DOCSLIB.ORG

Table 2. Comparison of Biologic Agents: Mechanisms of Action, Indications, Dosing, and Half-Lives [3, 14, 19-28]

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Table 2. Comparison of Biologic Agents: Mechanisms of Action, Indications, Dosing, and Half-Lives [3, 14, 19-28] Table 2. Comparison of biologic agents: mechanisms of action, indications, dosing, and half-lives [3, 14, 19-28] Drug Mechanism of Action On Label Indications Off Label Indications Dosing Half-Life Remicade Chimeric IgG1κ monoclonal Crohn’s disease; ulcerative colitis; For anti-TNF agents as a class: sarcoidosis; For plaque psoriasis, the recommended dose is 5 7.7-9.5 days (infliximab) antibody (human constant rheumatoid arthritis in combination pyoderma gangrenosum; Behcet's; apthous mg/kg given as an intravenous induction regimen at region and murine variable with methotrexate; ankylosing stomatitis; hidradenitis suppuritiva; pemphigus 0, 2, and 6 weeks, then every 8 weeks. If there is a region) specific for human spondylitis; psoriatic arthritis; vulgaris; graft versus host disease; granuloma suboptimal response , we shorten the interval by 1 tumor necrosis factor-alpha. plaque psoriasis annulare; necrobiosis lipoidica diabeticorum; to 2 weeks to a minimum of every four weeks, and if Binds to both soluble and erythema multiforme; Sweet's syndrome; that does not work, we increase the dose to membrane-bound TNF-alpha. subcorneal pustular dermatosis; vasculitis (e.g., 10mg/kg. Once 10mg/kg at q4weeks fails, it is time Wegener's granulomatosis); pityriasis rubra pilaris; to switch therapies. Infuse over not less than 2 SAPHO syndrome; multicentric hours. Have medication for treatment of reticulohistiocytosis16 hypersensitivity on hand: acetaminophen, antihistamines, corticosteroids, and/or epinephrine. Enbrel Enbrel is a dimeric fusion Rheumatoid arthritis alone or with See infliximab For psoriasis, a starting dose of 50 mg s.c. twice 102 hours (etanercept) protein consisting of the methotrexate; polyarticular juvenile weekly is given for three months followed by 50 mg extracellular ligand-binding idiopathic arthritis ages 2 and up; once weekly. For psoriatic arthritis, the dose is just portion of the human tumor psoriatic arthritis with or without 50mg sc weekly. If proper training is received, the necrosis factor receptor linked methotrexate in patients who do patient can self-administer the medication. Off to the Fc portion of human not respond to methotrexate alone; label: pediatric psoriasis at 0.8mg/kg up to 50mg IgG1. Etancercpt blocks both ankylosing spondylitis; plaque weekly14 TNF-alpha and TNF-beta. psoriasis in adults Therapeutic efficacy recapture rates are very high. Humira Recombinant human IgG1 Rheumatoid arthritis; juvenile See infliximab The recommended dosage for Humira is an initial 2 weeks (adalimumab) monoclonal antibody specific idiopathic arthritis (ages 4 and up); dose of 80 mg followed by 40 mg every other week for human tumor necrosis psoriatic arthritis; ankylosing starting one week after the initial dose. With proper spondylitis; Crohn’s disease; plaque training, the patient can self-administer the © 2012 Dermatology Online Journal factor-alpha. psoriasis medication subcutaneously. Simponi Human IgG1κ monoclonal Adults with rheumatoid arthritis in See infliximab Simponi is given subcutaneously once a month at a 2 weeks (golimumab) antibody that binds to both the combination with methotrexate; dose of 50 mg. With proper training, the patient soluble and transmembrane psoriatic arthritis alone or in can self-administer the medication. bioactive forms of human TNF- combination with methotrexate; alpha ankylosing spondylitis Cimzia Recombinant, humanized Crohn’s disease in adults with See infliximab Rheumatoid arthritis dosing: 400 mg initially and at 2 weeks (certolizumab) antibody Fab’ fragment with moderately to severely active weeks 2 and 4 followed by 200 mg every other specificity for TNF-alpha, disease who have failed week. For maintenance dosing, 400 mg every 4 conjugated to polyethylene conventional therapy; treatment of weeks can be considered. For Crohn’s, 400mg glycol adults with moderately to severely initially and at weeks 2 and 4 followed by 400mg active rheumatoid arthritis. Not every four weeks. indicated for children. Amevive Dimeric fusion protein Moderate to severe plaque Psoriatic arthritis The recommended dose of Amevive is 15 mg given 270 hours (alefacept) consisting of the extracellular psoriasis intramuscularly as an injection once weekly for 12 CD-2 binding portion of the weeks. Another 12 weeks of medication can be human leukocyte function given if CD4+ counts are normal. At least 12 weeks antigen-3 (LFA-3) linked to the must pass between courses. Some extend the initial Fc portion of human IgG1. course to 16 weeks. Use within four hours of Interferes with lymphocyte reconstitution. activation by specifically binding to the lymphocyte antigen, CD2, inhibiting LFA- 3/CD2 interaction. Induces reductions in CD4+ and CD8+ T lymphocyte counts. © 2012 Dermatology Online Journal Stelara Human IgG1κ monoclonal Plaque psoriasis of adults Psoriatic arthritis The recommended dose for patients weighing less 14.9-45.6 days (ustekinumab) antibody against the p40 than 100 kg is 45 mg initially followed by 45 mg subunit of the interleukin-12 given 4 weeks later. Then, 45 mg is given every 12 and -23 cytokines. weeks. If the patient is >100 kg the dose is 90 mg at the same intervals. Stelara is given by subcutaneous injection by a healthcare provider. Rituxan Chimeric murine/human Non-Hodgkin’s lymphoma; chronic Autoimmune mediated blistering diseases (e.g., Rheumatoid arthritis dosing: two IV infusions of 18 days (rituximab) monoclonal IgG1 kappa lymphocytic leukemia; rheumatoid pemphigus vulgaris, bullous pemphigoid); lupus; 1000 mg separated by two weeks every 24 weeks or antibody against CD20 antigen, arthritis in combination with Sjogren's syndrome; antibody-mediated vasculitis based on clinical evaluation but no more often than found on pre-B and mature-B methotrexate in adults failing one (e.g., cryoglobulinemia); dermatomyositis; other every 16 weeks. Administer 100 mg lymphocytes. Not found on or more TNF antagonist therapies antibody-mediated autoimmune disorders methylprednisolone IV or its equivalent 30 minutes hematopoietic stem cells, pro- prior to each infusion to reduce incidence and B-cells, or normal plasma cells. severity of infusion reactions. Also premedicate The Fc domain of rituximab with acetaminophen and an antihistamine before recruits immune effector each infusion. functions to mediate B-cell lysis. Rituxan is detected in the serum for up to six months after therapy. IVIG Not fully elucidated; in PV, Primary humoral Auto-immune blistering diseases (e.g., pemphigus 2g/kg divided over two to four consecutive days for 35 days perhaps triggers consumption immunodeficiency; idiopathic vulgaris, bullous pemphigoid); erythema acute flares – usually 2 to 3 months only. Authors of overexpressed pathological thrombocytopenic purpura; chronic multiforme; chronic urticaria; TEN; pyoderma try to get three doses in one week period if patient antibodies inflammatory demyelinating gangrenosum; systemic lupus erythematosus; cannot do consecutive days; no more than polyneuropathy dermatomyositis; Kawasaki's disease. Approved by 1g/kg/day is a good rule. Have epinephrine at Medicare as an indication for PV (one of many bedside in case of anaphylaxis. Not compatible with instances where insurance coverage drives choice saline, so dilute with D5W. Use only 18 gauge of medication over and above FDA) needle to penetrate the stopper from the 10mL vial; 16 gauge needles or dispensing pins for the 25mL vials and larger. Infuse at rate of 0.01mL/kg/min for © 2012 Dermatology Online Journal first 30 minutes, then increase to 0.02mL/kg/min in 15 minutes, then increase by 0.02mL/kg/min every 15 minutes to maximum of 0.08mL/kg/min17. Store no longer than 6 months at room temperature, 36 months at 2-8oC. In those predisposed to thrombotic events, use the minimum infusion rate practicable. © 2012 Dermatology Online Journal .
Load more

Recommended publications
  • Tinea Versicolor Mimicking Pityriasis Rubra Pilaris
    Tinea Versicolor Mimicking Pityriasis Rubra Pilaris Capt Matthew J. Darling, MC, USAF; CPT Matthew C. Lambiase, MC, USA; Capt R. John Young, MC, USAF Tinea versicolor is a common noninvasive cuta- neous fungal disease. We recount a case of tinea versicolor that mimicked type I (classic adult) pityriasis rubra pilaris. A 54-year-old white man reported a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and treatment with oral antihistamines. Results of a skin examination revealed erythematous plaques; islands of spared skin; and follicular erythematous keratotic papules on the trunk, shoulders, and upper arms. A lesion was scraped to obtain skin scales for potassium hydroxide staining. Examination of the stained samples revealed the characteristic “spaghetti and meatballs,” confirming the diagnosis. Cutis. 2005;75:265-267. Case Report A 54-year-old white man presented with a 20-year history of a recurrent pruritic eruption that had marginally improved with use of selenium sulfide shampoo and oral antihistamine therapy. Erythem- atous scaly plaques were noted over the trunk and extremities (Figure 1). Islands of spared skin were most notable on the trunk (Figure 2). Follicular, erythematous, keratotic papules were noted on the shoulders and upper arms (Figure 3). Results of Wood lamp examination revealed a yellow-green Figure 1. Erythematous scaly plaques and islands of fluorescence of the plaques. Results of potassium spared skin on the chest. hydroxide (KOH) staining revealed numerous yeast and hyphae. The patient was diagnosed with tinea versicolor and treated with itraconazole 200 mg/d for 2 weeks.
    [Show full text]
  • Skin Test Christina P
    SKINTEST Skin Test Christina P. Linton 1. A middle-aged, diabetic woman presents with 6. What is the estimated 5-year survival rate for well-demarcated, yellow-brown, atrophic, telangiectatic melanoma that has spread beyond the original area plaques with a raised, violaceous border on her shins. of involvement to the nearby lymph nodes (but What is the most likely diagnosis? not to distant nodes or organs)? a. Lipodermatosclerosis a. 25% b. Pyoderma gangrenosum b. 41% c. Necrobiosis lipoidica c. 63% d. Erythema nodosum d. 87% 2. Which of the following types of fruit is most likely 7. What is another name for leprosy? to cause phytophotodermatitis? a. von Recklinghausen’s disease a. Pineapple b. MuchaYHabermann disease b. Grapefruit c. Schamberg’s disease c. Kiwi d. Hansen’s disease d. Peach 8. Which of the following is not an expected 3. Hypothyroidism can cause several changes to the skin extracutaneous finding in patients with and skin appendages including all of the following, HenochYScho¨ nlein purpura? except: a. Abdominal pain a. Hyperpigmentation b. Hematuria b. Easy bruising c. Shortness of breath c. Thin, brittle nails d. Arthralgias d. Dry, coarse skin 9. When the term ‘‘papillomatous’’ is used to describe 4. In a patient with neurofibromatosis, which sign refers a skin lesion, it means that the lesion is to the presence of bilateral axillary freckling? a. characterized by multiple fine surface projections. a. Auspitz sign b. erupting like a mushroom or fungus. b. Crowe sign c. characterized by fine fissures and cracks in the skin. c. Russell sign d. sieve like and contains many perforations.
    [Show full text]
  • Skin Lesions in Diabetic Patients
    Rev Saúde Pública 2005;39(4) 1 www.fsp.usp.br/rsp Skin lesions in diabetic patients N T Foss, D P Polon, M H Takada, M C Foss-Freitas and M C Foss Departamento de Clínica Médica. Faculdade de Medicina de Ribeirão Preto. Universidade de São Paulo. Ribeirão Preto, SP, Brasil Keywords Abstract Skin diseases. Dermatomycoses. Diabetes mellitus. Metabolic control. Objective It is yet unknown the relationship between diabetes and determinants or triggering factors of skin lesions in diabetic patients. The purpose of the present study was to investigate the presence of unreported skin lesions in diabetic patients and their relationship with metabolic control of diabetes. Methods A total of 403 diabetic patients, 31% type 1 and 69% type 2, underwent dermatological examination in an outpatient clinic of a university hospital. The endocrine-metabolic evaluation was carried out by an endocrinologist followed by the dermatological evaluation by a dermatologist. The metabolic control of 136 patients was evaluated using glycated hemoglobin. Results High number of dermophytosis (82.6%) followed by different types of skin lesions such as acne and actinic degeneration (66.7%), pyoderma (5%), cutaneous tumors (3%) and necrobiosis lipoidic (1%) were found. Among the most common skin lesions in diabetic patients, confirmed by histopathology, there were seen necrobiosis lipoidic (2 cases, 0.4%), diabetic dermopathy (5 cases, 1.2%) and foot ulcerations (3 cases, 0.7%). Glycated hemoglobin was 7.2% in both type 1 and 2 patients with adequate metabolic control and 11.9% and 12.7% in type 1 and 2 diabetic patients, respectively, with inadequate metabolic controls.
    [Show full text]
  • The Prevalence of Cutaneous Manifestations in Young Patients with Type 1 Diabetes
    Clinical Care/Education/Nutrition/Psychosocial Research ORIGINAL ARTICLE The Prevalence of Cutaneous Manifestations in Young Patients With Type 1 Diabetes 1 2 MILOSˇ D. PAVLOVIC´, MD, PHD SLAANA TODOROVIC´, MD tions, such as neuropathic foot ulcers; 2 4 TATJANA MILENKOVIC´, MD ZORANA ÐAKOVIC´, MD and 4) skin reactions to diabetes treat- 1 1 MIROSLAV DINIC´, MD RADOSˇ D. ZECEVIˇ , MD, PHD ment (1). 1 5 MILAN MISOVIˇ C´, MD RADOJE DODER, MD, PHD 3 To understand the development of DRAGANA DAKOVIC´, DS skin lesions and their relationship to dia- betes complications, a useful approach would be a long-term follow-up of type 1 OBJECTIVE — The aim of the study was to assess the prevalence of cutaneous disorders and diabetic patients and/or surveys of cuta- their relation to disease duration, metabolic control, and microvascular complications in chil- neous disorders in younger type 1 dia- dren and adolescents with type 1 diabetes. betic subjects. Available data suggest that skin dryness and scleroderma-like RESEARCH DESIGN AND METHODS — The presence and frequency of skin mani- festations were examined and compared in 212 unselected type 1 diabetic patients (aged 2–22 changes of the hand represent the most years, diabetes duration 1–15 years) and 196 healthy sex- and age-matched control subjects. common cutaneous manifestations of Logistic regression was used to analyze the relation of cutaneous disorders with diabetes dura- type 1 diabetes seen in up to 49% of the tion, glycemic control, and microvascular complications. patients (3). They are interrelated and also related to diabetes duration. Timing RESULTS — One hundred forty-two (68%) type 1 diabetic patients had at least one cutaneous of appearance of various cutaneous le- disorder vs.
    [Show full text]
  • Pityriasis Rubra Pilaris: a Rare Inflammatory Dermatosis Aine Kelly, Aoife Lally
    BMJ Case Reports: first published as 10.1136/bcr-2017-224007 on 11 February 2018. Downloaded from Images in… Pityriasis rubra pilaris: a rare inflammatory dermatosis Aine Kelly, Aoife Lally Department of Dermatology, St DESCRIPTION Vincent’s University Hospital, An 18-year-old Caucasian woman presented with Dublin, Ireland a 2-week history of a pruritic rash commencing on the face and spreading distally to the trunk Correspondence to and limbs. There were no associated systemic Dr Aine Kelly, 107545606@ umail. ucc. ie symptoms. Her medical history was unremark- able and there was a family history of hypothy- Accepted 19 January 2018 roidism. Physical examination revealed extensive confluent scaly erythema with islands of sparing on the trunk and scaling of the scalp. There was hyperkeratotic plugging of the hair follicles (figure 1 and figure 2). There was a waxy orange keratoderma affecting the palms and soles with associated painful fissuring (figure 3). A clinical Figure 2 Close-up view of trunk showing small diagnosis of pityriasis rubra pilaris (PRP) was follicular papules with central keratin plug. made. Histopathology of involved skin showed focal parakeratosis and orthokeratosis alter- nating in both horizontal and vertical directions with an underlying perivascular inflammatory infiltrate. The patient had a raised thyroid stimu- lating hormone (TSH) and normal T4 indicative of subclinical hypothyroidism. Treatment for her skin was initiated with methotrexate and titrated to a dose of 15 mg weekly. There was complete http://casereports.bmj.com/ Figure 3 Waxy orange keratoderma affecting the palms and soles with associated painful fissuring. remission at 16 weeks. This case fits the descrip- tion of classical adult-type PRP.
    [Show full text]
  • Response of Ulcerated Necrobiosis Lipoidica to Clofazimine
    Letters to the Editor 651 Response of Ulcerated Necrobiosis Lipoidica to Clofazimine Frauke Benedix, Annette Geyer, Verena Lichte, Gisela Metzler, Martin Röcken and Anke Strölin* Department of Dermatology, University Hospital of Tuebingen, Liebermeisterstrasse 25, DE-72076 Tuebingen, Germany. *E-mail: anke.stroelin@med. uni-tuebingen.de Accepted May 25, 2009. Sir, The patient was referred to our department with multiple, Necrobiosis lipoidica (NL) is a chronic granulomatous pre-tibial brownish-livid, bizarrely configured, partly sclerotic maculae and plaques, pronounced central atrophy and several inflammatory disease of the skin of unknown aetiology, fibrinous ulcerations. which can be associated with diabetes mellitus. NL is Chronic venous insufficiency and peripheral arterial occlusion characterized by slowly growing initially erythematous were excluded by digital photoplethysmography, arterial and plaques that turn into yellow-brown, partly telangiectatic venous dopplersonography. Laboratory tests showed normal and atrophic scars. Ulcerations occur in approximately liver enzymes, creatinine and blood count. Borrelia serology, anti-nuclear antibody screening and HbA1c were in normal 35% of cases. ranges. Microbiological swabs detected Staphylococcus aureus Many therapies have been recommended for this without clinical signs of local inflammation. chronic disease; nevertheless, therapeutic success The biopsy showed granulomatous inflammation involving the is rare. We report here the successful treatment of entire corium and the upper subcutaneous fat tissue, with homo- ulcerated NL with clofazimine, without noteworthy genous necrobiosis lined by epithelioid histiocytes, foreign body giant cells and lymphoid cell aggregates with germinal centres, side-effects. as well as lymphoplasmacellular infiltrations around the vessels. Histology thus confirmed the diagnosis of NL (Fig. 1a). As the previous therapies were without effect, we started anti- CASE REPORT inflammatory treatment with clofazimine, 100 mg/day.
    [Show full text]
  • Treatment of Refractory Pityriasis Rubra Pilaris with Novel Phosphodiesterase 4
    Letters Discussion | Acrodermatitis continua of Hallopeau, also Additional Contributions: We thank the patient for granting permission to known as acrodermatitis perstans and dermatitis repens, publish this information. is a rare inflammatory pustular dermatosis of the distal fin- 1. Saunier J, Debarbieux S, Jullien D, Garnier L, Dalle S, Thomas L. Acrodermatitis continua of Hallopeau treated successfully with ustekinumab gers and toes. It is considered a variant of pustular psoriasis and acitretin after failure of tumour necrosis factor blockade and anakinra. or, less commonly, its own pustular psoriasis-like indepen- Dermatology. 2015;230(2):97-100. 1 dent entity. Precise pathophysiology and incidence 2. Kiszewski AE, De Villa D, Scheibel I, Ricachnevsky N. An infant with are unknown. Case literature suggests predominance in acrodermatitis continua of Hallopeau: successful treatment with thalidomide women, but the disease affects both sexes and, rarely, and UVB therapy. Pediatr Dermatol. 2009;26(1):105-106. children.2 3. Jo SJ, Park JY, Yoon HS, Youn JI. Case of acrodermatitis continua accompanied by psoriatic arthritis. J Dermatol. 2006;33(11):787-791. Acrodermatitis continua of Hallopeau initially presents 4. Sehgal VN, Verma P, Sharma S, et al. Acrodermatitis continua of Hallopeau: as erythema overlying the distal digits that evolves into evolution of treatment options. Int J Dermatol. 2011;50(10):1195-1211. pustules.2 The nail bed is often involved, with paronychial 5. Lutz V, Lipsker D. Acitretin- and tumor necrosis factor inhibitor-resistant 3 and subungual involvement and atrophic skin changes. acrodermatitis continua of Hallopeau responsive to the interleukin 1 receptor Most patients experience a chronic, relapsing course involv- antagonist anakinra.
    [Show full text]
  • Successful Treatment of Refractory Pityriasis Rubra Pilaris With
    Letters Discussion | The results of this study reveal important differ- OBSERVATION ences in the microbiota of HS lesions in obese vs nonobese pa- tients. Gut flora alterations are seen in obese patients,4,5 and Successful Treatment of Refractory Pityriasis HS has been associated with obesity. It is possible that altered Rubra Pilaris With Secukinumab gut or skin flora could have a pathogenic role in HS. Pityriasis rubra pilaris (PRP) is a rare inflammatory skin dis- Some of the limitations of the present study include the order of unknown cause. It is characterized by follicular use of retrospective data and the lack of a control group con- hyperkeratosis, scaly erythematous plaques, palmoplantar sisting of patients with no history of HS. Although these cul- keratoderma, and frequent progression to generalized tures were obtained from purulence extruding from HS le- erythroderma.1 Six types of PRP are distinguished, with type sions, the bacterial culture results could represent skin or gut 1 being the most common form in adults. Disease manage- flora contamination. Information about the specific ana- ment of PRP is challenging for lack of specific guidelines. Topi- tomic locations of HS cultures was not available. Because only cal emollients, corticosteroids, and salicylic acid alone or com- the first recorded culture of each patient was analyzed, it is un- bined with systemic retinoids, methotrexate, and tumor known if the culture results would change with time and fur- necrosis factor (TNF) inhibitors are considered to be most ther antibiotic therapy. The use of data obtained from swab- helpful.2,3 Unfortunately, PRP often resists conventional treat- based cultures may also represent a potential limitation because ment.
    [Show full text]
  • Successful Treatment of Ulcerative and Diabeticorum
    Letters 1. Picardi A, Pasquini P, Cattaruzza MS, et al. Psychosomatic factors in first- Another prevalent transverse linear crease of the face, the onset alopecia areata. Psychosomatics. 2003;44(5):374-381. nasal crease, appears across the lower third of the nasal dor- 2. Vannatta K, Gartstein MA, Zeller MH, Noll RB. Peer acceptance and social sum. In some cases, changes of pigmentation, milia, or pseudo- behavior during childhood and adolescence: how important are appearance, comedones are present along the nasal crease.5 Transverse na- athleticism, and academic competence? Int J Behav Dev. 2009;33(4): 303-311. sal milia in the absence of a transverse nasal crease are less frequently reported. Recently, our research team6 reported a OBSERVATION case of seborrheic keratosis–like hyperplasia and horn cysts aligned along this crease. These findings were attributed to the Deep Labiomental Fold With Pseudocomedones fact that the triangular cartilage and the alar cartilage attach The labiomental fold is a transverse indentation of the face, in a linear fashion at the junction of the middle and lower third which marks the intersection of the lower lip and chin.1 It plays of the nose, producing a potential embryonic fault line in which a significant role in movement of the lower lip and in facial ex- retention cysts presenting as milia and comedones can occur.5 pression. We describe herein a child with a linear pattern of Early acne lesions favor the forehead, nose, and chin in microcomedones located along a deep labiomental fold. many children. Although many times overlooked, the exter- nal ear is another common location for open and closed com- Report of a Case | A 7-year-old healthy girl presented with a line edones in young patients with acne.7 We think that the com- of black papules on her chin.
    [Show full text]
  • Chest Scars P.27 4
    DERM CASE DERM CASE Test your knowledge wTeitsht ymouulrtikpnleo-wchleodicgee cwaisthes multiple-choice cases This month – 6 cases: 1. Chest Scars p.27 4. Torso Clusters p.30 2. Redish-Brown Plaques p.28 5. Face Protrusions p.31 3. Demarcated Facial Birthmark p.29 6. Hypopigmented Papules p.32 Case 1 Chest Scars This gentleman has developed these skin lesions on his chest. He used to excessively pick his cystic acne, which was in the same area. What is your diagnosis? a. Dermatofibroma protuberans b. Keloid scar c. Perifollicular fibroma d. Angio fibroma Answer Keloid scar (answer b) , which is excessive connec - tive tissue proliferation following an injury. Therapy: No good therapy is available for Pathogenesis: Predisposing factors for keloid for - keloids. Never make any bold promises. Simple re- mation are: excision almost never works and oftentsigonifnicantly • Ethnic factors: Keloids are far more common in worsens th©e problem. ibu blacks. Treatmtent: Possibilities tinrcludead–,corticosteroid h is nlo • Location: Sternum, shoulders, neck (after iingjection, tangenltiaDl debudlkoiwng excision, and exci - yr ia an se thyroid operation), ear lobes (piercing), apnkles, sion and ccoveragerswcith skinalgruaft can be considered o er use son shins, over clavicle, edge of chin, and other sites monly if itedis certaipnetrhat the new wound can heal C ris for m tho py where skin tension is generally increaseCd. o . Auunder lcesos skin tension with exogenous pressure r ited gle • Type of injury: Burns and infections morheiboften saipnplied and that the graft donor site can be placed e pro t a form keloids, leading to aconltractusrees and prin under prophylactic pressure.
    [Show full text]
  • Necrobiosis Lipoidica with Superimposed Pyoderma Vegetans
    CASE REPORT Necrobiosis Lipoidica With Superimposed Pyoderma Vegetans Carl J. Barrick, DO; Omobola Onikoyi, DO; Nektarios I. Lountzis, MD; Tanya Ermolovich, DO; Stephen M. Purcell, DO foul odor was noted in the area underlying the lesion. PRACTICE POINTS Initial punch biopsy demonstrated epidermal hyperplasia • Necrobiosis lipoidica (NL), a chronic granulomatous with neutrophil-rich sinus tracts consistent with pyoderma disease characterized by collagen degeneration, vegetans (PV)(Figure 2A). Tissue culture was positive for granulomatous formation, and endothelial-wall thick- Staphylococcus aureus and Streptococcus anginosus. Cultures ening, is most often seen in association with insulin- for both fungi and acid-fast bacilli were negative for growth. dependent diabetes mellitus (DM). The patient was treated with mupirocin ointment 2% • Asymptomatic, well-circumscribed, violaceous pap- and 3 months of cephalexin 250 mg twice daily, which ules and nodules coalesce into plaques on the lower cleared the purulent crust; however, serous drainage, extremities, face, or trunk in NL. ulceration, and erythemacopy persisted. The patient needed an • Treatment mainstay is topical and intralesional extended course of antibiotics, which had not been previ- corticosteroids at active borders of lesions. Other ously administered to clear the purulence. During this treat- treatments used with some success include tumor ment regimen, the patient’s DM remained uncontrolled. necrosis factor α inhibitors, topical tretinoin, topical tacrolimus, and skin grafting. Control and manage- notA second deeper punch biopsy revealed a layered gran- ment of DM can be helpful. ulomatous infiltrate with sclerosis throughout the dermis most consistent with necrobiosis lipoidica (NL)(Figure 2B). Direct immunofluorescence biopsy was negative. Once the Necrobiosis lipoidica (NL) is a granulomatous inflammatory skin PV was clear, betamethasone dipropionate ointment 0.05% disease strongly associated with diabetes mellitus (DM).
    [Show full text]
  • A Novel Case of Recalcitrant Juvenile Pityriasis Rubra Pilaris with Response to Bexarotene Andrew P
    erimenta xp l D E e r & m l a a t c o i l n o i Journal of Clinical & Experimental Word et al. J Clin Exp Dermatol Res 2011, 2:7 l g y C f R DOI: 10.4172/2155-9554.1000131 o e l ISSN: 2155-9554 s a e n a r r u c o h J Dermatology Research Case Report Open Access A Novel Case of Recalcitrant Juvenile Pityriasis Rubra Pilaris with Response to Bexarotene Andrew P. Word*, Mahir Patel and Alan Menter M Baylor University Medical Center, Department of Dermatology, Dallas, TX, USA Abstract Pityriasis rubra pilaris (PRP) is generally treated with single or combination regimens of topical agents, systemic retinoids, methotrexate, biologics, various other immunosuppressant agents, and light therapy; however, cases of PRP that are not amenable to these therapies can be challenging to control. We present the case of a male with biopsy-proven juvenile PRP followed for ten years, with failure to respond to all traditional treatment regimens. Significant improvement in the patient’s cutaneous and rheumatological symptoms occurred when the patient was treated with bexarotene (Targretin®). To our knowledge, this represents the first reported successful treatment of PRP with bexarotene. Thus, treatment with bexarotene may represent a beneficial option for cases of PRP recalcitrant to traditional treatment modalities. Keywords: Bexarotene; Pityriasis rubra pilaris; Targretin At follow-up after two years of continuous bexarotene treatment, the now 16-year-old patient’s cutaneous condition had improved Abbreviations: PRP: Pityriasis Rubra Pilaris dramatically. The severity and frequency of erythrodermic flares and What’s already known about this topic? joint complaints had decreased.
    [Show full text]