Cutis
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Review
Biologic therapy for psoriasis: the tumor necrosis factor inhibitors infliximab and etanercept.
During the past several years, one of the major focuses in psoriasis research has been the development of novel biologic therapies for this disease. The aim of these therapies is to provide selective, immunologically directed intervention, with the hope that such specificity will result in fewer side effects than traditional therapies. ⋯ The structure and mechanism of each drug will be reviewed, as well as the most recent clinical experience and safety data. The first article of this review will focus on the therapies that inhibit tumor necrosis factor alpha (TNF-alpha).
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The most frequently used systemic treatments for severe psoriasis are methotrexate (MTX), oral retinoids, and cyclosporine; however, all of these agents are associated with dose-related toxicities that limit their use. The safety and efficacy of topical calcipotriene for the treatment of psoriasis have been demonstrated in numerous clinical studies. The rationale for using calcipotriene in combination with systemic therapies is based on their different modes of action and nonoverlapping side effects. Three controlled clinical trials have demonstrated that the addition of calcipotriene ointment to systemic antipsoriatic treatment with MTX, acitretin, and cyclosporine increases the therapeutic efficacy compared with systemic therapy alone and minimizes side effects by either reducing the dosage or duration of treatment.
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Cutis laxa is an uncommon condition characterized by loose and redundant skin. Biopsy results are positive for a reduction in or an absence of elastic fibers in the dermis. Cutis laxa is acquired or congenital. ⋯ Cardiovascular, pulmonary, gastrointestinal, and urologic complications may occur. In the past, cutis laxa was associated with plasma cell dyscrasia. We report on a characteristic cause of cutis laxa to alert clinicians to this uncommon manifestation of multiple myeloma.
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We review the current therapy for cutaneous malignant melanoma. Early surgical resection offers the best likelihood of cure. The initial staging of melanoma patients determines subsequent therapeutic decisions and follow-up care. ⋯ We review the controversy over lymph node dissection, and recent recommendations for the use of lymphoscintigraphy. Interferon-alpha continues to be the only Food and Drug Administration-approved adjuvant therapy for high-risk patients. In addition, the follow-up care of melanoma patients will be discussed.