RESUMEN
BACKGROUND: The use of ELISA testing of antibodies to desmogleins 1 and 3 (anti-Dsg1 and anti-Dsg3) and indirect immunofluorescence (IIF) has been strongly supported for the serologic diagnosis of pemphigus. The purpose of this study was to correlate anti-Dsg1 and anti-Dsg3 with IIF values, disease localization, treatment and clinical course in Greek patients with pemphigus vulgaris (PV). METHODS: A total of 54 patients with PV had ELISA serum testing for the presence and titers of anti-Dsg1, anti-Dsg3 and IIF. Anti-Dsg1, anti-Dsg3 and IIF were correlated with treatment and disease localization. For 40 patients, titers of anti-Dsg1 and anti-Dsg3 were assessed in relation to treatment and clinical course after 12 months. RESULTS: Anti-Dsg3 and anti-Dsg1 positivity in patients with negative IIF was 70.6% and 58.8%, respectively. Anti-Dsg1 and anti-Dsg3 were positive in 89.3% and 100% of patients with mucocutaneous disease, respectively, 88.9% and 66.7% of patients with skin limited disease, respectively and 52.9% and 76.5% of patients with mucosal limited disease, respectively. Both antibody titers showed significant correlation with IIF and treatment status. Improvement of clinical status was associated with significant decrease of both anti-Dsg1 and anti-Dsg3 after 12 months. CONCLUSIONS: Serum testing of anti-Dsg1 and anti-Dsg3 in PV patients not only provides significant correlations with IIF, treatment and disease type, but may serve as a monitoring tool for clinical course and treatment guidance.
Asunto(s)
Autoanticuerpos/sangre , Desmogleína 1/inmunología , Desmogleína 3/inmunología , Técnica del Anticuerpo Fluorescente Indirecta/métodos , Pénfigo/inmunología , Ensayo de Inmunoadsorción Enzimática , Grecia , Humanos , Pénfigo/fisiopatología , Estudios RetrospectivosRESUMEN
BACKGROUND: Calcineurin inhibitors show potent anti-inflammatory effects and favorable safety profile when used in the treatment of cutaneous lupus erythematosus (CLE). OBJECTIVE: The present study investigates the change in clinical parameters of erythema, desquamation and edema, when calcineurin inhibitors are used as monotherapy or in combination with hydroxychloroquine in CLE for a period of 60 days. METHODS: 18 patients were treated with topical tacrolimus and 20 patients with topical pimecrolimus, as monotherapy or in combination with hydroxychloroquine. Clinical parameters of erythema, desquamation and edema were assessed on a scale from 0 to 3 for erythema and edema and 0 to 2 for desquamation. RESULTS: Statistically significant improvement in erythema, desquamation and edema was observed in patients on monotherapy with calcineurin inhibitor and combination treatment with hydroxychloroquine, regardless of disease type. Combination treatment resulted in improvement of edema in 100% of patients, while monotherapy did so in 75% of patients. CONCLUSIONS: Topical calcineurin inhibitors enhance the therapeutic effect of systemic agents in cutaneous lupus erythematosus, and result in improvement of the clinical parameters studied.
Asunto(s)
Inhibidores de la Calcineurina , Hidroxicloroquina/uso terapéutico , Lupus Eritematoso Cutáneo/tratamiento farmacológico , Administración Tópica , Adulto , Femenino , Humanos , Hidroxicloroquina/administración & dosificación , Masculino , Estudios RetrospectivosRESUMEN
Alopecia areata is a chronic, nonscarring hair loss condition with an unpredictable course that may cause emotional stress in affected patients. Regarding its pathogenesis, the most accepted theory is that alopecia areata is a T-cell-mediated autoimmune condition that is most likely to occur in genetically predisposed individuals. Cyclosporin A is an immunosuppressive agent that has provided new approaches in the treatment of autoimmune diseases. Hypertrichosis, one of the common side effects of orally administered cyclosporin A, encouraged a number of investigators to use the drug in the treatment of alopecia areata, but the reports on this subject have been controversial. We present a small series of patients with severe alopecia areata treated systemically with cyclosporin A at a dose of 3-5 mg/kg for 6 months as well as their 3-month follow-up after cessation of the drug.
Asunto(s)
Alopecia Areata/clasificación , Alopecia Areata/tratamiento farmacológico , Ensayos Clínicos como Asunto , Ciclosporina/administración & dosificación , Inmunosupresores/administración & dosificación , Administración Oral , Adulto , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
Tacrolimus is an immunomodulatory agent that inhibits the activation and maturation of T-cells and blocks transcriptional activation of several cytokine genes. It also interferes with the function of Langerhans cells, basophil cells and mast cells. Recent studies have demonstrated the efficacy of topical tacrolimus in inflammatory skin disorders. Our objective was to assess the efficacy of topical treatment with tacrolimus ointment 0.1% in patients with psoriasis on the anogenital region and the face. Included in the study were 10 patients with a long-standing history of genital and facial psoriasis, partially controlled with periodic use of topical corticosteroids. Tacrolimus ointment 0.1% was applied twice daily for 10 days. The patients were followed-up every 3 weeks for a total period of 12 weeks. The severity of psoriasis was evaluated in all patients at baseline (day 0) and at the end of weeks 3, 6, 9 and 12. Clinical severity of erythema, scaling, infiltration and lesional extent were graded using a 0-3 scale indicating none, mild, moderate and severe expression, at baseline and at follow-ups. An overall severity score of 0 (clear), 1-4 (mild), 5-8 (moderate) or 9-12 (severe) was then assigned to each patient by adding the scores for the above parameters. On each visit, every patient was evaluated clinically. The decision to reapply the drug was determined by the clinical response of each patient at each visit. At the end of the study, patients also assessed efficacy, safety and tolerance after topical application of tacrolimus ointment using a 0-5 scale for each parameter: A marked improvement was noticed in all patients at the end of the first week without drug-related adverse effects. There were 15 recurrences during the 12-week period in all patients. In conclusion, tacrolimus ointment 0.1% seems to represent a safe new option for the treatment of genital and facial psoriasis. Further studies are probably needed to specify the therapeutic dosage and maintenance therapy
Asunto(s)
Cara , Enfermedades de los Genitales Masculinos/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Psoriasis/tratamiento farmacológico , Tacrolimus/uso terapéutico , Adulto , Femenino , Humanos , Inmunosupresores/administración & dosificación , Masculino , Tacrolimus/administración & dosificaciónRESUMEN
Impetigo is a contagious superficial pyogenic infection of the skin caused by Staphylococcus aureus and/or by group A Streptococcus. Two main clinical forms are recognized: bullous impetigo and non-bullous impetigo. We present an unusual case of pustular impetigo in a 35-year-old man. The pustules were localized symmetrically in the groin and the patient was successfully treated with clarithromycin. In bullous impetigo, exfoliative toxins produced by Staphylococcus aureus are accepted as the basis for the bulla formation just below the stratum granulosum. Although clarithromycin is considered to be a second-choice therapy for bullous impetigo, it was highly effective in our case.
Asunto(s)
Antibacterianos/uso terapéutico , Claritromicina/uso terapéutico , Impétigo/tratamiento farmacológico , Adulto , Humanos , Impétigo/patología , MasculinoRESUMEN
The ascomycin macrolactam derivative pimecrolimus is a novel, nonsteroidal, cell-selective inhibitor of inflammatory cytokines specifically developed for the treatment of inflammatory skin diseases. Our objective was to assess the efficacy, tolerability and safety of pimecrolimus cream 1% in the treatment of seborrheic dermatitis. Adults with seborrheic dermatitis of the face and upper trunk who were seen from October 2003 to April 2004 at the Dermatologic Outpatient Clinic of the University of Thrace were enrolled in this 9-week open-label uncontrolled study. Pimecrolimus cream 1% was applied as monotherapy twice daily for 7 days and for an additional period of 7 days thereafter, if needed, until complete clearance was achieved. In cases of recurrence a 5-day course was additionally applied. After screening and an appropriate washout period, subjects were evaluated at baseline (day 0) and at follow-up visits at weeks 1, 3, 6 and 9. The clinical severity of seborrheic dermatitis was estimated as mild (total score 1-3), moderate (total score 4-6) and severe (total score 7-9) in terms of erythema, scaling and lesional extent using a scale from 0 to 3 for each. Patients also assessed their symptoms on a scale from 0 to 5 in terms of the efficacy, safety and tolerability of topical application. Nineteen patients (12 males, seven females) were enrolled in this study. At the end of weeks 1, 3, 6 and 9 the percentages of complete clearance were 63%, 100%, 47% and 52%, respectively. At the end of the study, subjects' average assessment score was 9.73. Apart from topical burning and irritation of the skin in four patients, no other adverse event was mentioned. This pilot study indicates that pimecrolimus applied twice daily can be a safe and efficacious alternative in the treatment of seborrheic dermatitis. Further studies are needed to determine the initial and maintenance therapy.