Πέμπτη 10 Δεκεμβρίου 2020

investigation of thyroid blood tests and thyroid ultrasound findings of patients with rosacea

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Abstract

Background

We aimed to investigate the relationship between rosacea and thyroid diseases by analyzing thyroid blood tests and ultrasound findings of our patients recently diagnosed with rosacea.

Methods

This study was designed as a prospective, single‐center study. Dermatological examination findings, lesion locations were recorded, and rosacea clinical scores were calculated for all study group patients. The control group consisted of completely healthy women presented to our hospital during the study period for check‐up purposes. Serum free thyroxine, free triiodothyronine, thyroid‐stimulating hormone, anti‐thyroglobulin antibody, anti‐thyroid peroxidase antibody levels were measured, and thyroid ultrasound examinations were performed for all study participants.

Results

The entire study cohort consisted of 123 patients (63 cases and 60 controls). There was no significant difference between the groups in terms of mean patient age (p<0,05). Cheek was the most common lesion location (96.8%). There was no difference between the groups in terms of thyroid‐related laboratory parameters. However, anti‐TPO levels differed significantly with increasing disease severity (i.e., RCSs). There were significant relationships between cheek lesions and fT4 (p=0.021), while nose and chin lesions were associated with fT3 (p=0.01, p=0.001). Thyroid ultrasound findings revealed that rosacea patients tended to have larger thyroid nodules and more heterogeneous thyroid parenchymas than controls.

Conclusions

Our findings indicate that thyroid blood tests, including thyroid autoantibodies, should be tested and thyroid ultrasounds should be performed in patients diagnosed with rosacea. However, these findings need to be validated by prospective studies conducted in larger patient series with more extended follow‐up periods.

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Rituximab in Practice: Clinical Evaluation of Patients with Pemphigus after Rituximab Administration

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Abstract

Pemphigus Vulgaris (PV) is a rare autoimmune blistering disease, which mainly causes mucosal and/or cutaneous lesions. In June 2018, FDA approved Rituximab (RTX)‐ a B‐cell depleting agent‐ for the management of patients with moderate‐to‐severe pemphigus. Although the majority of patients respond well to this drug, some do not reach complete remission with a single cycle of RTX. In this review, following an overview of RTX and its clinical outcomes, we have focused on the possible outcomes after RTX therapy in patients with PV. The response is defined into four main categories; complete responders, partial responders, non‐responders, and paradoxical reactions, based on three possibilities of reaching the consolidation phase after three months, reaching remission until six months, and the ability of corticosteroid tapering in six months after RTX administration. Concerning the safety of RTX, three categories of infusion reactions, short and long‐term side effects are d iscussed. Additionally, we have suggested approaches for the evaluation of clinical and serological responses at different critical time‐points, including one, two, three, and six months after RTX administration. Finally, available markers to predict the response to RTX and research gaps in the field of RTX therapy have been summarized.

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The Most Common Allergens

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Abstract

Background

The skin prick test (SPT) could be applied as a useful in vivo method for the detection of sensitization in epidemiological and diagnostic studies if the wheal size is ideally evaluated. We focused on SPT wheal size to identify sensitization pattern to common inhalant and food allergens.

Methods

In this cross‐sectional study, SPT results were obtained from a total of 972 allergic patients. Common allergen extracts for SPT were selected according to the type of allergic diseases, and the geographical pattern. SPT with food allergens was performed for patients with atopic dermatitis (AD) and chronic urticaria (CU).

Results

A total of 461 male (47.4%) and 511 female (52.6%) participated in this study (median age: 31 years). The majority of individuals were affected with allergic rhinitis (AR) (n=624) and asthma (n=224); while 129 and 67 patients suffered from AD and CU, respectively. The most common aeroallergens were Russian thistle (52.1%) and Lamb's Quarter (50.7%) with the largest wheal diameter. The wheal size of lamb's quarter was significantly different between patients with asthma and AR (P<0.001). In addition, a significant difference was detected in wheal diameter in response to the Russian thistle between patients with AR and AD (P=0.001). Shrimp (23.6%) and Peanut (22.5%) caused the most common food sensitization in patients with AD and CU.

Conclusion

Having in mind the most common weed pollens including the Russian thistle and Lamb's Quarter, preventive strategies such as removing unwanted weeds or preventing them from growing, avoidance, and specific immunotherapy may be crucial for better disease control.

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The risk for severe COVID 19 in patients with autoimmune and/or inflammatory diseases: First wave lessons

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Abstract

Data regarding the risk for severe COVID19 in patients with autoimmune or inflammatory diseases are scarce. To estimate the risk of those patients to develop a more severe COVID19 infection All active patients and those with dermatologic and/or rheumatologic autoimmune/inflammatory diseases were identified in a single tertiary center. The charts of those tested positive for COVID19 between March 1stand May 31st, 2020 reviewed including demographics, co‐morbidities and medications. COVID19 outcome of those with dermatologic and/or rheumatologic autoimmune/inflammatory diseases were compared to COVID19 infected matched controls without an autoimmune/inflammatory background. Overall, 974 of 381 268 active patients were tested positive for COVID19, including 35 out of 13 225 with dermatologic and/or rheumatologic autoimmune/inflammatory diseases. No statistically significant difference in severity of COVID19 infection or mortality rate was found. The rate of asymptoma tic, mild, moderate, severe/critical and fatal COVID19 infection was 11.4%, 37.1%, 22.8%, 11.4% and 17.1% respectively for the patients with autoimmune diseases and 17.8%, 45.8%, 10.9%, 6.8% and 18.4% respectively for the controls . Patients with autoimmune/inflammatory diseases seem not to develop a more severe COVID19 infection than controls.

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Hypertrichosis and hair repigmentation in patients receiving interleukin‐17A inhibitors

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Adalimumab in the management of hidradenitis suppurativa

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Abstract

Background

Hidradenitis Suppurativa (HS) is a chronic relapsing, remitting disease which results in the formation of inflammatory nodules and pustules in intertriginous areas. HS is a complex disease with known psychosocial impact . Adalimumab is a biologic, used for treatment resistant HS, which working by inactivating TNF‐alpha.

Objectives

Our primary objective was to determine the effects of Adalimumab on HS‐PGA and DLQI scores in patients with HS that had been on the treatment for at least six months. Our secondary objective was to note and assess the significance of adverse effects and impacts on wider health, namely occupational and social.

Methods

A retrospective cross‐sectional study was performed using clinic notes from routine follow ups in biologic clinics in three specialist HS centres.

Results

77% (n= 78/101) patients demonstrated improvements in their HS‐PGA scores. We also demonstrated significants improvement in the DLQI scores of the patient cohort (p= 0.0001, 95% CI ‐12.8 to ‐5.9) . A total of 31.7% (32/101) patients experienced adverse effects spanning multiple organ systems, with 27.7% (28/101) requiring treatment cessation. Three of these patients stopped due to the worsening of pre‐existing mental health symptoms.

Conclusions

Adalimumab is effective in reducing HS‐PGA and DLQI scores, but patients still complain of systemic effects necessitating drug cessation in some instances. A holistic and multi‐systemic approach to follow up is required, and there is scope for further studies examining temporal causality in the context of Adalimumab and it's multisystemic physical and psychological effects.

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Unsuccessful palliative treatment of extraocular sebaceous carcinoma with shave removal and electrocoagulation

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Ectropion surgery might not be a long‐term solution for harlequin ichthyosis

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Can Rituximab Be Used In The Treatment Of Pemphigus Vulgaris During The COVID‐19 Pandemic?

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Abstract

Rituximab is a monoclonal antibody that targets CD20, a B‐lymphocyte antigen; that leads to a decline in the B‐cell counts for at least a year. The patients who have received rituximab treatment in the previous 5 years with the diagnosis of pemphigus group of diseases at CerrahpaŞa Medical Faculty were questioned for COVID‐19 infection. A total of 48 patients were included in this study; only one male patient had COVID‐19 infection which had a mild course. There is no significant difference in the total number of lymphocytes between patients who have received rituximab within the previous 5 years or last year. The number of lymphocytes is independent of the number of courses of rituximab treatment received. Therefore, we suggest that all pemphigus patients who have received rituximab treatment within the previous 5 years should be careful of the preventive measures against the COVID‐19 infection irrespective of the number of treatment courses or the number of year s which has passed since the treatment. The disease course was mild in the only infected patient. Thus, rituximab may be used in the treatment of pemphigus vulgaris during the COVID‐19 pandemic if its use is necessary.

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The additive efficacy of therapeutic low‐intensity pulsed ultrasound in the treatment of vitiligo: a randomized, left‐right comparison clinical trial

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Abstract

Repigmentation of vitiligo relies on the proliferation and migration of melanoblasts from hair follicles to the epidermis to replenish epidermal melanin. Our previous work has demonstrated low‐intensity pulsed ultrasound (LIPUS) can stimulate melanoblast migration in vitro. We sought to evaluate the potential additive efficacy and safety of LIPUS for repigmentation of vitiligo. Twenty‐seven adult patients with stable generalized vitiligo on the face or trunk were recruited in this randomized, open, left‐right comparison study. In each patient, two symmetric lesional sites were randomly selected; one was assigned as the target lesion, which was treated with add‐on LIPUS twice weekly for 24 weeks, and the other as the control lesion, which was administrated with sham sonification. The primary outcome was the difference of repigmentation degree between the target and control lesions at week 24, based on the 7‐point physician global assessment score. At the end of s tudy, 23 patients with vitiligo on the face (n = 10) or trunk (n = 13) completed the 24‐week treatment course. Enhanced repigmentation for vitiligo receiving LIPUS as compared to sham sonification was observed in 38.5% (5/13) of the patients with truncal vitiligo, but none of those with facial vitiligo. Truncal vitiligo (p = .046) and higher intensity of LIPUS administered (p = .01) were statistically significantly associated with the effectiveness of additive LIPUS treatment. The LIPUS treatment was well‐tolerated without remarkable adverse effects. This pilot study showed that LIPUS could provide therapeutic benefits and could be considered as a treatment adjunct for truncal vitiligo.

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Safety and efficacy profile of oral cyclosporine versus oral methotrexate versus oral acitretin in palmoplantar psoriasis ‐ A hospital based prospective investigator blind randomized controlled comparative study

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ABSTRACT

Background

Palmoplantar psoriasis (PPP) is a variant of psoriasis which affects only 5% body surface area, but has a devastating impact on affected individual's quality of life. There are few studies assessing efficacy of individual drugs, and few comparative studies of efficacy of two drugs in the literature, however randomized control trial comparing all three drugs against each other has not been done.

Methods

75 patients of PPP were enrolled for study and randomly divided into three groups A, B, C of 25 each and assigned for treatment with Cyclosporine (CSA)(2.5‐5mg/kg/day), Methotrexate (MTX)(7.5‐15mg/week) and Acitretin (ACT)(25‐50mg/day) respectively. Modified PASI, PSS, VAS, PGA & PPQOL were used for monitoring response to therapy and improvement in quality of life up to end of study, and thereafter monthly follow‐up was done to find duration of remission for next 90 days. Side effects if any were recorded.

Results

There was a statistically significant difference in modified PASI for CSA, MTX and ACT. The mean Modified PASI at baseline was 12.8±4.8 for CSA, 12.57±3.8 for MTX and 11.92±3.28 for ACT(P=0.75). Mean Modified PASI reduced to 2.91±1.8 for CSA, 6.57±2.2 for MTX and 4.7±2.2 for ACT at week 5(P=<0.01). Mean Modified PASI further reduced to 0.095±0.35 for CSA, 2.12±1.4 for MTX and 0.78±0.97 for ACT at end of study(P=<0.01). However, Average duration of remission was 9 weeks for ACT group, followed by 6.47 and 3 weeks for CSA and MTX group respectively. Adverse events were comparatively more in ACT group as compared to MTX and CSA groups.

Conclusion

PPP affects quality of life tremendously and warrants systemic treatment for the same. CSA provides fastest resolution of lesions and have highest efficacy. MTX and ACT have similar efficacy, but ACT provides longer duration of remission.

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