Archives of dermatology最新文献

OBJECTIVE To study a picosecond 755-nm alexandrite laser for the removal of tattoos to confirm the efficacy of this therapy, focusing on the effect of therapy on the target lesion as well as the surrounding tissues and quantifying the number of necessary treatments. DESIGN Fifteen patients with tattoos were enrolled. Treatments were scheduled approximately 6 ± 2 weeks apart. Standard photographs using 2-dimensional imaging were taken at baseline, before each treatment, and 1 month and 3 months after the last treatment. SETTING Dermatology clinic at SkinCare Physicians in Chestnut Hill, Massachusetts. PATIENTS Fifteen patients with darkly pigmented tattoos. MAIN OUTCOME MEASURES Treatment efficacy was assessed by the level of tattoo clearance in standard photographs. These photographs were assessed by a blinded physician evaluator and based on a 4-point scale. Efficacy was also assessed based on physician and patient satisfaction measured on a 4-point scale. RESULTS Twelve of 15 patients with tattoos (80%) completed the study. All 12 patients obtained greater than 75% clearance. Nine patients (75%) obtained greater than 75% clearance after having 2 to 4 treatments. The average number of treatment sessions needed to obtain this level of clearance was 4.25. All 12 patients (100%) were satisfied or extremely satisfied with the treatment. Adverse effects included pain, swelling, and blistering. Pain resolved immediately after therapy, while the swelling and blistering resolved within 1 week. Hypopigmentation and hyperpigmentation were reported at the 3-month follow-up. CONCLUSION The picosecond 755-nm alexandrite laser is a safe and very effective procedure for removing tattoo pigment.

OBJECTIVE To compare the efficacy of ustekinumab with that of other biological agents using the Psoriasis Area and Severity Index (PASI) among adult patients with moderate to severe plaque psoriasis. DATA SOURCES We conducted a systematic search of the period January 31, 1992, to February 1, 2012, using MEDLINE (PubMed), Embase, the Cochrane Library, and clinicaltrials.gov. STUDY SELECTION We included randomized controlled trials of biological agents compared with placebo or other biological agents using the PASI in patients who had moderate to severe plaque psoriasis. DATA EXTRACTION Study data were extracted independently by 2 of us, with disagreement resolved by consensus. Data extracted included the size of the trial, follow-up period, age range of patients, disease duration, body surface area involvement, baseline PASI, PASI response, and previous treatment with biological agents. DATA SYNTHESIS A Bayesian network meta-analysis was performed by fitting 3 regression models: a fixed-effects model, a random-effects model, and a random-effects model with meta-regression coefficients. The random-effects model achieved the best fit for these data. In pairwise comparisons, ustekinumab use was associated with statistically significantly higher odds for achieving a 75% reduction in the PASI compared with adalimumab use (odds ratio [OR], 1.84; 95% credible interval [CrI], 1.01-3.54), alefacept use (OR, 10.38; CrI, 3.44-27.62), and etanercept use (OR, 2.07; 95% CrI, 1.42-3.06) but was associated with lower odds compared with infliximab use (OR, 0.36; 95% CrI, 0.14-0.82) . In the therapeutic class comparison, the interleukin-12/23 inhibitor had the highest odds for achieving a 75% reduction in the PASI compared with placebo (OR, 69.48; 95% CrI, 36.89-136.46), followed by tumor necrosis factor inhibitors (OR, 42.22; 95% CrI, 27.94-69.34) and the T-cell inhibitor (OR, 5.63; 95% CrI, 1.35-24.24). CONCLUSION For the treatment of moderate to severe plaque psoriasis, ustekinumab may be more efficacious than adalimumab, etanercept, and alefacept but not infliximab.

OBJECTIVE To determine if there are differences in the expression of programmed death-1 (PD-1) between SS and MF, and in particular erythrodermic MF (E-MF). PD-1 is a marker of follicular helper T (TFH) cells and is expressed by the neoplastic T cells of some types of malignant T-cell lymphoma, including mycosis fungoides (MF) and Sézary syndrome (SS). Reported results of PD-1 staining in MF and SS are, however, conflicting. DESIGN Formalin-fixed, paraffin-embedded skin biopsy specimens were stained for PD-1. In addition, PD-1+ cases were stained with antibodies against BCL6, CXCL13, and CD10 to find possible relationship with TFH cells. SETTING Tertiary referral center for cutaneous lymphomas. PATIENTS Twenty-seven patients with SS and 60 patients with MF, including 8 patients with E-MF. RESULTS In patients with SS, expression of PD-1 by more than 50% of the neoplastic T cells was observed in 24 of 27 cases (89%). In contrast, PD-1 expression by more than 50% of neoplastic T cells was found in only 8 of 60 patients with MF (13%), including only 1 of 8 patients with E-MF (12%). In PD-1+ cases, serial skin sections showed that CXCL13 and BCL6 generally stained 25% to 50% of the PD-1+ cells, while expression of CD10 was uncommon. CONCLUSION The results of the present study show differential expression of PD-1 between SS and MF/E-MF, which provides further support for the view that SS and MF are distinct entities.