adolescence is an intriguing and complicated task. Given the paucity of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, physicians must rely on published experience from case reports both from the field of dermatology as well as from the application of these drugs for other pediatric conditions coming from the disciplines of rheumatology, gastroenterology, and oncology. Psoriatic adolescents deal with a potentially disfiguring and lifelong disease that could permanently impair their psychological development. It must be clarified to them that psoriasis does not have a permanent cure, and therefore the main goal of treatments is to establish disease control and prolonged periods between flares. The majority of adolescents suffer from mild psoriasis, and thus they are treated basically with topical treatment modalities. Phototherapy is reserved for adolescents with mild-to-moderate plaque disease and/or guttate psoriasis when routine visits to specialized centers do not create practical problems. Systemic agents and biologics are administered to patients with moderate-to-severe plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis.

Epidemiological trends in skin cancer.

Skin cancer, including melanoma and non-melanoma skin cancer (NMSC), represents the most common type of malignancy in the white population. The incidence rate of melanoma is increasing worldwide, while the associated mortality remains stable, or is slightly decreasing. On the other hand, the incidence for NMSC varies widely, with the highest rates reported in Australia. In the current review, we highlight recent global trends in epidemiology of skin cancer. We discuss controversial issues raised in current epidemiological data, we analyze the most important risk factors associated with the development of melanoma and NMSC and the impact of skin cancer on health care services. Furthermore, we underline the pressing need for improved registration policies, especially for NMSC, and lastly, we refer to the ongoing primary and secondary prevention strategies and their outcomes so far.

Calcipotriol/betamethasone dipropionate in the treatment of psoriasis vulgaris.

Psoriasis is one of the most common skin diseases. The mainstay of treatment for the vast majority of patients is topical therapy. A rising first-line treatment modality for psoriasis vulgaris is the two-compound ointment containing calcipotriol 50 μg/g plus betamethasone dipropionate 0.5 mg/g (Dovobet®, Daivobet®, Taclonex®), which combines a vitamin D analog and a corticosteroid. This innovative formulation preserves the activity and bioavailability of the two components and many clinical studies have demonstrated that it has a greater efficacy, tolerability, and a rapid onset of action compared with its individual ingredients or tacalcitol.

Efficacy of adalimumab in recalcitrant hidradenitis suppurativa

Auteur(s) : Elena Sotiriou, Zoe Apalla, Eustratios Vakirlis, Demetrios Ioannides First Dermatologic Department, Medical School, Aristotle University Thessaloniki, 8, Papakyriazi str, 54645 Thessaloniki, Greece Hidradenitis suppurativa (HS) is a recurrent, chronic inflammatory disease, localized in apocrine gland-bearing areas of the body [1]. Treating HS is challenging as common therapeutic approaches do not achieve complete remissions, or lead to relapses after their discontinuation [1]. Based [...]

Spotlight on vismodegib in the treatment of basal cell carcinoma: an evidence-based review of its place in therapy

Vismodegib is approved for the treatment of adult patients with metastatic (mBCC) or locally advanced basal cell carcinoma (laBCC) that have recurred following surgery or for those who are not good candidates for surgery (risk/benefit ratio is against patient’s benefit, either because of the general condition or because of the expected morbidity from the surgery) or radiation therapy. This article provides an evidence-based review of its current place in therapy. Analytically, the clinical implications in the management of laBCCs and mBCCs and possible new indications, including the neoadjuvant use before surgical excision, are discussed, while in the end, the challenges regarding class-related adverse events and their optimal management are highlighted.

Farmers develop more aggressive histologic subtypes of basal cell carcinoma. Experience from a Tertiary Hospital in Northern Greece

Ultraviolet radiation plays an important role in the pathogenesis of non‐melanoma skin cancer. Outdoor workers, including farmers, experience higher exposure levels compared to the general population. Available literature data suggest that occupational ultraviolet exposure represents an independent risk factor for squamous cell carcinoma; whereas for basal cell carcinoma (BCC) this association still remains unclarified.

Pemphigus vegetans of the tongue: a diagnostic and therapeutic challenge

A 68-year-old woman presented with a large, painful, hypertrophic plaque of the buccal cavity, mimicking cerebriform tongue. The lesion had appeared eight months previously and, under the diagnosis of candidiasis, the patient had been treated ineffectively with nystatin and oral fluconazole. Physical examination revealed a partially eroded, grayish-white, exophytic plaque at the dorsum of the tongue, as well as a whitish hypertrophic rim at the edge of the tongue (Fig. 1). The rest of the oral mucosa, the genital mucosa, and the skin were uninvolved. The presence of angular cheilitis, as seen in Figure 1, was the result of chronic mechanical irritation caused by the impaired adhesion of a denture. Our clinical diagnoses ranged between infectious and neoplastic etiologies and involved the vegetative type of pemphigus vulgaris and pyodermatitis-pyostomatitis vegetans (PPV). Direct microscopic examination and cultures obtained from the exudate were negative. A Tzanck smear revealed numerous acantholytic cells. Histologic examination showed marked acanthosis with microabscess formation, intraepithelial clefting, acantholytic cells, and some eosinophils (Fig. 2). The findings were in keeping with the diagnosis of pemphigus vegetans. However, PPV could not be entirely excluded. Direct immunofluorescence demonstrated intercellular deposits of immunoglobulin G (IgG). Indirect immunofluorescence was also positive. Antibodies to desmoglein 3 were detected using an enzyme-linked immunosorbent assay (ELISA). Further workup in order to exclude inflammatory bowel disease was unremarkable. Pemphigus vegetans was diagnosed according to clinical, histologic, immunofluorescence, and ELISA findings. The patient was started on oral prednisone (1.0 mg/kg/d). At the 4-week follow-up, the initial plaques were seen to have been unresponsive, and the patient’s discomfort was intense. Dapsone at 100 mg/d was introduced, with minimal response, and a concurrent cycle of 400 mg/kg/d of human intravenous immunoglobulin (IVIG) was administered for five days. The treatment resulted in gradual improvement and significant pain relief. Tapering of steroid was started. The patient experienced a flare-up when the dose reached 15 mg, and the dose was increased to 30 mg. Currently, one year after the initiation of treatment, the patient continues to use 5 mg of systemic prednisone every other day in combination with 50 mg/d of dapsone and demonstrates adequate disease control. 350

Targeting IL-23 in psoriasis: current perspectives

The recent advances in the understanding of psoriasis pathogenesis have clarified the pivotal role of interleukin (IL)-23. It is a heterodimeric cytokine consisting of two subunits, the unique p19 and the p40, which are shared with IL-12. The basic role of IL-23 in psoriasis is the activation and maintenance of the T-helper 17 pathway. New research findings indicate that IL-23 is more important than IL-12 in the pathogenesis of psoriasis. Based on that background, the selective targeting of the IL-23p19 subunit emerged as an attractive therapeutic option and led to the development of a new category of biologic agents. Three monoclonal antibodies that selectively inhibit the IL-23p19 subunit, guselkumab, tildrakizumab, and risankizumab, are in the pipeline for the treatment of moderate-to-severe psoriasis. In this article, we review the most recent efficacy and safety data regarding these IL-23p19 inhibitors.