Stanowisko polskich ekspertów dotyczące zastosowania leku brentuksymab vedotin w leczeniu chorych na pierwotne chłoniaki skóry CD30+

The group of primary cutaneous T-cell lymphomas (CTCLs) expressing CD30 + is consisted of primary cutaneous anaplastic T-cell lymphoma (pcACTL), lymphomatoid papulosis (LyP), some cases of mycosis fungoides (MF) and Sezary syndrome (SS). It is well known that patient cannot be cured completely by available therapeutic methods. In addition, the effectiveness of available therapies is especially limited in advanced stages of the disease. Based on the results of the most recent trials, the experts recommend that brentuximab vedotin (BV) should be reimbursed in Poland for the treatment of adult patients with CTCL expressing CD30 who have had at least one prior systemic treatment. In case of MF BV should be preferred to bexarotene or MTX therapy due to the higher efficacy in stage IIB or higher. BV treatment should be also considered as an alternative to bexarotene (after ineffectiveness of local treatment, phototherapy and IFN/MTX therapy) in early stages of MF (IB-IIA).Do pierwotnych chłoniaków skóry T-komórkowych (CTCL) z ekspresją CD30+ należą pierwotny skórny chłoniak anaplastyczny z dużych komórek (pcALCL), lymphomatoid papulosis (LyP), a także ziarniniak grzybiasty (MF) i zespół Sézary’ego (SS), spośród których u części można stwierdzić ekspresję CD30+. Istniejące metody terapii nie pozwalają na wyleczenie pacjenta cho­rującego na wymienione wyżej odmiany chłoniaków. Ponadto skuteczność dostępnych metod jest szczególnie ograniczona w zaawansowanych stadiach choroby. Na podstawie wyników najnowszych badań eksperci rekomendują, aby brentuksymab vedotin (BV) był dostępny w Polsce do leczenia do­rosłych pacjentów z CTCL z ekspresją CD30, u których uprzednio stosowano co najmniej jedno le­czenie systemowe. W stadium MF IIB i wyższym leczenie BV powinno być preferowane w stosunku do terapii beksarotenem lub metotreksatem (MTX) ze względu na wyższą skuteczność nowego leku. We wczesnych stadiach MF (IB–IIA) należy rozważyć leczenie BV alternatywnie do stosowania bek­sarotenu (po nieskuteczności leczenia miejscowego, fototerapii i terapii interferonem i/lub MTX). Skuteczność leczenia BV wykazano u chorych z pcALCL zarówno we wczesnej fazie z obecnością zmian ograniczonych do skóry, jak i w postaci zaawansowanej z pozaskórną lokalizacją zmian

The Skin Microbiome in Cutaneous T-Cell Lymphomas (CTCL)—A Narrative Review

In recent years, numerous studies have shown a significant role of the skin microbiome in the development and exacerbation of skin diseases. Cutaneous T-cell lymphomas (CTCL) are a group of malignancies primary involving skin, with unclear pathogenesis and etiology. As external triggers appear to contribute to chronic skin inflammation and the malignant transformation of T-cells, some microorganisms or dysbiosis may be involved in these processes. Recently, studies analyzing the skin microbiome composition and diversity have been willingly conducted in CTCL patients. In this review, we summarize currently available data on the skin microbiome in CTLC. We refer to a healthy skin microbiome and the contribution of microorganisms in the pathogenesis and progression of other skin diseases, focusing on atopic dermatitis and its similarities to CTCL. Moreover, we present information about the possible role of identified microorganisms in CTCL development and progression. Additionally, we summarize information about the involvement of Staphylococcus aureus in CTCL pathogenesis. This article also presents therapeutic options used in CTCL and discusses how they may influence the microbiome

Emerging biomarker in carcinogenesis. Focus on Nestin

Nestin is a protein belonging to class VI intermediate filaments, which is involved in organogenesis, cellular metabolism and cytoskeletal organisation. Originally found to be expressed in neuroepithelial stem cells, nestin is also expressed in other tissues. It plays an important role in the carcinogenesis and angiogenesis. Its increased expression in melanoma is associated with an aggressive course of the disease and poor prognosis. Research findings for non-melanocytic skin neoplasms are inconclusive. The aim of this paper was to systematize knowledge on the role of nestin in cancerogenesis. The authors focused in particular on the expression of nestin in skin malignancies, as well as on the potential role of nestin in the pathogenesis, prognosis and treatment of cutaneous neoplasms

Erytrodermia łuszczycowa po ogólnym zastosowaniu kortykosteroidów – opis przypadku

Introduction. Erythroderma (exfoliative dermatitis) is an acute, generalizedinflammation of the skin, which affects at least 90% of its surface.It is a life threatening illness in the course of which various types anddegrees of scaling and itching are observed. The main causes of erythrodermaare psoriasis, atopic dermatitis, drug reactions, mycosis fungoidesand pityriasis rubra pilaris. Psoriatic erythroderma is classified as a secondary erythroderma. It may develop spontaneously or moreoften as a result of incorrect treatment.Objective. To present side effects of oral corticosteroids administrationin a patient with psoriasis.Case report. A 36-year-old woman, suffering from psoriasis for over7 years, was admitted to the hospital inMarch 2011 due to exacerbationof skin lesions up to erythroderma after administration of oral corticosteroidtherapy. Three weeks after corticosteroids withdrawal, significantworsening of the disease was observed. On admission she presentedmassiveskin inflammation, scaling and itching. Laboratory testsrevealed increased markers of inflammation. The patient was treatedwith combined immunosuppressive therapy and topical ointments.After 3 weeks, significant regression of skin lesions and normalizationof laboratory tests were observed.Conclusions. Psoriasis is a common cause of erythroderma in adults.Although in Europe the disease affects about 2% of the population andknowledge of its treatment should be common, cases of systemicadministration of corticosteroids in patients with psoriasis in the treatmentof the underlying disease or of the comorbidities are still beingreported

Współistnienie zespołu ręka–stopa i rozległych zmian rumieniowo- -obrzękowych – skórne działania niepożądane po sorafenibie

Wprowadzenie: Zespół ręka–stopa (erytrodyzestezja dłoniowo-podeszwowa)to dermatoza wywoływana przez toksyczne działanie niektórychchemioterapeutyków i leków biologicznych na skórę, objawiającasię zmianami rumieniowymi, hiperkeratozą i pęcherzami zlokalizowanymigłównie na dłoniach i podeszwach. Zespół ten jest jednym z najczęściejwystępujących objawów ubocznych u pacjentów leczonychsorafenibem – inhibitorem kinaz tyrozynowych o działaniu antyangiogennymi antyproliferacyjnym. Rzadko opisywano współistnieniezespołu ręka–stopa ze zmianami rumieniowymi. Cel pracy: Przedstawienie obrazu klinicznego toksycznego działaniasorafenibu na skórę, w związku z coraz częstszym stosowaniem chemioterapeutykówz grupy inhibitorów kinaz. Opis przypadku: Przedstawiono 71-letnią kobietę leczoną sorafenibemz powodu rozsianego raka nerki, u której stwierdzono objawy erytrodyzestezjidłoniowo-podeszwowej współistniejące z rozległymi zmianamirumieniowymi, rozwijającymi się po 6 dniach stosowania leku.W terapii zastosowano kortykosteroidy ogólne, leki przeciwhistaminoweoraz leczenie miejscowe preparatami kortykosteroidowymii maściami z mocznikiem, a także zmniejszono dawkę chemioterapeutykuo połowę, uzyskując poprawę stanu skóry. Wnioski: Nowoczesne terapie przeciwnowotworowe charakteryzująsię dużym potencjałem toksycznym w stosunku do skóry, co stanowiwyzwanie nie tylko dla onkologów, ale także dla dermatologów

The Pathophysiology and Treatment of Pyoderma Gangrenosum—Current Options and New Perspectives

Pyoderma gangrenosum (PG) is an uncommon inflammatory dermatological disorder characterized by painful ulcers that quickly spread peripherally. The pathophysiology of PG is not fully understood; however, it is most commonly considered a disease in the spectrum of neutrophilic dermatoses. The treatment of PG remains challenging due to the lack of generally accepted therapeutic guidelines. Existing therapeutic methods focus on limiting inflammation through the use of immunosuppressive and immunomodulatory therapies. Recently, several reports have indicated the successful use of biologic drugs and small molecules administered for coexisting diseases, resulting in ulcer healing. In this review, we summarize the discoveries regarding the pathophysiology of PG and present treatment options to raise awareness and improve the management of this rare entity

Cutaneous larva migrans – case report and literature review

Cutaneous larva migrans (CLM) is a parasite dermatosis caused by skin penetration and the migration of larvae of the nematodes. The etiological factors are Ancylostoma braziliense and Ancylostoma caninum. The infection most often appears in tropical and subtropical countries. The main symptoms are creeping eruption, which is slightly elevated, migrating, erythematous and serpiginous track and severe pruritus. The areas that are the most occupied are the feet and buttocks. The diagnosis is based on characteristic clinical presentation and a history of tropical travel. The most frequently implemented treatment is ivermectin and albendazole. Ivermectin is used orally, 200 mcg/kg once daily for 1–2 days. Oral albendazole 400 mg once daily orally for 3 days is also a satisfying therapeutic option. There have also been reports of topical treatment with 10% thiabendazole cream or 1% ivermectin cream. Antihistamines can be helpful for the management of pruritus. Prevention of CLM includes wearing footwear at the beach and plays an extremely important role

Which factors are associated with the use of systemic antihistamines in patients with chronic hand eczema? Results from the CARPE registry

Background Antihistamines (AH) are often used to treat chronic skin diseases related to allergy and/or pruritus. Data on the use of AH in patients with chronic hand eczema (CHE) is scarce. Objective The objective of this study was to investigate prevalence and determinants of AH use in patients with CHE. Methods Data were drawn from the German CARPE registry. The relationship of clinical, demographic and treatment-related variables with AH use in the past 12 months was analysed by means of logistic regression. Odds ratios (OR) with corresponding 95% confidence intervals (CIs) were computed. Results A total of 1255 patients with CHE were eligible for analysis (54.1% female; mean age: 47.1 years, standard deviation (SD) 13.6 years). Mean subjective disease severity was 5.0 (SD 2.5). 25% of the sample reported to have used AH in the past 12 months. Significant positive associations with AH use were identified for moderate (OR - 3.05, 95% CI 1.81-5.15) or severe (OR = 4.27, 95% CI 2.40-7.59) pruritus, a history of systemic treatment (e.g. alitretinoin) (OR = 2.85, 95% CI: 2.06-3.96), UV phototherapy (OR = 1.78, 95% CI 1.28-2.46), flexural eczema (OR = 1.89, 95% CI 1.32-2.71), allergic rhinitis/conjunctivitis (OR = 2.41, 95% CI 1.71-3.39) and female gender (OR = 1.58, 95% CI 1.16-2.14) in multivariate analyses (N = 1184). Significant inverse associations were found for an eczema localization besides the hands (OR = 0.66, 95% CI 0.46-0.94) and for patients being recruited in hospital (vs. dermatological practice; OR = 0.47, 95% CI 0.33-0.67). Conclusions This study suggests that AH use is frequent in patients with CHE and mainly related to female gender, disease severity, pruritus, comorbid atopic disease and treatment centre