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Seretis K, Telli C, Bassukas ID. The divided full-thickness skin graft: A harvesting technique to optimize donor area normal skin sacrifice and closure. J Am Acad Dermatol 2024:S0190-9622(24)00533-4. [PMID: 38552906 DOI: 10.1016/j.jaad.2024.03.022] [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] [Received: 02/26/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Christina Telli
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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2
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Seretis K, Sfaelos K, Boptsi E, Gaitanis G, Bassukas ID. The Neutrophil-to-Lymphocyte Ratio as a Biomarker in Cutaneous Oncology: A Systematic Review of Evidence beyond Malignant Melanoma. Cancers (Basel) 2024; 16:1044. [PMID: 38473401 DOI: 10.3390/cancers16051044] [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: 02/14/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
With the ongoing progress of basic research along with the introduction of new pharmaceutical options spanning almost all therapeutic areas, the need for biomarkers that will be implemented into the personalized medical approach is higher than ever. Their use can be incorporated into clinical practice and can be applied to the classification of disorders and the evaluation of disease severity but also to the monitoring of the progress of therapeutic/pharmaceutical interventions. This systematic review collects the findings of hematologic biomarkers in various cutaneous malignancies, excluding malignant melanoma, to support their potential use in the prognosis but also in the assessment of therapeutic strategies for the specific category of skin disorders.
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Affiliation(s)
- Konstantinos Seretis
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Konstantinos Sfaelos
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Elena Boptsi
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece
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3
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Gaitanis G, Seretis K, Zampeta A, Spyridonos P, Bassukas ID. A single-centre retrospective comparison of immunocryosurgery with standard surgical excision for the treatment of non-superficial, head and neck basal cell carcinoma. J Eur Acad Dermatol Venereol 2024; 38:e134-e136. [PMID: 37641949 DOI: 10.1111/jdv.19479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Affiliation(s)
- G Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - K Seretis
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - A Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - P Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - I D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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4
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Pavlou E, Gaitanis G, Bassukas ID, Kourkoumelis N. BCC and Immunocryosurgery scar differentiation through computational resolution-enhanced OCT images and skin optical attenuation: A proof-of-concept study. Exp Dermatol 2024; 33:e15019. [PMID: 38284205 DOI: 10.1111/exd.15019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
Monitoring medical therapy remains a challenging task across all non-surgical skin cancer treatment modalities. In addition, confirmation of residual tumours after treatment is essential for the early detection of potential relapses. Optical coherence tomography (OCT), a non-invasive method for real-time cross-sectional imaging of living tissue, is a promising imaging approach for assessing relatively flat, near-surface skin lesions, such as those that occur in most basal cell carcinomas (BCCs), at the time of diagnosis. However, the skin's inherent property of strong light scattering impedes the implementation of OCT in these cases due to the poor image quality. Furthermore, translating OCT's optical parameters into practical use in routine clinical settings is complicated due to substantial observer subjectivity. In this retrospective pilot study, we developed a workflow based on the upscale of the OCT images resolution using a deep generative adversarial network and the estimation of the skin optical attenuation coefficient. At the site of immunocryosurgery-treated BCC, the proposed methodology can extract optical parameters and discriminate objectively between tumour foci and scar tissue.
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Affiliation(s)
- Eleftherios Pavlou
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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5
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Mavridou K, Karakasi A, Lampri E, Gaitanis G, Bassukas ID. Flagellate dermatitis in a patient with testicular germ cell neoplasia on bleomycin. Dermatol Reports 2023; 15:9761. [PMID: 38348421 PMCID: PMC10859905 DOI: 10.4081/dr.2023.9761] [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: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 02/15/2024] Open
Abstract
Bleomycin, an antineoplastic antibiotic that inhibits DNA synthesis, is used to treat various malignant tumors such as Hodgkin's lymphoma, squamous cell carcinoma, and germ cell tumors. Flagellate erythema is a rare rash with a linear pattern that has been observed in association with bleomycin treatment. Herein, we present a 43-year-old patient with metastatic testicular cell neoplasms who developed a whiplash rash during treatment with a chemotherapy regimen that included bleomycin. A typical case of bleomycin-related flagellate dermatitis has been diagnosed and the main features of this characteristic adverse drug event are briefly discussed.
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Affiliation(s)
| | | | | | - George Gaitanis
- Department of Dermatology, University Hospital of Ioannina
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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6
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Spyridonos P, Gaitanis G, Likas A, Seretis K, Moschovos V, Feldmeyer L, Heidemeyer K, Zampeta A, Bassukas ID. Image Perceptual Similarity Metrics for the Assessment of Basal Cell Carcinoma. Cancers (Basel) 2023; 15:3539. [PMID: 37509205 PMCID: PMC10377636 DOI: 10.3390/cancers15143539] [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: 06/10/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Efficient management of basal cell carcinomas (BCC) requires reliable assessments of both tumors and post-treatment scars. We aimed to estimate image similarity metrics that account for BCC's perceptual color and texture deviation from perilesional skin. In total, 176 clinical photographs of BCC were assessed by six physicians using a visual deviation scale. Internal consistency and inter-rater agreement were estimated using Cronbach's α, weighted Gwet's AC2, and quadratic Cohen's kappa. The mean visual scores were used to validate a range of similarity metrics employing different color spaces, distances, and image embeddings from a pre-trained VGG16 neural network. The calculated similarities were transformed into discrete values using ordinal logistic regression models. The Bray-Curtis distance in the YIQ color model and rectified embeddings from the 'fc6' layer minimized the mean squared error and demonstrated strong performance in representing perceptual similarities. Box plot analysis and the Wilcoxon rank-sum test were used to visualize and compare the levels of agreement, conducted on a random validation round between the two groups: 'Human-System' and 'Human-Human.' The proposed metrics were comparable in terms of internal consistency and agreement with human raters. The findings suggest that the proposed metrics offer a robust and cost-effective approach to monitoring BCC treatment outcomes in clinical settings.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Aristidis Likas
- Department of Computer Science & Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Seretis
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Vasileios Moschovos
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Athanasia Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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7
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Petrokilidou C, Gaitanis G, Velegraki A, Bassukas ID, Kourkoumelis N. Treatment of nail clippings with ethyl alcohol improves the efficacy of Raman spectroscopy in the diagnosis of Trichophyton rubrum onychomycosis. J Biophotonics 2023:e202300040. [PMID: 37071082 DOI: 10.1002/jbio.202300040] [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] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 06/19/2023]
Abstract
The purpose of this work was to enhance the diagnostic accuracy of nail Raman spectroscopy for fungal nail infections, specifically onychomycosis caused by Trichophyton rubrum. The study assessed the different ethyl alcohol retention rates between control and infected nails after soaking nail clippings in ethanolic solutions and drying. Results revealed that ethyl alcohol completely evaporated from infected nail samples, while significant amounts were still present in control samples. Principal component analysis (PCA) was applied to discriminate control from infected nails and showed superior group separation when nails were treated with ethyl alcohol. PCA loadings plot attributed the efficient classification to the νs (CCO) Raman vibrational mode of ethyl alcohol. As Raman spectroscopy can detect minute concentration changes of ethyl alcohol in nails and the deterioration caused by onychomycosis accelerates its evaporation, a simple and rapid method for detecting T. rubrum onychomycosis is proposed.
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Affiliation(s)
- Chrysoula Petrokilidou
- Department of Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aristea Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture Collection, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Mycology Laboratory, BIOMEDICINE S.A., Athens, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece
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8
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Mavridou K, Goussia AC, Spyridonos P, Papoudou-Bai A, Schulze HJ, Gaitanis G, Bassukas ID. Evidence for differing roles of CD11c + CD163 + and CD11c - CD163 + cells in intracellular pigment storing in tattoos and stasis dermatitis. J Eur Acad Dermatol Venereol 2023. [PMID: 36912804 DOI: 10.1111/jdv.19025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Affiliation(s)
| | - Anna C Goussia
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | - Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Department of Pathology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Georgios Gaitanis
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Ikiades A, Bassukas ID, Kourkoumelis N. A Fiber Optic Sensor for Monitoring the Spectral Alterations and Depth in Ex Vivo and In Vivo Cryosurgery. Sensors (Basel) 2023; 23:2690. [PMID: 36904893 PMCID: PMC10007682 DOI: 10.3390/s23052690] [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] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
This article discusses how to monitor the freezing depth during cryotherapy using a fiber optic array sensor. The sensor was used to measure the backscattered and transmitted light from frozen and unfrozen ex vivo porcine tissue and in vivo human skin tissue (finger). The technique exploited the variations in optical diffusion properties of the frozen and unfrozen tissues to determine the extent of freezing. Ex vivo and in vivo measurements yielded comparable results, despite spectral variations attributable to the hemoglobin absorption peak in the human frozen and unfrozen tissues. However, because the spectral fingerprints of the freeze-thaw process in the ex vivo and in vivo experiments were similar, we could extrapolate the maximum depth of freezing. Therefore, this sensor has the potential to be utilized for monitoring cryosurgery in real time.
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Affiliation(s)
- Aris Ikiades
- Department of Physics, University of Ioannina, 45110 Ioannina, Greece
| | - Ioannis D. Bassukas
- Department of Skin & Venereal Diseases, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Nikolaos Kourkoumelis
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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10
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Bassukas ID, Tatsioni A. Age-specific versus age-adjusted rates for the evaluation of the impact of the sex on cancer morbidity. Cancer 2023; 129:483. [PMID: 36426986 DOI: 10.1002/cncr.34569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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11
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Spyridonos P, Gaitanis G, Bassukas ID. Clinical photographs for the evaluation of the horizontal growth dynamics of the basal cell carcinoma. Australas J Dermatol 2023; 64:143-146. [PMID: 36309914 DOI: 10.1111/ajd.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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12
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Spyridonos P, Gaitanis G, Likas A, Bassukas ID. A convolutional neural network based system for detection of actinic keratosis in clinical images of cutaneous field cancerization. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Gaitanis G, Spyridonos P, Seretis K, Moschovos V, Bassukas ID. Application of a burn scar assessment tool for the evaluation of visual scarring following immunocryosurgery for facial basal cell carcinoma. Eur J Dermatol 2022; 32:709-715. [PMID: 36856377 DOI: 10.1684/ejd.2022.4354] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Background The therapeutic interventions for basal cell carcinoma (BCC) impact facial cosmesis. Objectives Our aim was to assess the aesthetic burden of facial BCC treatment by evaluating the extent of the tumour site visually based on clinical images before and after immunocryosurgery; a minimally invasive combination treatment of topical imiquimod and cryosurgery. Materials & Methods A three-item (texture, height, colour) burn scar scale was independently applied by four physicians (two dermatologists and two plastic surgeons) on archival semi-standardized clinical images of facial BCC before and one year after immunocryosurgery. The score assessments were compared using non-parametric statistical tests; internal consistency (reliability) and inter-rater agreement were assessed using Cronbach's α and Gwet's AC2, respectively. Results Images (before and one year after treatment) of 27 BCCs from 26 patients (15 males) were analysed. The reliability was good (α>0.80) for all items before surgery and for colour after surgery. The inter-rater agreement was acceptable (AC2>0.70) for all items except for height pre-treatment (AC2 = 0.482). Based on averaging of all raters, cosmesis improved significantly after treatment at all tumour sites (p<0.001, Wilcoxon signed ranks test). The main limitations of the study are the inclusion of cases from a single centre and its retrospective nature. Conclusion The evaluated burn scar scale can be reliably used to compare the extent of the BCC site visually before therapy and after resultant scars have formed. In this way, the impact of therapeutic interventions on cosmesis (from tumour to scar) can be evaluated, particularly for less aggressive facial skin tumours, such as most BCC.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, GR-45110 Ioannina, Greece
| | - Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, GR-45110 Ioannina, Greece
| | - Konstantinos Seretis
- Clinic of Plastic Surgery and Burns, University Hospital of Ioannina, Ioannina, Greece
- Department of Plastic Surgery, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, GR-45110 Ioannina, Greece
| | - Vasileios Moschovos
- Clinic of Plastic Surgery and Burns, University Hospital of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, GR-45110 Ioannina, Greece
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14
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Gravani A, Gaitanis G, Spyridonos P, Alexis I, Tigas S, Bassukas ID. Methylprednisolone Plus Low-Dose Methotrexate for Bullous Pemphigoid-A Single Center Retrospective Analysis. J Clin Med 2022; 11:jcm11113193. [PMID: 35683576 PMCID: PMC9181025 DOI: 10.3390/jcm11113193] [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: 04/12/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Monomodal systemic glucocorticoids remain the mainstay of treatment for bullous pemphigoid (BP). In this retrospective, single-arm study, we evaluated the feasibility (efficacy and tolerability) of the combination of methylprednisolone and low-dose (up to 12.5 mg/week) methotrexate (MP + MTX) for BP. At week 12, 53/55 (96.4%) patients initiated on MP + MTX during a five-year period (potential follow up time: ≥4 years) remained on treatment. At this time-point, BP remission was achieved in all compliant patients (including n = 24 cases of dipeptidyl peptidase-4 inhibitors-associated BP; 12-week remission rate: 100% [95% CI: 91.9–100.0%]; mean time to remission: 29.5 days, SEM: 2.3 days) at a mean cumulative MP dose to disease control of 678.4 mg (SEM = 49.4 mg). Eight patients relapsed during follow up (10.81 [95% CI: 5.16–21.72] relapses/100 person years, py), and seven manifested a severe adverse event (6.80 [95% CI: 3.00–14.28] severe adverse events/100 py); however, 73.4% (±7.9%) had suffered neither a relapse nor a SAE at the three-years follow up. Continuing low dose MP intake (≤8 mg/day) beyond week 12 in combination with MTX minimized the risk of a feasibility limiting event (p = 0.013). Conclusively, the combination of methylprednisolone with methotrexate is a promising, safe, and efficient modality for BP patients, which enables rapid glucocorticoid tapering.
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Affiliation(s)
- Agoritsa Gravani
- Department of Dermatology, University General Hospital of Ioannina, 45500 Ioannina, Greece; (A.G.); (G.G.); (I.A.)
| | - Georgios Gaitanis
- Department of Dermatology, University General Hospital of Ioannina, 45500 Ioannina, Greece; (A.G.); (G.G.); (I.A.)
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Ioannis Alexis
- Department of Dermatology, University General Hospital of Ioannina, 45500 Ioannina, Greece; (A.G.); (G.G.); (I.A.)
| | - Stelios Tigas
- Department of Endocrinology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Correspondence:
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15
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Tsironi T, Gaitanis G, Pappas C, Koutlas V, Dounousi E, Bassukas ID. Immunocryosurgery is a safe and feasible treatment for basal cell carcinoma and Bowen disease in renal transplant recipients. Dermatol Ther 2022; 35:e15405. [PMID: 35194902 DOI: 10.1111/dth.15405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Theodora Tsironi
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
| | - Charalambos Pappas
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Koutlas
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece
| | - Evangelia Dounousi
- Nephrology Department, University Hospital of Ioannina, Ioannina, Greece.,Department of Nephrology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, Ioannina, Greece
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Gaitanis G, Bassukas ID. A Review of Immunocryosurgery and a Practical Guide to Its Applications. Diseases 2021; 9:71. [PMID: 34698134 PMCID: PMC8544578 DOI: 10.3390/diseases9040071] [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: 08/03/2021] [Revised: 09/25/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
Immunocryosurgery is a minimally invasive combinational therapeutic procedure that has been designed, developed, and evaluated in the Dermatology Department of the University of Ioannina from 2004. In a fixed time protocol, this approach combines immune stimulatory therapy with imiquimod and cryosurgery, i.e., cryosurgery is applied during continuous imiquimod treatment. Laboratory findings in tissue and blood level credit the efficacy to the synergy of imiquimod and cryosurgery. The synergy has been established through clinical trials and the excellent feasibility and efficacy demonstrated in clinical practice. Immunocryosurgery has extensive proof of excellent efficacy, comparable to surgery, in the treatment of basal cell carcinoma. It has also been evaluated in cases of Bowen's disease, keratoacanthoma, Merkel cell carcinoma, lentigo maligna, and cutaneous squamous cell carcinoma with or without the addition of adjuvants. The aims of this review are to detail the immunocryosurgery protocol with the addition of daily practice clinical tips, compile data on the mechanism of action of immunocryosurgery, and delineate indications and possible future applications. Most of the available data originate from the treatment of BCC, of all histological types and localizations, and the principles reported mainly reflect on evidence related to the treatment of this common skin cancer.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
- Delc Clinique, 2502 Biel/Bienne, Switzerland
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
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Gravani A, Christou P, Tigas S, Bassukas ID. Co-medications and dipeptidyl peptidase-4 inhibitors associated bullous pemphigoid. An Bras Dermatol 2021; 96:782-784. [PMID: 34600789 PMCID: PMC8790199 DOI: 10.1016/j.abd.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/02/2020] [Indexed: 11/02/2022] Open
Affiliation(s)
- Agoritsa Gravani
- Department of Dermatology, University Hospital of Ioannina, Greece.
| | - Panagiota Christou
- Department of Endocrinology and Diabetes Centre, University Hospital of Ioannina, Ioannina, Greece
| | - Stelios Tigas
- Department of Endocrinology and Diabetes Centre, University Hospital of Ioannina, Ioannina, Greece; Department of Endocrinology and Diabetes Centre, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece; Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Sioka C, Moulias C, Voulgari PV, Fotopoulos A, Bassukas ID. Single photon emission computed tomography myocardial perfusion imaging in patients with moderate to severe psoriosissis. Nucl Med Rev Cent East Eur 2021; 24:46-50. [PMID: 34382667 DOI: 10.5603/nmr.2021.0014] [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: 07/24/2020] [Revised: 12/22/2020] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Psoriasis is a chronic inflammatory disorder with an increased risk for coronary artery disease (CAD). This retrospective study aimed to evaluate the rate of myocardial ischaemia in patients with psoriasis subjected to myocardial perfusion imaging (MPI). MATERIAL AND METHODS Twelve patients with moderate to severe psoriasis that had MPI were compared to 395 MPIs randomly retrieved from our MPIs pool data. All patients had a [99mTc]tetrofosmin stress - rest single-photon emission computer tomography ([99mTc]SPECT). Summed difference scores (SDS) were calculated for stress (SSS), rest (SRS) and their difference (SDS = SSS - SRS). RESULTS There was no significant difference in the frequency of abnormal MPI SPECT outcomes between patients with vs. without psoriasis (6/12 vs 214/395 respectively; p = 0.778). From the evaluation of SSS, SRS and SDS, only the SDS scores of inadequately compensated resting perfusion defects were significantly lower in patients with psoriasis (p = 0.012). CONCLUSIONS Patients with moderate-to-severe psoriasis had a similar rate of abnormal SSS scans compared to control patients. However, the SDS scans were significantly lower in patients with psoriasis indicating compromised reversibility of resting perfusion defects. Larger controlled studies are needed to verify these observations.
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Affiliation(s)
- Chrissa Sioka
- Department of Nuclear Medicine, Medical School, University Hospital of Ioannina, Greece
| | - Christos Moulias
- Department of Skin and Venereal Diseases, Medical School, University Hospital of Ioannina, Greece
| | - Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Greece
| | - Andreas Fotopoulos
- Department of Nuclear Medicine, Medical School, University Hospital of Ioannina, Greece.
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Medical School, University Hospital of Ioannina, Greece
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Vlachos C, Alexis I, Moulias C, Rammos A, Lakkas L, Gavriil S, Michalis LK, Bassukas ID. A single center experience of rapid aspirin desensitization in acute coronary syndrome patients. Hellenic J Cardiol 2021; 64:99-100. [PMID: 34311102 DOI: 10.1016/j.hjc.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/12/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022] Open
Affiliation(s)
- Christoforos Vlachos
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Alexis
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
| | - Christos Moulias
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
| | - Aidonis Rammos
- 2(nd) Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Lampros Lakkas
- 2(nd) Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Sofia Gavriil
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- 2(nd) Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece; Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece.
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20
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Murrell DF, Patsatsi A, Stavropoulos P, Baum S, Zeeli T, Kern JS, Roussaki-Schulze AV, Sinclair R, Bassukas ID, Thomas D, Neale A, Arora P, Caux F, Werth VP, Gourlay SG, Joly P. Proof of concept for the clinical effects of oral rilzabrutinib, the first Bruton tyrosine kinase inhibitor for pemphigus vulgaris: the phase II BELIEVE study. Br J Dermatol 2021; 185:745-755. [PMID: 33942286 PMCID: PMC8518737 DOI: 10.1111/bjd.20431] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 01/01/2023]
Abstract
Background Bruton tyrosine kinase (BTK) inhibition targets B‐cell and other non‐T‐cell immune cells implicated in the pathophysiology of pemphigus, an autoimmune disease driven by anti‐desmoglein autoantibodies. Rilzabrutinib is a new reversible, covalent BTK inhibitor demonstrating preclinical efficacy as monotherapy in canine pemphigus foliaceus. Objectives To evaluate the efficacy and safety of oral rilzabrutinib in patients with pemphigus vulgaris in a multicentre, proof‐of‐concept, phase II trial. Methods Patients with Pemphigus Disease Area Index severity scores 8–45 received 12 weeks of oral rilzabrutinib 400–600 mg twice daily and 12 weeks of follow‐up. Patients initially received between 0 and ≤ 0·5 mg kg−1 prednisone‐equivalent corticosteroid (CS; i.e. ‘low dose’), tapered after control of disease activity (CDA; no new lesions, existing lesions healing). The primary endpoints were CDA within 4 weeks on zero‐to‐low‐dose CS and safety. Results In total, 27 patients with pemphigus vulgaris were included: nine newly diagnosed (33%) and 18 relapsing (67%); 11 had moderate disease (41%) and 16 moderate to severe (59%). The primary endpoint, CDA, was achieved in 14 patients (52%, 95% confidence interval 32–71): 11 using low‐dose CS and three using no CS. Over 12 weeks of treatment, mean CS doses reduced from 20·0 to 11·8 mg per day for newly diagnosed patients and from 10·3 to 7·8 mg per day for relapsing patients. Six patients (22%) achieved complete response by week 24, including four (15%) by week 12. Treatment‐related adverse events were mostly mild (grade 1 or 2); one patient experienced grade 3 cellulitis. Conclusions Rilzabrutinib alone, or with much lower CS doses than usual, was safe, with rapid clinical activity in pemphigus vulgaris. These data suggest that BTK inhibition may be a promising treatment strategy and support further investigation of rilzabrutinib for the treatment of pemphigus. What is already known about this topic?Standard pemphigus treatment relies on systemic high‐dose corticosteroids (CS), rituximab and/or immunosuppressives, which are limited by delayed onset of action and potential toxicities. Immune‐mediated mechanisms that are fast acting on both the innate and adaptive immune systems, are steroid sparing, and have safety profiles well suited for chronic administration are greatly needed for patients with pemphigus.
What does this study add?Rilzabrutinib is an oral Bruton tyrosine kinase (BTK) inhibitor targeting B‐cell and other non‐T‐cell immune cells implicated in pemphigus pathophysiology. Treatment with rilzabrutinib (with or without low‐dose CS) demonstrated rapid disease control and a well‐tolerated safety profile in patients with newly diagnosed and relapsing pemphigus vulgaris. BELIEVE provides evidence for a promising treatment strategy via BTK inhibition, supporting further investigation of rilzabrutinib in other immune‐mediated diseases.
Linked Comment: A.M. Drucker and N.H. Shear. Br J Dermatol 2021; 185:691–692. Plain language summary available online
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Affiliation(s)
- D F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales Faculty of Medicine, Sydney, NSW, Australia
| | - A Patsatsi
- 2nd Dermatology Department, Aristotle University Faculty of Medicine, Papageorgiou General Hospital, Thessaloniki, Greece
| | - P Stavropoulos
- 1st Department of Dermatology, National and Kapodistrian University, School of Medicine, Athens, Greece
| | - S Baum
- Department of Dermatology, Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - T Zeeli
- Department of Dermatology, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J S Kern
- Dermatology Department, The Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Melbourne, VIC, Australia
| | - A-V Roussaki-Schulze
- Department of Dermatology, University General Hospital of Larissa, Larissa, Greece
| | - R Sinclair
- University of Melbourne and Sinclair Dermatology, Melbourne, VIC, Australia
| | - I D Bassukas
- Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - D Thomas
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - A Neale
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - P Arora
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - F Caux
- Department of Dermatology, Groupe Hospitalier Paris Seine-Saint-Denis, AP-HP, Bobigny, France
| | - V P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA
| | - S G Gourlay
- Principia Biopharma Inc., a Sanofi Company, South San Francisco, CA, USA
| | - P Joly
- Department of Dermatology, Rouen University Hospital, Centre de Référence des Maladies Bulleuses Autoimmunes, and INSERM U1234, Normandie University, Rouen, France
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21
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Sakkas H, Kittas C, Kapnisi G, Priavali E, Kallinteri A, Bassukas ID, Gartzonika K. Onychomycosis in Northwestern Greece Over a 7-Year Period. Pathogens 2020; 9:pathogens9100851. [PMID: 33080905 PMCID: PMC7603248 DOI: 10.3390/pathogens9100851] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/31/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Onychomycosis is considered as one of the major public health problems with a global distribution associated with geographic, demographic and environmental factors, underlying comorbidities and immunodeficiency disorders. This study was conducted to investigate the etiological agents of onychomycosis, in Northwestern Greece during a 7-year period. The study population included 1095 outpatients with clinically suspected onychomycosis that presented to the University Hospital of Ioannina, NW Greece (2011–2017). Samples were examined for causative fungi, and mycological identification was established using standard mycological methods. Demographic data of each patient, comorbidities, localization of infection and history of previous fungal infection were collected. Onychomycosis was diagnosed in 317 of the 1095 suspected cases (28.9%) and the most frequently isolated pathogens were yeasts (50.8%) followed by dermatophytes (36.9%) and non-dermatophyte molds (NDMs) (12.3%). Dermatophytes were mostly involved in toenail onychomycosis (90.6%) and more commonly affected males than females (57.3% vs. 42.7%), while the predominantly isolated pathogen was Τrichophyton rubrum (74.4%) followed by Τrichophyton interdigitale (21.4%). Candida albicans was the most prevalent isolated yeast (82%), whereas among the cases with onychomycosis due to NDMs, Aspergillus spp. were isolated as the principal species (59%). Continuous monitoring should be performed in order to identify possible trends and shifts in species isolation rates and to evaluate the impact of onychomycosis among the general population and high-risk groups.
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Affiliation(s)
- Hercules Sakkas
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
- Correspondence: (H.S.); (K.G.); Tel.: +30-265-100-7769 (H.S.); +30-265-100-7716 (K.G.)
| | - Christos Kittas
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Georgia Kapnisi
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Efthalia Priavali
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Amalia Kallinteri
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece;
| | - Konstantina Gartzonika
- Microbiology Department, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
- Department of Microbiology, University Hospital of Ioannina, 45110 Ioannina, Greece; (C.K.); (G.K.); (E.P.); (A.K.)
- Correspondence: (H.S.); (K.G.); Tel.: +30-265-100-7769 (H.S.); +30-265-100-7716 (K.G.)
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Gaitanis G, Bassukas ID. Combination therapy for toxic epidermal necrolysis: It is time for anti-TNFa biologics comparison. Burns 2020; 46:244-245. [DOI: 10.1016/j.burns.2019.10.028] [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] [Received: 09/26/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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23
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Chaniotakis I, Bassukas ID. The First Disease Episode: A Strategic Treatment Target to Prevent Cellulitis Relapses. Dermatology 2020; 237:142-144. [PMID: 31968332 DOI: 10.1159/000505538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ioannis Chaniotakis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece,
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24
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Gaitanis G, Tsiouri G, Spyridonos P, Stefos Τ, Stamatas GN, Velegraki A, Bassukas ID. Variation of cultured skin microbiota in mothers and their infants during the first year postpartum. Pediatr Dermatol 2019; 36:460-465. [PMID: 31025407 DOI: 10.1111/pde.13829] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND/OBJECTIVES The establishment of newborn skin flora depends on the ongoing skin maturation and the existence of potential microbial colonizers within the environment of the infant during a period of intense mother-infant physical interaction. This longitudinal study assessed culturable skin bacteria in the mother-infant dyad during the first year of life. METHODS A total of 17 mother-infant dyads were swabbed within 24 hours postpartum and at 3, 6, 9, and 12 months. Skin swabbing was performed on two anatomical areas per individual (mothers: chest-abdomen; infants: forehead-buttocks) and were incubated in five different solid culture media to optimize yield. Isolated bacterial species were identified to genus or species level using the API system (BioMeriéux, Marcy l'Etoile, France). RESULTS A total of 444 microbial strains were isolated belonging to 22 genera: 6 "frequent" (isolated from > 5% samples: S aureus, Proteus, Klebsiella, Pseudomonas, Enterobacter, and Enterococcus) and 16 "infrequent." Isolated genera per individual peaked at 6 months postpartum for mothers and infants (P < 0.05). Enterobacter, Enterococcus, Klebsiella, and Pseudomonas isolation rates varied significantly as a function of sampling time contrary to the rather constant isolation rates of Proteus and S aureus. The rates of concordant isolation of the same microbial species within the mother-infant dyad tended to drop from birth to the end of the first year postpartum. CONCLUSIONS Distinct variations in the isolation rates of skin commensals from specific anatomical sites of the mother-infant dyad indicate bidirectional microbial transmission. Increasing skin flora individuality of the growing infant was recorded, manifested by declining rates of concordant isolation of the same microbial species from mother and her infant.
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Affiliation(s)
- Georgios Gaitanis
- Faculty of Medicine, Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgia Tsiouri
- Faculty of Medicine, Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Panagiota Spyridonos
- Faculty of Medicine, Department of Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Τheodoros Stefos
- Faculty of Medicine, Department of Obstetrics and Gynecology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios N Stamatas
- Emerging Science & Innovation, Johnson & Johnson Santé Beauté France, Issy-les-Moulineaux, France
| | - Aristea Velegraki
- Microbiology Department, Mycology Research Laboratory & UOA/HCPF Culture Collection, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis D Bassukas
- Faculty of Medicine, Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
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25
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Petrokilidou C, Pavlou E, Gaitanis G, Bassukas ID, Saridomichelakis MN, Velegraki A, Kourkoumelis N. The lipid profile of three Malassezia species assessed by Raman spectroscopy and discriminant analysis. Mol Cell Probes 2019; 46:101416. [PMID: 31247316 DOI: 10.1016/j.mcp.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/01/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
Malassezia yeasts constitute the major eukaryotic cutaneous flora of homoeothermic vertebrates. These lipophilic yeasts are able to cause, trigger, or aggravate common skin diseases under favorable conditions. Species identification and subspecies differentiation is currently based on morphological characteristics, lipid assimilation profile, and molecular tests. Mass spectrometry has been also reported as a reliable, yet costly and labor-intensive, method to classify Malassezia yeasts. Here, we introduce Raman spectroscopy as a new molecular technique able to differentiate three phylogenetically close Malassezia species (M.globosa, M.pachydermatis, and M.sympodialis) by examining their lipid metabolic profile. Using Raman spectroscopy, lipid fingerprints of Malassezia cultures on Leeming-Notman agar, were analyzed by spectral bands assignment and partial least squares discriminant analysis. Our results demonstrate differential utilization of lipid supplements among these three species and the ability of Raman spectroscopy to rapidly and accurately discriminate them by predictive modelling.
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Affiliation(s)
- Chrysoula Petrokilidou
- Faculty of Medicine, Department Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Eleftherios Pavlou
- Faculty of Medicine, Department Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Faculty of Medicine, Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Faculty of Medicine, Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Manolis N Saridomichelakis
- Clinic of Medicine, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Karditsa, Greece
| | - Aristea Velegraki
- Microbiology Department, Mycology Research Laboratory & UOA/HCPF Culture Collection, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kourkoumelis
- Faculty of Medicine, Department Medical Physics, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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26
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Nomikos K, Lampri E, Spyridonos P, Bassukas ID. Alterations in the inflammatory cells infiltrating basal cell carcinomas during immunocryosurgery. Arch Dermatol Res 2019; 311:499-504. [PMID: 31115658 DOI: 10.1007/s00403-019-01933-w] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/09/2019] [Accepted: 05/14/2019] [Indexed: 12/15/2022]
Abstract
Immunocryosurgery, the combination modality of a cryosurgery session at day 14 of a 5-week daily imiquimod treatment cycle, has shown remarkable efficacy in the treatment of basal cell carcinoma (BCC). The modality was designed to exploit synergy of antitumor effects, including the induction of immune responses, elicited by imiquimod and cryosurgery. Herein, we report on the infiltration of the BCC by selected inflammatory cell species during an immunocryosurgery treatment cycle. The density of tissue infiltrating CD68+, CD3+ and Foxp3+ cells was studied by immunohistochemistry in 56 BCC biopsies from 28 treated sites (26 patients) at baseline and at days 12, 16 or 28 during treatment. Immunocryosurgery induces statistically significant alterations in all three cell species (p < 0.003): The density of CD68+ increased already by day 12 and remained at a higher level during the treatment thereafter. The density of CD3+ cells increased significantly between days 12 and 16 of treatment. The density of Treg (Foxp3+) cells increased in the early phase of treatment (highest at day 12) to decrease significantly already 2 days after the cryosurgery session (day 16) and thereafter up to day 28 of the treatment cycle (p = 0.033). Within the tumor tissue, these alterations result in an abrupt increase in the CD3+/Foxp3+ ratio, a finding suggesting that the cryosurgical perturbation may probably play a decisive modulating role in the cellular composition of the inflammatory infiltrate during immunocryosurgery, eventually heralding the induction of an effective tumor-destructing immune response.
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Affiliation(s)
- K Nomikos
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - E Lampri
- Pathologist in Private Practice, Ioannina, Greece
| | - P Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - I D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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27
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Gaitanis G, Magiatis P, Mexia N, Melliou E, Efstratiou MA, Bassukas ID, Velegraki A. Antifungal activity of selected
Malassezia
indolic compounds detected in culture. Mycoses 2019; 62:597-603. [DOI: 10.1111/myc.12893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 11/28/2018] [Accepted: 01/06/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Georgios Gaitanis
- Faculty of MedicineDepartment of Skin and Venereal DiseasesSchool of Health SciencesUniversity of Ioannina Ioannina Greece
| | - Prokopios Magiatis
- Faculty of PharmacyDepartment of Pharmacognosy and Natural Products ChemistryNational and Kapodistrian University of Athens Athens Greece
| | - Nikitia Mexia
- Faculty of PharmacyDepartment of Pharmacognosy and Natural Products ChemistryNational and Kapodistrian University of Athens Athens Greece
| | - Eleni Melliou
- Faculty of PharmacyDepartment of Pharmacognosy and Natural Products ChemistryNational and Kapodistrian University of Athens Athens Greece
| | | | - Ioannis D. Bassukas
- Faculty of MedicineDepartment of Skin and Venereal DiseasesSchool of Health SciencesUniversity of Ioannina Ioannina Greece
| | - Aristea Velegraki
- Mycology Research Laboratory and UOA/HCPF Culture CollectionDepartment of MicrobiologyMedical SchoolNational and Kapodistrian University of Athens Athens Greece
- Bioiatriki SA Athens Greece
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Tziortzioti C, Gartzonika C, Gaitanis G, Bassukas ID. Increased antistreptolysin O serum levels in cellulitis recurrences and head and neck disease localization. Int J Dermatol 2019; 58:e98-e99. [DOI: 10.1111/ijd.14383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chrysanthi Tziortzioti
- Department of Dermatology and Venereology General University Hospital of Ioannina Ioannina Greece
| | - Constantina Gartzonika
- Department of Microbiology Faculty of Medicine School of Health Sciences University of Ioannina and Laboratory of Microbiology General University Hospital of Ioannina Ioannina Greece
| | - Georgios Gaitanis
- Department of Dermatology and Venereology General University Hospital of Ioannina Ioannina Greece
- Department of Skin and Venereal Diseases Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece
| | - Ioannis D. Bassukas
- Department of Dermatology and Venereology General University Hospital of Ioannina Ioannina Greece
- Department of Skin and Venereal Diseases Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece
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Spyridonos P, Gaitanis G, Likas A, Bassukas ID. Late fusion of deep and shallow features to improve discrimination of actinic keratosis from normal skin using clinical photography. Skin Res Technol 2019; 25:538-543. [PMID: 30762255 DOI: 10.1111/srt.12684] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 12/17/2018] [Accepted: 01/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Actinic keratosis (AK) is a common premalignant skin lesion that can potentially progress to squamous cell carcinoma. Appropriate long-term management of AK requires close patient monitoring in addition to therapeutic interventions. Computer-aided diagnostic systems based on clinical photography might evolve in the future into valuable adjuncts to AK patient management. The present study proposes a late fusion approach of color-texture features (shallow features) and deep features extracted from pre-trained convolutional neural networks (CNN) to boost AK detection accuracy on clinical photographs. MATERIALS AND METHODS System uses a sliding rectangular window of 50 × 50 pixels and a classifier that assigns the window region to either the AK or the healthy skin class. 6010 and 13 915 cropped regions of interest (ROI) of 50 × 50 pixels of AK and healthy skin, respectively, from 22 patients were used for system implementation. Different support vector machine (SVM) classifiers employing shallow or deep features and their late fusion using the max rule at decision level were compared with the McNemar test and Yule's Q-statistic. RESULTS Support vector machine classifiers based on deep and shallow features exhibited overall competitive performances with complementary improvements in detection accuracy. Late fusion yielded significant improvement (6%) in both sensitivity (87%) and specificity (86%) compared to single classifier performance. CONCLUSION The parallel improvement of sensitivity and specificity is encouraging, demonstrating the potential use of our system in evaluating AK burden. The latter might be of value in future clinical studies for the comparison of field-directed treatment interventions.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aristidis Likas
- Department of Computer Science & Engineering, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Gravani A, Gaitanis G, Tsironi T, Tigas S, Bassukas ID. Changing prevalence of diabetes mellitus in bullous pemphigoid: it is the dipeptidyl peptidase-4 inhibitors. J Eur Acad Dermatol Venereol 2018; 32:e438-e439. [PMID: 29569760 DOI: 10.1111/jdv.14957] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- A Gravani
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - G Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - T Tsironi
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - S Tigas
- Department of Endocrinology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - I D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Gaitanis G, Magiatis P, Velegraki A, Bassukas ID. A traditional Chinese remedy points to a natural skin habitat: indirubin (indigo naturalis) for psoriasis and the Malassezia metabolome. Br J Dermatol 2018; 179:800. [PMID: 29791716 DOI: 10.1111/bjd.16807] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- G Gaitanis
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45100, Greece
| | - P Magiatis
- Department of Pharmacognosy and Natural Products Chemistry, Faculty of Pharmacy, University of Athens, Athens, 11527, Greece
| | - A Velegraki
- Mycology Research Laboratory and UOA/HCPF, Medical School, National and Kapodistrian University of Athens, Athens, 11527, Greece.,Biomedicine SA, Athens, 11526, Greece
| | - I D Bassukas
- Department of Dermatology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, 45100, Greece
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Kourkoumelis N, Gaitanis G, Velegraki A, Bassukas ID. Nail Raman spectroscopy: A promising method for the diagnosis of onychomycosis. An ex vivo pilot study. Med Mycol 2017; 56:551-558. [DOI: 10.1093/mmy/myx078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/18/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- Nikolaos Kourkoumelis
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Aristea Velegraki
- Mycology Research Laboratory, Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527, Athens, Greece
- Biomedicine SA, Athens 11526, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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Spyridonos P, Gaitanis G, Likas A, Bassukas ID. Automatic discrimination of actinic keratoses from clinical photographs. Comput Biol Med 2017; 88:50-59. [DOI: 10.1016/j.compbiomed.2017.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/29/2017] [Accepted: 07/02/2017] [Indexed: 11/28/2022]
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Vlachos C, Gaitanis G, Katsanos KH, Christodoulou DK, Tsianos E, Bassukas ID. Psoriasis and inflammatory bowel disease: links and risks. Psoriasis (Auckl) 2016; 6:73-92. [PMID: 29387596 PMCID: PMC5683131 DOI: 10.2147/ptt.s85194] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Psoriasis and the spectrum of inflammatory bowel diseases (IBD) are chronic, inflammatory, organotropic conditions. The epidemiologic coexistence of these diseases is corroborated by findings at the level of disease, biogeography, and intrafamilial and intrapatient coincidence. The identification of shared susceptibility loci and DNA polymorphisms has confirmed this correlation at a genetic level. The pathogenesis of both diseases implicates the innate and adaptive segments of the immune system. Increased permeability of the epidermal barrier in skin and intestine underlies the augmented interaction of allergens and pathogens with inflammatory receptors of immune cells. The immune response between psoriasis and IBD is similar and comprises phagocytic, dendritic, and natural killer cell, along with a milieu of cytokines and antimicrobial peptides that stimulate T-cells. The interplay between dendritic cells and Th17 cells appears to be the core dysregulated immune pathway in all these conditions. The distinct similarities in the pathogenesis are also reflected in the wide overlapping of their therapeutic approaches. Small-molecule pharmacologic immunomodulators have been applied, and more recently, biologic treatments that target proinflammatory interleukins have been introduced or are currently being evaluated. However, the fact that some treatments are quite selective for either skin or gut conditions also highlights their crucial pathophysiologic differences. In the present review, a comprehensive comparison of risk factors, pathogenesis links, and therapeutic strategies for psoriasis and IBD is presented. Specific emphasis is placed on the role of the immune cell species and inflammatory mediators participating in the pathogenesis of these diseases.
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Affiliation(s)
| | | | - Konstantinos H Katsanos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Epameinondas Tsianos
- Division of Gastroenterology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Abstract
Bowen's disease (BD) is widely treated with topical imiquimod or cryosurgery. The present single-center retrospective study reports on the application of standardized immunocryosurgery (cryosurgery during ongoing topical imiquimod) for the treatment of BD. Daily imiquimod 5% cream was applied on BD lesion and a 5 mm rim around it in 5-week treatment cycles; cryosurgery (liquid N2 , open spray; 2 cycles, 15 second each) was performed at the end of the second week of each treatment cycle. Between 1/1/2009 and 31/12/2014 21 patients (mean age ± SD: 74.4 ± 8.0 years; 12 males) with 24 lesions (mean maximum diameter ± SD: 45.8 ± 50.9 mm; range: 9-200 mm) completed the protocol. The anatomic distribution of the lesions included face/scalp (Ν = 14), neck/trunk (Ν = 6), and extremities (Ν = 4). Twenty-one out of twenty-four lesions with diameter <80 mm cleared after one immunocryosurgery cycle, while the rest three tumors (with the largest diameters: 100, 180, 200 mm) required two treatment cycles for complete response (clearance rate: 100%). After a median follow-up of 24 months (range: 6-60 months) the overall effectiveness was 91.7%: 22/24 lesions remained in sustained complete remission. With the exception of a variable degree of hypopigmentation, the cosmetic outcome was satisfactory even for extensive lesions. Immunocryosurgery, is feasible and highly efficacious minimally-invasive treatment alternative for BD.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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Gaitanis G, Kalogeropoulos CD, Bassukas ID. Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally Invasive Treatment Alternative. Dermatology 2015; 232:17-21. [PMID: 26583773 DOI: 10.1159/000441491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM Periocular basal cell carcinomas (pBCC) remain a treatment challenge. Our aim was to retrospectively evaluate the feasibility and efficacy of immunocryosurgery for the treatment of pBCC. METHODS Immunocryosurgery is given in 5-week cycles of daily imiquimod, with cryosurgery on day 14. Patients treated between 1/1/2008 and 31/12/2014 were included in this study. RESULTS Immunocryosurgery was offered to 19 patients. Of these, 16 (i.e., 6 males and 10 females, average age 74.9 years, median tumor diameter 15 mm, range 5-60 mm), with 1 tumor each, were treated. Six tumors (37.5%) were relapses after surgery and 2 were of metatypical histology. All BCC were high risk for recurrence after treatment; 10 tumors had 2 risk factors for relapse, 5 had 3, and 1 had 4. The follow-up period ranged between 3 and 60 months (average 25.6 months). Of the 16 tumors treated, 14 (all with a diameter <40 mm) cleared with immunocryosurgery (total efficacy 87.5%); 7 out of 16 tumors (44%; all with a diameter ≤20 mm) cleared with 1 conventional 5-week immunocryosurgery treatment cycle. Seven additional tumors (including 2 with a diameter >20 mm) required intensified treatment schemes (of up to 10 weeks) for clearance. The 2 tumors that did not clear responded partially and were also the 2 largest ones (diameter 40 and 60 mm). Of the 14 cleared tumors, 2 relapsed during follow-up; 1 cleared with immunocryosurgery. At the last examination during follow-up, 13 out of 16 (81%) patients were in sustained clinical remission. CONCLUSIONS For most pBCC, immunocryosurgery is a feasible and efficacious alternative to surgical excision.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Gaitanis G, Lolis CJ, Tsartsarakis A, Kalogeropoulos C, Leveidiotou-Stefanou S, Bartzokas A, Bassukas ID. An Aggregate of Four Anthrax Cases during the Dry Summer of 2011 in Epirus, Greece. Dermatology 2015; 232:112-6. [PMID: 26523995 DOI: 10.1159/000440860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/06/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human anthrax is currently a sporadic disease in Europe, without significant regional clustering. OBJECTIVE To report an unexpected aggregate of anthrax cases and correlate local climatic factors with yearly anthrax admissions. METHODS Clinical description of a geographical-temporal anthrax aggregate, correlation of disease admissions with local weather data in the period 2001-2014 and literature reports of anthrax clusters from Europe in the last 20 years. RESULTS We identified 5 cases, all cutaneous: an unexpected aggregate of 4 cases in mid-summer 2011 (including a probable human-to-human transmission) and a sporadic case in August 2005, all in relatively dry periods (p < 0.05). Remarkably, 3/6 reports of human anthrax aggregates from Europe were observed in Balkan Peninsula countries in the year 2011. CONCLUSION In the light of the predicted climatic change, unexpected anthrax aggregates during dry periods in southern Europe underscore the risk of future anthrax re-emergence on this continent.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Skandalis K, Vlachos C, Pliakou X, Gaitanis G, Kapsali E, Bassukas ID. Higher Serum Ferritin Levels Correlate with an Increased Risk of Cutaneous Morbidity in Adult Patients with β-Thalassemia: A Single-Center Retrospective Study. Acta Haematol 2015; 135:124-30. [PMID: 26509267 DOI: 10.1159/000438479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 07/05/2015] [Indexed: 11/19/2022]
Abstract
Disturbed iron homeostasis characterizes β-thalassemia and increases its morbidity. Our aim was to retrospectively associate β-thalassemia disease characteristics with treatment-requiring skin conditions. The files of adult β-thalassemia (including sickle β-thalassemia) patients were screened over a 10-year period for treatment-requiring skin disease episodes and their correlation with hematologic diagnoses and epidemiological and serological characteristics. Seventy-eight patients were identified, and 7 (9%) developed at least one relevant episode including cutaneous small-vessel vasculitis (CSVV), urticaria, and leg ulcers. Average ferritin serum level correlated significantly with development of a dermatosis (2,034 ± 799 μg/l in cases vs. 920 ± 907 μg/l in the overall population; p = 0.001, ANOVA). This difference relied exclusively on the high ferritin levels observed in patients with 'generalized' dermatoses (urticaria and CSVV: 3,860 ± 1,220 μg/l) as opposed to values within the normal range in the case of 'localized' ones (leg ulcers: 662 ± 167 μg/l). The employed iron chelation treatment influenced ferritin levels (p = 0.002, Kruskal-Wallis test) since chelation with a single agent seems to increase the risk of a skin disease (p = 0.013, likelihood ratio method). Conclusively, serum ferritin can be evaluated as risk factor for generalized dermatoses, but not for leg ulcers, in patients with the β-thalassemia genotype. This risk can be efficiently controlled with adequate chelation.
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Affiliation(s)
- Konstantinos Skandalis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Kourkoumelis N, Balatsoukas I, Moulia V, Elka A, Gaitanis G, Bassukas ID. Advances in the in Vivo Raman Spectroscopy of Malignant Skin Tumors Using Portable Instrumentation. Int J Mol Sci 2015; 16:14554-70. [PMID: 26132563 PMCID: PMC4519858 DOI: 10.3390/ijms160714554] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 06/20/2015] [Accepted: 06/24/2015] [Indexed: 01/09/2023] Open
Abstract
Raman spectroscopy has emerged as a promising tool for real-time clinical diagnosis of malignant skin tumors offering a number of potential advantages: it is non-intrusive, it requires no sample preparation, and it features high chemical specificity with minimal water interference. However, in vivo tissue evaluation and accurate histopathological classification remain a challenging task for the successful transition from laboratory prototypes to clinical devices. In the literature, there are numerous reports on the applications of Raman spectroscopy to biomedical research and cancer diagnostics. Nevertheless, cases where real-time, portable instrumentations have been employed for the in vivo evaluation of skin lesions are scarce, despite their advantages in use as medical devices in the clinical setting. This paper reviews the advances in real-time Raman spectroscopy for the in vivo characterization of common skin lesions. The translational momentum of Raman spectroscopy towards the clinical practice is revealed by (i) assembling the technical specifications of portable systems and (ii) analyzing the spectral characteristics of in vivo measurements.
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Affiliation(s)
- Nikolaos Kourkoumelis
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece.
| | - Ioannis Balatsoukas
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece.
| | - Violetta Moulia
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece.
| | - Aspasia Elka
- Department of Medical Physics, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece.
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece.
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece.
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Kalogeropoulos CD, Bassukas ID, Moschos MM, Tabbara KF. Eye and Periocular Skin Involvement in Herpes Zoster Infection. Med Hypothesis Discov Innov Ophthalmol 2015; 4:142-156. [PMID: 27800502 PMCID: PMC5087099] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Herpes zoster ophthalmicus (HZO) is a clinical manifestation of the reactivation of latent varicella zoster virus (VZV) infection and is more common in people with diminished cell-mediated immunity. Lesions and pain correspond to the affected dermatomes, mostly in first or second trigeminal branch and progress from maculae, papules to vesicles and form pustules, and crusts. Complications are cutaneous, visceral, neurological, ocular, but the most debilitating is post-herpetic neuralgia. Herpes zoster ophthalmicus may affect all the ophthalmic structures, but most severe eye-threatening complications are panuveitis, acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN) as well. Antiviral medications remain the primary therapy, mainly useful in preventing ocular involvement when begun within 72 hours after the onset of the rash. Timely diagnosis and management of HZO are critical in limiting visual morbidity. Vaccine in adults over 60 was found to be highly effective to boost waning immunity what reduces both the burden of herpes zoster (HZ) disease and the incidence of post-herpetic neuralgia (PHN).
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Affiliation(s)
- Chris D. Kalogeropoulos
- Department of Ophthalmology, Ocular Inflammation Service, University of Ioannina, Ioannina, Greece
| | - Ioannis D. Bassukas
- Department of Skin and Venereal Diseases, University of Ioannina, Ioannina, Greece
| | | | - Khalid F. Tabbara
- The Eye Center and the Eye Foundation for Research in Ophthalmology, Riyadh, Saudi Arabia
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Voulgari PV, Gaitanis G, Markatseli TE, Kempf W, Bassukas ID. In transit recurrence of Merkel cell carcinoma associated with polyarthritis effectively treated with immunocryosurgery. Acta Derm Venereol 2014; 94:739-40. [PMID: 24764027 DOI: 10.2340/00015555-1812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Paraskevi V Voulgari
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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Spyridonos P, Gaitanis G, Tzaphlidou M, Bassukas ID. Spatial fuzzy c-means algorithm with adaptive fuzzy exponent selection for robust vermilion border detection in healthy and diseased lower lips. Comput Methods Programs Biomed 2014; 114:291-301. [PMID: 24661607 DOI: 10.1016/j.cmpb.2014.02.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/17/2014] [Accepted: 02/26/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Accurate lip contour identification is demanding since variations in color, form and surface texture, even in normal lips, introduce artifacts in non-adapted segmentation algorithms. Herein, a method for vermilion border detection and quantification in healthy and diseased lower lips is presented. AIM To quantify the morphological irregularities of lower lip border, to validate its discriminative power in solar cheilosis diagnosis and to provide supportive tools toward, cost effective, non invasive, disease monitoring. MATERIALS Segmentation algorithm for lower lip border was based on spatial fuzzy c-means clustering algorithm with adaptive selection of fuzzy exponent m. Lip features measuring morphological lip border deviations were estimated. The method of lip border extraction and quantitative description was evaluated in a gold standard set of 25 young volunteers without onset of lip diseases. Quantitative descriptors were evaluated in terms of correct classification rates in differentiating 30 healthy control cases from 41 patients with solar cheilosis and were further applied to quantify the therapeutic outcome after immunocryosurgery in eight patients with solar cheilosis. RESULTS Adaptive estimation of fuzzy exponent m substantially boosted the segmentation quality in gold standard cases yielding quite smooth lip contours and uniformly low values of lip irregularity features. Discriminant analysis highlighted the distance between the extracted and modeled vermilion border as a feature with excellent diagnostic accuracy (sensitivity and specificity 98% and 93% respectively). Results on patients with solar cheilosis followed up after treatment with immunocryosurgery showed that proposed quantitative lip marker was able to trace the improvement of disease after treatment. CONCLUSION Correct lip border recognition is the prerequisite for extracting essential morphological descriptors from lips with epithelial diseases like solar cheilosis. In this paper we presented an efficient method for the automatic identification and quantitative description of lower lip vermilion border morphology in health and disease using digital photography and image analysis techniques.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece.
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece
| | - Margaret Tzaphlidou
- Department of Medical Physics, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece.
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, University of Ioannina, School of Health Sciences, University Campus, 45110 Ioannina, Greece
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Gaitanis G, Bassukas ID. Immunocryosurgery for non-superficial basal cell carcinoma: a pro-spective, open-label phase III study for tumours ≤ 2 cm in diameter. Acta Derm Venereol 2014; 94:38-44. [PMID: 23722308 DOI: 10.2340/00015555-1609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 11/16/2022] Open
Abstract
Cryosurgery and topical imiquimod are established mono-therapies for superficial basal cell carcinoma (BCC) but are often insufficient for thicker BCCs. We present here a phase III, prospective, interventional, single-arm (cases only) study (trial registration: NCT01212562) to evaluate the feasibility and efficacy of cryosurgery (liquid nitrogen, open spray, 2 × 15 s; day 14) during 5 weeks' imiquimod ("immunocryosurgery") for primary, non-superficial BCC, ≤ 2 cm in diameter. Ninety-one consecutive patients with 134 basal cell carcinoma were evaluated. A total of 83 patients (124 tumours) started treatment, and 79 patients (119 tumours) completed at least one cycle of immunocryosurgery (feasibility: 95.2%; follow-up: 18-60 months). The efficacy after one treatment cycle was 95 ± 2% stable complete remissions (116/119 tumours cleared, 3/116 tumours relapsed: 6 treat-ment "failures"). Neither tumour size (p = 0.865) nor localization (p = 0.233) predicted outcome. Repeat immunocryosurgery controlled 5/6 treatment failures (overall efficacy: 99%). Lack of a conventionally treated control group is a limitation of this study. However, the results show a high therapeutic efficacy of immunocryosurgery in a large series of primary non-superficial BCC.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, Medical School, University of Ioannina, GR-45110 Ioannina, Greece
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Gravani A, Gaitanis G, Zioga A, Bassukas ID. Synthetic antimalarial drugs and the triggering of psoriasis - do we need disease-specific guidelines for the management of patients with psoriasis at risk of malaria? Int J Dermatol 2013; 53:327-30. [PMID: 24320605 DOI: 10.1111/ijd.12231] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Α distinct side effect of the synthetic quinolinic antimalarial drugs, still widely used for the treatment and prophylaxis of malaria, is the induction of psoriasis in predisposed or susceptible individuals. OBJECTIVE To describe two patients that had induction and exacerbation of psoriasis due to the administration of hydroxychloroquine, to adapt pertinent literature on the pathophysiology of this side effect, to review psoriasis-triggered cases by newer, non-quinolinic antimalarials, and to propose malaria treatment and prophylaxis guidelines for psoriatic patients. PATIENTS AND METHODS Two patients, a 40-year-old female with unknown history of psoriasis and a 37-year-old primigravida with an established history of psoriasis, were treated with hydroxychloroquine for a newly diagnosed lichen planopilaris and for an exacerbation of psoriatic arthritis, respectively. PubMed was searched (last accessed 20 October 2012) employing as search strategy the keywords (psoriasis) AND (drug), where "drug" is the name of each of the newer, non-quinolinic antimalarials. RESULTS Psoriasis was controlled in both patients. The primigravida gave birth to a healthy child at 39 weeks of gestation. The literature review returned no articles that linked the newer antimalarials with psoriasis. CONCLUSION Despite the increased awareness, antimalarials-triggered psoriasis is still diagnosed. Fortunately, the current artemisinin-based antimalarial treatment can be safely offered to susceptible individuals. Additionally, prophylaxis with doxycycline or the combination atovaquone-proguanil could be a safe suggestion for malaria prophylaxis in psoriatic patients.
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Affiliation(s)
- Agoritsa Gravani
- Department of Dermatology, University Hospital of Ioannina, Ioannina, Greece
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Abstract
The implication of the yeast genus Malassezia in skin diseases has been characterized by controversy, since the first description of the fungal nature of pityriasis versicolor in 1846 by Eichstedt. This is underscored by the existence of Malassezia yeasts as commensal but also by their implication in diseases with distinct absence of inflammation despite the heavy fungal load (pityriasis versicolor) or with characteristic inflammation (eg, seborrheic dermatitis, atopic dermatitis, folliculitis, or psoriasis). The description of 14 Malassezia species and subsequent worldwide epidemiologic studies did not reveal pathogenic species but rather disease-associated subtypes within species. Emerging evidence demonstrates that the interaction of Malassezia yeasts with the skin is multifaceted and entails constituents of the fungal wall (melanin, lipid cover), enzymes (lipases, phospholipases), and metabolic products (indoles), as well as the cellular components of the epidermis (keratinocytes, dendritic cells, and melanocytes). Understanding the complexity of their interactions will highlight the controversies on the clinical presentation of Malassezia-associated diseases and unravel the complexity of skin homeostatic mechanisms.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, University of Ioannina Medical School, Ioannina, Greece.
| | - Aristea Velegraki
- Mycology Laboratory, Microbiology Department, Medical School, National and Kapodistrian University of Athens, Athens Greece
| | - Peter Mayser
- Department of Dermatology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, University of Ioannina Medical School, Ioannina, Greece
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Nakuçi M, Bassukas ID. Office-based treatment of basal cell carcinoma with immunocryosurgery: feasibility and efficacy. Acta Dermatovenerol Alp Pannonica Adriat 2013; 22:35-38. [PMID: 23836356] [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: 06/02/2023]
Abstract
INTRODUCTION Minimally invasive, non-surgical, office-based modalities are a welcome alternative to surgery for basal cell carcinoma(BCC). This study evaluates the treatment of BCC with immunocryosurgery (cryosurgery during topical imiquimod) in a dermatology office setting. METHODS Response of BCC to immunocryosurgery (daily imiquimod for 5 weeks and a liquid N2 cryosurgery session at the end of the 2nd week) was evaluated according to treatment feasibility, tumor clearance, and relapse. RESULTS Twenty-four patients with a total of 36 BCC (four relapses after cryosurgery or surgery) were recruited and all finished treatment (follow-up: 2-24 months). One month after the end of treatment, 30/36 sites were clinically cured. In five cases, a repeat cryosurgery at this time led to clinical cure (one patient refused cryosurgery; overall cure rate: 97.2%). Two relapses occurred after 12 and 14 months follow-up, which were successfully treated with immunosurgery and cryosurgery, respectively. Adverse effects included hypopigmentation, redness persisting for up to 3 months after treatment, superficial scarring that improved with time, and worry during treatment because of skin irritation (resolved with a phone discussion in all cases). CONCLUSION Immunocryosurgery is a feasible and efficacious procedure that can be performed at a dermatology office for the treatment of primary and relapsed BCC.
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Affiliation(s)
- Mikel Nakuçi
- Department of Skin and Venereal Diseases, University of Ioannina Medical School, GR-45110 Ioannina, Greece
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Spyridonos P, Gaitanis G, Bassukas ID, Tzaphlidou M. Gray Hausdorff distance measure for medical image comparison in dermatology: Evaluation of treatment effectiveness by image similarity. Skin Res Technol 2012; 19:e498-506. [PMID: 23020792 DOI: 10.1111/srt.12001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION In clinical dermatology, the stabilization of the overall skin condition can be in many cases the earliest qualitative measure of the effectiveness of the therapeutic intervention. Subjective image comparisons, that offer empirical 'qualitative' judgments of degrees of image similarities, are traditionally employed by the involved physicians. OBJECTIVES To quantify, by means of an image similarity metric, the degree of stabilization of an expanding skin disease, and to identify the situation of 'no further change' of the skin condition of the patient, providing thus the physician with an early, objective measure of the efficacy of the used therapy. METHODS For treatment assessment, a variant of gray Hausdorff distance metric was employed to compare images of lesional skin segments of a patient, taken at different time points during a therapeutic course. Prior to image comparison, an effective preprocessing scheme was adapted to constrain wide pose and light variations. The proposed similarity algorithm was tested on raw clinical image data sets of patients diagnosed with toxic epidermal necrolysis, a life-threatening condition with rapid evolution. Fine tuning of algorithm's parameters was optimized using Precision-Recall curves. RESULTS Proposed image comparison method resulted in a high-degree of image similarity (about 96%) between pictures taken at second and fifth day of hospitalization. Current similarity results substantiate a significant agreement between the computer-treatment assessment, by means of image comparison, and the corresponding clinical experts' review of skin condition. CONCLUSION Objective evidence of 'no further change' situation may provide (a) intuitive clinical decision support to dermatologists in assessing aggressive skin conditions, where the timely evaluation of treatment response is of vital importance and (b) a versatile end-point measure for corresponding therapeutic clinical trials.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, University of Ioannina Medical School, University Campus, Ioannina, Greece.
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Vlachos C, Gaitanis G, Alexopoulos EC, Papadopoulou C, Bassukas ID. Phospholipase activity after β-endorphin exposure discriminates Malassezia strains isolated from healthy and seborrhoeic dermatitis skin. J Eur Acad Dermatol Venereol 2012; 27:1575-8. [PMID: 22757641 DOI: 10.1111/j.1468-3083.2012.04638.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Phospholipase activity and its induction by β-endorphin have been associated with pathogenic Malassezia pachydermatis animal isolates. OBJECTIVE To evaluate Malassezia phosholipase activity in human isolates from seborrhoeic dermatitis (SD) and healthy controls before and after β-endorphin exposure. METHODS Eighty-four volunteers with or without SD (N = 41) were sampled. Isolated Malassezia strains were incubated in Dixon's medium with and without 100 nmol/L β-endorphin. Subsequently, phospholipase activity was assessed in egg-yolk agar and the results were compared employing Wilcoxon sign test for paired data, chi-squared test and multinomial logistic regression analysis. RESULTS A total of 64 Malassezia strains were isolated. SD strains tended to have decreased phospholipase activity before (P = 0.057) and increased after exposure to β-endorphin (P = 0.061) compared to isolates from healthy skin. Phospholipase activity after β-endorphin exposure related to basal enzyme activity as a measure of per strain phospholipase inducibility by β-endorphin did not depend on Malassezia species (P = 0.652). However, this latter biochemical trait discriminates strains isolated from SD lesional and healthy skin (P = 0.036). CONCLUSION β-endorphin exposure modifies the in vitro phosholipase activity in Malassezia species isolated from SD lesional skin. This is in accordance with emerging evidence that enhanced local lipase activity is involved in the pathogenesis of SD.
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Affiliation(s)
- Ch Vlachos
- Departments ofSkin and Venereal DiseasesMicrobiology, University of Ioannina Medical School, Ioannina, Greece
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Gaitanis G, Spyridonos P, Patmanidis K, Koulouras V, Nakos G, Tzaphlidou M, Bassukas ID. Treatment of toxic epidermal necrolysis with the combination of infliximab and high-dose intravenous immunoglobulin. Dermatology 2012; 224:134-9. [PMID: 22572593 DOI: 10.1159/000338202] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Accepted: 03/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Therapeutic evidence for toxic epidermal necrolysis (TEN) is indicative for high-dose intravenous immunoglobulin yet inconclusive for corticosteroids. OBJECTIVE To describe the combination of corticosteroids, infliximab and a high-dose intravenous immunoglobulin course for TEN. PATIENTS AND METHODS In three patients (SCORTEN survival probabilities: 41.7%, 64.2%, 41.7%) disease control was evaluated by (a) employing quantitative image analysis to measure progression of skin detachment and (b) patients' outcome (complete re-epithelization). Published cases of TEN treatments with infliximab were retrieved from PubMed. RESULTS Within 48 h skin disease progression was arrested in all patients. Two patients were discharged after 3 weeks without any sequels from skin or conjunctivae. One patient passed away on the ninth day, however with noticeably improved skin (mortality rate: 33% observed vs. 50% expected). A PubMed search retrieved five TEN patients treated successfully with infliximab. CONCLUSION The described combination presents a feasible therapeutic alternative for TEN that warrants further evaluation.
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Affiliation(s)
- Georgios Gaitanis
- Department of Skin and Venereal Diseases, University of Ioannina Medical School, Ioannina, Greece
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