Influence of body mass index, comorbidities and prior systemic therapies on the response of psoriasis to adalimumab: an exploratory analysis from the APHRODITE data.

Adalimumab is a fully human monoclonal antibody directed against tumor necrosis factor (TNF)-alpha, which is effective for the treatment of psoriasis and psoriatic arthritis (PsA). The aim of this study is to determine whether the response of psoriasis to adalimumab treatment might be influenced by certain particular factors, such as body mass index (BMI), history of biologic therapy, blood hypertension and metabolic comorbidities. For this reason, an exploratory analysis was conducted on 144 patients with psoriasis and concomitant PsA treated with adalimumab 40 mg every other week, evaluating the influence of such factors on the Psoriasis Area and Severity Index (PASI) response rate at week 12. Our preliminary results suggest that the response rate at week 12, in terms of both PASI-50 and PASI-75, appeared to be independent of the presence of hypertension and/or metabolic comorbidities. The PASI-50 response was observed more frequently in patients with BMI less than 30 as compared to obese patients (79% vs 58%, p = 0.02). Previous use of anti-TNF biologics did not appear to affect per se the rate of responders, although it was associated with a lower PASI-75 rate among responders.

Effects of topical testosterone propionate on the positive nickel patch test.

In a group of nickel sensitized women, we investigated the effects of topical application of testosterone propionate on the epidermic density of CD1 + dendritic cells and on the response to patch tests performed with scaled nickel concentrations. In a significant number of examined subjects, treatment with testosterone propionate induced an increase of the minimum eliciting dose of nickel and an evident reduction of CD1 + dendritic cell epidermic density. In those subjects in which the minimum eliciting dose resulted unmodified, the epidermic density of CD1 + dendritic cells also did not undergo significant variations following treatment with testosterone propionate. This parallelism between the behaviour of the responses to patch tests and the epidermic density of CD1 + dendritic cells induces us to think it possible that testosterone propionate is able to increase the tolerance to contact with allergen by interfering with the activity of Langerhans cells. The possible mechanisms of testosterone action on Langerhans cells remain to be elucidated.

[Subcutaneous adiponecrosis in newborn infants]. / Adiponecrosi sottocutanea del neonato.

A case of subcutaneous fat necrosis of the newborn gave us the opportunity of re-examining this disease in the light of recent reports. Clinical, histological and laboratorial data do not show any specific pattern, although, seen as whole, they seem to form a picture distinguishable from sclerema neonatorum.

[Sexual hormones and acne in adolescent women]. / Ormoni sessuali ed acne adolescenziale nella donna.

In a group of thirtyseven women who had been suffering from acne during adolescence and spontaneously healed within the 21st year of age, the plasma levels of nine sex hormones were evaluated during three different phases of the disease, i.e. the florid phase, the resolutive phase and the one following complete healing. During the florid phase the patients showed significantly lower oestradiol and progesterone levels compared to control subjects: such differences reduced during the following phase and disappeared almost completely after healing. Significant differences in prolactin, total testosterone, free testosterone, adrostenedione, dehydroepiandrosterone sulfate, FSH LH and LH plasma levels were not observed between patients and controls. The ratios obtained dividing the values of total testosterone and androstenedione by the ones of progesterone and oestradiol showed that, in acne patients, the hormonal balances deviated significantly in favour of androgens, exclusively during the florid phase of the disease. We have therefore hypothesized that, in the woman, adolescent self healing acne is almost never influenced by an increase of circulating androgens, but it is often related to a reduction in oestradiol and/or progesterone production that is responsible for a transitory condition of relative hyperandrogenism.

[Acanthosis nigricans in pregnancy]. / Acanthosis nigricans in gravidanza.

A case of Acanthosis nigricans developed in a pregnant 16 year old woman is reported. Laboratory studies disclosed an abnormal glucose tolerance and elevated levels of insulinemia with an insulin-resistant state. Two months after partum, the metabolic parameters became normal and parallel the complete resolution of acanthosis nigricans was observed. The possible pathogenetic role of pregnancy in the development of acanthosis nigricans is discussed.

[Condylomata acuminata of the external genitalia and dysplasia of the uterine cervix]. / Condilomi acuminati dei genitali esterni e displasie della cervice uterina.

Condylomata acuminata of the external genitalia and dysplasias of the uterine cervix The prevalence of cervical abnormalities indicative of papillomavirus infection and/or dysplasia was evaluated in a group of women previously treated for vulvar condylomata acuminata. The results obtained seem to demonstrate that the women affected by vulvar condylomata acuminata are particularly exposed to the risk of acquiring slight or moderate grade dysplasias. However, the lack of severe dysplasias in our patients tends to suggest that cervical dysplasias associated to vulvar condylomata acuminata are characterized by a poor inclination towards neoplastic evolution.