Clinics in dermatology
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Clinics in dermatology · Jan 2010
ReviewA new era in the management of psoriasis? The biologics: facts and controversies.
During the last 30 years, the tremendous progress in our knowledge of the pathogenesis of psoriasis has led to the development of new agents, the so-called biologics, that have revolutionized the management of severe psoriasis. Dermatologists and patients see this emerging therapy as a new perspective in the state of the art in managing moderate to severe psoriasis. After a few years of use in daily practice, we may begin to analyze the power of the currently available biologic agents in the management of severe psoriasis from the perspective of facts.
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Clinics in dermatology · Jul 2009
Sentinel lymph node biopsy and completion lymph node dissection for malignant melanoma are not standard of care.
Malignant melanoma is a cutaneous malignancy characterized by high metastatic potential and an unpredictable course. Enormous amounts of research have been done into surgical and adjunctive therapies for melanoma. Given the regularity with which sentinel lymph node biopsy and completion lymph node dissection are performed at private and academic hospitals, it would seem that evidence supporting these procedures is not controversial. A growing body of studies, however, points to sentinel lymph node biopsy and completion lymph node dissection as ineffective treatment for malignant melanoma and necessitates a discussion of what constitutes standard of care.
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Clinics in dermatology · Sep 2008
ReviewPsoriasis treatment in difficult locations: scalp, nails, and intertriginous areas.
Psoriasis comprises a broad spectrum of different clinical courses among which the chronic stable psoriasis by far occurs most frequently. The clinical presentation ranges from mild disease to more serious forms involving large areas of skin and/or joint disease. A number of modifying factors may impact on treatment choice in individual cases (eg, location of the lesions, disease phase, treatment history, response to previous treatments, comorbidity). ⋯ Finally, the usefulness of corticosteroids, vitamin D and analogues, and calcineurin inhibitors in treating intertriginous psoriasis clearly is demonstrated. Especially the use of calcineurin inhibitors exhibits efficacy in intertriginous regions and therefore may be seen as a promising treatment option in the future. Besides the important innovations in the last years, there is a need for new effective and well-tolerated treatment modalities, especially for long-term use in the 3 difficult-to-treat locations, which encompass cosmetic acceptability.
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The immunopathogenesis of sarcoidosis has been difficult to charaterize given the heterogeneity of disease, the elusiveness of the causative antigen, and the lack of an adequate animal model. However, by examining well-defined clinical cohorts, the interplay between genetic predisposition and immunologic response has been increasingly informative. Technological advances in cellular analysis have allowed researchers to characterize the immune responses important in the maintenance of granulomatous inflammation. Finally, "new" clinical observations such as granuloma responsiveness to targeted biological therapies, sarcoid developing during immune restoration, and the relationship between sarcoidosis and Hepatitis C will provide future insight to the immunopathogenesis of sarcoidosis.