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Wang D, Damman J, van Doorn MBA. [A woman with bumps in the eyebrows]. Ned Tijdschr Geneeskd 2020; 164:D4914. [PMID: 32395957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 28-year-old woman was seen at our clinic with asymptomatic bumps in the eyebrows which arose 3 months after microblading, a cosmetic procedure to make the eyebrows appear fuller. Physical examination showed red-brown confluent papules. A skin biopsy revealed a non-necrotizing granulomatous reaction with sarcoid granulomas. Blood test and a chest X-ray showed no abnormalities and histopathological stains were negative. We diagnosed her with a granulomatous reaction in response to pigment. The skin lesions eventually disappeared spontaneously within 6 months.
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Affiliation(s)
- D Wang
- Erasmus MC, Rotterdam, afd. Dermatologie
| | - J Damman
- Erasmus MC, Rotterdam,afd. Pathologie
| | - M B A van Doorn
- Erasmus MC, Rotterdam, afd. Dermatologie
- Contact: M. B.A. van Doorn
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2
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Vossen ARJV, van der Zee HH, Davelaar N, Mus AMC, van Doorn MBA, Prens EP. Apremilast for moderate hidradenitis suppurativa: no significant change in lesional skin inflammatory biomarkers. J Eur Acad Dermatol Venereol 2018; 33:761-765. [PMID: 30451329 PMCID: PMC6590194 DOI: 10.1111/jdv.15354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/06/2018] [Indexed: 01/20/2023]
Abstract
Background Treatment with apremilast has recently demonstrated clinically meaningful improvement in moderate hidradenitis suppurativa (HS). Objective To evaluate the change in expression of inflammatory markers in lesional skin of HS patients receiving apremilast 30 mg twice daily (n = 15) for 16 weeks compared with placebo (n = 5). Methods At baseline, 5‐mm punch biopsies were obtained from an index lesion (HSL) and non‐lesional (HSN) skin in the same anatomical area. Subsequent HSL samples were taken as close as possible to the previously biopsied site at week 4 and week 16. After sampling, biopsies were split; one half was processed for in vivo mRNA analysis using real‐time quantitative PCR; the other half was cultured for ex vivo protein analysis using a proximity extension assay (Olink). Linear mixed effects models were calculated to compare the levels of inflammatory markers in HSL skin between apremilast and placebo over time. Results At baseline, 17 proteins with a fold change >2 in HSL vs. HSN skin were identified in 20 patients. The top five were IL‐17A (5), S100A12, CST5, IL‐12/23p40, CD6 (1) with fold changes ranging from 6.6 to 1638, respectively (FDR <0.044). Linear mixed effects models for 75 assays were calculated. Protein levels of S100A12 decreased during treatment in the apremilast group compared with the placebo group (p = 0.014, FDR = 0.186). None of the 14 genes exhibited significant changes in expression over time. However, an evident downward trend in relative mRNA expression of IL‐17A and IL‐17F was demonstrated in patients receiving apremilast. Conclusion We did not detect statistically significant changes in inflammatory markers in HSL skin of HS patients receiving apremilast compared with placebo, despite clinical improvement in the apremilast group. Nonetheless, S100A12 and IL‐17A were significantly elevated in HSL skin and showed a decrease in response to apremilast. The translational model in clinical trials involving HS clearly needs further improvement.
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Affiliation(s)
- A R J V Vossen
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H H van der Zee
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N Davelaar
- Laboratory of Rheumatology & Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A M C Mus
- Laboratory of Rheumatology & Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Nguyen TV, van Rooijen GL, van Doorn MBA. [A man with severe skin rash]. Ned Tijdschr Geneeskd 2018; 162:D2078. [PMID: 29328012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 31-year-old man visited the outpatient clinic Dermatology with an exacerbation of his atopic eczema. Since a few day vesicles and crusts had appeared and his eyelids were swollen. He was known to have eczema, for which he was treated with ciclosporin 200 mg 2 times a day (4 mg/kg per day) since four months. Under this treatment the eczema used to be under control. There were no neurological symptoms or vision problems. At physical examination we saw erythematous papules, vesicles, superficial erosions and crusts on all body regions, but especially on the trunk and in the main neck region. The patient was diagnosed with eczema herpeticum and he was treated with intravenous aciclovir 1000 mg 3 times a day (10 mg/kg 3 dd) and flucloxacillin 1000 mg 4 times a day for seven days.
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Affiliation(s)
- T V Nguyen
- Erasmus MC, afd. Dermatologie, Rotterdam
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Greveling K, Prens EP, Liu L, van Doorn MBA. Non-invasive anaesthetic methods for dermatological laser procedures: a systematic review. J Eur Acad Dermatol Venereol 2017; 31:1096-1110. [PMID: 28107576 DOI: 10.1111/jdv.14130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/02/2017] [Indexed: 10/20/2022]
Abstract
Pain is a common side-effect of dermatological laser procedures. Non-invasive anaesthetic drugs and anaesthetic procedures can be used to provide pain relief and increase patient satisfaction and treatment efficacy. However, it remains unclear which method provides the best pain relief. The objective of this systematic review was therefore to assess the efficacy and safety of non-invasive anaesthetic methods during dermatological laser procedures. A systematic literature search was conducted. Randomized and non-randomized controlled clinical trials (RCTs and CCTs) were included. Two authors independently assessed study eligibility, extracted data and assessed the risk of bias. The quality of evidence was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Twenty RCTs and 12 CCTs were included, involving nine different laser indications: hair removal (n = 9), resurfacing/rejuvenation (n = 5), port wine stains (n = 8), leg telangiectasia (n = 3), facial telangiectasia (n = 2), tattoo removal (n = 2), naevus of Ota (n = 1), solar lentigines (n = 1) and HPV lesions (n = 1). The non-invasive anaesthetic methods (i.e. topical anaesthetic drugs, skin cooling, and pneumatic skin flattening [PSF]), types of lasers, laser settings, application time, and types of pain scales varied widely among the included studies. All of the studies had an unclear or high risk of bias, and the overall quality of evidence was rated as low. In general, active non-invasive anaesthetic methods seemed to provide favourable results compared to placebo or no anaesthesia, and topical anaesthetic drugs and PSF seemed to result in a better pain reduction than skin cooling. However, the current evidence is insufficient to provide recommendations for daily clinical practice. There is a need for more high-quality (head-to-head) RCTs. Future studies should also evaluate sex differences in pain perception, have uniformity with regard to validated pain measurement scales and address clinically significant differences in pain reduction besides statistically significant differences.
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Affiliation(s)
- K Greveling
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L Liu
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Greveling K, van der Klok T, van Doorn MBA, Noordhoek Hegt V, Prens EP. Lentigo maligna - anatomic location as a potential risk factor for recurrences after non-surgical treatment. J Eur Acad Dermatol Venereol 2016; 31:450-454. [PMID: 27557425 PMCID: PMC5363235 DOI: 10.1111/jdv.13941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/26/2016] [Indexed: 11/27/2022]
Abstract
Background A higher incidence of lentigo maligna (LM) recurrences on the nose was previously observed in our cohort after non‐surgical treatment. Objectives To determine histological parameters that might be related to the previously observed higher incidence of LM recurrences on the nose after non‐surgical treatment. Methods We randomly selected 22 surgical specimens of LM on the nose and 22 on the cheek. Histopathological analysis was performed on haematoxylin and eosin stained and microphthalmia transcription factor immunohistochemically stained slides. The number of pilosebaceous units (PSU) per mm, maximum depth of atypical melanocytes along the skin appendages and maximum depth of the PSU itself were determined. Results The nose had a significantly higher density of PSU than the cheek. The atypical melanocytes extended deeper along the PSU on the nose with a mean (SD) depth of 1.29 mm (0.48) vs. a mean depth of 0.72 mm (0.30) on the cheek (P < 0.001). The maximum depth of the PSU on the nose was greater than on the cheek, mean (SD) depth of 2.28 mm (0.41) vs. 1.65 mm (0.82) (P = 0.003). Conclusions The higher recurrence risk of LM on the nose after non‐surgical treatment that we previously observed in our cohort is most likely based on a higher density of atypical melanocytes and also their deeper extension into the follicles. These results shed more light on our previous findings and learn that anatomical location is relevant for the risk of recurrence of LM after non‐surgical treatment.
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Affiliation(s)
- K Greveling
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Th van der Klok
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - V Noordhoek Hegt
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Greveling K, de Vries K, van Doorn MBA, Prens EP. A two-stage treatment of lentigo maligna using ablative laser therapy followed by imiquimod: excellent cosmesis, but frequent recurrences on the nose. Br J Dermatol 2016; 174:1134-6. [PMID: 26615810 DOI: 10.1111/bjd.14330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- K Greveling
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Burg s'Jacobplein 51, 3015 CA, Rotterdam, the Netherlands.
| | - K de Vries
- Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Burg s'Jacobplein 51, 3015 CA, Rotterdam, the Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Burg s'Jacobplein 51, 3015 CA, Rotterdam, the Netherlands
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van Bezooijen JS, Prens EP, Pradeepti MS, Atiqi R, Schreurs MWJ, Koch BCP, van Gelder T, van Doorn MBA. Combining biologics with methotrexate in psoriasis: a systematic review. Br J Dermatol 2015; 172:1676-1680. [PMID: 25470815 DOI: 10.1111/bjd.13573] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- J S van Bezooijen
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands.,Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands
| | - E P Prens
- Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands
| | - M S Pradeepti
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - R Atiqi
- Department of Immunology, Erasmus MC, Rotterdam, the Netherlands
| | - M W J Schreurs
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands
| | - B C P Koch
- Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - T van Gelder
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, the Netherlands.,Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - M B A van Doorn
- Department of Dermatology, Erasmus MC, Rotterdam, the Netherlands
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8
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Smit P, Wiryasaputra DCMS, van Doorn MBA. A fistula in disguise--a case report. J Eur Acad Dermatol Venereol 2014; 30:366-7. [PMID: 25351526 DOI: 10.1111/jdv.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P Smit
- Department of Dermatology and Venereology, Erasmus MC, Rotterdam, the Netherlands
| | - D C M S Wiryasaputra
- Department of Oral-maxillofacial Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - M B A van Doorn
- Department of Dermatology and Venereology, Erasmus MC, Rotterdam, the Netherlands
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Houweling AC, Gijezen LM, Jonker MA, van Doorn MBA, Oldenburg RA, van Spaendonck-Zwarts KY, Leter EM, van Os TA, van Grieken NCT, Jaspars EH, de Jong MM, Bongers EMHF, Johannesma PC, Postmus PE, van Moorselaar RJA, van Waesberghe JH, Starink TM, van Steensel MAM, Gille JJP, Menko FH. Renal cancer and pneumothorax risk in Birt-Hogg-Dubé syndrome; an analysis of 115 FLCN mutation carriers from 35 BHD families. Br J Cancer 2012; 105:1912-9. [PMID: 22146830 PMCID: PMC3251884 DOI: 10.1038/bjc.2011.463] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Birt–Hogg–Dubé (BHD) syndrome is an autosomal dominant condition caused by germline FLCN mutations, and characterised by fibrofolliculomas, pneumothorax and renal cancer. The renal cancer risk, cancer phenotype and pneumothorax risk of BHD have not yet been fully clarified. The main focus of this study was to assess the risk of renal cancer, the histological subtypes of renal tumours and the pneumothorax risk in BHD. Methods: In this study we present the clinical data of 115 FLCN mutation carriers from 35 BHD families. Results: Among 14 FLCN mutation carriers who developed renal cancer 7 were <50 years at onset and/or had multifocal/bilateral tumours. Five symptomatic patients developed metastatic disease. Two early-stage cases were diagnosed by surveillance. The majority of tumours showed characteristics of both eosinophilic variants of clear cell and chromophobe carcinoma. The estimated penetrance for renal cancer and pneumothorax was 16% (95% minimal confidence interval: 6–26%) and 29% (95% minimal confidence interval: 9–49%) at 70 years of age, respectively. The most frequent diagnosis in families without identified FLCN mutations was familial multiple discoid fibromas. Conclusion: We confirmed a high yield of FLCN mutations in clinically defined BHD families, we found a substantially increased lifetime risk of renal cancer of 16% for FLCN mutation carriers. The tumours were metastatic in 5 out of 14 patients and tumour histology was not specific for BHD. We found a pneumothorax risk of 29%. We discuss the implications of our findings for diagnosis and management of BHD.
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Affiliation(s)
- A C Houweling
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands
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de Visser SJ, Uchida N, van Vliet-Daskalopoulou E, Fukazawa I, van Doorn MBA, van den Heuvel MW, Machielsen CSM, Uchida E, Cohen AF. Pharmacokinetic differences between Caucasian and Japanese subjects after single and multiple doses of a potential combined oral contraceptive (Org 30659 and EE). Contraception 2004; 68:195-202. [PMID: 14561540 DOI: 10.1016/s0010-7824(03)00140-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the pharmacokinetic parameters and safety of the progestagen, Org 30659, (17alpha)-17-hydroxy-11-methylene-19-norpregna-4,15-dien-20-yn-3-one), and ethinyl estradiol (EE) in Caucasian and Japanese women after single and multiple doses. METHODS This was an open-label parallel design of a single dose followed by a multiple dose period in healthy young Japanese and Caucasian subjects. RESULTS The area under the curve (AUC) of Org 30659 after single dosing was increased by a factor of 1.75 [90% confidence interval (CI): 1.48-2.08] in Japanese women compared to Caucasian women. At steady state, this difference increased to a factor of 1.90 (90% CI: 1.60-2.25). The AUC of EE after single dosing was similar in Caucasian and Japanese women, but at steady state it was increased by a factor 1.38 (90% CI: 1.15-1.64) in the Japanese group. Weight normalization reduced, but did not remove, all the observed differences. Sex hormone binding globulin played no significant role in the differences between Caucasian and Japanese subjects. Both the single- and multiple-dose treatments with Org 30659/EE were generally well tolerated by all subjects. The Japanese population reported more and different treatment-related adverse events than the Caucasian population. CONCLUSIONS The peak concentration and extent of exposure of Org 30659, and to a lesser extent of EE, in Japanese women are higher than in Caucasian women. Furthermore, the peak concentration and extent of exposure at steady state of Org 30659, and to a lesser extent of EE, are higher than would be predicted assuming linear pharmacokinetics over time. No major safety issues were observed.
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Affiliation(s)
- S J de Visser
- Centre for Human Drug Research, Zernikedreef 10, 2333 CL Leiden, The Netherlands.
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