Subject(s)
Gastrointestinal Agents/adverse effects , IgA Vasculitis/chemically induced , Infliximab/adverse effects , Colitis, Ulcerative/drug therapy , Follow-Up Studies , Gastrointestinal Agents/administration & dosage , Humans , IgA Vasculitis/pathology , Infliximab/administration & dosage , Male , Middle Aged , Severity of Illness IndexABSTRACT
INTRODUCTION: Although the efficacy of TNF blockers has been demonstrated in hidradenitis suppurativa (HS), many paradoxical effects have also been described with TNF antagonists. We wished to describe patients with adalimumab (ADA)-induced paradoxical HS. METHODS: This is a retrospective descriptive case series of four patients with ADA-induced paradoxical HS. RESULTS: All the patients had a good response to TNFa antagonist therapy at the time of HS occurrence. The time from TNFa antagonist initiation to HS onset or exacerbation ranged from a few weeks to 24 months. The outcome of HS was variable. Systemic antibiotics were required in all the cases to control HS. TNF blockers were continued in three cases with a switch to another anti-TNF class in one case. Switch to ustekinumab was prescribed in one patient with SA and Crohn's disease. CONCLUSION: Although the imputability of TNF blockers in paradoxical HS is still debatable, further research and observation are needed to confirm and distinguish patients with genetic and clinical predisposition in the onset or exacerbation of HS during anti-TNF treatment.
Subject(s)
Adalimumab/adverse effects , Anti-Inflammatory Agents/adverse effects , Hidradenitis Suppurativa/chemically induced , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adolescent , Adult , Anti-Bacterial Agents/therapeutic use , Arthritis/drug therapy , Crohn Disease/drug therapy , Dermatologic Agents/therapeutic use , Drug Substitution , Female , Glucocorticoids/therapeutic use , Hidradenitis Suppurativa/diagnosis , Hidradenitis Suppurativa/drug therapy , Humans , Middle Aged , Psoriasis/drug therapy , Retrospective Studies , Spondylitis, Ankylosing/drug therapy , Ustekinumab/therapeutic use , Young AdultSubject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antirheumatic Agents/adverse effects , Lichen Planus/chemically induced , Spondylitis, Ankylosing/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab , Antibodies, Monoclonal, Humanized/administration & dosage , Antirheumatic Agents/administration & dosage , Humans , Lichen Planus/pathology , Male , Middle AgedABSTRACT
BACKGROUND: Since the introduction of sentinel lymph node biopsy (SLNB), its use as a standard of care for patients with clinically node-negative cutaneous melanoma remains controversial. We wished to evaluate our experience of SLNB for melanoma. METHODS: A single center observational cohort of 203 melanoma patients with a primary cutaneous melanoma (tumour thickness > 1 mm) and without clinical evidence of metastasis was investigated from 2002 to 2009. Head and neck melanoma were excluded. SLN was identified following preoperative lymphoscintigraphy and intraoperative gamma probe interrogation. RESULTS: The SLN identification rate was 97%. The SLN was tumor positive in 44 patients (22%). Positive SLN was significantly associated with primary tumor thickness and microscopic ulceration. The median follow-up was 39.5 (5-97) months. Disease progression was significantly more frequent in SLN positive patients (32% vs 13%, p = 0.002). Five-year DFS and OS of the entire cohort were 79.6% and 84.6%, respectively, with a statistical significant difference between SLN positive (58.7% and 69.7%) and SLN negative (85% and 90.3%) patients (p = 0.0006 and p = 0.0096 respectively). Postoperative complications after SLNB were observed in 12% of patients. CONCLUSION: Our data confirm previous studies and support the clinical usefulness of SLNB as a reliable and accurate staging method in patients with cutaneous melanoma. However, the benefit of additional CLND in patients with positive SLN remains to be demonstrated.
