Pub Date : 2021-04-12DOI: 10.15226/2378-1726/8/1/001131
Dr Nikhil Oliveira, Prof Dr Georgi Tchernev
Non-melanoma skin cancer (NMSC) is one of the most common cutaneous malignancies, with an ever-increasing incidence rate worldwide [1]. Studies have shown an association between intermittent and chronic sunlight exposure and the development of BCC and SCC respectively [2]. UV radiation is a known carcinogen that can induce mutations in the p53 gene, known also as the guardian of the genome [3]. This can lead to persistent damage and failure to eliminate dysplastic cells as subsequent mechanisms like p21 and p16 activation fail to arrest cell cycle. Proapoptotic proteins such as BAK and BAX are also unable to activate programmed cell death, ultimately leading to the formation of precancerous lesions and NMSC [3, 4].
{"title":"Simultaneous Development of SCC of the head and BCC of the leg: Successful Surgical Approach in Bulgarian patient","authors":"Dr Nikhil Oliveira, Prof Dr Georgi Tchernev","doi":"10.15226/2378-1726/8/1/001131","DOIUrl":"https://doi.org/10.15226/2378-1726/8/1/001131","url":null,"abstract":"Non-melanoma skin cancer (NMSC) is one of the most common cutaneous malignancies, with an ever-increasing incidence rate worldwide [1]. Studies have shown an association between intermittent and chronic sunlight exposure and the development of BCC and SCC respectively [2]. UV radiation is a known carcinogen that can induce mutations in the p53 gene, known also as the guardian of the genome [3]. This can lead to persistent damage and failure to eliminate dysplastic cells as subsequent mechanisms like p21 and p16 activation fail to arrest cell cycle. Proapoptotic proteins such as BAK and BAX are also unable to activate programmed cell death, ultimately leading to the formation of precancerous lesions and NMSC [3, 4].","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83895468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-03-29DOI: 10.15226/2378-1726/8/1/001130
Faris Oumeish, H. Hamad, Hussain Tukmatchy, Niall Scully, M. Al Abadie
Bullous pemphigoid rarely presents in childhood age group and when it presents it has two age peaks infantile and childhood forms. Key presenting features of childhood BP include subepidermal blistering, eosinophilia and severe itching.The histological features of bullous pemphigoid are the same as those described in adulthood and vary with the age of the lesion.Childhood BP tends to have a generally good prognosis with appropriate therapy Keywords: Bullous Pemphigoid; Autoimmune Disorders; Blistering Diseases
{"title":"Bullous Pemphigoid in Children: Clinical Presentation, Pathology and Management","authors":"Faris Oumeish, H. Hamad, Hussain Tukmatchy, Niall Scully, M. Al Abadie","doi":"10.15226/2378-1726/8/1/001130","DOIUrl":"https://doi.org/10.15226/2378-1726/8/1/001130","url":null,"abstract":"Bullous pemphigoid rarely presents in childhood age group and when it presents it has two age peaks infantile and childhood forms. Key presenting features of childhood BP include subepidermal blistering, eosinophilia and severe itching.The histological features of bullous pemphigoid are the same as those described in adulthood and vary with the age of the lesion.Childhood BP tends to have a generally good prognosis with appropriate therapy Keywords: Bullous Pemphigoid; Autoimmune Disorders; Blistering Diseases","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79012956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-02-02DOI: 10.15226/2378-1726/8/1/001129
J. Penev, M. Balabanova, I. Bakardzhiev
Atopic Dermatitis (AD) is probably the most common type of eczema. The quality of life assessment reveals a number of negative consequences for patients with AD and their families. AD is associated with high levels of stress, stigma, social withdrawal, anxiety, depression, and even suicide ideation. Atopic dermatitis is a multisystem inflammatory disease with a multifactorial, and still controversial etiology. Complex interactions between genetic, psychoneuroimmune and endocrine factors, microbiome, exposome and environment, mental and social factors, diet and lifestyle are proposed. AD is difficult to treat, has a chronic course with peaks of exacerbation and pronounced manifestation of mental factors. Such complexity requires deeper understanding of mechanisms behind AD. We consider a possible psychogenic component in diseaseexacerbation, andoffera different point of view onrelationships of human body with the colonizing microbiomein the context of AD etiology and pathogenesis. These relationships are interpreted in evolutionary terms in an attempt to shed some light on mechanisms of chronic and pathological skin processes. Keywords: Atopic Dermatitis; Microbiome; Exposome;Obsessive- Compulsive Disorder
{"title":"Review: Atopic Dermatitis - Exposome, Microbiome, Psyche,and Evolution","authors":"J. Penev, M. Balabanova, I. Bakardzhiev","doi":"10.15226/2378-1726/8/1/001129","DOIUrl":"https://doi.org/10.15226/2378-1726/8/1/001129","url":null,"abstract":"Atopic Dermatitis (AD) is probably the most common type of eczema. The quality of life assessment reveals a number of negative consequences for patients with AD and their families. AD is associated with high levels of stress, stigma, social withdrawal, anxiety, depression, and even suicide ideation. Atopic dermatitis is a multisystem inflammatory disease with a multifactorial, and still controversial etiology. Complex interactions between genetic, psychoneuroimmune and endocrine factors, microbiome, exposome and environment, mental and social factors, diet and lifestyle are proposed. AD is difficult to treat, has a chronic course with peaks of exacerbation and pronounced manifestation of mental factors. Such complexity requires deeper understanding of mechanisms behind AD. We consider a possible psychogenic component in diseaseexacerbation, andoffera different point of view onrelationships of human body with the colonizing microbiomein the context of AD etiology and pathogenesis. These relationships are interpreted in evolutionary terms in an attempt to shed some light on mechanisms of chronic and pathological skin processes. Keywords: Atopic Dermatitis; Microbiome; Exposome;Obsessive- Compulsive Disorder","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86182498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.15226/2378-1726/8/2/001138
Ana Paula Galli Sanchez, Tatiane Ester Aidar Fernandes
Interleukins (IL) IL-4 and IL-13 are key players in diseases in which the Type 2 immune response is predominant, such as atopic dermatitis (AD), asthma, and chronic rhinosinusitis with nasal polyposis (CRSwNP), that are currently being treated with dupilumab. Dupilumab is a fully human IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), preventing both IL-4 and IL-13 mediated signaling. This mini-review summarizes the IL-4 receptor system as well as the mechanism of action of dupilumab. Keywords: IL-4; IL-13; dupilumab; Type 2 immunity Abbreviations AD: Atopic Dermatitis CRSwNP: Chronic Rhinosinusitis with Nasal Polyps DNA: Deoxyribonucleic Acid JAK: Janus Kinase IL: Interleukin IL-4R: Interleukin 4 Receptor IL-4Rα: Interleukin 4 Receptor alpha chain IL-13Rα1: Interleukin 13 Receptor alpha 1 chain IL-13Rα2:Interleukin 13 Receptor alpha 2 chain STAT: Signal Transducer and Activator of Transcription TGF-β: Transforming Growth Factor beta TNF: Tumor Necrosis Factor TYK2: Tyrosine Kinase 2 γc: Common gamma chain
{"title":"The Simultaneous Inhibition of IL‑4 and IL‑13 by Dupilumab","authors":"Ana Paula Galli Sanchez, Tatiane Ester Aidar Fernandes","doi":"10.15226/2378-1726/8/2/001138","DOIUrl":"https://doi.org/10.15226/2378-1726/8/2/001138","url":null,"abstract":"Interleukins (IL) IL-4 and IL-13 are key players in diseases in which the Type 2 immune response is predominant, such as atopic dermatitis (AD), asthma, and chronic rhinosinusitis with nasal polyposis (CRSwNP), that are currently being treated with dupilumab. Dupilumab is a fully human IgG4 monoclonal antibody that targets the IL-4 receptor alpha chain (IL-4Rα), preventing both IL-4 and IL-13 mediated signaling. This mini-review summarizes the IL-4 receptor system as well as the mechanism of action of dupilumab. Keywords: IL-4; IL-13; dupilumab; Type 2 immunity Abbreviations AD: Atopic Dermatitis CRSwNP: Chronic Rhinosinusitis with Nasal Polyps DNA: Deoxyribonucleic Acid JAK: Janus Kinase IL: Interleukin IL-4R: Interleukin 4 Receptor IL-4Rα: Interleukin 4 Receptor alpha chain IL-13Rα1: Interleukin 13 Receptor alpha 1 chain IL-13Rα2:Interleukin 13 Receptor alpha 2 chain STAT: Signal Transducer and Activator of Transcription TGF-β: Transforming Growth Factor beta TNF: Tumor Necrosis Factor TYK2: Tyrosine Kinase 2 γc: Common gamma chain","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76690312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.15226/2378-1726/8/2/001137
Kandathil Lj, O. N, Patterson Jw, Tchernev G
We present a 40-year-old female who visited our clinic with a solitary lesion on the posterolateral aspect of the lower left leg (Figure 1a). She noticed a progressive change in the size and shape of the lesion and decided to consult a dermatologist in March 2021. The patient had a history of Hashimoto’s thyroiditis that was well-controlled onlevothyroxine. No other comorbidities were reported and she was otherwise healthy. During the clinical examination a single pigmented patch measuring 2.5 cm in greatest diameter was identified. Morphologically the lesion was asymmetrical with irregular borders and uneven colour. At the centre, an exudative, ulcerated nodule was also noted (Figure1a-f). Clinical and dermatoscopic findings were consistent with the diagnosis of a superficial spreading cutaneous melanoma. Ultrasound diagnostics of the abdominal cavity and retroperitoneal organs showed no signs of tumor spread. Chest radiography was also within normal limits. Laboratory testing showed an elevated uric acid level of 456 μmol/l (reference range 142 - 340 μmol/l), but otherwise all other parameters were normal. Following the recommended American Joint Committee on Cancer (AJCC) guidelines, we performed a primary resection with 0.5 cm margins in all directions. The resected tissue was subsequently sent for histopathological evaluation and confirmed the diagnosis of borderline intermediate thickness malignant melanoma - class B, 4 mm Breslow thickness, Clark IV, (pT4BN0M0) (Figure2a-d). There was high mitotic activity but no spontaneous regression, insignificant lymphocytic stromal reaction and clear resection margins. Post diagnostic workup, including chest and abdominal CT, showed no signs of metastatic dissemination. One week later, the patient was sent to the National Oncology Hospital for re-excision and Sentinel Lymph Node Biopsy (SLNB). The re-excision of additional 2cm from the previous surgical scar was conducted in parallel with removal of the draining sentinel lymph node (Figures 3a & 3d). The closure of the defect after re-excision led to the unfortunate complication of wound dehiscence and failure to close successfully (Figure 3b-c). However, after several sessions of debridement, cleansing, rebandaging and administration of antibiotics, there was visible improvement with subsequent resolution(Figure 3d-f). Since that time, she has been in excellent condition, and no complications have been reported to date.
{"title":"Borderline Intermediate Thickness Cutaneous Melanoma Class B: Isn’t it Time for Personalised One Step Surgical Approach as Standard Clinical Behaviour?","authors":"Kandathil Lj, O. N, Patterson Jw, Tchernev G","doi":"10.15226/2378-1726/8/2/001137","DOIUrl":"https://doi.org/10.15226/2378-1726/8/2/001137","url":null,"abstract":"We present a 40-year-old female who visited our clinic with a solitary lesion on the posterolateral aspect of the lower left leg (Figure 1a). She noticed a progressive change in the size and shape of the lesion and decided to consult a dermatologist in March 2021. The patient had a history of Hashimoto’s thyroiditis that was well-controlled onlevothyroxine. No other comorbidities were reported and she was otherwise healthy. During the clinical examination a single pigmented patch measuring 2.5 cm in greatest diameter was identified. Morphologically the lesion was asymmetrical with irregular borders and uneven colour. At the centre, an exudative, ulcerated nodule was also noted (Figure1a-f). Clinical and dermatoscopic findings were consistent with the diagnosis of a superficial spreading cutaneous melanoma. Ultrasound diagnostics of the abdominal cavity and retroperitoneal organs showed no signs of tumor spread. Chest radiography was also within normal limits. Laboratory testing showed an elevated uric acid level of 456 μmol/l (reference range 142 - 340 μmol/l), but otherwise all other parameters were normal. Following the recommended American Joint Committee on Cancer (AJCC) guidelines, we performed a primary resection with 0.5 cm margins in all directions. The resected tissue was subsequently sent for histopathological evaluation and confirmed the diagnosis of borderline intermediate thickness malignant melanoma - class B, 4 mm Breslow thickness, Clark IV, (pT4BN0M0) (Figure2a-d). There was high mitotic activity but no spontaneous regression, insignificant lymphocytic stromal reaction and clear resection margins. Post diagnostic workup, including chest and abdominal CT, showed no signs of metastatic dissemination. One week later, the patient was sent to the National Oncology Hospital for re-excision and Sentinel Lymph Node Biopsy (SLNB). The re-excision of additional 2cm from the previous surgical scar was conducted in parallel with removal of the draining sentinel lymph node (Figures 3a & 3d). The closure of the defect after re-excision led to the unfortunate complication of wound dehiscence and failure to close successfully (Figure 3b-c). However, after several sessions of debridement, cleansing, rebandaging and administration of antibiotics, there was visible improvement with subsequent resolution(Figure 3d-f). Since that time, she has been in excellent condition, and no complications have been reported to date.","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88624883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-30DOI: 10.15226/2378-1726/7/5/001128
Ana Paula Galli Sanchez, Tatiane Ester Aidar Fernandes, Gustavo Martelli Palomino
Dozens of cytokines that bind Type I and Type II receptors use the Janus Kinases (JAK) and the Signal Transducer and Activator of Transcription (STAT) proteins pathway for intracellular signaling, orchestrating hematopoiesis, inducing inflammation, and controlling the immune response. Currently, oral JAK inhibitors are being used to treat many inflammatory and myeloproliferative diseases and are also under investigation in several clinical trials for skin diseases. Thus, dermatologists should understand how the JAK-STAT pathway works as well as the mechanism of action of the JAK inhibitors which will certainly become an important part of the dermatologist’s treatment armamentarium in the next few years. Keywords: JAK inhibitors; Janus Kinases; JAK-STAT Pathway List of Abbreviations: AD: Atopic Dermatitis ADP: Adenosine diphosphate Dmards: Disease-Modifying Antirheumatic Drugs JAK: Janus kinase(s) Jaki: Janus kinase Inhibitor(s) PIAS: Protein Inhibitor of Activated STAT P-STAT: Phosphorylated STAT STAT: Signal Transducer and Activator of Transcription TYK2: Tyrosine Kinase 2 Wsxws: Tryptophan-Serine-X-Tryptophan-Serine
结合I型和II型受体的数十种细胞因子使用Janus激酶(JAK)和信号转导和转录激活因子(STAT)蛋白途径进行细胞内信号传导，协调造血，诱导炎症和控制免疫反应。目前，口服JAK抑制剂正被用于治疗许多炎症性和骨髓增殖性疾病，并且在一些皮肤病的临床试验中也在研究中。因此，皮肤科医生应该了解JAK- stat通路是如何工作的，以及JAK抑制剂的作用机制，这必将成为未来几年皮肤科医生治疗手段的重要组成部分。关键词:JAK抑制剂;Janus激酶;JAK-STAT通路简写列表:AD:特应性皮炎ADP:二磷酸腺苷类药物:疾病改善抗风湿药物JAK: Janus激酶(s) Jaki: Janus激酶抑制剂(s) PIAS:活化STAT蛋白抑制剂P-STAT:磷酸化STAT STAT:信号转导和转录激活因子TYK2:酪氨酸激酶2 Wsxws:色氨酸-丝氨酸- x -色氨酸-丝氨酸
{"title":"The JAK-STAT Pathway and the JAK Inhibitors","authors":"Ana Paula Galli Sanchez, Tatiane Ester Aidar Fernandes, Gustavo Martelli Palomino","doi":"10.15226/2378-1726/7/5/001128","DOIUrl":"https://doi.org/10.15226/2378-1726/7/5/001128","url":null,"abstract":"Dozens of cytokines that bind Type I and Type II receptors use the Janus Kinases (JAK) and the Signal Transducer and Activator of Transcription (STAT) proteins pathway for intracellular signaling, orchestrating hematopoiesis, inducing inflammation, and controlling the immune response. Currently, oral JAK inhibitors are being used to treat many inflammatory and myeloproliferative diseases and are also under investigation in several clinical trials for skin diseases. Thus, dermatologists should understand how the JAK-STAT pathway works as well as the mechanism of action of the JAK inhibitors which will certainly become an important part of the dermatologist’s treatment armamentarium in the next few years. Keywords: JAK inhibitors; Janus Kinases; JAK-STAT Pathway List of Abbreviations: AD: Atopic Dermatitis ADP: Adenosine diphosphate Dmards: Disease-Modifying Antirheumatic Drugs JAK: Janus kinase(s) Jaki: Janus kinase Inhibitor(s) PIAS: Protein Inhibitor of Activated STAT P-STAT: Phosphorylated STAT STAT: Signal Transducer and Activator of Transcription TYK2: Tyrosine Kinase 2 Wsxws: Tryptophan-Serine-X-Tryptophan-Serine","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82852703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-06DOI: 10.15226/2378-1726/7/5/001127
G. Tchernev, G. Poterov
The side effects of antihypertensive drugs are often the subject of discussions, publications and presentations, but not in cases where they include in their “palette” or “repertoire” concepts such as generating / promoting or potentiating various types of cancer, as well as metastasis of already existing one. Unfortunately, progress within the real, clinical medicine often does not start with the desired results (from those expected within clinical observations or experimental data after administration of a particular substance or drug). Breakthroughs in medicine and progress start with the careful registration and analysis of unwanted and unexpected, unplanned results. Again, unfortunately, the analysis of it is often swept under the table, without thinking that the negative results should be the generator of progress. When the observations of certain clinical or experimental data remain insufficiently analyzed, neglected or deliberately hidden - the result is often alarming or fatal - similar to the scandals (from 2018) with Sartans and the generation of hundreds of cutaneous melanomas, as well as heterogeneous species and other cancerous forms. However, if we all focus together on the problems through the prism of the possibilities to solve them, there is a real chance to achieve a drastic decrease in the incidence of a number of tumor diseases, due to the possibility of rethinking their pathogenesis. The article is a kind of analysis and directing clinicians in the right direction in relation to an urgent need to clarify issues related to the procarcinogenic effect of drugs from the so-called group of Sartans and Thiazide diuretics. In the first mentioned drugs, the carcinogenic effect could be due to: 1) the action of the main substance of the Sartans themselves (proven in experimental conditions, but also in in vivo data) and 2) the additive, undesirable ingredients or the so-called nitrosamines arising as additional contamination within the production process. The combination of Sartans and Thiazide diuretics (plus Nitrosamines, the presence of which is not adequately tested) could in all likelihood have a fatal, mutually potentiating procarcinogenic effect, leading to the manifestation of 3 or even more cancers simultaneously. This publication presents for the first time in the world literature a patient who developed three cancers at the same time (Kaposi’s sarcoma, skin melanoma and colon cancer) after starting therapy with Valsartan and hydrochlorothiazide. Our critical analysis is focused on the regulatory authorities in the face of the FDA, EMA, but also on the National Agency for Drug Control. Attention is also paid to the non-traditional and illegal from the point of view of all ethical norms ways of influencing the pharmaceutical industry, in order to protect its positions in the framework of the daily emerging world scandals. Keywords: Valsartan, Hydrochlorothiazide; Cutaneous Melanoma; Colon Carcinoma; Kaposi Sarcoma; Drug Indu
{"title":"Drug Induced Cancers: Simultaneously Development of Cutaneous Melanoma, Colon Carcinoma and Kaposi Sarcoma under Valsartan/ Hydrochlorothiazide","authors":"G. Tchernev, G. Poterov","doi":"10.15226/2378-1726/7/5/001127","DOIUrl":"https://doi.org/10.15226/2378-1726/7/5/001127","url":null,"abstract":"The side effects of antihypertensive drugs are often the subject of discussions, publications and presentations, but not in cases where they include in their “palette” or “repertoire” concepts such as generating / promoting or potentiating various types of cancer, as well as metastasis of already existing one. Unfortunately, progress within the real, clinical medicine often does not start with the desired results (from those expected within clinical observations or experimental data after administration of a particular substance or drug). Breakthroughs in medicine and progress start with the careful registration and analysis of unwanted and unexpected, unplanned results. Again, unfortunately, the analysis of it is often swept under the table, without thinking that the negative results should be the generator of progress. When the observations of certain clinical or experimental data remain insufficiently analyzed, neglected or deliberately hidden - the result is often alarming or fatal - similar to the scandals (from 2018) with Sartans and the generation of hundreds of cutaneous melanomas, as well as heterogeneous species and other cancerous forms. However, if we all focus together on the problems through the prism of the possibilities to solve them, there is a real chance to achieve a drastic decrease in the incidence of a number of tumor diseases, due to the possibility of rethinking their pathogenesis. The article is a kind of analysis and directing clinicians in the right direction in relation to an urgent need to clarify issues related to the procarcinogenic effect of drugs from the so-called group of Sartans and Thiazide diuretics. In the first mentioned drugs, the carcinogenic effect could be due to: 1) the action of the main substance of the Sartans themselves (proven in experimental conditions, but also in in vivo data) and 2) the additive, undesirable ingredients or the so-called nitrosamines arising as additional contamination within the production process. The combination of Sartans and Thiazide diuretics (plus Nitrosamines, the presence of which is not adequately tested) could in all likelihood have a fatal, mutually potentiating procarcinogenic effect, leading to the manifestation of 3 or even more cancers simultaneously. This publication presents for the first time in the world literature a patient who developed three cancers at the same time (Kaposi’s sarcoma, skin melanoma and colon cancer) after starting therapy with Valsartan and hydrochlorothiazide. Our critical analysis is focused on the regulatory authorities in the face of the FDA, EMA, but also on the National Agency for Drug Control. Attention is also paid to the non-traditional and illegal from the point of view of all ethical norms ways of influencing the pharmaceutical industry, in order to protect its positions in the framework of the daily emerging world scandals. Keywords: Valsartan, Hydrochlorothiazide; Cutaneous Melanoma; Colon Carcinoma; Kaposi Sarcoma; Drug Indu","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"174 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76906004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-02DOI: 10.15226/2378-1726/7/5/001126
W. I. Kim, K. Hong, Sooyoung Kim, Moon Kyun Cho, K. Whang, Hyun-Sook Kim
Keywords: Pemphigus vulgaris;Modified Regimen;Rituximab biosimilar; IVIG Pemphigus Vulgaris (PV) has been known as fatal autoimmune bullous diseases affecting the skin and mucous membranes. Here, we report that a patient with PV responded rapidly to a modified regimen of rituximab biosimilar (CT-10, Truxima®)combined with Intravenous Immunoglobulin (IVIG). A 53-year-old man presented with extensive erosions due to blistering on the whole body following initial mucosal erosions which started at 3 years ago. Laboratory tests revealed an eosinophil count of 16.7% (normal range: 0~5%) with normal liver and renal functions. Antinuclear antibody was a nuclear membrane pattern with a titer of 1:40. Anti-dsDNA, anti-Ro/La, anti-Scl-70, and anti-phospholipid antibodies were negative. Myeloperoxidase and PR3 antineutrophil cytoplasmic autoantibody were both negative. Histological examination showed suprabasala cantholysis, while direct and indirect immunofluorescence assays demonstrated a deposition of immunoglobulin G (IgG) on anintercellular surface at 1:640 dilutions (Figure. 1a, b). Based on the blistering on the whole body and characteristic biopsy result, the patient was diagnosed as PV. Although he was initially treated with topical and highdose methylprednisolone (1000 mg/day) pulse therapy for 3 consecutive days, there was no significant improvement in skin blistering lesions. We decided to administer CT-P10 combined with IVIG. We treated the patient with CT-P10 (500, 500, and 1000mg once weekly for 3 weeks) combined with IVIG (1g/ kg at first and third week). During the treatment of CT-P10 combined with IVIG, a clinical response rapidly appeared, and levels of antibodies were decreased from 1:640 to 1:40 (Figure. 1c). Disease activity was dramatically controlled within 3 weeks. It achieved the end of the consolidation phase for PV within 5 weeks after starting CT-P10 combined with IVIG (Figure. 1dg). Then, we tapered oral prednisolone and steroid-sparing agents including mycophenolate mofetil and cyclosporine for maintenance therapy. Until now, there has been no recurrence of PV on 36 months follow up.
{"title":"Successful Treatment of Pemphigus Vulgaris with a Modified Regimen of Rituximab Biosimilar(CT-P10) Combined with IVIG","authors":"W. I. Kim, K. Hong, Sooyoung Kim, Moon Kyun Cho, K. Whang, Hyun-Sook Kim","doi":"10.15226/2378-1726/7/5/001126","DOIUrl":"https://doi.org/10.15226/2378-1726/7/5/001126","url":null,"abstract":"Keywords: Pemphigus vulgaris;Modified Regimen;Rituximab biosimilar; IVIG Pemphigus Vulgaris (PV) has been known as fatal autoimmune bullous diseases affecting the skin and mucous membranes. Here, we report that a patient with PV responded rapidly to a modified regimen of rituximab biosimilar (CT-10, Truxima®)combined with Intravenous Immunoglobulin (IVIG). A 53-year-old man presented with extensive erosions due to blistering on the whole body following initial mucosal erosions which started at 3 years ago. Laboratory tests revealed an eosinophil count of 16.7% (normal range: 0~5%) with normal liver and renal functions. Antinuclear antibody was a nuclear membrane pattern with a titer of 1:40. Anti-dsDNA, anti-Ro/La, anti-Scl-70, and anti-phospholipid antibodies were negative. Myeloperoxidase and PR3 antineutrophil cytoplasmic autoantibody were both negative. Histological examination showed suprabasala cantholysis, while direct and indirect immunofluorescence assays demonstrated a deposition of immunoglobulin G (IgG) on anintercellular surface at 1:640 dilutions (Figure. 1a, b). Based on the blistering on the whole body and characteristic biopsy result, the patient was diagnosed as PV. Although he was initially treated with topical and highdose methylprednisolone (1000 mg/day) pulse therapy for 3 consecutive days, there was no significant improvement in skin blistering lesions. We decided to administer CT-P10 combined with IVIG. We treated the patient with CT-P10 (500, 500, and 1000mg once weekly for 3 weeks) combined with IVIG (1g/ kg at first and third week). During the treatment of CT-P10 combined with IVIG, a clinical response rapidly appeared, and levels of antibodies were decreased from 1:640 to 1:40 (Figure. 1c). Disease activity was dramatically controlled within 3 weeks. It achieved the end of the consolidation phase for PV within 5 weeks after starting CT-P10 combined with IVIG (Figure. 1dg). Then, we tapered oral prednisolone and steroid-sparing agents including mycophenolate mofetil and cyclosporine for maintenance therapy. Until now, there has been no recurrence of PV on 36 months follow up.","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"234 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72844310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-15DOI: 10.15226/2378-1726/7/4/001122
Chiyun Wang, H. Chen, Shih-Hao Liu
Pigmented extramammary Paget’s disease (EMPD) is a rare variant which is often confused clinically and histologically with melanoma or other pigmented lesions. Herein, we describe a rare case of pigmented EMPD involving the axilla of a 40-year-old female thought initially to represent malignant melanoma clinically. Immunohistochemically, the neoplastic cells are positive for Estrogen Receptor (ER), Progesterone Receptor (PR), and weakly positive for Human Epidermal Growth Factor Receptor 2 (Her2). A review of the literature reveals that the pigmented variant of EMPD could be easily misdiagnosed as melanoma initially and additional confirmatory studies are almost always needed to confirm the diagnosis. The expression of ER and PR in pigmented EMPD is rarely mentioned previously. We believe it should be further investigated for the understanding of pathogenesis in pigmented EMPD and the potential role of adjuvant hormonal therapy. Keywords: Extramammary Paget’s Disease; Axilla; Estrogen Receptor; Progesterone Receptor
{"title":"Estrogen Receptor and Progesterone Receptor Positive Pigmented Extramammary Paget’s Disease of the Axilla Mimicking Melanoma: A Case Report and Review of the Literature","authors":"Chiyun Wang, H. Chen, Shih-Hao Liu","doi":"10.15226/2378-1726/7/4/001122","DOIUrl":"https://doi.org/10.15226/2378-1726/7/4/001122","url":null,"abstract":"Pigmented extramammary Paget’s disease (EMPD) is a rare variant which is often confused clinically and histologically with melanoma or other pigmented lesions. Herein, we describe a rare case of pigmented EMPD involving the axilla of a 40-year-old female thought initially to represent malignant melanoma clinically. Immunohistochemically, the neoplastic cells are positive for Estrogen Receptor (ER), Progesterone Receptor (PR), and weakly positive for Human Epidermal Growth Factor Receptor 2 (Her2). A review of the literature reveals that the pigmented variant of EMPD could be easily misdiagnosed as melanoma initially and additional confirmatory studies are almost always needed to confirm the diagnosis. The expression of ER and PR in pigmented EMPD is rarely mentioned previously. We believe it should be further investigated for the understanding of pathogenesis in pigmented EMPD and the potential role of adjuvant hormonal therapy. Keywords: Extramammary Paget’s Disease; Axilla; Estrogen Receptor; Progesterone Receptor","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"99 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90407204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-18DOI: 10.15226/2378-1726/7/2/001115
Nwanneka Okwundu, John Moesch, Sarah Belden
Background: Pseudoporyphyria is an uncommon bullous dermatosis. It shares clinical and histological features with porphyria cutanea tarda, but it occurs in the absence of porphyrin metabolic dysfunction. It is characterized by skin fragility, bullae, milia, and scarring on the dorsum of the hands and other sun-exposed areas. Case: We present a patient on naproxen with recurrent pseudoporyphyria of the dorsal hands associated with the consumption of lemon water. Findings: Biopsy showed a pauci-inflammatory sub epidermal vesicle with caterpillar bodies and laboratory studies lacked any urine or serum porphyrin abnormalities. The cutaneous lesions were noted to resolve with discontinuation of the consumption of lemon water. Keywords: Pseudoporyphyria; Porphyrin; Porphyria Cutanea Tarda; Chlorophyll; Vesicle and Depigmented
{"title":"Pseudoporyphyria Associated with Lemon Water and Naproxen","authors":"Nwanneka Okwundu, John Moesch, Sarah Belden","doi":"10.15226/2378-1726/7/2/001115","DOIUrl":"https://doi.org/10.15226/2378-1726/7/2/001115","url":null,"abstract":"Background: Pseudoporyphyria is an uncommon bullous dermatosis. It shares clinical and histological features with porphyria cutanea tarda, but it occurs in the absence of porphyrin metabolic dysfunction. It is characterized by skin fragility, bullae, milia, and scarring on the dorsum of the hands and other sun-exposed areas. Case: We present a patient on naproxen with recurrent pseudoporyphyria of the dorsal hands associated with the consumption of lemon water. Findings: Biopsy showed a pauci-inflammatory sub epidermal vesicle with caterpillar bodies and laboratory studies lacked any urine or serum porphyrin abnormalities. The cutaneous lesions were noted to resolve with discontinuation of the consumption of lemon water. Keywords: Pseudoporyphyria; Porphyrin; Porphyria Cutanea Tarda; Chlorophyll; Vesicle and Depigmented","PeriodicalId":15481,"journal":{"name":"Journal of Clinical Research in Dermatology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83043198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：