Search

To assess the real-world clinical treatment outcomes with brodalumab in patients with moderate-to-severe plaque psoriasis in Greece.This was a longitudinal, retrospective, real-world analysis of data from medical records of 106 patients with moderate-to-severe plaque psoriasis, treated with brodalumab for up to 24 months at four University Dermatology Centers in Greece. Efficacy assessments of psoriasis severity [Psoriasis Area and Severity Index (PASI) and Body Surface Area affected (BSA) scores] and its impact on patients' quality of life (QoL) [Dermatology Life Quality Index (DLQI) score] were evaluated at different timepoints up to 24 months.Treatment with brodalumab reduced both mean PASI (14.0-1.5,Brodalumab is effective long term, improving disease severity and health-related QoL in patients with moderate-to-severe plaque psoriasis in a real-world setting.

The objective of the current research was to investigate the possible association between Periodontal Disease indices and risk of development Acute Hematopoietic Cancer (Acute Myeloid and Acute Lymphoblastic Leukemia) in a representative Greek adult sample. 174 individuals with Acute Myeloid and Acute Lymphoblastic Leukemia-cases and 174 matched healthy individuals- controls underwent an oral and dental clinical examination and completed a questionnaire. The periodontal condition for cases and controls included Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL) and Gingival Index (GI). Chi-square test and logistic regression models were carried out to assess the possible association. The logistic regression model showed that CAL (p= 0.054) (OR= 2.467, 95% CI= 1.177-2.231), and GI (p= 0.043) (OR = 3.352, 95% CI= 1.285-4.745), were marginally significantly associated with an increased risk of developing Acute Hematopoietic Cancer.

Aim: The aim of the current study was to investigate the possible relationship between periodontal status indices and the risk for psoriasis development in a Greek adult population. Subjects and Methods: The study sample comprised 337 psoriasis patients-cases and 337 healthy individuals-controls between 40 to 69 years of age who referred by three dermatology and one dental private practice. Cases and controls completed a health medical and dental questionnaire and underwent an examination of their periodontal status that included the following parameters: Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), frequency of a regular/irregular annual dental follow-up, and number of missing teeth. Odds ratios (OR’s) and 95% Confidence Intervals (95% CI’s) were assessed using logistic regression model adjusted for possible confounders. Results: The multivariate regression analysis model showed that a higher BMI (p=0.009, OR= 3.154, 95% CI= 1.532-4.028), alcohol overconsumption (p= 0.012, OR= 2.024, 95% CI=1.445-3.435), moderate /severe CAL (p=0.047, 95% CI=2.112, 1.156-3.249), and a number of missing teeth more than four (p=0.027, OR=2.817, 95% CI= 1.267-3.872 and p= 0.016, OR=3.510, 95% CI= 1.350-4.145) were statistically significantly associated with risk for psoriasis development. Conclusion: Individuals with a higher BMI, excessive alcohol consumption, moderate/severe attachment loss and a number of missing teeth more than four were at significantly higher risk for developing psoriasis. Keywords: Periodontal disease; Psoriasis; Number of missing teeth; Risk factor.

Atopic dermatitis (AD) is a chronic inflammatory skin condition that affects more than 200 million people worldwide, including up to 20% of children and 10% of the adult population. Although AD appears frequently in childhood and often continues into adulthood, about 1 in 4 adults develop the adult-onset disease. The prenatal period, early childhood, and adolescence are considered critical timepoints for the development of AD when the exposome results in long-lasting effects on the immune system. The exposome can be defined as the measure of all the exposures of an individual during their lifetime and how these exposures relate to well-being. While genetic factors could partially explain AD onset, multiple external environmental exposures (external exposome) in early life are implicated and are equally important for understanding AD manifestation. In this review, we describe the conceptual framework of the exposome and its relevance to AD from conception and across the lifespan. Through a spatiotemporal lens that focuses on the multi-level phenotyping of the environment, we highlight a framework that embraces the dynamic complex nature of exposome and recognizes the influence of additive and interactive environmental exposures. Moreover, we highlight the need to understand the developmental origins of AD from an age-related perspective when studying the effects of the exposome on AD, shifting the research paradigm away from the per se categorized exposome factors and beyond clinical contexts to explore the trajectory of age-related exposome risks and hence future preventive interventions.

A 45-year-old HIV-negative Caucasian man with no reported past medical history was referred to our Department with a large (7 cm in diameter) oozing nodule on the occipital region of the scalp with spontaneous periodical bloody or purulent discharge. The lesion had appeared over a period of six months, had an irregular color, non-specific dermoscopic features, and resembled squamous cell carcinoma. The physical examination revealed three more atypical melanocytic lesions (on the abdomen, back, and buccal mucosa), and multiple swollen occipital, postauricular, as well as superficial and deep cervical lymph nodes. After clinical evaluation, the patient reported having another in situ melanoma (submammary region) excised 7 years ago. All the lesions were excised and sent for histopathologic examination, which was compatible with primary cutaneous melanoma. Total body computed tomography revealed the presence of multiple visceral metastases, and the patient was referred to an oncologist. He did not consent to proceed to genetic testing. The occurrence of multiple primary melanomas (MPM) is a rare but recognized phenomenon. The estimated incidence of a second primary tumor ranges from 0.2% to 8.7% in large retrospective reviews. While 63% to 88% of patients with MPM are reported to have two primary tumors, the occurrence of more than four primary melanomas is considered exceedingly rare (1-2). Whether the presence of multiple primary melanomas is a function of increased genetic susceptibility of the individual, consistent exposure to a common exogenous promoter of malignancy, or a combination of these two factors remains to be elucidated. These patients should undergo intensive dermatologic screening for the rest of their lives and should consider genetic testing.

Nipple pain and discomfort during or after breastfeeding remains one of the most common reasons for premature cessation of lactation among the affected women. The belief that yeasts, and especially

Acremonium is a large fungal genus that is comprised of approximately 150 species, found ubiquitously in nature. Although the majority are recognized as being saprophytes in soil and pathogens of plants, several species are emerging as causative agents of a variety of human infections, including mycetomas. Herein, we present a young man that was referred to our department with a painful subungual mass that developed following traumatic inoculation of Acremonium spp. In recent years, the role of Acremonium spp. has been increasingly recognized in localized infections, such as mycetoma, in humans. Other locally invasive as well as disseminated infections are also described. Optimal treatment of Acremonium spp. mycetoma is not well defined owing to the rarity of cases, thus posing a therapeutic challenge.

A full-term, 2-day-old female neonate with a congenital non-tender reticular patch that did not disappear with local warming was referred to our department for consultation. The family history as well as the antenatal course and delivery were unremarkable. On examination, we evidenced a fixed, marbled, bluish to deep purple lesion with a fishnet appearance extending over the right side of her body, face, and scalp. There was presence of atrophy of the involved skin, along with ulceration above the right lateral malleolus. Upon blanching, the lesions could not be emptied completely. Routine laboratory studies, chest X-rays, and abdominal and cranial ultrasound scan results were nonsignificant. Head and limb circumferences were within normal ranges. The patient was checked by the ophthalmology and neurology department to screen for associated anomalies, which were not detected. Based on the medical history and clinical presentation, the diagnosis of cutis marmorata telangiectatica congenita was established. The infant's parents were reassured about the benign nature of the cutaneous disorder as well as the need for periodic follow-up on an outpatient basis. Cutis marmorata telangiectatica congenita (CMTC), first described by the Dutch pediatrician Van Lohuizen in 1922, is an exceedingly rare congenital sporadic condition with fewer than 300 cases described in the medical literature to date. Affected infants have discolored vascular patches of skin with a blue-violet marbled appearance. The disorder may present with a segmental or generalized persistent reticular mottling but more frequently has localized distribution over the lower limbs (1,2). Skin lesions are reminiscent of cutis marmorata, a common benign response observed in infants, which resolves with warming of the skin surface. In contrast, CMTC lesions do not disappear with rewarming and occasionally present with ulceration and atrophy of the involved skin (aplasia cutis) (1,3). Cutis marmorata telangiectatica congenita is described as occuring in association with a plethora of extracutaneous malformations, including undergrowth or overgrowth of the involved extremity, ocular and neurological abnormalities, growth and developmental delays, as well as additional vascular anomalies. The pathogenesis is not fully elucidated, but a lethal gene hypothesis has been suggested by some authors, while others indicate that the disorder may be inherited as an autosomal dominant trait with low penetrance (1,2,4). Skin biopsy is nonspecific and differential diagnosis is rarely difficult due to the distinctive appearance of cutaneous lesions, and the diagnosis can thus be established on clinical grounds alone. CMTC can be associated with other congenital syndromes including phacomatosis pigmentovascularis and Adams-Oliver syndrome (2,4). Cutaneous lesions carry a good prognosis and show a tendency for fading or spontaneous resolution over the first years of life in most cases, but the extremity discrepancy tends to persist. A thorough screening for associated anomalies as well as annual controls of skin changes and psychomotor development of the patients should be performed (2-3).

Background Malacoplakia is a rare acquired, infection-related granulomatous disorder, that may affect many systems, but typically occurs in the urinary tract. Cutaneous involvement is less prevalent, and most commonly presents with a perianal or genital region localization. Cutaneous malacoplakia is believed to be caused by an acquired bactericidal defect of macrophages in the setting of chronic infections and immunocompromised states. A diagnosis of cutaneous malacoplakia should be considered when encountering non-specific granulomatous lesions that are refractory to treatment. Histologic findings are marked by the presence of foamy macrophages containing the pathognomonic Michaelis-Gutman bodies. Objectives The aim of this review is to discuss the current perspectives on the pathophysiology, clinical features, diagnosis, and treatment of this disease. We would also like to emphasize that the integration of clinical information, microscopic findings, and exclusion of other cutaneous granulomatous processes is necessary to accurately diagnose this exceedingly rare disease and provide opportunity for therapeutic intervention. Patients/methods Data for this work were collected from the published literature and textbooks. Results Combined surgical excision and protracted antibiotic courses appear to have the highest success rate. Antibiotics should be culture specific, but drugs that easily permeate the macrophages appear to be the best choice.

Background:The introduction of Immune Checkpoint Inhibitors in the recent years has resulted in high response rates and extended survival in patients with metastatic/advanced malignancies. Their mechanism of action is the indirect activation of cytotoxic T-cells through the blockade of inhibitory receptors of immunomodulatory pathways, such as cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4), programmed cell death protein-1 (PD-1) and its ligand (PD-L1). Despite their impressive therapeutic results, they can also induce immune-related toxicity, affecting various organs, including the skin.Objective:To provide an updated summarized overview of the most common immune-mediated cutaneous side effects and their management.Method:English articles derived from the databases PubMed and SCOPUS and published between 2009 and 2018, were analyzed for this narrative review.Results:The most common adverse cutaneous reactions include maculopapular rash, lichenoid reactions, vitiligo and pruritus, with severity Grade 1 or 2. Less frequent but eventually life-threatening skin side effects, including Stevens-Johnson syndrome, Drug Reaction with Eosinophilia and Systemic Symptoms and Toxic Epidermal necrolysis, have also been reported.Conclusion:Basic knowledge of the Immune-Checkpoint-Inhibitors-induced skin toxicity is necessary in order to recognize these treatment-related complications. The most frequent skin side effects, such as maculopapular rash, vitiligo and pruritus, tend to subside under symptomatic treatment so that permanent discontinuation of therapy is not commonly necessary. In the case of life-threatening side effects, apart from the necessary symptomatic treatment, the immunotherapy should be permanently stopped. Information concerning the management of ICIs-mediated skin toxicity can be obtained from the literature as well as from the Summary of Product Characteristics of each agent.

Ribonuclease P (RNase P) is ubiquitous and essential Mg(2+)-dependent endoribonuclease that catalyzes the 5'-maturation of transfer RNAs. RNase P and the ribosome are so far the only ribozymes known to be conserved in all kingdoms of life. Eukaryotic RNase P activity has been detected in nuclei, mitochondria and chloroplasts and demonstrates great variability in sequence and subunit composition. In the last few years we have developed methodologies and pursued projects addressing the occurrence, distribution and the potential physiological role of RNase P in human epidermal keratinocytes. In view of the vital importance of lymphocytes for an effective immune system and their successful application after transfection with RNase P-associated external guide sequences in gene therapy, we concerned ourselves with the isolation and characterization of RNase P of peripheral human lymphocytes. We developed a method described herein, that will enable the study of the possible involvement of this ribozyme in the pathogenetic mechanisms of diverse autoimmune, inflammatory and neoplastic cutaneous disorders and may facilitate the further development of RNase P-based technology for gene therapy of infectious and neoplastic dermatoses.

The aim of this study was to determine whether imiquimod, a Toll-like receptor-7/8 agonist, in addition to its well-known topical action on the cutaneous immune response, might also induce alterations in the peripheral blood lymphocytes. A 62.5 mg quantity of imiquimod (5% cream) was applied topically under occlusion once daily every second day for 3 weeks to the skin of 10 healthy volunteers, age range 30–57 years. Ten sex- and age-matched healthy controls applied corresponding quantities of the vehicle under occlusion. Before, and one and 3 weeks after the start of treatment, peripheral blood lymphocyte subpopulations were measured by flow cytometry. Statistically significant alterations in the percentage or absolute numbers of peripheral blood lymphocyte subpopulations were found in the imiquimod-treated group compared with the control group. These alterations indicate for the first time that topical application of imiquimod induces alterations in peripheral blood lympho cyte subsets in healthy individuals, which may be of importance in the immunotherapy of neoplastic and infectious disorders and should be taken into careful consideration in patients who are treated with imiquimod.

Sir, Stevens-Johnson syndrome (SJS) is a rare and severe mucocutaneous disorder, most frequently caused by systemic drugs, with an incidence of 1–6 cases per million person-years (1). It is characterized clinically by a maculopapular and bullous eruption with epidermal necrosis and detachment, mucosal ulcers and erosions and constitutional signs and symptoms. SJS and toxic epidermal necrolysis (TEN) are presently regarded as clinical forms of the same disorder that share common aetiopathogenetic factors but mainly differ in: (i) the extent of epidermal detachment (SJS 30%); (ii) the prognosis (SJS = good; TEN = poor); and (iii) the mortality rate (SJS < 5% vs. TEN = 30–40%) (2, 3). Although the exact pathogenetic mechanisms of SJS and TEN at the molecular and cellular level remain to be elucidated, there is evidence suggesting a cytotoxic cell immune response against keratinocytes that is induced by various drugs, mostly sulphonamides, allopurinol, phenytoine, phenobarbital, carbamazepine, lamotrigine, non-steroidal anti-inflammatory drugs and nevirapine (4). Since it is of essential importance to recognize and report drugs capable of inducing severe adverse reactions, we describe herein the first case of SJS occurring in a HIVnegative patient during oral fluconazole treatment. CASE REPORT A 50-year-old Caucasian woman was admitted to the Department of Dermatology at the University of Patras Medical Center with a 3-day history of skin and mucosal lesions accompanied by high fever and malaise. The cutaneous manifestations had developed one week after the onset of treatment of vaginal candidiasis with 200 mg/day oral fluconazole (Flucodrug caps; Med-One, Athens, Greece). Apart from fluconazole, the patient had received no other medication and had no history or evidence of infectious, autoimmune or neoplastic disorders. Physical examination of the patient on admission revealed a confluent erythematoviolaceous, maculopapular and focally bullous pruritic skin rash with large numbers of targeted lesions over her face, upper trunk and the extremities. In a small area on her back, epidermal detachment was clearly seen (Fig. 1A). There were superficial ulcers and erosions in the oral mucosae, erosions and crusts on her oedematous lips (Fig. 1B) and a severe conjunctivitis. Blisters and epidermal detachment affected about 9% of the patient’s body surface. Apart from a vaginal culture positive for Candida albicans, all haematological, biochemical, immunological and serological investigations (including tests for HSV, HIV 1 & 2, hepatitis A, B and C, Toxoplasma, Epstein Barr virus, Fluconazole-induced Stevens-Johnson Syndrome in a HIV-negative Patient

Behçet's disease (BD) is a multisystemic disease of unknown etiopathogenesis with various clinical features including manifestations from central nervous system involvement. We report the case of a patient presented with a 20-year history of BD and a 10-year history of epileptic seizures refractory to various antiepileptic drugs. Under systemic treatment with interferon-alpha 2a (IFN-alpha) a complete remission of the cutaneous manifestations and a seizure-free state were achieved. The impressive therapeutic response of both the seizures and the non-neurological manifestations to IFN-alpha was also observed upon re-administration of this cytokine subsequent to a severe BD relapse. In view of this response and the lack of any other obvious etiology of the seizures in our patient, it seems reasonable to consider them as being the sole manifestation of neuro-BD. The patient is presently completing a 40-month seizure-free follow-up, despite withdrawal of all antiepileptic drugs for the last 35 months. Further studies on large numbers of patients are now warranted to define the therapeutic efficacy and safety of IFN-alpha in neuro-BD and particularly in neuro-BD-related epileptic seizures.