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Orfali RL, Lorenzini D, Bressan A, Tanaka AA, Cerqueira AMMD, Hirayama ADS, Ramos AMC, Proença CC, Silva CMDR, Laczynski CMM, Carneiro FR, Duarte G, Hans Filho G, Gonçalves HDS, Melo LPD, Azulay-Abulafia L, Weber MB, Rivitti-Machado MC, Zaniboni MC, Ogawa M, Pires MC, Ianhez M, Felix PAO, Bonamigo R, Takaoka R, Lazzarini R, Cestari S, Mayor SAS, Cestari T, Oliveira ZNPD, Spuls PI, Gerbens LAA, Aoki V. Consensus on the therapeutic management of atopic dermatitis ‒ Brazilian Society of Dermatology: an update on phototherapy and systemic therapy using e-Delphi technique. An Bras Dermatol 2023; 98:814-836. [PMID: 37302894 PMCID: PMC10589461 DOI: 10.1016/j.abd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 06/13/2023] Open
Abstract
This publication is an update of the "Consensus on the therapeutic management of atopic dermatitis - Brazilian Society of Dermatology" published in 2019, considering the novel, targeted-oriented systemic therapies for atopic dermatitis. The initial recommendations of the current consensus for systemic treatment of patients with atopic dermatitis were based on a recent review of scientific published data and a consensus was reached after voting. The Brazilian Society of Dermatology invited 31 experts from all regions of Brazil and 2 international experts on atopic dermatitis who fully contributed to the process. The methods included an e-Delphi study to avoid bias, a literature search and a final consensus meeting. The authors added novel approved drugs in Brazil and the indication for phototherapy and systemic therapy for AD. The therapeutical response to systemic treatment is hereby reported in a suitable form for clinical practice and is also part of this updated manuscript.
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Affiliation(s)
- Raquel Leao Orfali
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Daniel Lorenzini
- Department of Dermatology, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
| | - Aline Bressan
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Anber Ancel Tanaka
- Department of Dermatology, Hospital Universitário Evangélico Mackenzie, Curitiba, PR, Brazil
| | | | - André da Silva Hirayama
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Andréa Machado Coelho Ramos
- Department of Dermatology, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Carolina Contin Proença
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Gleison Duarte
- Department of Dermatology, Instituto Bahiano de Imunoterapia, Salvador, BH, Brazil
| | - Gunter Hans Filho
- Department of Dermatology, Hospital Universitário Maria Aparecida Pedrossian, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Heitor de Sá Gonçalves
- Department of Health, National Reference Center in Sanitary Dermatology Dona Libânia, Fortaleza, CE, Brazil
| | - Ligia Pessoa de Melo
- Department of Dermatology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE, Brazil; Health Department, Hospital Otávio de Freitas, Recife, PE, Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade Estadual do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Professor Rubem David Azulay Institute of Dermatology, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Maria Cecília Rivitti-Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; Department of Dermatology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Mariana Colombini Zaniboni
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marília Ogawa
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Mario Cezar Pires
- Department of Dermatology, Complexo Hospitalar Padre Bento, Guarulhos, SP, Brazil; Department of Dermatology, State Public Servant Hospital, São Paulo, SP, Brazil
| | - Mayra Ianhez
- Department of Dermatology, Hospital for Tropical Diseases, Goiânia, GO, Brazil; Department of Dermatology, Universidade Federal de Goiás, Goiânia, GO, Brazil
| | | | - Renan Bonamigo
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Roberto Takaoka
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rosana Lazzarini
- Dermatology Clinic, Irmandade Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil
| | - Silmara Cestari
- Department of Dermatology, Teaching and Research Institute of Hospital Sírio-Libanês, São Paulo, SP, Brazil
| | | | - Tania Cestari
- Department of Dermatology, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Phyllis I Spuls
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Louise A A Gerbens
- Department of Dermatology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Elrewiny EM, Shawky A, Mohamed SFF, Ammar AM, Mansour M, Rageh MA. Intralesional methotrexate in the treatment of localized vitiligo: A pilot study. Australas J Dermatol 2023; 64:e207-e211. [PMID: 37166107 DOI: 10.1111/ajd.14071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND/OBJECTIVES Vitiligo is an immune-mediated skin disorder that targets epidermal melanocytes leading to the appearance of depigmented skin patches. Different treatment modalities have been reported with varied efficacy. We tried to evaluate the safety and efficacy of intralesional methotrexate in treating localized areas of vitiligo. METHODS Thirty participants with localized patches of vitiligo were recruited. They were treated with intralesional injections of methotrexate every 2 weeks for a maximum of six sessions. At the end of the study, the degree of repigmentation was categorized into: excellent improvement (>75% repigmentation), good improvement (50%-75% repigmentation), fair improvement (25%-50% repigmentation) and poor improvement (<25% repigmentation). RESULTS We included 7 males (23.3%) and 23 females (76.7%). Their mean age was 33.6 ± 8.6 years. The duration of the disease ranged from 1 to 22 years. Four patients had a family history of vitiligo. At the end of the study, there was a highly statistically significant improvement (p < 0.001) after treatment regarding repigmentation. CONCLUSIONS This study showed that intralesional methotrexate is a safe and effective treatment option for patients with localized vitiligo lesions. Further studies on a larger scale are needed to evaluate the long-term effects of treatment and detect the ideal dose to be injected.
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Affiliation(s)
- Emad M Elrewiny
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Shawky
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Amr Mohammad Ammar
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mofreh Mansour
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mahmoud A Rageh
- Department of Dermatology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Terto WDS, Moura MQD, Borchardt JL, Santos FDS, Avila LFDC, Pinheiro NB, Leite FPL, Villela MM, Berne MEA. Cyclosporine A increases the intensity of Toxocara canis infection in swiss mice. BRAZ J BIOL 2022; 82:e260199. [PMID: 36134869 DOI: 10.1590/1519-6984.260199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/18/2022] [Indexed: 11/22/2022] Open
Abstract
Toxocariasis is a zoonotic disease of worldwide distribution. The connection between parasitic diseases and conditions that depress the immune system, such as the use of immunosuppressive drugs, has been studied. The purpose of this study was to evaluate the effect of Cyclosporine A (CsA) on the intensity of infection, humoral response and gene transcription of interleukins IL-4, IL-10 and IL-12 in mice experimentally infected with Toxocara canis. To this end, mice were divided into two groups treated with CsA (G1: 10 mg/Kg and G2: 50 mg/kg), the G3 and G4 group received PBS. After the last administration of the drug or PBS (orally every 48 hours for 15 days), groups G1, G2 and G3 were inoculated with 1200 eggs of T. canis. Was collected blood samples on days zero, 15 and 30 days post-inoculation (PI), for ELISA test and the mice were euthanized 30 days PI. The organs and striated muscle tissue were collected for the recovery of larvae. The splenocytes were analyzed by RT-PCR. The intensity of infection in the mice treated with 50 mg/kg of CsA was 65.5% higher than in the control group (p=0.001). An analysis of the kinetics of anti-Toxocara antibody revealed that the groups treated with CsA showed significantly higher mean levels of antibodies on day 15 PI. The transcription of the three tested interleukins showed no statistical difference between G2 and G3 (control). It was concluded that the immunosuppression triggered by CsA (50 mg/Kg) favored the establishment of a larger number of T. canis larvae without, however, altering immunoglobulin production and IL-4, IL-10 and IL-12 transcription on day 30 PI.
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Affiliation(s)
- W D S Terto
- Universidade Federal de Pelotas - UFPel, Institute of Biology, Department of Microbiology and Parasitology, Post-Graduate Program in Microbiology and Parasitology, University Campus of Capão do Leão, Pelotas, RS, Brasil
| | - M Q de Moura
- Universidade Federal de Pelotas - UFPel, Institute of Biology, Department of Microbiology and Parasitology, Post-Graduate Program in Microbiology and Parasitology, University Campus of Capão do Leão, Pelotas, RS, Brasil
| | - J L Borchardt
- Universidade Federal de Pelotas - UFPel, Institute of Biology, Department of Microbiology and Parasitology, Post-Graduate Program in Microbiology and Parasitology, University Campus of Capão do Leão, Pelotas, RS, Brasil
| | - F D S Santos
- Universidade Federal de Pelotas - UFPel, Institute of Biology, Department of Microbiology and Parasitology, Post-Graduate Program in Microbiology and Parasitology, University Campus of Capão do Leão, Pelotas, RS, Brasil
| | - L F da Costa Avila
- Universidade Federal do Rio Grande - FURG, Faculty of Medicine, Academic Area of the University Hospital, Post-Graduate Program in Health Sciences - Parasitology Laboratory, Rio Grande, RS, Brasil
| | - N B Pinheiro
- Universidade Federal de Pelotas - UFPel, Institute of Biology, Department of Microbiology and Parasitology, Post-Graduate Program in Microbiology and Parasitology, University Campus of Capão do Leão, Pelotas, RS, Brasil
| | - F P Leivas Leite
- Universidade Federal de Pelotas - UFPel, Biotechnology Center, Post-Graduate Program in biotechnology, University Campus of Capão do Leão, Pelotas, RS, Brasil
| | - M M Villela
- Universidade Federal de Pelotas - UFPel, Institute of Biology, Department of Microbiology and Parasitology, Post-Graduate Program in Microbiology and Parasitology, University Campus of Capão do Leão, Pelotas, RS, Brasil
| | - M E A Berne
- Universidade Federal de Pelotas - UFPel, Institute of Biology, Department of Microbiology and Parasitology, Post-Graduate Program in Microbiology and Parasitology, University Campus of Capão do Leão, Pelotas, RS, Brasil
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Altun E, Yaylı S, Aksu Arıca D, Baykal Selcuk L, Bahadır S. Retrospective analysis of methylprednisolone treatment alone and in combination with methotrexate in patients with extensive alopecia areata. Dermatol Ther 2022; 35:e15776. [DOI: 10.1111/dth.15776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ece Altun
- Department of Dermatology and Venereology Istanbul Medipol University Istanbul Turkey
| | - Savaş Yaylı
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Deniz Aksu Arıca
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Leyla Baykal Selcuk
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
| | - Sevgi Bahadır
- Department of Dermatology, Faculty of Medicine Karadeniz Technical University Trabzon Turkey
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Hamdino M, El-Barbary RA, Darwish HM. Intralesional methotrexate versus triamcinolone acetonide for localized alopecia areata treatment: A randomized clinical trial. J Cosmet Dermatol 2021; 21:707-715. [PMID: 33749975 DOI: 10.1111/jocd.14090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Multiple therapeutic modalities are available for alopecia areata (AA) but still a challenging disease with variable severity, recurrence, and a major cosmetic concern. AIMS Compare the effectiveness and safety of intralesional methotrexate (MTX) versus triamcinolone acetonide (TrA) in the treatment of localized AA in adults, both clinically and trichoscopically. PATIENTS/METHODS 40 adult patients with localized AA were recruited and divided into two groups. 20 patients were treated by intralesional TrA and the other 20 patients were treated by intralesional MTX every 3 weeks, for maximum four sessions. Clinical and trichoscopic evaluation at baseline, each session and for 3 months after the last session was performed. RESULTS At the end of sessions (12 weeks), regrowth scale was significantly higher in TrA group compared to MTX group (p-value = 0.028). But, after 3-month follow-up, regrowth scale was higher in MTX group compared to TrA group (p-value = 0.153). A statistically significant reduction in AA specific trichoscopic signs after 12 weeks and at the 3-month follow-up in both groups. Local adverse events in both groups were transient and disappeared during the follow-up period. CONCLUSION Intralesional MTX in treatment of localized AA in adults can be promising and comparable to intralesional TrA with the need for further controlled and extensive trials. Trichoscopy can reveal early clinical response through disappearance of AA-specific trichoscopic signs and also early detection of adverse effects.
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Affiliation(s)
- Mervat Hamdino
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Rasha Aly El-Barbary
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
| | - Hanan Mohammed Darwish
- Dermatology and Venereology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt
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Th1, Th17, and Treg Responses are Differently Modulated by TNF-α Inhibitors and Methotrexate in Psoriasis Patients. Sci Rep 2019; 9:7526. [PMID: 31101850 PMCID: PMC6525159 DOI: 10.1038/s41598-019-43899-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/18/2019] [Indexed: 11/23/2022] Open
Abstract
Psoriasis is a chronic, recurrent, immune-mediated, hyperproliferative inflammatory skin disease. The role of the adaptive immune system, particularly of Th1 and Th17 lymphocytes, has been regarded as prominent in the immunopathogenesis of psoriasis, as well as decreased Tregs function. Immunobiological drugs were administered in therapeutic pulses and a few studies evaluate their effects on the immune repertoire. The aim of this study was to evaluate the adaptive immune profile of patients with severe psoriasis under immunobiological treatment in two time points. Thirty-two psoriasis patients and 10 control patients were evaluated. In the group of psoriasis patients, 10 patients were on anti-TNF and 14 patients on methotrexate treatment, while 8 individuals were not treated. IL-17, IFN-γ, TNF-α, IL-6, IL-2, and IL-10 were analyzed. CD4 T cell intracellular cytokines were analyzed. It was observed that stimulation could significantly increase the production of IL-17, IFN-γ, TNF-α, and IL-10 only before anti-TNF pulse therapy. The activation of Th1 and Treg cells after stimulation was significantly higher before anti-TNF pulse. Patients on methotrexate or anti-TNF therapy produced significantly lower levels of TNF-α, IL-10, and IL-6. Furthermore, these patients showed a significant decrease in the activated CD4+ T cells. The treatment with immunomodulator or methotrexate modulates the activation of CD4+ T cells, and anti-TNF treatment appears to have a modulating effect on the activation and production of Th1, Th17, and Treg cells.
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Bressan AL, Pereira D, Medeiros PM, Carneiro S, Azulay-Abulafia L. How relevant are vascular endothelial growth factor and intercellular adhesion molecule in the systemic capillary leak syndrome of psoriasis? An Bras Dermatol 2017; 92:826-829. [PMID: 29364440 PMCID: PMC5786398 DOI: 10.1590/abd1806-4841.20175994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 12/24/2016] [Indexed: 12/26/2022] Open
Abstract
Psoriasis is a chronic disease, characterized by erythematous scaly lesions, presented in eight different forms: plaques, guttate, pustular, erythrodermic, inverse, nail and scalp psoriasis, and psoriatic arthritis. Its development depends on genetic factors, external stimulus and immune response alteration.1 Proinflammatory cytokines such as TNF-alpha, IL-12 and 23 may also be involved. In the worst cases, systemic complications linked to endothelial alterations may occur. A literature review was conducted for a better understanding of what roles VEGF (vascular endothelial growth factor) and ICAM-1 (intercellular adhesion molecule) have, among other cytokines, in systemic capillary leak syndrome, involved in erythrodermic and pustular psoriasis, the most unstable forms of the disease.
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Affiliation(s)
- Aline Lopes Bressan
- Department of Dermatology, Hospital Universitário Pedro
Ernesto - Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro
(RJ), Brazil
| | | | - Paula Mota Medeiros
- Department of Dermatology, Centro Universitário Cesmac -
Maceió (AL), Brazil
- Department of Dermatology, Centro Universitário Tiradentes
(Unit) - Maceió (AL), Brazil
| | - Sueli Carneiro
- Department of Dermatology, Hospital Universitário Pedro
Ernesto - Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro
(RJ), Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro
Ernesto - Universidade do Estado do Rio de Janeiro (HUPE-UERJ) - Rio de Janeiro
(RJ), Brazil
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Festugato M. Adenosine: an endogenous mediator in the pathogenesis of psoriasis. An Bras Dermatol 2016; 90:862-7. [PMID: 26734868 PMCID: PMC4689075 DOI: 10.1590/abd1806-4841.20153689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 08/11/2014] [Indexed: 11/22/2022] Open
Abstract
It is known that inflammatory and immune responses protect us from the
invasion of micro-organisms and eliminate "wastes" from the injured sites,
but they may also be responsible for significant tissue damage. Adenosine,
as a purine nucleoside, which is produced in inflamed or injured sites,
fulfills its role in limiting tissue damage. Although, it may have a
pleiotropic effect, which signals it with a proinflammatory state in
certain situations, it can be considered a potent anti-inflammatory
mediator. The effects of adenosine, which acts through its receptors on T
cell, on mast cell and macrophages, on endothelial cells, on neutrophils
and dendritic cells, as they indicate TNF-alpha and cytokines, show that
this mediator has a central role in the pathogenesis of psoriasis. The way
it acts in psoriasis will be reviewed in this study.
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Kim J, Chan JJ. Cyclophosphamide in dermatology. Australas J Dermatol 2016; 58:5-17. [PMID: 26806212 DOI: 10.1111/ajd.12406] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 09/02/2015] [Indexed: 01/19/2023]
Abstract
Cyclophosphamide is a chemotherapeutic agent which was first discovered in experimental tumours in rats, and it has since been widely used to treat malignancies and severe manifestations of various auto-immune diseases. High-dose chemotherapy and continuous daily oral regimens are associated with significant toxicity profiles, but i.v. pulsed regimens have lowered the rates of adverse effects in rheumatological studies. Cyclophosphamide has been shown to be useful in the treatment of severe autoimmune conditions due to its powerful immunosuppressive ability; however, it remains a relatively underused modality in dermatology. This article reviews the current literature on cyclophosphamide and its clinical applications in dermatology.
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Affiliation(s)
- Janet Kim
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Jonathan J Chan
- Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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Biot SDRN, Franco JPDA, Lima RB, Pereira HNC, Marques LPJ, Martins CJ. Refractory pemphigus vulgaris treated with rituximab and mycophenolate mofetil. An Bras Dermatol 2015; 89:980-4. [PMID: 25387507 PMCID: PMC4230671 DOI: 10.1590/abd1806-4841.20143128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/13/2013] [Indexed: 11/22/2022] Open
Abstract
The main treatment for pemphigus vulgaris are systemic corticosteroids and
immunosuppressive agents, but due to adverse reactions and therapeutic failure, new
drugs such as rituximab and mycophenolate mofetil have been used. In this case report
are described two cases of severe pemphigus vulgaris refractory to various
treatments, with resolution after use of rituximab and mycophenolate mofetil,
associated with corticosteroids. A higher-than-usual dose of rituximab was employed,
without the occurrence of serious adverse reactions. Mycophenolate mofetil was added
as adjunctive therapy due to lack of response to azathioprine.
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Affiliation(s)
| | | | - Ricardo Barbosa Lima
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
| | | | | | - Carlos José Martins
- Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil
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Hammerschmidt M, Mulinari Brenner F. Efficacy and safety of methotrexate in alopecia areata. An Bras Dermatol 2015; 89:729-34. [PMID: 25184911 PMCID: PMC4155950 DOI: 10.1590/abd1806-4841.20142869] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 09/09/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alopecia areata is a chronic disorder of the hair follicles and nails, of unknown
etiology, with clear autoimmune components and genetic factors. Several
therapeutic options have been suggested; however, no treatment is able to modify
the disease course. Methotrexate is an immunosuppressant used in various
dermatoses and recently introduced as a therapeutic option for alopecia
areata. OBJECTIVES To evaluate the efficacy and safety of methotrexate in alopecia areata. METHODS In a retrospective, non-controlled study, we evaluated 31 patients with alopecia
areata in current or prior treatment with methotrexate to assess the therapeutic
response according to sex, age, pattern of alopecia areata, disease duration,
cumulative dose of methotrexate, use of systemic corticosteroids or other
treatments, and drug safety. RESULTS Regrowth greater than 50% was observed in 67.7% of patients, with the best
responses observed in those with <5 years of disease progression (79%), age
over 40 years (73.3%), male patients (72.8%), cumulative dose of methotrexate
1000-1500 mg, and multifocal alopecia areata (93%). Among patients receiving
systemic corticosteroids in combination with methotrexate, 77.3% had greater than
50% regrowth, compared with 44.4% in those who used methotrexate alone. The
therapeutic dose ranged from 10-25 mg/week. No patient had serious adverse
effects. Relapse was observed in 33.3% of patients with more than 50%
regrowth. CONCLUSION Methotrexate appears to be a promising and safe medication for the treatment of
severe alopecia areata when used alone or in combination with corticosteroids.
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Ali Hussei S, A. Ragab O, A. El-Eshm M. Protective Effect of Green Tea Extract on Cyclosporine A: Induced Nephrotoxicity
in Rats. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/jbs.2014.248.257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ali Hussei S, A. Ragab O, A. El-Eshm M. Renoprotective Effect of Dietary Fish Oil on Cyclosporine A: Induced Nephrotoxicity in Rats. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajb.2014.71.85] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Redighieri IP, Maia TDC, Nadal MA, Caliman TRL, Ruiz MDFMA, Petri V. Erythrodermic psoriasis with regression after prophylaxis with isoniazid and antidepressant therapy: case report. An Bras Dermatol 2012; 86:S141-3. [PMID: 22068795 DOI: 10.1590/s0365-05962011000700037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 12/08/2011] [Indexed: 01/08/2023] Open
Abstract
An 83 year old woman, exhibiting severe psoriasis, was treated conventionally (phototherapy, acitretin, and cyclosporine). After poor clinical results and significant changes in laboratory procedures, those treatments were suspended. She was then being prepared to be submitted to biological treatment, when preliminary results disclosed a 30 mm PPD. Complete improvement occurred [only] after introducing prophylactic therapy for tuberculosis and anti-depressive medication.
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Miranda LQ, Bressan AL, Rehfeldt FVDS, Vasconcelos BN, Gripp AC. Psoriasis, lymphoma and etanercept: is there a correlation? An Bras Dermatol 2012; 87:139-41. [DOI: 10.1590/s0365-05962012000100020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/07/2011] [Indexed: 11/22/2022] Open
Abstract
Psoriasis is a chronic inflammatory disease that can affect skin and joints. Their treatment varies depending on the severity and includes topical and systemic. Among the latter are the immunobiological that target the T cell We report a case that demonstrates the close relationship between psoriasis, lymphoma and biologic therapies.
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Bomm L, Zimmermann CC, Souto R, Bressan A, Gripp A. Uso da ciclosporina em paciente portador de hepatite C e psoríase pustulosa. An Bras Dermatol 2011; 86:S193-5. [DOI: 10.1590/s0365-05962011000700050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 03/30/2011] [Indexed: 11/21/2022] Open
Abstract
A ciclosporina tem sido contraindicada nos pacientes com infecções crônicas, como a infecção pelo vírus da hepatite C, devido ao seu efeito imunossupressor. No entanto, estudos recentes têm demonstrado que a ciclosporina suprime a replicação viral e pode, desta forma, não exacerbar a infecção pelo vírus da hepatite C, quando administrada como tratamento para pacientes com psoríase. Apresentamos o caso de uma paciente portadora de psoríase há 30 anos e hepatite C há 20 anos, com lesões circinadas difusas, que apresentou melhora cutânea e das enzimas hepáticas com o uso da ciclosporina, sem apresentar nenhum efeito adverso
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