RESUMEN
BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects patients' quality of life (QoL). OBJECTIVE: To investigate changes in QoL in patients with HS after wide local excision (WLE) and to examine the level of pain, rate of postoperative complications, recurrences, and the time to complete wound closure. METHODS: Fifty-five patients were enrolled in this prospective study. All patients underwent WLE of HS, followed by secondary wound healing. Dermatologic Life Quality Questionnaire, pain, and wound size were measured 1 day, 3 weeks, 3 months, and 6 months after surgery. RESULTS: Dermatologic Life Quality Questionnaire and pain scores (mean ± SD) improved significantly (both p < .001) from 14.5 ± 7.3 and 3.7 ± 2.8 at baseline to 5.8 ± 6.9 and 0.8 ± 1.7, 6 months postoperatively, respectively. Wounds were closed completely by secondary intention after 4.4 ± 2.8 months. Sixteen patients (29.1%) experienced postoperative complications, local recurrences in the treated sites were observed in 11 patients (20%), and new lesions in untreated sites were observed in 5 cases (9.1%). CONCLUSION: Wide local excision significantly improves patients' QoL and pain, and, given its low rate of recurrence and complications, should be considered as a first-line therapy, especially in patients with higher Hurley stages.
Asunto(s)
Hidradenitis Supurativa/complicaciones , Hidradenitis Supurativa/cirugía , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/epidemiología , Estudios Prospectivos , Recurrencia , Factores de Tiempo , Cicatrización de Heridas , Adulto JovenAsunto(s)
Eritema/tratamiento farmacológico , Eritema/patología , Hidroxicloroquina/administración & dosificación , Mucinosis/tratamiento farmacológico , Mucinosis/patología , Administración Oral , Biopsia con Aguja , Eritema/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Mucinosis/complicaciones , Luz Solar/efectos adversos , Pared Torácica , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Aim: Autoimmune colitis is a typical and possible severe side effect among patients treated with ipilimumab. Patients & methods: We prospectively included 100 patients with metastasized melanoma under ipilimumab treatment in a radiological study of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT). PET evidence of pancolitis ('PET-colitis') was correlated with clinical variables. Results: We observed a significant correlation between PET-colitis and clinically significant diarrhoea, although PET-colitis was more frequent (49 vs 29% of patients, respectively). Neither PET-colitis nor diarrhoea was significantly correlated with response to therapy. Other immune-related adverse events, however, such as hypophysitis and hepatitis were associated with response to therapy and overall survival. Conclusion: Increased 18F-FDG uptake in the colon correlated with clinical symptoms but did not predict clinical outcome to ipilimumab.
Asunto(s)
Enfermedades Autoinmunes , Colitis , Fluorodesoxiglucosa F18/administración & dosificación , Ipilimumab/administración & dosificación , Melanoma , Tomografía Computarizada por Tomografía de Emisión de Positrones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Autoinmunes/diagnóstico por imagen , Enfermedades Autoinmunes/tratamiento farmacológico , Enfermedades Autoinmunes/patología , Colitis/diagnóstico por imagen , Colitis/tratamiento farmacológico , Colitis/patología , Femenino , Humanos , Masculino , Melanoma/diagnóstico por imagen , Melanoma/tratamiento farmacológico , Melanoma/patología , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de NeoplasiasRESUMEN
BACKGROUND: Photodynamic therapy (PDT) is an effective therapy treating photodamaged areas with multiple actinic keratoses (AK). Still pain during therapy is one of the most challenging obstacles for patients. This retrospective study compares pain and efficacy intra-individual in patients using conventional PDT (c-PDT) compared to a low irradiance PDT protocol (li-PDT) with a reduced irradiance to 25% of c-PDT. METHODS: Thirty-one patients were enrolled into this retrospective analysis treated with li-PDT and c-PDT on comparable fields of actinic damage on the forehead or the cheek. Pain was scored by the patients using a VAS. Moreover, number and time to therapy interruptions were documented. For effectiveness number and grade of AK were counted before and 4 weeks after PDT. RESULTS: Maintaining a total light dose of 37 J/cm2 , a decrease in irradiation in li-PDT patients resulted in significant less pain (VAS score 2.8 vs 7.6) and fewer therapy interruptions compared to treatment with c- PDT (P < 0.0005). No significant difference in treatment outcome was found (P = 0.068). CONCLUSION: Our data shows that li-PDT can reduce pain with at least comparable clinical outcome compared to c-PDT. Therefore, it is an effective and well-tolerated treatment for patients with multiple AK.
Asunto(s)
Queratosis Actínica/tratamiento farmacológico , Queratosis Actínica/fisiopatología , Dolor/fisiopatología , Fotoquimioterapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/prevención & control , Dimensión del Dolor , Estudios RetrospectivosAsunto(s)
Síndrome Retroviral Agudo/diagnóstico , Síndrome Retroviral Agudo/tratamiento farmacológico , Exantema/diagnóstico , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Enfermedades Cutáneas Virales/diagnóstico , Adulto , Fármacos Anti-VIH/uso terapéutico , Diagnóstico Diferencial , Exantema/prevención & control , Humanos , Masculino , Enfermedades Cutáneas Virales/tratamiento farmacológicoRESUMEN
Ipilimumab, a monoclonal CTLA-4 antibody, was the first drug improving overall survival in patients with metastatic melanoma. However, there are still unanswered questions concerning therapeutic regimes, e.g. if maintenance therapy is needed to achieve long-term response. We present three patients with metastatic melanoma who received ipilimumab after progression under chemotherapy. In all of these patients ipilimumab led to a long-term tumor control of at least 32 months. Interestingly, all of them developed severe autoimmune toxicity and ipilimumab treatment was discontinued after 1 respectively 2 cycles. The present cases demonstrate that a long-term response to ipilimumab can be achieved without maintenance therapy.