RESUMEN
OBJECTIVE: This study aims to describe the frequency of biologic therapy failure in psoriasis patients along with associated patient demographics and characteristics. METHODS: This was a retrospective medical-record review of psoriasis patients evaluated from January 1st, 2013, through May 1st, 2018, and who failed at least once to adhere to their biologic therapy. RESULTS: Seventy-seven patients with psoriasis who had discontinued biologic therapy at least once were included in this study. Hypertension (58.4%), diabetes (37.7%), dyslipidemia (27.3%), and psoriatic arthritis (23.4%) were the main comorbidities observed. Adalimumab (ADA, 80.5%), ustekinumab (UST, 70.1%), and etanercept (ETA, 14.2%) were the most frequently used biologics in our cohort. The biologic with the longest mean duration of use prior to its discontinuation was UST (17.0 months), followed by ADA (15.9 months) and ETA (13.6 months). CONCLUSION: The most common reason for discontinuing biologic therapy was that said therapy was not effective, though for ETA and UST, the fact that biologic therapies are not universally covered by insurance company was found to be associated with their discontinuation, as well. There were no statistically significant associations found between biologic therapy discontinuation and age, gender, or comorbidities, which last included obesity, class I. Larger studies are warranted to identify risk factors associated with biologic therapy failure to help guide drug selection, decrease morbidity associated with such nonadherence and improve patient outcomes.
Asunto(s)
Adalimumab/uso terapéutico , Terapia Biológica , Etanercept/uso terapéutico , Psoriasis/tratamiento farmacológico , Ustekinumab/uso terapéutico , Humanos , Psoriasis/epidemiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially life-threatening mucocutaneous reactions. Given their rarity, limited cohort studies have been done. The aim of this study is to evaluate and compare the demographics, etiology, management, clinical and laboratory characteristics, complications, and outcome of SJS/TEN patients seen by the inpatient dermatology service at the University of Puerto Rico. METHODS: A retrospective review of 30 cases with identified diagnosis of SJS, overlap SJS/TEN, or TEN who were consulted to the Dermatology Department of the University of Puerto Rico from 2006 to 2017. RESULTS: A total of 24 adult and six pediatric cases were reviewed. Females were predominant with a female to male ratio of 1.3 : 1. The most frequent offending drugs identified were antibiotics (56.7%), anticonvulsants (23.3%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (16.7%) with the most frequent antibiotic identified being trimethoprim/sulfamethoxazole (23.3%). Seventy percent of patients experienced at least one complication, most often of infectious etiology (80.1%). During hospital course, 73% received pharmacologic therapy (23% received IVIG alone, 17% received steroids alone, and 33% both) versus 27% which received only supportive care. Mortality rate in this study was 13.8%. When comparing SCORTEN at day one of admission, deceased cases had a mean SCORTEN at day 1 of 4.0, while survivors had an average of 1.54 (P < 0.001). CONCLUSION: Antibiotics followed by anticonvulsants were the most frequently offending drugs identified within this study.
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Antibacterianos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Anticonvulsivantes/efectos adversos , Síndrome de Stevens-Johnson/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Mortalidad Hospitalaria , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Puerto Rico , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/mortalidad , Síndrome de Stevens-Johnson/terapia , Adulto JovenRESUMEN
OBJECTIVE: To describe the behavior of non-melanoma skin cancer (NMSC) based on tumor's characteristics. METHODS: A total of 219 of NMSC were analyzed via a retrospective medical chart review. The data obtained from each record included but was not limited to: number of Mohs micrographic surgery (MMS) stages required for tumor clearance, defect size, repair type and size according to the neoplasm's histopathologic subtype. RESULTS: The mean number of stages required to clear morpheaphorm/infiltrative and micronodular basal cell carcinomas (BCCs) (n= 34) was 2.03, while the nodular and superficial BCCs (n= 125) needed a mean of 1.56 stages (p value= .034). Of the tumors located on a high-risk zone, 59.6% required two or more stages to be cleared while 67.7% of the lesions on a non-high risk zone were cleared with one stage (p value = 0.001). Recurrent tumors required a mean 2.22 MMS stages to be cleared, whereas primary tumors required a mean 1.61 stages (p value= .006). CONCLUSION: Subclinical spread was seen in morpheaform/infiltrative and micronodular BCC histologic subtypes, recurrent tumors, and tumors in high-risk locations. These could help predict aggressive tumor behavior and optimize surgical planning.
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Carcinoma Basocelular/patología , Cirugía de Mohs/métodos , Neoplasias Cutáneas/patología , Anciano , Carcinoma Basocelular/cirugía , Femenino , Humanos , Masculino , Márgenes de Escisión , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Neoplasias Cutáneas/cirugíaRESUMEN
FPrecursor T- or B-cell non-Hodgkin lymphoblastic lymphomas represent only a small fraction of pediatric cancer cases. Due to its rarity, the diagnosis of lymphoblastic lymphoma (LBL) in a pediatric patient is challenging, particularly if its manifestation is solely cutaneous. We describe the case of an infant with primary cutaneous B-cell LBL who was initially diagnosed by a primary care physician with an infectious etiology and consequently treated with topical and oral antibiotics. Subcutaneous nodules located on the head or neck of infants should raise suspicion for lymphoma and biopsy should be performed in order to rule out malignancy. A prompt diagnosis is imperative when considering the aggressive nature of LBLs. Expedited therapy has been known to help cease systemic involvement of primary cutaneous B-cell LBLs and encourage a more favorable outcome.