13 research outputs found
Photo-recall cutaneous reaction to gemcitabine
No full textCutaneous reactions attributable to chemotherapy too often result in a modification of patients’ treatment plan. Most treatments remain largely unproven: only small series or case reports may indicate possible treatment options. Main observations: We reported the case of a male patient with gemcitabine-induced skin reaction occurred after a cycle of therapy with carboplatin plus gemcitabine following a 21 days’ schedule. The patient came to our attention for an extensive, well-demarked, erythematous, lilaceous, warm indurated lesion, covering his dorsal faces of both hands, without systemic symptoms. Clobetasol propionate 0.05% ointment was prescribed as main therapy, followed by a cream containing boswellic acids. Conclusions: It is presumable that similar dermatological lesions consist in a ‘radiation recall reaction’ whereby an inflammatory reaction occurs in the area previously treated with radiotherapy or affected by a sun-burn in the past. In our patient, interestingly, there is no history of radiotherapy even if there is history of strong sun exposure. Pharmacological anti-inflammatory effect due to boswellic acids was studied and relieved only in radiation-induced dermatitis, and even if larger studies would have been set in order to have more effective results, it would be useful to study application of this compound in chemotherapy-induced cutaneous adverse reactions too
Alexithymia and Plaque Psoriasis: Preliminary Investigation in a Clinical Sample of 250 Patients
No full text<b><i>Background/Aims:</i></b> Psoriasis as a dermatological disorder has complex effects on mental health and the psychological status of the patient. Many authors proposed that assessing how psoriasis affects a patient's life is better than a body surface area measurement for delineating psoriasis severity. Alexithymia is a personality dimension characterized by difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking observed in many clinical conditions, especially in psychosomatic disorders. This study aimed to determine the prevalence of alexithymia in patients with plaque psoriasis compared with healthy participants, while taking into consideration demographic and clinical variables. <b><i>Methods:</i></b> We enrolled 250 patients with chronic plaque psoriasis, naïve to any systemic treatment, and 215 healthy individuals. The 20-item Toronto Alexithymia Scale (TAS-20) was used to assess alexithymia. Data analysis was done. <b><i>Results:</i></b> The mean TAS score was 53.5 (±15.3) for the patient group and 45.1 (±10.8) for controls (<i>p</i> < 0.0001). Compared to controls, the psoriasis group showed significant alexithymic features (32.4 vs. 9.3%), and no significant differences of alexithymia between patients with severe and mild psoriasis were observed. A significant relationship was determined between alexithymia and female gender and sensitive area involvement, such as the face, hands, and genital area. <b><i>Conclusion:</i></b> This study suggests that the assessment of alexithymia should be a part of the comprehensive care of patients with moderate to severe psoriasis. For this purpose, the TAS-20 is a useful and simple tool to be used in daily clinical practice.</jats:p
Treating a Multidrug-Resistant Psoriatic HLA-C*18:01 Allele Carrier with Combination Ustekinumab Apremilast Therapy
No full textNowadays, even though several biologic therapies are available to treat psoriasis, multidrug-resistant disease continues to be a therapeutic challenge. Combination therapy has therefore become increasingly important. In this context, apremilast, according to its safety profile, could easily be combined with biologics in patients with comorbidities and/or recalcitrant multidrug-resistant psoriasis
Biologic therapy for acrodermatitis continua of Hallopeau: Successful treatment with secukinumab and review of the literature
No full textAcrodermatitis continua of Hallopeau (ACH) is a rare pustular psoriasis variant refractory to many conventional treatments. We report the successful treatment with secukinumab of a patient with a long history of ACH with marked onychodystrophy with frank pustulosis on the nail bed and with accompanying arthritis. Blockade of the IL-17 receptor A has shown promise in the treatment of psoriatic erythroderma and generalized pustular psoriasis not responsive to conventional treatment. A rapid response was observed in our patient, in both skin lesions and arthritic symptoms, underlining the ability of secukinumab to improve symptoms beyond those of plaque psoriasis
Psoriasis in pregnancy: case series and literature review of data concerning exposure during pregnancy to ustekinumab
No full textSuccessful treatment of psoriatic crumbly nails with ustekinumab
No full textNail involvement can place a significant burden on patients as a result of functional damage and psychosocial problems, leading to major repercussions on the quality of life. There is strong evidence that nail psoriasis can often be difficult to treat. We report a 69-year-old man with severe onychodystrophy, onycholysis, and pain in the hands; he had been previously treated with topical and systemic traditional therapies without satisfactory response. The patient showed multiple severe psoriatic crumbly nails (nail psoriasis severity index [NAPSI] score of 69) and started ustekinumab treatment at standard dosage of 45 mg fl.s.c. After 24 weeks, both nail matrix and nail bed disease showed marked improvement and the patient continued therapy with ustekinumab (NAPSI 0 at week 104). At week 136 (September 2015), the patient had been complaining of hands pain (visual analogue scale pain: 80) and ultrasonographic (US) evaluations found a synovial proliferation with effusion on metacarpophalangeal joints. The patient continued therapy with ustekinumab, adding methotrexate 10 mg fl.s.c/week. In November 2016, the patient showed a remission of symptoms; clinical and US evaluations did not find signs of synovitis. Methotrexate treatment was suspended and currently the patient reached more than 4 years of ustekinumab treatment without sign and symptoms of synovitis
Secukinumab in moderate-to-severe plaque psoriasis: a multi-center, retrospective, real-life study up to 52 weeks observation
No full textTo evaluate efficacy and safety of the anti-IL-17 drug secukinumab in
a real-life large cohort of patients with moderate-to-severe plaque psoriasis in
Central Italy.
METHODS: Multicenter, retrospective study with an observation period of up to
52 weeks. Efficacy was assessed by Psoriasis Area and Severity Index (PASI)
score; clinical and laboratory examinations were performed at baseline and at
weeks 4, 12, 24, 36, and 52.
RESULTS: A 90% and a 100% PASI score reduction (PASI90 and PASI100) were reported
in 67.5% and 55% of patients at week 12, respectively. A rapid improvement of
skin lesions was observed particularly in young patients and in patients naïve to
biologics: at week 4, the achievement of PASI90 and PASI100 was higher in younger
patients (odds ratio [OR] 0.95, and 0.95; p = 0.003, and 0.005, respectively);
PASI90 was achieved by 42.0% of patients naïve to biologics and by 17.0% of
patients with prior exposure to biologics (PBT) (OR 0.24; p = 0.001); and PASI100
was reached by 25.5% of naïve patients and 9.8% of PBT (OR 0.28; p = 0.015).The
drug was well tolerated.
CONCLUSION: Secukinumab was effective in this real-life analysis, with rapid
clinical improvement and long-term maintenance of results
Guselkumab for the treatment of psoriasis: a 60-week real-life multicenter retrospective experience
No full textBackground: Real-world data for guselkumab, the first interleukin-23 inhibitor approved to treat moderate-to-severe psoriasis, are scarce. This study represents the first 60-week, real-life, multicenter, retrospective experience to investigate the effectiveness, safety, tolerability, and drug retention of guselkumab in psoriatic patients. Research design and methods: Clinical information was collected at baseline and at weeks 12, 24, 36, 48, and 60. Results: The mean baseline Psoriasis Activity Severity Index (PASI) reduced from 14.2 to 3.1 at week 12 and decreased to around 0 at weeks 36, 48, and 60. PASI 75, PASI 90, and PASI 100 were 100%, 96.8%, and 83.9% at week 60, respectively. Multiple logistic regression analysis showed that neither body mass index >30, smoking, ≥3 comorbidities, difficult-to-treat areas, nor a failure to ≥2 prior biologic treatments significantly influenced PASI reduction (p > 0.05). Conclusions: Our findings confirm guselkumab as an appropriate therapeutic option in routine clinical practice, especially when dealing with complex patients with comorbidities or previous failure to biologic treatments
Clinical and histopathological characterization of eczematous eruptions occurring in course of anti IL-17 treatment: a case series and review of the literature
No full textBackground: Real-life data often highlight the side effects of certain drugs not previously reported in randomized controlled trials (RCTs).Objective: To describe cutaneous inflammatory eruptions in psoriatic patients treated with an anti IL-17A agent (secukinumab or ixekizumab).Methods: Retrospective analysis of a cohort of patients with chronic plaque psoriasis who started an anti IL-17A agent between September 2016-February 2019 and who developed cutaneous inflammatory eruptions during treatment. A systematic review of similar events reported in the literature was performed.Results: Data of 468 patients were reviewed and 27 cutaneous inflammatory eruptions of 27 (5.8%) patients were collected. The eruptions appeared after a mean of 16.9 ± 17.0 weeks of therapy showing a classical acute eczema in 11 patients (40.7%), an atopic dermatitis-like rash in 11 patients (40.7%) and a psoriasiform eruption in 5 patients (18.5%). Histopathology of 12/27 cases showed epidermal spongiosis in all these variants.Conclusion: We described the clinic-pathologic features of some eczematous eruptions occurring in psoriatic patients, 3-4 months after treatment initiation with an anti IL-17A agent. Further investigations are needed to explain this phenomenon, that might be defined a paradoxical adverse event, based upon the role of IL17 in eczema pathogenesis
Use of apremilast in the psoriasis treatment: a real-life multicentre Italian experience
No full textBackground: Apremilast is the first small molecule approved for the treatment of moderate-to-severe psoriasis in adult patients; however, real-life data are still limited. We investigated the effectiveness and safety of this drug in a multicentre real-world setting.
Methods: We retrospectively reviewed data from all psoriatic patients who received at least one dose of apremilast, collecting demographic data and medical history, at baseline and periodically until 36 months.
Results: A total of 111 patients entered in the study. The mean drug survival duration was 21.8±10.6 months, significantly shorter when comorbidities were≥3 and if biologic drugs were previously administered.ΔPASI90 was achieved in 29% of patients and ΔPASI50 in 68% at T4;the rate of ΔPASI improvement increased progressively at T12, T24, T36 in patients who continued to receive apremilast.At the end of the study 50 patients discontinued the treatment because of adverse events (19.8%), primary failure(19%) or secondary failure(6.3%).
Conclusions: Apremilast proved to be an effective, safe, and manageable drug, showing effectiveness also in difficult-to-treat patients with psoriasis, with a favourable tolerability profile and a potentially valid weight loss effect. We believe that treating patients with few comorbidities who are naive to biological therapy may result in higher response rates and longer mean drug survival
