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Frontiers in Medicine 2021Skin pathergy reaction (SPR) is a hyperreactivity response to needle induced trauma which is characterized by a papule or pustule formation, 24-48 h after sterile-needle... (Review)
Review
Skin pathergy reaction (SPR) is a hyperreactivity response to needle induced trauma which is characterized by a papule or pustule formation, 24-48 h after sterile-needle prick. It is affected by a wide array of factors, including the physical properties of the needles being used, number of pricks and disease related factors such as male gender, active disease. There is a great variation in reactivity among different populations with very low positivity rate in regions of low prevalence like Northern Europe, and higher prevalance mainly in communities living along the historical Silk Road, like Turkey, China and Middle Eastern countries. SPR is not constant during the disease course, has lost its sensitivity over decades and can be positive in various disorders including Sweet's syndrome, pyoderma gangrenosum, Crohn's diesease, A20 haploinsufficiency, deficiency of IL-1-receptor antagonist and few others. Nevertheless, it is a criteria included into many currently used diagnostic or classification criteria for Behçet's disease. Although, not being fully uncovered yet, available data points to the activation of both innate and adaptive immune system with an inflammatory response mediated by polymorphonuclears and T-cells. In addition to its utility in diagnosis of Behçet's Disease, SPR may serve as a model for investigating the inflammatory pathways involved in the etiopathogenesis of this complex disease.
PubMed: 34113630
DOI: 10.3389/fmed.2021.639404 -
The Journal of Family Practice Sep 2021THE COMPARISONA. A 27-year-old Hispanic woman with comedonal and inflammatory acne. Erythema is prominent around the inflammatory lesions. Note the pustule on the cheek...
THE COMPARISONA. A 27-year-old Hispanic woman with comedonal and inflammatory acne. Erythema is prominent around the inflammatory lesions. Note the pustule on the cheek surrounded by pink color.B. A teenaged Black boy with acne papules and pustules on the face. There are comedones, hyperpigmented macules, and pustules on the cheek.C. A teenaged Black girl with pomade acne. The patient used various hair care products, which obstructed the pilosebaceous units on the forehead.
Topics: Acne Vulgaris; Adolescent; Adult; Black or African American; Erythema; Female; Health Services Accessibility; Hispanic or Latino; Humans; Hyperpigmentation; Male; Skin Pigmentation; Young Adult
PubMed: 34818170
DOI: 10.12788/jfp.0271 -
American Journal of Clinical Dermatology Sep 2023Palmoplantar pustulosis (PPP) is a pruritic, painful, recurrent, and chronic dermatitis with limited therapeutic options. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Palmoplantar pustulosis (PPP) is a pruritic, painful, recurrent, and chronic dermatitis with limited therapeutic options.
OBJECTIVE
To evaluate the efficacy and safety of apremilast for the treatment of Japanese patients with PPP and inadequate response to topical treatment.
METHODS
This phase 2, randomized, double-blind, placebo-controlled study enrolled patients with Palmoplantar Pustulosis Area and Severity Index (PPPASI) total score ≥ 12 and moderate or severe pustules/vesicles on the palm or sole (PPPASI pustule/vesicle severity score ≥ 2) at screening and baseline with an inadequate response to topical treatment. Patients were randomized (1:1) to apremilast 30 mg twice daily or placebo for 16 weeks, followed by a 16-week extension phase during which all patients received apremilast. The primary endpoint was achievement of PPPASI-50 response (≥ 50% improvement from baseline in PPPASI). Key secondary endpoints included change from baseline in PPPASI total score, Palmoplantar Pustulosis Severity Index (PPSI), and patient's visual analog scale (VAS) for PPP symptoms (pruritus and discomfort/pain).
RESULTS
A total of 90 patients were randomized (apremilast: 46; placebo: 44). A significantly greater proportion of patients achieved PPPASI-50 at week 16 with apremilast versus placebo (P = 0.0003). Patients receiving apremilast showed greater improvement in PPPASI at week 16 versus placebo (nominal P = 0.0013), as well as PPSI and patient-reported pruritus and discomfort/pain (nominal P ≤ 0.001 for all). Improvements were sustained through week 32 with apremilast treatment. The most common treatment-emergent adverse events included diarrhea, abdominal discomfort, headache, and nausea.
CONCLUSIONS
Apremilast treatment demonstrated greater improvements in disease severity and patient-reported symptoms versus placebo at week 16 in Japanese patients with PPP with sustained improvements through week 32. No new safety signals were observed.
CLINICALTRIALS
GOV: NCT04057937.
Topics: Humans; East Asian People; Psoriasis; Pain; Pruritus; Double-Blind Method; Treatment Outcome; Severity of Illness Index
PubMed: 37233897
DOI: 10.1007/s40257-023-00788-2 -
Ugeskrift For Laeger Nov 2020In this review, we discuss Malassezia folliculitis (MF), which is an inflammation in the hair follicles caused by different Malassezia species. The prevalence of MF in... (Review)
Review
In this review, we discuss Malassezia folliculitis (MF), which is an inflammation in the hair follicles caused by different Malassezia species. The prevalence of MF in the population worldwide ranges from 1% to 17%. Clinically, it may be difficult to distinguish from acne vulgaris, as it presents as erythematous 2-4 mm large papules and pustules on the back, chest and neck. Adequate diagnostic methods, including microscopy or biopsy, are essential to confirm the MF diagnosis, and to ensure initiation of the appropriate anti-fungal treatment.
Topics: Acne Vulgaris; Biopsy; Dermatomycoses; Folliculitis; Humans; Malassezia
PubMed: 33215579
DOI: No ID Found -
Expert Opinion on Pharmacotherapy Nov 2022Rosacea is a chronic and relapsing facial dermatosis that encompasses a wide spectrum of clinical phenotypes (transient/persistent erythema, telangiectasias,... (Review)
Review
INTRODUCTION
Rosacea is a chronic and relapsing facial dermatosis that encompasses a wide spectrum of clinical phenotypes (transient/persistent erythema, telangiectasias, papules/pustules, edema, phymatous changes, and ocular symptoms) often with uncomfortable symptoms such as flushing, pain, burning, edema, and dryness. Current pharmacological treatment includes topical agents, spanning from several conventional (azelaic acid, metronidazole, sodium sulfacetamide) to new ones (brimonidine, oxymetazoline, ivermectine, minocycline), and systemic agents (doxycycline 40 mg modified-release), all Food and Drug Administration approved.
AREAS COVERED
The aim of our article is to review the state of art of pharmacological treatment, either as monotherapy or in combination therapy, tailored to the most common rosacea phenotypes (persistent erythema, inflammatory papules/pustules). Other topical or systemic drugs and several adjuvant phytotherapeutic agents are considered.
EXPERT OPINION
Combined therapies to target different phenotypes, when present in the same patient, represent one of the major achievements in the management of vascular and inflammatory papules and pustules of rosacea. Future investigations should be addressed to early inflammatory phyma or ocular rosacea, which have actually been neglected. Finally, there is still an ongoing need for therapeutic interventions able to relieve symptoms and social burden, all factors that greatly contribute to improve rosacea quality of life.
Topics: Humans; Dermatologic Agents; Erythema; Metronidazole; Quality of Life; Rosacea; Guidelines as Topic
PubMed: 36330970
DOI: 10.1080/14656566.2022.2142907