Subject(s)
Dermatitis, Allergic Contact/etiology , Dermatologic Agents/adverse effects , Drug Eruptions/etiology , Mometasone Furoate/adverse effects , Administration, Cutaneous , Aged , Dermatitis, Allergic Contact/diagnosis , Dermatologic Agents/administration & dosage , Drug Eruptions/diagnosis , Exanthema/drug therapy , Female , Humans , Mometasone Furoate/administration & dosage , Patch Tests , Pruritus/drug therapyABSTRACT
Therapy principles of the last decade and recent advances in the research of polynuclear eosinophil have led to a new approach in the hypereosinophilic syndrome (HES), with important consequences on the development of new and effective therapies. HES is defined by persistent and marked eosinophilia and eosinophil-related organ damage in the absence of any evident cause of hypereosinophilia. Two variants of HES have been characterized, with different prognosis and possible associations with malignant diseases such as myeloid leukemia or T-cell lymphomas. The lymphocytic variant of HES (L-HES) is characterized by the presence of T cell clones, IL-5 expression and possible progression to T-cell lymphoma. Besides steroid therapy, the anti-IL-5 monoclonal antibody mepolizumab is considered as a target therapy for L-HES. The myeloproliferative variant of HES (M-HES) is associated with an increased risk of myeloid leukemia and good response to anti-tyrosine-kinase therapy. The imatinib target is a kinase resulting from an 800-kb deletion on chromosome 4. The fusion gene Fip1-like 1-platelet-derived growth factor receptor alpha (FIP1L1-PDGFRA) has been validated as a marker of response to anti-tyrosine-kinase therapy. Early identification of HES variants is crucial for the rapid introduction of early and appropriately adjusted therapy.
Subject(s)
Hypereosinophilic Syndrome/diagnosis , Hypereosinophilic Syndrome/therapy , Lymphoma, T-Cell/diagnosis , Lymphoma, T-Cell/therapy , Myeloproliferative Disorders/diagnosis , Myeloproliferative Disorders/therapy , Humans , Hypereosinophilic Syndrome/etiology , Lymphoma, T-Cell/etiology , Myeloproliferative Disorders/etiologyABSTRACT
Biologic therapies improved dramatically the outcome of psoriatic arthritis and moderate to severe chronic plaque psoriasis. Anti-TNF agents were developed approximately one decade ago by rheumatologists and today represent one of the most effective classes of drugs in severe psoriasis resistant to 2 out of 3 "classic" systemic therapies (methotrexate, cyclosporine, and PUVA). Recent studies on psoriasis pathogenesis were focused on early steps of the inflammatory cascade, i.e. activation of T cells with a recently described phenotype Th17 and consequent expression of interleukins (IL) 12 and 23. IL12 and IL23 have a common p40 subunit that is a target of a new therapeutic class, fully human monoclonal antibodies anti IL12/23: ustekinumab and ABT-874. Randomized, placebo-controlled clinical trials in patients with moderate to severe chronic plaque psoriasis using ustekinumab and ABT-874 showed PASI 75 achievements at week 12 in 80% and 93% of patients, respectively. Larger studies are ongoing in order to assess the safety profile of this new therapy. As anti-TNF drugs represent an important and effective treatment of psoriatic arthritis and moderate to severe plaque psoriasis, comparative studies are needed to assess the advantages, the safety and the place of anti-IL12/23 in the era of biologic therapy.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Biological Therapy/methods , Psoriasis/drug therapy , Antibodies, Monoclonal, Humanized , Humans , Interleukin-12/antagonists & inhibitors , Interleukin-23/antagonists & inhibitors , Psoriasis/physiopathology , Randomized Controlled Trials as Topic , Tumor Necrosis Factor-alpha/antagonists & inhibitors , UstekinumabABSTRACT
Sun exposure is today well recognized as having an adverse effect on human skin. Part of sun radiation, ultraviolet radiation A (UVA) and B (UVB), can modify skin structures and induce short-term skin changes (sunburn, tanning, hyperkeratinization, brown spots) and long-term skin damages (accelerated skin aging and skin cancers). Protection against both UVA and UVB is very important, therefore sun protection by clothes, avoiding sun exposure and correct use of sunscreens are important means to reduce short- and long-term solar radiation effects. The recommendation of appropriate sunscreen by doctors and cosmetic professionals (the function of skin type and sun radiation intensity) is today easier due to the recently implemented European uniform labeling system of sunscreens and detailed information for consumers.
Subject(s)
Drug Labeling , Sunburn/prevention & control , Sunscreening Agents/administration & dosage , HumansABSTRACT
Blood and tissue eosinophils can be associated with Hodgkin and non-Hodgkin lymphomas in that they have prognostic value. Tissue eosinophils in T-cell lymphoma patients with blood eosinophilia have not been systematically assessed. The objective of this research was to study the presence, density, and activation of tissue eosinophils in patients with primary cutaneous T-cell lymphomas (CTCLs) with blood eosinophilia and a possible relationship between features of the disease and prognosis. With skin biopsy specimens from 26 CTCL patients with blood eosinophilia, tissue eosinophils were studied with electron microscopy, extracellular eosinophil peroxidase deposits, and interleukin-5 expression. Tissue eosinophils, found in 22 of 26 cases, were constantly activated. Both density and activation of tissue eosinophils were significantly related to disease progression. The state of activation of tissue eosinophils in CTCL might reflect inflammatory flare-ups associated with aggressive lymphomas. Further studies are needed to confirm the value of eosinophil density as a simple and reliable marker of CTCL progression.
