An oral manifestation of IBD: Pyostomatitis vegetant, about two cases

INTRODUCTION

Pyostomatitis vegetan (PV) is often associated with chronic inflammatory bowel disease (IBD).

OBSERVATION

Two cases of PV are reported. Case number 1 is a 66-year-old patient treated with infliximab for ulcerative colitis (UC). He presented himself with rapidly progressing crusty, whitish, ulcerated lesions on his lips. Diagnosis of PV was made after biopsy. Regression of oral lesions was favourable with local application of dermocorticoids while continuing infliximab treatment. Case number 2 is a 20-year-old patient treated with infliximab for Crohn's disease (CD). She had cheilitis and angular cheilitis. Diagnosis of PV was made after biopsy. The evolution was favourable after treating with topical dermocorticoids.

DISCUSSION

PV is associated in 75% of the cases with IBD. The digestive check-up is systematic. Diagnostic delay is often noted. Topical dermocorticoids are the first line of therapy.

Optimization of placebo use in clinical trials with systemic treatments for atopic dermatitis: an International Eczema Council survey-based position statement

BACKGROUND

As novel systemic therapeutics for patients with atopic dermatitis (AD) are developed, ethical and methodological concerns regarding placebo-controlled-trials (PCT) have surfaced.

OBJECTIVE

To guide the design and implementation of PCT in AD, focusing on trials with systemic medications.

METHODS

A subgroup of the International Eczema Council (IEC) developed a consensus e-survey, which was disseminated to IEC members.

RESULTS

The response rate was 43/82 (52%). Consensus was reached on 24/27 statements and on 3/11 options from multiple-selection statements, including: performing monotherapy studies in proof-of-concept phases; avoiding concomitant topical corticosteroids or calcineurin inhibitors until a predefined timepoint as rescue (borderline consensus); selection of sites and assessors with recognized expertise in AD clinical trials; clear definition and identification of baseline disease severity; minimizing time and proportion of patients on placebo; using daily emollients with several options provided; instigating open-label extension studies for enrolment after a predefined timepoint; and including outcomes which set a higher bar for disease clearance.

CONCLUSION

Conducting PCT in AD requires balancing several, sometimes opposing principles, including ethics, methodology, regulatory requirements and real-world needs. This paper can provide a framework for conducting PCT with systemic medications for patients with AD.

The RAPid COmmunity COGnitive screening Programme (RAPCOG): Developing the Portuguese version of the Quick Mild Cognitive Impairment (Qmci-P) screen as part of the EIP on AHA Twinning Scheme

As populations age and the prevalence of cognitive impairment increases, healthcare professionals and researchers require short, validated cognitive screening instruments (CSIs). As part the EIP-on-AHA Twinning Support Scheme (2016), four reference sites developed the RAPid COmmunity COGnitive screening Programme (RAPCOG) twinning project to validate translated versions of the Quick Mild Cognitive Impairment (Qmci) screen that could be adapted quickly for use with future eHealth screening and assessment programmes. Here we present the cultural adaption and translation of the Qmci-Portuguese (Qmci-P) screen as part of RAPCOG and explore its subsequent validation against two commonly-used CSIs (MMSE-P and MoCA-P) with 93 participants aged ≥65, attending ten day care centres or resident in two long-term care institutions; median age 74 (+/-15), 66% female. The Qmci-P's internal consistency was high (Cronbach's Alpha 0.82), compared with the MoCA (0.79) and SMMSE (0.54). Qmci-P screen scores moderately correlated with the SMMSE (r=0.61, 95% CI:0.45-0.72, p<0.001) and MoCA (r=0.63, 95% CI:0.36-0.80, p<0.001). The Qmci-P screen demonstrates high internal consistency and concurrent validity against more established CSIs and given its brevity (3-5mins), may be preferable for use in community settings. This project shows the potential of the EIP-on-AHA Twinning initiative to promote the scaling-up of innovative good practices.

Clinical Response in Plaque Psoriasis Patients Switching from Etanercept to Certolizumab Pegol in a Phase 3, Randomized, Controlled Study

Abstract not available. Disclosures: Study sponsored by Dermira. Copyright 2018 SKIN

E. Durability of Response in Patients with Chronic Plaque Psoriasis Treated with Certolizumab Pegol over 48 Weeks: Pooled Results from Ongoing Phase 3, Multicenter, Randomized, Placebo-Controlled Studies (CIMPASI-1, CIMPASI-2 and CIMPACT)

Abstract not available. Disclosures: Study sponsored by Dermira.Copyright 2018 SKIN

Prioritizing topics in guideline development: results of a two-phase online survey of dermatologist members of the EADV

BACKGROUND

Most clinical guidelines in dermatology are encyclopaedic, covering a disease and its aetiology, diagnosis, treatment and prevention in their entirety. The usability and uptake of guideline recommendations might be improved by guidelines that are more concise and address specific questions ranked by users according to their perceived importance.

OBJECTIVE

To survey the largest association of dermatologists in Europe, identify which questions in their everyday practice they felt would benefit from short, evidence-based guidance and rank these systematically.

METHODS

A two-phase online survey using a structured ranking approach and the members directory of the European Academy of Dermatology and Venereology (EADV).

RESULTS

The first survey yielded 265 suggestions, indicating a response rate of 3.7%. We grouped all responses according to themes and subsequently combined these into a list of 35 broader topics. These were presented to all members of the EADV in the second survey (response rate: 9.7%), which yielded a list of the top 10 topics participants felt were most in need of guidance. The first three were 'Systemic drug treatment in dermatology during pregnancy and for women wishing to have children in the near future', 'alopecia areata' and 'interpretation of laboratory results in connective tissue diseases'.

CONCLUSION

Our two-phase survey of EADV members and a structured ranking process were practical to implement and yielded a list of the top 10 topics in dermatology and venereology for guideline development. Guideline dissemination needs to be improved, and practical, more concise guidelines may facilitate efforts to do so.