ABSTRACT
Introduction: Ustekinumab is a human monoclonal antibody that binds to the p40 subunit of both interleukin (IL)-12 and IL-23, and it is approved for the treatment of moderate to severe plaque psoriasis. In this study, we assessed the efficacy and safety of patients receiving ustekinumab for psoriasis. Methods: This retrospective study included all adults with chronic plaque psoriasis who were prescribed ustekinumab in a tertiary dermatologic centre between December 2009 and December 2015. Efficacy end points included a proportion of patients achieving at least 50% and 75% improvement from baseline psoriasis area and severity index (PASI) and body surface area (BSA) at Weeks 4 and 16. Results: A total of 99 patients were prescribed ustekinumab; 69% of these were Chinese, followed by 15% Indians and 9% Malays. 31 patients had documented PASI scores and 55 patients had documented BSA improvements. In patients with recorded PASI scores, 29 (93.5%) of 31 patients achieved PASI 50, and 21 (67.7%) of 31 achieved PASI 75 at week 16. In patients with recorded BSA, 43 (78.2%) of 55 had at least 50% BSA improvement, and 31 (56.4%) of 55 achieved 75% BSA improvement at 16 weeks. Regarding safety, no patient experienced tuberculosis reactivation. A total of 11 (11%) of 99 patients had latent tuberculosis infection and were treated with prophylactic isoniazid. No patient experienced serious adverse events. No cardiovascular events, cutaneous malignancies or deaths were reported over six years. Conclusion: Ustekinumab is safe and efficacious in the treatment of patients with moderate to severe plaque psoriasis in a multiethnic Asian population.
Subject(s)
Psoriasis , Ustekinumab , Adult , Humans , Ustekinumab/therapeutic use , Singapore , Retrospective Studies , Treatment Outcome , Severity of Illness Index , Double-Blind Method , Psoriasis/drug therapySubject(s)
Dermatomyositis/pathology , Interferon-Induced Helicase, IFIH1/immunology , Lung Diseases, Interstitial/etiology , Skin Diseases/pathology , Biopsy, Needle , Dermatomyositis/diagnosis , Dermatomyositis/drug therapy , Dermatomyositis/immunology , Disease Progression , Erythema/diagnosis , Erythema/etiology , Fatal Outcome , Female , Humans , Immunohistochemistry , Lung Diseases, Interstitial/pathology , Lung Diseases, Interstitial/therapy , Middle Aged , Nose/pathology , Risk Assessment , Skin Diseases/complications , Skin Diseases/diagnosis , Skin Diseases/immunologySubject(s)
Betamethasone/analogs & derivatives , Calcitriol/analogs & derivatives , Nail Diseases/drug therapy , Psoriasis/drug therapy , Severity of Illness Index , Administration, Topical , Anti-Inflammatory Agents/administration & dosage , Betamethasone/administration & dosage , Calcitriol/administration & dosage , Dermatologic Agents/administration & dosage , Drug Therapy, Combination , Gels , Humans , Male , Middle Aged , Nail Diseases/diagnosis , Psoriasis/diagnosis , Treatment OutcomeABSTRACT
Decorative tattooing has been linked with a range of complications, with pseudolymphoma being unusual and challenging to manage. We report a case of tattoo-induced pseudolymphoma, who failed treatment with potent topical and intralesional steroids. She responded well to sequential treatment with ablative fractional resurfacing (AFR) followed by Q-Switched (QS) Nd:YAG 532 nm laser. Interestingly, we managed to document the clearance of her tattoo pigments after laser treatments on histology and would like to highlight the use of special stains such as the Grocott's Methenamine Silver (GMS) stain as a useful method to assess the presence of tattoo pigment in cases where dense inflammatory infiltrates are present.
ABSTRACT
Lichen planus pemphigoides (LPP) is an autoimmune disease characterised by evolution of subepidermal blisters on normal and lichen planus affected skin. We describe a case of LPP in a 54-year-old Chinese woman. The patient presented with psoriasiform plaques and was diagnosed with guttate psoriasis. Narrowband ultraviolet B (NBUVB) therapy was commenced, and she experienced a generalised eruption of violaceous papules, bullae over the lower limbs, and Wickham's striae over the buccal mucosa. Histology from a plaque revealed interface dermatitis, while a specimen from a blister showed subepidermal bulla. Direct immunofluorescence showed linear deposition of IgG and C3 along the basement membrane. A diagnosis of LPP was made on clinicopathological grounds. This is the first case report of NBUVB alone in unmasking LPP. In this case report, we describe the pathological mechanism of NBUVB in the development of LPP and key features distinguishing LPP from bullous lupus erythematosus, bullous lichen planus, bullous pemphigoid, and psoriasis.
