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Georgala S, Katoulis AC, Kanelleas A, Befon A, Georgala C. Letter: Human papilloma virus and molluscum contagiosum lesions related to infliximab therapy for psoriasis: a case series. Dermatol Online J 2012; 18:9. [PMID: 22559024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Biological therapy for psoriasis exerts its action via an immunomodulatory and eventually immunosuppressive mode. Immunosuppression is linked to HPV flares. Our purpose is to investigate a possible relationship between infliximab therapy for psoriasis and human papilloma virus and molluscum (HPV/MC) infections. METHODS We report a case series of three patients with psoriasis on infliximab, who developed HPV/MC lesions following their treatment. RESULTS Our patients developed HPV/MC lesions within a few months after the initiation of infliximab infusions for psoriasis. DISCUSSION Immunosuppresion is related to HPV/MC flares. Biological therapy and in particular infliximab treatment acts by immunomodulation and eventually a degree of immunosuppression. CONCLUSIONS Anti-TNF treatment could be associated with HPV and/or MC flares. For this reason, we suggest the consideration of obtaining a routine cervical PAP smear before the commencement and during treatment with anti-TNF agents for psoriasis.
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Georgala S, Katoulis AC, Kanelleas A, Befon A, Georgala C. Human papilloma virus and molluscum contagiosum lesions related to infliximab therapy for psoriasis: A case series. Dermatol Online J 2012. [DOI: 10.5070/d37g14415n] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Kanelleas A, Liapi C, Katoulis A, Stavropoulos P, Avgerinou G, Georgala S, Economopoulos T, Stavrianeas NG, Katsambas A. The role of inflammatory markers in assessing disease severity and response to treatment in patients with psoriasis treated with etanercept. Clin Exp Dermatol 2011; 36:845-50. [PMID: 21790728 DOI: 10.1111/j.1365-2230.2011.04131.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Psoriasis is a chronic, systemic, inflammatory disease. Inflammatory markers are used in clinical practice to detect acute inflammation, and as markers of treatment response. Etanercept blocks tumour necrosis factor (TNF)-α, which plays a central role in the psoriatic inflammation process. AIM To reveal any possible association between disease severity [measured by Psoriasis Area and Severity Index (PASI)] and the inflammatory burden (measured by a group of inflammatory markers), before and after etanercept treatment. METHODS In total, 41 patients with psoriasis vulgaris, eligible for biological treatment with etanercept, were enrolled in the study. A set of inflammatory markers was measured, including levels of white blood cells and neutrophils, fibrinogen, ferritin, high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), haptoglobin, ceruloplasmin and α1-antitrypsin, before and after 12 weeks of etanercept 50 mg twice weekly. RESULTS All markers were reduced after treatment (P < 0.001). PASI correlated with fibrinogen and hs-CRP. Of the 41 patients, 19 (46.3%) achieved reduction of 75% in PASI (PASI75). An increase in hs-CRP and ESR difference (values before minus values after treatment) was related to higher likelihood of achieving PASI75. CONCLUSIONS Inflammatory markers, particularly hs-CRP and to a lesser extent, fibrinogen and ESR, can be used to assist in assessing disease severity and response to treatment in patients with psoriasis. A combination of selected inflammatory factors (which we term the Index of Psoriasis Inflammation) in combination with PASI might reflect inflammatory status in psoriasis more accurately than each one separately.
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Affiliation(s)
- A Kanelleas
- Second Department of Dermatology and Venereology, Attikon University General Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece.
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Moustou AE, Stratigos AJ, Vergou T, Gregoriou S, Georgala S, Danopoulou I. Arthralgia as an adverse event to infliximab: a reactive arthritis or triggering of psoriatic arthritis? Successful management by switching to etanercept. J Eur Acad Dermatol Venereol 2009; 23:968-9. [DOI: 10.1111/j.1468-3083.2008.03075.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Katoulis A, Alevizou A, Bozi E, Georgala S, Mistidou M, Kalogeromitros D, Stavrianeas N. Biologic Agents and Alopecia Areata. Dermatology 2008; 218:184-5. [DOI: 10.1159/000174826] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Georgala S, Georgala C, Nicolaidou E. Pyoderma Gangrenosum of the Penis: A Potentially Dramatic Skin Disease. Urology 2008; 72:1185.e9-10. [DOI: 10.1016/j.urology.2008.01.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Revised: 01/05/2008] [Accepted: 01/15/2008] [Indexed: 11/26/2022]
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Georgala S, Gregoriou S, Georgala C, Papaioannou D, Befon A, Kalogeromitros D, Rigopoulos D. Pimecrolimus 1% Cream in Non-Specific Inflammatory Recurrent Balanitis. Dermatology 2007; 215:209-12. [PMID: 17823517 DOI: 10.1159/000106578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Accepted: 03/27/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-specific balanitis is a common inflammatory dermatosis with frequent relapses and considerable impact on male sexual life. OBJECTIVE To evaluate the efficacy and safety of pimecrolimus 1% cream in recurrent non-specific balanitis. METHODS Twenty-six patients with recurrent flares of non-specific balanitis were randomly assigned to 1 group applying pimecrolimus cream 1% and 1 group applying placebo on the glans twice daily for 7 days. The patients were assessed on day 14. They were instructed to continue applying the agent whenever symptoms initialized for the following 90 days and take account of the cumulative days with symptoms. RESULTS Seven out of the 11 (63.6%) patients in the pimecrolimus group and 1 out of 11 (9%) in the control group were free of all symptoms and lesions after 14 days, 3 (27.3%) in both groups reported improvement, while 1 (9.1%) in the pimecrolimus and 7 (63.6%) in the control group remained unaffected. (chi(2) = 9.0, d.f. = 2, p = 0.011). Days with symptoms during the 90-day follow-up period were 7.50 +/- 3.02 for the pimecrolimus and 17.62 +/- 4.40 for the control group (p = 0.000064). CONCLUSIONS Pimecrolimus 1% cream is promising in relieving symptoms and signs of non-specific balanitis during flares and controlling the disease during long-term follow-up.
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Affiliation(s)
- S Georgala
- Department of Dermatology, A. Sygros Hospital, University of Athens, Athens, Greece
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Rigopoulos D, Gregoriou S, Ifandi A, Efstathiou G, Georgala S, Chalkias J, Katsambas A. Coping with acne: beliefs and perceptions in a sample of secondary school Greek pupils. J Eur Acad Dermatol Venereol 2007; 21:806-10. [PMID: 17567312 DOI: 10.1111/j.1468-3083.2006.02091.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Information on the understanding of acne in adolescents has only occasionally been reported in the medical literature. OBJECTIVE To evaluate the perceptions of Greek high school students regarding acne causation, exacerbating factors, sources of information, and effect on their daily life and school performance. PATIENTS AND METHODS Three-hundred and forty-seven students (aged 13-18) of four Athenian high schools completed a self-reported questionnaire. RESULTS Self-reported acne was present in 59.2% (187/316). Popular sources of information were parents (31.6%), dermatologists (26.7%), magazines and television (17.5%), pharmacists (16.2%), friends (5.3%), beauticians (1.6%) and other doctors (1.1%). Fifty-two per cent considered the information received as inadequate. Reported causal or exacerbating acne factors included: diet (62.3%), hormones (55.1%), poor hygiene (42.4%), stress (31.9%), infection (14.9%) and genetics (5.7%). Reported ameliorating factors included frequent washing (80.7%), sunbathing (38.6%) and adequate hours of sleep (32%). These notions did not differ among pupils with and without acne or among pupils receiving information from different sources (P < 0.05 in all comparisons). Smoking habits, school performance, hours of sleep, sleep disturbances and self-assessment of stress status were not statistically significantly different between pupils with and without acne. Among pupils with acne 48.6% believed that acne was compromising interpersonal relations while 64.4% believed that acne was compromising their self-image. Fifteen per cent of adolescents reported pruritus associated with their acne lesions. CONCLUSION Beliefs of Greek adolescents about acne were shown to be similar to those of pupils in other developed countries.
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Affiliation(s)
- D Rigopoulos
- University of Athens, Department of Dermatology, A Sygros Hospital, Athens, Greece.
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Katoulis AC, Stavrianeas NG, Panayiotides JG, Bozi E, Vamvasakis E, Kalogeromitros D, Georgala S. Poikiloderma of Civatte: A Histopathological and Ultrastructural Study. Dermatology 2007; 214:177-82. [PMID: 17341870 DOI: 10.1159/000098580] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Accepted: 09/04/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poikiloderma of the face and neck (Civatte) has not been studied in depth for decades, especially as far as the histopathology is concerned. MATERIAL AND METHODS We studied 50 consecutive patients with poikiloderma of Civatte (PC). Their evaluation included: history, physical examination, lesional skin biopsy and histological examination of sections stained with hematoxylin-eosin, PAS, Fontana-Masson, acid orcein Giemsa for elastic fibers and toluidine blue for mast cells. In 10 randomly selected subjects, a second skin biopsy was performed and specimens were examined under the electron microscope. RESULTS There were 34 females (68%) and 16 males. The mean age at diagnosis was 47.8 years for females and 61.7 years for males. Histological examination revealed an atrophic (62%), flattened (84%) epidermis with hyperkeratosis (92%) and occasional follicular plugging (34%). In some cases, mild hydropic degeneration of the basal cell layer was evident (46%). Melanin was irregularly distributed in the lower epidermis (94%), and melanophages were often present in the dermis (92%). The most prominent and constant feature (100%) was solar elastosis of the papillary dermis. The blood vessels were almost invariably dilated (96%) with a mild perivascular lymphohistiocytic infiltrate (78%), sometimes with plasmacytes (56%). At the ultrastructural level, the epidermis showed only minor changes. The dermoepidermal junction was intact. The most constant findings were swelling and disruption of the collagen fibers as well as focal degeneration of the collagen bundles. Occasionally, several vacuolar spaces were found just under the basal lamina. Melanin-laden macrophages scattered in the dermis were also detected. CONCLUSIONS PC shows distinct histological and ultrastructural features, supporting the theory that it represents a separate entity. The histology of PC is characteristic but not pathognomonic. On this basis, the differential diagnosis from Riehl's melanosis, poikiloderma atrophicans et vasculare and other acquired poikilodermas can be made. Ultrastructural findings were consistent with the histological findings. Changes of the dermal connective tissue (solar elastosis) predominated, providing morphological evidence for the role of ultraviolet radiation in the pathogenesis of PC.
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Affiliation(s)
- A C Katoulis
- 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Athens, Greece.
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Georgala S, Katoulis AC, Befon A, Georgala C, Rigopoulos D. Oral inosiplex in the treatment of cervical condylomata acuminata: a randomised placebo-controlled trial. BJOG 2006; 113:1088-91. [PMID: 16956341 DOI: 10.1111/j.1471-0528.2006.01041.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Conventional therapies for human papillomavirus infection aim to remove clinically apparent lesions, while latent infection may remain, representing a threat for transmission and carcinogenesis. The use of a systemic agent may more effectively control the virus. We conducted a randomised placebo-controlled study to investigate the efficacy and safety of oral inociplex in the treatment of cervical condylomata acuminata (CA) that had been resistant to conventional therapies. Thirty-eight white European women, aged 20-43 years, with genital warts of the cervix, refractory to at least one conventional therapy, were randomly assigned to receive either inosiplex, 50 mg/kg daily peros for 12 weeks (group 1), or placebo (group 2). Of the 17 evaluable group 1 women, 4 responded to the treatment completely, 7 responded partially and 6 did not respond. Of the 19 group 2 women, none responded to the treatment completely, 3 responded partially and 16 did not respond. The therapeutic difference between women receiving active and placebo therapy was statistically significant (chi(2)= 6.69, P < 0.01) and remained significant when an intention-to-treat analysis was performed (chi(2)= 7.69, P < 0.01). None of the complete responders experienced recurrence during the 12-month follow up. Adverse effects were mild and resolved upon completion of therapy. Compared with placebo, inosiplex showed considerable efficacy with insignificant and reversible adverse effects and without recurrences. Inosiplex may represent an efficacious and safe alternative systemic form of therapy for cervical genital warts.
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Affiliation(s)
- S Georgala
- First Department of Dermatology and Venereology, 'A. Sygros' Hospital, Athens, Greece.
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Rigopoulos D, Gregoriou S, Charissi C, Kontochristopoulos G, Kalogeromitros D, Georgala S. Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study. Br J Dermatol 2006; 155:152-5. [PMID: 16792767 DOI: 10.1111/j.1365-2133.2006.07181.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pityriasis alba (PA) is a frequent reason for dermatological consultation because of its chronic course, tendency to relapse and aesthetic impact. OBJECTIVES In view of its strong association with atopic dermatitis, the objective of this open-label study was to assess the efficacy and safety of tacrolimus ointment in the treatment of PA compared with the efficacy of moisturizers. PATIENTS/METHODS The study population consisted of 60 individuals of phototype III or IV according to Fitzpatrick's classification, aged 6-21 years. Patients were randomly assigned to one of two groups. Subjects in group A were instructed to apply tacrolimus ointment 0.1% twice daily, 12 h apart, on all hypopigmented macules. Standard moisturizers with SPF 20 sunscreen were used on all lesions applied at least 30 min apart from the tacrolimus ointment. Subjects in group B used solely the same moisturizers with sunscreen. Hypopigmented areas were evaluated at baseline and weeks 0, 3, 6 and 9 by investigators for scaling, hypopigmentation and pruritus on a scale of 0-3. Patient satisfaction was also recorded on a scale of 0-3. All adverse effects were recorded. RESULTS A statistically significant improvement through time, in hypopigmentation, pruritus and scaling was observed in both groups during the course of 9 weeks. Hypopigmentation resolved from a baseline score of 2.38+/-0.64 to 1.15+/-0.54 at week 3, 0.46+/-0.51 at week 6 and 0.00+/-0.00 at week 9 for the group applying tacrolimus ointment 0.1%. The difference in improvement between the two groups was statistically significant on all three assessments for hypopigmentation (P<0.001), and for pruritus on week 6 and 9 assessments (P<0.05). Three patients (11.5%) in the tacrolimus group reported a mild transient sensation of burning. All patients in the tacrolimus group reported they were completely satisfied or just satisfied with the treatment compared with only 50% of patients using the placebo. CONCLUSIONS Tacrolimus ointment 0.1% appears to be an effective and safe treatment for PA.
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Affiliation(s)
- D Rigopoulos
- Department of Dermatology, Andreas Sygros Hospital, University of Athens, 5 Ionos Dragoumi Str, 16121 Athens, Greece.
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Stavropoulos PG, Boubouka DC, Anyfantakis NV, Panagiotopoulos KA, Kostakis GP, Georgala S, Katsambas AD. Cutaneous small vessel vasculitis and pulmonary tuberculosis: an unusual association. Int J Dermatol 2006; 45:996-8. [PMID: 16911400 DOI: 10.1111/j.1365-4632.2006.02733.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Katoulis AC, Stavrianeas NG, Georgala S, Bozi E, Kalogeromitros D, Koumantaki E, Katsambas AD. Poikiloderma of Civatte: a clinical and epidemiological study. J Eur Acad Dermatol Venereol 2005; 19:444-8. [PMID: 15987290 DOI: 10.1111/j.1468-3083.2005.01213.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although a common dermatosis, idiopathic poikiloderma of the face and neck has not been studied in depth for decades. OBJECTIVES To reassess the clinical and epidemiological characteristics of poikiloderma of Civatte (PC). MATERIAL AND METHODS Fifty consecutive patients with PC. Evaluation included history taking and physical examination. Epidemiological and clinical parameters were recorded and analysed. The literature from 1923 until today, was reviewed thoroughly. RESULTS The frequency of PC among dermatologic patients was estimated to be 1.4%. There were 34 females (68%) and 16 males in the present study. The mean age at diagnosis was 47.8 years for females and 61.7 years for males. The majority (88%) had skin phototype II or III. Among females, 26 were at their peri-menopausal stage, including three cases of iatrogenic menopause. Four patients reported that other blood-related family members also had PC. The v and the sides of the neck and the upper chest were most often affected in a symmetric distribution. The face (preauricular and parotid region) was involved in 19 patients (38%). The erythemato-telangiectatic clinical type predominated (58%), followed by the mixed (22%) and the pigmented type (20%). Almost half of the patients (46%) were symptomatic (itching, burning and 'flushing'). The mean duration from onset to diagnosis was 6.2 years according to the patients' report. The course was usually slowly progressive (82%) and irreversible. CONCLUSIONS PC shows characteristic features, supporting the theory that it represents a distinct entity. It is rather common in Greece. Although menopausal women predominated in our cohort, men were not uncommonly affected and were diagnosed at an older age. Based on the predominating clinical feature, PC can be classified into three clinical forms. Symmetry and sparing of the anatomically shaded areas of the neck are highly characteristic for PC. Face involvement was not as common and as severe as it had been considered in the past. Recognition of clinical type is important for the selection of the most appropriate treatment, which, despite the advent of novel modalities, remains problematic.
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Affiliation(s)
- A C Katoulis
- National Kapodistrian University of Athens, 2nd Department of Dermatology and Venereology, Attikon Hospital.
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Stratigos AJ, Kapranos N, Petrakou E, Anastasiadou A, Pagouni A, Christofidou E, Petridis A, Papadopoulos O, Kokka E, Antoniou C, Georgala S, Katsambas AD. Immunophenotypic analysis of the p53 gene in non-melanoma skin cancer and correlation with apoptosis and cell proliferation. J Eur Acad Dermatol Venereol 2005; 19:180-6. [PMID: 15752287 DOI: 10.1111/j.1468-3083.2005.01094.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Sunlight precipitates a series of genetic events that lead to the development of skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The p53 tumour suppressor gene, which plays a pivotal role in cell division and apoptosis, is frequently found mutated in sunlight-induced skin tumours. OBJECTIVE To investigate the immunoreactivity of the p53 gene in non-melanoma skin cancers and to correlate its expression with apoptotic and cell proliferation markers. METHODS We analysed 35 non-melanoma tumours including 19 BCCs and 16 SCCs from sun-exposed skin areas. p53 protein expression was studied immunohistochemically using the DO7 monoclonal antibody against wild-type and mutant p53 forms. The percentage of p53-immunopositive nuclei was measured by image analysis. Cell proliferation and apoptosis were also assessed by image analysis following Ki-67 immunostaining and application of the TUNEL method on paraffin sections, respectively. RESULTS The percentage of p53-expressing cells varied from 3.5 to 90 in BCCs (median value 54.4%) and from 3.7 to 94 in SCCs (median value 40.3%). The mean value of Ki-67-positive cells was comparable in both groups of tumours with a mean value of 40.6% in BCCs and 34.6% in SCCs. Conversely, the TUNEL assay showed sporadic staining of apoptotic cells within the tumours with a mean value of 1.12% in BCCs and 1.8% in SCCs. p53 protein expression was correlated positively with cell proliferation (r = 0.75, P = 0.000001) and negatively with apoptosis (r = -0.23, P = 0.05). CONCLUSION p53 immunoreactivity was high in the majority of the skin carcinomas examined and correlated positively with cell proliferation and negatively with apoptosis. The p53 protein overexpression appears to be related to an inactivated protein resulting from mutations of the p53 gene or other unclear molecular mechanisms.
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Affiliation(s)
- A J Stratigos
- Department of Dermatology, University of Athens, Andreas Sygros Hospital, Athens, Greece.
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Georgala S, Katoulis AC, Georgala C, Bozi E, Mortakis A. Oral isotretinoin in the treatment of recalcitrant condylomata acuminata of the cervix: a randomised placebo controlled trial. Sex Transm Infect 2004; 80:216-8. [PMID: 15170007 PMCID: PMC1744851 DOI: 10.1136/sti.2003.006841] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Conventional therapies for human papillomavirus (HPV) infection are often associated with unsatisfactory response rates and high recurrence rates. The use of a systemic agent may more effectively control the virus. OBJECTIVES To investigate the efficacy and safety of low dose oral isotretinoin in recalcitrant condylomata acuminata (RCA) of the cervix. METHODS Double blind placebo controlled clinical trial. 60 women, aged 21-43 years, with RCA of the cervix, refractory to at least one conventional therapy, were randomly assigned to receive either isotretinoin, 0.5 mg/kg daily for 12 weeks (group 1), or placebo (group 2). RESULTS Of the 28 evaluable group 1 patients, nine (32.1%) responded to the treatment completely, 11 (39.2%) responded partially, and eight (28.5%) did not respond. Of the 25 group 2 patients, no one responded to the treatment completely, two (8%) responded partially, and 23 (92%) did not respond. The therapeutic difference between patients receiving active and placebo therapy was statistically significant (chi(2) = 19.35, p<0.001). Only one (11.1%) of the complete responders experienced recurrence during the 12 month follow up. Side effects were generally mild and resolved upon completion of therapy. CONCLUSIONS Compared to placebo, low dose oral isotretinoin showed considerable efficacy with insignificant and reversible side effects and a low recurrence rate. Isotretinoin may represent an efficacious and safe alternative systemic form of therapy for RCA of the cervix.
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Affiliation(s)
- S Georgala
- National and Kapodistrian University of Athens, Department of Dermatology and Venereology, "A Sygros" Hospital, Athens, Greece.
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Rigopoulos D, Katoulis A, Georgala S. Combination treatment of candidal fingernail onychomycosis: reply from authors. Br J Dermatol 2004. [DOI: 10.1111/j.1365-2133.2004.05998.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Georgala S, Katoulis AC, Georgala C, Moussatou V, Bozi E, Stavrianeas NG. Topical Estrogen Therapy for Androgenetic Alopecia in Menopausal Females. Dermatology 2004; 208:178-9. [PMID: 15057016 DOI: 10.1159/000076497] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Stavrianeas NG, Katoulis AC, Moussatou V, Bozi E, Petropoulou H, Limas C, Georgala S. Eruptive Large Melanocytic Nevus in a Patient with Hereditary Epidermolysis bullosa simplex. Dermatology 2004; 207:402-4. [PMID: 14657636 DOI: 10.1159/000074124] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2003] [Accepted: 06/10/2003] [Indexed: 11/19/2022] Open
Abstract
Hereditary epidermolysis bullosa (HEB) is a group of genetically determined mechanobullous disorders characterized by blister formation following minor trauma. Unusual melanocytic lesions may be a rare feature of all major categories of HEB. We report a large melanocytic nevus, clinically simulating malignant melanoma, which developed at a site of healing blisters in an 8-year-old male with recessive generalized epidermolysis bullosa simplex (EBS). Histological findings were consistent with a compound nevus. This is the third reported case of an eruptive melanocytic nevus developing in EBS. Due to their unique features, it has been suggested that these nevi may represent a distinct variant, referred to as epidermolysis bullosa nevi. Despite the atypical picture, no malignant transformation of HEB nevi has been seen. Therefore, after histologic verification, regular long-term follow-up rather than radical surgery is recommended.
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Affiliation(s)
- N G Stavrianeas
- Department of Dermatology and Venereology, A. Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Rigopoulos D, Katoulis AC, Ioannides D, Georgala S, Kalogeromitros D, Bolbasis I, Karistinou A, Christofidou E, Polydorou D, Balkou P, Fragouli E, Katsambas AD. A randomized trial of amorolfine 5% solution nail lacquer in association with itraconazole pulse therapy compared with itraconazole alone in the treatment of Candida fingernail onychomycosis. Br J Dermatol 2003; 149:151-6. [PMID: 12890209 DOI: 10.1046/j.1365-2133.2003.05381.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Treatment failures and relapses are not uncommon in onychomycosis. Therefore, it is worthwhile to consider the combination of systemic and topical antifungals to improve the cure rates further and to reduce the duration of systemic treatment. OBJECTIVES To evaluate and compare itraconazole pulse therapy combined with amorolfine with itraconazole alone in the treatment of Candida fingernail onychomycosis. METHODS Ninety patients with moderate to severe Candida fingernail onychomycosis were randomized into two treatment groups of 45 subjects each. Group 1 received itraconazole pulse therapy for 2 months and applied amorolfine 5% solution nail lacquer for 6 months, while group 2 received monotherapy with three pulses of itraconazole. The primary efficacy criterion was the result of mycological examination at 3 months. The secondary criterion was the combined mycological and clinical response at 9 months. A pharmacoeconomic analysis was also performed to compare the cost-effectiveness of combined therapy vs. monotherapy. RESULTS Eighty-five patients were analysed (73 women and 12 men, mean +/- SD age 44.2 +/- 12.9 years). Patients had a mean +/- SD of 3.64 +/- 2.0 nails involved and 228.6 +/- 148.0 mm2 of their nail surface diseased. The mean duration of onychomycosis was 11 months. Paronychial involvement was evident in 71 patients. C. albicans was isolated in 85 cases, C. parapsilosis in three and other Candida species in two cases. Side-effects were uncommon and in only one case led to withdrawal. At the 3-month visit, mycological cure was seen in 32 (74%) of 43 patients in group 1 and in 25 (60%) of 42 patients in group 2. At the 9-month visit, a global cure was seen in 40 patients (93%) in group 1 and in 34 patients (81%) in group 2. Statistical analysis showed no statistically significant difference (P > 0.1) between the two treatment groups. The cost per cure ratio was 1.63 and 1.70euro for groups 1 and 2, respectively. CONCLUSIONS The combination of amorolfine and oral itraconazole, which interfere with different steps of ergosterol synthesis, exhibited substantial synergy. Compared with oral itraconazole alone, the combination achieved greater mycological cure and increased total cure rate. However, no statistically significant difference was documented for this number of observations. Combination treatment with amorolfine and two pulses of itraconazole is at least as safe and effective as three pulses of itraconazole, with a lower cost per patient. In our opinion, the addition of amorolfine to oral itraconazole pulse therapy is of value in the treatment of moderate to severe Candida fingernail onychomycosis.
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Affiliation(s)
- D Rigopoulos
- National and Kapodistrian University of Athens, Department of Dermatology and Venereology, A.Sygros Hospital, 5 Dragoumi Str., Athens 16121, Greece.
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Stavrianeas NG, Katoulis AC, Kanelleas A, Hatziolou E, Georgala S. Papulonodular lichenoid and pseudolymphomatous reaction at the injection site of hepatitis B virus vaccination. Dermatology 2002; 205:166-8. [PMID: 12218234 DOI: 10.1159/000063898] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Immunization with the hepatitis B virus (HBV) is effective and safe with an estimated incidence of adverse reactions, either local or systemic, of less than 0.1%. Cutaneous side effects are rare and include lichen planus (LP) and lichenoid reactions. We report the case of a 21-year-old female, in whom a persistent, papulonodular lesion developed at the site of the injection, 6 weeks after the second dose of the HBV. Histological examination revealed lichenoid and pseudolymphomatous features. In addition, sensitization to thiomersal, a vaccine constituent, was documented by patch testing. The association of LP with chronic liver disease is well established. Furthermore, less than 20 cases of lichen or lichenoid reactions, following HBV vaccination, have been reported. Although several arguments have been presented, it is still debated whether there is a causal association or the occurrence of LP following HBV vaccination is a simple coincidence. It has been speculated that a T-cell-mediated, graft-versus-host-like reaction, triggered by a sensitizing protein, is directed against keratinocytes expressing an epitope of hepatitis B surface antigen or a similar epitope. Our case may represent a localized lichenoid reaction to HBV vaccination, a local reactive hyperplasia or a persisting delayed hypersensitivity reaction to a vaccine constituent. This is the first case of a local lichenoid reaction at the injection site of the HBV vaccine, providing further documentation for a causal association linking the HBV vaccine with LP.
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Affiliation(s)
- N G Stavrianeas
- Department of Dermatology and Venereology, 'A Sygros' Hospital, National and Kapodistrian University of Athens, Greece.
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Katoulis AC, Stavrianeas NG, Katsarou A, Antoniou C, Georgala S, Rigopoulos D, Koumantaki E, Avgerinou G, Katsambas AD. Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte. Br J Dermatol 2002; 147:493-7. [PMID: 12207589 DOI: 10.1046/j.1365-2133.2002.04993.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. OBJECTIVE To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). METHODS Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. RESULTS Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. CONCLUSIONS Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.
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Affiliation(s)
- A C Katoulis
- National and Kapodistrian University of Athens, Department of Dermatology and Venereology, 'A. Sygros' Hospital, Athens, Greece
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Georgala S, Katoulis AC, Georgala C, Katoulis EC, Hatziolou E, Stavrianeas NG. Pretibial myxedema as the initial manifestation of Graves' disease. J Eur Acad Dermatol Venereol 2002; 16:380-3. [PMID: 12224697 DOI: 10.1046/j.1468-3083.2002.00567.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pretibial myxedema (PM) is a localized thickening of the pretibial skin due to accumulation of acid mucopolysacharides (glycosaminoglycans). Its pathogenesis is still under investigation. Pretibial myxedema, exophthalmus and thyroid acropachy are the dassic extrathyroidal manifestations of Graves' disease. Almost invariably, PM follows the onset of ophthalmopathy, developing after the diagnosis and treatment of hyperthyroidism. Pretibial myxedema preceding Graves' ophthalmopathy is rare. We report the case of a 28-year-old Greek woman, who presented with multiple, asymptomatic nodules and plaques of the lower legs in the absence of other physical findings. Histopathologic examination revealed deposition of mucopolysacharides in the lower dermis. Laboratory investigation showed elevated serum T3 and T4 and depressed TSH levels. In our patient, pretibial myxedema was the earliest manifestation, leading to the diagnosis of Graves' disease.
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Affiliation(s)
- S Georgala
- National and Kapodistrian University of Athens, Department of Dermatology and Venereology, A. Sygros Hospital, Greece.
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Georgala S, Schulpis K, Georgala C, Karikas G. Gonorrhoea control programme in Athens, 1974-98. Sex Transm Infect 2001; 77:458-9. [PMID: 11714949 PMCID: PMC1744405 DOI: 10.1136/sti.77.6.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- S Georgala
- Dermatological Clinic Athens University, A Syngros Hospital Kesariani, 161 21 Athens, Greece
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Georgala S, Katoulis AC, Kylafis GD, Koumantaki-Mathioudaki E, Georgala C, Aroni K. Increased density of Demodex folliculorum and evidence of delayed hypersensitivity reaction in subjects with papulopustular rosacea. J Eur Acad Dermatol Venereol 2001; 15:441-4. [PMID: 11763386 DOI: 10.1046/j.1468-3083.2001.00331.x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rosacea is a common chronic dermatosis that evolves in stages. The mite Demodex folliculorum has been implicated in its obscure aetiopathogenesis. AIM To evaluate the importance of D. folliculorum in the aetiology and course of rosacea. METHODS We studied 92 consecutive cases of papulopustular rosacea and 92 age- and sex-matched controls. Prevalence and density of D. folliculorum were estimated by microscopic examination of the expressed follicular content. Histological examination and immunohistochemical study of the inflammatory infiltrate were performed in 10 subjects (five with positive D. folliculorum finding and five with negative finding). RESULTS D. folliculorum was detected in 83 (90.2%) of the 92 rosacea subjects but only 11(11.9%) of the controls. The mean mite density was 2.03 mites/visual field in the rosacea group (range 0-5, SD = 1.2) and 0.16 mites/visual field (range 0-2, SD = 0.52) in the control group. The difference was statistically significant (P < 0.0001) for both mite prevalence and density. Hair follicle infestation was associated with intense perifollicular infiltrate of predominantly (90-95%) CD4 helper/inducer T cells. We observed an increased number of macrophages and Langerhans cells only in those subjects with a positive D. folliculorum finding. CONCLUSIONS Although Demodex mites do not seem to be the cause of rosacea, they may represent an important cofactor, especially in papulopustular rosacea. Immunohistochemical findings suggest that a delayed hypersensitivity reaction, possibly triggered by antigens of follicular origin, probably related to D. folliculorum, may occur, stimulating progression of the affection to the papulopustular stage.
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Affiliation(s)
- S Georgala
- National University of Athens, Department of Dermatology and Venereology, A. Sygros' Hospital, Greece
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Abstract
UNLABELLED This study aimed to provide associations of age and gender with serum lipoprotein(a) [Lp(a)] levels and percentile distribution data for Greek children. In total, 3298 children (1590M, 1708F, aged 6-14 y) participated in the study. Lp(a) levels were evaluated with an immunosorbent assay. Mean Lp(a) levels were 153-157 mg l(-1) for boys and 146-151 mg l(-1) for girls, and median levels 133-139 mg l(-1) for boys and 100-108 mg l(-1) for girls. CONCLUSION The Lp(a) levels in these children were the lower ever reported. These results suggest that the young Greek population is not at high risk of developing coronary heart disease as a result of high Lp(a) levels.
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Affiliation(s)
- K H Schulpis
- Institute of Child Health, Aghia Sophia Children's Hospital, Athens, Greece
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Georgala S, Katoulis AC, Symeonidou S, Georgala C, Vayopoulos G. Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature. J Eur Acad Dermatol Venereol 2001; 15:62-4. [PMID: 11451328 DOI: 10.1046/j.1468-3083.2001.00198.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A purpuric eruption may be an unusual early manifestation of mycosis fungoides (MF). On the other hand, persistent pigmented purpuric dermatoses (PPPD) may, occasionally, evolve to cutaneous T-cell lymphoma. Coexistence of these two conditions has been reported, but it is extremely rare. We present the case of an elderly woman with a long-standing pruritic, pigmented purpuric eruption. On 1-year follow-up, histological features suggesting early MF were observed and molecular analysis of the rearrangement of T-cell receptor genes revealed clonality. Our patient may represent a case of PPPD evolving to MF, a case of MF clinically featuring PPPD, or an intermediate condition in a nosological continuity extending from PPPD to MF. A persistent pigmented purpuric eruption may rarely be a harbinger of cutaneous T-cell lymphoma. Therefore, vigilant long-term follow-up of PPPD is highly recommended.
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Affiliation(s)
- S Georgala
- National University of Athens, Department of Dermatology and Venereology, A. Sygros Hospital, Greece
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Abstract
We report an 8-month-old girl with tinea capitis caused by Microsporum canis which was successfully treated with two pulses of oral itraconazole 50 mg/day, each of 1 week duration with an interval of 2 weeks. M. canis tinea capitis can be a difficult therapeutic problem in an infant, as the treatment is usually long, lasting up to 4-6 weeks with griseofulvin and 6-12 weeks with terbinafine, and the desire to provide a safe systemic therapy is particularly important. With an intermittent regimen the duration of treatment with active drug can be much shorter compared to continuous therapy. We found that itraconazole pulse therapy for M. canis tinea capitis was a safe and effective treatment in an infant.
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Affiliation(s)
- E Koumantaki
- Department of Dermatology, A. Syggros Hospital, Athens, Greece
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Abstract
BACKGROUND The use of Isotretinoin (Iso) for cystic acne (CA) therapy includes marked side-effects such as dyslipidemia, increased liver enzymes, and reduction of biotinidase activity. Moreover, Homocysteine (Hcy), an amino acid, is metabolized in the liver requiring folate, vitamin B6, vitamin B12, and the activity of enzymes, i.e. cystathionine-beta-synthase. Increased blood levels of Hcy are associated with premature occlusive vascular disease. OBJECTIVE The aim of this study was the evaluation of Hcy levels and the responsible vitamins for its metabolism in patients with CA on Iso treatment. METHODS AND RESULTS Twenty-eight patients with CA were submitted to laboratory examinations before (Value 1) and after (Value 2) 45 days on Iso (0.5 mg/kg/24 h) therapy. Blood levels of Hcy and vitamin B6 were evaluated by HPLC methods, and folate and vitamin B12 using a commercial Kit. Hcy levels (Value 1 = 7.86 +/- 1.6 micromol/L; Value 2 = 13.65 +/- 3.3 micromol/L; P < 0.001) were statistically significantly increased in patients on treatment. Vitamins were unaltered, and lipids and liver enzymes increased. Significant correlation between Hcy levels, vitamins, and liver enzymes was found. Methionine loading tests performed in nine patient-volunteers showed an abnormal response post-treatment. CONCLUSIONS It is suggested that the elevated Hcy levels in patients after 45 days on Iso therapy could be due either to the 'inhibition' of cystathionine-beta-synthase by the drug and/or their liver dysfunction. Daily vitamin supplementation along with frequent evaluations of Hcy blood levels are recommended for the prevention of a premature occlusive vascular disease.
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Affiliation(s)
- K H Schulpis
- Institute of Child Health, and Pharmacokinetics and Parenteral Nutrition Unit, Aghia Sophia Children's Hospital, Athens, Greece
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Georgala S, Koumantaki E, Rallis E, Papadavid E. Generalized pustular psoriasis developing during withdrawal of short-term cyclosporin therapy. Br J Dermatol 2000; 142:1057-8. [PMID: 10809879 DOI: 10.1046/j.1365-2133.2000.03503.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- S Georgala
- Dermatological Clinic, Athens University, A Syngros Hospital, Greece
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Georgala S, Schulpis KH, Georgala C, Michas T. L-carnitine supplementation in patients with cystic acne on isotretinoin therapy. J Eur Acad Dermatol Venereol 1999; 13:205-9. [PMID: 10642057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Patients with cystic acne (CA) on Isotretinoin (Iso) therapy might present muscular symptoms as side effect of the drug. Myalgia, weakness, hypotension are also some of the main characteristics of carnitine (car) deficiency. METHODS Two hundred and thirty (N = 230) patients with CA were treated with Isotretinoin (0.5 mg/kg per 24 h). All the patients were requested to visit our out-patient department at the onset of muscular symptoms. Laboratory tests including car (total, free, acylcarnitine) were determined in blood and urine before treatment, at the onset of muscular symptoms and after the end of a 45 day study. Fifty percent of the patients with muscular involvement received L-carnitine (100 mg/kg per 24 h per os) (group C) and 50% placebo (group P). RESULTS Their laboratory tests showed the well known increases of their liver enzymes and lipids, whereas car blood levels were remarkably decreased at the onset of their muscular symptoms and or at the end of the study. Their supplementation with L-car, in patients of group C (N = 20) without Iso discontinuation or reduction, resulted in the disappearance of their muscular symptoms within 5-6 days and normalisation not only of the increased levels of their liver enzymes but also those of car, at the 45 day of their therapy. Additionally, the patients who received placebo (group P, N = 20) continued complaining for mualgias. The rest of the patients (group A, N = 190) did not experience any muscular symptoms, their laboratory tests showed elevation of liver enzymes and lipids and a decrease in car levels in the blood whereas a remarkable increase of car excretion was determined in their urine. CONCLUSIONS Iso therapy decreases car blood levels in patients with CA. L-car supplementation might treat liver and muscular side effects of the drug. These hopeful preliminary results need further investigation.
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Affiliation(s)
- S Georgala
- Dermatological Clinic of Athens University, A. Syngros, Hospital, Kesariani, Greece
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Katoulis AC, Stavrianeas NG, Georgala S, Katsarou-Katsari A, Koumantaki-Mathioudaki E, Antoniou C, Stratigos JD. Familial cases of poikiloderma of Civatte: genetic implications in its pathogenesis? Clin Exp Dermatol 1999; 24:385-7. [PMID: 10564328 DOI: 10.1046/j.1365-2230.1999.00508.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Poikiloderma of Civatte (PC) is a rather common, benign skin condition of obscure etiopathogenesis: cumulative exposure to UV radiation, hormonal changes associated with the menopause, and photo-allergic mechanisms have been implicated. We present seven cases of PC among the members of two unrelated Greek families, who have not shared common extrinsic influences. Literature review revealed no other reported familial cases. Familial tendencies, as well as the not unusual occurrence of PC in individuals with minimal sun exposure, and who are not using perfumes or cosmetics, provide support for the hypothesis that a genetic predisposition to the disease may exist; this predisposition is possibly transmitted as an autosomal dominant trait.
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Affiliation(s)
- A C Katoulis
- Department of Dermatology and Venereology, National University of Athens, A. Sygros Hospital, Athens, Greece
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Schulpis K, Georgala S, Papakonstantinou ED, Michas T. Psychological and sympatho-adrenal status in patients with cystic acne. J Eur Acad Dermatol Venereol 1999; 13:24-7. [PMID: 10565626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Patients with cystic acne (CA) frequently report feeling self conscious, anxiety and social isolation. METHODS Mood characteristics as well as self-esteem scores of 38 patients with CA were evaluated before and after 30 days treatment with isotretinoin. A high pressure, liquid chromatography method was used for the evaluation of catecholamines (epinephrine (E) and nor-epinephrine (NE)) in the blood of the patients at the time of the study and in controls (n = 30) after their psychological testing. Moreover, E and NE were measured in the blood of eight healthy volunteers before and after 1 month 'treatment' with the drug. RESULTS The CA subjects evidenced anxiety and high catecholamine plasma levels (E = 98.0+/-0.8 pg/ml, NE = 250.8+/-56.6 pg/ml) before treatment compared to controls (E = 71.8+/-23.0 pg/ml, NE = 190.0+/-52 pg/ml, P < 0.006), and these levels were lower (E = 75.4+/-21.4 pg/ml, NE = 202.0+/-49.9 pg/ml, P < 0.001) when their psychological status returned to normal after treatment. No differences were observed in E and NE levels in the eight healthy volunteers who received the same dose of the drug at the same time of study. CONCLUSIONS It is suggested that not only the psychological status is influenced in subjects with CA but also their sympathoadrenal system.
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Affiliation(s)
- K Schulpis
- Institute of Child Health, Aghia Sophia Children's Hospital, Athens, Greece
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Abstract
BACKGROUND The most common reaction to fragrances is contact dermatitis, a delayed hypersensitivity reaction; however, other reactions include immediate contact reactions (contact urticaria) and photo-allergic reactions. Fragrance mix (FM) and balsam of Peru (BP) are used to screen for fragrance allergy. OBJECTIVE To study the different types of allergic skin reactions to fragrance compounds. METHODS Delayed hypersensitivity reactions to FM and BP were studied in 4,975 patients with suspected contact dermatitis by routine patch testing interpreted at 48 and 96 hours. In 664 of the patients, patch tests were read at 30 minutes to evaluate for immediate (wheal-and-flare) contact reactions and again at 48 and 96 hours. Photopatch tests to FM were performed in 111 patients with suspected photo-allergic dermatitis. RESULTS Delayed contact reactions to FM occurred in 6.6% of females and 5.4% of males and to BP in 3.9% of females and 4.1% of males. Analysis of data over time (12 study years) showed an increased trend for reactions to fragrances, particularly in males. Sensitivity to other contact allergens (polysensitivity) was found in 62% of patients and polysensitivity presented more often with generalized contact dermatitis. The most sensitizing components of the fragrance mix that were tested in 38 patients were cinnamic alcohol, oak moss, and cinnamic aldehyde. There were 112 immediate patch test reactions to FM and 113 to BP in 664 patients. Immediate contact reactions were followed by delayed contact reactions in 13.4% of patients for FM and 8.8% for BP, representing a significant increase in the frequency of delayed contact reactions. Patients with immediate contact reactions to fragrances did not have a higher incidence of atopy (25.9%). No cases of positive photopatch test reactions to FM were seen. CONCLUSION Fragrances commonly cause both delayed and immediate patch test reactions and patients with immediate contact reactions have an increase in delayed contact reactions to the same allergen.
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Affiliation(s)
- A Katsarou
- Department of Dermatology, University of Athens, A. Sygros Hospital, Greece
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Abstract
BACKGROUND Among the reaction and effects of isotretinoin, mucocutaneous reactions, xerosis and erythema of the skin as well as elevation of liver enzymes and lipids except high density lipoprotein have been reported. OBJECTIVE Since biotinidase is mainly produced in the liver and partial biotinidase deficiency causes dermatological manifestations, seborrheic dermatitis, alopecia etc., isotretinoin side effects in relation to biotinidase activity were studied. METHODS Forty-two (n = 42) patients with severe cystic acne had liver function tests, lipid estimations, serum biotin as well as biotinidase activity evaluations before (value 1) and on the 30th day (value 2) of treatment with isotretinoin monotherapy (Roaccutane 0.5 mg/kg/24 h). The same laboratory tests were evaluated in 50 controls only once. Moreover, the effect of isotretinoin on a known plasma biotinidase activity was evaluated after incubation in vitro with various concentrations of the drug. RESULTS A statistically significant elevation of liver enzymes and lipids, except high density lipoprotein, was observed at the end of this study. On the contrary, biotinidase activity was found to be significantly decreased as compared to the initial values (value 1 = 4.70 +/- 0.89 nmol/min/l, value 2 = 2.50 +/- 0.8 nmol/min/l, p < 0.001) and to controls (5.2 +/- 0.9 nmol/min/l vs. value 2 = 2.50 +/- 0.8 nmol/min/l, p < 0.001). Additionally, biotin levels showed no significant alterations and the in vitro incubation of the enzyme with various concentrations of the drug exhibited no effect on its activity. CONCLUSION It is suggested that isotretinoin isomers-metabolites act in the liver, resulting in low biotinidase activity.
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Affiliation(s)
- K H Schulpis
- Institute of Child Health, Aghia Sophia Children's Hospital, Athens, Greece
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Schulpis KH, Nyalala JO, Papakonstantinou ED, Leondiadis L, Livaniou E, Ithakisios D, Georgala S. Biotin recycling impairment in phenylketonuric children with seborrheic dermatitis. Int J Dermatol 1998; 37:918-21. [PMID: 9888332 DOI: 10.1046/j.1365-4362.1998.00603.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effect of a therapeutic diet on serum biotin levels and to explain the seborrheic dermatitis in phenylketonuric (PKU) patients on a "loose" diet. DESIGN Forty-seven patients were divided into two groups: group A (n=21) demonstrated good compliance to a special diet and group B (n=26) were on a "loose" diet. Most of the patients in group B (20/26), who suffered from mild seborrheic dermatitis, were requested to return to phenylalanine (Phe)-restricted diet for at least 15 days. Seventy-nine healthy children of comparable age were used as controls. Biotin serum levels and plasma biotinidase activity were measured in patients as well as controls. In addition, biotinidase activity was evaluated in vitro after incubation with various concentrations of Phe. RESULTS Biotin levels in group A patients (636+/-118 ng/L) were statistically significantly elevated (P < 0.01) compared with those of group B patients before (412+/-184 ng/L) and after (501+/-160 ng/L) 15 days on a Phe-restricted diet, as well as with those of controls (337+/-290 ng/L). Furthermore, biotinidase activities were decreased in group B patients (4.2+/-1.68 nmol/min/L) compared with those of group A patients (6.4+/-0.7 nmol/min/L) and controls (6.10+/-0.8 nmol/min/L). Additionally, biotinidase activities in the patients of group B were restored to normal (5.78+/-0.81 nmol/min/L), with a simultaneous remission of their skin lesions, after 15 days on a Phe-restricted diet. Moreover, the in vitro findings showed a 51% inhibition of biotinidase activity when incubated with Phe (20 mg/dL). CONCLUSIONS It is suggested that the high biotin levels in group A patients reflect the intake of water-soluble biotin of vegetable origin. In contrast, the low biotinidase activity in group B patients may be attributed to their high Phe plasma levels, which acts as an enzyme inhibitor, as shown by the in vivo and in vitro results. Consequently, the observed seborrheic dermatitis in PKU children (group B) is associated with an impairment of biotin recycling.
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Affiliation(s)
- K H Schulpis
- Institute of Child Health, Aghia Sophia Children's Hospital, Radioimmunochemistry Laboratory, Athens, Greece
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Rigopoulos D, Katoulis AC, Stavrianeas NG, Sboukis D, Christofidou E, Georgala S. Acquired progressive kinking of the hair in a prepubertal boy. Br J Dermatol 1997; 137:832-3. [PMID: 9415258 DOI: 10.1111/j.1365-2133.1997.tb01135.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
BACKGROUND Increases in plasma concentrations of lipids, triglycerides, and liver enzymes have been reported in patients on isotretinoin therapy. Lipoprotein (a). (Lp (a)), a cholesterol-rich plasma lipoprotein, influences the clotting system and is related to premature coronary heart disease and stroke. METHODS Blood (7 mL) was obtained from 30 patients with cystic acne before and 30 days after the initiation of oral isotretinoin (0.5 mg/kg/day). RESULTS An increase in liver enzymes and lipids, except high density lipoprotein, was found in our patients at the end of the study. The mean Lp (a) levels (initial value, 25.91 +/- 3.17 mg/dL) were statistically reduced (p < 0.0001) at the end of treatment (14.80 +/- 2.35 mg/dL). CONCLUSIONS It is suggested that isotretinoin could be used as an Lp (a) lowering agent in the future.
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Affiliation(s)
- S Georgala
- University Dermatological Clinic, A. Sygros Hospital, Athens, Greece
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Affiliation(s)
- G A Karikas
- Chemistry Dept., University of Athens, Greece
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Georgala S, Schulpis K, Papakonstantinou E, Kalogirou S, Michas T. Possible involvement of partial biotinidase deficiency in alopecia areata. J Eur Acad Dermatol Venereol 1996. [DOI: 10.1111/j.1468-3083.1996.tb00609.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- K Aroni
- Department of Pathology, University of Athens, Greece
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Georgala S, Rigopoulos D, Gourgiotou K, Christofidou E. Isotretinoin-induced pemphigus. Acta Derm Venereol 1995; 75:413. [PMID: 8615073 DOI: 10.2340/0001555575413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Abstract
Atopic dermatitis (AD) is a pruritic cutaneous inflammatory condition. As pruritus and pain are very close symptoms, we determined the beta-endorphin serum concentrations in 21 atopic children with pruritus (group A) and 20 children with healed AD without pruritus (group B). Twenty-five healthy school children were the control group. The beta-endorphin serum concentrations (14.95 +/- 2.75 pmol/l) in group A were statistically (P < 0.001) elevated in our patients compared to controls (8.85 +/- 2.39 pmol/l) whereas these in group B were not elevated (9.4 +/- 2.46 pmol/l). We suggest that the elevated beta-endorphin concentrations in atopic patients with pruritus confirm the hypothesis that there is an increased activity of their opioid system and that an opioid antagonist might block itching which is their major clinical symptom.
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Affiliation(s)
- S Georgala
- A. Syngros University Hospital, Dermatologic Clinic, Athens, Greece
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Affiliation(s)
- S Georgala
- A. Sygros Hospital, Department of Dermatology, University of Athens, Greece
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Abstract
The development of androgenetic alopecia is thought to be caused by increased androgen action on hair follicles with menopause. Testosterone, estradiol and sex hormone binding globulin (SHBG) serum levels were determined in ten postmenopausal women with androgenetic alopecia and in ten sex and age matched healthy controls. No statistically significant differences were found in the hormone levels between the patients and the controls. These findings suggest that a genetically determined functional alteration of androgen receptors and/or a metabolic disturbance may exist in the hair follicle keratinocytes in androgenetic alopecia.
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Affiliation(s)
- S Georgala
- Department of Dermatology, University of Athens, Greece
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Georgala S, Schulpis K, Tolis G. The corticotrophin releasing factor test: a valuable and rapid procedure for the differential diagnosis of hirsutism. J Int Med Res 1992; 20:40-4. [PMID: 1314743 DOI: 10.1177/030006059202000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Plasma concentrations of adrenocorticotrophic hormone, cortisol, 17-hydroxyprogesterone, testosterone, delta 4-androstenedione and dehydroepiandrosterone sulphate were determined in 10 regularly menstruating hirsute women 0, 15, 30, 60, 90 and 120 min after intravenous injection of 100 micrograms corticotrophin releasing factor. The baseline concentrations of adrenocorticotrophic hormone, cortisol, progesterone and dehydroepiandrosterone sulphate were within the normal range, whereas the mean delta 4-androstenedione and testosterone concentrations were mildly elevated. The administration of corticotrophin releasing factor induced a rapid and significant increase in plasma concentrations of adrenocorticotrophic hormone, cortisol, 17-hydroxyprogesterone and delta 4-androstenedione after 60 min, whereas dehydroepiandrosterone sulphate and testosterone concentrations were not significantly elevated. These findings suggest that the corticotrophin releasing factor test can readily be used as an out-patient procedure to exclude adrenal hirsutism.
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Affiliation(s)
- S Georgala
- Department of Dermatology, A. Syngros Hospital, University of Athens, Greece
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Abstract
Fifteen patients with treatment-resistant condylomata acuminata have been treated by application of Dinitrochlorobenzene (DNCB). The agent was applied weekly as a 0.5 or 1% solution in acetone for a period of 6 to 8 weeks. Patients were sensitised 15 days before the onset of treatment by applying a 2% DNCB solution on the right arm in a quantity of 0.15 ml. In one patient treatment had to be stopped because of local irritation and one discontinued treatment. In the other 13 patients all lesions cleared completely. Patients were followed up for a year and no recurrence has appeared as yet. DNCB seems to be useful agent for treatment-resistant condylomata acuminata and justifies further clinical trials.
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Affiliation(s)
- S Georgala
- University Clinic for Skin and Venereal Diseases, A Sygros Hospital, Athens, Greece
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