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Objective: In clinical studies, it is crucial to assess psoriasis severity accurately and with no substantial variation between different raters. The Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA) are the two most commonly used tools for the assessment of psoriasis severity. The aim of this study was to evaluate the intra-rater and inter-rater reliability of these methods and to determine whether inter-rater reliability is affected by rater experience. Design: An open uncontrolled study Setting: Dermatology Department of Ege University, Medical Faculty Subjects: Fifty-five patients with plaque psoriasis who were examined between 15 August 2012 and 15 November 2012 in the dermatology department of Ege University Interventions: Three dermatology residents with varying experience evaluated the patients individually using both the PASI and PGA for each patient (in that order). Main Outcome Measure: PASI and PGA Results: PASI and PGA scores showed high intra-rater correlation for all three residents. Inter-rater reliability for PASI was high between the most experienced and second most experienced resident and between the most experienced and least experienced resident. However, inter-rater reliability for PGA was high between the most experienced and second most experienced residents, but only moderate between the most experienced and least experienced resident. Conclusions: There were no significant interrater differences between PGA and PASI scores in our study. However, because PGA is more subjective and may be affected by rater experience, PASI is considered to be a more reliable method for assessing severity of psoriasis. © 2021, Kuwait Medical Association. All rights reserved.

Although we tend to be reluctant in exposing mother and child to drugs, treatment with medicinal products during pregnancy cannot always be avoided. In the past decades several safety issues occurred that highlighted the need for special attention for the use of medicinal products during pregnancy. Whether or not a drug causes a potential teratogenic effect depends on several factors. Moreover, effects may be visible at birth, but may also become apparent later in life, among which developmental disorders. Before marketing of a drug the information about the safety in pregnancy is sparse and mainly limited to animal studies and scarce observational data. Clinical trials carried out before marketing, rarely include pregnant women, except when the product is specifically intended to be used in pregnancy. For the most part, effects of drug use during pregnancy can only be identified after marketing of the drug and when used by pregnant women. The optimal method for evaluating the risk of exposure to drugs in pregnancy strongly depends on the stage of drug development. Preapproval data on risks during pregnancy is limited and most information in this phase comes from embryo-fetal toxicity studies in animals. In the post-marketing phase observational studies are preferred. Next to the clinical presentation, epidemiology, and mechanisms of congenital malformations, the most prominent study types used in the premarketing phase; case reports and case series, cohort- and case control studies, will be discussed. Subsequently, possible ways to study the safety of drugs after marketing will be highlighted as well as current regulations for monitoring drug safety during pregnancy will be addressed.

The data on long-term efficacy, safety and drug survival rates of conventional systemic therapeutics in pediatric psoriasis is lacking. The primary aim of this study is to investigate acitretin, methotrexate, cyclosporin efficacy, safety and drug survival rates in pediatric patients as well as predictors of drug survival. This is a multicenter study including 289 pediatric cases being treated with acitretin, methotrexate and cyclosporin in four academic referral centers. Efficacy, adverse events, reasons for discontinuation, 1, 2- and 3-year drug survival rates, and determinants of drug survival were analyzed. A 75% reduction of Psoriasis Area and Severity Index score or better response rate was obtained in 47.5%, 34.1% and 40% of the patients who were treated with acitretin, methotrexate and cyclosporin, respectively. One-year drug survival rates for acitretin, methotrexate and cyclosporin were 36.3%, 21.1% and 15.1%, respectively. The most significant determinant of drug survival, which diminished over time, was treatment response whereas arthritis, body mass index and sex had no influence. Although all three medications are effective and relatively safe in children, drug survival rates are low due to safety concerns at this age group. Effective disease control through their rational use can be expected to improve survival rates. Pfizer Novartis Merck & Company - Schering Plough Corporation AbbVie Merck & Company Johnson & Johnson - Johnson & Johnson USA - Janssen Biotech Inc

The present study determines the relative developmental toxicity potencies of retinoids in the embryonic stem (ES)-D3 cell differentiation assay of the embryonic stem cell test, and compares the outcomes with their relative potencies in in vivo and two other in vitro assays for developmental toxicity. The results reveal that the potency ranking obtained in the ES-D3 cell differentiation assay is similar to the reported potency rankings in the two other in vitro assays for developmental toxicity. TTNPB ((E)-4[2-(5,6,7,8-tetrahydro-5,5,8,8-tetramethyl-2-naphthalenyl)-1-propenyl]benzoic acid) was the most potent retinoid, whereas etretinate and retinol had the lowest potency. All- trans-retinoic acid, 13- cis-retinoic acid, 9- cis-retinoic acid and acitretin showed an intermediate potency. In vivo potency rankings of the developmental toxicity of retinoids appear to be dependent on the species and/or exposure regimens used. The obtained in vitro potency ranking does not completely correspond with the in vivo potency rankings, although TTNPB is correctly predicted to be the most potent and retinol the least potent congener. The lack of in vivo kinetic processes in the ES-D3 cell differentiation assay might explain the deviating potency predictions of some retinoids. Therefore, knowledge on the species-dependent in vivo kinetics is essential when using in vitro toxicity data for the estimation of in vivo developmental toxicity potencies within series of related compounds. © 2011 Elsevier Ireland Ltd.

Biologic agents are an important new class of drugs, offering targeted treatment for chronic skin diseases such as psoriasis. The biologic therapy efalizumab is an anti-CD11a monoclonal antibody, which was approved by the European regulatory agency in 2004 for the treatment of moderate-to-severe plaque psoriasis. Here we describe our 2-year experience in treating over 100 patients with moderate-to-severe psoriasis with efalizumab at two dermatology centres in Italy. Overall, we found efalizumab is efficacious for a large subset of patients, regardless of previous therapies received, and has an easily manageable safety profile. We believe one important quality of efalizumab is the stability and maintenance of clinical response over time. We found that most patients who respond to treatment experience a long-term clearing of psoriasis with only mild recurrence events. Our experience with individual cases provides specific insights into efalizumab re-treatment, the use of efalizumab in patients with a history of heart failure, and the management of patients who become pregnant or conceive while receiving efalizumab therapy. In summary, our off-trial experience in over 100 patients confirms the efficacy and safety of efalizumab in the treatment of moderate-to-severe plaque psoriasis.

Bazal hücreli karsinom (BHK), insanlarda en sık görülen deri kanseri tipidir. BHK'ların tedavisinde cerrahi, halen altın standart olarak yerini korumaktadır. Buna rağmen, cerrahiye uygun olmayan ve kozmetik kaygıları olan bireylerde imikimod krem ve intralezyonel interferon (IFN) alfa2b gibi, daha az invaziv, cerrahi olmayan seçenekler de bulunmaktadır. Yalnız başına imikimod ya da imikimod ile kombine olarak interferon alfa-2b ile başarılı bir şekilde tedavi ettiğimiz değişik alt tiplerde 11 BHK vakasını sunduk. 2005-2010 yılları arasında polikliniğimizde histopatolojik olarak BHK oldukları kanıtlanmış, tek başına ya da IFN alfa-2b ile kombine olarak imikimod ile tedavi edilmiş çeşitli alt tiplerdeki hastalar bu rapora dahil edildi. Sunduğumuz 11 hastadan sadece 4 'ü (3 infiltratif, 1 solid tipler) topikal imikimoda ek olarak haftada 3 gün intralezyonel interferon alfa2b 3 milyon IU tedavisi de almıştı. Geri kalan 7 hasta sadece imikimod %5 krem kullanmıştı. Tüm hastalarda bu tedavi seçenekleri ile tam iyileşme sağlandığı görüldü. Bu olgulardaki gözlemlerimiz, İmikimodun sadece yüzeyel değil; infiltratif, solid, nodüler tip BHK'larda da etkili olduğunu düşündürmektedir. İmikimod, sadece yüzeyel değil, aynı zamanda, infiltratif, solid ve nodüler tip BHK'larda da etkili olduğunu düşündürmektedir. İntralezyonel interferon alfa-2b'nin de BHK'larda etkili olduğu ve imikimod ile kombine edildiğinde sinerjistik etki gösterdiği bilinmektedir. Basal cell carcinoma (BCC) is the most common type of skin cancer in humans. Surgery is still the gold standard for treating BCCs. However, there are also less-invasive, nonsurgical therapies such as imiquimod cream and intralesional interferon (IFN) alpha-2b for patients who are poor surgical candidates and who care about cosmetic outcomes. We report 11 patients with various subtypes of. BCC successfully treated with either imiquimod alone or in combination with interferon alfa-2b. In this paper, we present 11 patients with various subtypes of histopathologically proven BCCs, who were treated with imiquimod or combination of imiquimod and IFN alpha-2b, in our outpatient clinic between 2005 and 2010. Of 11 patients, only 4 patients (3 infiltrative, 1 solid types) had received intralesional interferon alpha-2b at a dose of 3 million IU, 3 times a week combined with topical imiquimod while 7 patients had received only 5% imiquimod cream. All patients were cured with these regimens. Imiquimod is found to be effective not only in superficial, but also in infiltrative, solid, and nodular types. Intralesional interferon alpha-2b is also known to be effective in BCCs and it has a synergistic effect when combined with imiquimod.

Psoriasis is a common chronic inflammatory skin condition in which patients suffer from mild to chronic plaque skin plaques. The disease manifests through an excessive inflammatory response in the skin due to complex interactions between different genetic and environmental factors. Psoriasis can affect the physical, emotional, and psychosocial well-being of patients, and currently there is no cure with treatments focusing primarily on the use of anti-inflammatory agents to control disease symptoms. Traditional anti-inflammatory agents can cause immunosuppression and adverse systemic effects. Further understanding of the disease has led to current areas of research aiming at the development of selective molecular targets to suppress the pathogenic immune responses. Refereed/Peer-reviewed

Bu çalışma, 12-16 Ekim 2005 tarihlerinde Londra[Birleşik Krallık]'da düzenlenen 14. Congress of The European Academy of Dermatology and Venereology'de poster olarak sunulmuştur. A 20-year-old woman with a 2-year history of histologically confirmed palmoplantar keratoderma due to psoriasis, resistant to several topical agents, was admitted to the Department of Dermatology, Uludag University, Bursa, Turkey. Therapy with oral acitretin (0.5mg/kg/day, 35mg/day) was initiated. A month after starting acitretin treatment, she noted slight reddening of the second left fingernail. Clinical examination revealed red-brown discoloration of the second fingernail associated with subungual hemorrhage involving the proximal nail bed (lunula region) (Fig. 1). The nail change was asymptomatic. The patient complained only of discoloration underneath the nail plate. No abnormalities were detected on the skin, mucous membranes, or toenails/ other fingernails. The patient denied exposure to microtrauma or any other drugs. The erythrocyte sedimentation rate, full blood cell count, electrolytes, renal and hepatic tests, and serum lipids were normal. Coagulation tests, including blood clotting time, international normalized ratio, activated partial thromboplastin time, thrombin time, platelet number, and function tests, were within normal levels. Treatment with acitretin was discontinued, and the nail change resolved completely after 3 weeks. A similar episode of subungual hemorrhage recurred, however, within 48 h after re-challenge with a lower dose of acitretin (25 mg/day). The drug was definitively stopped and the eruption faded again within a week. An objective causality assessment suggests that subungual hemorrhage was probably related to acitretin in this patient.

Psoriasis affects approximately 2% of the world’s population and results in disability similar to or exceeding that associated with other major illnesses such as diabetes mellitus, rheumatoid arthritis (RA), depression, and cancer. 1,2 It is chronic and incurable and can develop at any age. The disease is characterized by unpredictable periods of remission and relapse. As an added complication, the nature and morphology of the disease may be altered by therapy such as psoralen plus UVA. The lifelong nature of psoriasis invariably means a requirement for therapy that may be used long term. Clinical management is currently dictated by the physical and psychologic aspects of the disease coupled with historic response to therapy, with physical aspects identified as mild to severe. Perhaps we should instead consider psoriasis as easy or difficult to treat. This philosophy is exemplified by the holistic tool used for psoriasis measurement, the Salford Psoriasis Index. 3 New systemic therapies require reconsideration of psoriasis treatment paradigms.