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Salman S, Awad M, Sarsik S, Ibrahim AM, Fathi M, Agha NY, Anis R, El Ashal G, Salem ML. Treatment options for autoimmune bullous dermatoses other than systemic steroids: A systematic review and network meta-analysis. Dermatol Ther 2020; 33:e13861. [PMID: 32558137 DOI: 10.1111/dth.13861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/09/2020] [Accepted: 06/05/2020] [Indexed: 02/05/2023]
Abstract
Autoimmune blistering diseases can eventually cause life-threatening complications if left untreated. Although there is no cure for these bullous diseases; their therapy is based on suppressing the immune system to cease the de novo formation of the generated antibodies. The current study aimed to assess the safety and efficacy of using standing alone alternative therapies beyond systemic steroids for management of autoimmune bullous diseases. We searched six literature databases for both randomized and quasi-randomized clinical trials that assessed the efficacy of drugs other than systemic steroids in autoimmune bullous diseases. Outcomes were calculated as odds ratios with 95% confidence-interval. We used the R software to perform conventional and network meta-analyses with a frequentist approach. The network ranking order for 629 bullous pemphigoid patients, from the best to the worst was, clobetasol propionate cream (40 mg; (P-score = .87), clobetasol propionate cream (10-30 mg; P-score = .77), nicotinamide plus tetracycline (P-score = .56), steroids (P-score = .29) and doxycycline (P-score = .01). Limitations of this study are the small sample of the included studies except for blister trial and lack of randomization in most trials. To conclude, Combined doxycycline and nicotinamides are safer and more effective option for extensive bullous pemphigoid patients than the usual use of systemic steroids. For limited disease, topical corticosteroid (40 mg/d) use provides a safer and better response modality than the other proposed treatments.
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Affiliation(s)
- Samar Salman
- Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mina Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sameh Sarsik
- Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Mohamed Fathi
- Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
| | - Nadim Y Agha
- Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
| | - Ruba Anis
- Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
| | - Gehad El Ashal
- Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
| | - Mohamed L Salem
- Immunology and Biotechnology Division, Zoology Department, Faculty of Science, Tanta University, Tanta, Egypt
- Center of Excellence in Cancer Research, Tanta University, Tanta, Egypt
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Lalor LE, Chiu YE. Rare Vesiculopustular Eruptions of the Neonatal Period. Clin Perinatol 2020; 47:53-75. [PMID: 32000929 DOI: 10.1016/j.clp.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Numerous disorders present with vesiculopustular eruptions in the neonatal period, ranging from benign to life-threatening. Accurate and prompt diagnosis is imperative to avoid unnecessary testing and treatment for benign eruptions, while allowing for adequate treatment of potentially fatal disorders. In this review, we highlight several rare blistering diseases of the newborn. A diagnostic approach is outlined to provide clinicians with a framework for approaching a neonate with vesicles, pustules, or ulcers.
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Affiliation(s)
- Leah E Lalor
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
| | - Yvonne E Chiu
- Department of Dermatology (Pediatric Dermatology), Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
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Jiménez-Zarazúa O, Guzmán-Ramírez A, Vélez-Ramírez LN, López-García JA, Casimiro-Guzmán L, Mondragón JD. A Case of Acute Pemphigus Vulgaris Relapses Associated with Cocaine Use and Review of the Literature. Dermatol Ther (Heidelb) 2018; 8:653-663. [PMID: 30415373 PMCID: PMC6261113 DOI: 10.1007/s13555-018-0271-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 12/28/2022] Open
Abstract
Pemphigus is a bullous autoimmune disease that affects the skin and mucous membranes. It is very difficult to establish the etiology and the triggering factors that influence reactivations in pemphigus vulgaris (PV). The case of a 33-year-old male with chronic history of intranasal cocaine consumption is presented in this report. We present the clinical case of the patient, followed for a total of 86 weeks, with ten relapses secondary to probable cocaine use. The patient was admitted to the emergency department after presenting polymorphic dermatosis characterized by blisters, vesicles, and excoriations extending from the oral cavity to the thorax, and to the inguinal and genital regions, affecting approximately 35 % of the body surface area with a score of 56 on the Pemphigus Skin Disorder Index. Skin biopsies were compatible with PV diagnosis. The patient had clinical improvement with a combination of methylprednisolone 500 mg intravenously (IV) and cyclophosphamide 500 mg IV every 15 days, along with prednisone 50 mg orally (PO) q24 h and mycophenolic acid 500 mg PO q6 h. Persistent cocaine use is highly likely to be the factor triggering lesion reactivation and responsible for the torpid evolution. We cannot definitively conclude whether the change from azathioprine to mycophenolic acid after the tenth relapse was the adjuvant medication responsible for the end of the consolidation phase and complete remission on therapy. This case study could potentially serve as a guide for management of patients who continuously persist with cocaine use, leading to a clinical picture refractory to multiple therapeutic schemes.
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Affiliation(s)
- Omar Jiménez-Zarazúa
- Department of Internal Medicine, Hospital General León, León, Guanajuato, Mexico.,Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico
| | | | | | - Jesús A López-García
- Head of the Department of Internal Medicine and Rheumatology, Hospital General León, León, Guanajuato, Mexico
| | | | - Jaime D Mondragón
- Department of Neurology, Alzheimer Research Center Groningen, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Taylor J, McMillan R, Shephard M, Setterfield J, Ahmed R, Carrozzo M, Grando S, Mignogna M, Kuten-Shorrer M, Musbah T, Elia A, McGowan R, Kerr A, Greenberg M, Hodgson T, Sirois D. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120:161-71.e20. [DOI: 10.1016/j.oooo.2015.01.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 01/06/2023]
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Ojaimi S, O'Connor K, Lin MW, Schifter M, Fulcher DA. Treatment outcomes in a cohort of patients with mucosal-predominant pemphigus vulgaris. Intern Med J 2015; 45:284-92. [DOI: 10.1111/imj.12674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/17/2014] [Indexed: 01/16/2023]
Affiliation(s)
- S. Ojaimi
- Department of Clinical Immunology; Westmead Hospital; Sydney New South Wales Australia
| | - K. O'Connor
- Department of Clinical Immunology; Westmead Hospital; Sydney New South Wales Australia
| | - M. W. Lin
- Department of Clinical Immunology; Westmead Hospital; Sydney New South Wales Australia
- Department of Medicine; The University of Sydney; Sydney New South Wales Australia
| | - M. Schifter
- Department of Medicine; The University of Sydney; Sydney New South Wales Australia
- Oral Medicine/Oral Pathology Unit; Westmead Hospital; Sydney New South Wales Australia
| | - D. A. Fulcher
- Department of Clinical Immunology; Westmead Hospital; Sydney New South Wales Australia
- Department of Medicine; The University of Sydney; Sydney New South Wales Australia
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