G. A. Vena

Survival rate of antitumour necrosis factor‐α treatments for psoriasis in routine dermatological practice: a multicentre observational study

Adherence is an overall marker of treatment success, and it depends on multiple factors including efficacy and safety. Despite the wide use of tumour necrosis factor (TNF)‐α blockers in the treatment of plaque‐type psoriasis, few data regarding treatment adherence in routine clinical practice are available.

Allergic contact dermatitis to some medicaments.

Over the years, changes have had to be made in the list of topical drags most frequently responsible for allergic contact dermatitis. The 4 most common sensitizers in Italy in the past have been penicillin. Sulfonamide, promethazine and neomycin. Now the list is headed by neomycin, benzoeaine and ethylenediamine. Antihislumines and parabens are less frequently observed as sensilizers. The increasing topical use of new drujis and additives, as well as older sensitizers, produces reactions 10 other substances, such as non‐steroidal anti‐inflammatory agents, some antimycotic drugs, propylene glycol and benzoyl peroxide.

Narrow‐band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients

Background  Narrow‐band ultraviolet B (NB‐UVB) phototherapy and topical tacrolimus are included among the most innovative approaches to vitiligo.

Shoe contact dermatitis

The incidence of contact allergy was studied in a series of 165 patients with eczematous dermatitis of the feet correlated clinically with shoe contact. Positive reactions to one or more substances were recorded in 108 patients (65.4%). Among the relevant sensitizers were chromium, paraphenylenediamine, paratertiary butylphenolformaldehyde resin and nickel, while the other allergens were benzocaine, neomycin, balsam of Peru, ethylenediamine and parabens. Allergic contact dermatitis of the feel can he prevented by recognition of the allergens responsible, control of hyperhidrosis and avoidance of topical allergens.

Infliximab in recalcitrant severe atopic eczema associated with contact allergy.

Infliximab is an anti-tumour necrosis factor (TNF)-alpha chimeric monoclonal antibody which is effective in diseases associated with a T-helper (Th) 1 response, such as rheumatoid arthritis, Crohns disease and psoriasis. There are sporadic case reports of atopic dermatitis (AD) induced or precipitated by anti-TNF-alpha therapy, which have been attributed to the switch towards Th2-mediated reactions. We report the case of a 30-year-old man with long-standing severe AD associated with contact allergy and poorly responding to conventional treatments. The use of infliximab resulted in a dramatic amelioration of AD lesions and pruritus, persisting at follow-up examinations over a 3-year period. Probably, the unexpected response to infliximab therapy in this case might be due to some peculiar features of AD in our patient (i.e. chronic-continuous course and concomitant contact allergy) which could have been responsible for a more preponderant recruitment of Th1 cells as compared to common forms of AD.

Cell-mediated immunity in alopecia areata.

SummaryA study of cell-mediated immunity was carried out in a total of 69 subjects with alopecia areata (AA) of the scalp in various phases of its evolution. The blastic responses to mitogens PHA, Con A, and PWM proved significantly reduced, quite independently of the phase of the disease. The total E-rosettes test demonstrated a significant reduction in T-lymphocytes in patients with active AA. On the other hand, no significant differences could be demonstrated between the patients and the controls by means of active E rosette test. The mean values for Tγ and for theophylline-sensitive T-lymphocytes were reduced in patients with active AA. The significance of the results is discussed.ZusammenfassungZellvermittelte Immunität wurde bei insgesamt 69 Personen mit Alopecia areata (AA) der Kopfhaut in verschiedenen Entwicklungsphasen studiert. Die Blastenantwort auf die Mitogene PHA, Con A and PWM war, unabhängig von der Entwicklungsphase der Krankheit, signifikant reduziert. Der Test der totalen E-Rosetten zeigt eine signifikante Verminderung der T-Lymphocyten bei Patienten mit AA in progredienter Phase. Im Falle der aktiven E-rosetten gab es dagegen keine signifikanten Unterschiede zwischen Patienten und Kontrollpersonen. Die Durchschnittszahl der theophyllinsensiblen und Tγ-Lymphocyten war bei Patienten mit AA in der progredienten Phase vermindert. Die Bedeutung der Ergebnisse wird diskutiert.

Secretan's syndrome: an artefact oedema of the hand

Henri Secret an, a Swiss insurance and accident physician, was the first to describe persistent hard oedema of the dorsum of the hands in workers involved in compensation claims after injury (1). All the patients described by Secret an sustained minor injuries, the results from which persisted beyond the normal time required for resolution after simple contusions. Since this first report, similar cases have been described by other authors in the non-dermatological literature (2-4). Herewith we report a similar case observed over a period of 18 months.

Clobetasol propionate 0·05% in a novel foam formulation is safe and effective in the short-term treatment of patients with delayed pressure urticaria: a randomized, double-blind, placebo-controlled trial

Background  Delayed pressure urticaria (DPU) is characterized by the appearance of typical painful skin lesions (weals) after pressure stimulus. Oral corticosteroids are effective treatments but long‐term therapy is problematic. A new topical formulation of clobetasol propionate 0·05% in thermophobic foam (CF) (Olux®) has recently become available. The foam is easy to apply, with low skin residues.

Over‐expression of Mn‐superoxide dismutase as a marker of oxidative stress in lesional skin of chronic idiopathic urticaria

Summary We studied the involvement of oxidative stress in chronic idiopathic urticaria (CIU), assessing the activities of superoxide dismutase (SOD) and glutathione and the levels of malondialdeyde (MDA), a marker of lipid peroxidation, in samples taken from lesional skin (n = 16) and nonlesional skin (n = 11) of CIU patients. The activity of SOD and glutathione and the levels of MDA were markedly increased in lesional skin as compared with skin of healthy subjects, whereas no differences were detected between nonlesional skin of CIU patients and control samples. Immuno‐dot blot assay revealed an up‐regulation of Mn‐SOD expression in lesional skin. These findings show that oxidative stress is crucially involved in CIU. The evidence of lipid peroxidation and compensatory increase of Mn‐SOD and glutathione activities in lesional skin, in the absence of any alteration in uninvolved skin, suggests that oxidative stress is secondary to the development of inflammation.

Psoriasis relapse evaluation with week-end cyclosporine A treatment: results of a randomized, double-blind, multicenter study.

Cyclosporine A (CsA) effectively controls psoriasis, however, its long-term continuous use is not recommended. This study aims to evaluate the efficacy and tolerability of week-end CsA microemulsion for the reduction of relapse rate in patients with chronic plaque psoriasis who had achieved clinical remission following continuous CsA therapy. The PREWENT (Psoriasis Relapse Evaluation with Week-End Neoral Treatment) study was a 24-week, randomized, double-blind, multicenter study, carried out in 22 Italian hospital or university Dermatology units. CsA was discontinued for 8 days previous to the patients being randomized to oral CsA 5 mg/kg/day or placebo for two consecutive days/week, for a total period of 24 weeks. The primary endpoint was clinical success rate at week 24, defined as the proportion of patients with no clinical worsening (no relapse or a Psoriasis Area and Severity Index [PASI] <75% of pre-treatment PASI). A total of 162 patients were randomized to CsA and 81 to placebo. Clinical success rates at 24 weeks were 66.9% and 53.2% with CsA and placebo, respectively (p = 0.072). Time to first relapse was significantly prolonged with CsA versus placebo (p = 0.023), and PASI was significantly lower from weeks 4 to 16 in CsA recipients. In patients with moderate-severe psoriasis, the clinical success rate was significantly increased with CsA compared to placebo (69.9% vs 46.3%; p = 0.011), and significantly lower increases in PASI were observed from week 4 to week 24 (p < 0.05 vs placebo). CsA was well tolerated, with no differences in mean blood creatinine or blood pressure between CsA and placebo recipients. However, the high withdrawal rate (22.2% of randomized patients), which was not related to side effects, may have led to an overestimation of efficacy, but the study had a good statistical power (88% greater than that observed in similar studies, i.e. 80%). Week-end CsA administration was shown to prolong safely and effectively the time to first relapse in psoriasis patients.