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Biomedical subjects

Andreas D Katsambas

Publications and source records attributed to Andreas D Katsambas.

17 recordsLinked to original sources
PubMed2007

Efficacy, predictors of response, and long-term follow-up in patients with vitiligo treated with narrowband UVB phototherapy.

BACKGROUND: Narrowband UVB (NB-UVB) phototherapy is considered an accepted therapy for vitiligo. OBJECTIVE: We sought to estimate the effectiveness of NB-UVB in patients with vitiligo, identify predictive factors of response, and assess the stability of NB-UVB-induced repigmentation. METHODS: In all, 70 patients with vitiligo were treated twice weekly with NB-UVB. RESULTS: Cosmetically acceptable (>75%) repigmentation was achieved in 34.4% of patients with lesions on the face and in 7.4% of patients with lesions on the body. Patients with phototypes III to V had a greater chance to achieve greater than 75% repigmentation on the face. Patients who responded in the first month of treatment were more likely to achieve better repigmentation rates. Repigmentation was stable in 14.3% of patients 4 years after cessation of treatment. LIMITATIONS: The study was uncontrolled. Treatment frequency was twice weekly. These results may not be representative of different treatment regimens. CONCLUSION: Patients with vitiligo who have lesions on the face, darker phototypes, and early response to treatment have a greater chance to achieve satisfactory repigmentation after NB-UVB phototherapy.

Adolescent↗
PubMed2006

Melanocortin receptor-1 gene polymorphisms and the risk of cutaneous melanoma in a low-risk southern European population.

Individuals with melanocortin 1 receptor (MC1R) gene variants have been shown to carry an increased risk for the development of melanoma. In this study, we investigated the relationship of MC1R gene variants and the risk of melanoma in 123 melanoma patients and 155 control subjects from Greece. The entire MC1R gene was sequenced for polymorphisms and the results were correlated with host factors and pigmentary characteristics. MC1R polymorphisms were present in 59.4% of melanoma patients compared to 37.5% of controls, yielding an odds ratio (OR) of 2.43 (95% confidence interval (CI) = 1.50-3.96, P < 0.001) for melanoma among MC1R carriers. The risk of melanoma was enhanced in individuals carrying multiple variant alleles (OR = 6.97; 95% CI = 1.86-26.12, P = 0.004). Only the Val60Leu, Arg142His, and Arg151Cys variants were significantly associated with melanoma risk. In stratified analysis, the risk of melanoma among MC1R carriers was not influenced by skin phototype, skin color, or hair color. No association was found between MC1R genotype and the age of onset of melanoma, the tumor location, or the tumor thickness. In conclusion, MC1R polymorphisms are a predisposing factor of melanoma in a southern European population with a relatively low incidence of the disease.

Adult↗
PubMed2006

Germline CDKN2A mutations among Greek patients with early-onset and multiple primary cutaneous melanoma.

The genetic basis of melanoma susceptibility among Greek patients is uncharacterized. From 107 consecutive cutaneous melanoma patients, we analyzed the CDKN2A and CDK4 loci among 18 early-onset (< or =40 years) and two multiplex melanoma cases. Overall, we found three CDKN2A mutations (3/20; 15%), including one novel nonsense mutation (Trp110Stop) and two Arg24Pro missense alterations. There were no mutations in ARF or CDK4. CDKN2A mutations are not uncommon among Greek melanoma patients considering that none of the mutation carriers reported a family history of melanoma.

Adult↗
PubMed2006

Polymorphic eruption of pregnancy.

Polymorphic eruption of pregnancy (PEP) is a benign, self-limiting, pruritic disorder of pregnancy, which usually affects the primigravida during the last trimester or immediately postpartum. Its pathogenesis is unclear and its clinical manifestations are variable, leading frequently to an incorrect diagnosis. In cases of PEP the histological findings are nonspecific and the laboratory results, including direct immunofluorescence (DIF) and indirect immunofluorescence (IIF), are negative. Polymorphic eruption of pregnancy is not associated with any fetal risk and symptomatic treatment is all that is usually required. In this review we present the clinical presentation of PEP and a differential diagnosis which defines PEP as a separate entity. We will also review all current data of possible etiologic factors, histologic and immunologic findings, prognosis and therapy.

Diagnosis, Differential↗
PubMed2005

Association of clinical progression in classic Kaposi's sarcoma with reduction of peripheral B lymphocytes and partial increase in serum immune activation markers.

OBJECTIVE: To evaluate various immunologic markers in the peripheral blood of patients with early and advanced classic Kaposi's sarcoma (CKS). DESIGN: Cross-sectional study. SETTING: A major referral center for skin and venereal diseases. PATIENTS: Sixty-eight patients with histologically confirmed CKS staged according to a modified version of the Mitsuyasu-Groopman classification in stage I-II (cutaneous involvement only) and stage IV (skin and systemic involvement). MAIN OUTCOME MEASURES: Concentrations of neopterin and beta2-microglobulin, titer of anti-human herpesvirus 8 antibodies, number of natural killer cells, and numbers of total lymphocytes, B lymphocytes, T lymphocytes, and their subsets in peripheral blood. RESULTS: The median values of beta2-microglobulin and neopterin were elevated in patients with CKS in stage IV (median, 3.679 microg/mL [312.72 nmol/L] and 14.0 nmol/L, respectively) compared with patients in stage I-II (median, 2.406 microg/mL [204.51 nmol/L] and 6.5 nmol/L, respectively). A statistically significant reduction in total lymphocyte and B-lymphocyte counts was observed in patients with advanced-stage CKS (1679/microL and 79/microL, respectively) compared with patients in earlier stages of the disease (2142/microL and 224/microL, respectively). The human herpesvirus 8 antibody titer, determined by latent immunofluorescent assay, decreased from stage I-II to stage IV, although not at a statistically significant level (P = .14). CONCLUSION: The evolution of CKS from the early stages of the disease to the more advanced may be associated with a partial activation of the immune system and a gradual decrease in the number of total and B lymphocytes.

Aged↗
PubMed2005

The role of topical retinoids in the treatment of photoaging.

Aging of the skin is a complex biological process which is influenced by the interaction of several intrinsic and extrinsic factors. Intrinsic or chronological aging is an inevitable, genetically programmed process, of unclear underlying mechanism, for which no prevention or effective treatment is currently available. Photoaging refers to the gross and microscopic cutaneous changes that are induced by cumulative exposure to UV radiation and are superimposed on the background of chronological aging. Although primarily an aesthetic problem with significant psychological effects, photoaging constitutes the background for the development of precancerous and cancerous skin lesions.Overwhelming clinical and histological evidence indicate that certain structural changes induced by excessive sun exposure can be reversed, to some extent, by the use of topical retinoids. A number of retinoid compounds, for example tretinoin, isotretinoin, retinaldehyde and tazarotene, have been employed for the treatment of photoaged skin, and demonstrate beneficial clinical and histological effects. Adverse effects have been limited to an irritant reaction of variable intensity presenting with dryness, scaling and erythema. Ongoing research will enhance our understanding of the molecular mechanisms that determine the effects of retinoids on photodamaged skin and contribute to the employment of new, more effective and less irritating retinoid compounds.

Administration, Topical↗
PubMed2004

Juvenile spring eruption: clinicopathologic features and phototesting results in 4 cases.

Juvenile spring eruption is a distinct photodermatosis characterized by the development of papules and vesicles on light-exposed areas of the ears usually in the early springtime. It primarily affects boys and young men, and has a tendency to occur in the form of small epidemics. We report a similar outbreak in separate groups of soldiers who were performing military exercises during cold and sunny weather of a midwinter season. The clinicopathologic features and phototesting results are described in 4 of these cases. All patients showed normal erythemal responses to monochromator phototesting with UV and visible wave bands. Photoprovative testing with repeated daily exposures of the ears to a broadband UVA source provoked diffuse erythema and itching in 1 case, whereas similar photoprovocation of a nonaffected area, ie, the flexor surface of the forearm, in 2 patients did not yield a skin reaction. Although the cause of juvenile spring eruption is not known, our observations further strengthen the hypothesis that the disorder is a localized variant of polymorphous light eruption.

Adolescent↗
PubMed2004

Early cutaneous alterations in experimental sepsis by Pseudomonas aeruginosa.

BACKGROUND: To evaluate whether histopathologic findings of skin in sepsis by Pseudomonas aeruginosa correlate with the clinical course. METHODS: Histological alterations after bacterial challenge by one susceptible (A) and two multidrug-resistant isolates (B and C) of P. aeruginosa were studied in 18 rabbits. Sepsis was induced by the intravenous infusion of 1 x 10(8) CFU by a catheter in the right jugular vein; blood was sampled for the estimation of tumor necrosis factor alpha (TNF-alpha) and malondialdehyde (MDA). Skin biopsies were collected along with a subcutaneous fat specimen for culture. RESULTS: The mean survival was 0.85, 1.75 and 11.00 days after challenge by isolates A, B and C, respectively. The main histologic findings of skin were: inflammation and swelling of the dermis; thickening of the endothelium and infiltration of vessel wall and lumen by polymorphonuclear leukocytes; extravasation of red blood cells, and necrobiotic changes of the hair follicles. Serum TNF-alpha was elevated in animals challenged by isolate A compared to challenge by isolates B and C. Concentrations of MDA were similar for all isolates. Mean log(10) of viable cells isolated from subcutaneous fat were 5.74, 2.74 and 1.40 after challenge by isolates A, B and C, respectively. CONCLUSIONS: Prolongation of survival was accompanied by lower serum TNF-alpha, decreased viable cells from subcutaneous fat and intensified inflammatory response in the dermis and subcutaneous tissue. These findings might be of importance for immunomodulatory intervention.

Analysis of Variance↗
PubMed2004

Optimal management of recalcitrant disorders of hyperpigmentation in dark-skinned patients.

Alterations in skin pigmentation may often have a dramatic expression in individuals with a dark skin complexion and can be a source of significant emotional distress in these individuals. Hyperpigmented disorders such as melanosis (melasma), post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, and erythema dyschromicum perstans tend to have a prolonged course and, in many cases, are refractory to treatment, further contributing to the psychological impairment of the affected patients. Melanosis, is a common form of facial pigmentation attributable to sunlight and hormonal factors. A range of treatment modalities, such as depigmenting agents, topical retinoids, and chemical peels in conjunction with rigorous sun protection, can improve the melanosis but the condition usually recurs. Combination regimens, including frequent applications of superficial- and medium-depth chemical peels, appear to be particularly effective and well tolerated in dark-skinned patients with melanosis. Post-inflammatory hyperpigmentation is the result of excess pigment deposition following an inflammatory skin disorder. Topical tretinoin, hydroquinone, azelaic acid, kojic acid, and glycolic acid peels have been employed with variable degrees of success. Drug-induced pigmentation is a frequent cause of acquired hypermelanosis, its clinical expression depending on the triggering molecule and the underlying pathogenetic mechanism. Identifying and discontinuing the offending agent is the main approach in this condition, although, recent reports have demonstrated the efficacy of Q-switched lasers in accelerating the pigment removal. Erythema dischromicum perstans is a characteristic dermal pigmentation occurring mainly in dark-skinned individuals. Immunomodulating agents, such as clofazimine and dapsone have been shown to lighten this disorder, although, the exact mode of action is not clear.

Humans↗
PubMed2003

Spectrum of idiopathic photodermatoses in a Mediterranean country.

BACKGROUND: Idiopathic photodermatoses are considered to be common disorders in the population of northern latitude countries, presumably because of the dominance of more "sun-sensitive" individuals with a light-skinned complexion. The incidence of these disorders in the Mediterranean or tropical countries is often under-appreciated because of the higher degree of perennial presence of sunlight and the prevalence of darker skin-type individuals who are seemingly more resistant to the development of sun sensitivity. METHODS: We performed a retrospective, chart-based review of all patients who were diagnosed with idiopathic photodermatoses at a photodermatology referral center in Athens, Greece, during a period of 10 years. Our aim was to assess the pattern of idiopathic photosensitivity disorders in a Mediterranean country and to determine their epidemiological, clinical, and photobiological profile. RESULTS: A total of 310 patients were referred to our center with symptoms of photosensitivity. One hundred and forty-six patients (47.0%) were diagnosed with an idiopathic photosensitivity disorder by means of history, clinical examination, biochemical screening, histology, and phototesting. The most prevalent disorder was polymorphous light eruption, which was diagnosed in 95 patients (65.0%) of our cohort. Chronic actinic dermatitis occurred in 15 patients (10.2%), solar urticaria in 26 patients (17.8%), actinic prurigo in three patients (2.0%), hydroa vacciniforme in one patient (0.6%) and juvenile spring eruption in six patients (4.1%). CONCLUSIONS: Compared with the results of other studies, the prevalence of idiopathic photodermatoses appears to have a similar trend to that of higher latitude countries. Distinct features in our series include the higher incidence of idiopathic photosensitivity in patients with a fair-skinned complexion (skin types II-III) and the frequent appearance of photo-induced eruptions during sunny weather breaks in the winter period.

Adolescent↗
PubMedDate not supplied

Guidelines for treating acne.

Acne, a chronic inflammatory disease of the pilosebaceous units of the face, neck, chest, and back, is the most common skin disorder occurring universally, with an estimated prevalence of 70-87%.(1) It is a pleomorphic disorder characterized by both inflammatory (papules, pustules, nodules) and noninflammatory (comedones, open and closed) lesions. Grading of acne is mandatory to determine the appropriate therapeutic strategy. Mild acne can be purely comedonal or mild papulopustular, with a few papulopustules present as well.(2) Moderate acne is characterized by numerous comedones, few to many pustules, and few small nodules, with no residual scarring.(2) In severe acne papulopustules are numerous, many nodules can be detected, inflammation is marked, and scarring is present.(2) Very severe acne can be recognized by sinus tracts, grouped comedones, many deeply located nodules, and severe inflammation and scarring.(2) Although acne does not affect health overall, its impact on emotional well-being and function can be critical and is often associated with depression, anxiety, and higher-than-average unemployment rates.(3) Effective treatment can dramatically improve a person's quality of life.

Acne Vulgaris↗
PubMedDate not supplied

Comparison of topical retinoids in the treatment of acne.

Topical retinoids are been used to successfully treat acne for almost 3 decades. At the beginning, a retinoid was a compound of similar structure and action to retinol (vitamin A).(1) Changes at the carboxylic end group, the polyene chain, and the aromatic ring can result in the modification of the original molecule. To date, three generations of retinoids have been developed: the nonaromatics (retinol, tretinoin, and isotretinoin), the monoaromatics (etretinate and acitretin), and the polyaromatics (arotinoid, adapalene, and tazarotene). The new synthetic retinoid molecules have little resemblance with retinol but nonetheless are included in this family because they have the ability to bind with or activate retinoid receptors. Therefore, retinoids are vitamins and also hormones.(3)

Administration, Cutaneous↗
PubMedDate not supplied

Human immunodeficiency virus infection and pregnancy.

Human immunodeficiency virus infection profoundly affects the medical community and is spreading rapidly in women of childbearing age worldwide. Transmission of HIV from mother to child can occur in utero, during labor, or after delivery through breast-feeding. Most of the infants are infected during delivery. We focus on the factors affecting the transmission of HIV, diagnostic and resistance tests, strategies to prevent mother-to-child transmission with special reference to mode of delivery, infant feeding, and use of antiretroviral therapy. The risk of infection for the infant can be decreased by reducing maternal viral load, by elective cesarean delivery, and by avoidance of breast-feeding. The efficacy of antiretroviral treatment should be balanced against the possibility of embryonic or fetal toxicity. The choice of therapy should be based on the woman's treatment history, the clinical status, and the available prognostic markers, which are related to the progression of disease in the mother and the risk of mother-to-child transmission HIV transmission.

Anti-Retroviral Agents↗
PubMedDate not supplied

Medical and cutaneous disorders associated with homelessness.

Homelessness is a rising problem with socioeconomic roots that affects millions of people around the world. Homeless people suffer from a wide range of health problems and, consequently, have high rates of morbidity and mortality. Various infectious and noninfectious skin conditions have been described among the homeless, with trauma, superficial fungal infections, and foot problems being the most prevalent. Poor hygiene conditions, exposure to harmful environmental agents, and impaired access to health care may further exacerbate these skin diseases and lead to serious and occasionally life-threatening situations. As an integral part of the medical care for the homeless, dermatologic care is essential in diagnosing and managing their skin diseases, in preventing more serious complications and in improving the overall health status of the homeless population.

Female↗