Erosive pustular dermatosis of the scalp (EPDS) is a rare entity characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The aetiology is unknown, but predisposing facto...Erosive pustular dermatosis of the scalp (EPDS) is a rare entity characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The aetiology is unknown, but predisposing factors have been reported such as trauma, skin grafting, prolonged exposure to UV light of a bald scalp a s well as co-existence of auto-immune diseases. Laboratory data, bacteriologic al and mycological investigations and histopathology are generally not diagnosti c. A 45-year-old Caucasian man with 1-year-old pustular, erosive and crusted lesions on his bald scalp was seen. Laboratory data, including auto-immunity, bacteriological and mycological investigations were negative. Histopathology was not diagnostic showing a diffuse polymorphous infiltrate involving the dermis. A diagnosis of EPDS was made. The patient was treated with topical and systemic antibiotics and steroids as well as oral nimesulide with no or partial response. Consequently, isotretinoin (0.75 mg/kg/day) was started obtaining complete reso lution in few months. No relapse after 1 year of follow-up was seen. EPDS repre sents a distinct disease with a history of relapsing and unsatisfactory response to common treatments. Systemic retinoids may be considered as a potentially res olutive choice.展开更多
Background: Biological therapies are a new breakthrough in the treatment of psoriasis and psoriatic arthritis (PsA). Among these, tumour necrosis factor (TNF)- α antagonists such as infliximab and etanercept are the ...Background: Biological therapies are a new breakthrough in the treatment of psoriasis and psoriatic arthritis (PsA). Among these, tumour necrosis factor (TNF)- α antagonists such as infliximab and etanercept are the most promising as TNF is considered to be essential in driving cytokine cascade at sites of cutaneous and synovial inflammation in this disease. Objectives: To evaluate the time- related response of serum cytokine release during infliximab monotherapy and assess serum cytokine levels in order to provide a fast, minimally invasive tool to monitor and/or predict efficacy of anti- TNF- α therapy. Methods: Twenty patients affected by PsA with Psoriasis Area and Severity Index (PASI) score between 0.4 and 42.8 were treated with infliximab for 30- 42 weeks. The assessment of arthritis severity was performed using the American College of Rheumatology (ACR) criteria and ultrasonography evaluation. The treatment schedule consisted of infliximab (5 mg kg- 1 intravenously) at 0, 2 and 6 weeks and every 12 weeks on an individual basis determined by therapeutic results and adverse events reported. At baseline and before every infusion blood samples were taken to assess serum cytokine levels [TNF- α , interleukin (IL- 6), E- selectin, vascular endothelial cell growth factor (VEGF), fibroblast growth factor (FGF), matrix metalloproteinase(MMP- 2)]. Results: Eighteen of 20 psoriatic patients achieved>50% improvement and 14 of 20 patients attained>75% improvement in the PASI score at 10 weeks. All arthritic patients achieved>50% improvement (ACR- 50) and 16 of 20 patients attained>75% improvement (ACR- 75) at 10 weeks. TNF- α did not decrease immediately during the first part of the study. A significant decrease was detected at week 12 (P < 0.01). In contrast, IL- 6, VEGF, FGF and E- selectin showed significant decreases after early infliximab infusions. PASI was not correlated with TNF- α in the serum but was significantly correlated with FGF, VEGF and MMP- 2. Treatment was well tolerated and there were no significant adverse events in most patients, other than an urticarial reaction and an autoimmune hepatitis. Conclusions: Monotherapy with infliximab has to be considered an efficacious and safe treatment for PsA in comparison with traditional disease- modifying antirheumatic drugs. The resolution of cutaneous and synovial symptoms is not related to TNF- α serum levels in the initial phases. Apoptosis may play an important role in the modulation of the inflammatory response.展开更多
文摘Erosive pustular dermatosis of the scalp (EPDS) is a rare entity characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The aetiology is unknown, but predisposing factors have been reported such as trauma, skin grafting, prolonged exposure to UV light of a bald scalp a s well as co-existence of auto-immune diseases. Laboratory data, bacteriologic al and mycological investigations and histopathology are generally not diagnosti c. A 45-year-old Caucasian man with 1-year-old pustular, erosive and crusted lesions on his bald scalp was seen. Laboratory data, including auto-immunity, bacteriological and mycological investigations were negative. Histopathology was not diagnostic showing a diffuse polymorphous infiltrate involving the dermis. A diagnosis of EPDS was made. The patient was treated with topical and systemic antibiotics and steroids as well as oral nimesulide with no or partial response. Consequently, isotretinoin (0.75 mg/kg/day) was started obtaining complete reso lution in few months. No relapse after 1 year of follow-up was seen. EPDS repre sents a distinct disease with a history of relapsing and unsatisfactory response to common treatments. Systemic retinoids may be considered as a potentially res olutive choice.
文摘Background: Biological therapies are a new breakthrough in the treatment of psoriasis and psoriatic arthritis (PsA). Among these, tumour necrosis factor (TNF)- α antagonists such as infliximab and etanercept are the most promising as TNF is considered to be essential in driving cytokine cascade at sites of cutaneous and synovial inflammation in this disease. Objectives: To evaluate the time- related response of serum cytokine release during infliximab monotherapy and assess serum cytokine levels in order to provide a fast, minimally invasive tool to monitor and/or predict efficacy of anti- TNF- α therapy. Methods: Twenty patients affected by PsA with Psoriasis Area and Severity Index (PASI) score between 0.4 and 42.8 were treated with infliximab for 30- 42 weeks. The assessment of arthritis severity was performed using the American College of Rheumatology (ACR) criteria and ultrasonography evaluation. The treatment schedule consisted of infliximab (5 mg kg- 1 intravenously) at 0, 2 and 6 weeks and every 12 weeks on an individual basis determined by therapeutic results and adverse events reported. At baseline and before every infusion blood samples were taken to assess serum cytokine levels [TNF- α , interleukin (IL- 6), E- selectin, vascular endothelial cell growth factor (VEGF), fibroblast growth factor (FGF), matrix metalloproteinase(MMP- 2)]. Results: Eighteen of 20 psoriatic patients achieved>50% improvement and 14 of 20 patients attained>75% improvement in the PASI score at 10 weeks. All arthritic patients achieved>50% improvement (ACR- 50) and 16 of 20 patients attained>75% improvement (ACR- 75) at 10 weeks. TNF- α did not decrease immediately during the first part of the study. A significant decrease was detected at week 12 (P < 0.01). In contrast, IL- 6, VEGF, FGF and E- selectin showed significant decreases after early infliximab infusions. PASI was not correlated with TNF- α in the serum but was significantly correlated with FGF, VEGF and MMP- 2. Treatment was well tolerated and there were no significant adverse events in most patients, other than an urticarial reaction and an autoimmune hepatitis. Conclusions: Monotherapy with infliximab has to be considered an efficacious and safe treatment for PsA in comparison with traditional disease- modifying antirheumatic drugs. The resolution of cutaneous and synovial symptoms is not related to TNF- α serum levels in the initial phases. Apoptosis may play an important role in the modulation of the inflammatory response.
