Treatment of coexisting bullous pemphigoid and psoriasis with the tumor necrosis factor antagonist etanercept.
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Anti-Inflammatory Agents↗
Biomedical subjects
Nicholas J Lowe
Publications and source records attributed to Nicholas J Lowe.
Cessation of cyclosporine therapy by treatment with etanercept in patients with severe psoriasis.
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Adult↗
Treatment of recurrent Sweet's syndrome with coexisting rheumatoid arthritis with the tumor necrosis factor antagonist etanercept.
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Adult↗
Injectable hyaluronic acid implant for malar and mental enhancement.
BACKGROUND: The use of a thicker injectable implant version of one of the hyaluronic acid dermal fillers (Restylane SubQ, Q-Med, Uppsala, Sweden) is described. OBJECTIVE: A group of treated patients has been studied for more than 1 year. Restylane SubQ was injected to the submuscular plane of the upper cheeks and chin to observe efficacy of augmentation and side effect profile, and further observations were made of the duration of benefit. METHODS: Patient details--72 patients were treated, 68 for upper cheek augmentation, 2 for chin augmentation, and 2 for both areas. Four patients received second injections 8 weeks after the first to increase augmentation. RESULTS: Patients all showed a persistence of benefit during the posttreatment observation period of up to 64 weeks. Four patients had minor side effects that resolved with local treatment and time. Four patients had second injections to complete augmentation without complications. CONCLUSIONS: Restylane SubQ is a useful injectable agent to augment and lift upper cheeks and recontour chins. Further efficacy studies seem justified.
Biocompatible Materials↗
The use of photodynamic therapy in dermatology: results of a consensus conference.
Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.
Aminolevulinic Acid↗
Pilot study to determine the efficacy of ALA-PDT photo-rejuvenation for the treatment of facial ageing.
OBJECTIVE: The study was divided into two parts. The objective of the preliminary study was to evaluate the optimum dose and tolerance of 5-aminolaevulinic acid (5-ALA) compared to a placebo cream with a 633-nm LED light in normal, healthy, volunteer forearm skin. The second study was to establish if ALA-PDT treatments improve the signs of ageing. RESULTS: Threshold photosensitization was observed using 5% 5-ALA under plastic occlusion for 30 minutes following a dose response study of forearm skin. Mild improvement was observed, using this concentration and time, for periorbital skin aging. Other anecdotal positive results of photo-rejuvenation are reported for facial and chest areas.
Aminolevulinic Acid↗
Double-blind, randomized, placebo-controlled, dose-response study of the safety and efficacy of botulinum toxin type A in subjects with crow's feet.
BACKGROUND: Published evidence suggests that botulinum toxin type A (BTX-A) is an effective treatment for crow's feet. However, few dose-ranging studies have been performed. OBJECTIVES: To assess the safety and efficacy of a single treatment with one of four doses of BTX-A (Botox/Vistabel, Allergan Inc) compared with placebo for the improvement of crow's feet. METHODS: Subjects received a single bilateral treatment of 18, 12, 6, or 3 U of BTX-A or placebo injected into the lateral aspect of the orbicularis oculi muscle (parallel-group, double-blind design). Investigators and subjects rated crow's feet severity at maximum smile on day 7 and at 30-day intervals from days 30 to 180. RESULTS: As observed by both investigators and subjects, all doses of BTX-A resulted in improvements in crow's feet severity when compared with placebo. A dose-dependent treatment effect for efficacy was observed, with higher doses having an increased magnitude and duration of effect. However, a clear differentiation between the 18 U and 12 U doses was not apparent. Few adverse events were reported, with no statistically significant differences between BTX-A and placebo in the incidence of subjects experiencing adverse events. CONCLUSION: BTX-A is safe and effective in decreasing the severity of crow's feet, with 12 U per side suggested as the most appropriate dose.
Adult↗
A comparison of two botulinum type a toxin preparations for the treatment of glabellar lines: double-blind, randomized, pilot study.
BACKGROUND: Botulinum toxins have been proven effective for reducing facial lines. There are two commercial types of botulinum toxin type A available in many countries but no published comparison studies. OBJECTIVE: To compare the efficacy and tolerability of Botox Cosmetic and Dysport 50 U in the treatment of glabellar lines (using 20 U of Botox Cosmetic, which is the dose approved by the US Food and Drug Administration for the treatment of glabellar lines, and 50 U of Dysport, which has been reported to be the optimal dose for this formulation). STUDY DESIGN: Parallel-group double-blind pilot study. Evaluation by observing physician, photographic, and patient evaluations. CONCLUSION: Botox 20 U provided better and more prolonged efficacy than Dysport 50 U in the treatment of glabellar lines.
Adult↗
Adverse reactions to dermal fillers: review.
BACKGROUND: For many patients, injectable filling agents offer the promise of facial rejuvenation while offering reduced risks compared with more invasive surgery. With the increase in products available and the rise in the number of patients seeking this type of intervention, it is crucial that both the physician and the patient are fully cognizant of the risks involved with each product. OBJECTIVE: To review the incidences and types of reaction to various commonly used injectable products. METHODS: A literature review and personal experiences (gained largely in Europe over the past 8 years) of dermal fillers from 1996 to the present, including illustrative case reviews. RESULTS: Reactions can be attributed to the procedure itself, the procedural technique, and the agent injected. Some of these reactions are preventable, whereas others are inevitable; most are mild and transient. Improving product formulations, altering the concentration of product injected, or changing the injection technique can dramatically reduce the incidence of adverse reactions. Since its reformulation in mid-1999, the biologically engineered hyaluronic acid filler Restylane (Medicis Pharmaceuticals, Scottsdale, AZ, USA) elicits less than one allergic reaction in 1600 treatments. Skin reactions with poly-L-lactic acid (New-Fill/Sculptra, Dermik Laboratories, Berwyn, PA, USA) are considerably less likely if a greater dilution and deeper injection technique are employed. CONCLUSION: Different injectable products have highly divergent properties, associated risks, and injection requirements. The dermasurgeon should be suitably experienced to select and use these products correctly.
Acrylates↗
Laser and novel light source treatments for psoriasis.
BACKGROUND AND OBJECTIVES: There are many treatment modalities for psoriasis including topical therapy, ultraviolet light therapy, systemic agents, and more recently the advent of the biologic agents. STUDY DESIGN/MATERIALS AND METHODS: In addition, selective treatment using lasers and light sources that target the individual psoriatic plaques have also been employed. RESULTS/CONCLUSION: This article will highlight and review the employment of laser-assisted devices in the treatment of plaque psoriasis.
Humans↗
The treatment of psoriasis and psoriatic arthritis with etanercept: practical considerations on monotherapy, combination therapy, and safety.
It is quite evident the pathogenesis of psoriasis is modulated by immune-mediated mechanisms that invoke activated T cells and inflammatory cytokines, such as tumor necrosis factor-alpha. Current immunosuppressive systemic treatments may be effective in controlling psoriasis to a certain degree but have significant drawbacks, such as toxicity and relapse of the disease on discontinuation. The advantages of biologic agents are their greater selectivity in targeting specific pathways in the inflammatory cascade of psoriasis with a much higher safety profile. With specific antagonism directed against tumor necrosis factor-alpha, etanercept has demonstrated remarkable efficacy in the treatment of psoriasis and psoriatic arthritis.
Adolescent↗
Recognition, diagnosis, and treatment of primary focal hyperhidrosis.
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Adolescent↗
Effect of a single course of isotretinoin therapy on bone mineral density in adolescent patients with severe, recalcitrant, nodular acne.
BACKGROUND: Adverse changes in bone have been reported for patients undergoing high-dose, long-term (several years) isotretinoin therapy for disorders of cornification. The effect of short-term (4-5 months) therapy at the lower dose recommended for acne on bone development in younger, growing adolescent (12-17 years) patients has not been well studied. OBJECTIVE: The purpose of the study was to evaluate the effect of a standard, single course of isotretinoin (Accutane) therapy on bone mineral density (BMD) of the lumbar spine and hip in adolescents ages 12 to 17 years with severe, recalcitrant, nodular acne. METHODS: In this open-label, multicenter study, 217 adolescents (81 girls) with severe, recalcitrant, nodular acne were enrolled and treated with isotretinoin twice daily with food at the recommended total dose of approximately 1 mg/kg for 16 to 20 weeks. BMD in the lumbar spine and hip was measured at baseline and at the end of therapy by dual energy radiograph absorptiometry. RESULTS: There was no clinically significant mean change in BMD measured at the lumbar spine (+1.4%, range: -4.9% to +12.3%) or total hip (-0.26%, range: -11.3% to +15.0%). Hyperostosis was not observed in any patient. Typical efficacy expected in the treatment of acne was observed. CONCLUSIONS: A 16- to 20-week course of isotretinoin treatment at the recommended dose for severe acne has no clinically significant effect on lumbar spine and total hip BMD in the adolescent (12-17 years) population.
Acne Vulgaris↗
Retinoid therapy for psoriasis.
This article focuses on the treatment of psoriasis with acitretin, the only systemic retinoid approved for psoriasis, and also briefly discusses its predecessor, etretinate, which was replaced by acitretin in 1997 and is no longer available. The use of topical tazarotene is also discussed in detail. Combination therapy of retinoids, both topical and systemic,with phototherapy and other therapeutic agents is described. In addition, new retinoid analogues that are undergoing clinical investigation are mentioned. Finally, potential toxicities and adverse effects associated with retinoids are discussed.
Administration, Oral↗
Botulinum toxin type A gives adjunctive benefit to periorbital laser resurfacing.
OBJECTIVE: Periorbital aging and lines are a result of intrinsic skin aging, ultraviolet damage, and repetitive action of periorbital muscles. Rejuvenation of this area should therefore be optimized by combining treatments that approach the different causative factors. METHODS: This was a single-center, prospective, randomized, placebo-controlled study comparing the efficacy and safety of combining Botox injections (18 units per area) with ablative laser resurfacing versus laser resurfacing alone without Botox in the treatment of periorbital rhytids. RESULTS: We have concluded a bilateral study comparing the effects of Botox versus saline placebo injections to the periorbital areas before and following erbium: YAG laser resurfacing of the areas in 33 patients. The results demonstrated that the Botox-treated side with laser resurfacing improved significantly more than the contralateral area treated with saline and laser in diminishing periorbital rhytids as well as textural, pigmentation, and other features of periorbital skin aging. CONCLUSION: This study illustrates the benefits of a combined approach to treating periorbital skin aging.
Botulinum Toxins, Type A↗
Current systemic therapies for psoriasis: where are we now?
Many systemic agents are used in the treatment of psoriasis. They provide good control of psoriasis in the majority of patients and have improved their life quality indices. Frequently, combination therapy is utilized to synergize the efficacy of these medications. Many dermatologists are hesitant in prescribing systemic agents because of their adverse effects. However, such potential toxicities arising from these medications can largely be avoided if proper patient selection and close monitoring are performed.
Acitretin↗
Botulinum toxin type A in the treatment of bilateral primary axillary hyperhidrosis: efficacy and duration with repeated treatments.
BACKGROUND: Botulinum toxin type A (BTX-A) has been shown to be effective for the temporary reduction of local hyperhidrosis. OBJECTIVE: To investigate the duration of efficacy of BTX-A with repeat treatments for axillary hyperhidrosis. METHODS: Patients who completed a prior randomized, controlled, parallel-group study comparing BTX-A with vehicle for bilateral primary axillary hyperhidrosis were eligible for this 18-month, open-label, noncomparative, follow-up study. Patients had to request further treatment, fulfill the preceding study inclusion/exclusion criteria, and have spontaneous sweat production that was more than 50% of the baseline value of the previous study. Patients received up to four treatments of intradermal BTX-A (2 mL, 50 U). All of the 12 patients who were enrolled completed the study. Two of the 12 patients (17%) were previously treated with placebo. RESULTS: In the 18 months of study and follow-up, five patients (42%) required a total of two active injections. Three patients (25%) required a total of three active injections, and four patients (33%) required a total of four active injections. The response rate was 83% (10 of 12) at 4 weeks after the first treatment. The mean percentage change from baseline in overall sweat production was approximately 80% at Week 4. The mean time between the first and second treatment in this study was just over 29 weeks, with a range of 17.8 to 57.5 weeks. CONCLUSION: BTX-A is an effective repeat treatment for axillary hyperhidrosis giving variable but clinically helpful remission. No clinically relevant changes in vital signs or safety parameters were noted.
Adult↗
Tazarotene cream in the treatment of psoriasis: Two multicenter, double-blind, randomized, vehicle-controlled studies of the safety and efficacy of tazarotene creams 0.05% and 0.1% applied once daily for 12 weeks.
BACKGROUND: Tazarotene in a gel formulation is widely used in the treatment of psoriasis. OBJECTIVE: To determine the efficacy and safety of tazarotene 0.1% and 0.05% creams in the treatment of psoriasis. METHODS: A total of 1303 patients participated in 2 clinical trials. Patients applied tazarotene creams 0.1% and 0.05% or vehicle once daily to all psoriatic lesions for 12 weeks followed by a 12-week posttreatment period. RESULTS: Both creams were significantly more effective than vehicle on the basis of an overall assessment of psoriasis, a global response to treatment, and reduction in plaque elevation and scaling. Therapeutic effect was maintained during the posttreatment period. Common adverse events included signs and symptoms of skin irritation. CONCLUSION: Tazarotene creams were associated with significant reductions in the severity of the clinical signs of psoriasis and were found to be safe with acceptable tolerability. Tazarotene cream 0.1% was generally more effective, although slightly less well tolerated, than the 0.05% cream.
Administration, Topical↗