Risk of What

Immune Cytokines and Their Receptors in Inflammatory Pain

Importance Large case series suggest that patients with folliculotropic mycosis fungoides (FMF) have a worse prognosis than patients with classic mycosis fungoides (MF). However, recent studies described a subgroup of patients with FMF with a more favorable prognosis. Distinction between indolent and aggressive FMF may have important therapeutic consequences but is hampered by the inability of the current tumor-node-metastasis-blood (TNMB) staging system to classify patients with FMF in a clinically meaningful way. Objective To differentiate between indolent and aggressive FMF using clinicopathological criteria and to define prognostic factors in patients with FMF. Design, Setting, and Participants In this prospective cohort study, we followed 203 patients with FMF, included in the Dutch Cutaneous Lymphoma Registry between October 1985 and May 2014 at a tertiary referral center hosting the Dutch Cutaneous Lymphoma Registry. Overall, 220 patients with FMF had been registered, but 17 patients with incomplete follow-up data or a history of classic MF were excluded. Main Outcomes and Measures Main outcomes included clinical and histological characteristics, disease progression, and survival. Prognostic factors were investigated using Cox proportional hazard regression analysis. Distinction between early plaque-stage FMF and advanced plaque-stage FMF was made by a blinded review of skin biopsy specimens from patients presenting with plaques. Results In a cohort of 147 men and 56 women (median [range] age, 59 [15-93] years), patients with histologically early plaque-stage FMF had a very similar overall survival (OS) rate to patients with only patches and/or follicular papules (10-year OS, 71% vs 80%), while the survival rate of patients with histologically advanced plaque-stage FMF was almost identical to that of patients presenting with tumors (10-year OS, 25% vs 27%). Subsequently, 3 clinical subgroups with significantly different survival data were distinguished: early skin-limited FMF (group A; n = 84; 5-year and 10-year OS, 92% and 72%); advanced skin-limited FMF (group B; n = 102; 5-year and 10-year OS, 55% and 28%); and FMF presenting with extracutaneous disease (group C; n = 17; 5-year and 10-year OS, 23% and 2%). Age at diagnosis, large cell transformation and secondary bacterial infection were independent risk factors for disease progression and/or poor survival. Conclusions and Relevance The results of this study provide useful criteria to differentiate between indolent and aggressive FMF and confirm the existence of a subgroup of FMF with a favorable prognosis.

/pdf/clinical-staging-and-prognostic-factors-in-folliculotropic-4ry17x8zmu.pdf

Clinical Staging and Prognostic Factors in Folliculotropic Mycosis Fungoides

Psoriasis is a common disease, which has a considerable impact on patients and the health care system. Treatment approaches to the disease may be various because some issues are not definitely addressed. Moreover, the therapeutic paradigms are continuously changing because of the recent approval of new treatments for psoriasis such as interleukin (IL)-17 inhibitors and apremilast. In this review, the factors influencing psoriasis severity, the indications for systemic treatments, the overall parameters to be considered in the treatment choice, life style interventions, and the recommendations for the use, screening, and monitoring of systemic therapies available including acitretin, cyclosporine, methotrexate, apremilast, adalimumab, etanercept, infliximab, secukinumab, ixekizumab, and ustekinumab are discussed. Finally, treatment approaches in special patient populations including children, the elderly, pregnant women, patients with a history of neoplasm, and candidates for surgical procedures are reported.

Treatment Approaches to Moderate to Severe Psoriasis.

Cytokines play an important role in the regulation of the immune system (adaptive and innate). Given their importance in proinflammatory processes, cytokines have been used for understanding the pathogenesis and as biomarkers in many diseases. IL-31 and IL-33 are still considered novel cytokines. IL-31 controls signalling and regulates a huge amount of biological functions: it induces proinflammatory cytokines, regulates cell proliferation, and is involved also in tissue remodelling. On the other hand, IL-33 has been identified as an “alarmin” released from the epithelial cells and from different human tissues and organs after a damage following, that is, an inflammatory process. The aim of this literature review is to strengthen the hypothesis about an IL-31/IL-33 axis by evaluating the most recent studies linking these two cytokines. Literature data showed that, in many cases, IL-31 and IL-33 are linked to each other and that their expression is correlated with disease severity. The presence of one interleukin might stimulate the induction of the other, amplifying inflammation and the consequent detrimental processes. In a near future, influencing their balance could be helpful in modulating the first responses of the immune system in order to prevent the development of many inflammation-related diseases.

/pdf/il-33-il-31-axis-a-potential-inflammatory-pathway-4lb1qez4xb.pdf

IL-33/IL-31 Axis: A Potential Inflammatory Pathway

Background Psoriasis is associated with numerous comorbidities, often reported in terms of relative risk. Both doctors and the general population tend to overestimate the effects of exposures when presented in relative terms, leading to anxiety and potentially poor treatment decisions. Absolute risks might provide a better basis for risk assessment. Objective To characterize and compare relative and absolute risks of comorbidities in patients with psoriasis. Methods A systematic review using Medline identified comorbidities associated with psoriasis, their relative risks, and information for calculating absolute risks. Results The comorbidities associated with psoriasis with the highest relative risk were nonmelanoma skin cancer, melanoma, and lymphoma, with relative risks of 7.5, 6.12, and 3.61, respectively; the attributable risk for these 3 conditions were 0.64, 0.05, and 0.17 per 1000 person-years, respectively. To attribute 1 event of these conditions to psoriasis would require seeing 1551; 20,135; and 5823 patients, respectively. Limitations Database studies might not fully account for confounders, resulting in overestimates of the risk impact of comorbidities. Conclusions Presenting attributable risk in the form of the number needed to harm provides a clearer picture of the magnitude of risk and a basis for wiser medical decision making and patient education.

Relative versus absolute risk of comorbidities in patients with psoriasis

Introduction: The incidence of adult acne is increasing worldwide. Despite clinical overlap with conventional acne, it has distinct features.Areas covered: A literature search of English-language review articles, randomized control studies and retrospective studies conducted over the past 30 years was performed using PubMed and Google Scholar. Search terms included acne, adult, topical medication, oral medication and skin of color. We highlight important clinical features and treatment modalities pertinent to the evaluation and management of adult acne. Given the relative dearth of literature detailing treatment options specific to adult acne, we offer expert opinion regarding management of the condition especially in special populations such as skin of color and pregnancy.Expert Opinion: It is unclear whether adult acne represents a distinct entity or a continuum of adolescent disease. Providers may opt to use topical medication as first-line, but should have a low threshold for switching to syst...

Chemical pharmacotherapy options for managing adult acne.

P soriasis, the most common dermatologic immune-mediated disease, affects 2% of the population and is associated with a higher prevalence of chronic pulmonary disease, diabetes mellitus, reduced bone density, peptic ulcer disease, and liver, cardiovascular, and renal disease. Health care providers should accurately interpret and communicate these comorbidities with concerned patients. Journals, books, and media often communicate these associations using relative risk. Unfortunately, doctors and patients overestimate risk when presented on a relative basis, which may lead to anxiety and inappropriate emphasis or attention on a comorbidity. Alternatively, these relationships may be better communicated and understood in terms of absolute level of risk. The excess risk that psoriasis contributes to a disease is best expressed as attributed risk. For instance, the relative risk of developing an abdominal aortic aneurysm (AAA) in patients with mild psoriasis is 1.20 (95% confidence interval, 1.031.39); the attributed risk, the incidence of AAA caused by psoriasis, is 7 per 100,000 population. The incidence of motor vehicle traffic death in the United States is 11 per 100,000 population. Does the comorbidity of AAA, generally an asymptomatic disease, require the attention of the physician? Maybe, but the risk of death to the patient from driving to the clinic requires more attention, and perhaps should take priority. The goal of screening is to prevent or detect latent disease, implement early therapy, and improve prognosis. However, recommendations for

Comorbidities in patients with psoriasis: The role of the dermatologist.

Background: Traditionally, ointments were the vehicle of choice for psoriasis. Poor adherence of traditional vehicles limits the use of topical corticosteroids. Alternative formulations have gained...

Topical 0.25% desoximetasone spray efficacy for moderate to severe plaque psoriasis: a randomized clinical trial

Background: In extensive psoriasis, topical corticosteroids are generally only used to supplement phototherapy and systemic therapy. Spray formulations are easier than other vehicle preparations to...

Desoximetasone 0.25% spray, adrenal suppression and efficacy in extensive plaque psoriasis

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