Risk of malignancies using anti-TNF agents in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis: a systematic review and meta-analysis.

INTRODUCTION: Malignancies have been reported in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, treated with anti-tumour necrosis factor (anti-TNF) agents. Areas covered: We conducted a systematic review of randomized controlled trials (RCTs) to determine the effect of anti-TNF agents on the occurrence of cancer (any type). Literature databases were searched up to May 2014 to identify relevant studies that evaluated adalimumab, certolizumab, etanercept, golimumab, or infliximab, compared with placebo or no treatment. Data on cancer occurrence were extracted at the maximum follow-up time reported. Expert opinion: Fifty-five RCTs with 20,631 patients met the eligibility criteria. Of these, 32 trials with 15,539 patients reported at least one case of cancer, for a total of 112 malignancies. The degree of variability between studies was consistent with what would be expected to occur by chance alone. There was no evidence of an association between anti-TNF agents and cancer risk (fixed-effects model (OR: 1.31, 95% CI: 0.89, 1.95); a random-effects model (OR: 1.16, 95% CI: 0.75, 1.81)). We found evidence of selective outcome reporting or publication bias suggesting that the pooled effect estimate for cancer may have been overestimated. The evidence is imprecise, and the risk of bias was high or unclear across primary studies.

Air Pollution Impact on Pregnancy Outcomes in Como, Italy.

OBJECTIVE: This retrospective observational study investigates the association between maternal exposure to air pollutants and pregnancy adverse outcomes in low urbanization areas. METHODS: We used multivariate regression analysis to estimate, in the Como province (2005-2012), the effects of NO(x), NO2, SO2, O3, CO, and PM10 on low birth weight (LBW), babies small for gestational age (SGA), and preterm birth (PTB). RESULTS: PTB was inversely associated with high (5.5 µg/m³) exposure to SO2 (adjusted odds ratio [aOR] = 0.74, 95% confidence interval [95% CI] = 0.58-0.95) and to CO (1.8 mg/m³, aOR = 0.84, CI = 0.72-0.99). PTB risk increased with second trimester exposure to NO(x) (118.3 µg/m³, aOR = 1.53, CI = 1.25-1.87), while LBW risk increased with third trimester PM10 (56.1 µg/m³, aOR = 1.44, CI = 1.03-2.02). SGA was inversely associated with third trimester NO(x) (115.8 µg/m³, aOR = 0.89, CI = 0.79-0.99). CONCLUSIONS: Exposure to SO2 and CO seems to postpone delivery: a longer gestation could compensate for maternal hypoxemic-hypoxic damage.

Tungiasis in Northern Tanzania: a clinical report from Qameyu village, Babati District, Manyara Region.

INTRODUCTION: Tungiasis is an infestation caused by the penetration in the skin of the gravid female of the flea Tunga penetrans (T. penetrans). The current epidemiological situation of tungiasis in Eastern Africa is poorly known. We present the results of a cross-sectional study on tungiasis which was carried out in Qameyu (Northern Tanzania). METHODOLOGY: Sixty-two schoolchildren with suspected cases of tungiasis were examined. Location, number, morphology and symptoms associated with T. penetrans infestation were recorded for each patient. RESULTS: A total of 62 schoolchildren (38 males and 24 females), with ages ranging from 6 to 14 years, were examined. Sixty children were infested by T. penetrans. A total of 865 lesions were observed: 170 lesions were vital and 695 were non-vital. The first and the fifth toes were especially involved. The highest number of lesions observed in a single patient was more than 55 lesions. Pain was reported by 42 children, itching by 39 and difficult walking by 28. One child presented with fever which was considered to be caused by superinfected tungiasis. Complications were nail dystrophy (48 patients), deformity of the fingers or toes (12 patients), scarring (4 patients) and nail loss (4 patients). Thirteen children needed oral antibiotic therapy because of bacterial superinfections. CONCLUSIONS: Tungiasis is a public health concern in this region of Tanzania and it is associated with high morbidity. Improvement in housing hygiene, confining domestic animals and increasing the knowledge of the disease via health education are measures that should be taken to control the disease.

Acral subcutaneous steatocystoma multiplex: a distinct subtype of the disease?

Steatocystoma multiplex (SM) is a hamartomatous malformation of the pilosebaceous duct consisting of dermal cysts filled with a sebum-like material. SM lesions are typically located in areas with sebaceous follicles, although atypical presentations involving sites lacking sebaceous follicles have exceptionally been described. We reviewed retrospectively a series of 32 histologically diagnosed SM observed in our department in the period 2006-2010, evaluating the kinds of lesions and their locations, and family history of SM and associated disorders, to focus on the clinical features of the acral subcutaneous variety of SM and to estimate its prevalence. We found five patients (four women and one man) with asymptomatic deep, skin-colored nodules on the flexor surfaces of distal upper extremities with a mean age at diagnosis and at disease onset of 32.5 and 26 years, respectively. The prevalence was 15%. All five cases were sporadic. The male patient had eruptive syringomas as an associated condition, together with a family history of this tumour. Acral subcutaneous SM may represent a distinct disease variety by virtue of its distinctive clinical features. Dermatologists should be aware of this form, which has to be included in the wide panel of diseases involving subcutaneous tissue.

Vulvar pyoderma gangrenosum with renal involvement.

Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis of unknown etiology which usually occurs over the lower extremities; however, unusual presentations such as that involving the genital region have been described. Extracutaneous involvement of PG in the form of sterile neutrophilic infiltrates in various organs has infrequently been reported. We hereby describe a case of PG that was limited to the vulvar and perianal area in a 37-year-old female, with associated renal involvement in the form of a slight increase in the serum creatinine, microhematuria of glomerular origin and proteinuria. The patient had a rapid response of both her mucocutaneous lesions and renal dysfunction after the initiation of systemic steroids. The present case highlights the importance of evaluating all patients with PG for extracutaneous disease to avoid potentially harmful diagnostic or therapeutic procedures. Two other reasons for interest are the localized presentation of disease on the genital region and the presence of vascular involvement, albeit without signs of true vasculitis, vascular changes possibly being a histological hallmark of PG involving genitalia.

Interactions between inflammation and coagulation in autoimmune and immune-mediated skin diseases.

Inflammation and coagulation systems are simultaneously activated in autoimmune and immune-mediated skin disorders, and the cross-talk that amplifies and maintains their activation seems to have both local and systemic implications. This interplay occurs in bullous pemphigoid (BP), the prototype autoimmune blistering disease in which eosinophil recruitment and thrombin generation locally contribute to the formation of bullae and inflammatory tissue damage. Moreover, the systemic activation of coagulation may explain the increased thrombotic risk observed in BP patients. Atopic dermatitis (AD), a chronically relapsing immune-mediated inflammatory skin disease, also involves the local and systemic activation of coagulation, which means that a prothrombotic state could theoretically develop, although the incidence of thrombosis is not increased in AD patients probably because of their young age. In psoriasis, a erythematous-squamous inflammatory immune-mediated skin disorder, the activation of coagulation seems to be mainly systemic and related to systemic inflammation, thus potentially contributing to the disease-related increase in cardiovascular risk in this disease. The activation of coagulation has also been suggested an additional pathomechanism in dermatitis herpetiformis (DH), a chronic-relapsing autoimmune skin disease associated with gluten sensitivity and celiac disease, but its precise role has not yet been defined. Taken together, these data provide the rationale for controlled clinical trials aimed at evaluating the usefulness of anticoagulant treatment in autoimmune skin disorders to counteract the local and systemic effects of coagulation activation.