ABSTRACT
BACKGROUND: Plaque-type palmoplantar psoriasis (PPTP) is a chronic recalcitrant dermatosis with treatment modalities ranging through topical, phototherapy or systemic. Phototherapy options include various forms of ultraviolet B (UVB) and ultraviolet A with prior psoralen sensitization (PUVA). Currently, few comparative studies have been reported. PURPOSE: To compare Broad-Band UVB (BB-UVB) versus paint PUVA (p-PUVA) in regard to efficacy and safety in the treatment of PPTP. METHODS: A retrospective non-randomized cohort study comprised of all the patients with PPTP treated in our phototherapy centre during 2010-2012, either with BB-UVB or p-PUVA. RESULTS: Among the 248 patients included in this study, 122 received BB-UVB and 126 followed p-PUVA treatment. About 36 (30%) and 53 (42%) had complete remission, 29 (24%) and 59 (47%) responded partially and 57 (47%) and 14 (11%) patients did not improve with BB-UVB and p-PUVA, respectively. The odds ratio for remission (p-PUVA: BB-UVB) was 7.9. Duration of remission was 21.9 ± 1.34 months for p-PUVA and 16.75 ± 1.83 months for BB-UVB. CONCLUSION: Both BB-UVB and p-PUVA are good therapeutic options for PPTP. P-PUVA emerges as the superior treatment modality, yielding a better and more extended response. BB-UVB represents a feasible alternative in patients with milder disease or possible contraindications for p-PUVA.
Subject(s)
Foot Dermatoses/therapy , Hand Dermatoses/therapy , PUVA Therapy/methods , Psoriasis/therapy , Ultraviolet Therapy/methods , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Foot Dermatoses/drug therapy , Foot Dermatoses/physiopathology , Foot Dermatoses/radiotherapy , Hand Dermatoses/drug therapy , Hand Dermatoses/physiopathology , Hand Dermatoses/radiotherapy , Humans , Male , Middle Aged , Psoriasis/drug therapy , Psoriasis/physiopathology , Psoriasis/radiotherapy , Retrospective Studies , Treatment Outcome , Ultraviolet RaysABSTRACT
BACKGROUND: Localized scleroderma (LS) comprises a spectrum of sclerotic autoimmune diseases primarily affecting the dermis. Various treatment modalities have been recommended for the management of LS, but only a few studies exist regarding the efficacy of bath PUVA photochemotherapy in the treatment of LS. OBJECTIVES: To evaluate the efficacy of bath PUVA photochemotherapy in the management of LS in a retrospective study. METHODS: Twenty-eight patients (23 women and five men) with a diagnosis of LS, confirmed by histology, were included in the study. Patients were treated with a thrice-weekly regimen of bath immersion in 0.2 mg/1 water solution of 8-methoxypsoralen, followed by irradiation with UVA. RESULTS: Eleven patients (39%) showed complete remission (complete softening of the sclerotic plaques with or without postinflammatory hyper- or hypopigmentation) after a mean of 71 treatments (range 33-170) and a mean cumulative dose of 115 J/cm(2) (range 11-232). Partial softening and regression of the sclerotic plaques was observed in 14 patients (50%). Three patients (10.7%) showed no effect, and in none of the patients was worsening noted during treatment. CONCLUSIONS: In our experience, bath PUVA photochemotherapy is an effective and well-tolerated treatment option for LS and should be considered as one of the first-line treatment modalities.
Subject(s)
Baths , Methoxsalen/administration & dosage , PUVA Therapy , Photosensitizing Agents/administration & dosage , Scleroderma, Limited/therapy , Adolescent , Adult , Aged , Child , Dermis/pathology , Female , Humans , Male , Middle Aged , Retrospective Studies , Scleroderma, Limited/pathology , Young AdultABSTRACT
Autoimmune bullous skin disorders are characterized by a severe and potentially lethal course and may require aggressive long-term treatment with systemic corticosteroids and other immunosuppressive drugs, which can lead to serious adverse events. Recently, anti-CD20 antibody, Rituximab, was reported to be beneficial as an adjuvant therapy in these diseases. Herein, we present 2 case reports of patients suffering from resistant rare diseases from the aforementioned spectrum: linear IgA dermatosis and Pemphigoid gestationis. The patients were successfully treated with Rituximab (Mabthera). This is one of the first reports of this kind of treatment for these rare life-threatening diseases. These case reports emphasize the role of Rituximab as a crisis therapy in autoimmune blistering diseases.
Subject(s)
Antibodies, Monoclonal, Murine-Derived/administration & dosage , Linear IgA Bullous Dermatosis , Pemphigoid Gestationis , Skin/pathology , Adult , Anemia, Hemolytic/chemically induced , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/adverse effects , Biopsy , Dapsone/administration & dosage , Dapsone/adverse effects , Drug Resistance , Female , Fluorescent Antibody Technique, Direct/methods , Glucocorticoids/administration & dosage , Humans , Immunologic Factors/administration & dosage , Linear IgA Bullous Dermatosis/drug therapy , Linear IgA Bullous Dermatosis/immunology , Linear IgA Bullous Dermatosis/pathology , Linear IgA Bullous Dermatosis/physiopathology , Pemphigoid Gestationis/drug therapy , Pemphigoid Gestationis/immunology , Pemphigoid Gestationis/pathology , Pemphigoid Gestationis/physiopathology , Prednisone/administration & dosage , Pregnancy , Pruritus/etiology , Rare Diseases/drug therapy , Rare Diseases/immunology , Rare Diseases/pathology , Rare Diseases/physiopathology , Rituximab , Severity of Illness Index , Skin/drug effects , Treatment OutcomeABSTRACT
The opportunistic pathogen Pseudomonas aeruginosa causes infections that are difficult to treat by antibiotic therapy. This bacterium can cause biofilm infections where it shows tolerance to antibiotics. Here we report the novel use of a metallo-complex, desferrioxamine-gallium (DFO-Ga) that targets P. aeruginosa iron metabolism. This complex kills free-living bacteria and blocks biofilm formation. A combination of DFO-Ga and the anti-Pseudomonas antibiotic gentamicin caused massive killing of P. aeruginosa cells in mature biofilms. In a P. aeruginosa rabbit corneal infection, topical administration of DFO-Ga together with gentamicin decreased both infiltrate and final scar size by about 50% compared to topical application of gentamicin alone. The use of DFO-Ga as a Trojan horse delivery system that interferes with iron metabolism shows promise as a treatment for P. aeruginosa infections.
