Efstathia Pasmatzi

Calcipotriol Plus Short-Contact Dithranol: A Novel Topical Combination Therapy for Chronic Plaque Psoriasis

The purpose of this double-blind randomised parallel-group study was to compare the efficacy and safety of short-contact treatment with dithranol ointment (2%) with its combination with calcipotriol ointment (50 µg/g) in 2 groups of in-patients with chronic plaque psoriasis. The patients of the first group (n = 23) topically applied dithranol once daily for 30 min and the vehicle of calcipotriol twice daily. The patients of the second group (n = 23) used a single topical application of dithranol for 30 min daily and additionally applied calcipotriol twice daily. The extent and the severity of psoriasis were assessed by means of psoriasis area and severity index score (PASI score) before the onset of the 6-week therapy and weekly thereafter. The difference between the two groups with regard to the mean PASI score became statistically significant already after the first week of treatment and remained so until the end of the trial. No significant differences were observed between the two groups with respect to the cutaneous adverse events. These findings indicate that the addition of calcipotriol ointment to short-contact dithranol markedly augments the therapeutic efficacy of the latter in chronic plaque psoriasis and impressively accelerates the response of psoriatic plaques to this well-tolerated regimen.

Sensorimotor polyneuropathy after a three-month oral acitretin therapy.

We report a patient with chronic plaque psoriasis who developed clinical and electrophysiologic features of polyneuropathy affecting motor and sensory fibers in upper and lower extremities after three months of treatment with oral acitretin. Drug withdrawal resulted in a complete clinical recovery and normalization of all electrophysiologic abnormalities within two months.

Peripheral sensory neuropathy associated with short-term oral acitretin therapy.

A 57-year-old female patient with widespread chronic plaque psoriasis and a 32-year-old male patient with severe oral lichen planus are reported, who developed sensory symptoms in the extremities 3 and 4 months after the onset of oral acitretin therapy, respectively. Both patients showed clinical and electrophysiological evidence of a sensory peripheral neuropathy, which completely resolved 2 and 2.5 years after discontinuation of oral acitretin administration, respectively.

Stiff-person syndrome associated with oral isotretinoin treatment

We describe a patient with severe nodulocystic acne who developed disabling muscle stiffness and painful superimposed spasms of the neck, back and upper limbs 10 days after the onset of oral isotretinoin treatment. The muscle hyperactivity condition, which revealed the clinical and electromyographic features of the stiff-person syndrome, gradually resolved 2 weeks after drug withdrawal.

Treatment of Porphyria cutanea tarda with Oral Thalidomide

Eight male patients with overt clinical and biochemical features of porphyria cutanea tarda (PCT) were orally treated with 300 mg/day thalidomide for 1 week and with 200 mg/day for 3 more weeks. Already after the first week of treatment no new vesicles and/or bullae could be observed. Spontaneous blisters completely disappeared, increased skin fragility subsided and skin hyperpigmentation receded about 2 months after completion of therapy, whereas hypertrichosis persisted. There was a rapid decrease in the urinary total porphyrin excretion which reached normal levels in all patients by the end of the fourth week of therapy, whereas the posttreament chromatographic pattern of urinary porphyrins revealed a slight reduction of higher carboxylated porphyrin metabolites and an increase in the amount of the excreted coproporphyrin, as compared to the pretreatment period. Somnolence, intermittent constipation and dry mouth occurred in all patients, 2 patients additionally experienced dizziness. No evidence of peripheral neuropathy could be detected and laboratory investigations revealed no abnormalities, as compared to the pretreatment period. During the 16- to 28-month follow-up of the patients, no clinical or biochemical relapse was observed. In view of the encouraging results of the present investigation, further studies are now warranted in order to definitely answer the question whether oral thalidomide may be regarded as an effective alternative approach to the treatment of PCT.

Temporary remission of disseminated granuloma annulare under oral isotretinoin therapy.

In addition to cancer cells, EGFR is located in basal epidermal keratinocytes, the outer root sheath, sebocytes, and dermal arteries. 2 Acneiform drug eruption has been reported previously as a cutaneous adverse reaction due to gefinitib; 3 however, no purpuric drug eruption due to gefinitib has yet been reported. A 76-year-old woman was referred on December 9th 2002 for purpura (ecchymosis) on the buttock and sole (Fig. 1). One week later, she developed purpura (petechiae) on the leg with no other symptoms. The purpura was of two types: ecchymosis on the buttock and sole, and petechiae on the leg. The purpuric lesion on the sole was ulcerated, with hemorrhage due to fissure formation (Fig. 1). The clinical features on the sole resembled pernio. The patient had been treated with gefinitib for advanced primary lung cancer (adenocarcinoma) since September 24th 2002. She had no complaints of arthralgia or abdominal pain. Laboratory tests were within the normal range, except for elevated white blood cell count, glutamate oxaloacetate transaminase, glutamine pyruvate transaminase, and lactic dehydrogenase, also present before the oral administration of gefinitib. The histopathologic results from the purpuric lesion on the leg showed subcorneal pustules with lymphocytes and some neutrophils. In the papillary dermis, remarkable erythrocytes were extravasated diffusely, and perivascular lymphocyte infiltration was observed with edema and dilated capillaries (Fig. 2). Fibrinoid necrosis was not seen in the dermis. The histopathologic findings showed leukocytoclastic vasculitis. On December 16th 2002, gefinitib was discontinued. All other drugs were continued. The patient was treated orally with betamethasone at 2 mg/day. By December 20th 2002, the patient had developed a painful redness and swelling on the toe and finger, similar to paronychia. On December 24th 2002, the purpura had subsided to a brown pigmentation, and the ulceration on the sole had re-epithelialized. The paronychia-like symptoms had also improved. Although oral challenge test by gefinitib was not performed because of the severe general condition of the patient, we diagnosed purpuric drug eruption, possibly due to gefinitib, as a result of the history. gefinitib is a newly developed anticancer drug effective for non-small-cell carcinoma of the lung. 1 The etiology of purpuric drug eruption was not clear in the present case, as there was no blood disorder due to gefinitib. We therefore propose that gefinitib is involved in a disorder of the vascular system. Although the presence of EGFR in the capillaries has not been demonstrated, we speculate that a direct or indirect disorder in the capillaries caused by gefinitib induces leukocytoclastic vasculitis. The onset of purpuric drug eruption in our patient was in the winter. It is possible, therefore, that it may have been a cold-related injury, such as pernio. gefinitib had been given since September 24th 2002, and the patient had not reported any problems for 2.5 months. A previous report on this agent has also mentioned fragility and easy bruising of the skin. 3

Disseminated erythematous and pityriasiform plaques caused by imatinib mesylate

Sir, Imatinib mesylate (formerly STI 571, now referred to as Glivec in Europe andGleevec in theUnited States) is a rationally developed, orally administered potent competitive inhibitor of the BCR-ABLprotein tyrosine kinase that reveals a significant efficacy and a favourable safety profile in patients with chronic myeloid leukaemia (CML) (1). This compound has been reported to be effective also in gastrointestinal stromal tumours unresponsive to standard chemotherapy (2) and in metastatic dermatofibrosarcoma protuberans (3). We report here a patient who developed a skin rash during treatment with imatinib mesylate.

Lectin‐binding pattern of primary malignant melanomas and melanocytic nevi

A panel of six biotinylated lectins was applied in order to study the composition and distribution of plasma membrane carbohydrate residues in 83 primary cutaneous melanomas (MMs) and in 85 melanocytic nevi (MN) with the avidin‐biotin peroxidase technique. No clear‐cut differences between MN and MMs were observed with regard to the staining with lectins. In MN and MMs derived from different patients, the lectin‐binding pattern was variable and heterogeneous even within the individual nevi or melanomas. It seems reasonable, therefore, to assume that the lectin‐binding pattern cannot be regarded as a reliable histochemical marker for the differentiation of MN from MMs. Moreover, because the pattern reveals no statistically significant correlation with the thickness or the depth of invasion of MM, it seems to lack prognostic significance.

Sensorimotor polyneuropathy after a 1-month treatment with oral acitretin.

We report a 40-year-old male patient with widespread chronic plaque psoriasis, who complained of distal numbness in the right leg with gradual proximal extension after 1 month of treatment with oral acitretin. Neurological examination showed suppressed ankle reflexes, reduced pain and vibration sense in a glove and stocking distribution, and mild weakness of feet dorsiflexion. Neurophysiologic examination revealed a shift of the amplitude of all sensory and compound muscle action potentials toward low values, whereas in the case of sural and popliteal nerves, the amplitude felt below reference limits. Follow-up examination of the patient 1 month after treatment discontinuation revealed no abnormal neurological symptoms or signs, whereas the values of the neurophysiologic measurements had returned to normal levels. The case of sensorimotor polyneuropathy presented herein underlines the necessity for detailed neurological and neurophysiologic examinations of patients before and during oral administration of acitretin.

Safety of Systemic Biologic Agents in the Treatment of Non-malignant Skin Disorders

The recent significant breakthroughs in the understanding of the pathogenetic mechanisms of psoriasis and other immune-mediated inflammatory disorders, have led to the emergence of a wide array of biologic agents or biologics, that are especially designed to target selective intracellular or extracellular components and pathways of the dysregulated immune response. These targeted biologic agents have altered the landscape in dermatotherapy aiming to offer higher therapeutic efficacy and an alternative in patients who either failed on conventional systemic regimens or have no other therapeutic options. In the last two decades, the number of the commercially available biologic agents and the extent of their use have dramatically increased; today, these compounds represent a substantial part of modern dermatologic armamentarium. Due to the immunosuppressive potential of biologics, serious concerns were raised about their safety profile, already during the pre-approval period. These concerns did not subside after the incorporation of the postmarketing experience, particularly after the withdrawal of a biologic agent (efalizumab) due to its serious and even fatal side effects. The purpose of the present article is to review the cutaneous and systemic side effects of all biologic agents used so far in modern systemic dermatotherapy and to contribute to a better and updated awareness of their safety risks among clinicians, which will enable the latter to make the best informed and personalized drug selection and therapeutic decisions. This review was mainly based on data derived from Medline and Scopus databases and from manufacturing companies, as well.