E. Castela

Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review.

Background  Oral 8‐methoxypsoralen–UV‐A (PUVA) and narrowband UV‐B (NB‐UVB or UVB TL‐01) are effective and widely used treatments for chronic plaque psoriasis. Although the role of PUVA therapy in skin carcinogenesis in humans with psoriasis has been clearly demonstrated, there is still controversy regarding the risk of skin cancer with NB‐UVB. Furthermore, there is no clear evidence about the maximum cumulative number of sessions not to be exceeded in a lifetime.

Effects of low-dose recombinant interleukin 2 to promote T-regulatory cells in alopecia areata.

IMPORTANCE An impaired inhibitory function of circulating CD4+CD25+ regulatory T (Treg) cells was reported to play a key role in alopecia areata (AA). We report the first use to our knowledge of low-dose interleukin 2 for treating severe AA by promoting the recruitment of Treg cells. OBSERVATIONS We conducted a prospective open pilot study in 5 patients with severe AA resistant to previous systemic treatments. Subcutaneous interleukin 2 (1.5 million IU/d) was administered during 5 days, followed by three 5-day courses of 3 million IU/d at weeks 3, 6, and 9. The primary outcome was the evolution of the Severity of Alopecia Tool (SALT) score, evaluated by 2 independent investigators on standardized photographs. Lesional skin biopsy specimens and peripheral blood lymphocyte phenotype were analyzed. The median SALT score went from 82 (range, 63-100) at baseline to 69 (range, 28-100) at 6 months. Immunochemical analysis revealed the appearance or a notable increase in Treg cell count in 4 of 5 patients at the end of the treatment compared with baseline. No serious adverse event was reported. CONCLUSIONS AND RELEVANCE The partial regrowth achieved in 4 of 5 patients and the recruitment of Treg cells in lesional skin support the interest of promoting Treg cells for treating AA. Further investigations are now required to confirm and to optimize the design in order to enhance the Treg cell response. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01840046.

Efficacy of Psoralen UV‐A therapy vs. Narrowband UV‐B therapy in chronic plaque psoriasis: a systematic literature review

Background  Oral 8‐methoxypsoralen‐UV‐A (PUVA) and Narrowband UV‐B (NB‐UVB or UVB TL‐01) are well established treatments for chronic plaque psoriasis but there is limited evidence regarding their respective efficacy.

Evidence-based recommendations on topical treatment and phototherapy of psoriasis: systematic review and expert opinion of a panel of dermatologists

Background  Although topical treatments and phototherapy are available for more than 40 years, there is a paucity of evidence‐based recommendations regarding their use.

Maintenance Therapy of Adult Vitiligo with 0.1% Tacrolimus Ointment: A Randomized, Double Blind, Placebo–Controlled Study

The risk of relapse after successful repigmentation in vitiligo is estimated to 40% within the first year. It has been shown in atopic dermatitis that continuous low-level use of topical corticosteroids and calcineurin inhibitors in previously affected skin can prevent new flares. We hypothesized that a twice-weekly application of 0.1% tacrolimus ointment might be effective for maintaining repigmentation in therapeutically repigmented lesions of vitiligo patients. After randomization, sixteen patients with 31 patches were assigned to the placebo group and 19 patients with 41 patches were assigned to the tacrolimus group. In the intention-to-treat analysis, 48.4% of lesions showed depigmentation in the placebo group, whereas 26.8% did in the tacrolimus group (P=0.059). The intention-to-treat results did not remain significant after adjustment for within-patient clustering, odds ratio (OR) 2.55; 95% confidence interval (CI; 0.65-9.97); P=0.1765. The per-protocol analysis (n=56) showed that 40% of lesions had some depigmentation in the placebo group, whereas only 9.7% did in the tacrolimus group (P=0.0075). The per-protocol results remained significant after adjustment for within-patient clustering: OR 6.22; 95% CI (1.48-26.12); P=0.0299. Our study shows that twice-weekly application of 0.1% tacrolimus ointment is effective in preventing the depigmentation of vitiligo patches that have been previously successfully repigmented.

Topical corticosteroids in plaque psoriasis: a systematic review of risk of adrenal axis suppression and skin atrophy

Background  Topical steroids have been used for more than 50 years in mild‐to‐moderate plaque psoriasis and carry a theoretical risk of adverse events.

Topical corticosteroids in plaque psoriasis: a systematic review of efficacy and treatment modalities

Introduction  Topical steroids are used for more than 50 years to treat mild‐to‐moderate plaque psoriasis. The purpose of this systematic review was to evaluate the efficacy but also the optimal modalities of administration of topical corticosteroids in psoriasis i.e. influence of steroid potency on clinical response, putative impact of topical formulation, occlusion procedure, rate of application to control the initial response and the potential interest of a maintenance treatment to prolong psoriasis clearance.

Evolution of Nevi During Treatment With Natalizumab: A Prospective Follow-up of Patients Treated With Natalizumab for Multiple Sclerosis

BACKGROUND Natalizumab is a monoclonal antibody directed against α₄ integrin used in the treatment of multiple sclerosis (MS). Four cases of melanomas occurring in patients prescribed natalizumab to treat MS were recently reported. Although some fundamental data suggested that α₄β1 integrin could be linked to the invasiveness of melanoma, none showed any relation with the transformation of melanocytes. OBSERVATIONS We performed a prospective follow-up of a cohort of patients with MS treated with natalizumab to assess the evolution of nevi under treatment. Clinical dermatologic examination and videodermoscopy were performed every 6 months. Nevi were compared side-by-side with baseline photographs, and histologic analysis was proposed based on clinical and dermoscopic criteria. Forty-four patients were included, and 248 nevi were examined and followed up. The mean duration of follow-up was 14 months (range, 6-20 months). Seventeen lesions (6.8%) showed modifications over time. Only 12 (4.8%) presented substantial dermoscopic changes. Five lesions were removed. All of them were classified as benign after histologic examination. CONCLUSIONS Our results showed the same rate of clinical and dermoscopic changes of nevi during treatment with natalizumab compared with the spontaneous evolution of nevi reported in literature. In accordance with fundamental data, those results suggest that the inhibition of the α₄ integrin does not promote the transformation of melanocytic lesions.

Fractionated bipolar radiofrequency and bipolar radiofrequency potentiated by infrared light for treating striae: A prospective randomized, comparative trial with objective evaluation

Very few treatments for striae are based on prospective randomized trials. The objective of this study was to assess the efficacy of bipolar fractional radiofrequency and bipolar radiofrequency potentiated with infrared light, alone or combined, for treating abdominal stretch marks.

Blue Pseudochromhidrosis Secondary to Topiramate Treatment

© 2009 The Authors. doi: 10.2340/00015555-0696 Journal Compilation