Non-invasive evaluation of tacalcitol plus puva versus tacalcitol plus UVB-NB in the treatment of psoriasis: "right-left intra-individual pre/post comparison design".

Photochemotherapy with psoralen plus ultraviolet A (PUVA) and phototherapy with UVB narrow band (UVB-NB) are used in the treatment of psoriasis. Numerous studies have shown that the additional administration of either topical or systemic antipsoriatic agents may effectively increase the efficacy of these therapies. This study aimed to compare through objective data the efficacy of topical tacalcitol in combination with PUVA or UVB-NB versus PUVA and UVB-NB monotherapy in the treatment of mild to moderate chronic plaque psoriasis. Modified Psoriasis Area and Severity Index (PASI) score, transepidermal water loss (TEWL) and stratum corneum hydration were used to monitor the restoration of skin barrier in the psoriatic plaques of 40 patients during photochemotherapy. The study was a right-left, intra-individual, pre/post comparison trial. PUVA and UVB-NB treatments were given three times a week. On those plaques localized on the right side of the body tacalcitol ointment was applied once a day, in the evening. Corneometry, TEWL and modified PASI score were used to evaluate the response to the treatment at baseline, one month and two months. Thirty-six of the forty enrolled subjects completed the study. The comparison between combination treatments and the PUVA/UVB-NB monotherapy showed no significant differences with regard to modified PASI index. However, significant differences were recorded with regard to TEWL and corneometry. The combination of tacalcitol plus PUVA or tacalcitol plus UVB-NB restored epidermal barrier functions as well as skin hydration faster than PUVA or UVB-NB monotherapy (TEWL: p=0.0050 and corneometry: p=0.003). The combination of tacalcitol plus UVB-NB allowed a better restoration of skin barrier functions than tacalcitol plus PUVA (p=0.013). In conclusion, the combination of tacalcitol plus PUVA or plus UVB-NB improves the therapeutic result. In addition, the data from TEWL and skin hydration suggest a means in which tacalcitol plus UVB-NB induces a better normalization of skin biophysical parameters

Efficacy and Safety of Systemic Treatments for Psoriasis in Elderly Patients

0.12, 0.32, 1.4 and 0.5 per patient-year in the methotrexate, acitretin, cyclosporine and PUVA groups and 0.11, 0.35, 0.19, 0.3 and 0.26 in the etanercept, adalimumab, infliximab, efalizumab and ustekinumab groups. Traditional drugs were less effective than biologics in our e

Long-term narrowband UVB phototherapy in vitiligo: Good results are correlated with a long period of continuous and constant therapy

Aim. The treatment of vitiligo remains a challenge. In literature various treatment modalities have been proposed. In the present study a long-term narrowband UVB (UVB-NB) approach to vitiligo is proposed in 25 patients. Methods. Treatment frequency was twice a week, on 2 non-consecutive days; treatment was continued for 1 year or discontinued earlier, in case of satisfactory or even complete repigmentation. Photographs of the body surface interested by vitiligo were taken before, during and after treatment; phototherapy responses were expressed as more than 75% repigmentation (group A); between 26% and 75% repigmentation (group B); less than 25% repigmentation (group C) and not responders (group D). Results. At the end of the study (12 months), 11 patients (44%) showed an excellent repigmentation (group A); 8 patients (32%) had a satisfactory good repigmentation (group B); 2 patients (8%) had an unsatisfactory response (group C), and 4 patients (16%) were not responders (group D). The best response was achieved by those patients who had recent vitiligo (100% of patients in group A and 70% of patients in group B). Conclusion. This study suggests that UVB-NB therapy represents a valuable and safe option for vitiligo and confirms that good results are correlated with a long period of continuous therapy; moreover, further improvement could be observed when UVB-NB therapy was prolonged till the end of the first year of treatment or more

Narrow-band ultraviolet therapy in early-stage mycosis fungoides: study on 20 patients

Background: In recent years, narrow-band ultraviolet B (NB-UVB, 311-313 nm) has been found to be beneficial for early-stages mycosis fungoides (MF). The aim of this study is to investigate the effect of NB-UVB in 20 patients with early-stage MF. Methods: Twenty patients ( 10 women and 10 men, mean age 54 +/- 22 years) with clinically and histologically confirmed MF were enrolled in the study. All of the patients had clinical stage I disease (T1 or T2, N0, M0) with cutaneous involvement, consisting of patchstage disease of limited extent, in 50% of the cases (stage IA), and more widespread in the other 50% (stage IB). All the patients were treated with NB-UVB therapy until more than 95% clearance of the patient's skin lesions had occurred. Results: A complete response was achieved in 90% of the cases after a mean of 29 +/- 14 treatments within a mean period of 4 months (range 1-8 months), with an average cumulative dose of 25 +/- 16.77 J/cm(2). In the follow-up period, relapse occurred after a mean period of 8 months (range 3-17 months), and then therapy was restarted. Conclusion: This study provides evidence that NB-UVB might be an efficient option for stage IA and IB MF patients

HIV seronegative eosinophilic pustular folliculitis successfully treated with doxicycline.

Eosinophilic pustular folliculitis (EPF) is an unusual disease, first described in adult East Asians in 1970 by Ofuji. It is characterized by follicular papules and pustules tending to coalesce and form plaques involving the trunk, face and extremities. In recent years, it has been often associated with human immunodeficiency virus (HfV) infection or with immunosuppressed and/or oncohaematological patients. EPF has been described in immunocompetent adult caucasian patients only occasionally. The diagnosis requires clinical and microbiological features such as sterile folliculitis and histopathological findings characterized by folliculitis and perifolliculitis with eosinophilic infiltrate. We describe an HfV seronegative caucasian male with EPF, allergic to non-steroidal anti-inflammatory drugs and indomethacin, treated with oral doxicycline. The treatment led to the complete remission of the lesions within 2 months

Peutz-Jeghers syndrome. Study of a family and survey of the literature

Peutz-Jeghers syndrome (PJS) is a genetic disease with an autosomic dominant transmission. The 40% of patients present the disease in a sporadic form. There is not a predilection of sex and not all the clinical manifestations of the syndrome are always present in the affected patients. PJS is characterized by skin and mucosal pigmentations (lentigines) associated with hamartomatous polyps of the gastrointestinal tract with a high incidence of neoplastic transformation. Among the non-gastrointestinal neoplasms associated with PJS, endocrine tumors including thyroid cancer and ovarian and Sertoli cell tumors are the most frequent. PJS has been mapped to chromosomal region 19p; a tumor suppressor gene called STK11 or LKB1 is responsible for the disease in families that map to chromosomal region 19p. However, PJS is genetically heterogeneous and a second locus may lie on chromosomal region 19q and/or on another chromosome. A ten year-old boy presenting brown macules and lentigines with a predominant periorificial distribution has been observed; numerous lentigines were localized on labial and oral mucosa as well as on hands and feet. A diagnosis of PJS was suspected. The clinical observation of his father showed the same pigmented lesions particularly evident in the oral cavity, on the lips and in the palmoplantar region. Moreover the father had undergone previous surgical removal of a colonic adenocarcinoma. Despite the fact that at the time of surgery multiple intestinal polyps coli were detected, the finding failed to be correlated with the dermatologic alterations. Clinical recognition of this syndrome at a young age improves clinical outcome and prognosis of the various tumors and decreases associated morbidity and mortality. Observation of multiple pigmented skin and mucosal lesions in a child emphasizes their importance as risk marker of neoplasia of other organs in the patient and in his family