Summary
Biologic agents are an important new class of drugs, offering targeted treatment for chronic skin diseases such as psoriasis. The biologic therapy efalizumab is an anti‐CD11a monoclonal ...antibody, which was approved by the European regulatory agency in 2004 for the treatment of moderate‐to‐severe plaque psoriasis. Here we describe our 2‐year experience in treating over 100 patients with moderate‐to‐severe psoriasis with efalizumab at two dermatology centres in Italy. Overall, we found efalizumab is efficacious for a large subset of patients, regardless of previous therapies received, and has an easily manageable safety profile. We believe one important quality of efalizumab is the stability and maintenance of clinical response over time. We found that most patients who respond to treatment experience a long‐term clearing of psoriasis with only mild recurrence events. Our experience with individual cases provides specific insights into efalizumab re‐treatment, the use of efalizumab in patients with a history of heart failure, and the management of patients who become pregnant or conceive while receiving efalizumab therapy. In summary, our off‐trial experience in over 100 patients confirms the efficacy and safety of efalizumab in the treatment of moderate‐to‐severe plaque psoriasis.
Background Early detection of basal cell carcinoma (BCC) is crucial to reduce the morbidity of this tumor. Objective We sought to investigate the variability and diagnostic significance of ...dermatoscopic features of BCCs. Methods We conducted retrospective dermatoscopic analysis of 609 BCCs and 200 melanocytic and nonmelanocytic lesions, and assessment of interrater reliability of dermatoscopic BCC criteria. Results Lesions included nonpigmented (15.1%), lightly pigmented (33.2%), pigmented (42.7%), and heavily pigmented (9%) BCCs. Classic BCC patterns including arborizing telangiectasia (57.1%), blue/gray ovoid nests (47.5%), ulceration (39.2%), multiple blue/gray globules (26.1%), leaflike areas (15.9%), and spoke-wheel areas (9%) were significantly increased in pigmented BCCs compared with nonpigmented and heavily pigmented BCCs ( P = .0001). Among nonclassic BCC patterns, we detected short fine superficial telangiectasia (10%) and multiple small erosions (8.5%), and described two new patterns named “concentric structures” (7.6%) and “multiple in-focus blue/gray dots” (5.1%). Dermatoscopic features suggestive of melanocytic lesions (eg, multiple brown to black dots/globules, blue/white veillike structures, and nonarborizing vessels) were observed in 40.6% BCCs and significantly increased in heavily pigmented BCCs ( P < .0001). Expert observers provided an accurate (sensitivity: 97%) and reliable (K: 87%) dermatoscopic diagnosis of BCC, although a significant difference in terms of specificity ( P = .0002) and positive predictive value ( P = .0004) was found. Arborizing telangiectasia, leaflike areas, and large blue/gray ovoid nests represented reliable and robust diagnostic parameters. Limitation The study was retrospective. Conclusion BCCs show a large spectrum of global and local dermatoscopic features; heavily pigmented BCCs show the most challenging combinations of dermatoscopic features.
Background Few data exist on the relationship between psoriasis and melanocytic lesions. Objectives We sought to investigate number of melanocytic nevi in psoriatic patients compared with control ...subjects and its relationship with disease severity and treatment. Methods We performed a prospective study in 189 psoriatic patients and 189 control subjects. Sociodemographic and clinical data were recorded for all participants. Results As compared with control subjects, patients had fewer nevi overall χ2 (5) = 52.24, P < .001, fewer nevi less than 5 mm χ2 (4) = 60.28, P < .001, and fewer congenital nevi χ2 (1) = 10.41, P = .002; no differences in atypical nevi and family history of cancer, including melanoma, were observed. Among psoriatic patients, number of biologics used was a risk factor for a higher nevus count odds ratio 1.35 (95% CI 1.04-1.76), P = .02 whereas disease severity did not correlate with number of nevi. Limitations Low number of psoriatic patients naïve to systemic therapies was a limitation. Conclusions Psoriatic patients have fewer nevi than control subjects. Frequency of nevi in psoriatic patients is related to treatment, not to disease severity.
The spectrum of dermatoscopic patterns in blue nevi Di Cesare, Antonella, MD; Sera, Francesco, BSc; Gulia, Andrea, MD ...
Journal of the American Academy of Dermatology,
08/2012, Letnik:
67, Številka:
2
Journal Article
Recenzirano
Background Blue nevi are congenital or acquired, dermal dendritic melanocytic proliferations that can simulate melanocytic and nonmelanocytic lesions including melanoma, cutaneous metastasis of ...melanoma, Spitz/Reed nevi, and basal cell carcinoma. Objective We sought to investigate global and local dermatoscopic patterns of blue nevi compared with melanomas and basal cell carcinomas. Methods We retrospectively analyzed global and local features in 95 dermatoscopic images of blue nevi and in 190 melanomas and basal cell carcinomas that were selected as control lesions on the basis of similar pigmentation. Lesion pigmentation was classified as monochromatic, dichromatic, or multichromatic. Results A global pattern characterized by homogeneous pigmentation was observed in all of 95 (100%) blue nevi. Eighty of 95 (84.2%) blue nevi presented a homogeneous pattern consisting of one color (blue, black, or brown) or two colors (blue-brown, blue-gray, or blue-black). Fifteen of 95 (15.8%) blue nevi had a multichromatic (blue, gray, black, brown, and/or red) pigmentation. In all, 47 of 95 (49.5%) blue nevi were characterized by pigmentation in the absence of pigment network or any other local dermatoscopic features. And 48 of 95 (50.5%) blue nevi showed local dermatoscopic patterns including whitish scarlike depigmentation, dots/globules, vascular pattern, streaks, and networklike pattern. Limitations The study was retrospective and involved only Caucasian people of Italian origin. Conclusion The characteristic feature of blue nevi is a homogeneous pigmentation that is blue, blue-gray, blue-brown, or blue-black. We showed that a wide spectrum of local dermatoscopic features (whitish scarlike depigmentation, dots/globules, peripheral streaks or vessels) may also be present. In such cases, clinical and dermatoscopic distinction from melanoma or nonmelanocytic lesions may be difficult or impossible, and surgical excision is necessary.
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