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Bullous Pemphigoid (BP) is an autoimmune blistering disease associated with a number of predisposing factors including age, neurological disease, diabetes mellitus and drugs. Over the past few years Dipeptidyl peptidase-4 Inhibitors (DPP4-Is), referred to as gliptins have been increasingly associated with the development of this blistering disease. Locally, since the introduction of gliptins into the national formulary we have noted a surge in the number of cases of presumed gliptin-induced BP. We present a local case report followed by a short case series which highlights the typical characteristics of patients with gliptin-induced BP and shows the surge in the number of local cases. Patients with drug-induced BP as opposed to conventional BP, tend to respond quicker upon cessation of the culprit drug, therefore physicians should be aware of this association and have a low threshold for investigating diabetics who present with unexplained pruritus, erythema and bullae especially if these patients are on DPP4-Is., peer-reviewed

BACKGROUND: There are currently no studies looking specifically at the characteristics of the primary melanoma in patients who died of metastatic melanoma in Malta. This retrospective study looks at the demographics of these patients and the characteristics of their primary melanoma., METHOD: Mortality data secondary to metastatic melanoma between 2007 and 2016 was gathered from the Malta National Mortality Registry. All patients whose death certificates had metastatic melanoma as the cause of death were included. Further data on histology and imaging was gathered from the Malta National Cancer Registry and the hospital electronic database., RESULTS: There were 87 recorded deaths (45 male; 42 female) in Malta secondary to metastatic melanoma between 2007 and 2016, with an average age at diagnosis of the primary melanoma of 64.3 years (range 23-92 years), average age at death of 67.9 years (range 28-96 years) and an average duration of survival after diagnosis of primary melanoma of 34.7 months (range 1-180 months). The commonest histological subtype of the primary cutaneous melanoma was nodular. The commonest site for the primary cutaneous melanoma was the back. The mean Breslow thickness was 4.23mm (range 0.3-13mm). The commonest site of metastasis was to distant lymph nodes, followed by the skin, liver and lung., CONCLUSION: Mortality secondary to metastatic melanoma is prevalent in the over 60 age group, with the back being the commonest site of the primary melanoma. Identification of patients who are at higher risk of death from melanoma in Malta allows for their more effective targeting in local melanoma screening and education campaigns., peer-reviewed

info:eu-repo/semantics/published

Background: Basal cell carcinoma (BCC) is the commonest skin malignancy with a significant risk of recurrence and new primaries. The major risk factor is ultraviolet (UV) radiation, which is relevant to Malta, where the UV index is high for most of the year. Objective: The aim of this study was to follow up a group of patients diagnosed with BCC and analyse the occurrence of subsequent malignant and pre-malignant skin tumours, to obtain a local perspective and aid screening methods and follow-up protocols. Method: All patients registered with BCC in the Malta National Cancer Registry in 2007 were included in our study. This cohort was followed up by searching for histology results showing subsequent skin tumours until the end of 2014. Results: A total of 382 patients were diagnosed with BCC in 2007. The majority of patients were males older than 60. Almost one third of these patients (30.1%) had at least another skin tumour biopsied on follow up; 71.7% of these tumours were BCCs. Squamous cell carcinomas and actinic keratoses were also commonly biopsied. Nine patients developed malignant melanoma. The commonest location for BCCs and other non-melanoma skin tumours was the face. Males and the elderly had significantly higher risks to develop further skin tumours, reflected by the Chi^2 test for Independence and hazard ratios. Conclusion: Our results are consistent with most international data. Since BCC fulfils most criteria for screening, regular follow-up in high risk patients is recommended., peer-reviewed

Introduction: Biologic therapy has revolutionalised the treatment of moderate to severe psoriasis leading to improved clinical outcomes and quality of life scores. This study aims to determine current biologic use in psoriatic patients at our Dermatology department at Sir Paul Boffa hospital, Malta. Method: All patients who were administered biologic therapy for psoriasis in Malta until the end of 2014 were included. Data included demographic details, disease duration and severity, biologic use and duration, previously attempted treatments, side effects, early and late response to biologic using Psoriasis Area Severity Index (PASI) scores and Dermatology Life Quality index (DLQI) scores. Results: A total of 36 patients were started on a biologic between 2009 and 2014 for psoriasis (M:25, F:11) with a mean age of 46.9 years. These included etanercept (n=22), infliximab (n=8), adalimumab (n=4) and ustekinumab (n=2). Secondary failure was the main reason why biologics were stopped and switched. Most patients had an improvement in their PASI scores after 2 to 4 weeks of starting the biologic and had a PASI 90 score improvement. All patients had more than a 5 point improvement in DLQI score. Discussion: Biologic use in our department is on the increase. Our patients had considerable improvements in their PASI and DLQI scores. Secondary failures have occurred usually after 2 to 4 years and switching has yielded positive results. Biologics are expensive drugs and recently we have switched to cheaper biosimilars. Doctors should be aware of the treatment options available for psoriasis patients, their possible side effects and when to refer to our department. In most cases a satisfactory response can be achieved., peer-reviewed

Urticaria is a common and characteristic skin condition presenting with wheals and/or angioedema. It may be acute or chronic and has various causes and triggers. Patients with urticaria are often referred to allergy clinics to find out ‘what they are allergic to’. Urticaria may impact significantly on a patient’s quality of life. Its management involves identifying and removing causes or triggers, together with oral antihistamines as first line treatment for symptomatic control. Omalizumab is a recently licensed expensive treatment option for patients with urticaria resistant to oral antihistamines, and has shown a high success rate and good safety profile., peer-reviewed

Summary - Background: There are poorly documented variations in the journey a skin cancer patient will follow from diagnosis to treatment in the European Union. Objectives: To investigate the possible difficulties or obstacles that a person with a skin malignancy in the European Union may have to overcome in order to receive adequate medical screening and care for his/her condition. In addition, we wished to explore differences in European health systems, which may lead to health inequalities and health inequities within Europe. Methods: Ten European countries took part in this investigation (in alphabetical order): Finland, Germany, Greece, Italy, Malta, Poland, Romania, Spain, the Netherlands and the U.K. The individual participants undertook local and national enquiries within their own country and completed a questionnaire. Results This exercise has identified important differences in the management of a skin cancer patient, reflecting major disparities in health care between European countries. Conclusions: Further investigation of health disparities and efforts to address health inequalities should lead to improvements in European health care quality and reduction in morbidity from skin cancer., This publication arises from the EPIDERM project, which was funded by the European Commission’s Executive Agency for Health and Consumers (EPIDERM project: PHEA 2007- A ⁄100994 HI). Funding for publication of this supplement was provided by the European Skin Cancer Foundation (ESCF)., peer-reviewed

A survey of the outpatient service provided by a consultant dermatologist at the national dermatology department in Malta was carried out. The aims of this study were to identify the main conditions being treated and to analyze management and referral practices. Possible implications for future training of primary care physicians were also investigated. The survey was carried out for one week every season over a 12-month period, giving a total study period of four weeks. Data was collected on a total of 662 patients (401 new patients and 261 follow-ups). The average waiting time for a routine clinic appointment for new cases was 4 weeks, but 18% of patients were seen within 48 hours of referral and 7% were seen within one week. Age-specific attendance rates were highest for females over 50 years and males over 60. Overall, the commonest conditions seen were chronic leg ulcers, psoriasis, skin infections and seborrhoeic keratoses. Skin biopsy was the most frequent investigation performed and topical treatment was the commonest form of therapy. Private general practitioners and government doctors based in health centres accounted for 51% and 29% of all referrals respectively. A diagnosis was offered in 65% of referral notes. Of these, 44% had a diagnosis matching that given by the dermatologist at the patient's first visit. Treatment was attempted prior to referral in 64% of patients with acne but in only 15% of patients with viral warts., peer-reviewed