Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the esophagus.Beside proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a firs...Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the esophagus.Beside proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a first line therapy according to current guidelines.This review describes the background and practical management of STCs in EoE.So far,mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications“off label”.Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85%-an orodispersible tablet of budesonide has been approved as the first“in label”medication for EoE in Europe in June 2018.Whereas it was shown that disease remission induction of EoE by STCs is highly effective,there is still a lack of data regarding long-term and maintenance therapy.However,current studies on STC maintenance therapy add some movement into the game.展开更多
Objective To assess which of topical tacrolimus and topical highly potent steroids,is more effective and safer in the treatment of pediatric vitiligo.Methods The PubMed,Cochrane library,Scopus and CINAHL plus database...Objective To assess which of topical tacrolimus and topical highly potent steroids,is more effective and safer in the treatment of pediatric vitiligo.Methods The PubMed,Cochrane library,Scopus and CINAHL plus databases were retrieved.The search was confined to English language articles.The randomized controlled trial(RCT)articles were included in our study.The quality of the identified articles was examined by using the CASP Randomised Controlled Trials Checklist.Results As a result,there were only a few studies related to the comparison.However,there were only two RCTs regarding a comparison of topical tacrolimus 0.1%and clobetasol propionate 0.05%in childhood vitiligo.Conclusion When the body surface area(BSA)involved in the child is<20%,and the disease is not rapidly spreading,topical therapy is the first choice.Topical tacrolimus may be considered as an alternative therapy for childhood vitiligo,especially for acrofacial and segmental types,before considering other modalities,but still need to observe long-term side effects.展开更多
BACKGROUND Erythrodermic psoriasis(EP)is a rare and life-threatening form of psoriasis associated with significant morbidity and mortality.Systemic immunosuppre-ssive therapies are often required but may predispose to...BACKGROUND Erythrodermic psoriasis(EP)is a rare and life-threatening form of psoriasis associated with significant morbidity and mortality.Systemic immunosuppre-ssive therapies are often required but may predispose to opportunistic infections.Disseminated herpes simplex virus type-1(HSV-1)is an unusual complication in otherwise immunocompetent patients and has not been reported in association with ixekizumab therapy for EP.CASE SUMMARY We describe a 49-year-old man with longstanding severe plaque psoriasis,liver cirrhosis,and bipolar disorder who developed EP involving>90%of body surface area[Psoriasis Area and Severity Index(PASI)45].Following initial stabil-ization,he was admitted to the intensive care unit(ICU)with hemodynamic instability,leukocytosis with eosinophilia,and diffuse desquamation.Ixekizumab was initiated with high-dose topical clobetasol.During his ICU stay,he developed recurrent bacteremias and neurologic decline(Glasgow Coma Scale 7/15),fo-llowed by the appearance of widespread vesicles and hemorrhagic crusts.HSV-1 infection was confirmed by polymerase chain reaction(PCR).Immunosuppressive therapy was withheld,and intravenous acyclovir was started,leading to progre-ssive improvement.After ten days,ixekizumab was reintroduced with careful monitoring,resulting in marked clinical improvement(PASI 9.7 at six weeks).The patient remained stable on long-term follow-up with oral acyclovir prophylaxis.CONCLUSION This case highlights the diagnostic and therapeutic challenges of managing EP in the setting of biologic therapy.Disseminated cutaneous HSV-1 should be considered in immunosuppressed patients presenting with new vesicular eruptions,and prompt PCR testing with early antiviral therapy is essential.A multidisciplinary approach is critical to balance immunosuppression for disease control with infection risk.展开更多
文摘Eosinophilic esophagitis(EoE)is an emerging chronic local immune-mediated disease of the esophagus.Beside proton pump inhibitors and food-restrictiondiets swallowed topical corticosteroids(STC)can be offered as a first line therapy according to current guidelines.This review describes the background and practical management of STCs in EoE.So far,mainly asthma inhalers containing either budesonide or fluticasone have been administered to the esophagus by swallowing these medications“off label”.Recently esophagus-targeted formulations of topical steroids have been developed showing clinicopathological response rates up to 85%-an orodispersible tablet of budesonide has been approved as the first“in label”medication for EoE in Europe in June 2018.Whereas it was shown that disease remission induction of EoE by STCs is highly effective,there is still a lack of data regarding long-term and maintenance therapy.However,current studies on STC maintenance therapy add some movement into the game.
文摘Objective To assess which of topical tacrolimus and topical highly potent steroids,is more effective and safer in the treatment of pediatric vitiligo.Methods The PubMed,Cochrane library,Scopus and CINAHL plus databases were retrieved.The search was confined to English language articles.The randomized controlled trial(RCT)articles were included in our study.The quality of the identified articles was examined by using the CASP Randomised Controlled Trials Checklist.Results As a result,there were only a few studies related to the comparison.However,there were only two RCTs regarding a comparison of topical tacrolimus 0.1%and clobetasol propionate 0.05%in childhood vitiligo.Conclusion When the body surface area(BSA)involved in the child is<20%,and the disease is not rapidly spreading,topical therapy is the first choice.Topical tacrolimus may be considered as an alternative therapy for childhood vitiligo,especially for acrofacial and segmental types,before considering other modalities,but still need to observe long-term side effects.
文摘BACKGROUND Erythrodermic psoriasis(EP)is a rare and life-threatening form of psoriasis associated with significant morbidity and mortality.Systemic immunosuppre-ssive therapies are often required but may predispose to opportunistic infections.Disseminated herpes simplex virus type-1(HSV-1)is an unusual complication in otherwise immunocompetent patients and has not been reported in association with ixekizumab therapy for EP.CASE SUMMARY We describe a 49-year-old man with longstanding severe plaque psoriasis,liver cirrhosis,and bipolar disorder who developed EP involving>90%of body surface area[Psoriasis Area and Severity Index(PASI)45].Following initial stabil-ization,he was admitted to the intensive care unit(ICU)with hemodynamic instability,leukocytosis with eosinophilia,and diffuse desquamation.Ixekizumab was initiated with high-dose topical clobetasol.During his ICU stay,he developed recurrent bacteremias and neurologic decline(Glasgow Coma Scale 7/15),fo-llowed by the appearance of widespread vesicles and hemorrhagic crusts.HSV-1 infection was confirmed by polymerase chain reaction(PCR).Immunosuppressive therapy was withheld,and intravenous acyclovir was started,leading to progre-ssive improvement.After ten days,ixekizumab was reintroduced with careful monitoring,resulting in marked clinical improvement(PASI 9.7 at six weeks).The patient remained stable on long-term follow-up with oral acyclovir prophylaxis.CONCLUSION This case highlights the diagnostic and therapeutic challenges of managing EP in the setting of biologic therapy.Disseminated cutaneous HSV-1 should be considered in immunosuppressed patients presenting with new vesicular eruptions,and prompt PCR testing with early antiviral therapy is essential.A multidisciplinary approach is critical to balance immunosuppression for disease control with infection risk.
