Search

Introduction: Immunomodulation using TNF-α inhibitors (anti-TNF-a), especially adalimumab, is highly effective in the treatment of hidradenitis suppurativa (HS) in cases that are poorly controlled by conventional treatments. However, paradoxical psoriasis represents a peculiar type of psoriasis that may occur de novo or as the worsening of pre-existent psoriatic lesions during treatment with adalimumab. Case Presentation: We reported 4 cases of patients suffering from HS, who developed paradoxical psoriasis after treatment with adalimumab for their HS, analyzing their clinical and epidemiological characteristics. All 4 cases were middle aged, smokers, overweight or obese. Half of the patients were males (50%). All of them were classified as Hurley stage III, with a mean duration of HS of 20 years. Two patients had a family history of psoriasis. All 4 patients had been on at least 5 months of successful treatment with adalimumab before the onset of the lesions. Conclusions: Paradoxical psoriasis emerged in 4 patients who received at least 5-month regimen of adalimumab for long-lasting HS. Although different mechanisms have been hypothesized for such events, the exact underlying pathogenetic pathway remains unclear. Consistent reporting of such rare cases, and on a larger scale, is encouraged in order to enrich the available literature.

Atopic dermatitis (AD) is a common inflammatory skin disease with a complex pathophysiology, intertwining immune dysregulation, epidermal barrier dysfunction, IgE sensitization, environmental factors and genetic predisposition. It has been recently identified that interleukins -4 and -13 play crucial roles in the type-2-driven inflammation that characterizes AD, contributing to its symptomatology. Novel therapeutic approaches that target Th2 cytokines and their respective pathways have been developed, aiming to optimize the treatment of AD.

Background In the era of precision medicine, identification of possible predictive factors of clinical response to treatment is fundamental. This need is particularly strong for anogenital warts (AGW), because there are several treatment modalities with different clearance and recurrence rates. However, data regarding the effect of mental health parameters on response to treatment in patients with AGW are lacking. Objectives The purpose of the present study was to evaluate the association between patients' mental health parameters and AGW treatment outcomes. Methods This was a single-centre, prospective study that included newly diagnosed male patients with AGW. At their initial visit, all patients completed the State-Trait Anxiety Inventory (STAI), the Symptom Checklist-90-Revised (SCL-90-R), and the Eysenck Personality Questionnaire (EPQ) questionnaires, which evaluate anxiety, psychopathological manifestations, and personality traits, respectively. All patients received cryotherapy until clearance of lesions and were followed up for 18 months for detection of recurrences. Results The study included 167 male patients. The mean number of days for AGW clearance was 89+/-65. During the 18-month follow up, 28 % of participants showed a recurrence, after a mean number of 150+/-132 days. No statistically significant association was detected between questionnaires scores and a) time needed for AGW clearance, b) time until 1st recurrence, and c) number of recurrences. Conclusion If confirmed, our findings indicate that we may not need to modify our AGW treatment plan according to a patient's mental health profile.

Background: Studies comparing head-to-head treatment modalities for anogenital warts are lacking. Aim: We sought to compare a short, 8-week course of imiquimod 5% cream to versus the standard 4 week course of podophyllotoxin in the treatment of anogenital warts and to assess factors that may affect response to treatment. Methods: This was a retrospective cohort study. We reviewed medical files of otherwise healthy patients with a first episode of anogenital warts who were treated with either a short, 8-week course of imiquimod or the standard 4-week course of podophyllotoxin. Inverse probability of treatment weighted (IPTW). Logistic regression was employed to evaluate factors that may affect response to therapy. Results: The study included 347 patients. In patients with lesions on dry, keratinized anatomical sites, the complete clearance rates were 7.6% for imiquimod and 27.9% for podophyllotoxin (P < 0.001). In patients with lesions on moist, partially keratinized sites, no difference between the treatments was revealed. Significant predictors of > 50% reduction in wart area were location of lesions [odds ratio (OR) (95% confidence interval (CI)): 3.6 (1.84–7.08), P = 0.0002] for “partially keratinized” versus “keratinized” sites and treatment used [OR (95% CI): 1.79 (1.08–2.97), P = 0.024] for podophyllotoxin versus imiquimod. Limitations: The retrospective design of the study was a limitation that we mitigated against with the use of IPTW logistic regression. Conclusion: A standard 4 week course of Podophyllotoxin was more effective than an 8-week course of imiquimod only for lesions on keratinized sites. Treatment with podophyllotoxin and location of lesions on partially keratinized sites were independent predictors of >50% reduction in wart area.

Introduction: Immunomodulation using TNF-α inhibitors (anti-TNF-a), especially adalimumab, is highly effective in the treatment of hidradenitis suppurativa (HS) in cases that are poorly controlled by conventional treatments. However, paradoxical psoriasis represents a peculiar type of psoriasis that may occur de novo or as the worsening of pre-existent psoriatic lesions during treatment with adalimumab. Case Presentation: We reported 4 cases of patients suffering from HS, who developed paradoxical psoriasis after treatment with adalimumab for their HS, analyzing their clinical and epidemiological characteristics. All 4 cases were middle aged, smokers, overweight or obese. Half of the patients were males (50%). All of them were classified as Hurley stage III, with a mean duration of HS of 20 years. Two patients had a family history of psoriasis. All 4 patients had been on at least 5 months of successful treatment with adalimumab before the onset of the lesions. Conclusions: Paradoxical psoriasis emerged in 4 patients who received at least 5-month regimen of adalimumab for long-lasting HS. Although different mechanisms have been hypothesized for such events, the exact underlying pathogenetic pathway remains unclear. Consistent reporting of such rare cases, and on a larger scale, is encouraged in order to enrich the available literature. © 2022 S. Karger AG, Basel. Copyright: All rights reserved.

Acute Localized Exanthematous Pustulosis (ALEP) is a rare skin reaction characterized by the sudden onset of multiple, small, sterile, non-follicular pustules in an erythematous and edematous base succeeding systemic drug administration. ALEP is considered a subtype of Acute Generalized Exanthematous Pustulosis (AGEP), although the exact pathogenic mechanism of the disease remains poorly defined. Numerous drugs have been implicated in the pathogenesis of ALEP, while contact mechanisms have also been reported. Herein, we describe the first case of ALEP attributed to minoxidil in a female patient with androgenetic alopecia. The positivity of patch tests and the topical application of minoxidil proposes a contact-induced hypersensitivity reaction. Identifying new agents—including minoxidil—which serve as inducers of drug-specific T-cell-mediated responses in the clinical spectrum of ALEP, adds further value in understanding the complex, yet unknown, pathophysiological mechanisms of this rare drug hypersensitivity reaction.

Basosquamous carcinoma (BSC) is a relatively rare type of neoplasm originating from basal cell carcinoma with features of squamous differentiation. BSC has an aggressive local behaviour with a tendency for recurrence and a less frequent metastatic potential The primary objective was to describe the dermatoscopic features of the tumour. Secondary goals were to detect the morphological features of the tumour along with patients' characteristics and to evaluate possible dermatoscopic and histopathological correlations Twenty-two patients with 25 BSCs were enrolled. All tumours were surgically excised and diagnosis was based on histopathology. Clinical and dermatoscopic images were evaluated by two investigators based on pre-defined criteria, and a statistical analysis was performed The median age of the patients was 78 years old (range: 52-88) and the male/female ratio was 2.14. All patients reported history of either occupational (50%) or recreational (50%) intensive sun exposure and 72.73% had signs of actinic keratosis. The most common anatomical site of the tumours was the head/neck area (72%). Clinically, nodular (64%), ulcerated (88%) and non-pigmented (76%) lesions prevailed. Dermatoscopically, 92% had prominent vasculature and monomorphous arborizing vessels with a diffuse arrangement, representing the most frequently observed type. Ulceration (88%), SCC dermatoscopic criteria (56%), white strands/blotches (56%) and features of pigmentation (40%) were also detected We suggest that the most common prototype of BSC is an ulcerated, facial nodule in elderly males with photo-damaged skin, dermatoscopically displaying combined features of mostly nodular BCC and, to a less extent, SCC.

ΕΙΣΑΓΩΓΗΗ ψωρίαση είναι μια χρόνια, συστηματική, φλεγμονώδης δερματοπάθεια, η οποία προσβάλλει περίπου το 2% του πληθυσμού. Η αιτιολογία της νόσου θεωρείται πολυπαραγοντική. Είναι σίγουρο ότι υπάρχει γενετική προδιάθεση, με ασαφές μέχρι στιγμής μοντέλο κληρονομικότητας. Κάποιοι περιβαλλοντικοί παράγοντες (λοιμώξεις, φάρμακα, τραύμα κλπ) έχουν επίσης ενοχοποιηθεί για την εμφάνιση ή επιδείνωση της νόσου. Οι φλεγμονώδεις δείκτες χρησιμοποιούνται κυρίως για τη διάγνωση οξείας φλεγμονής και την παρακολούθηση ανταπόκρισης στη θεραπεία. Η ουσία etanercept ανήκει στους λεγόμενους βιολογικούς παράγοντες για τη θεραπεία της ψωρίασης. Αναστέλλει τη δράση του TNF-α, ο οποίος φαίνεται να κατέχει κεντρικό ρόλο στην παθογένεια της νόσου.ΣΚΟΠΟΣΗ ανάδειξη πιθανής συσχέτισης μεταξύ της κλινικής βαρύτητας της νόσου, όπως αυτή εκφράζεται από το δείκτη PASI, και του φλεγμονώδους φορτίου, όπως αυτό αποτυπώνεται από ένα σύνολο φλεγμονωδών παραγόντων, πριν και μετά τη θεραπεία με etanercept.ΥΛΙΚΟ ΚΑΙ ΜΕΘΟΔΟΙ Στη μελέτη συμπεριλήφθησαν 41 ασθενείς με κοινή κατά πλάκας ψωρίαση, που πληρούσαν τις προϋποθέσεις χορήγησης βιολογικής θεραπείας. Μετρήσαμε το δείκτη PASI και ένα σύνολο φλεγμονωδών δεικτών: λευκά αιμοσφαίρια και ουδετερόφιλα, ινωδογόνο, φερριτίνη, υψηλής ευαισθησίας CRP (hs-CRP), ταχύτητα καθίζησης ερυθρών, απτοσφαιρίνη, σερουλοπλασμίνη και α1-αντιθρυψίνη, πριν και μετά από θεραπεία 12 εβδομάδων με etanercept 50 mg δις εβδομαδιαίως.ΑΠΟΤΕΛΕΣΜΑΤΑΌλοι οι φλεγμονώδεις δείκτες μειώθηκαν μετά τη θεραπεία (p < 0,001). Ο δείκτης PASI βρέθηκε να συσχετίζεται θετικά με το ινωδογόνο και τη hs-CRP. Δεκαεννέα ασθενείς σε σύνολο 41 (46,3%) πέτυχαν μείωση του δείκτη PASI κατά 75% (PASI75). Η αύξηση στη διαφορά της hs-CRP και της ΤΚΕ (τιμές φλεγμονωδών δεικτών προ – τιμές μετά τη θεραπεία) σχετίζεται με αυξημένη πιθανότητα να επιτευχθεί ο κλινικός θεραπευτικός στόχος, δηλ. το PASI75.ΣΥΜΠΕΡΑΣΜΑΤΑΟι φλεγμονώδεις δείκτες, κυρίως η hs-CRP και δευτερευόντως το ινωδογόνο και η ΤΚΕ μπορούν να χρησιμοποιηθούν για την εκτίμηση της βαρύτητας της ψωριασικής νόσου καθώς και για την παρακολούθηση της θεραπευτικής ανταπόκρισης. Προτείνουμε τη δημιουργία ενός νέου δείκτη (Index of Psoriasis Inflammation, IPI) από το συνδυασμό συγκεκριμένων φλεγμονωδών δεικτών. Παράλληλα με το PASI θα μπορούσε να αποτυπώσει σε εργαστηριακό επίπεδο τη φλεγμονώδη δραστηριότητα της νόσου.

Background: In the era of precision medicine, identification of possible predictive factors of clinical response to treatment is fundamental. This need is particularly strong for anogenital warts (AGW), because there are several treatment modalities with different clearance and recurrence rates. However, data regarding the effect of mental health parameters on response to treatment in patients with AGW are lacking. Objectives: The purpose of the present study was to evaluate the association between patients’ mental health parameters and AGW treatment outcomes. Methods: This was a single-centre, prospective study that included newly diagnosed male patients with AGW. At their initial visit, all patients completed the State-Trait Anxiety Inventory (STAI), the Symptom Checklist-90-Revised (SCL-90-R) and the Eysenck Personality Questionnaire (EPQ) questionnaires, which evaluate anxiety, psychopathological manifestations and personality traits, respectively. All patients received cryotherapy until clearance of lesions and were followed up for 18 months for detection of recurrences. Results: The study included 167 male patients. The mean number of days for AGW clearance was 89 ± 65. During the 18-month follow-up, 28% of participants showed a recurrence, after a mean number of 150 ± 132 days. No statistically significant association was detected between questionnaires scores and (a) time needed for AGW clearance, (b) time until 1st recurrence and (c) number of recurrences. Conclusion: If confirmed, our findings indicate that we may not need to modify our AGW treatment plan according to a patient’s mental health profile. © 2021 European Academy of Dermatology and Venereology

Background: Basosquamous carcinoma (BSC) is a relatively rare type of neoplasm originating from basal cell carcinoma with features of squamous differentiation. BSC has an aggressive local behaviour with a tendency for recurrence and a less frequent metastatic potential Objectives: The primary objective was to describe the dermatoscopic features of the tumour. Secondary goals were to detect the morphological features of the tumour along with patients’ characteristics and to evaluate possible dermatoscopic and histopathological correlations Materials & Methods: Twenty-two patients with 25 BSCs were enrolled. All tumours were surgically excised and diagnosis was based on histopathology. Clinical and dermatoscopic images were evaluated by two investigators based on pre-defined criteria, and a statistical analysis was performed Results: The median age of the patients was 78 years old (range: 52-88) and the male/female ratio was 2.14. All patients reported history of either occupational (50%) or recreational (50%) intensive sun exposure and 72.73% had signs of actinic keratosis. The most common anatomical site of the tumours was the head/neck area (72%). Clinically, nodular (64%), ulcerated (88%) and non-pigmented (76%) lesions prevailed. Dermatoscopically, 92% had prominent vasculature and monomorphous arborizing vessels with a diffuse arrangement, representing the most frequently observed type. Ulceration (88%), SCC dermatoscopic criteria (56%), white strands/blotches (56%) and features of pigmentation (40%) were also detected Conclusion: We suggest that the most common prototype of BSC is an ulcerated, facial nodule in elderly males with photo-damaged skin, dermatoscopically displaying combined features of mostly nodular BCC and, to a less extent, SCC

Background: Studies comparing head-to-head treatment modalities for anogenital warts are lacking. Aim: We sought to compare a short, 8-week course of imiquimod 5% cream to versus the standard 4 week course of podophyllotoxin in the treatment of anogenital warts and to assess factors that may affect response to treatment. Methods: This was a retrospective cohort study. We reviewed medical files of otherwise healthy patients with a first episode of anogenital warts who were treated with either a short, 8-week course of imiquimod or the standard 4-week course of podophyllotoxin. Inverse probability of treatment weighted (IPTW). Logistic regression was employed to evaluate factors that may affect response to therapy. Results: The study included 347 patients. In patients with lesions on dry, keratinized anatomical sites, the complete clearance rates were 7.6% for imiquimod and 27.9% for podophyllotoxin (P < 0.001). In patients with lesions on moist, partially keratinized sites, no difference between the treatments was revealed. Significant predictors of > 50% reduction in wart area were location of lesions [odds ratio (OR) (95% confidence interval (CI)): 3.6 (1.84-7.08), P = 0.0002] for “partially keratinized” versus “keratinized” sites and treatment used [OR (95% CI): 1.79 (1.08-2.97), P = 0.024] for podophyllotoxin versus imiquimod. Limitations: The retrospective design of the study was a limitation that we mitigated against with the use of IPTW logistic regression. Conclusion: A standard 4 week course of Podophyllotoxin was more effective than an 8-week course of imiquimod only for lesions on keratinized sites. Treatment with podophyllotoxin and location of lesions on partially keratinized sites were independent predictors of >50% reduction in wart area.