Acquired microcystic lymphatic malformation of the distal upper extremity mimicking verrucae vulgaris.

An 18-year-old African American male with a history of congenital lymphedema of the right upper extremity presented for evaluation of multiple verrucous lesions on his right hand. Clusters of 2 to 4-mm dome-shaped vesicles were intermixed with scattered verrucous papules on the right forearm and the dorsal and palmar aspects of the hand. Histopathology of one the verrucous lesions showed well-circumscribed areas of dilated lymphatic vascular channels with lymph in the lumen. The patient was diagnosed with microcystic lymphatic malformation, verrucous type. This article reviews the literature regarding reports of this variant of microcystic lymphatic malformation in the pediatric population.

Ustekinumab: an evidence-based review of its effectiveness in the treatment of psoriasis.

INTRODUCTION: Psoriasis is a chronic inflammatory skin disease affecting approximately 2% to 3% of the population worldwide. Discoveries over the past 3 to 5 years have significantly altered our view of psoriasis as primarily a T-cell mediated condition. The most recent research has demonstrated the essential role of specific cytokines in the development of this complex disease, including TNF-alpha, interleukin-23 (IL-23), and potentially, IL-22. These are all part of a newly defined autoimmune pathway directed by specialized T cells called Th17 helper T cells. Ustekinumab is a fully human monoclonal antibody that targets IL-12 and IL-23, thus targeting both Th1 and Th17 arms of immunity. It has a promising efficacy and safety profile that not only represents a valuable treatment alternative, but also a continuation in our constantly evolving understanding of this disorder. AIMS: To review the emerging evidence supporting the use of ustekinumab in the management of moderate to severe plaque psoriasis. EVIDENCE REVIEW: There is clear evidence that ustekinumab is effective in the treatment of moderate to severe psoriasis. Phase III trials (PHOENIX 1 and 2) demonstrated a statistically significant difference between Psoriasis Area and Severity Index (PASI) 75 responses achieved by patients receiving ustekinumab, given as a 45 mg or 90 mg subcutaneous injection every 12 weeks, than their placebo counterparts. Treatment with this novel agent resulted in a rapid onset of action, with over 60% of treated patients attaining Physician's Global Assessment (PGA) scores of "cleared" or "minimal" by week 12. Quality of life assessments paralleled clinical improvements. CLINICAL POTENTIAL: Ustekinumab is an effective and efficient therapeutic option for patients with moderate to severe psoriasis. Although further studies are required to establish ustekinumab's place in the therapy of psoriasis, with its convenient dosing schedule and rapid onset of action, this drug could provide a great addition to the current therapeutic armamentarium available for psoriatic patients.

Long-term efficacy of biologics in the treatment of psoriasis: what do we really know?

Psoriasis is a chronic inflammatory condition that often requires life-long treatment. Conventional therapies have not fully met the needs of psoriatic patients, because of limited efficacy, adverse effects with cumulative use, and patient inconvenience. In the past decade, biologic immunotherapies have become accepted treatments for psoriasis as a result of perceived efficacy and safety on the part of patients and practitioners. However, most data on these medications come from relatively limited short-term trials. In this review, we will focus on the available long-term data on the efficacy of the biologic agents. We will emphasize the strengths and weakness of the available data of the biologic agents that are Food and Drug Administration (FDA)-approved for the treatment of moderate to severe psoriasis (alefacept, efalizumab,* etanercept, infliximab, and adalimumab), with the inclusion of a newer agent currently under FDA evaluation (ustekinumab).

Uso de biológicos para el tratamiento de la psoriasis / Biologic therapies for psoriasis

La psoriasis es una enfermedad inflamatoria crónica, mediada por los linfocitos T, que afecta a 1 por ciento-3 por ciento de la población mundial. Afectando primordialmente la piel y las articulaciones (artritis psoriática), también está asociada con otras condiciones inflamatorias, como son la enfermedad intestinal inflamatoria y patología coronaria, entre otras. El tratamiento de la psoriasis viene dado según su extensión y severidad, variando desde modalidades locales (tópicas e intralesionales), fototerapia, hasta regímenes sistémicos. Estos últimos generalmente conllevan efectos secundarios cuando son utilizados a largo plazo. Hoy en día, gracias a los últimos avances científicos, se ha logrado profundizar el entendimiento de la patogénesis de la psoriasis, dando lugar a terapias específicamente dirigidas conocidas como “biológicos”. A continuación se discutirán los principales biológicos utilizados en el tratamiento de la psoriasis en placa moderada a severa: efalizumab, alefacept, etanercept, infliximab, adalimumab e inhibidores de la interleuquina (IL) 12/23.

Psoriasis is a chronic T cell-mediated inflammatory disease that mainly affects the skin and joints, and is present in 1 percent-3 percent of world population. It is also associated to other inflammatory conditions such as inflammatory intestinal disease and coronary pathologies, among others. Conventional treatments for moderate to severe psoriasis are associated to broad band immunosuppression and/or organ-toxicities which can be problematic when used in a long-term. Advances in the understanding of psoriasis pathogenesis have led to targeted therapy in the form of biologics. These agents have gained popularity as safe, effective and convenient alternatives for the treatment of chronic moderate to severe plaque psoriasis. This review focuses on the main biologics used in the treatment of moderate to severe plaque psoriasis: efalizumab, alefacept, etanercept, infliximab, adalimumab and interleukin inhibitors (IL) 12/23. Mechanisms of action, guidelines for usage, efficacy data, and safety concerns will be discussed for each biologic. In addition, the new Th17 biologics and their role in psoriasis pathogenesis will also be examined.