Adverse reactions of biological therapy for psoriasis.

AIM: To detect in patients with psoriasis the adverse effects during TNF-a inhibitor therapy. MATERIAL AND METHODS: Fifty-seven patients with psoriasis, aged between 12 and 75 years were analyzed. They were treated with different TNF-α antagonists, the maximum treatment duration being 59 months. All patients were followed monthly after the initiation of therapy by clinical checkup, then every 3 months during the first 6 months of treatment by laboratory screening, and then every 6 month. Chest x-ray and tuberculin intradermal skin test were performed annually or as needed. All symptoms reported by patients were recorded, the treating doctor deciding the need for additional investigations or specialist consult. RESULTS: Of the total of 57 patients with psoriasis on biological therapy, 9 patients developed diseases requiring temporary or permanent discontinuation of therapy. The recorded adverse reactions were: infectious (pulmonary tuberculosis, pulmonary empyema), oncologic (rectal cancer, renal cancer), dermatologic (vesiculobullous erythema multiforme major, nodular hypodermtis, secondary erythroderma, and hives) disorders. CONCLUSIONS: Despite its adverse reactions, biological therapy is safe and is a necessary tool in the treatment of moderate and severe forms of psoriasis unresponsive to other treatments.

Erythema multiforme--etiopathogenic, clinical and therapeutic aspects.

AIM: To present the epidemiological, etiopathogenic, clinical and therapeutic aspects in Erythema multiforme (EM). MATERIAL AND METHODS: This is a 3-year retrospective study based on medical records of patients with EM admitted to the Dermatology Clinic. Forty patients were included in this study. The obtained data allowed the classification of patients according to their distribution by sex, age group, area of residence, etiology, clinical aspects, and type of administered treatment. RESULTS: The prevalence of EM during the 3 study years was 0.4%. EM prevailed among the rural population, more frequently in women. The minimum age at which EM was diagnosed was 12 years and maximum age 78 years, with a peak incidence between 20-40 years old (37.5% cases). In 42.50% of the cases EM was drug-induced, and in 17.50% of cases it was caused by infection with herpes simplex virus (HSV). There were 18 cases of erythemotous-papular EM (45%), 14 cases of erythematous--vesiculobullous EM (35%) and 8 cases of recurrent EM (20%). All patients received treatment with antihistamines and nonspecific desensitizing agents. Systemic corticotherapy was used in 22 cases. Three patients received treatment with acyclovir. CONCLUSIONS: Erythema multiforme is a rare skin condition, easily diagnosed based on its characteristic clinical appearance, but remains a challenge for the physician in terms of establishing its causal agent.

Napkin psoriasis--case report.

Psoriasis is a chronic inflammatory disease that can affect up to 1% of children. Genetic (family history of psoriasis) and environmental factors (bacterial or viral infections, stress, and trauma) are frequently involved in its occurrence. Napkin psoriasis is a particular form of psoriasis affecting mainly children younger than 2 years of age and can be classified together with other diseases under diaper rash. We present the case of a 4-month-old infant, born at term, naturally, weight and height within the normal range, who was brought to the Dermatology Clinic for the occurrence of erythematosquamous lesions in the anogenital area, buttocks and upper third of the thighs, with subsequent dissemination of lesions. The onset of symptoms began a few days after a respiratory tract infection. Initially he received treatment with systemic antibiotic and topical corticosteroid and antibiotic with unfavorable outcome. Laboratory tests revealed iron-deficiency anemia, leukocytosis, thrombocytosis, accelerated ESR, marked hepatic cytolysis, hyperphosphatemia and nasal carriage of Staphylococcus aureus. A systemic antihistamine and nonspecific desensitization treatment was administered. Topical treatment consisted in the removal of predisposing factors and irritants (diaper, urine) by rigorous hygiene, application of topical non-fluorinated cortico-steroid and use of emollients, with favorable course of the lesions. The peculiarity of the case is that the diagnosis of psoriasis was based on history, physical examination and laboratory tests, in the absence of a pathology examination to confirm the diagnosis. Pathology examination could not be performed due to patient's age as biopsy required general anesthesia.