SAPHO syndrome associated with hidradenitis suppurativa and pyoderma gangrenosum successfully treated with adalimumab and methotrexate: a case report and review of the literature

Abstract

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome is a rare inflammatory condition describing the combination of skin, bone, and joint manifestations that has a heterogeneous presentation. We report a case of severe SAPHO syndrome in association with hidradenitis suppurativa and pyoderma gangrenosum in a 27-year-old male. The patient had an initial migratory arthritis affecting the knees, ankles, metacarpophalangeal joints, proximal interphalangeal joints, wrists, shoulder, and lower back, which progressed to a persistent arthritis and swelling at the sternum, shoulders, wrists, hands, feet, and lower back. Radiographic changes were consistent with the diagnosis of SAPHO syndrome. Serum proinflammatory cytokine levels were significantly elevated and improved substantially after 3 months of therapy. Rationale for therapy in this patient was the observation that tumor necrosis alpha antagonists have been successfully used in SAPHO syndrome, and since arthropathy was so prominent in our patient, we elected to use adalimumab combined with methotrexate.

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Teriflunomide-induced psoriasiform changes of fingernails: a new example of paradoxical side effect?

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Evaluation of the relation between lipid coat, transepidermal water loss, and skin pH

Abstract

Objective

The epidermis is an epidermal barrier which accumulates lipid substances and participates in skin moisturizing. An evaluation of the epidermal barrier efficiency can be made, among others, by the measurement of the following values: the lipid coat, the transepidermal water loss (TEWL) index, and pH.

Materials

The study involved 50 Caucasian, healthy women aged 19–35 years (mean 20.56).

Methods

Measurements were made using Courage & Khazaka Multi Probe Adapter MPA 580: Tewameter TM 300, pH-Meter PH 905, Sebumeter SM 815. The areas of measurements included forehead, nose, left cheek, right cheek, chin, and thigh.

Results

In the T-zone, the lipid coat was in the range between 0 and 270 μg/cm² (mean 128 μg/cm²), TEWL between 1 and 55 g/m²/h (mean 11.1 g/m²/h), and pH 4.0–5.6 (mean 5.39). Lower values of the lipid coat up to 100 μg/cm² were accompanied by TEWL greater than 30 g/m²/h and less acidic pH of 5.6–9.0. In the U-zone the range of lipid coat was up to 200 μg/cm² (mean 65.2 μg/cm²), the skin pH remained 4.0–5.6 (mean 5.47), and TEWL was in the range between 1 and 20 g/m²/h (mean 8.7 g/m²/h). Lower values of the lipid coat up to 100 μg/cm² were accompanied by TEWL between 1 and 20 g/m²/h and less acidic pH of 5.6–9.0. High values of the lipid coat between 180 and 200 μg/cm² were connected with TEWL of 1–15 g/m²/h. On the skin of the thigh, we observed a very thin lipid coat – 35 μg/cm² (mean 5.6 μg/cm²), pH (mean 5.37), and TEWL (mean 8.5 g/m²/h) were considered by us to be within regular limits.

Conclusions

In the T-zone, a thinner lipid coat resulted in relatively high TEWL and pH levels changing toward alkaline. In the U-zone, thinner lipid coat was accompanied by lower TEWL and pH changing toward alkaline. We also observed that lower values of lipid coat up to 100 μg/cm² were associated with higher pH values ranging toward the basic character pH 5.6–9.0).

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Neonatal skin care: what should we do? A four-week follow-up randomized controlled trial at Zagazig University Hospitals

Abstract

Introduction

Taking care of newborn skin is necessary to avoid skin infections. The normal daily exposure to external factors affects the skin negatively. Skin hygiene and proper skin cleansing as well as protection of the infant skin barrier are essential to maintain barrier function and overall infant health.

Aim

The aim of this work is to assess the neonatal skin care effectiveness in promotion of normal skin development and protection of the optimal skin function by avoiding the different neonatal skin disorders which cause skin infection.

Conclusion

In conclusion, proper care and good hygiene of the normal mature neonatal skin are essential to maintain skin barrier function and overall health. This is achieved by optimizing epidermal barrier integrity that includes:

• bathing and using emollient;
• preventing and managing infections and skin injury;
• minimizing transepidermal water loss (TEWL);
• minimizing heat loss and percutaneous absorption of toxins.

Baby bath products as well as baby wipes are safe to use and do not appear to affect an infant's skin barrier integrity. It is therefore sensible to use cleansers that have been specially designed for baby's skin, which are pH neutral and very mild to avoid irritant dermatitis and allergic dermatitis.

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A photoconverter gel-assisted blue light therapy for the treatment of rosacea

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Triple cancers concurrently detected in a case of antitranscriptional intermediary factor-1γ antibody-positive dermatomyositis

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EGFR T790M mutation testing of non-small cell lung cancer tissue and blood samples artificially spiked with circulating cell-free tumor DNA: results of a round robin trial

Abstract

The European Commision (EC) recently approved osimertinib for the treatment of adult patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) harboring EGFR T790M mutations. Besides tissue-based testing, blood samples containing cell-free circulating tumor DNA (ctDNA) can be used to interrogate T790M status. Herein, we describe the conditions and results of a round robin trial (RRT) for T790M mutation testing in NSCLC tissue specimens and peripheral blood samples spiked with cell line DNA mimicking tumor-derived ctDNA. The underlying objectives of this two-staged external quality assessment (EQA) approach were (a) to evaluate the accuracy of T790M mutations testing across multiple centers and (b) to investigate if a liquid biopsy-based testing for T790M mutations in spiked blood samples is feasible in routine diagnostic. Based on a successfully completed internal phase I RRT, an open RRT for EGFR T790M mutation testing in tumor tissue and blood samples was initiated. In total, 48 pathology centers participated in the EQA. Of these, 47 (97.9%) centers submitted their analyses within the pre-defined time frame and 44 (tissue), respectively, 40 (plasma) successfully passed the test. The overall success rates in the RRT phase II were 91.7% (tissue) and 83.3% (blood), respectively. Thirty-eight out of 48 participants (79.2%) successfully passed both parts of the RRT. The RRT for blood-based EGFR testing initiated in Germany is, to the best of our knowledge, the first of his kind in Europe. In summary, our results demonstrate that blood-based genotyping for EGFR resistance mutations can be successfully integrated in routine molecular diagnostics complementing the array of molecular methods already available at pathology centers in Germany.

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