Biologics in the treatment of psoriasis
Treating high-need psoriasis patients in clinical practice differs markedly from treatment in clinical trials, researchers in the Netherlands have highlighted. Their prospective cohort study followed 101 patients treated with etanercept or efalizumab for two years. Researchers found that in many cases, unsatisfactory efficacy necessitated combination therapy or dose adjustment. Treatment interruptions occurred in 56 per cent of those treated with etanercept 2 x 50mg and 84 per cent of those treated with etanercept 2 x 25mg, and in 10 per cent of efalizumab-treated patients. The researchers point out that interruptions, dose adjustments and combination therapy all influence outcomes and such information about biologics in daily clinical practice is important for adjusting treatment schedules and guidelines.
Driessen RJ, Berends MA, Boezeman JB et al. Br J Dermatol 2008; 158: 1098-106
Treating children with refractory SLE
B-cell depletion therapy with rituximab is effective for treating children with refractory or life- or organ-threatening systemic lupus erythematosus (SLE), UK researchers have concluded. They retrospectively reviewed 19 children (89 per cent female) with SLE, aged six to 16 years, who had been treated with two infusions of rituximab 750mg/m2 within a two-week period, at a single centre. Patients were followed for a median 20 months. Within the first month, there was a significant rapid reduction of British Isles Lupus Assessment Group index scores (14 to six, p<0.005) and SLE disease activity. Renal function, immunological and haematological parameters also improved. There were no serious side-effects, other than five cases of herpes zoster.
Podolskaya A, Stadermann M, Pilkington C et al. Arch Dis Child 2008; 93(5): 401-6
Optimal regimen for anogenital warts
The optimal application schedule for imiquimod cream in the treatment of external anogenital warts is three times per week, researchers in the US have concluded. They reviewed six studies on the efficacy and safety of imiquimod 5% cream and found that a once-daily regimen compared with three times per week did not improve treatment efficacy, but resulted in a greater incidence and severity of local skin reactions. There was no difference between the two regimens in terms of the number of medication-related withdrawals.
Gotovtseva EP, Kapadia AS, Smolensky MH, Lairson DR. Sex Transm Dis 2008; 35: 346-51
Topical treatment alternative for VIN
Imiquimod may also be an effective alternative to surgery for vulval intraepithelial neoplasia (VIN), according to results from a randomised controlled trial. Fifty-two patients with VIN grade 2 or 3 were treated with topical imiquimod or placebo, applied twice weekly for 16 weeks. Lesion size was reduced by more than 25 per cent at 20 weeks in 21 of 26 patients (81 per cent) treated with imiquimod, compared with none of those treated with placebo. Histologic regression was significantly greater in the imiquimod group, while clearance of HPV from lesions was seen in 15 patients using imiquimod (58 per cent), but only two of the placebo group (8 per cent).
Van Seters M, van Beurden M, ten Kate FJ et al. N Engl J Med 2008; 358: 1465-73
Delayed adverse reaction with dermal fillers
Polyalkylimide dermal fillers can cause adverse reactions some time after they have been injected, researchers in Spain have found. They investigated a prospectively acquired series of 25 patients with severe and/or persistent delayed adverse effects after polyalkylimide implant injection. The average latency period for onset of symptoms was 13.4 months. Eight patients were previously injected with another implant. Tender inflammatory nodules were seen in 24 patients, systemic or distant manifestations appeared in six and laboratory abnormalities were found in 20. After an average 21.3 months' follow-up, 11 patients appeared to be free of adverse effects, while 10 had recurrent bouts.
Alijotas-Reig J, Garcia-Gimenez V, Miro-Mur F, Vilardell-Tarres M. Arch Dermatol 2008; 144(5): 637-42
Family history in herpes zoster
Family history may be another risk factor for herpes zoster infection, along with age and immunosuppression, the results of a US study suggest. The case-control study involved 504 non-immunocompromised patients with confirmed herpes zoster and 523 non-immunocompromised controls with new diagnoses of skin diseases other than herpes zoster. Cases were more likely to report blood relatives with a history of herpes zoster (39 per cent) than controls (11 per cent). Risk was increased with multiple blood relatives (OR 13.77) compared with single blood relatives (OR 4.50). Future studies are needed to investigate this association, the researchers conclude.
Hicks LD, Cook-Norris RH, Mendoza N. Arch Dermatol 2008; 144(5): 603-8
Tomatoes could offer sun protection
A daily dose of tomatoes could be a useful tool in sun protection, UK researchers have found. They compared the skin of 20 people, half of whom were fed 55g tomato paste with 10g olive oil daily, the other half only olive oil, for 12 weeks. The tomato paste group were found to have 33 per cent more protection against sunburn than controls, equivalent to a sun protection factor of 1.3. Not only did eating tomato paste boost levels of procollagen, but the antioxidant lycopene, the red pigment found in tomatoes and other fruits and vegetables, was found to reduce damage to mitochondrial DNA in the skin.
Rizwan M, Rodriguez-Blanco I, Harbottle A. British Society of Investigative Dermatology annual meeting, scientific session C, presentation 17;