Robert A Weiss MD, Margaret A Weiss MD, Roy G Geronemus MD, David H McDaniel MD
Photomodulation is a process that manipulates or regulates cell activity using light sources without thermal effect. Previous studies
of LED photomodulation have shown skin textural improvement accompanied by increased collagen deposition with reduced MMP-
1 (collagenase) activity in the papillary dermis. The purpose of this study was to investigate a separate cohort of patients (N=93) with
a wide range of Fitzpatrick skin types treated by LED photomodulation using the Gentlewaves™ full panel 590 nm high energy LED
array with a specific sequence or code of pulsing in the millisecond domain. Results showed improvement of signs of photoaging in
90%. The majority of patients demonstrated improvement in peri-ocular wrinkles, reduction in Fitzpatrick photoaging classification,
global skin texture and background erythema, and pigmentation. No side effects were noted. LED photomodulation is a safe and
effective non-painful non-ablative modality for improvement of photoaging.
Alice B Gottlieb MD PhD, Kenneth B Gordon MD, Mark G Lebwohl MD, Ivor Caro MD, Patricia A Walicke MD PhD, Nicole Li PhD,Craig L Leonardi MD, for the Efalizumab Study Group
Agents that safely provide long-term control of psoriasis are needed. To determine the safety and efficacy of extended efalizumab therapy,
339 patients with moderate to severe chronic plaque psoriasis received 2 mg/kg subcutaneous (SC) efalizumab weekly for 12
weeks. At Week 12, 290 patients who achieved ?50% Psoriasis Area and Severity Index (PASI-50) improvement or a static
Physician’s Global Assessment grading of “mild,” “minimal,” or “clear” entered maintenance treatment with weekly SC efalizumab.
At Week 12, 82%, 41%, and 13% of 339 patients achieved a PASI-50, PASI-75, and PASI-90 response, respectively. At 15 months,
65%, 50%, and 25% of patients achieved a PASI-50, PASI-75, and PASI-90 response, respectively (intent-to-treat, n = 339). The
incidence of adverse events did not increase over time, and no new common adverse events were reported. The majority of patients
experienced sustained efficacy with no increase in toxicity. This study is planned to continue; patients will receive up to 36 months
of continuous efalizumab.
Primary axillary hyperhidrosis is a medical condition characterized by excessive underarm sweating that is thought to result from localized
hyperstimulation of sweat glands by cholinergic sympathetic nerve fibers. It can be associated with significant professional, physical,
and emotional impairment as well as considerable difficulties in social situations and in personal relationships. Available therapies
have been limited by short-lived effectiveness and in some cases significant adverse effects that can put patients at risk for potentially
serious complications. Chemodenervation of sweat glands using botulinum toxin type A (BTX-A), which has long-lasting therapeutic
efficacy with minimal adverse effects, has emerged as a unique therapy for treating primary axillary hyperhidrosis. This article
reviews the chemodenervation procedure, including patient preparation, BTX-A administration, and patient assessment and follow-
A Kapp MD PhD, B Wedi MD PhD
Chronic urticaria (CU) involves release of histamine from mast cells and/or basophils, which in turn promotes the classic inflammatory
cascade. The resultant symptoms can severely impact sufferers’ quality of life and in severe cases prevent them from leading a normal
existence, with consequent burdens on family and society.
Rapid initiation of effective reliable therapy is important in combating CU, together with avoidance of triggers or exacerbating factors,
if known. While newer immunologically-based therapies are beginning to be developed, antihistamines remain a cornerstone of
effective therapy. Treatment should be tailored to individual patient circumstances, but in principle the choice of antihistamine component
should be governed by the availability of evidence of rapid and prolonged efficacy specifically in CU and evidence of good tolerability
and safety. Increasingly, evidence of beneficial effects on patient quality of life is also required for rational selection of an
antihistamine from amongst those available. Levocetirizine is a new single-isomer antihistamine with a proven efficacy on chronic
urticaria as documented in two recent clinical studies, which have included effectiveness and quality of life assessments.
James Leyden MD, Gary Grove PhD, Charles Zerweck PhD
The facial tolerability of various topical retinoids was evaluated in 253 healthy volunteers in a series of split-face, randomized, investigator-
masked studies—all conducted at the same site by the same investigator. Four variables were evaluated to determine if they
influenced tolerability—retinoid concentration, formulation vehicle, skin sensitivity, and individual retinoid. Lower retinoid concentrations
were associated with less irritation. Vehicle influenced tolerability but whether a gel or cream formulation was better tolerated
varied from retinoid to retinoid. Tolerability was superior on normal skin than “sensitive skin.” On normal skin, tazarotene
cream was better tolerated than tretinoin cream whereas adapalene and tretinoin microsponge gels were better tolerated than
tazarotene gel. On sensitive skin, tazarotene and adapalene creams were better tolerated than tretinoin cream whereas adapalene gel
was better tolerated than tazarotene gel. Retinoid concentration, vehicle, skin sensitivity, and retinoid can all affect facial tolerability.
Skin vulnerability may be the most important factor.
Etanercept is a dimeric fusion protein that has been approved for the treatment of rheumatoid arthritis, juvenile rheumatoid arthritis,
psoriatic arthritis, active ankylosing spondylitis and moderate to severe plaque psoriasis. It has been reported to be useful in other
variants of psoriasis, Still’s disease, recurrent aphthous ulcers, and a variety of rare cutaneous conditions. Its cutaneous side effects are
rare and include injection site reactions, cutaneous lupus, and cutaneous vasculitis. Its systemic side effects are also rare and include
induction or worsening of infections, lupus, multiple sclerosis, and congestive heart failure. Linkage to an increased risk of lymphoma
is unclear. In short, etanercept is a promising medication with substantial benefits and use will probably increase in the future. This
review surveys off-label uses and side effects of etanercept.
Amit S Kulkarini MS, Rajesh Balkrishnan PhD, fabian T Camacho MS, Roger T Anderson PhD, Steven R Feldman MD PhD
Objective: This study examined the relationship between depressive symptoms and related medication adherence and health care
costs in older adults (age ? 65 years) with psoriasis.
Design: Prospective longitudinal cohort study over a 2-year post enrollment period in a population of older adults with psoriasis
enrolled in managed care.
Setting: A Medicare Health Maintenance Organization (HMO) in southeastern United States with prescription benefits.
Participants: Sixty-three older adults with psoriasis using topical corticosteroids therapy and enrolled in a Medicare HMO for a 2-
year continuous period.
Measurement: Upon enrollment, each enrollee was mailed a comprehensive health status assessment battery, which included the
Center for Epidemiologic Studies Depression (CES-D) scale. Information on medication adherence (using medication possession
ratio) and total health care utilization/costs following enrollment were retrieved from the Medicare HMO database.
Results: Nearly one-fifth of the patient population had depressive symptoms. Patients with psoriasis who had depressive symptoms
at the time of enrollment were less likely to be adherent to topical corticosteroid medication (r= -0.29, p<0.01) and less likely to utilize
health care resources as evidenced by lower health care costs (r= -0.27, p<0.05), after confounder adjustment.
Conclusions: The prevalence of depressive symptoms in older adults with psoriasis is commonplace, with strong, yet unexplained correlations
between presence of depressive symptoms and lower rates of medication and health care service use among these patients.