Clinical and dermatoscopic predictors of squamous cell carcinoma of the lips: a case-control, multicentric study.

BACKGROUND: Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips. OBJECTIVES: To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions. METHODS: Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively. RESULTS: A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43-fold and 6-fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6-fold and 4-fold increased risk for squamous cell carcinoma respectively. CONCLUSIONS: A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip.

3D printed replicas for endodontic education.

AIM: To assess the feasibility of producing artificial teeth for endodontic training using 3D printing technology, to analyse the accuracy of the printing process, and to evaluate the teeth by students when used during training. METHODOLOGY: Sound extracted human teeth were selected, digitalized by cone beam computed tomography (CBCT) and appropriate software and finally reproduced by a stereolithographic printer. The printed teeth were scanned and compared with the original ones (trueness) and to one another (precision). Undergraduate dental students in the third and fourth years performed root canal treatment on printed molars and were subsequently asked to evaluate their experience with these compared to real teeth. RESULTS: The workflow was feasible for manufacturing 3D printed tooth replicas. The absolute deviation after printing (trueness) ranged from 50.9 to 104.3 µm. The values for precision ranged from 43.5 to 68.2 µm. Students reported great benefits in the use of the replicated teeth for training purposes. CONCLUSION: The presented workflow is feasible for any dental educational institution who has access to a CBCT unit and a stereolithographic printer. The accuracy of the printing process is suitable for the production of tooth replicas for endodontic training. Undergraduate students favoured the availability of these replicas and the fairness they ensured in training due to standardization.

3D-printed model for hands-on training in dental traumatology.

AIM: To assess the feasibility of creating a realistic model for hands-on training in dental traumatology using 3D printing technology, and then to investigate the added value of working with the website dentaltraumaguide.org. METHODOLOGY: With the use of special software applications, a model was designed based on the CBCT of the maxilla of a real patient that imitated several traumatic dental injuries. The model was reproduced using a stereolithographic printer to use the specimens in a hands-on training course on dental traumatology for undergraduate students in their final year in the Department of Conservative Dentistry and Periodontology in Munich, Germany. During the course, half of the participants had access to dentaltraumaguide.org, whereas the others did not. The students were then assessed according to their theoretical knowledge and practical performance in simulated treatment. These data were analysed by Kolmogorov-Smirnov test, unpaired t-test and Mann-Whitney U test. Subsequently, the participants were asked to evaluate the model. RESULTS: The workflow for manufacturing a model of dental traumatology for training purposes was practical and relatively inexpensive. In the evaluation process, the model was considered to be highly realistic and useful during an instructive hands-on training course. There were significant differences between the two groups in favour of using the dentaltraumaguide.org website. CONCLUSIONS: 3D printing technology offers new possibilities for training specific dental treatments that are currently difficult to imitate. The online platform dentaltraumaguide.org assisted students in correctly managing traumatic dental injuries.

Scalp psoriasis and biologic agents: a retrospective, comparative study from a tertiary psoriasis referral centre.

BACKGROUND: The scalp is a frequent and difficult-to-treat localization of psoriasis. Little evidence exists regarding the use of biologic agents in recalcitrant cases of scalp psoriasis that are resistant to other treatment options. OBJECTIVES: To evaluate and compare the efficacy of currently available biologic agents (infliximab, etanercept, adalimumab, ustekinumab) in the treatment of scalp symptoms in patients suffering from moderate to severe plaque psoriasis. MATERIALS AND METHODS: This retrospective cohort study consisted of a review of the database of all psoriasis patients who suffered from scalp symptoms and received biologic treatment between January 2012 and December 2014. The patients were divided into four groups based on the drug administered. Scalp psoriasis severity was assessed by the Psoriasis Scalp Severity Index (PSSI) at baseline and at weeks 4, 12, 24 and 48. Psoriasis severity was evaluated with the Psoriasis Area and Severity Index (PASI) at the same time points. RESULTS: In total, 145 patients were enroled in the study (infliximab n = 35, etanercept n = 30, adalimumab n = 39, ustekinumab n = 41). At week 4, the infliximab group achieved a 74% mean decrease in the PSSI (ΔPSSI), followed by mean decreases of 61.7%, 53.1% and 53.7% in the ustekinumab, etanercept and adalimumab groups respectively. The differences in the ΔPSSI were lower at week 48: ustekinumab 94.9%, infliximab 94.3%, etanercept 83.1% and adalimumab 89.0%. The PASI score improved sufficiently in all treatment groups. Infliximab and ustekinumab exhibited greater efficacy at weeks 4 and 12. This difference was not as prominent as that revealed by the PSSI. At week 48, the differences in the ΔPASI were barely statistically significant (P = 0.048). CONCLUSIONS: All four biologic agents yielded significant improvement in both scalp and skin lesions. Ustekinumab and infliximab exhibited the greatest efficacy, which was clinically meaningful from the early stages of the study. Adalimumab and etanercept followed, yielding satisfactory improvement rates.

Association of chronic plaque psoriasis and severe periodontitis: a hospital based case-control study.

BACKGROUND: Both chronic plaque psoriasis and periodontitis have an increasing prevalence worldwide and have been associated with the metabolic syndrome; however limited information is available on their association. OBJECTIVE: To evaluate the possible association of severe periodontitis and chronic plaque psoriasis. METHODS: This was a hospital based case-control study. Chronic plaque psoriasis patients and age- and gender-matched controls have been recruited. Baseline demographic data have been recorded. To explore correlations between different dichotomous variables the Sperman Rho correlation coefficient was used. Correlations were further explored non-parametrically and univariate and multivariate logistic regression was utilized after adjustment for the effect of confounders. RESULTS: During the study enrollment period 100 patients with CPP and 100 age- and gender-matched controls were included in this study. Mean age for both groups was 57.2 ± 5.3 years. 43% of patients and controls were males. Significant correlations where noted between psoriasis and 1) periodontitis (rho = 0.219, P = 0.02) and 2) metabolic syndrome (rho = 0.191, P = 0.07) using Spearman's Rho correlation co-efficient. Univariate logistic regression reported significant relations between psoriasis and periodontitis (OR = 3.329, 95%CI: 1.513-7.324, P = 0.003) and psoriasis and metabolic syndrome (OR = 2.293, 95%CI: 1.250-4.207, P = 0.007). On the contrary, a non-significant relation between psoriasis and active smoking status was detected (OR = 1.041, 95%CI: 0.597-1.817, P = 0.887). In a multivariate analysis model we found a significant correlation of psoriasis and periodontitis when controlled for the presence of metabolic syndrome (OR: 2.486, 95%CI: 1.002-5.842, P = 0.049). CONCLUSION: Periodontitis may be associated with psoriasis but further studies are required to elucidate their relationship in the context of the biologic plausibility.

Adalimumab for psoriasis in Greece: clinical experience in a tertiary referral centre.

BACKGROUND: Adalimumab, a fully human, anti-TNFα monoclonal antibody has been shown to be effective for moderate-to-severe psoriasis in clinical trial setting. However, only a limited number of studies reflect everyday clinical experience with this drug. OBJECTIVES: To provide evidence on the efficacy, dose optimization and safety of adalimumab based on everyday clinical experience in a tertiary referral centre for psoriasis, in Greece. METHODS: We retrospectively reviewed the records of all patients with moderate-to-severe psoriasis who received adalimumab, in our referral centre, between January 2008 and October 2010. RESULTS: In total, 52 patients were treated with adalimumab for a mean period of 14 months (range 4-30 months). Mean baseline Psoriasis Area and Severity Index (PASI) was 16.7 (range 9-40.3). At 4, 6, 12 and 18 months, PASI75 was attained by 68%, 82%, 89% and 88% of patients respectively. Nineteen of 52 patients (36%) reached a PASI100 at a mean time of 10 months (range 4-18 months). The dose interval between the injections of adalimumab was increased from 2 to 3 weeks for 14 patients (27%) who achieved and sustained a PASI100 after the first year of treatment, without any relapse. The overall rate of adverse events reached 38%, but treatment was discontinued only in two cases (4%). CONCLUSIONS: Our study demonstrates that adalimumab is effective and safe in patients with moderate-to-severe psoriasis in short- and long-term setting. At the same time, it points out novel and interesting issues for further investigation.

Clinical and laboratory study of ocular rosacea in northern Greece.

BACKGROUND: The prevalence of ophthalmic involvement in rosacea is probably higher than previously presumed and varies considerably among several studies. OBJECTIVE: This study aimed to determine the incidence of ocular disease among a population of rosacea patients in Northern Greece, to objectively determine the presence of eye dryness in rosacea patients with and without clinical ophthalmic involvement and correlate the severity of ocular disease with the severity of cutaneous rosacea. METHODS: One hundred patients with rosacea were assessed for the stage of their disease and examined for ocular symptoms and signs. In 24 of them the tear break up time (TBUT) and Schirmer test were performed in each eye, along with 24 controls. RESULTS: A total of 33 patients (33%) were positive for ophthalmic findings. The most frequent symptoms and signs were burning sensation and tearing, and conjunctivitis and blepharitis, respectively. Eleven patients with ophthalmic manifestations had mild to moderate erythematotelangiectatic rosacea, 17 had moderate papulopustular rosacea and four exhibited findings of phymatous rosacea. The total mean value of patients' Schirmer tests was significantly lower compared with the healthy controls (P < 0.0001). Mean TBUT was shorter in the rosacea group than that in the age-matched controls (P < 0.0001). CONCLUSION: Ocular involvement in rosacea is a common phenomenon with eye dryness being an early sign. Tear function tests, like Schirmer test and TBUT, although not specific, could contribute to the screening and early diagnosis of the disease, to prevent the potential development of sight-threatening conditions.

Safety of anti-tumour necrosis factor-α agents in psoriasis patients who were chronic hepatitis B carriers: a retrospective report of seven patients and brief review of the literature.

BACKGROUND: Issues concerning the potential risks of reactivating chronic hepatitis B virus arise when the use of anti-Tumour Necrosis Factor-α (TNFα) agents is imperative in patients with concurrent psoriasis and hepatitis B virus infection. OBJECTIVE: The aim of this study was to report the experience regarding safety in the management of patients with coexisting psoriasis and chronic hepatitis B with the anti-TNFα agents: infliximab, etanercept and adalimumab. METHODS: The psoriasis outpatient database of our dermatological department was searched for psoriasis and hepatitis B diagnoses and the medical records of these patients were reviewed for use of anti-TNFα agents. RESULTS: Seven cases (four women and three men) were identified, with mean age of 51years (34-65years). Three patients received adalimumab, three patients were given etanercept and one infliximab. All patients received lamivudin, 100mg/day, which started 2weeks before the initiation of anti-TNFα medication and went on during the whole treatment period. Follow-up period extended from 6-24months. All patients were inactive HbsAg (+) carriers. Liver function tests - at baseline and at the end of follow-up period - were within the normal range. There was no considerable rise in the viral load in any case, from baseline until the last available measurement, although a patient receiving infliximab showed an increase that reached 600 IU/mL. CONCLUSION: Successful treatment of psoriasis with anti-TNFα agents in patients who are inactive HBsAg carriers is possible and could be safe under the conditions of concomitant lamivudin administration and intensive monitoring. Larger randomized controlled studies are needed to confirm these findings.

Clinical and laboratory study of rosacea in northern Greece.

BACKGROUND: Numerous factors have been implicated in the pathogenesis of rosacea, which remains obscure. OBJECTIVES: To examine the epidemiological characteristics of rosacea patients, the histopathological alterations, the prevalence of gastric Helicobacter pylori infection and the role of ultraviolet radiation, to detect the presence of Demodex folliculorum on affected skin and to elucidate the immunological nature of this disorder. METHODS: The study included 100 patients with rosacea. Each patient was assessed with a clinical, haematological, biochemical and histological examination; serology test for the detection of antibodies against H. pylori; direct immunofluorescence on perilesional, sun exposed skin and indirect immunofluorescence with monkey oesophagus as a substrate; antinuclear antibody titre and a skin surface biopsy to search for Demodex folliculorum. RESULTS: Women were more frequently affected. Half of our patients were 51-70 years old. About two-thirds were photo-types I and II and 73% complained of worsening of conditions after sun exposure. An almost permanent histopathological feature was solar elastosis. Higher prevalence of H. pylori was not established. Prevalence and mean density of Demodex folliculorum were significantly increased in rosacea patients. Direct and indirect immunofluorescence tests were positive in 6.4% and 6.7% respectively. Antinuclear antibody titres were found in 21.1%. CONCLUSIONS: Our results suggest the pivotal role of chronic sun exposure in the pathogenesis of rosacea. Demodex folliculorum represents a significant cofactor that may contribute to the transition of the disease from a vascular to an inflammatory stage. The low positive results of direct and indirect immunofluorescence do not support a potential autoimmune role in the development of rosacea.