Skin barrier status during dupilumab treatment in patients with severe atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a common chronic-relapsing inflammatory skin disease hallmarked by epidermal barrier dysfunction, increased transepidermal water loss (TEWL) and decreased skin hydration. Recent findings on the T helper 2 (Th2)-driven pathogenesis of AD have led to the development of dupilumab, a monoclonal antibody directed against interleukin-4 and interleukin-13 that has been demonstrated to be effective in the treatment of moderate-to-severe AD. The effect of dupilumab on skin barrier dysfunction, however, has not yet been adequately investigated. OBJECTIVES: The primary endpoint of this study was to assess the status of the skin barrier in nonlesional skin of patients with severe AD treated with dupilumab, by evaluating the association between the relative variation of TEWL and the achievement of a 75% reduction of EASI (EASI75) over time. METHODS: TEWL was measured below the antecubital fossae by means of the Vapometer® at baseline, at week 4 (T4), at week 16 (T16) and at week 32 after dupilumab starting. EASI and NRS-itch were measured at the same time points. RESULTS: Seventy-eight patients with severe AD treated with dupilumab were enrolled. Median TEWL relative variation respect to baseline was significantly higher in patients who achieved EASI75 as compared with those who did not achieve EASI75 at T16 and at T32, but not at T4. CONCLUSION: During dupilumab treatment, TEWL on nonlesional skin tends to significantly improve 4 months after treatment initiation and could be a good tool for monitoring response to therapy.

Fish Pedicure: A Risky Aesthetic Treatment for Tourists.

Fish pedicure is considered to be an aesthetic treatment, first conceived in Turkey, in Kangal Hot Springs. These hot waters are rich in two species of fish of the Cyprinidae family that feed on the stratum corneum layer of patients with psoriasis. This treatment was later adapted to many spa resorts for "fish pedicure." In this article, we performed a review of the skin infections already reported, explaining why this procedure, performed usually during summer holidays by tourists, is not risk free and should be discouraged by health workers.

Efficacy of Dupilumab on Different Phenotypes of Atopic Dermatitis: One-Year Experience of 221 Patients.

BACKGROUND: The clinical features of adult-onset atopic dermatitis (AD) are heterogeneous and the diagnosis can be a challenge. A new biologic drug (dupilumab) has been approved for moderate to severe AD in adult patients. The efficacy and safety have been demonstrated in clinical trials, but these studies do not reflect conditions in daily practice and do not consider the different clinical manifestations of AD. OBJECTIVES: Analyzing the dupilumab activity in a real-world setting and comparing its efficacy on different AD phenotypes. METHODS: We retrospectively evaluated 221 AD patients treated with dupilumab, stratified into six clinical phenotypes: classic, generalized eczema inflammatory and lichenoid patterns, prurigo, nummular eczema, and erythroderma. At baseline and at weeks 4, 16, and 52, the disease severity was assessed through the Eczema Area and Severity Index (EASI) and the quality of life was assessed through the Dermatology Life Quality Index (DLQI) questionnaire, Peak Pruritus Numerical Rating Scale (itch NRS), and Peak Sleep NRS. RESULTS: We found a significant improvement after 16 weeks of treatment (p < 0.0001) in all six phenotypes for all the assessed scores mentioned above, persisting up to week 52. The best improvement was seen in the more severe phenotypes, particularly the erythrodermic one. CONCLUSIONS: The present study confirmed the efficacy and safety of dupilumab in the treatment of severe AD. Its strength was in the stratification of AD patients in six different phenotypes based on their clinical presentation, all of whom markedly improved in terms of both clinically evident and reported symptoms, as well as their quality of life.

Bone involvement in classic Kaposi's sarcoma.

BACKGROUND: Classic Kaposi's sarcoma (KS) is a rare angioproliferative neoplasm which typically occurs on the skin of the lower limbs of immunocompetent elderly men. Bone involvement in classic KS has been exceptionally reported. OBJECTIVES: To identify patients with classic KS who developed bone involvement based on a retrospective analysis of our departmental database. MATERIALS AND METHODS: Clinical presentation, diagnostic method, treatment, and outcome were analysed and compared with cases reported in the literature. RESULTS: In total, we identified 1,196 patients with classic KS, three (0.25%) of whom developed bone involvement. The patients were all male and the average age at onset of bone involvement was 81.3 years. All three patients had biopsy-proven anaplastic KS affecting a bone of the lower limb. Bone radiological features were non-specific in one patient, while in all patients magnetic resonance imaging revealed osteolytic lesions and/or a solid tumour. HHV8 genotype analysis was performed in two patients, and subtypes A and C were found. CONCLUSION: Bone involvement should be considered in patients with known KS presenting with bone pain.

Clinical Response and Quality of Life in Patients with Severe Atopic Dermatitis Treated with Dupilumab: A Single-Center Real-Life Experience.

Dupilumab is an anti-interleukin-4 receptor monoclonal antibody that was recently approved for the treatment of atopic dermatitis (AD). In this single-center retrospective study, clinical baseline data of 117 severe AD patients treated with dupilumab were collected. At baseline and at weeks 4 and 16, disease severity was assessed through the Eczema Area and Severity Index (EASI) and quality of life through the Dermatology Life Quality Index (DLQI) questionnaire, Patient-Oriented Eczema Measure (POEM), Hospital Anxiety and Depression Scale (HADS), Peak Pruritus Numerical Rating Scale (NRS-itch), and VAS-sleep. Response to dupilumab was defined as an improvement of ≥75% in EASI from baseline (EASI75). At multivariate analysis, AD onset before 18 years [OR, 2.9; 95% CI, 1.2-7.2; p = 0.0207] and absence of hypereosinophilia [OR, 2.24; 95% CI, 1.03-4.86; p = 0.0412] were identified as significant predictive parameters for response to dupilumab in terms of EASI75 at week 4 but not at week 16. Significant reductions in EASI, DLQI, POEM, HADS, NRS-itch, and VAS-sleep were found between week 4 versus baseline (p < 0.0001 for all) and week 16 versus baseline (p < 0.0001 for all). Early AD onset and absence of hypereosinophilia may be suggested as predictive markers of early response to dupilumab. We confirmed the efficacy and safety of this agent along with the improvement of life quality in severe AD patients.

Paclitaxel as first- or second-line treatment for HIV-negative Kaposi's sarcoma: a retrospective study of 58 patients.

Background: Paclitaxel has recently been approved for AIDS-related Kaposi's sarcoma (KS) and there is much interest also in HIV-negative KS.Objective: To assess the safety and effectiveness of intravenous paclitaxel in the treatment of non-HIV-associated KS.Method: A retrospective database analysis of our departmental database in histologically proven, HIV-negative KS.Results: Fifty-eight patients treated with intravenous paclitaxel 100 mg weekly were identified. Among these patients, 11 patients underwent paclitaxel as first-line treatment, whereas 47 received paclitaxel after other types of systemic chemotherapy. Fifty-three (94.6%) patients achieved a partial or a complete remission after a mean of 13.5 infusions. Disease progression was observed in two patients and one patient had a stable disease. Thirty-one (58.5%) of 53 responding patients are still stable after a mean of 19.1 months of follow-up, while 22 (41.5%) patients relapsed after a mean of 14 months. Paclitaxel was repeated in relapsed patients obtaining PR/CR in all cases. Tolerance was good except for one patient who discontinued the treatment because of a severe allergic reaction.Conclusion: Paclitaxel is effective for the treatment of non-HIV-related KS, both as first- and as second-line treatment. It is well tolerated and can be repeated without loss of efficacy.