A systematic review of treatments for pityriasis lichenoides Bellinato, F.; Maurelli, M.; Gisondi, P. ...
Journal of the European Academy of Dermatology and Venereology,
November 2019, 2019-Nov, 2019-11-00, 20191101, Letnik:
33, Številka:
11
Journal Article
Recenzirano
Pityriasis lichenoides (PL) represents a spectrum of inflammatory skin diseases comprising pityriasis lichenoides et varioliformis acuta (PLEVA) and pityriasis lichenoides chronica (PLC). This study ...aimed to provide a summary of effective treatments for PL. A systematic review was performed according to PRISMA guidelines for studies investigating PL treatment including ≥3 subjects and published in English between 1 January 1970 and 15 April 2019. A total of 441 papers were screened, and 37 original manuscripts meeting the inclusion and exclusion criteria were found, including 12 case series, 18 reviews, four prospective studies, two comparative studies and a single randomized controlled study. In most studies, ultraviolet (UV) phototherapy (narrow‐band UVB, broadband UVB, UVA1 or PUVA) was used. Clearance rates with the different modalities are hardly comparable between different studies, ranging approximately between 70% and 100%. Narrow‐band UVB showed an efficacy similar to PUVA as such as the combination of UVA and UVB vs. PUVA. Oral erythromycin showed clearance rates ranging between 66% and 83%, whereas methotrexate up to 100% but in small and dated studies. Evidence for other treatments is scarce. There is a lack of high level of evidence studies on PL treatment. The interpretation of the results is biased by the possible auto‐resolution of the disease, the sample heterogeneity between children and adults and the short follow‐up period of the studies. Only some studies investigated how results were durable after cessation of therapy. Quality of life and the impact of treatment were never assessed. According to the results of this review, we suggest narrow‐band UVB phototherapy as first‐line treatment. Oral erythromycin with or without topical corticosteroids and low‐dose methotrexate as second‐line therapies. High‐powered studies and randomized controlled trials are needed to establish the optimal treatment for PL.
Summary
Background
Acquired perforating dermatoses (APDs) are characterized by transepidermal elimination of skin materials. Altered glycation of dermal components may be involved in pathogenesis.
...Aim
To assess whether patients affected by APDs have increased levels of cutaneous advanced glycation end‐products (AGEs).
Methods
A cross‐sectional controlled study involving a total of 109 patients was conducted, enrolling 29 patients consecutively diagnosed with primary APDs reactive perforating collagenosis (RPC), elastosis perforans serpiginosa (EPS), perforating folliculitis (PF) and Kyrle disease (KD), 40 age‐ and sex‐matched healthy controls (HCs) and 40 patients with mild atopic dermatitis (AD). The levels of cutaneous AGEs were measured using a validated fluorescence technique.
Results
The median skin autofluorescence value in patients with APDs was significantly higher 2.7 arbitrary units (AU), interquartile range (IQR) 1.9–3.9 AU compared with HCs (1.8 AU, IQR 1.6–2.3 AU; P < 0.001) and patients with AD (2.1 AU, IQR 1.9–2.3 AU; P = 0.01). Median values were 3.5 AU (IQR 2.7–4.6 AU) for RPC, 1.83.5 AU (1.4–2.4 AU) for EPS, 3.1 AU (2.4–4.4 AU) for PF and 2.6 AU (2.3–3.1 AU) for KD.
Conclusions
Our results may suggest a possible physiopathological role of AGEs in the transepidermal elimination mechanisms involved in certain APDs.
Acquired perforating dermatoses (APDs) are characterized by transepidermal elimination of skin materials. Patients with APDs show higher cutaneous advanced glycation end‐products levels compared to the expected value for healthy patients and to patients with mild atopic eczema. Altered glycation of skin materials may be involved in the pathogenesis of certain APDs.
The present study was aimed at carrying out a calibration and a comparison of diagnostic accuracy of three faecal egg counts (FEC) techniques, simple flotation, McMaster and FLOTAC, in order to find ...the best flotation solution (FS) for
Dicrocoelium dendriticum,
Moniezia expansa and gastrointestinal (GI) strongyle eggs, and to evaluate the influence of faecal preservation methods combined with FS on egg counts. Simple flotation failed to give satisfactory results with any samples. Overall, FLOTAC resulted in similar or higher eggs per gram of faeces (EPG) and lower coefficient of variation (CV) than McMaster. The “gold standard” for
D. dendriticum was obtained with FLOTAC when using FS7 (EPG
=
219, CV
=
3.9%) and FS8 (EPG
=
226, CV
=
5.2%) on fresh faeces. The “gold standard” for
M. expansa was obtained with FLOTAC, using FS3 (EPG
=
122, CV
=
4.1%) on fresh faeces. The “gold standard” for GI strongyles was obtained with FLOTAC when using FS5 (EPG
=
320, CV
=
4%) and FS2 (EPG
=
298, CV
=
5%). As regard to faecal preservation methods, formalin 5% and 10% or freezing showed performance similar to fresh faeces for eggs of
D. dendriticum and
M. expansa. However, these methods of preservation were not as successful with GI strongyle eggs. Vacuum packing with storage at +4
°C permitted storage of GI strongyle eggs for up to 21 days prior to counting. Where accurate egg counts are required in ovine samples the optimum method of counting is the use of FLOTAC. In addition, we suggest the use of two solutions that are easy and cheap to purchase and prepare, saturated sodium chloride (FS2) for nematoda and cestoda eggs and saturated zinc sulphate (FS7) for trematoda eggs and nematoda larvae.
•A 8-year integrated program to control CE was implemented in southern Italy.•New strategies have been developed and applied for animal-centered interventions.•The control programme resulted in a ...noteworthy reduction of CE in livestock.•The new strategies developed could be extended to other endemic Mediterranean areas.
Cystic echinococcosis (CE) is a severe zoonosis, caused by the larval stage of the tapeworm Echinococcus granulosus. This helminth infection is of increasing public health and socio-economic concern due to the considerable morbidity rates that cause economic losses both in the public health sector and in the livestock industry. Control programmes against E. granulosus are considered long-term actions which require an integrated approach and high expenditure of time and financial resources. Since 2010, an integrated approach to control CE has been implemented in a highly endemic area of continental southern Italy (Campania region). Innovative procedures and tools have been developed and exploited during the control programme based on the following strategies: i) active and passive surveillance in livestock (using geospatial tools for georeferencing), ii) diagnosis in dogs (using the FLOTAC techniques and molecular analysis), iii) targeted treatment of farm dogs (using purpose-built confinement cages), iv) early diagnosis in livestock (by ultrasonography), v) surveillance in humans (through hospital discharge records analysis), vi) monitoring the food chain (analysing raw vegetables), vii) outreach activities to the general public (through dissemination material, e.g. brochures, gadgets, videos, virtual reality). Over eight years, the integrated approach and the new strategies developed have resulted in a noteworthy reduction of the parasite infection rates in livestock (e.g. up to 30 % in sheep). The results obtained so far highlight that using a one health multidisciplinary and multi-institution effort is of pivotal importance in preparing CE control programmes at regional level and could be extended to other endemic Mediterranean areas.
Introduction
Dupilumab is an interleukin-4 (IL-4) receptor alpha antagonist indicated for the treatment of moderate-to-severe atopic dermatitis (AD), which could be associated with atopic and ...non-atopic comorbidities for which concomitant administration of targeted pharmacotherapy including monoclonal antibodies could be required. However, the safety of combining dupilumab with other monoclonal antibodies for different therapeutic indication may be debated.
Methods
We conducted an extensive search in MEDLINE via PubMed for original articles published from January 1, 2017 to October 22, 2022, reporting clinical cases in which dupilumab has been associated with other monoclonal antibodies.
Results
Four small case series were identified reporting data on a total of 16 patients. To them, we have added other patients (
n =
8) derived from our clinical practice, achieving a total of 24 cases followed for a period of 2–22 months. Patients were receiving dupilumab mainly because of AD (except one patient for bullous pemphigoid and one for asthma) and other monoclonal antibodies for psoriasis treated with guselkumab (
n =
7) and secukinumab (
n =
1), asthma with omalizumab or benralizumab (
n =
3), Crohn’s disease with adalimumab (
n =
3), chronic spontaneous urticaria with omalizumab (
n =
3), primary familial hypercholesterolemia with evolocumab (
n =
2), hidradenitis suppurativa with adalimumab (
n =
1), psoriatic arthritis with secukinumab (
n =
1), rheumatoid arthritis with abatacept (
n =
1), ankylosing spondylitis with secukinumab (
n =
1) and colorectal carcinoma with cetuximab (
n =
1). No adverse events related to the combination of the two monoclonal antibodies were reported except for a mild injection site reaction (
n =
1) and arthralgia, which resolved spontaneously within a few weeks (
n =
1).
Conclusions
Because the evidence is modest, the question remains open as to whether dupilumab can be safely combined with other monoclonal antibodies. Dupilumab does not exert immunosuppressive effects and does not impair the activity of cytochrome P450 isozymes.
