Position statement : topical calcineurin inhibitors in atopic dermatitis

Background Atopic dermatitis (AD) is a common inflammatory skin disease in both adults and children. Whilst topical calcineurin inhibitors (TCIs), tacrolimus ointment and pimecrolimus cream, have proven efficacy for the treatment of AD, it is important to involve experts to obtain their opinion on its optimal treatment. Objective Methods Using a modified Delphi approach, this project aimed to generate consensus amongst experts on the use of TCIs in the treatment of AD, with a focus on the differentiation between tacrolimus and pimecrolimus. Six expert dermatologists from different European countries participated in this project based on their experience with AD and its treatment, which was evaluated by literature analysis and expert opinion. Consensus amongst the experts was generated using a modified Delphi approach, consisting of three distinct phases, during which a web meeting (June 2017), two online rounds of blinded Delphi voting (July-September 2017) and a face-to-face meeting (November 2017) were conducted. The consensus statements concerned two main topics: (i) Background of AD; and (ii) TCIs in AD. Hot topics in the treatment of AD not supported by meta-analysis, clinical trials or large observational studies were also discussed based on clinical experience. Results Conclusion In total, 25 consensus statements were defined and validated: eight statements on the general background of AD and 17 statements on the use of TCIs in AD, including their mechanism of action and therapeutic indications in AD, efficacy in adult and paediatric AD patients, pharmacokinetics, incidence of adverse events and safety concerns. Hot topics on the use of TCIs for the treatment of AD included cream vs. ointment, dosages, TCIs contact allergy, burning sensation management, superinfection and vaccination concerns. Topical calcineurin inhibitors are a suitable therapy for AD, and selection of the specific TCI should be based on factors which differentiate tacrolimus from pimecrolimus.Peer reviewe

Allergic contact dermatitis to Elidel® cream itself?

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A MAN WITH RECURRENT SKIN ULCERATIONS

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A man with recurrent skin ulcerations

Pyoderma gangrenosum is a rare, chronic, non infectious ulcerative skin disease. It is an inflammatory neutrophilic dermatosis. It is associated in 50% with a systemic disorder. Unfortunately, there are no randomized controlled studies concerning PG treatment. Immunosuppression is the mainstay of treatment and includes local and systemic measures, with high risk of potential side effects. Multidisciplinary care to patients with PG is essential for best management. We present a patient with pyoderma gangrenosum which was admitted in our Infectious Diseases Unit and first treated based on an infectious assumption. Collaboration between internists and dermatologists led to quick correct diagnosis, PG management, exclusion of an associated systemic disorder and management of further complications.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Pathogenesis and risk factors of small bowel adenocarcinoma: a colorectal cancer sibling?

Small bowel adenocarcinoma (SBA) is a very rare entity accounting for one-fourth of the small intestine neoplasms. Usually accompanied by nonspecific symptoms occurring late in the course of the disease, they are associated with a dismal prognosis. It appears that SBA shares several genetic characteristics with large bowel tumors, but also has unique features. The purpose of this article is to review pathogenesis and risks factors of SBA to better understand its molecular features as well as its resemblances and dissimilarities with colorectal cancer (CRC). Better understanding of sporadic and hereditary genetic pathways potentially involved will undoubtedly lead to better prevention and therapeutic management of this rare but aggressive disease.Journal ArticleResearch Support, Non-U.S. Gov'tReviewinfo:eu-repo/semantics/publishe

Skin manifestations of paraneoplastic syndromes

Acrokeratosis paraneoplastica, hypertrichosis lanuginosa, erythema gyratum repens, hypertrophic osteoarhtropathy, dermatomyositis and Sweet's syndrome are often -although not always- associated with a malignant tumor. Recognition of any of these potential paraneoplastic skin disorders should lead to a strong suspicion for an occult malignancy and trigger appropriate work-up. In case of negative investigation, a high suspicion level for an occult malignancy must be maintained for years. Paraneoplastic skin manifestations with well known pathophysiological mechanisms related to a tumor, such as cutaneous amyloidosis, melanic pigmentation, vasculitis, carcinoid flushing, hirsutism, gynecomastia and others, can be responsible for signs and symptoms requiring specific therapies. These manifestations ususally follow a course that is clearly related to that of the tumor and can thus serve as surrogates for its evolution. © 2012 by Nova Science Publishers, Inc. All rights reserved.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Management of in situ melanoma of the nail apparatus with functional surgery: Report of 11 cases and review of the literature

Background Nail apparatus melanoma (NAM) is a rare melanocytic neoplasm with pejorative prognosis often related to late diagnosis. Early diagnosis at in situ stage (NAMis) is difficult, but essential to improve prognosis. NAMis management is not well established yet. Removal of the whole nail unit has been advocated in several small series as a potential treatment for NAMis. Objective To report and assess 'functional' or 'conservative' surgery for NAMis and evaluate its long-term oncologic safety. Methods Retrospective study of cases diagnosed in the University Hospital Saint-Pierre collected over a 13 year period and compared with the published data. Results Eleven cases of NAMis were identified: 73% concerned females. Thumb and first toe were the most affected digits (63% of total). Monodactylic longitudinal melanonychia (LM) was the most frequent presentation (92%). Mean diagnosis delay was 5 years. Diagnosis was suspected on the basis of clinical and dermatoscopic signs and was confirmed by pathological examination. All patients underwent complete nail unit removal with 6 mm security margins around the anatomic boundaries of the nail. Two late local recurrences were observed at 7 and 11 years follow-up. Conclusions Our series, the largest up to now, demonstrates that 'functional surgery' is a rational approach for NAMis with an excellent oncologic safety at 5 years. However, this study suggests that a very long-term follow-up is mandatory, as recurrences may appear late. © 2013 European Academy of Dermatology and Venereology.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

A case of recalcitrant face eczema

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A case of recalcitrant face eczema

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Medical management of pancreatic neuroendocrine tumors

BACKGROUND: Pancreatic neuroendocrine tumors (PNET) are rare malignancies frequently diagnosed at a late stage, with symptoms related to bulky disease. Hormonal secretion, when responsible for symptoms, permits, on the other hand, early diagnosis of the disease. Surgery remains the cornerstone of therapeutic management. However, due to advanced disease, many patients are not candidates for aggressive surgical therapy. Tumor growth control and symptom management are thus achieved through medical approaches, including somatostatin (SST) analogs, chemotherapy, interferon, and more recently, targeted therapy. The purpose of this review is to collect, examine, and analyze data available in the literature regarding contemporary therapeutic management of PNET, with emphasis on medical approaches. It also offers perspectives on the future of molecular targeted therapies in these neoplasms. However, we point out that much of the literature published to date includes noncomparative studies (mainly phase II studies), leading to thorny interpretation of the results. METHODS: A systematic search of all the literature in English regarding PNET was performed, based on a MEDLINE search (Pubmed) carried out from January 1970 to May 2005. RESULTS: Approximately 40 trials, including over 1,000 patients, have been retrieved from our MEDLINE search. SST analogs and interferon therapies do allow control over hormone secretion and subsequent symptoms in the majority of treated subjects, but offer a poor tumor growth control rate. Chemotherapies, although more efficient in reducing tumor burden, are often toxic. New approaches such as immunotherapy and targeted therapies are still under investigation. CONCLUSIONS: Whether alone or in combination with surgery, conventional medical therapies represent a crucial aspect of PNET management. Hopefully, in the near future, a new era of antitumoral agents, such as targeted therapies, will strengthen our therapeutic arsenal, either alone or combined with other therapies. © 2008 by Am. Coll. of Gastroenterology.SCOPUS: re.jinfo:eu-repo/semantics/publishe