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Yamauchi PS. Management of scrotal pruritus with topical roflumilast 0.3% once daily treatment. JAAD Case Rep 2024; 47:4-5. [PMID: 38576905 PMCID: PMC10990720 DOI: 10.1016/j.jdcr.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Affiliation(s)
- Paul S. Yamauchi
- Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Gebauer K, Spelman L, Yamauchi PS, Bagel J, Nishandar T, Crane M, Kopeloff I, Kothekar M, Yao SL, Sofen HL. Efficacy and safety of tildrakizumab for the treatment of moderate-to-severe plaque psoriasis of the scalp: A multicenter, randomized, double-blind, placebo-controlled, Phase 3b study. J Am Acad Dermatol 2024:S0190-9622(24)00536-X. [PMID: 38554938 DOI: 10.1016/j.jaad.2024.03.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/27/2024] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Scalp psoriasis is common and difficult to treat. OBJECTIVE To evaluate efficacy and safety of tildrakizumab for the treatment of scalp psoriasis. METHODS In this Phase 3b, randomized, double-blind, placebo (PBO)-controlled study (NCT03897088), patients with moderate-to-severe plaque psoriasis affecting the scalp (Investigator Global Assessment modified [IGA mod] 2011 [scalp] ≥3, Psoriasis Scalp Severity Index [PSSI] ≥12, ≥30% scalp surface area affected) received tildrakizumab 100 mg or PBO at W0 and W4. The primary endpoint was IGA mod 2011 (scalp) score of "clear" or "almost clear" with ≥2-point reduction from baseline at W16 (IGA mod 2011 [scalp] response). Key secondary endpoints were PSSI 90 response at W12 and W16 and IGA mod 2011 (scalp) response at W12. Safety was assessed from adverse events. RESULTS Of patients treated with tildrakizumab (n = 89) vs PBO (n = 82), 49.4% vs 7.3% achieved IGA mod 2011 (scalp) response at W16 (primary endpoint) and 46.1% vs 4.9% at W12; 60.7% vs 4.9% achieved PSSI 90 response at W16 and 48.3% vs 2.4% at W12 (all P < .00001). No serious treatment-related adverse events occurred. LIMITATIONS Only short-term data are presented. CONCLUSION Tildrakizumab was efficacious for the treatment of scalp psoriasis with no new safety signals.
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Affiliation(s)
- Kurt Gebauer
- Fremantle Dermatology, Fremantle, WA, Australia; Probity Medical Research, Waterloo, Ontario, Canada.
| | - Lynda Spelman
- Veracity Clinical Research, Brisbane, QLD, Australia; Probity Medical Research, Woolloongabba, QLD, Australia
| | - Paul S Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor, New Jersey
| | | | - Michael Crane
- Sun Pharmaceutical Industries, Inc., Princeton, New Jersey
| | - Iris Kopeloff
- Sun Pharmaceutical Industries, Inc., Princeton, New Jersey
| | | | - Siu-Long Yao
- Sun Pharmaceutical Industries, Inc., Princeton, New Jersey
| | - Howard L Sofen
- David Geffen School of Medicine at UCLA, Los Angeles, California
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Zirwas MJ, Draelos ZD, DuBois J, Kircik LH, Moore AY, Stein Gold L, Alonso-Llamazares J, Bukhalo M, Bruce S, Eads K, Green LJ, Guenthner ST, Ferris LK, Forman SB, Kempers SE, Lain E, Lynde CW, Pariser DM, Toth DP, Yamauchi PS, Higham RC, Krupa D, Burnett P, Berk DR. Efficacy of Roflumilast Foam, 0.3%, in Patients With Seborrheic Dermatitis: A Double-blind, Vehicle-Controlled Phase 2a Randomized Clinical Trial. JAMA Dermatol 2023:2804569. [PMID: 37133856 PMCID: PMC10157502 DOI: 10.1001/jamadermatol.2023.0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Importance Current topical treatment options for seborrheic dermatitis are limited by efficacy and/or safety. Objective To assess safety and efficacy of roflumilast foam, 0.3%, in adult patients with seborrheic dermatitis affecting the scalp, face, and/or trunk. Design, Setting, and Participants This multicenter (24 sites in the US and Canada) phase 2a, parallel group, double-blind, vehicle-controlled clinical trial was conducted between November 12, 2019, and August 21, 2020. Participants were adult (aged ≥18 years) patients with a clinical diagnosis of seborrheic dermatitis for a 3-month or longer duration and Investigator Global Assessment (IGA) score of 3 or greater (at least moderate), affecting 20% or less body surface area, including scalp, face, trunk, and/or intertriginous areas. Data analysis was performed from September to October 2020. Interventions Once-daily roflumilast foam, 0.3% (n = 154), or vehicle foam (n = 72) for 8 weeks. Main Outcomes and Measures The main outcome was IGA success, defined as achievement of IGA score of clear or almost clear plus 2-grade improvement from baseline, at week 8. Secondary outcomes included IGA success at weeks 2 and 4; achievement of erythema score of 0 or 1 plus 2-grade improvement from baseline at weeks 2, 4, and 8; achievement of scaling score of 0 or 1 plus 2-grade improvement from baseline at weeks 2, 4, and 8; change in Worst Itch Numeric Rating Scale (WI-NRS) score from baseline; and WI-NRS success, defined as achievement of 4-point or greater WI-NRS score improvement in patients with baseline WI-NRS score of 4 or greater. Safety and tolerability were also assessed. Results A total of 226 patients (mean [SD] age, 44.9 [16.8] years; 116 men, 110 women) were randomized to roflumilast foam (n = 154) or vehicle foam (n = 72). At week 8, 104 (73.8%) roflumilast-treated patients achieved IGA success compared with 27 (40.9%) in the vehicle group (P < .001). Roflumilast-treated patients had statistically significantly higher rates of IGA success vs vehicle at week 2, the first time point assessed. Mean (SD) reductions (improvements) on the WI-NRS at week 8 were 59.3% (52.5%) vs 36.6% (42.2%) in the roflumilast and vehicle groups, respectively (P < .001). Roflumilast was well tolerated, with the rate of adverse events similar to that of the vehicle foam. Conclusions and Relevance The results from this phase 2a randomized clinical trial of once-daily roflumilast foam, 0.3%, demonstrated favorable efficacy, safety, and local tolerability in the treatment of erythema, scaling, and itch caused by seborrheic dermatitis, supporting further investigation as a nonsteroidal topical treatment. Trial Registration ClinicalTrials.gov Identifier: NCT04091646.
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Affiliation(s)
- Matthew J Zirwas
- Dermatologists of the Central States, Bexley, Ohio
- Probity Medical Research, Bexley, Ohio
- Ohio University, Bexley
| | - Zoe D Draelos
- Dermatology Consulting Services, High Point, North Carolina
| | | | - Leon H Kircik
- Icahn School of Medicine at Mount Sinai, New York, New York
- Physicians Skin Care, PLLC, Louisville, Kentucky
- Indiana Medical Center, Indianapolis
- Skin Sciences, PLLC, Louisville, Kentucky
| | - Angela Y Moore
- Arlington Center for Dermatology, Arlington Research Center, Arlington, Texas
- Baylor University Medical Center, Dallas, Texas
| | | | | | | | | | - Kimmie Eads
- The Indiana Clinical Trials Center, PC, Plainfield
| | - Lawrence J Green
- George Washington University School of Medicine, Rockville, Maryland
| | - Scott T Guenthner
- The Dermatology Center of Indiana, PC, Plainfield
- The Indiana Clinical Trials Center, PC, Plainfield
| | - Laura K Ferris
- University of Pittsburgh, Department of Dermatology, Pittsburgh, Pennsylvania
| | | | | | | | - Charles W Lynde
- University of Toronto, Toronto, Ontario, Canada
- Lynde Centre for Dermatology, Markham, Ontario, Canada
- Probity Medical Research, Markham, Ontario, Canada
| | - David M Pariser
- Eastern Virginia Medical School, Norfolk
- Virginia Clinical Research, Inc, Norfolk
| | - Darryl P Toth
- XLR8 Medical Research, Windsor, Ontario, Canada
- Probity Medical Research, Windsor, Ontario, Canada
| | - Paul S Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Dermatology Institute & Skin Care Center, Inc, Santa Monica, California
| | | | - David Krupa
- Arcutis Biotherapeutics, Inc, Westlake Village, California
| | | | - David R Berk
- Arcutis Biotherapeutics, Inc, Westlake Village, California
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Lunge SB, Shetty NS, Sardesai VR, Karagaiah P, Yamauchi PS, Weinberg JM, Kircik L, Giulini M, Goldust M. Therapeutic application of machine learning in psoriasis: A Prisma systematic review. J Cosmet Dermatol 2023; 22:378-382. [PMID: 35621249 DOI: 10.1111/jocd.15122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/15/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
Dermatology, being a predominantly visual-based diagnostic field, has found itself to be at the epitome of artificial intelligence (AI)-based advances. Machine learning (ML), a subset of AI, goes a step further by recognizing patterns from data and teaches machines to automatically learn tasks. Although artificial intelligence in dermatology is mostly developed in melanoma and skin cancer diagnosis, advances in AI and ML have gone far ahead and found its application in ulcer assessment, psoriasis, atopic dermatitis, onychomycosis, etc. This article is focused on the application of ML in the therapeutic aspect of psoriasis.
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Affiliation(s)
- Snehal Balvant Lunge
- Department of Dermatology, Venereology and Leprosy, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, India
| | - Nandini Sundar Shetty
- Department of Dermatology, Venereology and Leprosy, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, India
| | - Vidyadhar R Sardesai
- Department of Dermatology, Venereology and Leprosy, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, India
| | - Priyanka Karagaiah
- Department of dermatology, Bangalore Medical College and Research Institute, Bangalore, India
| | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, California, USA
- Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | | | - Leon Kircik
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mario Giulini
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Lebwohl MG, Kircik LH, Moore AY, Stein Gold L, Draelos ZD, Gooderham MJ, Papp KA, Bagel J, Bhatia N, Del Rosso JQ, Ferris LK, Green LJ, Hebert AA, Jones T, Kempers SE, Pariser DM, Yamauchi PS, Zirwas M, Albrecht L, Devani AR, Lomaga M, Feng A, Snyder S, Burnett P, Higham RC, Berk DR. Effect of Roflumilast Cream vs Vehicle Cream on Chronic Plaque Psoriasis: The DERMIS-1 and DERMIS-2 Randomized Clinical Trials. JAMA 2022; 328:1073-1084. [PMID: 36125472 PMCID: PMC9490499 DOI: 10.1001/jama.2022.15632] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Once-daily roflumilast cream, 0.3%, a potent phosphodiesterase 4 inhibitor, demonstrated efficacy and was well tolerated in a phase 2b trial of patients with psoriasis. OBJECTIVE To evaluate the efficacy of roflumilast cream, 0.3%, applied once daily for 8 weeks in 2 trials of patients with plaque psoriasis. DESIGN, SETTING, AND PARTICIPANTS Two phase 3, randomized, double-blind, controlled, multicenter trials (DERMIS-1 [trial 1; n = 439] and DERMIS-2 [trial 2; n = 442]) were conducted at 40 centers (trial 1) and 39 centers (trial 2) in the US and Canada between December 9, 2019, and November 16, 2020, and between December 9, 2019, and November 23, 2020, respectively. Patients aged 2 years or older with plaque psoriasis involving 2% to 20% of body surface area were enrolled. The dates of final follow-up were November 20, 2020, and November 23, 2020, for trial 1 and trial 2, respectively. INTERVENTIONS Patients were randomized 2:1 to receive roflumilast cream, 0.3% (trial 1: n = 286; trial 2: n = 290), or vehicle cream (trial 1: n = 153; trial 2: n = 152) once daily for 8 weeks. MAIN OUTCOMES AND MEASURES The primary efficacy end point was Investigator Global Assessment (IGA) success (clear or almost clear status plus ≥2-grade improvement from baseline [score range, 0-4]) at week 8, analyzed using a Cochran-Mantel-Haenszel test stratified by site, baseline IGA score, and intertriginous involvement. There were 9 secondary outcomes, including intertriginous IGA success, 75% reduction in Psoriasis Area and Severity Index (PASI) score, and Worst Itch Numeric Rating Scale score of 4 or higher at baseline achieving 4-point reduction (WI-NRS success) at week 8 (scale: 0 [no itch] to 10 [worst imaginable itch]; minimum clinically important difference, 4 points). RESULTS Among 881 participants (mean age, 47.5 years; 320 [36.3%] female), mean IGA scores in trial 1 were 2.9 [SD, 0.52] for roflumilast and 2.9 [SD, 0.45] for vehicle and in trial 2 were 2.9 [SD, 0.48] for roflumilast and 2.9 [SD, 0.47]) for vehicle. Statistically significantly greater percentages of roflumilast-treated patients than vehicle-treated patients had IGA success at week 8 (trial 1: 42.4% vs 6.1%; difference, 39.6% [95% CI, 32.3%-46.9%]; trial 2: 37.5% vs 6.9%; difference, 28.9% [95% CI, 20.8%-36.9%]; P < .001 for both). Of 9 secondary end points, statistically significant differences favoring roflumilast vs vehicle were observed for 8 in trial 1 and 9 in trial 2, including intertriginous IGA success (71.2% vs 13.8%; difference, 66.5% [95% CI, 47.1%-85.8%] and 68.1% vs 18.5%; difference, 51.6% [95% CI, 29.3%-73.8%]; P < .001 for both), 75% reduction in PASI score (41.6% vs 7.6%; difference, 36.1% [95% CI, 28.5%-43.8%] and 39.0% vs 5.3%; difference, 32.4% [95% CI, 24.9%-39.8%]; P < .001 for both), WI-NRS success (67.5% vs 26.8%; difference, 42.6% [95% CI, 31.3%-53.8%] and 69.4% vs 35.6%; difference, 30.2% [95% CI, 18.2%-42.2%]; P < .001 for both). The incidence of treatment-emergent adverse events was 25.2% with roflumilast vs 23.5% with vehicle in trial 1 and 25.9% with roflumilast vs 18.4% with vehicle in trial 2. The incidence of serious adverse events was 0.7% with roflumilast vs 0.7% with vehicle in trial 1 and 0% with roflumilast vs 0.7% with vehicle in trial 2. CONCLUSIONS AND RELEVANCE Among patients with chronic plaque psoriasis, treatment with roflumilast cream, 0.3%, compared with vehicle cream resulted in better clinical status at 8 weeks. Further research is needed to assess efficacy compared with other active treatments and to assess longer-term efficacy and safety. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT04211363, NCT04211389.
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Affiliation(s)
| | - Leon H. Kircik
- Icahn School of Medicine at Mount Sinai, New York, New York
- Indiana Medical Center, Indianapolis
- Physicians Skin Care PLLC, Louisville, Kentucky
- Skin Sciences PLLC, Louisville, Kentucky
| | - Angela Y. Moore
- Arlington Research Center, Arlington, Texas
- Baylor University Medical Center, Dallas, Texas
| | | | - Zoe D. Draelos
- Dermatology Consulting Services, High Point, North Carolina
| | - Melinda J. Gooderham
- SkiN Centre for Dermatology, Peterborough, Ontario, Canada
- Probity Medical Research, Peterborough, Ontario, Canada
- Queen’s University, Peterborough, Ontario, Canada
| | - Kim A. Papp
- Probity Medical Research, Waterloo, Ontario, Canada
- K Papp Clinical Research, Waterloo, Ontario, Canada
| | - Jerry Bagel
- Psoriasis Treatment Center of Central New Jersey, East Windsor
| | - Neal Bhatia
- Therapeutics Clinical Research, San Diego, California
| | - James Q. Del Rosso
- JDR Dermatology Research Center LLC, Las Vegas, Nevada
- Advanced Dermatology and Cosmetic Surgery, Maitland, Florida
| | - Laura K. Ferris
- University of Pittsburgh Clinical and Translational Science Institute, Pittsburgh, Pennsylvania
| | - Lawrence J. Green
- George Washington University School of Medicine, Rockville, Maryland
| | | | | | | | - David M. Pariser
- Eastern Virginia Medical School, Norfolk
- Virginia Clinical Research Inc, Norfolk
| | - Paul S. Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, California
- Dermatology Institute and Skin Care Center Inc, Santa Monica, California
| | - Matthew Zirwas
- Dermatologists of the Central States, Bexley, Ohio
- Probity Medical Research, Bexley, Ohio
- Ohio University, Bexley, Ohio
| | - Lorne Albrecht
- Enverus Medical Research, Surrey, British Columbia, Canada
- Probity Medical Research, Surrey, British Columbia, Canada
| | - Alim R. Devani
- Dermatology Research Institute, Calgary, Alberta, Canada
- Probity Medical Research, Calgary, Alberta, Canada
| | - Mark Lomaga
- DermEdge Research, Mississauga, Ontario, Canada
- Probity Medical Research, Mississauga, Ontario, Canada
| | - Amy Feng
- Arcutis Biotherapeutics Inc, Westlake Village, California
| | - Scott Snyder
- Arcutis Biotherapeutics Inc, Westlake Village, California
| | | | | | - David R. Berk
- Arcutis Biotherapeutics Inc, Westlake Village, California
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Ferris LK, Draelos ZD, Hebert AA, Lynde CW, Pariser DM, Papp KA, Yamauchi PS, Feng A, Higham RC, Burnett P, Berk DR. 33468 Efficacy and safety of once-daily roflumilast cream 0.3% in patients with knee/elbow involvement: Pooled results from phase 3 trials (DERMIS-1 and DERMIS-2). J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.678] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Armstrong AW, Patil D, Levi E, McGuiness CB, Wang X, Wang Y, Chen CC, Nguyen E, Yamauchi PS. Real-World Satisfaction with Secukinumab in Clearing the Skin of Patients with Plaque Psoriasis through 24 Months of Follow-Up: Results from US Dermatology Electronic Medical Records. Dermatol Ther (Heidelb) 2021; 11:1733-1749. [PMID: 34455554 PMCID: PMC8484392 DOI: 10.1007/s13555-021-00599-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Information on the long-term treatment satisfaction with secukinumab for patients with plaque psoriasis in real-world settings is limited. The objective of this study was to describe real-world treatment satisfaction in patients with plaque psoriasis who initiated secukinumab using data from an electronic medical records-based dermatology database. METHODS Patients aged ≥ 18 years with plaque psoriasis in Modernizing Medicine Data Services' affiliate's database who received secukinumab 3/1/2018-1/21/2020 were included. Satisfaction with the treatment's effectiveness in clearing the skin of psoriasis was evaluated using a 5-point Likert scale during the 12-month baseline period and at 6-, 12-, 18-, and 24-month postindex visits for the overall population and at 6-, 12-, and 18-month postindex visits for subgroups stratified by prior biologic and systemic therapy use. Additionally, satisfaction levels were assessed among patients who were unsatisfied with treatment at baseline. RESULTS Overall, 82.3% agreed that secukinumab was effective in clearing their skin at 6 months, which was maintained through 12 (81.7%), 18 (83.3%), and 24 months (81.4%). Similar results were observed in biologic-experienced/naive and systemic-experienced/naive patients. Overall mean (SD) treatment satisfaction improved from 2.49 (1.36) at baseline to 1.77 (1.06) at 6 months, with similar improvements in satisfaction scores reported at each follow-up period up through 24 months. Of the patients who were not satisfied at baseline, 77.9% reported being satisfied with their treatment at 6 months, which continued through 12 (74.4%), 18 (82.8%), and 24 months (71.4%). Patients receiving secukinumab experienced meaningful changes in percent affected body surface area and Physician Global Assessment scores that were sustained through 24 months, regardless of prior treatment experience. CONCLUSIONS These real-world findings highlight the high level of sustained satisfaction with secukinumab treatment for improving and maintaining skin clearance in patients with moderate-to-severe disease, regardless of prior treatment experience.
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Affiliation(s)
- April W Armstrong
- Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Dhaval Patil
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Eugenia Levi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | - Xin Wang
- IQVIA, Plymouth Meeting, PA, USA
| | - Yi Wang
- IQVIA, Plymouth Meeting, PA, USA
| | | | | | - Paul S Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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8
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Gupta M, Weinberg JM, Yamauchi PS, Patil A, Grabbe S, Goldust M. Psoriasis: Embarking a dynamic shift in the skin microbiota. J Cosmet Dermatol 2021; 21:1402-1406. [PMID: 34089221 DOI: 10.1111/jocd.14273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/28/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Recent interest has arisen regarding the role of microbiome and its composition in the pathogenesis of psoriasis. Numerous studies have shown that there are alterations in skin flora arrangement between normal individuals and psoriatic patients. Psoriasis exacerbation could be interconnected with epidermal or mucosal colonization with streptococci, Malassezia, Staphylococcus aureus, or Candida albicans. The role of cutaneous and gut microbiome in psoriasis pathogenesis has recently been studied in both human and animal models. In this review, we try to evaluate various pathogenic mechanisms linking the microbiota and psoriasis. The literature research included peer-reviewed articles which included clinical trials, original reports, and scientific reviews. MEDLINE and PubMed databases were searched from January 1990 to March 2021, including the reference lists of articles meeting our criteria.
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Affiliation(s)
- Mrinal Gupta
- DNB Dermatology Consultant Dermatologist, Treatwell Skin Centre, Jammu, India
| | | | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, CA, USA.,Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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Abstract
Pustular psoriasis refers to a heterogeneous group of chronic inflammatory skin disorders that are clinically, histologically, and genetically distinct from plaque psoriasis. Pustular psoriasis may present as a recurrent systemic illness (generalized pustular psoriasis [GPP]), or as localized disease affecting the palms and/or soles (palmoplantar pustulosis [PPP], also known as palmoplantar pustular psoriasis), or the digits/nail beds (acrodermatitis continua of Hallopeau [ACH]). These conditions are rare, but their possible severity and consequences should not be underestimated. GPP, especially an acute episode (flare), may be a medical emergency, with potentially life-threatening complications. PPP and ACH are often debilitating conditions. PPP is associated with impaired health-related quality of life and psychiatric morbidity, while ACH threatens irreversible nail and/or bone damage. These conditions can be difficult to diagnose; thus, primary care providers should not hesitate to contact a dermatologist for advice and/or patient referral. The role of corticosteroids in triggering and leading to flares of GPP should also be noted, and physicians should avoid the use of systemic corticosteroids in the management of any form of psoriasis.
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Affiliation(s)
- Jeffrey J Crowley
- Bakersfield Dermatology & Skin Cancer Medical Group, Bakersfield, CA, USA
| | - David M Pariser
- Eastern Virginia Medical School and Virginia Clinical Research, Inc., Norfolk, VA, USA
| | - Paul S Yamauchi
- Dermatology Institute & Skin Care Center, Santa Monica, CA, USA
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Gupta M, Yamauchi PS, Bagot M, Szepietowski J, Bhatia S, Lotti T, Goldust M. Uncommon presentation of morphea related to interferon beta in a patient with concomitant multiple sclerosis and chronic hepatitis C: A case report. Clin Case Rep 2020; 8:1647-1650. [PMID: 32983469 PMCID: PMC7495805 DOI: 10.1002/ccr3.2971] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 11/24/2022] Open
Abstract
Recombinant interferon beta-1b is one of the treatment options of multiple sclerosis (MS). Insertional biologics that are used in the treatment of MS may lead to skin adverse effects, for example, morphea.
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Affiliation(s)
| | - Paul S. Yamauchi
- Dermatology Institute and Skin Care CenterSanta MonicaCaliforniaUSA
- Division of DermatologyDavid Geffen School of Medicine at University of CaliforniaLos AngelesCaliforniaUSA
| | - Martine Bagot
- AP‐HP Dermatology DepartmentSaint‐Louis HospitalINSERM U976Université Paris Diderot‐Paris VIISorbonne Paris CitéParisFrance
| | - Jacek Szepietowski
- Department of Dermatology, Venereology and AllergologyWroclaw Medical UniversityWroclawPoland
| | - Shibani Bhatia
- Department of Dermatology, Venereology and LeprosyKasturba medical collegeManipal Manipal Academy of Higher EducationManipalIndia
| | | | - Mohamad Goldust
- Mazandaran University of Medical SciencesSariIran
- University of Rome G. MarconiRomeItaly
- Department of DermatologyUniversity Medical Center MainzMainzGermany
- Department of DermatologyUniversity Hospital BaselBaselSwitzerland
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11
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Walters ME, Lee DJ, Yamauchi PS. Increased Trend of Cosmetic Procedures in Patients With Psoriasis Who Attain 75% or Greater Improvement. J Drugs Dermatol 2020; 19:698-701. [PMID: 32845593 DOI: 10.36849/jdd.2020.5104r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: The relationship between the clearance of psoriasis and improved quality of life together with an increased uptake of cosmetic procedures has not been reported to date. Objective: A survey was conducted at a single dermatology center to determine if there was an increased trend in cosmetic procedures in patients with moderate to severe psoriasis who attained 75% or greater reduction of the body surface area (BSA) with biologic agents and oral systemic therapies, and if this was related to an improvement in quality of life following psoriasis clearance. Study Design: In this case series, 138 patients with a history of moderate to severe psoriasis who attained 75% or greater body surface area (BSA) reduction with biologic agents or oral systemic therapies and had undergone at least one cosmetic procedure in the past 2 years were surveyed. Patient characteristics were collected including age, sex, percent BSA at initiation of therapy, the class of biologic or oral systemic therapies, and the different types of cosmetic procedures. Patients were asked to answer a 5-question survey on quality of life improvement, satisfaction with treatment, and correlation with the cosmetic procedure they had undergone, Patients also completed the Dermatology Quality of Life Index (DLQI) questionnaire in the survey. Results: The majority of patients who had undergone a cosmetic procedure after achieving 75% BSA stated that their psoriasis had previously prevented them from undergoing a cosmetic procedure. Regardless of therapy, all patients felt their quality of life had improved as a result of their treatment, and 91% of patients stated this was the impetus to undergo a cosmetic procedure. The mean DLQI score prior to therapy was 14.3 and 71% of patients reported a DLQI score of 0/1 after their psoriasis improved. Conclusion: There was a correlation between improvement in quality of life in patients who had achieved at least a 75% reduction in BSA with either a biologic agent, oral agent, or both, and the uptake of cosmetic procedures. J Drugs Dermatol. 2020;19(8): doi:10.36849/JDD.2020.5104R1.
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Salimi S, Yamauchi PS, Thakur R, Weinberg JM, Kircik L, Abdelmaksoud A, Wollina U, Lotti T, Sharma A, Grabbe S, Goldust M. Interleukin 23p19 inhibitors in chronic plaque psoriasis with focus on mirikizumab: A narrative review. Dermatol Ther 2020; 33:e13800. [PMID: 32530083 DOI: 10.1111/dth.13800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/29/2022]
Abstract
Psoriasis, a T-cell mediated chronic dermatosis, has a complex etiopathogenesis. There has been extensive research into the aberrant immune response, which leads to the formation of clinical lesions, and the need for developing better and safer drugs has been unrelenting. The past two decades of research has opened up new areas of the immune pathway that can be targeted in order to control the disease. Therefore, we have seen the emergence of biologics which either target T-cell receptors or inhibit Tumor Necrosis Factor-alpha (TNF-α) or inhibit interleukins (IL) like IL-12, IL-17, IL-17 receptor, and more recently IL-23. Drugs specifically targeting the p19 subunit of IL-23 have shown promising results in the management of chronic plaque psoriasis. This has given way to the development of a new class of biologics, that is, the IL-23p19 inhibitors that have a better safety profile as compared to its predecessors. In this review, we shall scrutinize the role of IL-23 and Th17 cell signaling in the evolution of the psoriatic lesions and summarize the clinical experience with IL-23p19 inhibitors especially mirikizumab in the treatment of chronic plaque psoriasis.
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Affiliation(s)
- Sohrab Salimi
- Department of Anesthesiology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, California, USA.,Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Rohini Thakur
- Dermatology, Venereology and Leprology Consultant Dermatology and Cosmetology, Columbia Asia Hospital, Patiala, Punjab, India
| | | | - Leon Kircik
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Torello Lotti
- Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy
| | - Aseem Sharma
- Dermatology Unit, Skin Saga Centre for Dermatology, Mumbai, India
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.,University of Rome G. Marconi, Rome, Italy.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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13
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Patel DS, Veverka KA, Hansen JB, Yamauchi PS, Alonso-Llamazares J, Lebwohl M. Efficacy of Fixed-combination Calcipotriene 0.005% and Betamethasone Dipropionate 0.064% Foam for Scalp Plaque Psoriasis: Additional Analysis of a Phase II, Randomized Clinical Study. J Clin Aesthet Dermatol 2020; 13:12-18. [PMID: 32802249 PMCID: PMC7380692] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND: There are a variety of treatment options currently available for plaque psoriasis affecting the scalp, yet scalp psoriasis remains one of the most frustrating and difficult-to-manage forms of the disease. OBJECTIVE: We investigated the efficacy of fixed-combination calcipotriene 0.005% plus betamethasone dipropionate 0.064% (Cal/BD) foam for the treatment of scalp psoriasis. METHODS: Additional (including post-hoc) analysis was conducted on data from a Phase II, randomized, double-blind, multicenter study of Cal/BD foam for the treatment of psoriasis vulgaris (NCT01536938). A total of 302 patients, ages 18 years or older, with psoriasis vulgaris of at least mild severity (scalp involvement of at least 10%) were included; 100, 101, and 101 patients were randomized to once-daily Cal/BD foam, Cal foam, or BD foam, respectively. Assessments included a severity score for lesion redness, scaliness, and plaque thickness, modified Psoriasis Area and Severity Index (mPASI) score, proportion of patients with reduction of 50 percent or greater in total sign score (TSS-50), and proportion of patients with at least a 75-percent reduction in mPASI score (mPASI-75). RESULTS: Patients achieved greater improvements in their scalp psoriasis with Cal/BD foam versus BD or Cal foam alone at Week 4 considering mPASI, mPASI-75, and TSS-50 outcomes. After four weeks of treatment, more patients receiving Cal/BD foam had a severity score for redness, scaliness, and thickness indicating "none" or "mild" versus BD foam or Cal foam alone. Improvements on the scalp appear to be consistent with those on the trunk and limbs. CONCLUSION: Scalp lesion severity improved considerably and rapidly with a four-week regimen of Cal/BD foam, suggesting that Cal/BD foam is an effective topical treatment option for scalp psoriasis.
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Affiliation(s)
- Dharm S Patel
- Drs. Patel and Veverka are with LEO Pharma in Madison, New Jersey
- Dr. Hansen is with LEO Pharma in Ballerup, Denmark
- Dr. Yamauchi is with the Division of Dermatology at the David Geffen School of Medicine at UCLA in Los Angeles, California
- Dr. Alonso-Llamazares is with the Department of Dermatology at the VA Medical Center in Miami, Florida
- Dr. Lebwohl is with the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Karen A Veverka
- Drs. Patel and Veverka are with LEO Pharma in Madison, New Jersey
- Dr. Hansen is with LEO Pharma in Ballerup, Denmark
- Dr. Yamauchi is with the Division of Dermatology at the David Geffen School of Medicine at UCLA in Los Angeles, California
- Dr. Alonso-Llamazares is with the Department of Dermatology at the VA Medical Center in Miami, Florida
- Dr. Lebwohl is with the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Jes B Hansen
- Drs. Patel and Veverka are with LEO Pharma in Madison, New Jersey
- Dr. Hansen is with LEO Pharma in Ballerup, Denmark
- Dr. Yamauchi is with the Division of Dermatology at the David Geffen School of Medicine at UCLA in Los Angeles, California
- Dr. Alonso-Llamazares is with the Department of Dermatology at the VA Medical Center in Miami, Florida
- Dr. Lebwohl is with the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Paul S Yamauchi
- Drs. Patel and Veverka are with LEO Pharma in Madison, New Jersey
- Dr. Hansen is with LEO Pharma in Ballerup, Denmark
- Dr. Yamauchi is with the Division of Dermatology at the David Geffen School of Medicine at UCLA in Los Angeles, California
- Dr. Alonso-Llamazares is with the Department of Dermatology at the VA Medical Center in Miami, Florida
- Dr. Lebwohl is with the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Javier Alonso-Llamazares
- Drs. Patel and Veverka are with LEO Pharma in Madison, New Jersey
- Dr. Hansen is with LEO Pharma in Ballerup, Denmark
- Dr. Yamauchi is with the Division of Dermatology at the David Geffen School of Medicine at UCLA in Los Angeles, California
- Dr. Alonso-Llamazares is with the Department of Dermatology at the VA Medical Center in Miami, Florida
- Dr. Lebwohl is with the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York
| | - Mark Lebwohl
- Drs. Patel and Veverka are with LEO Pharma in Madison, New Jersey
- Dr. Hansen is with LEO Pharma in Ballerup, Denmark
- Dr. Yamauchi is with the Division of Dermatology at the David Geffen School of Medicine at UCLA in Los Angeles, California
- Dr. Alonso-Llamazares is with the Department of Dermatology at the VA Medical Center in Miami, Florida
- Dr. Lebwohl is with the Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York, New York
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14
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Gordon KB, Reich K, Crowley JJ, Korman NJ, Murphy FT, Poulin Y, Spelman L, Yamauchi PS, Mendelsohn AM, Parno J, Rozzo SJ, Ellis CN. Disease activity and treatment efficacy using patient-level Psoriasis Area and Severity Index scores from tildrakizumab phase 3 clinical trials. J DERMATOL TREAT 2020; 33:219-228. [PMID: 32349565 DOI: 10.1080/09546634.2020.1747590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND It is unclear whether primary efficacy outcomes in plaque psoriasis clinical trials represent residual disease during treatment. OBJECTIVES To evaluate supplementing dichotomous efficacy with residual disease activity. METHODS This post hoc analysis used pooled, patient-level data after tildrakizumab 100 mg (N = 616) or placebo (N = 309) treatment from reSURFACE 1/2 (NCT01722331/NCT01729754) phase 3 clinical trials of patients with moderate to severe plaque psoriasis. RESULTS Median baseline Psoriasis Area and Severity Index (PASI) was 17.9 for patients receiving tildrakizumab 100 mg. At Week 12, median PASI was 2.9, whereas dichotomous PASI 90 response rate was 36.9%, and absolute PASI <5.0, <3.0, and <1.0 were 64.0%, 50.8%, and 23.3%, respectively. At Week 28, median PASI was 1.7, whereas PASI 90 response rate was 51.9%, and absolute PASI <5.0, <3.0, and <1.0 were 75.3%, 62.8%, and 38.0%, respectively. Dermatology Life Quality Index and PASI scores were correlated through Week 28 (r = 0.51, p ≤ .0001). CONCLUSIONS Disease activity was more reliably estimated by PASI scores than percentage PASI improvement; this may partially explain efficacy disparities between clinical trials and practice. These results suggest supplementing dichotomous PASI improvement with PASI scores and consideration of patient treatment goals could facilitate clinical decisions.
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Affiliation(s)
- K B Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf and Skinflammation®, Hamburg, Germany
| | - J J Crowley
- Bakersfield Dermatology, Bakersfield, CA, USA
| | - N J Korman
- University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - F T Murphy
- Altoona Arthritis and Osteoporosis Center, Duncansville, PA, USA.,Villanova University, Villanova, PA, USA
| | - Y Poulin
- Centre Hospitalier de l'Université Laval, Hôpital Hôtel-Dieu de Québec, Québec City, QC, Canada.,Centre de Recherche Dermatologique du Québec Métropolitain, Québec City, QC, Canada
| | - L Spelman
- Veracity Clinical Research, Brisbane, QLD, Australia.,Probity Medical Research, Waterloo, ON, Canada
| | - P S Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - J Parno
- Sun Pharmaceutical Industries, Inc, Princeton, NJ, USA
| | - S J Rozzo
- Sun Pharmaceutical Industries, Inc, Princeton, NJ, USA
| | - C N Ellis
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, MI, USA
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15
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Green LJ, Yamauchi PS, Kircik LH. Comparison of the Safety and Efficacy of Tumor Necrosis Factor Inhibitors and Interleukin-17 Inhibitors in Patients With Psoriasis. J Drugs Dermatol 2019; 18:776-788. [PMID: 31424708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Psoriasis (PsO) is a common, systemic, chronic inflammatory disease characterized by key clinical symptoms, including itching, pain, and scaling, and is associated with substantial physical, psychosocial, and economic health burdens. Currently, there is no cure for PsO; however, the introduction of biologic therapies has revolutionized the clinical management of patients with PsO by expanding treatment options to include multiple therapies with different mechanisms of action targeting cytokines, including tumor necrosis factor inhibitors (TNFis), interleukin (IL)-17A inhibitors, an IL-12/23 inhibitor, and IL-23 inhibitors. TNFis are historically considered the first-line biologic treatment and the first-generation biologics; however, increased understanding of TNF-α and IL-17 synergistic functions have recently led to evidence that specifically targeting IL-17 may be more likely to improve disease activity than a more general, nonspecific therapy target, such as TNF-α. This review highlights currently available evidence and demonstrates the differences between TNFis and IL-17A inhibitors in patients with PsO with regard to efficacy and safety.
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16
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Dehpouri T, Rokni GR, Narenjbon NA, Goldust M, Yamauchi PS, Wollina U, Lotti T, Kircik L, Lernia VGD, Sonthalia S, Vojvodic A, Szepietowski J, Bahadoran P, Errichetti E, Cantisani C, Atzori L, Rezaee E, Kutlubay Z, Engin B, Nisticò S, Damiani G, Conic RRZ, Goren A, Čabrijan L, Tchernev G. Evaluation of the glycemic effect of methotrexate in psoriatic arthritis patients with metabolic syndrome: A pilot study. Dermatol Reports 2019; 11:7965. [PMID: 31210916 PMCID: PMC6547029 DOI: 10.4081/dr.2019.7965] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 01/18/2019] [Indexed: 01/10/2023] Open
Abstract
Methotrexate (MTX) is a systemic immunosuppressant drug used for the treatment of psoriasis and psoriatic arthritis. Previous studies demonstrated a potential association between psoriasis and diabetes mellitus, obesity, atherosclerosis, hypertension, eventuating into metabolic syndrome. This study aimed at exploring the glycemic effects of MTX in psoriatic arthritis (PsA) patients. In this prospective cross-sectional study, 27 patients with PsA were evaluated. The status of PsA and presence of accompanying metabolic syndrome was determined by standard criteria and indices. Blood indicators including HbA1c, erythrocyte sedimentation rate, fasting blood sugar, total cholesterol, high-density lipoprotein, triglycerides, and C-reactive protein were examined before and 12 weeks after MTX therapy. There were no significant changes between HbA1c levels before and after MTX therapy in both genders (men: P=0.131, women: P=0.803). In addition, HbA1c levels in PsA patients with metabolic syndrome were not different before and after treatment (P=0.250). Finally, HbA1c levels did not change in PsA patients without metabolic syndrome before and after therapy (P=0.506). MTX in PsA patients does not appear to have hyperglycaemic effects in the short-term and can be safely used in patients with metabolic syndrome and diabetes.
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Affiliation(s)
- Tannaz Dehpouri
- Student Research Committee, Mazandaran University of Medical Sciences, Ramsar International Branch, Ramsar, Iran
| | | | | | - Mohamad Goldust
- Department of Dermatology, Mazandaran University of Medical Sciences, Sari, Iran
| | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, California, USA.,Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Torello Lotti
- Department of Dermatology, "Guglielmo Marconi" University, Rome, Italy
| | - Leon Kircik
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Sidharth Sonthalia
- Skinnocence: The Skin Clinic & Research Center, Gurugram, Haryana, India.,Dermasource India, Gurugram, Haryana, India
| | - Aleksandra Vojvodic
- Department of Dermatology and Venereology, Military Medical Academy, Belgrade, Serbia
| | - Jacek Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Udine, Italy
| | - Carmen Cantisani
- Department of Dermatology, "Umberto I" Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Laura Atzori
- Dermatology Clinic, Department Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Elham Rezaee
- Department of Pharmaceutical Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zekayi Kutlubay
- Department of Dermatology, Cerrahpasa Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Burhan Engin
- Department of Dermatology, Cerrahpasa Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Steven Nisticò
- Department of Health Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Giovanni Damiani
- Department of Medical and Surgical Pathophysiology and Transplantation, University of Milan, Dermatology Unit, IRCCS Ca' Granda Foundation, Ospedale Maggiore Policlinico, Milan, Italy.,Young Dermatologists Italian Network (YDIN), Centro Studi GISED, Bergamo, Italy
| | - Rosalynn R Z Conic
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
| | - Andy Goren
- Department of Dermatology, "Guglielmo Marconi" University, Rome, Italy
| | - Leo Čabrijan
- Department of Dermatovenereology, Rijeka Clinical Hospital Center, Rijeka, Croatia
| | - Georgi Tchernev
- Medical Institute of Ministry of Interior (MVR), Department of Dermatology, Venereology and Dermatologic Surgery, Sofia, Bulgaria
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Rathod D, Weinberg JM, Yamauchi PS, Kircik LH, Wollina U, Lotti T, Goldust M. Successful Treatment of Refractory Plaque-Type Psoriasis and Psoriatic Arthritis With Guselkumab and Adalimumab Combination Therapy: A Case Report. J Drugs Dermatol 2019; 18:394-396. [PMID: 31017383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Copy: A number of biologics have been approved for use in plaque-type psoriasis. They act by either blocking the action of a specific type of cell or protein in the immune system. Case presentation: Herein, we report a case of a 46-year-old woman with a 12-year history of severe plaque psoriasis and psoriatic arthritis who was treated successfully with guselkumab and adalimumab after failure of prior topical corticosteroids, cyclosporine and narrow-band ultraviolet B (NBUVB) phototherapy. Conclusion: There is limited data supporting the combination of biological agents in the management of psoriasis and psoriatic arthritis. This is the first case report of plaque psoriasis with arthritis, successfully treated with guselkumab and adalimumab combination therapy, without concurrent use of other systemic agents during the treatment. However, further studies need to be carried out to evaluate the efficacy and safety of this biologic combination therapy. J Drugs Dermatol. 2019;18(4):394-396.
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18
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Blauvelt A, Green LJ, Lebwohl MG, Yamauchi PS, Lin T, Martin G, Pillai R. Efficacy of a Once-Daily Fixed Combination Halobetasol (0.01%) and Tazarotene (0.045%) Lotion in the Treatment of Localized Moderate-to-Severe Plaque Psoriasis. J Drugs Dermatol 2019; 18:297-299. [PMID: 30909352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Recently, clinical data on 8 weeks’ once-daily treatment of localized moderate-to-severe psoriasis with a novel fixed combination halobetasol propionate 0.01%/tazarotene 0.045% (HP/TAZ) lotion were published.1,2 HP/TAZ lotion was significantly more effective than individual active ingredients or vehicle, based on improvements in Investigator’s Global Assessment (IGA), body surface area (BSA) involvement, and signs and symptoms of psoriasis (erythema, plaque elevation, and scaling) at the target lesion as well as a synergistic benefit over individual active ingredients, and good tolerability.
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Sugarman JL, Weiss JS, Tanghetti EA, Soung J, Yamauchi PS, Lin T, Harris S, Martin G, Pillai R. Safety and efficacy of halobetasol propionate lotion 0.01% in the treatment of moderate to severe plaque psoriasis: a pooled analysis of 2 phase 3 studies. Cutis 2019; 103:111-116. [PMID: 30893392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Potent topical corticosteroids (TCSs) are the mainstay of psoriasis treatment. Safety concerns have limited use to 2 to 4 weeks. The objective of our study was to investigate the safety and efficacy of once-daily halobetasol propionate (HP) lotion 0.01% in moderate to severe plaque psoriasis through 2 multicenter, randomized, double-blind, vehicle-controlled phase 3 studies (N=430). Participants were randomized (2:1) to HP lotion 0.01% or vehicle once daily for 8 weeks, followed by 4 weeks of follow-up. The primary efficacy assessment was treatment success (at least a 2-grade improvement in baseline investigator global assessment [IGA] score and a score of 0 [clear] or 1 [almost clear]). Additional assessments included improvement in psoriasis signs and symptoms, body surface area (BSA), and a composite score of IGA×BSA. Safety and treatment-emergent adverse events (AEs) were evaluated throughout. We found that HP lotion 0.01% demonstrated statistically significant superiority over vehicle as early as week 2 and also was superior in reducing psoriasis signs and symptoms and BSA involvement.
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Affiliation(s)
| | - Jonathan S Weiss
- Gwinnett Dermatology, PC, and Gwinnett Clinical Research Center, Inc, Snellville, Georgia, USA
| | - Emil A Tanghetti
- Center for Dermatology and Laser Surgery, Sacramento, California, USA
| | | | - Paul S Yamauchi
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tina Lin
- Ortho Dermatologics, Bridgewater, New Jersey, USA
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20
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Sugarman JL, Weiss J, Tanghetti EA, Bagel J, Yamauchi PS, Stein Gold L, Lin T, Martin G, Pillai R, Israel R. Safety and Efficacy of a Fixed Combination Halobetasol and Tazarotene Lotion in the Treatment of Moderate-to-Severe Plaque Psoriasis: A Pooled Analysis of Two Phase 3 Studies. J Drugs Dermatol 2018; 17:855-861. [PMID: 30124724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Topical corticosteroids (TCS) are the mainstay of psoriasis treatment. Safety concerns may limit use. Combination with tazarotene may optimize efficacy and minimize safety and tolerability concerns. OBJECTIVE Investigate safety and efficacy of halobetasol propionate 0.01%/tazarotene 0.045% (HP/TAZ) lotion in moderate-to-severe plaque psoriasis. METHODS Two multicenter, randomized, double-blind, vehicle-controlled phase 3 studies (N=418). Subjects randomized (2:1) to HP/TAZ lotion or vehicle once-daily for 8 weeks, 4-week follow-up. Primary efficacy assessment: treatment success (at least a 2-grade improvement from baseline in IGA score and 'clear' or 'almost clear'). Safety and treatment emergent AEs evaluated throughout. RESULTS HP/TAZ lotion demonstrated statistically significant superiority over vehicle as early as week 2 (P equals 0.002). By week 8, 40.6% of subjects were treatment successes compared with 9.9% on vehicle (P less than 0.001). A third of subjects remained treatment successes post-treatment. HP/TAZ lotion was also superior in reducing psoriasis signs and symptoms, and Body Surface Area (BSA) involvement. Most frequently reported treatment related AEs were contact dermatitis (6.3%), application site pain (2.6%), and pruritus (2.2%). LIMITATIONS No data were collected beyond the 4-week follow-up. CONCLUSIONS HP/TAZ lotion provides synergistic efficacy that is both rapid and sustained, with good tolerability and safety over 8 weeks use. J Drugs Dermatol. 2018;17(8):855-861.
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21
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Kimball AB, Pariser D, Yamauchi PS, Menter A, Teller CF, Shi Y, Creamer K, McCroskery P, Kricorian G, Gelfand JM. OBSERVE-5, an Observational Post-Marketing Safety Surveillance Registry of Etanercept for the Treatment of Psoriasis: A Model for Studying New Psoriasis Therapies. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/247553031016a00301] [Citation(s) in RCA: 4] [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] [Indexed: 11/16/2022]
Abstract
Background OBSERVE-5 is collecting safety data from real-world use of etanercept in the treatment of psoriasis per a post-marketing commitment of the U.S. Food and Drug Administration. Methods This phase IV prospective, multicenter, 5-year observational registry was designed to enroll patients with plaque psoriasis for whom etanercept is indicated. Patients receive etanercept per standard medical care and can discontinue etanercept therapy at any time following receipt of the baseline dose. Visits occur at least twice yearly; follow-up will be up to 5 years. Conclusions Data from the OBSERVE-5 registry will complement safety data from clinical trials of etanercept.
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Affiliation(s)
- Alexa B. Kimball
- Massachusetts General Hospital, Boston, Massachusetts, California
| | - David Pariser
- Virginia Clinical Research Inc., Norfolk, Virginia, California
| | - Paul S. Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, California
| | - Alan Menter
- Baylor Research Institute, Dallas, Texas, California
| | - Craig F. Teller
- Bellaire Dermatology Associates, Bellaire, Texas, California
| | - Yifei Shi
- Amgen Inc., Thousand Oaks, California
| | | | | | | | - Joel M. Gelfand
- University of Pennsylvania Health System, Philadelphia, Pennsylvania California
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Armstrong AW, Siegel MP, Bagel J, Boh EE, Buell M, Cooper KD, Callis Duffin K, Eichenfield LF, Garg A, Gelfand JM, Gottlieb AB, Koo JY, Korman NJ, Krueger GG, Lebwohl MG, Leonardi CL, Mandelin AM, Menter MA, Merola JF, Pariser DM, Prussick RB, Ryan C, Shah KN, Weinberg JM, Williams MO, Wu JJ, Yamauchi PS, Van Voorhees AS. From the Medical Board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. J Am Acad Dermatol 2017; 76:290-298. [DOI: 10.1016/j.jaad.2016.10.017] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/04/2016] [Accepted: 10/07/2016] [Indexed: 02/03/2023]
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23
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Choi YM, Debbaneh M, Weinberg JM, Yamauchi PS, Van Voorhees AS, Armstrong AW, Siegel M, Wu JJ. From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis. J Am Acad Dermatol 2016; 75:798-805.e7. [DOI: 10.1016/j.jaad.2016.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/07/2016] [Accepted: 06/13/2016] [Indexed: 02/08/2023]
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24
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Matsunaga MC, Yamauchi PS. IL-4 and IL-13 Inhibition in Atopic Dermatitis. J Drugs Dermatol 2016; 15:925-929. [PMID: 27537991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Atopic dermatitis (AD) is a chronic, prevalent, multi-factorial condition that affects infants, children, and adults. Beyond topical therapy, a variety of systemic agents such as steroids, methotrexate, cyclosporine, azathioprine, mycophenoloic acid, and other agents are utilized to treat moderate to severe AD. However, these agents are associated with potential long term adverse events and organ toxicity. There is an unmet need for a safer, long-term systemic agent to adequately control moderate to severe AD. The role of the Th2 cytokines, IL-4 and IL-13, in AD has led to the development of biologic agents to treat AD. The aim of this article is to review the role of IL-4 and IL-13 in the pathogenesis of AD and discuss some of the clinical trial data that target and inhibit IL-4 and IL-13 in positively altering the course and outcome of AD.<BR /><BR /> <EM>J Drugs Dermatol</EM>. 2016;15(8):925-929.
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Abstract
Psoriasis is a common inflammatory disease with significant comorbidities, whose management can be challenging given the variety of treatment options. It is critical for nurse practitioners, physician assistants, general practitioners, and dermatology trainees to have useful information about the treatment and monitoring of patients with psoriasis. Although certain aspects of care apply to all patients, each therapeutic agent has its own nuances in terms of assessments, dosing, and monitoring. The most appropriate treatment is based not only on disease severity but also on comorbid conditions and concomitant medications. These practitioners are vital in facilitating patient care by thorough understanding of systemic agents, selection criteria, dosing, and recommended monitoring. This article provides high-yield practical pearls on managing patients with moderate to severe psoriasis. It includes case-based discussions illustrating considerations for special populations, such as pregnant women, children, and patients with comorbidities (eg, human immunodeficiency virus infection, hepatitis C, hepatitis B, and history of malignancy).
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Affiliation(s)
- April W Armstrong
- Department of Dermatology, University of Colorado Denver, Aurora, CO, USA
| | - Lakshi Aldredge
- Department of Dermatology, Portland Veterans Affairs Medical Center, Portland, OR, USA
| | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, CA, USA Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Yamauchi PS, Bissonnette R, Teixeira HD, Valdecantos WC. Systematic review of efficacy of anti-tumor necrosis factor (TNF) therapy in patients with psoriasis previously treated with a different anti-TNF agent. J Am Acad Dermatol 2016; 75:612-618.e6. [PMID: 27061047 DOI: 10.1016/j.jaad.2016.02.1221] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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: 08/07/2015] [Revised: 02/16/2016] [Accepted: 02/23/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tumor necrosis factor (TNF) antagonists have improved outcomes for patients with psoriasis, but some patients are unresponsive to treatment (primary failure) or lose an initially effective response (secondary failure). OBJECTIVE We sought to systematically investigate the efficacy and safety of a second TNF antagonist after failure of a first TNF antagonist. METHODS Published primary studies evaluating the efficacy of switching TNF antagonists after failure were systematically extracted. RESULTS Fifteen studies were included. Although response rates to a second TNF antagonist were lower than for a first, a substantial proportion of patients in every study achieved treatment success. Week-24 response rates for a second antagonist were 30% to 74% for a 75% improvement in Psoriasis Area and Severity Index score and 20% to 70% for achieving a Physician Global Assessment score of 0/1; mean improvements in Dermatology Life Quality Index ranged from -3.5 to -13. In general, patients who experienced secondary failure achieved better responses than patients with primary failure. Adverse event incidences ranged from 20% to 71%, without unexpected adverse events; 0% to 11% of patients experienced serious adverse events. LIMITATIONS There was no common definition of treatment failure across these studies of varied design. CONCLUSIONS Some patients benefit from switching to a second TNF antagonist after failure of a first TNF antagonist, with improved quality of life.
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Affiliation(s)
- Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, California; Division of Dermatology, David Geffen School of Medicine at University of California, Los Angeles, California.
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Armstrong AW, Bagel J, Van Voorhees AS, Robertson AD, Yamauchi PS. Combining Biologic Therapies With Other Systemic Treatments in Psoriasis. JAMA Dermatol 2015; 151:432-8. [DOI: 10.1001/jamadermatol.2014.3456] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Jerry Bagel
- currently in private practice in East Windsor, New Jersey
| | - Abby S. Van Voorhees
- Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia
| | | | - Paul S. Yamauchi
- Department of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California
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Yamauchi PS, Bagel J. Next-generation biologics in the management of plaque psoriasis: a literature review of IL-17 inhibition. J Drugs Dermatol 2015; 14:244-253. [PMID: 25738846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Advances in the understanding of the pathogenesis of psoriasis have led to the development of biologic agents that target T cells and cytokines that play a specific role in the underlying inflammation associated with psoriasis (eg, tumor necrosis factor-α inhibitors, interleukin [IL]-12/23 inhibitors). In this review, evidence for the central role of IL-17 in the pathophysiology of psoriasis is presented, along with available clinical trial data on the selective IL-17 inhibitors in development. Three biologic agents that target IL-17 are currently in clinical development: secukinumab, ixekizumab, and brodalumab. Clinical studies to date suggest a favorable safety profile and the potential for better efficacy over the previous generation of agents, with Psoriasis Area Severity Index 75 response rates of up to 80% or greater. Fully published results of phase III studies of these agents are eagerly awaited.
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Abstract
A plethora of soft tissue fillers have been developed within the past decade to correct the cutaneous changes that occur with photoaging. Such fillers, whether nonpermanent, semipermanent, or permanent, are widely used to fill undesired facial rhytides. In addition, fillers are employed to correct atrophy of the face as well as other parts of the body such as the dorsum of the hands through volumization and contouring. The extensive long-term safety outcomes reported with fillers and the ease with which they are administered make them an ideal choice to correct rhytides and to contour the face. However, as with any cosmetic procedure, in order to ensure high patient satisfaction and a safe outcome, proper training in injection techniques, the choice of the proper candidate, and awareness of potential adverse events are essential. This review article focuses on the permanent filler, Aquamid, which is composed of polyacrylamide hydrogel.
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Affiliation(s)
- Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, CA, USA ; Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Kimball AB, Rothman KJ, Kricorian G, Pariser D, Yamauchi PS, Menter A, Teller CF, Aras G, Accortt NA, Hooper M, Rice KC, Gelfand JM. OBSERVE-5: observational postmarketing safety surveillance registry of etanercept for the treatment of psoriasis final 5-year results. J Am Acad Dermatol 2014; 72:115-22. [PMID: 25264239 DOI: 10.1016/j.jaad.2014.08.050] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [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: 04/23/2014] [Revised: 08/14/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND OBSERVE-5 was a 5-year Food and Drug Administration-mandated surveillance registry of patients with psoriasis. OBJECTIVE We sought to assess long-term etanercept safety and effectiveness. METHODS Patients with moderate to severe psoriasis enrolled; a single baseline dose of etanercept was required. Key outcome measures included serious adverse events, serious infectious events, events of medical interest, psoriasis-affected body surface area, physician global assessment score, and Dermatology Life Quality Index score. Safety outcomes were assessed relative to data from the MarketScan database. RESULTS For 2510 patients, 5-year cumulative incidence was 22.2% (95% confidence interval [CI] 20.3%-24.2%) for serious adverse events; 6.5% (95% CI 5.4%-7.7%) for serious infectious events; 3.2% (95% CI 2.3%-4.1%) for malignancies excluding nonmelanoma skin cancer; 3.6% (95% CI 2.7%-4.5%) for nonmelanoma skin cancer; 2.8% (95% CI 2.0%-3.6%) for coronary artery disease; 0.7% (95% CI 0.3%-1.2%) for psoriasis worsening; 0.2% (95% CI 0.0%-0.4%) for central nervous system demyelinating disorder; 0.1% (95% CI 0.0%-0.3%) for lymphoma and for tuberculosis; and 0.1% (95% CI 0.0%-0.2%) for opportunistic infection and for lupus; 55 fatal events were reported. Rates of malignancies, lymphomas, nonmelanoma skin cancer, and hospitalization-associated infections were not higher than expected relative to administrative claims data. The percentage of patients rated as clear/almost clear was 12% at baseline, which increased to 51% at month 6 and remained relatively stable throughout 5 years. LIMITATIONS No internal comparator group was included; rare events may not have been detected. CONCLUSION No new safety signals were observed with long-term, real-world etanercept use.
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Affiliation(s)
| | - Kenneth J Rothman
- RTI Health Solutions, RTI International, Research Triangle Park, North Carolina
| | | | - David Pariser
- Eastern Virginia Medical School and Virginia Clinical Research Inc, Norfolk, Virginia
| | - Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, California
| | | | | | | | | | | | | | - Joel M Gelfand
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Kimball AB, Pariser D, Yamauchi PS, Menter A, Teller CF, Shi Y, Yong M, Creamer K, Hooper M, Aras G, Kricorian G, Gelfand JM. OBSERVE-5 interim analysis: An observational postmarketing safety registry of etanercept for the treatment of psoriasis. J Am Acad Dermatol 2013; 68:756-64. [DOI: 10.1016/j.jaad.2012.10.055] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 10/26/2012] [Accepted: 10/28/2012] [Indexed: 11/27/2022]
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Yamauchi PS. Soft tissue filler and botulinum toxin treatment techniques. GIORN ITAL DERMAT V 2012; 147:29-44. [PMID: 22370567] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A variety of non-invasive techniques have been utilized for the enhancement of cutaneous changes seen with photoaging. Such methods include chemical peels, microdermabrasion, ablative and nonablative lasers, and various rejuvenating light sources. However, the most widely used minimally invasive cosmetic procedures for the correction of undesired rhytides and enhance facial features through contouring and volumization are injections with botulinum toxin and soft tissue fillers. Their extensive long term safety and relative ease of procedural techniques have led to high satisfaction levels worldwide. Nonetheless, proper training of the fundamentals in injection technique, the choice of the appropriate candidate, and knowledge of potential adverse events are imperative to ensure an excellent and safe outcome.
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Affiliation(s)
- P S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, CA, USA.
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33
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Strober BE, Crowley JJ, Yamauchi PS, Olds M, Williams DA. Efficacy and safety results from a phase III, randomized controlled trial comparing the safety and efficacy of briakinumab with etanercept and placebo in patients with moderate to severe chronic plaque psoriasis. Br J Dermatol 2011; 165:661-8. [PMID: 21574984 DOI: 10.1111/j.1365-2133.2011.10419.x] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The tumour necrosis factor-α antagonist etanercept and the interleukin (IL)-12/23p40 antagonist ustekinumab have been shown to be effective psoriasis therapies. The IL-12/23p40 antagonist briakinumab was shown to be effective psoriasis treatment in a phase II study. OBJECTIVES To assess the efficacy, safety and tolerability of briakinumab compared with etanercept and placebo in patients with moderate to severe psoriasis. METHODS Three hundred and fifty patients were enrolled in this phase III, 12-week study (M10-315, NCT00710580) and randomized in the following 2:2:1 ratio: 139 patients received 200 mg briakinumab at weeks 0 and 4 followed by 100 mg briakinumab at week 8; 139 patients received 50 mg of etanercept twice weekly 3-4 days apart at weeks 0-11; 72 patients received placebo injections matching active treatment. The co-primary efficacy endpoints were the proportion of patients achieving a Physician's Global Assessment (PGA) of 0/1 at week 12, and the proportion of patients achieving a Psoriasis Area and Severity Index (PASI) 75 response at week 12. RESULTS Of the briakinumab-treated patients, 72·7% achieved a PGA of 0/1 at week 12 as compared with 29·5% of etanercept-treated patients and 4·2% of placebo-treated patients (P < 0·001, for both comparisons). Of the briakinumab-treated patients, 80·6% achieved a PASI 75 response at week 12 as compared with 39·6% of etanercept-treated and 6·9% of placebo-treated patients (P < 0·001, for both comparisons). Serious adverse events were reported in two (1·4%) briakinumab-treated patients, one (0·7%) etanercept-treated patient and two (2·8%) placebo-treated patients. CONCLUSIONS In patients with moderate to severe psoriasis, briakinumab had superior efficacy to both placebo and etanercept at 12 weeks as administered in this study.
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Affiliation(s)
- B E Strober
- Department of Dermatology, New York University School of Medicine, New York, NY 10016, USA.
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34
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Yamauchi PS. Selection and preference for botulinum toxins in the management of photoaging and facial lines: patient and physician considerations. Patient Prefer Adherence 2010; 4:345-54. [PMID: 20859461 PMCID: PMC2943226 DOI: 10.2147/ppa.s6494] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Indexed: 11/23/2022] Open
Abstract
Various noninvasive to minimally invasive techniques can be used for the improvement of cutaneous changes seen with photoaging. These include dermabrasion, chemical peels, ablative and nonablative lasers, and filler agents such as hyaluronic acid. However, the most common nonsurgical cosmetic procedure performed in the treatment of rhytides is injection with botulinum toxin. Its extensive safety history and relative ease of use by the practitioner has led to high satisfaction in millions of patients. Nonetheless, proper training of the fundamentals in injection technique, the choice of the appropriate candidate, and knowledge of potential adverse events are imperative to ensure a satisfactory and safe outcome.
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Affiliation(s)
- Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, CA
- Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Correspondence: Paul S Yamauchi, Dermatology Institute and Skin Care Center, 2001 Santa Monica Blvd, Ste 490W, Santa Monica, CA 90404, USA, Tel +1 (310) 829-4104, Fax +1 (310) 829-4150, Email
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35
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Yamauchi PS, Mau N. Adalimumab treats psoriasis in patients previously treated with etanercept: a case series. J Am Acad Dermatol 2009; 61:158-60. [PMID: 19539861 DOI: 10.1016/j.jaad.2008.12.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 12/10/2008] [Accepted: 12/23/2008] [Indexed: 11/26/2022]
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36
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Abstract
There are numerous treatments for cellulite including topical, surgical, laser and other therapies. Many of these treatments are expensive. Part of the difficulty in treating cellulite arises from our incomplete understanding of this phenomenon. As noted previously in this journal, there is no consensus as to the etiology of cellulite. This article will focus on both traditional and novel treatments for cellulite and assess their efficacy based on the scientific literature.
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Abstract
OBJECTIVE Periorbital aging and lines are a result of intrinsic skin aging, ultraviolet damage, and repetitive action of periorbital muscles. Rejuvenation of this area should therefore be optimized by combining treatments that approach the different causative factors. METHODS This was a single-center, prospective, randomized, placebo-controlled study comparing the efficacy and safety of combining Botox injections (18 units per area) with ablative laser resurfacing versus laser resurfacing alone without Botox in the treatment of periorbital rhytids. RESULTS We have concluded a bilateral study comparing the effects of Botox versus saline placebo injections to the periorbital areas before and following erbium: YAG laser resurfacing of the areas in 33 patients. The results demonstrated that the Botox-treated side with laser resurfacing improved significantly more than the contralateral area treated with saline and laser in diminishing periorbital rhytids as well as textural, pigmentation, and other features of periorbital skin aging. CONCLUSION This study illustrates the benefits of a combined approach to treating periorbital skin aging.
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38
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Abstract
There are various treatment modalities for acne vulgaris including topical and oral therapy as well as microdermabrasion and chemical peels. Recently, there has been an emergence of novel laser and light sources as a means for treating acne vulgaris. This article will review the advances of laser and light sources in the treatment of acne vulgaris.
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39
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Abstract
Pseudofolliculitis barbae is a common skin disorder of the beard area that is characterized by the presence of inflammatory follicular papules due to terminal hair shafts re-entering the epidermis. Postinflammatory hyperpigmentation and scarring often occur with pseudofolliculitis barbae. Such skin changes can lead to cosmetic disfigurement and be of great concern to the patient. We report a case of pseudofolliculitis barbae and hirsutism with associated postinflammatory hyperpigmentation in an African-American woman who was effectively treated with the diode laser.
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Affiliation(s)
- P S Yamauchi
- Dermatologic Laser Center, UCLA, Los Angeles, CA, USA
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40
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Ortiz A, Yamauchi PS. Rapidly growing squamous cell carcinoma from permanent makeup tattoo. J Am Acad Dermatol 2009; 60:1073-4. [DOI: 10.1016/j.jaad.2008.11.902] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 11/17/2008] [Accepted: 11/24/2008] [Indexed: 10/20/2022]
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41
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Yamauchi PS, Mau N. Hidradenitis suppurativa managed with adalimumab. J Drugs Dermatol 2009; 8:181-183. [PMID: 19213236] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Hidradenitis suppurativa (HS), a chronic, inflammatory, relapsing disease of the apocrine glands in the skin, commonly occurs in women aged 20 to 40 years. Patients typically present with discomfort and/or itching associated with papules or nodules that may recur and lead to abscess formation and sinus tracts. Recent reports have demonstrated that adalimumab, a tumor necrosis factor (TNF) antagonist, may be effective in the treatment of patients with HS who have failed conventional therapy. The authors describe 3 patients who experienced the resolution of skin lesions associated with HS after treatment with adalimumab. The patients found this treatment to be convenient, as they could administer the therapy at home, and 1 patient was able to avoid surgical intervention through use of TNF-antagonist therapy. Adalimumab may resolve symptoms of HS when conventional therapy fails. More studies are necessary to investigate the efficacy and safety of adalimumab for the treatment of HS.
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Affiliation(s)
- Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, CA 90404, USA.
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43
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Yamauchi PS, Lowe NJ. Etanercept therapy allows the tapering of methotrexate and sustained clinical responses in patients with moderate to severe psoriasis. Int J Dermatol 2008. [PMID: 18211500 DOI: 10.1111/j.1365-4632.2008.03419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Methotrexate, the most common systemic small molecule used in the treatment of moderate to severe psoriasis, is associated with significant toxicities and adverse events. Long-term continuous usage is not recommended due to potential liver toxicity, myelosuppression, and other side effects. Abrupt cessation of methotrexate without tapering can lead to flare-up and rebound of psoriasis. Here we describe sustained clinical responses in 6 patients with psoriasis following gradual cessation of methotrexate through the addition of etanercept therapy.
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Affiliation(s)
- Paul S Yamauchi
- Dermatology Institute and Skin Care Center, Santa Monica, and Division of Dermatology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
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44
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Yamauchi PS, Lowe NJ. Etanercept therapy allows the tapering of methotrexate and sustained clinical responses in patients with moderate to severe psoriasis. Int J Dermatol 2008; 47:202-4. [DOI: 10.1111/j.1365-4632.2008.03419.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Ram R, Lowe NJ, Yamauchi PS. Current and emerging therapeutic modalities for hyperhidrosis, part 2: moderately invasive and invasive procedures. Cutis 2007; 79:281-8. [PMID: 17500375] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Hyperhidrosis (HH) hinders patient quality of life and causes the secondary effect of excess cutaneous sweat. Treatment modalities include conservative and noninvasive therapies such as topical agents and iontophoresis. This article reviews moderately invasive and invasive procedures, such as botulinum toxin, curettage, and endoscopic thoracic sympathectomy (ETS), and compares their advantages and disadvantages in safety and efficacy.
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Affiliation(s)
- Ramin Ram
- Cedars-Sinai Medical Center, University of Southern California, Keck School of Medicine, Department of Dermatology, Los Angeles, USA.
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46
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Ram R, Lowe NJ, Yamauchi PS. Current and emerging therapeutic modalities for hyperhidrosis, part 1: conservative and noninvasive treatments. Cutis 2007; 79:211-7. [PMID: 17674587] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Approximately 1% to 3% of the US population has hyperhidrosis (HH). HH can be an incapacitating medical condition because it not only hinders patient quality of life but also causes the secondary effect of excess cutaneous sweat. There is a broad spectrum of treatment modalities including topical and systemic therapies, iontophoresis, localized neuroinhibitory injections, and surgical interventions. This article reviews HH and the conservative treatments for the condition.
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Affiliation(s)
- Ramin Ram
- Cedars-Sinai Medical Center, Los Angeles, California, USA
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47
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Abstract
Systemic agents such as methotrexate and cyclosporine are commonly used in the treatment of psoriasis. Long-term continuous use is not recommended due to potential organ toxicity, myelosuppression, and carcinogenicity. Abrupt cessation of systemic agents without tapering can lead to flare-up and rebound of psoriasis. The addition of a biologic agent during transitional therapy from a systemic agent is a good strategic maneuver to prevent a potential rebound complication. Even with a gradual cessation of systemic agents, the psoriasis will eventually relapse if biologic agents are not added to the treatment regimen. No additional toxicities or adverse events are evident during combination therapy with a systemic agent and a biologic agent.
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48
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Thiboutot DM, Shalita AR, Yamauchi PS, Dawson C, Kerrouche N, Arsonnaud S, Kang S. Adapalene Gel, 0.1%, as Maintenance Therapy for Acne Vulgaris. ACTA ACUST UNITED AC 2006; 142:597-602. [PMID: 16702497 DOI: 10.1001/archderm.142.5.597] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [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: 11/14/2022]
Abstract
OBJECTIVE To assess the maintenance effect of adapalene gel, 0.1%, relative to gel vehicle in subjects successfully treated in a previous 12-week study of adapalene-doxycycline, 100 mg, combination therapy. DESIGN Multicenter, investigator-blind, randomized, controlled study. SETTING Thirty-four US centers. SUBJECTS A total of 253 subjects with severe acne vulgaris who showed at least moderate improvement from baseline (50% improvement from baseline) when treated with either adapalene plus doxycycline or doxycycline plus gel vehicle in a previous 12-week study. INTERVENTIONS Subjects were randomized to receive adapalene gel, 0.1%, or gel vehicle once daily for 16 weeks. MAIN OUTCOME MEASURES Efficacy and safety criteria included maintenance rate (subjects maintaining at least 50% improvement in lesion counts from previous therapy), lesion counts (total, inflammatory, and noninflammatory), global severity assessment, cutaneous tolerability, and adverse events. RESULTS Adapalene maintenance therapy resulted in significantly larger maintenance rates (75% vs 54%; P<.001) and significantly lower lesion counts (total [P = .005], inflammatory [P = .01], and noninflammatory [P = .02]) compared with gel vehicle. Adapalene was safe and well tolerated in this study. Conclusion This study demonstrates a clinical benefit of continued treatment with adapalene gel, 0.1%, as a maintenance therapy for acne.
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Affiliation(s)
- Diane M Thiboutot
- The Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, USA.
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Yamauchi PS, Turner L, Lowe NJ, Gindi V, Jackson JM. Treatment of recurrent Sweet's syndrome with coexisting rheumatoid arthritis with the tumor necrosis factor antagonist etanercept. J Am Acad Dermatol 2006; 54:S122-6. [PMID: 16488324 DOI: 10.1016/j.jaad.2005.11.1089] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 11/14/2005] [Accepted: 11/21/2005] [Indexed: 02/05/2023]
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Yamauchi PS, Lowe NJ. Cessation of cyclosporine therapy by treatment with etanercept in patients with severe psoriasis. J Am Acad Dermatol 2006; 54:S135-8. [PMID: 16488328 DOI: 10.1016/j.jaad.2005.11.1043] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 09/29/2005] [Accepted: 11/08/2005] [Indexed: 10/25/2022]
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