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Pediatrics Apr 2015Atopic dermatitis (AD) primarily affects infants and young children. Although topical corticosteroids (TCSs) are often prescribed, noncorticosteroid treatments are... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND AND OBJECTIVES
Atopic dermatitis (AD) primarily affects infants and young children. Although topical corticosteroids (TCSs) are often prescribed, noncorticosteroid treatments are needed because compliance with TCSs is poor due to concerns about their side effects. In this longest and largest intervention study ever conducted in infants with mild-to-moderate AD, pimecrolimus 1% cream (PIM) was compared with TCSs.
METHODS
A total of 2418 infants were enrolled in this 5-year open-label study. Infants were randomized to PIM (n = 1205; with short-term TCSs for disease flares) or TCSs (n = 1213). The primary objective was to compare safety; the secondary objective was to document PIM's long-term efficacy. Treatment success was defined as an Investigator's Global Assessment score of 0 (clear) or 1 (almost clear).
RESULTS
Both PIM and TCSs had a rapid onset of action with >50% of patients achieving treatment success by week 3. After 5 years, >85% and 95% of patients in each group achieved overall and facial treatment success, respectively. The PIM group required substantially fewer steroid days than the TCS group (7 vs 178). The profile and frequency of adverse events was similar in the 2 groups; in both groups, there was no evidence for impairment of humoral or cellular immunity.
CONCLUSIONS
Long-term management of mild-to-moderate AD in infants with PIM or TCSs was safe without any effect on the immune system. PIM was steroid-sparing. The data suggest PIM had similar efficacy to TCS and support the use of PIM as a first-line treatment of mild-to-moderate AD in infants and children.
Topics: Adrenal Cortex Hormones; Child, Preschool; Dermatitis, Atopic; Dermatologic Agents; Dose-Response Relationship, Drug; Drug Therapy, Combination; Humans; Infant; Long-Term Care; Tacrolimus
PubMed: 25802354
DOI: 10.1542/peds.2014-1990 -
Indian Journal of Dermatology,... 2018N-acetylcysteine is a mucolytic drug which is commonly used as an antidote for acetaminophen toxicity. It is a thiol compound, which acts as a donor of cysteine, leading... (Review)
Review
N-acetylcysteine is a mucolytic drug which is commonly used as an antidote for acetaminophen toxicity. It is a thiol compound, which acts as a donor of cysteine, leading to replenishment of glutathione and thus acts as an antioxidant. It also has anti-inflammatory effects, alters the levels of neurotransmitters, inhibits proliferation of fibroblasts and keratinocytes and causes vasodilatation. Due to these actions, n-acetylcysteine has found use in several dermatologic conditions in systemic and topical form. The drug has been used as an adjuvant in the management of conditions such as toxic epidermal necrolysis, drug hypersensitivity syndrome, trichotillomania, skin picking disorders and onychotillomania, ichthyoses, contact dermatitis, atopic dermatitis, melasma, pseudoporphyria, connective tissue diseases, wound healing and alopecia. It also has a role in protection from radiation-induced skin damage including photo-ageing, photocarcinogenesis and radiation dermatitis. Most indications in dermatology are supported by case reports, small case series and small trials. Higher quality of evidence is needed for its wider use. The drug is cheap and is generally safe with few adverse effects. Thus a greater role is possible for use of n-acetylcysteine in various skin conditions. This review explores the various uses of n-acetylcysteine in the field of dermatology, the evidence supporting the same, the possible mechanisms of action and the adverse effects of the drug.
Topics: Acetylcysteine; Animals; Anti-Inflammatory Agents; Antioxidants; Dermatologic Agents; Dermatology; Humans; Skin Diseases
PubMed: 30246706
DOI: 10.4103/ijdvl.IJDVL_33_18 -
BMC Veterinary Research Aug 2015In 2010, the International Task Force on Canine Atopic Dermatitis (now International Committee on Allergic Diseases of Animals, ICADA) published the first consensus...
BACKGROUND
In 2010, the International Task Force on Canine Atopic Dermatitis (now International Committee on Allergic Diseases of Animals, ICADA) published the first consensus guidelines for the treatment of atopic dermatitis (AD) in dogs. This is the first 5-year minor update of this document.
RESULTS
The treatment of acute flares of AD should involve the search for, and then elimination of, the cause of the flares, bathing with mild shampoos, and controlling pruritus and skin lesions with interventions that include topical and/or oral glucocorticoids or oclacitinib. For chronic canine AD, the first steps in management are the identification and avoidance of flare factors, as well as ensuring that there is adequate skin and coat hygiene and care; this might include more frequent bathing and possibly increasing essential fatty acid intake. The medications currently most effective in reducing chronic pruritus and skin lesions are topical and oral glucocorticoids, oral ciclosporin, oral oclacitinib, and, where available, injectable recombinant interferons. Allergen-specific immunotherapy and proactive intermittent topical glucocorticoid applications are the only interventions likely to prevent or delay the recurrence of flares of AD.
CONCLUSIONS
This first 5-year minor update of the international consensus guidelines for treatment of AD in dogs further establishes that the treatment of this disease is multifaceted, and that interventions should be combined for a proven (or likely) optimal benefit. Importantly, treatment plans are likely to vary between dogs and, for the same dog, between times when the disease is at different stages.
Topics: Acute Disease; Administration, Oral; Administration, Topical; Animals; Anti-Infective Agents; Anti-Inflammatory Agents; Baths; Chronic Disease; Dermatitis, Atopic; Dermatologic Agents; Dog Diseases; Dogs; Drug Therapy, Combination; Glucocorticoids; International Cooperation; Practice Guidelines as Topic
PubMed: 26276051
DOI: 10.1186/s12917-015-0514-6 -
BMJ Open Jan 2019This study aimed to investigate the association between the use of isotretinoin and the risk of depression in patients with acne. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to investigate the association between the use of isotretinoin and the risk of depression in patients with acne.
DESIGN
This was a meta-analysis in which the standardised mean difference (SMD) and the relative risk (RR) were used for data synthesis employing the random-effects model.
SETTING
Studies were identified via electronic searches of PubMed, Embase and the Cochrane Library from inception up to 28 December 2017.
PARTICIPANTS
Patients with acne.
INTERVENTIONS
Studies comparing isotretinoin with other interventions in patients with acne were included.
RESULTS
Twenty studies were selected. The analysis of 17 studies showed a significant association of the use of isotretinoin with improved symptoms compared with the baseline before treatment (SMD = -0.33, 95% CI -0.51 to -0.15, p<0.05; =76.6%, p<0.05)). Four studies were related to the analysis of the risk of depression. The pooled data indicated no association of the use of isotretinoin with the risk of depressive disorders (RR=1.15, 95% CI 0.60 to 2.21, p=0.14). The association of the use of isotretinoin with the risk of depressive disorders was statistically significant on pooling retrospective studies (RR=1.39, 95% CI 1.05 to 1.84, p=0.02), but this association was not evident on pooling prospective studies (RR=0.85, 95% CI 0.60 to 2.21, p=0.86).
CONCLUSIONS
This study suggested an association of the use of isotretinoin in patients with acne with significantly improved depression symptoms. Future randomised controlled trials are needed to verify the present findings.
Topics: Acne Vulgaris; Depressive Disorder; Dermatologic Agents; Humans; Isotretinoin; Prospective Studies; Retrospective Studies; Risk Assessment
PubMed: 30670500
DOI: 10.1136/bmjopen-2018-021549 -
The Journal of Rheumatology Aug 2023To report safety and efficacy of ixekizumab (IXE) from the COAST program at 3 years, including 1 year from the originating studies (COAST-V, COAST-W, and COAST-X), and 2...
OBJECTIVE
To report safety and efficacy of ixekizumab (IXE) from the COAST program at 3 years, including 1 year from the originating studies (COAST-V, COAST-W, and COAST-X), and 2 years from COAST-Y.
METHODS
In COAST-Y, patients continued with the dose received at the end of the originating study at week 52: 80 mg IXE either every 4 weeks (Q4W) or every 2 weeks (Q2W). Placebo-treated patients from COAST-X received IXE Q4W in COAST-Y. Starting at week 116 (week 64 of COAST-Y), patients receiving IXE Q4W could be escalated to Q2W. Safety for patients receiving ≥ 1 dose of IXE and efficacy for patients receiving ≥ 1 dose of IXE Q4W was assessed. Data are summarized as observed.
RESULTS
For the 932 patients who received ≥ 1 dose of IXE (Q2W or Q4W) through 3 years, treatment-emergent adverse events (TEAEs) occurred at an incidence rate (IR) of 38.0 per 100 patient-years (PYs). The most frequently reported were infections (IR 25.7 per 100 PYs) and injection site reactions (IR 7.4 per 100 PYs); the majority of TEAEs were mild or moderate in severity. In total, 7.1% of TEAEs led to discontinuation (IR 3.1 per 100 PYs). All patient groups receiving IXE Q4W assessed through 3 years saw sustained improvements in Ankylosing Spondylitis Disease Activity Score, clinically important improvement, and other efficacy end points.
CONCLUSION
The 3-year safety profile of IXE in the COAST program is consistent with the previously established long-term safety profile. IXE Q4W provided sustained improvement of disease activity in patients who received treatment through 3 years. (ClinicalTrials.gov: NCT02696785 [COAST-V], NCT02696798 [COAST-W], NCT02757352 [COAST-X], and NCT03129100 [COAST-Y]).
Topics: Humans; Treatment Outcome; Double-Blind Method; Dermatologic Agents; Spondylitis, Ankylosing
PubMed: 36792107
DOI: 10.3899/jrheum.221022 -
Anais Brasileiros de Dermatologia 2017Infantile myofibromatosis is a mesenchymal disorder characterized by the fibrous proliferation of the skin, bone, muscle and viscera. It is the most common fibrous tumor...
Infantile myofibromatosis is a mesenchymal disorder characterized by the fibrous proliferation of the skin, bone, muscle and viscera. It is the most common fibrous tumor in childhood. We present a newborn with skin and bone disease without visceral involvement, who showed good response to vinblastine and methotrexate. Clinical features, etiology, diagnosis, and treatment are reviewed.
Topics: Dermatologic Agents; Humans; Immunohistochemistry; Infant, Newborn; Male; Methotrexate; Myofibromatosis; Treatment Outcome; Vinblastine
PubMed: 29364448
DOI: 10.1590/abd1806-4841.20175001 -
Journal of the American Academy of... Jan 2020Psoriasis severity categories have been important tools for clinicians to use in treatment decisions as well as to determine eligibility criteria for clinical studies....
BACKGROUND
Psoriasis severity categories have been important tools for clinicians to use in treatment decisions as well as to determine eligibility criteria for clinical studies. However, owing to the heterogeneity of severity classifications and their lack of consideration for the impact of psoriasis involvement of special areas or past treatment history, patients may be miscategorized, which can lead to undertreatment of psoriasis.
OBJECTIVE
To develop a consensus statement on the classification of psoriasis severity.
METHODS
A modified Delphi approach was developed by the International Psoriasis Council to define psoriasis severity.
RESULTS
After completion of the exercise, 7 severity definitions were preferentially ranked. This most preferred statement rejects the mild, moderate, and severe categories in favor of a dichotomous definition: Psoriasis patients should be classified as either candidates for topical therapy or candidates for systemic therapy; the latter are patients who meet at least one of the following criteria: (1) body surface area >10%, (2) disease involving special areas, and (3) failure of topical therapy.
LIMITATIONS
This effort might have suffered from a lack of representation by all relevant stakeholders, including patients.
CONCLUSION
The consensus statement describes 2 categories of psoriasis severity, while accounting for special circumstances where patients may require systemic therapy.
Topics: Body Surface Area; Consensus; Delphi Technique; Dermatologic Agents; Humans; Psoriasis; Severity of Illness Index
PubMed: 31425723
DOI: 10.1016/j.jaad.2019.08.026 -
Ugeskrift For Laeger Jan 2018Atopic dermatitis is a chronic and relapsing inflammatory skin disease. The clinical features vary among different age and ethnic groups, but pruritus is a hallmark. The... (Review)
Review
Atopic dermatitis is a chronic and relapsing inflammatory skin disease. The clinical features vary among different age and ethnic groups, but pruritus is a hallmark. The treatment of atopic dermatitis includes skin barrier restoration with daily application of moisturizers. Topical corticosteroids and calcineurin inhibitors are first-line treatment for acute flares. In severe cases, immunosuppressive drugs are indicated. Targeted biological drugs are being tested in clinical trials.
Topics: Administration, Cutaneous; Adrenal Cortex Hormones; Calcineurin Inhibitors; Comorbidity; Dermatitis, Atopic; Dermatologic Agents; Humans; Immunosuppressive Agents; Risk Factors
PubMed: 29393034
DOI: No ID Found -
Dermatology Online Journal Jun 2002Dapsone (4,4'-diaminodiphenylsulfone, DDS) was synthesized a century ago and continues to be a powerful therapeutic tool in many skin diseases. We have tried to retrieve... (Review)
Review
Dapsone (4,4'-diaminodiphenylsulfone, DDS) was synthesized a century ago and continues to be a powerful therapeutic tool in many skin diseases. We have tried to retrieve and present the available knowledge and relevant information on this old but still very useful drug with the hope of encouraging and guiding practicing dermatologists to adapt it for various indications. Our objective is to familiarize the clinician with how this agent works, in what disease states it is effective, how to administer it, what adverse effects may occur, and how to monitor the patient receiving this drug.
Topics: Animals; Dapsone; Dermatologic Agents; Humans; Skin Diseases
PubMed: 12165212
DOI: No ID Found -
Skin Therapy Letter Jan 2012Several variants of psoriasis are seen in children, the most prevalent types include plaque, guttate, and psoriatic diaper rash; pustular and erythrodermic psoriasis are...
Several variants of psoriasis are seen in children, the most prevalent types include plaque, guttate, and psoriatic diaper rash; pustular and erythrodermic psoriasis are less frequently observed. Genetic susceptibility and environmental triggers are both involved in the development of this autoimmune disease. As well as improving symptoms, a treatment plan should strive to identify and eliminate precipitating factors. Topical medications are the first choice therapy for children with psoriasis. Systemic agents are used to treat more severe cases. Patient education and supportive care should be incorporated into the treatment plan.
Topics: Administration, Cutaneous; Adolescent; Age of Onset; Child; Dermatologic Agents; Environmental Exposure; Genetic Predisposition to Disease; Humans; Patient Education as Topic; Psoriasis
PubMed: 22358228
DOI: No ID Found