Les effets cutanés indésirables des antagonistes du TNF alpha

in Revue Médicale de Liège (2012)

The TNF alpha antagonists, including adalimumab, etanercept and infliximab, represent a class of anti-inflammatory and immunosuppressive drugs. Although cutaneous adverse effects are uncomon, they are ... [more ▼]

The TNF alpha antagonists, including adalimumab, etanercept and infliximab, represent a class of anti-inflammatory and immunosuppressive drugs. Although cutaneous adverse effects are uncomon, they are varied. There is no particular risk profile to develop cutaneous adverse effects. The principal acute side effects are injection site reactions and pruritus. The major long term cutaneous side effects are infectious and inflammatory conditions. Neoplastic skin diseases are exceptional. the association with other immunosuppressive agents can increase the risk of developing cutaneous adverse effects. Some adverse effects, such as lupus erythematosus, require immediate withdrawal of the biological treatment, while in other cases temporary withdrawal is sufficient. The majority of the other cutaneous adverse effects can be dealt without interrupting biologic treatment. Preclinical and clinical investigations revealed that the new biologics, aiming IL12/23, IL23 and IL17, present a similar profile of cutaneous adverse effects, although inflammatory skin reactions may be less often encountered compared to TNF alpha antagonists. [less ▲]

Childhood Herpes Zoster-Triggered Guttate Psoriasis

in Open Dermatology Journal (The) (2012)

Psoriasis is commonly triggered or exacerbated by various stress factors, certain drugs, or streptococcal throat infections. Viral infections such as HIV, CMV, chikungunya, or herpes simplex virus are ... [more ▼]

Psoriasis is commonly triggered or exacerbated by various stress factors, certain drugs, or streptococcal throat infections. Viral infections such as HIV, CMV, chikungunya, or herpes simplex virus are very uncommon triggers for psoriasis. Cases of varicella-triggered psoriasis are exceptional. A 7-year-old boy with a previous history of guttate psoriasis presented with generalized acute guttate psoriasis shortly after an extensive herpes zoster infection affecting the first and second left lumbar dermatomes. INF-alpha and granulocyte monocyte colony stimulating factor influence peripheral monocytes to transform into INF-dendritic cells (DC's), similar to those involved in psoriasis. These INF-DC's express toll-like receptors 7 and 8, which are responsive to viral single stranded RNA. Hence, viral infections and interferon (INF)-alpha may play a role in triggering psoriasis. [less ▲]

Journée mondiale du Psoriasis

in Skin Inc (2011), 14

La journée mondiale du Psoriasis a eu lieu le 29/10/2011, une bonne occasion de rappeler l'importance de considérer le patient psoriasique dans sa globalité, tant sur le plan cutané que physique et ... [more ▼]

La journée mondiale du Psoriasis a eu lieu le 29/10/2011, une bonne occasion de rappeler l'importance de considérer le patient psoriasique dans sa globalité, tant sur le plan cutané que physique et psychique. Une interaction positive entre les différents acteurs comme le dermatologue, le psychologue et le pharmacien, permet une prise en charge efficace et globale du patient psoriasique. C'est sur ces trois axes que la Journée mondiale du Psoriasis s'est focalisée au CHU de Liège, avec l'intervention des services de Dermatologie, de Psychologie médicale et de Pharmacie galénique. [less ▲]

Alitrétinoïne : une nouvelle arme dans l'eczéma chronique des mains

in Skin Inc (2011)

L'eczéma chronique des mains représente une difficulté thérapeutique majeure en dermatologie, et en particulier, quand l'exploration allergologique ne permet pas d'identifier l'agent responsable de l ... [more ▼]

L'eczéma chronique des mains représente une difficulté thérapeutique majeure en dermatologie, et en particulier, quand l'exploration allergologique ne permet pas d'identifier l'agent responsable de l'affection ou que l'éviction de celui-ci est difficile à obtenir pour raisons professionnelles. La première approche thérapeutique consiste en l'application de dermocorticoïdes. Cependant, leur utilisation chronique n'est pas recommandée en raison de leurs effets secondaires tels que l'atrophie cutanée. L'application topique des inhibiteurs de la calcineurine, comme le tacrolimus ou le pimecrolimus peut être envisagée comme traitement complémentaire. La photothérapie par UVB ou par PUVA est un traitement de deuxième ligne. Le méthotrexate et la ciclosporine sont des médicaments à réserver aux cas graves et multirésistants. L'alitrétinoïne, rétinoïde endogène et agoniste des récepteurs aux rétinoïdes, est une nouvelle thérapeutique contre l'eczéma chronique des mains qui ne répond plus aux dermocorticoïdes et est réfractaire aux autres options thérapeutiques. Plusieurs études randomisées, multicentriques et contrôlées contre placebo ont montré l'efficacité et l'innocuité de l'alitrétinoïne dans l'eczéma chronique des mains résistant aux traitements classiques. [less ▲]

A propos de la réticence à l’immunothérapie spécifique chez les personnes allergiques : les nouvelles données de la littérature

in Revue Médicale de Liège (2010)

The increasing number of allergic subjects and the alteration of their quality of life are major concerns of public health. Symptomatic treatments of allergic diseases are not always able to improve the ... [more ▼]

The increasing number of allergic subjects and the alteration of their quality of life are major concerns of public health. Symptomatic treatments of allergic diseases are not always able to improve the patient’s complaints. Allergic exploration aims to identify IgE-dependant mechanisms and subsequently to prove the responsibility of the detected allergen in the allergic disease. The efficacy of the specific immunotherapy (SIT ) using allergens in either subcutaneous or sublingual forms has been proven in rhinitis, conjunctivitis, asthma and IgE-induced reactions to hymenoptera venom. The lack of training in allergology is an important reticence of general practitioners and specialists to prescribe SIT . Furthermore, the duration of the treatment and its important cost in Belgium (where, only venom SIT is reimbursed by the Social Security) interfere significantly with the compliance of the patients. [less ▲]

Congenital infantile digital fibromatosis: a case report and review of the literature

in Rare tumors (2009), 1

Infantile digital fibromatosis (IDF) is a rare benign fibroproliferative tumor of early childhood. IDF preferentially affects the fingers and the toes. Malignant transformation or metastases habe never ... [more ▼]

Infantile digital fibromatosis (IDF) is a rare benign fibroproliferative tumor of early childhood. IDF preferentially affects the fingers and the toes. Malignant transformation or metastases habe never been reported. Surgical treatment has been advocated previously but local recurrences were frequently observed. Recent literature supports clinical surveilllance without any medical or surgical intervention as spontaneous regression usually occurs after two to three years. A six-month-old Caucasian girl with IDF on the left fourth digit is presented here. The tumor progressively increased in size after birth. Topical imiquimod cream and diflucortolone valerate cream, both displaying antifibrotic properties, had no effect on tumor growth. Currently, the lesion size remains stable without any treatment. Early recognition of IDF is important in order to avoid unnecessary surgical intervention that may prove to be potentially aggravating, unless serious functional or cosmetic concerns intervene. Parents should be rassured concerning the benign nature of IDF and be informed that spontaneous involution of IDF might be expected. [less ▲]