M. Lahfa

A randomized controlled evaluator-blinded trial of intravenous immunoglobulin in adults with severe atopic dermatitis

Background There is a need for alternative therapy in severe adult atopic dermatitis (AD). Intravenous immunoglobulin (IVIG) treatment has been shown to be beneficial in a few open observations, but evidence of effectiveness is still lacking.

Quantification of Demodex folliculorum by PCR in rosacea and its relationship to skin innate immune activation

The aim of this study is to quantify D. folliculorum colonisation in rosacea subtypes and age‐matched controls and to determine the relationship between D. folliculorum load, rosacea subtype and skin innate immune system activation markers. We set up a multicentre, cross‐sectional, prospective study in which 98 adults were included: 50 with facial rosacea, including 18 with erythematotelangiectatic rosacea (ETR), and 32 with papulopustular rosacea (PPR) and 48 age‐ and sex‐matched healthy volunteers. Non‐invasive facial samples were taken to quantify D. folliculorum infestation by quantitative PCR and evaluate inflammatory and immune markers. Analysis of the skin samples show that D. folliculorum was detected more frequently in rosacea patients than age‐matched controls (96% vs 74%, P < 0.01). D. folliculorum density was 5.7 times higher in rosacea patients than in healthy volunteers. Skin sample analysis showed a higher expression of genes encoding pro‐inflammatory cytokines (Il‐8, Il‐1b, TNF‐a) and inflammasome‐related genes (NALP‐3 and CASP‐1) in rosacea, especially PPR. Overexpression of LL‐37 and VEGF, as well as CD45RO, MPO and CD163, was observed, indicating broad immune system activation in patients with rosacea. In conclusion, D. folliculorum density is highly increased in patients with rosacea, irrespective of rosacea subtype. There appears to be an inverse relationship between D. folliculorum density and inflammation markers in the skin of rosacea patients, with clear differences between rosacea subtypes.

Superiority of tacrolimus 0.1% ointment compared with fluticasone 0.005% in adults with moderate to severe atopic dermatitis of the face: results from a randomized, double-blind trial.

Summary Background  No specific data are available on tacrolimus ointment as a second‐line treatment in adults with facial eczema.

Significant delay in the introduction of systemic treatment of moderate to severe psoriasis: a prospective multicentre observational study in outpatients from hospital dermatology departments in France

Background  There is a low rate of systemic treatment usage in moderate to severe psoriasis.

Efficacy of Ustekinumab in Palmoplantar Psoriasis

Case 1 A 42-year-old nonsmoking man, a craftsman, was suffering from isolated PP since the age of 18 years. He had a history of concomitant axial and/or peripheral psoriatic arthritis. His previous treatments included topical therapies (topical corticosteroids, vitamin D derivatives), acitretin, phototherapy, methotrexate, etanercept, infliximab and adalimumab without any significant improvement. In 2007 he lost his job due to the severity of PP. In June 2009 he presented with multiple painful fissures on his hands ( fig. 1 a) and feet ( fig. 1 b), which severely impeded walking. The localized PP area and severity index (PPASI) was 54. A monotherapy with 45 mg of subcutaneous ustekinumab (weight: 95 kg; BMI: 24) was introduced. After 7 months and 3 injections of ustekinumab, a dramatic improvement in PP was seen ( fig. 2 ). The localized PPASI improved by 85%. A slight improvement in psoriatic arthritis observed. Ustekinumab therapy was continued, combined with a low dose of methotrexate.

Are we giving patients enough information on how to use topical treatments? Analysis of 767 prescriptions in psoriasis.

Background  Unclear instructions probably contribute to the suboptimal efficacy and adherence to topical agents in psoriasis.

Large scale study of epidermal recovery after stratum corneum removal: dynamics of genomic response

Please cite this paper as: Large scale study of epidermal recovery after stratum corneum removal: dynamics of genomic response. Experimental Dermatology 2010; 19: 259–268.

A Multicenter, Randomized, Open-Label, Controlled Study Comparing the Efficacy, Safety and Cost-Effectiveness of a Sequential Therapy with RV4104A Ointment, Ciclopiroxolamine Cream and Ciclopirox Film-Forming Solution with Amorolfine Nail Lacquer Alone in Dermatophytic Onychomycosis

Background: The efficacy of topical antifungals is controversial. Objective: To compare the efficacy and safety of a sequential (SEQ) treatment with chemical nail avulsion and topical antifungals to amorolfine nail lacquer in dermatophytic onychomycosis. Methods: This was a randomized, parallel-group, controlled study comparing a 36-week SEQ treatment with chemical nail avulsion with RV4104A ointment (class I medical device containing 40% urea) followed by ciclopirox cream for 8 weeks and ciclopirox nail lacquer for 25 weeks (SEQ group) to amorolfine nail lacquer for 36 weeks (AMO group). Patients had to have a big toenail onychomycosis, sparing the matrix. The primary efficacy criterion was complete cure at week 48. A cost-effectiveness analysis was performed. Results: A total of 142 patients were randomized. The complete cure rate at week 48 was significantly higher in the SEQ group than in the AMO group (36.6 vs. 12.7%, p = 0.001). Clinical cure at week 48 was observed in 53.5% of patients in the SEQ group versus 17% in the AMO group (p < 0.01). The cost of cure per patient was 50% lower with SEQ treatment (EUR 33) compared with amorolfine (EUR 76). Conclusion: A treatment of onychomycosis comprising chemical avulsion of the pathological nail, ciclopirox cream and nail lacquer is significantly more effective than amorolfine nail lacquer.

Incidence and risk factors for treatment failure with infliximab in psoriasis

G.U. Sawatkar, A.J. Kanwar,* S. Dogra, S.K. Bhadada, D. Dayal Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India *Correspondence: Prof. A. J. Kanwar. E-mail: ajkanwar1948@gmail.com

Élaboration d’un référentiel d’éducation thérapeutique dans le psoriasis

INTRODUCTION Psoriasis is a chronic inflammatory skin disease which can cause significant impairment of quality of life, absenteeism at work and significant psychological distress. This justifies the elaboration of a multidisciplinary education program for patients. The objective of this work was to develop the content of a therapeutic education program in psoriasis, which may serve as a basis for teams wishing to develop psoriasis therapeutic education in their community. PATIENTS AND METHODS A group of 15 health professionals (dermatologists, dermatology nurses, and psychologist) and four psoriasis patients representatives of the psoriasis patient association (Association pour la lutte contre le psoriasis) participated in the development of this program. Health professionals all had an experience in therapeutic patient education in psoriasis through prior participation in a multicenter open pilot study, evaluating a therapeutic education program in psoriasis. Based on the previous experience, preparatory work in subteams was initiated to prepare draft objectives and content of the program. A two-day meeting was then organized to discuss in depth content of the therapeutic education program and elaborate recommendations. The meeting structure combined subteam work and plenary sessions. The following program was elaborated: two individual sessions and three group sessions. The groups have worked for two days, according to a predefined pattern: interview guide of educational diagnostic, content of collective workshops and knowledge questionnaire. All these documents were validated in plenary session. The methodology used for the development of this program followed the recommendations of the HAS in the field of chronic disease. RESULTS In the end, were retained three collective workshops, preceded by a consultation of individual educational diagnosis and knowledge questionnaire followed by an evaluation session at the end of the program. The interview guide for educational diagnosis and the knowledge basis questionnaire have been defined. Three themes of group workshops were defined: (1) understanding the disease, (2) understanding the mechanism of onset of disease and treatments available, (3) how to live with psoriasis in everyday life. For each workshop, were defined learning objectives, skills to acquire and how to get there. DISCUSSION We describe here a framework of educational therapy program in psoriasis comprising educational objectives, skills to acquire, basic disease knowledge, suitable for patients with psoriasis. The content was tailored to patient language and knowledge based on feedback from participating patients. The list of skills may be adapted to patients individual needs. This program serves primarily as a working basis for the caregiver, to standardize practices in terms of therapeutic education in psoriasis in France.