Jessica Price BS, Monali Bhosle MS, Steven R. Feldman MD PhD, Rajesh Balkrishnan PhD
An estimated 2.1% of Americans have psoriasis and approximately 30% of them have moderate to severe psoriasis. Although
the disease is not associated with mortality, it has a significant impact on health-related quality of life among patients. Several
therapies are available for psoriasis including topical agents, phototherapy, and systemic medications. Recently, effective
yet expensive biologic agents have been added as treatments for moderate to severe psoriasis. Biologics are recommended
in patients for whom all other available treatment options have failed. This extensive review provides important information
on the clinical and patient-related outcomes associated with the biologic agents used in psoriasis.
Frank Martiniuk PhD, Marc Tambini, Joseph Rahimian MD, Andre Moreira MD, Herman Yee MD, Kam-Meng Tchou-Wong PhD, Bruce A. Hanna PhD, William N. Rom MD, William R. Levis MD
Leprosy or Hansen’s disease is a chronic infectious disease caused by an acid-fast bacillus, Mycobacterium leprae (M. leprae).
The bacilli proliferate in macrophages infiltrating the skin and gain entry to the dermal nerves via the laminar surface of
Schwann cells where they replicate. After entry, the Schwann cells proliferate and then die. Conclusive identification of
M. leprae DNA in a sample can be obtained by polymerase chain reaction-restriction fragment length polymorphism (PCRRFLP)
for the heat shock 65 gene (hsp65). Molecular epidemiology will make it possible to study the global distributions
of M. leprae, explore the relationship between genotypes-incidence rates, mode of transmission, and the type of disease
(tuberculoid vs. lepromatous). We amplified DNA using PCR for the hsp65 gene from 24 skin lesions from patients diagnosed
with various types of leprosy. Fifteen out of 24 were positive for the hsp65 gene. Digestion with HaeIII-PAGE for
the RFLP confirmation of the presence of M. leprae DNA showed the typical pattern in 5 out of 24 and 2 novel patterns
in 10 out of 24 patients. We confirmed the presence of M. leprae DNA by sequencing the genes for gyraseA or B and folP, which contained only M. leprae specific single nucleotide polymorphisms (SNPs). Thus, we describe novel hsp65 RFLP's for M. leprae found in a high frequency making them ideal for future epidemiology and transmission studies.
Vanessa Lichon BS MS, Amor Khachemoune MD CWS
Xeroderma pigmentosum (XP) is a rare, autosomal-recessive inherited disease that is found worldwide at a frequency of
approximately 1:250,000. XP is caused by a deficiency in either nucleotide excision repair (NER) or postreplication repair
(PRR), and is characterized by severe actinic changes leading to early onset of skin cancers, various ocular manifestations,
and occasional neurological abnormalities. Diagnosis is usually made clinically and can be confirmed by unscheduled DNA
synthesis. Early preventative care is the most important treatment modality. We present a review of the history, clinical
manifestations, pathogenesis, diagnosis, and treatment of XP.
G. Martín-Ezquerra MD, M. Sánchez-Regaña MD, P. Umbert-Millet MD
Oleic acid is a monounsaturated fatty acid with a known action of penetration enhancer which has been used for various
purposes, such as a tanning increaser. Narrow-band ultraviolet B (UVB) is a also first-line treatment for psoriasis. The
purpose of this study was to evaluate if the use of a 5% oleic acid emulsion previous to the phototherapy sessions was useful
in reducing the total dosage necessary for whitening in patients with psoriasis.
Forty-four patients were included, 24 received application of the emulsion before phototherapy and 20 received phototherapy
with no emulsion. Patients received the UVB sessions just to achieve a reduction of 80% of the basal PASI.
The total dose received and number of sessions were compared within the 2 groups. A reduction in these parameters
(29.68 J/cm2 vs. 18.16 J/cm2; 24 vs. 19 sessions) was seen in the group that received application of the emulsion. However,
this was not statistically significant.
The fact that we did not achieve the statistical significance may be due to the small sample size. These results must be
cautiously interpreted and confirmed with further studies.
Shahram Pourrabbani MD, Diego E. Marra MD, Julie Iwasaki BS, Edgar F. Fincher MD PhD, Ronald L. Moy MD
Colloid milium (CM) is a rare cutaneous deposition disease with at least 3 distinct subtypes. The exact histogenesis of
the condition is still unresolved and awaits definitive elucidation. Electron microscopy and immunohistochemical
analysis have allowed the distinction of CM from clinically similar conditions such as amyloidosis. Successful treatment
has been achieved with dermabrasion and, more recently, with ablative and fractional laser resurfacing of affected skin.
Alexa Boer Kimball MD MPH, J. Mark Jackson MD, Jeffrey M. Sobell MD, Erin E. Boh MD PhD, Steven Grekin MD, Elaine B. Yu PharmD MS, J. Michael Woolley PhD, H. Amy Xia PhD, Chiun-Fang Chiou PhD, Seth R. Stevens MD
The Experience Diagnosing, Understanding Care, and Treatment with Enbrel® (EDUCATE) trial is a phase IV, 24-week,
multicenter, open-label study of etanercept 50 mg weekly in the treatment of psoriatic arthritis (PsA) in community dermatology
clinics. In this study, patients with active PsA and moderate to severe plaque psoriasis have measurable uses of
healthcare resources at baseline, reflecting a burden of illness. Etanercept significantly reduced healthcare resource utilization,
absenteeism, and caregiver assistance in PsA patients after 24 weeks of treatment. These results could translate
into savings on both direct and indirect costs and improvements in health-related quality of life for patients with PsA.
Michael P. Heffernan MD, David I. Smith MD, Danette Bentley MD, Mary Tabacchi, Julia E. Graves MD
Objective: To evaluate the efficacy of efalizumab in the treatment of oral erosive lichen planus.
Design: A single-center, open-label, prospective pilot study. The primary efficacy outcome measure was the change in
oral mucosal surface area involvement after 12 weeks of treatment. Secondary outcome measures included the 100-mm
visual analog scale (VAS) for pain and a modified Oral Health Impact Profile (OHIP-14) questionnaire.
Results: Four adult patients with oral erosive lichen planus were enrolled and treated with efalizumab 0.7 mg/kg subcutaneously
at week 0 followed by 1.0 mg/kg weekly from week 1 to week 11. The mean reduction in the affected mucosal
surface area was 71.1% (range 57.3% to 96.8%). The mean improvement in the 100-mm VAS for pain was 82%. The
mean improvement in the OHIP-14 questionnaire was 69.3%. Significant adverse events included hospitalization for
urticaria and a staphylococcal abscess of an artificial hip joint in one patient and drug-induced subacute cutaneous lupus
in another patient.
Conclusion: Efalizumab may be effective in the treatment of oral erosive lichen planus.
Michael H. Gold MD, Julie Biron BS
The use of photodynamic therapy (PDT) with 20% 5-aminolevulinic acid (ALA) for the treatment of acne vulgaris has
been explored. This study evaluates the safety and efficacy of a new Advanced Fluorescence Technology (AFT) pulsed
light source (420-950 nm) for photoactivation in ALA PDT for the treatment of moderate to severe inflammatory facial
acne vulgaris. Nineteen subjects received 4 ALA PDT treatments with the AFT pulsed light source. Treatments were
spaced 2 weeks apart. ALA was incubated for 15 to 30 minutes. At the end of the fourth treatment, the total reductions
in inflammatory and noninflammatory lesion counts were 54.5%and 37.5%, respectively.Median Global Severity Scores
suggest a trend toward reduction after several treatments. Investigator and subject assessments show moderate to marked
improvement in most patients. The new AFT pulsed light source with ALA PDT appears to be a safe and effective modality for the treatment of moderate to severe inflammatory acne vulgaris.