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Systemic 9-Valent Human Papillomavirus Vaccine for Recalcitrant Common Cutaneous Warts in Preparation for Renal Transplant. JAAD Case Rep 2022; 22:62-63. [PMID: 35321257 PMCID: PMC8935342 DOI: 10.1016/j.jdcr.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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ShengYang Lian B, Lee Krishnamoorthy T, Oh CC. Skin conditions in liver transplant recipients in a Singapore academic medical center: A retrospective cohort study. JAAD Int 2021; 4:70-78. [PMID: 34409397 PMCID: PMC8362318 DOI: 10.1016/j.jdin.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background Liver transplant recipients are at lifelong risk of immunosuppression-related cutaneous complications, such as malignancy and infection. Objective Our study aims to assess the epidemiology of dermatologic conditions among liver transplant recipients in an academic medical center in Singapore. Methods Medical records of liver transplant recipients on follow-up with gastroenterology and dermatology departments at the Singapore General Hospital between 2006 and 2021 were retrospectively reviewed. A literature review was subsequently performed on the keywords “liver transplant” and “dermatology.” Results A total of 99 liver transplant recipients were identified in this study. Sixty-nine patients (70%) had at least 1 dermatologic condition. Inflammatory skin conditions were the most common (53%), followed by cutaneous infection (36%) and benign cutaneous tumors (30%). Malignant and premalignant lesions were the least common skin conditions reported (10%). Our study results concurred with many other studies reported worldwide, demonstrating a low cutaneous malignancy burden after liver transplantation. Limitations The study included a small population size in a single center and did not have a pre-existing protocol for pretransplant dermatologic surveillance. Conclusion Although the incidence of skin cancer after liver transplant in Singapore is low, the patients will benefit from long-term dermatology surveillance, given the long-term risks of infection and malignant skin conditions.
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Affiliation(s)
| | - Thinesh Lee Krishnamoorthy
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
| | - Choon Chiat Oh
- Department of Dermatology, Singapore General Hospital, Singapore.,DUKE-NUS Medical School, Singapore
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3
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Combined pulsed dye laser and systemic retinoids for the treatment of hypertrophic resistant warts among organ transplant patients. Lasers Med Sci 2020; 35:1653-1657. [DOI: 10.1007/s10103-020-03011-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/25/2020] [Indexed: 11/26/2022]
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Sathe P, Saka R, Kommineni N, Raza K, Khan W. Dithranol-loaded nanostructured lipid carrier-based gel ameliorate psoriasis in imiquimod-induced mice psoriatic plaque model. Drug Dev Ind Pharm 2019; 45:826-838. [PMID: 30764674 DOI: 10.1080/03639045.2019.1576722] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to formulate nanostructured lipid carriers (NLCs) of dithranol-loaded in gel for ease of application and to evaluate its anti-psoriatic efficacy vis-a-vis conventional ointment formulation. SIGNIFICANCE This study will provide an insight about the use of nanocarriers, esp. NLCs loaded with dithranol for the effective treatment of psoriasis. METHODS Dithranol-loaded NLCs were prepared by hot melt homogenization method and characterized for particle size and percentage entrapment efficiency. The optimized NLCs were loaded into gel and evaluated for drug release, spreadability, rheological behavior, and staining. Anti-psoriatic efficacy of the NLC gel was evaluated in imiquimod (IMQ) induced psoriatic plaque model in comparison with prepared conventional ointment formulation (1.15% w/w dithranol). RESULTS NLCs were prepared with particle size below 300 nm, polydispersity index (PDI) below 0.3 and percentage entrapment efficiency of ∼100%. The prepared NLC gel was then compared with the ointment for drug release, staining property, and efficacy. Topical application of dithranol-loaded NLC gel on IMQ-induced psoriatic plaque model reduced the symptoms of psoriasis assessed by both Psoriasis area severity index (PASI) scoring and enzyme-linked immunosorbent assay. There was a significant reduction in disease severity and cytokines like Interleukins-17, 22, 23 and Tumor necrosis factor-α by the developed system in comparison to the negative control. CONCLUSIONS To conclude dithranol-loaded NLCs in gel base was efficacious in management of psoriasis at the same drug concentration and also offer less cloth staining to that of the ointment product.
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Affiliation(s)
- Priyadarshini Sathe
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Raju Saka
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Nagavendra Kommineni
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
| | - Kaisar Raza
- b Department of Pharmacy, School of Chemical Sciences and Pharmacy , Central University of Rajasthan , Ajmer , India
| | - Wahid Khan
- a Department of Pharmaceutics , National Institute of Pharmaceutical Education & Research (NIPER) , Hyderabad , India
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6
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Herold M, Nielson C, Longo MI. Isotretinoin and candida immunotherapy for recalcitrant warts in solid organ transplant recipients. Dermatol Ther 2019; 32:e12803. [DOI: 10.1111/dth.12803] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Colton Nielson
- Department of DermatologyUniversity of Florida Gainesville FL
| | - Maria I. Longo
- Department of DermatologyUniversity of Florida Gainesville FL
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7
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Maor D, Brennand S, Goh MS, Chong AH. Recalcitrant hyperkeratotic verrucae in a renal transplant recipient clearing with cessation of immunosuppression. JAAD Case Rep 2018; 4:471-473. [PMID: 29984286 PMCID: PMC6031480 DOI: 10.1016/j.jdcr.2017.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Danit Maor
- Skin and Cancer Foundation Inc, Melbourne, Australia
- Correspondence to: Danit Maor, MBBS, Skin and Cancer Foundation, Level 1/80 Drummond Street Carlton, Melbourne, Victoria, Australia 3053.
| | | | - Michelle S.Y. Goh
- Skin and Cancer Foundation Inc, Melbourne, Australia
- St Vincent's Hospital, Melbourne, Australia
| | - Alvin H. Chong
- Skin and Cancer Foundation Inc, Melbourne, Australia
- St Vincent's Hospital, Melbourne, Australia
- Department of Medicine (Dermatology), University of Melbourne, Melbourne, Australia
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8
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Güleç AT. Natural Thermal Spa Water Versus Hyperthermic Tap Water for Treatment of Recalcitrant Hand Warts in Organ Transplant Recipients: A Patient-Blinded, Comparative Preliminary Study. EXP CLIN TRANSPLANT 2018. [PMID: 29528025 DOI: 10.6002/ect.tond-tdtd2017.p59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Cutaneous warts represent a major problem in organ transplant recipients because of their extensive involvement and persistent course. Current therapeutic modalities often fail to achieve a successful response in patients with warts. We experienced a case involving an organ transplant recipient with recalcitrant mosaic warts who presented with complete clearance of lesions in 3 days after thermal spa bathing. Here, we evaluated the efficacy of natural thermal water versus hyperthermic tap water for treatment of recalcitrant hand warts in organ transplant recipients. MATERIALS AND METHODS In this preliminary study, the right hands of 5 organ transplant recipients with hand warts were immersed in thermal water, while the left hands were soaked in tap water at 44°C to 47°C. Treatment involved three 45-minute sessions per week for 1 month. The total number and size of the warts and the hyperkeratosis severity grade were noted. RESULTS After 12 sessions, none of the patients exhibited any marked improvement in the size or number of warts, although 3 patients had a slight decrease in their hyperkeratosis severity grade. CONCLUSIONS Our preliminary data indicate that neither thermal spa water nor hyperthermic tap water is effective for treatment of recalcitrant hand warts in organ transplant recipients. However, new trials using thermal water supplied from different geographical locations should be performed before this observation can be generalized.
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Affiliation(s)
- A Tülin Güleç
- Department of Dermatology, Baskent University Faculty of Medicine, Ankara, Turkey
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9
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Imko-Walczuk B, Okuniewska A, Prędota-Głowacka A, Jaśkiewicz J, Placek W, Włodarczyk Z, Dębska-Ślizień A, Rutkowski B. Benign Cutaneous Disease Among Polish Renal Transplant Recipients. Transplant Proc 2016; 48:1660-6. [DOI: 10.1016/j.transproceed.2016.02.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/15/2016] [Accepted: 02/24/2016] [Indexed: 12/18/2022]
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10
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Evaluation of specific humoral and cellular immune responses against the major capsid L1 protein of cutaneous wart-associated alpha-Papillomaviruses in solid organ transplant recipients. J Dermatol Sci 2014; 77:37-45. [PMID: 25439730 DOI: 10.1016/j.jdermsci.2014.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/07/2014] [Accepted: 11/02/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Infection with different species of cutaneous human papillomaviruses (cHPV) of genus alpha (cαHPVs) and associated skin disease are highly prevalent in solid organ transplant recipients (OTR), documenting the importance of the immunological control of HPV infection. OBJECTIVES To investigate the natural course of cαHPV-specific cellular and humoral immune responses during systemic long-term immunosuppression. METHODS Integrating bead-based multiplex serology and flow cytometry we analyzed natural cαHPV-specific antibodies and T(H) cell responses against the major capsid protein L1 of HPV types 2, 27, 57 (species 4) and 3, 10 and 77 (species 2) in sera and blood of OTR before and after initiation of iatrogenic immunosuppression and in comparison to immunocompetent individuals (IC). RESULTS Among OTR we observed an overall 42% decrease in humoral L1-specific immune responses during the course of iatrogenic immunosuppression, comparing median values 30 d before and 30 d after initiation of immunosuppressive therapy (p < 0.05). This difference disappeared after long-term (>1 year) immunosuppression. The predominant cellular L1-specific immune response was of type T(H)1 (CD4(+)CD40L(+)IL-2(+)IFN-γ(+)). Consistent with the detected L1-specific antibody titers, L1-specific T(H)1 responses were unchanged in long-term immunosuppressed OTR compared to IC. Notably, cαHPV-L1-specific IL-2(+)/CD40L(+)CD4(+) or IFN-γ(+)/CD40L(+) CD4(+) T(H) cell responses against any of the cαHPV-L1 types were significantly higher in OTR with clinically apparent common warts. CONCLUSION The systemic humoral immune response against cαHPV may reflect the individual degree of iatrogenic immunosuppression indicating a higher susceptibility for cαHPV infection among OTR during the early phase after organ transplantation. Humoral cαHPV-specific immune responses may show a reconstitution to pre-transplantation levels despite continuous potent immunosuppression.
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11
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Meyer T, Püschel K, Seifert D. Diagnostik sexuell übertragbarer Infektionen. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0992-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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12
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EXP CLIN TRANSPLANTExp Clin Transplant 2014; 12. [DOI: 10.6002/ect.25liver.p11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Martínez-Martínez MU, Baranda-Cándido L, Abud-Mendoza C. Cutaneous papillomavirus infection in patients with rheumatoid arthritis or systemic lupus erythematosus. A case-control study. Lupus 2013; 22:948-52. [PMID: 23722231 DOI: 10.1177/0961203313490431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Previous studies informed an increased prevalence of cutaneous papillomavirus (cHPV) infection in patients with systemic lupus erythematosus (SLE). The main objective of our study was to evaluate factors associated with cHPV infection in patients with either rheumatoid arthritis (RA) or SLE, and to determine whether SLE itself is an independent risk factor for cHPV infection. We included 670 patients (in consecutive selection) in this cross-sectional study (550 with RA and 120 with SLE). All patients were evaluated by a dermatologist; patients with cHPV infection were selected as cases (63) and the other 607 patients were selected as controls. The prevalence of cHPV infection was increased 2.8-fold in SLE patients (20%) compared with RA patients (7.1%). When comparing cases with controls, bivariate analysis showed statistically significant differences for: age, having SLE, and treatment with mycophenolate mofetil (MMF). When all of the potential risk factors identified using bivariate analysis (age, having SLE, and MMF) were included into a multivariate model, independent risk factors for cHPV infection were: having SLE (odds ratio: 2.16, 95% confidence interval: 1.04-4.48) and MMF therapy (odds ratio: 2.91, 95% confidence interval: 1.18-7.14).
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Affiliation(s)
- M U Martínez-Martínez
- Regional Unit of Rheumatology and Osteoporosis, Hospital Central Dr. Ignacio Morones Prieto and Faculty of Medicine, Universidad Autónoma de San Luis Potosí, México
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Freitas AC, Mariz FC, Silva MAR, Jesus ALS. Human papillomavirus vertical transmission: review of current data. Clin Infect Dis 2013; 56:1451-6. [PMID: 23392393 DOI: 10.1093/cid/cit066] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Despite the increasing evidence of human papillomavirus (HPV) vertical transmission, this route is regarded as less clinically important because of the detections of transient HPV DNA. However, recent studies have provided clear evidence of papillomavirus productive infection in lymphocytes, placenta, and bovine fetal tissue. Furthermore, a model of papillomavirus latency has been recently proposed that could explain the failure or transience in HPV detection observed in some infected infants. This new evidence of hematogeneous and vertical spread of HPV suggests that these modes of transmission should be investigated in greater detail to obtain a better understanding of the infection and a fuller awareness of the preventive measures that can be taken against HPV-related diseases.
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Affiliation(s)
- A C Freitas
- Department of Genetics, Federal University of Pernambuco, Recife, Brazil.
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15
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Systemic therapy for squamous cell carcinoma of the skin in organ transplant recipients. Am J Clin Oncol 2012; 35:498-503. [PMID: 21297431 DOI: 10.1097/coc.0b013e318201a3ef] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
During the second half of the 20th century, organ transplantation saved thousands of lives. This, unfortunately, also led to unforeseen consequences that need to be addressed to help extend the lives of patients who require these life-saving procedures. Secondary malignancies have been recognized as a potential consequence for decades. One of these malignancies, squamous cell carcinoma of the skin, not only appears more frequently in organ transplant recipients than the general population, but also is more aggressive in organ transplant recipients. It also shows a high propensity to nodal spread and metastasis in transplant patients. Unfortunately, there are no clear guidelines for a chemotherapy in this population, who have an increased need for alternative therapies to surgery given the high recurrence and metastasis rate. In this review, we attempt to describe the characteristics of squamous cell carcinoma of the skin in transplant recipients and discuss what chemotherapeutic options can be used to treat this aggressive malignancy.
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Abud-Mendoza C, Cuevas-Orta E, Santillán-Guerrero EN, Martínez-Martínez MU, Hernández-Castro B, Estrada-Capetillo L, González-Amaro R, Baranda L. Decreased blood levels of B lymphocytes and NK cells in patients with systemic lupus erythematosus (SLE) infected with papillomavirus (HPV). Arch Dermatol Res 2012; 305:117-23. [DOI: 10.1007/s00403-012-1258-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 06/05/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022]
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17
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Generalized verrucosis: A review of the associated diseases, evaluation, and treatments. J Am Acad Dermatol 2012; 66:292-311. [DOI: 10.1016/j.jaad.2010.12.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 12/02/2010] [Accepted: 12/10/2010] [Indexed: 12/23/2022]
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Abstract
The discovery that certain high-risk strains of human papillomavirus (HR-HPV) cause nearly 100% of invasive cervical cancer has spurred a revolution in cervical cancer prevention by promoting the development of viral vaccines. Although the efficacy of these vaccines has already been demonstrated, a complete understanding of viral latency and natural immunity is lacking, and solving these mysteries could help guide policies of cervical cancer screening and vaccine use. Here, we examine the epidemiological and biological understanding of the natural history of HPV infection, with an eye toward using these studies to guide the implementation of cervical cancer prevention strategies.
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Affiliation(s)
- Patti E Gravitt
- Perdana University Graduate School of Medicine, Serdang, Malaysia.
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19
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Caucanas M, Gillard P, Vanhooteghem O. Efficiency of photodynamic therapy in the treatment of diffuse facial viral warts in an immunosuppressed patient: towards a gold standard? Case Rep Dermatol 2010; 2:207-13. [PMID: 21537372 PMCID: PMC3085036 DOI: 10.1159/000323215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
A 64-year-old man with a pulmonary transplant developed diffuse verrucae vulgares of the neck. After the failure of multiple cryotherapy treatments, 3 sessions of photodynamic therapy resulted in rapid therapeutic clinical success. This moderately painful and well-tolerated treatment is reproducible and can be very useful in treating papillomavirus infections in the immunosuppressed patient.
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Affiliation(s)
- M Caucanas
- Department of Dermatology, Sainte Elisabeth Hospital, Namur, Belgium
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20
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Trakatelli M, Katsanos G, Ulrich C, Kalabalikis D, Sotiriadis D, Stockfleth E. Efforts to counteract locally the effects of systemic immunosupression: a review on the use of imiquimod, a topical immunostimulator in organ transplant recipients. Int J Immunopathol Pharmacol 2010; 23:387-96. [PMID: 20646334 DOI: 10.1177/039463201002300201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The potent systemic immunosuppression therapy necessary to sustain a life-saving solid organ transplant is associated with an increased incidence of various infections including human papillomavirus infection and skin cancers in organ transplant recipients. Imiquimod, a topical agent that functions through local induction of a specific anti-viral or anti-tumor immune response, appears to be a promising therapeutic option that could potentially counteract in situ the effects of systemic immunosupression in this vulnerable group. Up-to-date studies using this local immune-response modifier in transplanted patients have yielded reassuring and encouraging results regarding its safety and efficacy in this population. However, in order to establish the use of imiquimod as a standard treatment option for organ transplant recipients, additional research and clinical trials are required.
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[Human papillomavirus-associated warts in organ transplant recipients. Incidence, risk factors, management]. Hautarzt 2010; 61:220-9. [PMID: 20165825 DOI: 10.1007/s00105-009-1860-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human papillomaviruses infect the squamous epithelia of the skin and cause warts, and are occasionally found in squamous cell carcinomas. Since cell-mediated immunity plays a crucial role in the control of HPV-infections, organ transplant recipients, unable to mount an adequate T-helper 1 cell-mediated immune surveillance, frequently develop widespread and resistant induced warts. Skin tumors, especially squamous cell carcinomas, are the most common post-transplantation neoplasm. Warts, actinic keratoses and invasive squamous cell carcinomas are known to develop at the same time in the areas. The role of HPV in the development of invasive squamous cell carcinoma under immunosuppression, remains to be elucidated in respect to common risk factors and increased numbers of warts potentially identifying patients at increased risk for carcinoma. We prospectively studied 1690 organ transplant recipients in the dermatology clinic at the Charité University Hospital in Berlin, to evaluate risk factors being involved in the development of HPV-induced warts and to assess a potential association of with the development of non-melanoma skin cancers in this population. The cumulative incidence of warts steadily increased throughout the post-transplant years. The presence of more than 10 verrucae was associated with the development of actinic keratoses, invasive squamous cell carcinoma and basal cell carcinoma. This study shows clear evidence that certain risk factors of skin carcinogenesis in organ transplant recipient such as increased age at transplantation, a high dose of immunosuppression related to a specific type of graft and use of azathioprine or cyclosporine are strongly associated with an increased incidence of warts. Furthermore, HPV-induced verrucae vulgares could be used as a potential predictor for the development of coincidental non melanoma skin cancer in organ transplant recipients and therefore could serve as an early identification marker of skin cancer high-risk patients. The challenging management of warts in organ transplantation patients is reviewed.
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Kwak EJ, Julian K. Human papillomavirus infection in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S151-60. [PMID: 20070675 DOI: 10.1111/j.1600-6143.2009.02906.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- E J Kwak
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Coremans G, Snoeck R. Cidofovir: clinical experience and future perspectives on an acyclic nucleoside phosphonate analog of cytosine in the treatment of refractory and premalignant HPV-associated anal lesions. Expert Opin Pharmacother 2009; 10:1343-52. [PMID: 19463071 DOI: 10.1517/14656560902960154] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cidofovir, a nucleotide analog with antiviral activity against a broad range of DNA viruses including human papilloma viruses (HPV), is available off label to clinicians. OBJECTIVE To provide a better knowledge of pharmacology and effects when topically applied. METHODS After reviewing the chemistry, physiology, and animal studies, an overview of clinical studies is provided. RESULTS/CONCLUSIONS Cidofovir, as a result of its antiviral and antiproliferative activity and its ability to induce apoptosis, can offer a solution for the treatment of severe recurrent HPV-induced lesions. It can also be used to attempt to treat dysplastic lesions and as an adjuvant treatment. The long-lasting antiviral activity allows infrequent dosing. As a rule, cidofovir applied on the skin is well tolerated, even in long-term treatment. The dose-limiting nephrotoxicity of the drug is not a concern in patients with a glomerular filtration rate within the normal range. Cidofovir has clearly influenced the landscape of refractory and dysplastic anogenital condylomata acuminata and its use has increased over the last decade. However, further controlled clinical trials are needed to assess the role of cidofovir and its derivatives.
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Affiliation(s)
- Georges Coremans
- Department of Gastroenterology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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Meyer T, Stockfleth E. Clinical investigations of Toll-like receptor agonists. Expert Opin Investig Drugs 2008; 17:1051-65. [PMID: 18549341 DOI: 10.1517/13543784.17.7.1051] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Toll-like receptors (TLR) represent a family of surface molecules that function as primary sensors of the innate immune system to recognize microbial pathogens. Ligand binding to TLR results in activation of cellular signaling pathways that regulate expression of genes involved in inflammation and immunity. OBJECTIVE Use of synthetic TLR ligands (agonists) for treatment and prevention of infectious and neoplastic diseases. METHODS Review of literature about clinical investigations of agonists of TLR 4, 7, 8, and 9. RESULTS/CONCLUSIONS Imiquimod was the first TLR agonist approved for treatment of anogenital warts, actinic keratosis and superficial basal cell carcinoma in humans. Several other agonists of TLRs 4, 7, 8 and 9 were also shown to be effective for treatment of infections and cancers and, furthermore, were used as adjuvants for vaccination. Based on safety and efficacy of the TLR agonists used to date, applications are likely to increase in the future.
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Affiliation(s)
- Thomas Meyer
- University of Hamburg, University Hospital Hamburg-Eppendorf, Institute of Medical Microbiology, Virology and Hygiene, Martinistrasse 52, 20246 Hamburg, Germany.
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25
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Ulrich C, Bichel J, Euvrard S, Guidi B, Proby CM, van de Kerkhof PCM, Amerio P, Rønnevig J, Slade HB, Stockfleth E. Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients. Br J Dermatol 2008; 157 Suppl 2:25-31. [PMID: 18067628 DOI: 10.1111/j.1365-2133.2007.08269.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In this study the safety and efficacy of imiquimod 5% cream for the treatments of actinic keratoses in kidney, heart and liver transplant recipients is evaluated. BACKGROUND Growing populations of organ transplant recipients face increased risk of developing actinic keratosis (AK) and skin cancer secondary to continuous systemic immunosuppressive therapy. Imiquimod 5% cream is an effective option for the treatment of AK, but the safety of topical immune stimulation in immunocompromised patients has not been widely evaluated. METHODS A total of 43 patients in six European transplant centres applied two sachets of topical imiquimod or vehicle cream three times per week to a 100 cm(2) field. Dosing continued for 16 weeks regardless of lesion clearance. Patients were assessed for safety variables that included adverse events, local skin reactions, laboratory results, vital signs, dosage of immunosuppressive medication and indication of graft rejection. A blinded independent expert committee was responsible for safety monitoring and final safety assessment. RESULTS No graft rejections or trends for a deterioration of graft function were detected. No meaningful trends were observed in laboratory results. Among patients randomized to imiquimod, the complete clearance rate was 62.1% (18/29); for vehicle patients, the complete clearance rate was 0% (0/14). Clinical clearance was confirmed histologically in all cases. CONCLUSIONS Imiquimod appears to be a safe alternative for the treatment of multiple actinic keratoses in patients with solid organ transplants. Efficacy was within the range previously observed in nontransplanted populations.
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Affiliation(s)
- C Ulrich
- Clinic for Dermatology of the Charité, Charité Hospital, Campus Mitte, Charité-Platz 1, 10117-Berlin, Germany.
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26
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Tannus BG, Sato MS, Cavalin LC, Brenner FM. Dermatologia comparativa: verrugas virais. An Bras Dermatol 2008. [DOI: 10.1590/s0365-05962008000100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O caso demonstra apresentação atípica de verrugas vulgares no dorso das mãos de paciente do sexo masculino de 53 anos e com história prévia de tratamento para linfoma de Hodgkin. As pápulas espiculadas, confluentes, de superfície rugosa, com centro ceratótico e ligeiramente descamativas são comparáveis a cristais de rocha.
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Ulrich C, Hackethal M, Meyer T, Geusau A, Nindl I, Ulrich M, Forschner T, Sterry W, Stockfleth E. Skin infections in organ transplant recipients. J Dtsch Dermatol Ges 2007; 6:98-105. [PMID: 17995969 DOI: 10.1111/j.1610-0387.2007.06431.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In contrast to the well-described high risk of skin cancer in organ transplant recipients, skin infections in these patients are not as well explored. Skin infections caused by viruses, bacteria or fungi represent a growing diagnostic and therapeutic challenge in the dermatological aftercare of organ transplant recipients. Differing immunosuppressive drugs and their variable dosage in chronologic sequence after transplantation probably influence the type and appearance of skin infections. The typical chronology of skin infections are wound infections, pyoderma or the reactivation of herpes viruses in the first month post-transplant; the main problems in months 2-5 are opportunistic infections and reactivation of varicella-zoster virus. After 6 months as immunosuppression is reduced, the spectrum of causative organisms approaches that of the general population; mycoses and human papilloma virus (HPV) infections dominate. A causal connection exists between infection with oncogenic viruses such as HPV, Epstein-Barr virus and human herpesvirus 8 and specific skin cancers (squamous cell carcinoma, Kaposi sarcoma and post-transplant lymphoproliferative disorders). Dermatological care of organ transplant recipients using appropriate diagnostic methods adapted to the modified clinical pattern may lead to early adequate treatment.
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Affiliation(s)
- Claas Ulrich
- Department of Dermatology, Allergy, Venereology, Charité University Hospital, Berlin, Germany
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28
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Herman S, Rogers HD, Ratner D. Immunosuppression and squamous cell carcinoma: a focus on solid organ transplant recipients. Skinmed 2007; 6:234-8. [PMID: 17786101 DOI: 10.1111/j.1540-9740.2007.06174.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
As transplant medicine advances, new immunosuppressive regimens are increasing the long-term survival of solid organ transplant recipients (SOTRs). This growing population is at significantly increased risk for developing cutaneous malignancies, particularly squamous cell carcinoma (SCC), as a result of chronic immunosuppression. Conventional risk factors for the development of skin cancer, including fair skin type, advanced age, sun exposure, and genetic predisposition, also play a crucial role in the initiation and progression of SCC in SOTRs. Immunosuppressed patients develop more aggressive and more numerous SCCs than immunocompetent individuals, however. It is important to understand the mechanisms underlying immunosuppression-mediated SCC development to identify prognostic markers and to develop effective prevention and treatment strategies. This article addresses the fundamental differences between SCC in SOTRs and those in the general population, focusing on the role that immunosuppression plays in the pathogenesis of this malignancy.
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Affiliation(s)
- Sara Herman
- Department of Dermatology, Columbia University Medical Center, 161 Fort Washington Avenue, New York, NY 10012, USA
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29
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Wrone DA, Sauder DN. Topical immunotherapy for skin disease. Expert Rev Clin Immunol 2007; 3:451-4. [PMID: 20477149 DOI: 10.1586/1744666x.3.4.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Bonatti H, Aigner F, De Clercq E, Boesmueller C, Widschwendner A, Larcher C, Margreiter R, Schneeberger S. Local administration of cidofovir for human papilloma virus associated skin lesions in transplant recipients. Transpl Int 2007; 20:238-46. [PMID: 17291217 DOI: 10.1111/j.1432-2277.2006.00430.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Human papilloma virus (HPV)-associated diseases are increasingly diagnosed in solid organ recipients. Cidofovir (CDV) is a broad-spectrum antiviral agent with activity against all human herpes viruses and HPV. From 2000-2004, a total of 1303 solid organ transplants (SOT) were performed at our center. Six transplant recipients were treated with topical CDV for HPV-associated lesions. One cardiac recipient responded to a single injection of CDV into his recurrent anal condylomata. In a renal recipient with recurrent penile condylomata CDV was injected into the lesions four times (2 week interval) until lesions regressed. One renal recipient developed multiple vaginal and anal intradermal neoplasias, which relapsed after laser ablation. The lesions were repeatedly injected with CDV and completely disappeared. Two renal recipients with widespread verrucae vulgares were treated with CDV gel, which resulted in regression of the lesions. One patient developed donor derived verrucae vulgares on both transplanted hands, which responded to CDV gel. Four of the six patients were switched from calcineurin inhibitors (CNIs) to Sirolimus (SIR). CDV was found effective in the treatment of HPV-associated skin lesions in SOT recipients. It needs to be determined whether switch from CNIs to SIR might have contributed to the beneficial effect of CDV.
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Affiliation(s)
- Hugo Bonatti
- Department of General and Transplant Surgery, Innsbruck, Austria.
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31
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Faurschou A, Wulf HC. Treatment of multiple warts in a renal transplant recipient with decreased laser doses after application of a light absorbing dye. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2007; 22:265-6. [PMID: 16948830 DOI: 10.1111/j.1600-0781.2006.00248.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Multiple warts are a tremendous problem in immunosuppressed patients. Standard treatment has low efficacy and is often painful. We examined a new treatment combination of gentian violet and dye-laser. METHODS A 55-year-old male renal transplant recipient was treated with dye-laser at 585 nm after application of gentian violet 0.5%. RESULTS One laser pulse made the stain explode and evaporate and resulted in a considerable reduction in warts size with minimal pain and tissue damage. CONCLUSION Application of gentian violet before dye-laser treatment may be effective in the battle against warts in immunocompromised patients.
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Dharancy S, Catteau B, Mortier L, Boleslawski E, Declerck N, Canva V, Piette F, Mathurin P, Pruvot FR. Conversion to sirolimus: a useful strategy for recalcitrant cutaneous viral warts in liver transplant recipient. Liver Transpl 2006; 12:1883-7. [PMID: 17133572 DOI: 10.1002/lt.20927] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Dermatological complications following transplantation are very common and the majority of immunosuppressed transplant recipients develop some to many warts due to human papillomavirus (HPV) infection. In the setting of immunosuppression, therapeutic management may be disappointing because of the extent of the lesions in patients unable to develop a sufficient immune response directed against HPV. We report here a case of a young liver transplant recipient who developed diffuse recalcitrant HPV-induced warts leading to an impairment of her quality of life. Taking into account the antiproliferative and cytostatic properties of the target-of-rapamycin (TOR) inhibitors, a new class of immunosuppressive drug, we significantly modified the immunosuppressive regimen. Conversion to sirolimus was followed by a rapid improvement of cutaneous state suggesting that this strategy may be useful for recalcitrant cutaneous viral warts in transplant recipient.
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Affiliation(s)
- Sébastien Dharancy
- Service des Maladies de l'Appareil Digestif et de la Nutrition, Lille, France.
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Hersoug LG, Arnau J. A built-in co-carcinogenic effect due to viruses involved in latent or persistent infections. Med Hypotheses 2006; 68:1001-8. [PMID: 17125934 DOI: 10.1016/j.mehy.2006.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 10/03/2006] [Indexed: 11/29/2022]
Abstract
A new hypothesis for some cancers, which combines the chromosomal instability theories with a co-carcinogenic effect of viruses causing latent or persistent infection, is presented. The hypothesis incorporates the multi-step model of cancer and that pre-cancerous cells reach a state of chromosomal instability. Because of chromosomal instability, the genome of these cell lines will lead to changes from generation to generation and will face a remarkable selection pressure both from lost traits, apoptosis, and from the immune system. Viruses causing latent or persistent infections have evolved many different genes capable to evade the immune system. If these viruses are harboured in the genome of pre-cancerous cells they could provide them with "superpowers" and with genes that may assist the cells to elude the immune system. The theory explains why cancer predominantly is a disease of old age. Upon aging, the immune system becomes reduced including the ability to control and suppress the viruses that cause latent or persistent infections. The risk of cancer could thereby increase as the immune functions decrease. The theory provides new insights to the genesis of cancers.
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Affiliation(s)
- Lars-Georg Hersoug
- Research Centre for Prevention and Health, Glostrup University Hospital, 57 Nrd Ringvej, Building 84/85, DK-2600 Glostrup, Denmark.
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Abstract
The advent of organ transplantation identified a new group of diseases. Dermatologists are studying transplant-associated diseases along with the atypical behavior of already known dermatoses. Pediatric patients have been treated as an extension of adult population, but unique aspects of age required clarification. A prospective cohort was studied including patients from both genders up to 17 yr of age who were recipients of kidney, liver or BMT during 2003 in Porto Alegre, Brazil. Regular skin examinations were performed up to the sixth month after the procedure, and an analysis was determined by ID (i.e. = number of skin changes/number of patients-month x 100). Thirty-nine patients were examined: 20 were kidney transplant recipients; 11 were BMT recipients (10 autologous transplants and 1 allogeneic transplant); and 8 were liver transplant recipients. Skin changes result primarily from the use of medication (87.2). Individually, kidney transplant patients presented the highest ID of skin changes because of medications (104.1). BMT recipients presented the highest ID of alterations occurring on skin appendages (85.4) and liver transplant recipients had the highest ID of vascular changes (94.9). In conclusion, this study shows that cutaneous alterations in pediatric transplant recipients present some particularities not described in adult recipients, such as ichthyosiform xerosis in renal recipients and skin scaling with pellagroid appearance in bone marrow recipients. Also, dermatoses secondary to medication use were the main finding in pediatric population.
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Abstract
Solid organ transplant recipients are a growing population at increased risk for the development of cutaneous premalignant and malignant lesions, resulting in significant morbidity and mortality. Topical immunomodulators, in particular imiquimod, have shown efficacy in the management of multiple malignant, precancerous, and viral conditions. The ability to locally induce an immune response, presumably against tumor and viral antigens, and induce apoptosis makes topical immunomodulators a promising therapeutic option in organ transplant recipients. Although limited, data have begun to accumulate on the use of imiquimod in transplant patients for the management of superficial, nodular, and infiltrative basal cell carcinomas; in situ and invasive squamous cell carcinomas; condyloma acuminata; and common warts. As more experience is gathered, the role of imiquimod and other topical immunomodulators in the care of OTRs will be clarified. The authors reviewed the existing data on the use of topical imiquimod in OTRs with mention of its presumed mechanisms of action and other immunomodulators with potential efficacy against cancerous and precancerous lesions.
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Affiliation(s)
- Bradley T Kovach
- Division of Dermatology, Vanderbilt University, Nashville, TN 37232-5227, USA
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Kane D, FitzGerald O. Tumor necrosis factor-alpha in psoriasis and psoriatic arthritis: a clinical, genetic, and histopathologic perspective. Curr Rheumatol Rep 2005; 6:292-8. [PMID: 15251081 DOI: 10.1007/s11926-004-0041-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The successful introduction of anti-tumor necrosis factor (TNF) therapies in psoriasis and psoriatic arthritis has sharpened considerable interest in this chronic and frequently disabling disease. Unlike the situation in rheumatoid arthritis, where anti-TNF therapies were introduced after years of painstaking research which confirmed a key proinflammatory role for TNF, the evidence for TNF having a key role in psoriatic arthritis has lagged behind. In this paper, the emerging immunohistochemical, genetic, and clinical literature relating to TNF's role in skin and joint manifestations of this disease is reviewed and areas for future research are suggested.
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Affiliation(s)
- David Kane
- Department of Rheumatology, St. Vincent's University Hospital, Elm Park, Dublin, 4 Ireland
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Harwood CA, Perrett CM, Brown VL, Leigh IM, McGregor JM, Proby CM. Imiquimod cream 5% for recalcitrant cutaneous warts in immunosuppressed individuals. Br J Dermatol 2005; 152:122-9. [PMID: 15656812 DOI: 10.1111/j.1365-2133.2005.06322.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Viral warts may cause significant morbidity in individuals unable to mount an adequate T-helper 1 cell-mediated immune response to human papillomavirus. Imiquimod is a potent inducer of antiviral cytokine activity which has shown significant efficacy in the treatment of genital warts. Similar efficacy in cutaneous warts is not yet established. OBJECTIVES To assess the response of persistent cutaneous warts to 5% imiquimod cream in immunosuppressed individuals. METHODS Fifteen immunosuppressed patients with warts on the hands and/or feet present for more than 18 months, which had failed to respond to a minimum of 12 weeks of topical salicylic acid and four cycles of cryotherapy, were recruited. Imiquimod 5% cream was applied in an open label, right vs. left comparison study for 24 weeks (three times weekly for 8 weeks, daily for 8 weeks, then daily with occlusion for 8 weeks). RESULTS Twelve (80%) patients completed the study protocol. Benefit was seen in five patients [36% in the intent-to-treat analysis (14 patients)], including more than 30% clearance of warts in three patients and reduction in overall size of warts in two further cases. Local skin reactions occurred in four (29%) patients and were usually mild. A transient rise in creatinine (11-29% above baseline) was measured in three renal transplant recipients, but we did not consider that this was related to imiquimod exposure. CONCLUSIONS This is the first controlled study to assess therapeutic efficacy of topical 5% imiquimod cream in persistent warts associated with immunosuppression. It provides preliminary evidence that topical imiquimod may benefit a subgroup of immunosuppressed patients with recalcitrant cutaneous warts.
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Affiliation(s)
- C A Harwood
- Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London, 2 Newark Street, London, E1 2AT, UK.
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38
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Eedy DJ, English JSC. Updates from the British Association of Dermatologists 83rd Annual Meeting, 1-4 July 2003, Brighton, U.K. Br J Dermatol 2004; 150:11-32. [PMID: 14746613 DOI: 10.1111/j.1365-2133.2004.05774.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- D J Eedy
- Craigavon Area Hospital Group Trust, 68 Lurgan Road, Portadown BT63 5QQ, U.K.
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