Immunotherapy with checkpoint inhibitors significantly improves the outcome for stage III and IV melanoma. Cutaneous adverse events during treatment are often reported. We herein aim to review the ...principal pigmentation changes induced by immune check-point inhibitors: the appearance of vitiligo, the Sutton phenomenon, melanosis and hair and nail toxicities.
Background
Diagnosis and treatment of skin disease in sea workers is an unmet need. The purpose of this study is to highlight how remote management of dermatological conditions appears inadequate in ...this scenario.
Objective
This study aimed to identify the best epidemiology for seafarers' diseases and analyze the adequacy of medical assistance in the diagnosis of dermatological maritime diseases.
Material and methods
A total of 420 cases of requests for dermatological diseases received by the Telemedical Maritime Assistance Service of the International Medical Radio Center (C.I.R.M.). in a referral year were included in this cross-sectional study. All pictures of cutaneous lesions had been submitted to both C.I.R.M. doctors and an expert dermatologist who provided their diagnosis.
Results
The most frequent diagnosis in both groups was infectious or inflammatory skin diseases. The main differences are represented by the amount of “unclassified dermatitis” or descriptive diagnosis, such as “cutaneous eruption” which were the most frequent diagnosis of C.I.R.M. doctors (
p
< 0.05 and
p
> 0.0001). In these cases, Cohen's K was <0.5 consistent with low concordance between dermatologic diagnosis and C.I.R.M. diagnosis.
Conclusion and relevance
Our study emphasizes the magnitude of dermatological diseases in the maritime sector, although often underestimated, and highlights the difficulty in their diagnosis for doctors on call that need more training on specific dermatological issues.
In the last years, adalimumab biosimilars have represented a commonly used alternative to the originator agent in the treatment of moderate to severe hidradenitis suppurativa. As of today, studies ...investigating the switch from adalimumab originator to biosimilar, following pharmacoeconomic policies, are lacking. Herein we present a real‐life setting retrospective study aimed at assessing the safety and efficacy of this switch in 37 patients, evaluated for 12 months in terms of IHS4 (International Hidradenitis Suppurativa Severity Score System) and HiSCR (Hidradenitis Suppurativa Clinical Response). Overall, no significant differences emerge between adalimumab originator and biosimilar in terms of clinical response following non‐medical switch. High discontinuation rates (43.2%) raise questions on patients' compliance to the new drug regimen, as severe pain at the injection site represents a substantial cause of biosimilar discontinuation (i.e., 31.5% of the cases). In selected cases, rechallenge with adalimumab originator may represent a valid option, as 66.6% (n = 8) of the patients who switched back to the former agent have benefited in terms of tolerability and efficacy. Carefully integrating pharmacoeconomic policies with a thorough assessment regarding the benefit–risk ratio of a nonmedical switch from originator to biosimilars remains essential to provide each HS patient with the best therapeutic option.
Adalimumab is the only biological drug approved to date for the treatment of moderate and/or severe hidradenitis suppurativa. Adverse events reported during therapy include paradoxical psoriasiform ...reactions. No guidelines are currently available for the management of this clinical condition. The aim of this paper is to describe the incidence and clinical features of paradoxical psoriasiform eruptions occurring during treatment with adalimumab in patients with hidradenitis suppurativa and to report real‐life experience in management and the possible role of other biologic agents for the treatment of both conditions.
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