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Genetics
Bone marrow
transplant risky,
but may help
of & ALLERGY epidermolysis
P R A C T I C A L T H E R A P E U T I C S and C L I N I C A L N E W S from the W O R L D of D E R M AT O L O G Y I SEPTEMBER 2010
bullosa patients
Small study shows
patients who received
stem cell transplant
from bone marrow had
better wound healing,
reduced blistering
Variety of
approaches B one marrow stem cell trans-
plantation may help fight a
rare genetic blistering skin
disease—but could be too risky for
H aving a dog in the house- Center, and her colleagues. toddlers with SPTs for 15 aeroaller- died during preparation for the trans-
hold may help prevent gens, cow’s milk allergy, and hen’s plant. Of the remaining transplant
New definitions proposed patients, one child had a severe regi-
children from developing egg allergy annually from ages one
Alternately, children whose SPT men-related cutaneous toxicity and
eczema, but it turns out that a cat to four—636 completed the annual
was positive for cat allergy but another died 183 days afterward
in the house may make eczema visits to the four-year endpoint.
lived with a cat before their first
even worse, researchers have Parents’ home environments were from graft rejection and infection,
year had a significantly higher rate
found. assessed before the end of the Dr. Wagner’s team reported in the
of eczema than those who tested
Children who have lived with a child’s first year through the mea- Aug. 12 issue of the New England
positive but didn’t live with a cat
dog since before age one and test and those who tested negative on surement of allergens in a dust sam- Journal of Medicine (Wagner JE, et
positive for dog allergy on a skin the SPT, the researchers reported ple from his or her primary living al: Bone marrow transplantation for
prick test (SPT) have a significantly in the Sept. 15 issue of the Journal area. recessive dystrophic epidermolysis
lower risk of developing eczema of Pediatrics (Epstein TG, et al: The study also proposed two bullosa 2010; 363:629-639).
than children who tested positive Opposing effects of cat and dog definitions for eczema a priori “Despite the potential benefits of
but didn’t live with a dog, according ownership and allergic sensitiza- Please turn to Eczema page 10 Please turn to EB patientspage 26
to the results of a study by Dr. Tolly tion on eczema in an atopic birth
S TUDY DATA SUGGEST THAT THE USE OF A GLOBAL ASSESSMENT SCALE FOR
acne scar severity (SCAR-S), inclusive of the trunk and the face,
might be a practical, validated, global system for acne scar
evaluation, and one that is clinically relevant in overall severity grad-
Please turn to Acne severity scale page 28
21683B_Skin_Allergy_Pg_:Sept_Skin_2010_rar19 (2),rar.qxd 10/18/2010 4:39 PM Page 2
† Quality of life (Dermatology Life Quality Index [DLQI]) significantly improved in patients treated with ENBREL vs. they develop a serious systemic illness.
placebo (p≤0.0001).¶ Very rare cases of hepatitis B virus (HBV) reactivation have been reported in patients treated with TNF antagonists.
ENBREL is indicated for reducing signs and symptoms, inhibiting structural damage progression and improving physical Patients at risk for HBV infection should be evaluated for prior evidence of HBV infection before initiating TNF antagonist
function of moderately to severely active arthritis in adult patients with rheumatoid arthritis (RA) and psoriatic arthritis therapy. Patients identified as chronic HBV carriers should be monitored for signs and symptoms of active HBV infection
(PsA). ENBREL can be initiated in combination with methotrexate in adult patients or used alone in RA and PsA. ENBREL while on ENBREL and for several months after discontinuing ENBREL.
is indicated for the treatment of adult patients with chronic moderate to severe plaque psoriasis who are candidates There have been rare reports of CNS demyelinating disorders. Prescribers should exercise caution when considering
for systemic therapy or phototherapy. ENBREL for patients with these disorders.
ENBREL is contraindicated in patients with, or at risk of, sepsis syndrome, such as immunocompromised and HIV+ Rare cases of neutropenia, leukopenia, thrombocytopenia, anemia and pancytopenia (including aplastic anemia), some
patients and in patients with a known hypersensitivity to ENBREL or any of its components. with fatal outcomes, have been reported in patients treated with ENBREL. Exercise caution in patients who have a
Serious infections leading to hospitalization or death, including sepsis, tuberculosis (TB), invasive fungal previous history of significant hematologic abnormalities.
and other opportunistic infections, have been observed with the use of TNF blocking agents including Lymphoma and other malignancies, some fatal, have been reported in children and adolescent patients
ENBREL. Cases of TB may be due to reactivation of latent TB infection or to new infection. Patients have treated with TNF blockers, including ENBREL.
frequently presented with disseminated rather than localized disease. Many of the serious infections have occurred In clinical trials of TNF antagonists, more cases of lymphoma were seen compared to control patients. Patients with RA
in patients on concomitant immunosuppressive therapy that, in addition to their underlying disease, could predispose or psoriasis may be at higher risk for the development of lymphoma. Non-melanoma skin cancer has been reported
them to infections. in patients treated with TNF blockers, including ENBREL. Cases of acute and chronic leukemia have been reported in
Treatment with ENBREL should not be initiated in patients with active infections, including TB, chronic or association with post-marketing TNF blocker use in RA and other indications. Whether treatment with ENBREL might
localized infections. Administration of ENBREL should be discontinued if a patient develops a serious infection influence the development and course of malignancies is unknown.
or sepsis. Physicians also should exercise caution when considering the use of ENBREL in patients with a There have been post-marketing reports of worsening of congestive heart failure (CHF), with and without identifiable
history of recurring or latent infections, including TB, or with underlying conditions, which may predispose precipitating factors, in patients taking ENBREL. Physicians should exercise caution when using ENBREL in patients
patients to infections, such as advanced or poorly controlled diabetes. Before starting treatment with ENBREL, who also have CHF.
all patients should be evaluated for both active and inactive (‘latent’) TB. Prescribers are reminded of the risk Adverse reactions reported in plaque psoriasis patients were similar to those in RA clinical trials. Adverse events, including
of false negative tuberculin skin test results, especially in patients who are severely ill or immunocompromised. serious adverse events, occurred at a higher frequency in plaque psoriasis patients over age 65 treated with 50 mg
If inactive (‘latent’) TB is diagnosed, treatment for latent TB should be started with anti-TB therapy before twice weekly. In RA patients, the most common adverse events in placebo-controlled trials were injection site reactions
the initiation of ENBREL. Patients should be monitored for the development of signs and symptoms of (37%), infection (35%), headache (3%), dizziness (3%) and rash (3%). In RA patients, infections and malignancies
infection during and after treatment with ENBREL, including the possible development of tuberculosis in were the most common serious adverse events observed. In plaque psoriasis trials, serious infections experienced by
patients who tested negative for latent tuberculosis infection prior to initiating therapy. Histoplasmosis and ENBREL-treated patients have included: cellulitis, gastroenteritis, pneumonia, abscess, osteomyelitis, viral meningitis,
other invasive fungal infections are not consistently recognized in patients taking TNF blockers, including ENBREL. For myositis, fascial infection and septic shock.
patients who reside or travel in regions where mycoses are endemic, invasive fungal infection should be suspected if Please refer to Product Monograph for complete prescribing information.