Psoriasis is a chronic inflammatory disease of the skin that can have a major effect on patient quality of life. Conventional psoriasis
treatments, often identified empirically, fail to meet the clinical needs for a safe and remittive therapy. These unmet needs, together
with the rapid advances in understanding the molecular basis of psoriasis, have led to the development of targeted biologic therapies.
Using recombinant DNA technology, a new generation of therapeutic agents is being designed to interfere at specific pathogenic steps
that involve T-cells or T-cell-mediated immune responses. These targeted therapies promise improved tolerability and safety in the
treatment of psoriasis. Furthermore, they will redefine clinical response in psoriasis by providing long-lasting remissions of disease
and extended treatment-free periods.
Actinic keratoses (AKs) are common dysplastic epidermal lesions that share clinical, histologic, and molecular features with squamous
cell carcinoma. Therapeutic options include destructive modalities (i.e., cryosurgery, curettage) or topical fluorouracil treatment.
The efficacy of topical fluorouracil for the treatment of widespread AK lesions has been demonstrated in multiple studies, but
treatment is often associated with significant skin irritation. Various approaches to decrease irritation while maintaining efficacy have
been attempted, including altered treatment regimens, combination therapies, and variations in vehicle formulations. Recently, a
novel topical fluorouracil cream that contains 0.5% 5-fluorouracil in a microsphere vehicle has been approved for the treatment of AK.
Data demonstrate that this low-dose formulation is effective in reducing AK lesions while maintaining a tolerable irritation profile.
Alan Menter MD, Mark Kosinski MA, Brian W Bresnahan PhD, Kim A Papp MD PHdd, John E Ware Jr PhD
The objective of this study was to document the disease burden associated with moderate to severe plaque psoriasis, and assess the
impact of efalizumab psoriasis treatment in improving patient-reported outcomes. This included analysis of patient-reported dermatology-
related quality of life (DRQL) and psoriasis symptom scores among patients with moderate to severe psoriasis participating
in three phase III, randomized, double-blinded, parallel-group, placebo-controlled, multi-center clinical trials conducted to evaluate
the efficacy and safety of efalizumab.
A total of 1,242 patients with moderate to severe psoriasis treated either with efalizumab
1.0 mg/kg /wk or placebo were followed for
12 weeks. DRQL and psoriasis symptom severity were assessed at baseline (pre-treatment) and at the end of the first treatment
phase (12 weeks). DRQL was measured using the Dermatology Life Quality Index (DLQI). Symptoms were measured using the
Psoriasis Symptom Assessment (PSA) and an Itch scale. Disease burden was assessed at baseline by examining responses to individual
questions of the DLQI, PSA, and Itch patient-reported outcome measures. The impact of treatment on disease burden was
assessed over a 12-week double-blind study period by comparing changes in DLQI, PSA, and Itch scale scores between the active
treatment and placebo groups. Patient-reported outcomes were also assessed during a 12-week extended treatment phase.
Prior to treatment, the responses to DLQI and PSA items revealed significant disease burden. Greater than 90% of patients reported
being embarrassed or self conscious because of their skin, 53% reported that their skin prevented them from working or studying,
and 98% reported that scaling and itching was bothersome. Compared to placebo-treated patients, efalizumab-treated patients
showed significant improvement in patient-reported outcomes, reducing the limitations and burden associated with moderate to
severe psoriasis within each of the three studies, as measured by DLQI (p<0.001), PSA-Severity (p<0.001), PSA-Frequency (p<0.001),
and Itch (p<0.001) scores. Across all measures, the proportion of patients that improved on both statistical and clinical criteria for
meaningful improvement was at least twofold greater among efalizumab-
treated patients than in placebo-treated patients. The benefit
of efalizumab was maintained over the course of an additional 12
weeks during an extended treatment phase.
In conclusion, patients with moderate to severe plaque psoriasis
reported significant DRQL burden and symptom severity at baseline,
but efalizumab significantly improved patient-reported DRQL
and reduced the frequency and severity of psoriasis symptoms during
12-week double-blind and 12-week extended treatment periods.
Neil S Sadick MD, Robert Weiss MD, Suzanne Kilmer MD, Patrick Bitter MD
This multi-center study evaluating the role of Intense Pulsed Light (IPL) in the non-ablative rejuvenation of Type I and Type II photoaged
skin study was conducted in order to evaluate the clinical efficacy and safety of using IPL in treating clinical indications associated
with photoaged skin. Ninety-three patients of Fitzpatrick skin phenotypes I-III, Fitzpatrick Wrinkle Classes I-II, and Elastosis
Scores 1-6 were enrolled in the study. Up to five treatments were performed at 4-week intervals with follow-up visits at 4 and 6
months after the last treatment. Patients received full-face treatments using the recommended parameters of the Quantum SR /HR
(Lumenis Ltd.) with the 560 or 640 nm cutoff filter. Parameters of elastometry, physicians’ evaluation of the Elastosis Score (‘W/ES’),
and global improvement as well as patient satisfaction were analyzed. Results showed that the average Fitzpatrick W/ES improved
significantly (p<0.001) by 1.39 and 1.32 units at the 4 and 6 months follow-ups, respectively; an improved W/ES evaluation was recorded
for 82% and 75% of the patients at each of these time points. In conclusion, IPL treatment is an effective non-invasive, non-ablative
method for rejuvenating photoaged skin with minimal adverse events, no downtime, excellent long-term results, and a very high
measure of patient satisfaction.
Aditya K Gupta MD PhD FRCP(C), Jennifer E Ryder HBSc, Richard C Summerbell PhD
Onychomycosis is a common infection of the nail predominantly caused by anthropophilic dermatophytes, and to a lesser extent by
yeasts (Candida species) and non-dermatophyte molds. The treatment of onychomycosis is dependent on several variables, including
the type of onychomycosis and the causative organism. Various techniques have been used to accurately diagnose onychomycosis,
with microscopy and culture being used most frequently. Histological examination of the distal nail plate can aid in confirming
the presence of invasive nail disease, but histological examination should not be limited to the nail plate as it may also be helpful in
diagnosing subungual onychomycosis. Nucleic acid-based identification techniques may also be valuable when diagnosing onychomycosis;
however, multiple steps may be necessary to determine the causative species. Confocal microscopy may also be a fast
and reliable method of diagnosing onychomycosis, though it has very limited ability to distinguish between dermatophyte and mold
infections. Prior to treatment an accurate diagnosis can provide guidance about the choice of antifungal therapies available.
Picaridin is a new insect repellent that is comparable in effect and less irritating than diethyl toluamide (deet). Its activity and effects
are reviewed in this article.
Loretta Gremillion MD and Daniel J Hogan MD
Medication errors contribute substantially to patient injury and death, with 25% of these errors attributed to drug names that look
or sound alike. This article was written to heighten the awareness of dermatologists and related health care professionals of confusing
dermatologic drug names and includes a table of 166 look- and sound-alike drug names. Measures to decrease medication errors
due to confusing drug nomenclature in dermatology are suggested in order to maximize patient safety
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