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Barak Levitt JA, Alemi S, Ollech A, Reiss-Huss S, Sah M, Renert-Yuval Y, Friedland R, Greenberger S, Cohen Barak E. Treatment with Methotrexate in Infants and Toddlers with Atopic Dermatitis: A Retrospective Multi-Center Study. J Clin Med 2023; 12:5409. [PMID: 37629451 PMCID: PMC10455795 DOI: 10.3390/jcm12165409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin disease affecting up to 20% of children. Methotrexate (MTX) is used off-label as a systemic treatment for AD patients unresponsive to topical therapies, but limited data exist regarding its safety and efficacy in children, especially in those < 4 years old. To further investigate MTX in younger patients, we screened the medical records of three referral centers between 2016 and 2022 and identified 28 infants and toddlers < 4 years old with AD treated with MTX. Mean age upon MTX initiation was 2.7 ± 1.2 years and mean investigator global assessment (IGA) score was 3.78 ± 0.4. Median duration of MTX treatment was five months. Following 12 and 24 weeks of MTX treatment, the response rate was 50% and IGA 0/1 was achieved in 14.2% and 21.4% of patients, respectively. Most treatment cessations were attributed to a lack of efficacy or parental concern. Although adverse events were reported in 57.1% of patients, MTX was discontinued due to such adverse events only in two patients (7.1%). Taken together, MTX demonstrated a high safety profile in AD patients <4 years old. MTX efficacy was moderate and presumably underestimated by parents who opted for premature treatment cessation due to concerns associated with an immunomodulatory drug.
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Affiliation(s)
| | - Sima Alemi
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
| | - Ayelet Ollech
- Department of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Ramat-Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shiran Reiss-Huss
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Dermatology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
| | - Mohammad Sah
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
| | - Yael Renert-Yuval
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Dermatology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
| | - Rivka Friedland
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Pediatric Dermatology Unit, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
| | - Shoshana Greenberger
- Department of Dermatology, Pediatric Dermatology Service, Sheba Medical Center, Ramat-Gan 5265601, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Eran Cohen Barak
- Department of Dermatology, Emek Medical Center, Afula 1834111, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3200003, Israel
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Rozenblat M, Halaj A, Rozenblat T, Fisher S, Sah M, Dodiuk-Gad RP, Ziv M. Mortality and risk factors among Israeli bullous pemphigoid patients. Arch Dermatol Res 2018; 311:19-27. [PMID: 30382340 DOI: 10.1007/s00403-018-1875-z] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 10/25/2018] [Accepted: 10/27/2018] [Indexed: 10/28/2022]
Abstract
There are differences concerning reported mortality rates and prognostic factors of bullous pemphigoid (BP) patients in different studies. Our objectives were to evaluate the mortality rates and prognostic factors among Israeli BP patients compared to matched control subjects. Three age- and sex-matched patients without BP (n = 261) who were treated in our clinic were selected and compared to BP patients (n = 87). Mean survival period of the BP group was 4.1 years (95% CI: 3.3-4.8 years) and 5.9 years among the non-BP group (95% CI: 5.6-6.3 years). The 1-year mortality rate was 24.1% for the BP group and 6.5% for the control group. In multivariate analysis, age above 80 was a significant risk factor for mortality [HR 3.22 (95% CI, 1.15-8.96), p = 0.03], while statins intake had a protective role [HR 0.36 (95% CI, 0.15-0.88), p = 0.03]. In univariant analysis, dementia [HR 2.44 (95% CI, 1.02-5.99), p = 0.04] was a risk factor. In conclusion, BP patients' mortality is correlated to increasing age at diagnosis, dementia, and statins use. Statins' protective role is newly discussed in the literature.
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Affiliation(s)
- Mati Rozenblat
- Department of Dermatology, Emek Medical Center, Afula, Israel.
| | - Awad Halaj
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Tal Rozenblat
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shani Fisher
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | - Mohammad Sah
- Department of Dermatology, Emek Medical Center, Afula, Israel
| | | | - Michael Ziv
- Department of Dermatology, Emek Medical Center, Afula, Israel
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Sah M, Rozenman D, Cohen E, Ziv M. [BULLOUS PEMPHIGOID RESISTANT TO CORTICOSTEROIDS]. Harefuah 2016; 155:593-595. [PMID: 28530051] [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
Bullous pemphigoid is the most common autoimmune bullous disease, treated with low dosage local or systemic corticosteroids. This is a case report of a 65 years-old female patient with a month long history of a bullous disease before admission to the dermatology department with a generalized bullous rash. Clinical examination and histopathology revealed bullous pemphigoid. She was treated according to the established protocol with systemic corticosteroids. The amount of prednisone was raised to 100mg per day for 8 weeks without any noticeable improvement, instead there was a worsening of her symptoms. In light of the treatment failure we carried out an adrenocorticotropic stimulation hormone test with a normal result. The patient was diagnosed as being resistant to corticosteroids and the treatment with prednisone was immediately terminated. Treatment was initiated with cyclophosphamide with an immediate improvement in her symptoms, and the patient was discharged after complete recovery. Discussion: Resistance to corticosteroids is a rare occurrence that has been reported in the literature on pulmonary and gastric disease. In dermatology, there is a single case report on atopic dermatitis that was treated locally. Awareness of the possibility will allow for a prompt diagnosis and appropriate treatment. Conclusion: We presented the case of a 65 year old female with bullous pemphigoid resistant to corticosteroids that has not been previously reported in the dermatologic literature.
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Affiliation(s)
- Mohammad Sah
- Department of Dermatology, Ha'Emek Medical Center, Afula, Israel
| | - Dganit Rozenman
- Department of Dermatology, Ha'Emek Medical Center, Afula, Israel
| | - Eran Cohen
- Department of Dermatology, Ha'Emek Medical Center, Afula, Israel
| | - Michael Ziv
- Department of Dermatology, Ha'Emek Medical Center, Afula, Israel
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Dodiuk‐Gad R, Cohen‐Barak E, Khayat M, Milo H, Amariglio‐Diskin L, Danial‐Faran N, Sah M, Ziv M, Shani‐Adir A, Amichai B, Zlotogorski A, Borochowitz Z, Rozenman D, Shalev S. Response to ‘Darier disease in Israel: combined evaluation of genetic and neuropsychiatric aspects’: reply from the authors. Br J Dermatol 2016; 175:224. [DOI: 10.1111/bjd.14544] [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: 11/29/2022]
Affiliation(s)
- R.P. Dodiuk‐Gad
- Department of Dermatology Haemek Medical Center Afula Israel
- Division of Dermatology Department of Medicine Sunnybrook Health Sciences Centre University of Toronto Toronto ON Canada
- The Rappaport Faculty of Medicine Technion Haifa Israel
| | - E. Cohen‐Barak
- Department of Dermatology Haemek Medical Center Afula Israel
- The Rappaport Faculty of Medicine Technion Haifa Israel
| | - M. Khayat
- The Rappaport Faculty of Medicine Technion Haifa Israel
- Genetic Institute Haemek Medical Center Afula Israel
| | - H. Milo
- Genetic Institute Haemek Medical Center Afula Israel
| | | | - N. Danial‐Faran
- The Rappaport Faculty of Medicine Technion Haifa Israel
- Genetic Institute Haemek Medical Center Afula Israel
| | - M. Sah
- Department of Dermatology Haemek Medical Center Afula Israel
- The Rappaport Faculty of Medicine Technion Haifa Israel
| | - M. Ziv
- Department of Dermatology Haemek Medical Center Afula Israel
- The Rappaport Faculty of Medicine Technion Haifa Israel
| | - A. Shani‐Adir
- Department of Dermatology Haemek Medical Center Afula Israel
- The Rappaport Faculty of Medicine Technion Haifa Israel
| | - B. Amichai
- Department of Dermatology Sheba Medical Center Tel‐Hashomer Israel
| | - A. Zlotogorski
- Department of Dermatology Hadassah – Hebrew University Medical Center Jerusalem Israel
| | - Z. Borochowitz
- The Rappaport Faculty of Medicine Technion Haifa Israel
- The Simon Winter Institute for Human Genetics Bnei‐Zion Medical Center Haifa Israel
| | - D. Rozenman
- Department of Dermatology Haemek Medical Center Afula Israel
- The Rappaport Faculty of Medicine Technion Haifa Israel
| | - S. Shalev
- The Rappaport Faculty of Medicine Technion Haifa Israel
- Genetic Institute Haemek Medical Center Afula Israel
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Dodiuk-Gad R, Cohen-Barak E, Khayat M, Milo H, Amariglio-Diskin L, Danial-Faran N, Sah M, Ziv M, Shani-Adir A, Amichai B, Zlotogorski A, Borochowitz Z, Rozenman D, Shalev S. Darier disease in Israel: combined evaluation of genetic and neuropsychiatric aspects. Br J Dermatol 2015; 174:562-8. [DOI: 10.1111/bjd.14220] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- R.P. Dodiuk-Gad
- Department of Dermatology; Haemek Medical Center; Afula Israel
- Division of Dermatology; Department of Medicine; Sunnybrook Health Sciences Centre; University of Toronto; Toronto ON Canada
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - E. Cohen-Barak
- Department of Dermatology; Haemek Medical Center; Afula Israel
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - M. Khayat
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
- Genetic Institute; Haemek Medical Center; Afula Israel
| | - H. Milo
- Genetic Institute; Haemek Medical Center; Afula Israel
| | | | - N. Danial-Faran
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
- Genetic Institute; Haemek Medical Center; Afula Israel
| | - M. Sah
- Department of Dermatology; Haemek Medical Center; Afula Israel
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - M. Ziv
- Department of Dermatology; Haemek Medical Center; Afula Israel
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - A. Shani-Adir
- Department of Dermatology; Haemek Medical Center; Afula Israel
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - B. Amichai
- Department of Dermatology; Sheba Medical Center; Tel-Hashomer Israel
| | - A. Zlotogorski
- Department of Dermatology; Hadassah - Hebrew University Medical Center; Jerusalem Israel
| | - Z. Borochowitz
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
- The Simon Winter Institute for Human Genetics; Bnei-Zion Medical Center; Haifa Israel
| | - D. Rozenman
- Department of Dermatology; Haemek Medical Center; Afula Israel
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
| | - S. Shalev
- The Rappaport Faculty of Medicine; Technion; Haifa Israel
- Genetic Institute; Haemek Medical Center; Afula Israel
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Cohen-Barak E, Sah M, Kerner M, Rozenman D, Ziv M. Impact of antipsoriatic therapy on endothelial function. Br J Dermatol 2015; 173:1440-6. [DOI: 10.1111/bjd.14076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 02/02/2023]
Affiliation(s)
- E. Cohen-Barak
- Department of Dermatology; Haemek Medical Center; Afula 18101 Israel
| | - M. Sah
- Department of Dermatology; Haemek Medical Center; Afula 18101 Israel
| | - M. Kerner
- Department of Dermatology; Haemek Medical Center; Afula 18101 Israel
| | - D. Rozenman
- Department of Dermatology; Haemek Medical Center; Afula 18101 Israel
| | - M. Ziv
- Department of Dermatology; Haemek Medical Center; Afula 18101 Israel
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Agius M, Pepper H, Sah M, Jayalath S, Pinto R, Zaman R. The pattern of development of psychotic symptoms after trauma. Eur Psychiatry 2008. [DOI: 10.1016/j.eurpsy.2008.01.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Behere PB, Sah M, Joshi PN. The validity of the neurotic depression concept. J Nerv Ment Dis 1993; 181:458-60. [PMID: 8320552 DOI: 10.1097/00005053-199307000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Chien CP, Sah M, Dubiel GC, Lu L. Double-blind study comparing the intramuscular usage of an acridan derivative, SK&F 14336, to chlorpromazine. Curr Ther Res Clin Exp 1970; 12:52-6. [PMID: 4989872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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