Summary
Background
Corticosteroids (CS) with or without adjuvant immunosuppressant agents are standard treatment for pemphigus vulgaris (PV). The efficacy of adjuvant therapies in minimizing ...steroid‐related adverse events (AEs) is unproven.
Objectives
To utilize data collected in a French investigator‐initiated, phase III, open‐label, randomized controlled trial to demonstrate the efficacy and safety of rituximab and seek approval for its use in PV.
Methods
This was an independently conducted post hoc analysis of the moderate‐to‐severe PV subset enrolled in the Ritux 3 study. Patients were randomized to rituximab plus 0·5 or 1·0 mg kg−1 per day prednisone tapered over 3 or 6 months, or 1·0 or 1·5 mg kg−1 per day prednisone alone tapered over 12 or 18 months, respectively (according to disease severity). The primary end point was complete remission at month 24 without CS (CRoff) for ≥ 2 months, and 24‐month efficacy and safety results were also reported.
Results
At month 24, 34 of 38 patients (90%) on rituximab plus prednisone achieved CRoff ≥ 2 months vs. 10 of 36 patients (28%) on prednisone alone. Median total cumulative prednisone dose was 5800 mg in the rituximab plus prednisone arm vs. 20 520 mg for prednisone alone. Eight of 36 patients (22%) who received prednisone alone withdrew from treatment owing to AEs; one rituximab‐plus‐prednisone patient withdrew due to pregnancy. Overall, 24 of 36 patients (67%) on prednisone alone experienced a grade 3/4 CS‐related AE vs. 13 of 38 patients (34%) on rituximab plus prednisone.
Conclusions
In patients with moderate‐to‐severe PV, rituximab plus short‐term prednisone was more effective than prednisone alone. Patients treated with rituximab had less CS exposure and were less likely to experience severe or life‐threatening CS‐related AEs.
What's already known about this topic?
Pemphigus vulgaris (PV) is the most common type of pemphigus.
Corticosteroids, a standard first‐line treatment for PV, have significant side‐effects.
Although their effects are unproven, adjuvant corticosteroid‐sparing agents are routinely used to minimize steroid exposure and corticosteroid‐related side‐effects.
There is evidence that the anti‐CD20 antibody rituximab is effective in the treatment of patients with severe recalcitrant pemphigus and in patients with newly diagnosed pemphigus.
What does this study add?
This study provides a more detailed analysis of patients with PV enrolled in an investigator‐initiated trial.
Rituximab plus prednisone had a steroid‐sparing effect and more patients achieved complete remission off prednisone.
Fewer patients experienced grade 3 or grade 4 steroid‐related adverse events than those on prednisone alone.
This collaboration between academia and industry, utilizing independent post hoc analyses, led to regulatory authority approvals of rituximab in moderate‐to‐severe PV.
Linked Comment: Scorer et al. Br J Dermatol 2020; 182:1078–1079.
Simian retroviruses in African apes Peeters, M.; Delaporte, E.
Clinical microbiology and infection,
June 2012, Volume:
18, Issue:
6
Journal Article
Peer reviewed
Open access
It is now well established that simian immunodeficiency viruses (SIVs) from chimpanzees (SIVcpz) and gorillas (SIVgor) from west Central Africa are at the origin of HIV-1/AIDS. Apes are also infected ...with other retroviruses, notably simian T-cell lymphotropic viruses (STLVs) and simian foamy viruses (SFVs), that can be transmitted to humans. We discuss the actual knowledge on SIV, STLV and SFV infections in chimpanzees, gorillas, and bonobos. We especially elaborate on how the recent development of non-invasive methods has allowed us to identify the reservoirs of the HIV-1 ancestors in chimpanzees and gorillas, and increased our knowledge of the natural history of SIV infections in chimpanzees. Multiple cross-species events with retroviruses from apes to humans have occurred, but only one transmission of SIVcpz from chimpanzees in south-eastern Cameroon spread worldwide, and is responsible for the actual HIV pandemic. Frequent SFV transmissions have been recently reported, but no human-to-human transmission has been documented yet. Because humans are still in contact with apes, identification of pathogens in wild ape populations can signal which pathogens may be cause risk for humans, and allow the development of serological and molecular assays with which to detect transmissions to humans. Finally, non-invasive sampling also allows the study of the impact of retroviruses and other pathogens on the health and survival of endangered species such as chimpanzees, gorillas, and bonobos.
Summary
Background
Patients with inflammatory bowel diseases (IBD) may present with lesions in their oral cavity. Lesions may be associated with the disease itself representing an extraintestinal ...manifestation, with nutritional deficiencies or with complications from therapy.
Aim
To review and describe the spectrum of oral nonmalignant manifestations in patients with inflammatory bowel diseases ulcerative colitis (UC), Crohn's disease (CD) and to critically review all relevant data.
Methods
A literature search using the terms and variants of all nonmalignant oral manifestations of inflammatory bowel diseases (UC, CD) was performed in November 2014 within Pubmed, Embase and Scopus and restricted to human studies.
Results
Oral lesions in IBD can be divided into three categories: (i) lesions highly specific for IBD, (ii) lesions highly suspicious of IBD and (iii) nonspecific lesions. Oral lesions are more common in CD compared to UC, and more prevalent in children. In adult CD patients, the prevalence rate of oral lesions is higher in CD patients with proximal gastrointestinal tract and/or perianal involvement, and estimated to range between 20% and 50%. Oral lesions can also occur in UC, with aphthous ulcers being the most frequent type. Oral manifestations in paediatric UC may be present in up to one‐third of patients and are usually nonspecific.
Conclusions
Oral manifestations in IBD can be a diagnostic challenge. Treatment generally involves managing the underlying intestinal disease. In cases presenting with local disabling symptoms and impaired quality of life, local and systemic medical therapy must be considered and/or oral surgery may be required.
Severe scurvy: an underestimated disease Levavasseur, M; Becquart, C; Pape, E ...
European journal of clinical nutrition,
09/2015, Volume:
69, Issue:
9
Journal Article
Peer reviewed
Scurvy is one of the oldest diseases in human history. Nowadays, although scurvy tends to become a forgotten disease in developed country, rare cases still occur, especially in people undergoing ...extreme diet, old people or children with poor diet and patients with malabsorption. We describe three cases of scurvy. The first case is a patient diagnosed with Crohn's disease, the second one is in a context of anorexia nervosa and drug addiction, and the third case is in a context of social isolation. Early recognition of scurvy can be difficult because symptoms may appear nonspecific and can mimic more common conditions. In any patient with spontaneous hematoma and purpura, in the context of nutritional disorder, scurvy should be systematically considered. As this disease can lead to severe complications, such as bone pain, heart failure or gastrointestinal symptoms, nothing should delay vitamin C supplementation, which is a simple and rapidly effective treatment.
Summary
Background
Specific trichoscopic signs of tinea capitis (TC) were first described in 2008. The accuracy of this diagnostic tool has not been evaluated.
Objectives
To assess the diagnostic ...accuracy of trichoscopy.
Methods
A prospective, multicentre study was done between March 2015 and March 2017 at the dermatology departments of four French university medical centres. Patients with a presumed diagnosis of TC were included. Trichoscopy was considered to be positive if at least one specific trichoscopic sign was observed. Trichoscopy results were compared with the gold standard for diagnosis of TC (mycological culture).
Results
One hundred patients were included. Culture was positive for 53 patients and negative for 47. The sensitivity of trichoscopy was 94% 95% confidence interval (CI) 88–100, specificity was 83% (95% CI 72–94), positive predictive value was 92% and negative predictive value was 86%. Comma hairs, corkscrew hairs, zigzag hairs, Morse‐code‐like hairs and whitish sheath were significantly more frequent in patients with a positive mycological culture (P < 0·001). Comma hairs were more frequent in patients with Trichophyton TC (P = 0·026), and zigzag hairs were more frequent in patients with Microsporum TC (P < 0·001). Morse‐code‐like hair was not observed in any patients with Trichophyton TC and therefore appears to be highly specific for Microsporum TC.
Conclusions
The presence of a single trichoscopic finding is predictive of TC. Trichoscopy is a useful, rapid, painless, highly sensitive tool for the diagnosis of TC – even for dermoscopists with little experience of trichoscopy. It enhances physicians’ ability to make treatment decisions.
What's already known about this topic?
Tinea capitis (TC) must be confirmed by a mycological culture that may take up to 6 weeks, delaying treatment.
Specific trichoscopic signs of TC were first described in 2008, but the accuracy of trichoscopy for diagnosing TC has not previously been evaluated.
What does this study add?
The present series is the largest yet on the use of trichoscopy in the diagnosis of TC.
Our results demonstrated that the presence of a single feature (comma hair, corkscrew hair, zigzag hair, Morse‐code‐like hair or whitish sheath) is predictive of TC.
Trichoscopy is painless and highly sensitive.
Morse‐code‐like hair appears to be highly specific for Microsporum TC.
Linked Comment: Brasileiro. Br J Dermatol 2019; 181:893–894.
Plain language summary available online
Respond to this article
Psoriasis and inflammatory bowel diseases (Crohn's disease and ulcerative colitis) are among the immune-mediated inflammatory diseases. This group includes approximately 80 disorders, some of which ...can at times be associated in a single patient. In psoriasis, Crohn's disease may be observed slightly more frequently, but ulcerative colitis and celiac disease are also an issue. The underlying relations between these disorders comprise: i) genetic data obtained by genome-wide association studies that show the involvement of shared predisposing loci and/or genes, for example, in innate immunity; ii) immunological data: these disorders share inflammation effector mechanisms, particularly the activation pathway of Th17 lymphocytes, which explains the efficacy of anti-TNF antibodies and anti-IL-12/23; and iii) environmental co-factors such as smoking, possibly certain food proteins (gliadin, etc.), and bacterial infections that are probably decisive elements in the genesis of these diseases.
To the best of our knowledge, only 52 cases of squamous cell carcinoma (SCC) complicating hidradenitis suppurativa (HS) have been reported since 1958. We describe 13 new cases.
We propose a clinical ...and histological analysis of our cases. We include these results in a review of previously reported cases to analyze a total of 65 patients. In our series of 13 cases, we also investigate the presence of human papillomavirus (HPV) in tumor samples, by polymerase chain reaction (PCR) on paraffin-embedded material.
Malignant transformation affects mainly men with a long-term history of genitoanal HS. Although our cases were 7 well-differentiated carcinomas and 6 verrucous carcinomas, lymphatic and visceral metastasis occurred in 2 and 3 cases, respectively. With PCR, we demonstrated presence of HPV in genitoanal tumoral lesions, principally HPV-16.
SCC complicating HS evolves poorly, despite a good histological prognosis. Our results sustain the implication of HPV in the malignant transformation of HS.
PDF
