clinical considerations on the use of alitretinoin
TRANSCRIPT
P6699Allergic contact dermatitis: Clinicopathologic correlation of the expres-sion of interleukin-17 and neutrophil elastase at 48 hours of exposure toallergens
Francisco Manuel Almaz�an-Fern�andez, Hospital General de Baza, Baza, Spain; AnaClara Abad�ıa Molina, Centro de Investigaci�on Biom�edica, CIBM, Universidad deGranada, Granada, Spain
Background: The IL-17, involved in allergic processes, plays a key role in allergiccontact dermatitis, being very important in inflammation and apoptosis of kerati-nocytes. It also functions as a chemoattractant for various cells such as macro-phages, which infiltration is necessary after contact with the allergen.
Objective: To establish clinical pathologic correlation between different clinicalmanifestations and different allergens in the same exposure time, 48 hours, inrelation to the expression of IL-17 and neutrophil elastase.
Methods: Detection of patients with clinical suspicion of allergic contact dermatitis.Patch testing with positivity in 48 hours. Punch biopsy positive areas aftergraduation clinic. Immunohistochemical study with Ab anti-IL-17 and Ab anti-neutrophil-elastase, and ranking of the infiltrate.
Results: The presence of IL-17 cells in tissue is directly related to the degree ofclinical expression in patients with CAD. The time is not the major determinant ofthe infiltrate because may be more or less infiltrated at the same time even in thesame patient to different allergens, or different patient to different allergens,resulting in variable clinical expressions. There is a clinical-pathological correlationbetween the increased presence of neutrophil elastase, the increased presence of IL-17 and increased clinical expression and vice versa.
Conclusion: There is more infiltration of IL-17 in biopsies of higher clinicalexpression. The presence of IL-17 in tissue is not directly or exclusively dependenton exposure time. The presence of neutrophil elastase in tissue correlates with thepresence of IL-17 and the clinical severity.
AB80
cial support: None identified.
CommerP6424Clinical considerations on the use of alitretinoin
Antonio Carpentieri, Antonio Carpentieri, Taranto, Italy; Francesco Loconsole,Francesco Loconsole, Bari, Italy; Rosalba Buquicchio, Rosalba Buquicchio, Bari,Italy
Since March 2012 the dermatologic Clinic of Policlinico in Bari (Italy) began aselection of patients (of both sexes, excluded the pediatric people only) to betreated with alitretinoin (9-cis-retinoic acid) for severe chronic hand eczemarefractory to powerful topical corticosteroids. Such pathology compromises theprofessional efficiency of manual work and the emotional and relational aspect ofthe patients’ life. A significant number of patients presents comorbidity, evendermatologic, treated with specific pharmacologic therapies and hand eczematousonychopathy. Our target is to evaluate: (1) possible interactions of alitretinoin withother drugs taken by selected patients; (2) pharmacologic results of alitretinoin onchronic hand eczema, onychopathy included; (3) patient life quality during and afteralitretinoin therapy; (4) alitretinoin potential effects on the comorbidity whichaffect the selected patients; (5) occurrence of possible adverse reactions, evenunexpected, in patients treated with alitretinoin; (6) temporary or definitivepossible remedies to adverse reactions; (7) patient compliance during therapywith alitretinoin.
cial support: None identified.
CommerJ AM ACAD DERMATOL
P5940Comparative efficacy and safety of azathioprine versus methotrexate assteroid-sparing agent in the treatment of airborne contact dermatitiscaused by parthenium
Dipankar De, MD, Postgraduate Institute of Medical Education and Research,Chandigarh, India; Rishu Sarangal, MD, Postgraduate Institute of MedicalEducation and Research, Chandigarh, India; Sanjeev Handa, MD, PostgraduateInstitute of Medical Education and Research, Chandigarh, India
Background: Airborne contact dermatitis (ABCD) caused by the weed Partheniumhysterophorus is quite rampant all over India, and is often a cause of misery to poorfarming community. Management of this chronic ailment is a challenge. Because ofubiquitousness of the weed, getting rid of it is difficult. Corticosteroids haveremained the mainstay of treatment of ABCD. Like most other chronic dermatiticprocesses, finding an effective, safe, and cheap adjuvant to steroids is the need of thehour to reduce oral steroid requirement.
Aim: To study the comparative efficacy and safety of azathioprine versus metho-trexate as steroid-sparing agent in the treatment of extensive airborne contactdermatitis secondary to parthenium.
Methods: Thirty patients of airborne contact dermatitis, suspected to be sensitive toparthenium and later confirmed on patch testing, with cutaneous severity score(CSS)[30, were randomly assigned to 2 groups. Initial treatment in group A wasazathioprine 100 mg daily along with oral prednsiolone and that for group B wasmethotrexate 15 mg/week along with oral prednisolone. Prednisolone was initiatedin both the groups at the dose of 0.75 mg/kg/day and the dose was decreased by 10mg every 2 weeks once [75% reduction in CSS was achieved. In case ofexacerbation the prevailing dose of prednisolone was increased by 10 mg andthen tapered slowly. Antihistamines and emollients were used as andwhen required.The patients were evaluated fortnightly for first 2 months and then monthly for 4months, for improvement in CSS and side effects if any. The time taken for[75%reduction in CSS and the mean dose of oral corticosteroids in 6 months of studyperiod was calculated in both the groups and compared.
Results: The mean cutaneous severity score in group A was 60.3 and in group B,it was 58.45. The mean time taken for [75% reduction in CSS was 9.5 weeks ingroup A and 5.6 weeks in group B. This difference was statistically significant(P ¼ .001). The mean total cumulative requirement of oral prednisolone in groupA and group B was 1329 mg and 1202 mg respectively and this was statisticallynonsignificant (P ¼ .13). Incidence of side effects in both groups wascomparable.
Conclusion: Both azathioprine and methotrexate are effective and safe in conjunc-tion with prednisolone in the treatment of ABCD secondary to parthenium.Methotrexate may be a better alternative as it induces early achievement of[75%reduction in cutaneous severity score and is cheaper.
cial support: None identified.
CommerP6135Comparison of therapeutic effectiveness of weekly azathioprine pulse anddaily azathioprine in treatment of parthenium dermatitis
Kaushal Verma, MD, All India Institute of Medical Sciences, New Delhi, India; G.Sethuraman, MD, All India Institute of Medical Sciences, New Delhi, India;Pradeep Kumar, MBBS, All India Institute of Medical Sciences, New Delhi, India
Parthenium dermatitis caused by weed Parthenium hysterophorus is thecommonest cause of airborne contact dermatitis in India. Corticosteriods arethe mainstay of treatment, however they may cause serious side effects onprolong use. Azathioprine used as daily doses has been shown to be effective andsafe in treatment of parthenium dermatitis. Weekly azathioprine pulse (WAP) hasalso been found to be effective in this disease, but there are no reportscomparing effectiveness and safety of weekly pulse doses of azathioprine withdaily azathioprine in this condition. In this study we compared the therapeuticeffectiveness and adverse effects of weekly azathioprine pulse with dailyazathioprine in patients of parthenium dermatitis. Sixty patch test confirmedpatients of airborne contact dermatitis to P hysterophorus were randomlyassigned to treatment with azathioprine 300 mg pulse dose once a week (groupA) or azathioprine 100 mg daily (group B), orally for 6 months in a blindedmanner. The patients were evaluated every month for 6 months to determine theresponse to treatment and side effects. The response to treatment was assessedby change in clinical severity score of the dermatitis and healing of the lesions.The patients were then further followed up for another 6 months to determineany relapse. The study was supported by the Indian Council of Medical Research.There were 32 patients in group A and 28 in group B, of which 25 patients ingroup A and 22 in group B completed the study. Fifteen (60%) patients in groupA and 16 (73%) patients in group B had excellent response (complete remission)to treatment and 8 (32%) patients in group A and 5 (23%) patients in group B hadgood response. The mean pretreatment clinical severity score decreased from26.37 6 14.47 to 4.68 6 5.09 in group A, while it decreased from 36.10 6 18.06to 5.67 6 5.97 in group B. Response to treatment in both the groups wasstatistically highly significant and comparable (P ¼ .366). Patients in group A,however, had more adverse effects (nausea/vomiting; Fisher exact test; P ¼ .02).Four and 2 patients relapsed respectively in group A and B during theposttreatment follow-up (P ¼ .654). Azathioprine used as 300 mg weekly pulsedoses appears to be as effective as 100 mg daily azathioprine in the treatment ofparthenium dermatitis. However, nausea/vomiting were more frequent with WAPtherapy. Further studies are needed to confirm our results.
cial support: None identified.
CommerAPRIL 2013