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Paquet P.,University Hospital Sart Tilman | Pierard G.E.,University Hospital Sart Tilman
Expert Opinion on Pharmacotherapy | Year: 2010

Importance of the field: Drug-induced toxic epidermal necrolysis (TEN) is a dreadful skin condition. The mortality rate of 25 30% is mainly due to both metabolic failures and septicemia following loss of epidermal integrity. Topical treatments are important options in these patients. Areas covered in this review: Topical TEN care includes specific bedding, debridement of epidermal necrosis, applications of bioactive skin substitutes or semi-synthetic and synthetic dressings, as well as antiseptic and antibiotic agents. What the reader will gain: In the early exudating phase of TEN, the use of air-fluidized bed combined with gentle debridement are recommended. Next, an alternating pressure mattress and silver impregnated absorbent dressings should be used. During the re-epithelialization phase, antiseptic or antibiotic creams overlaid with nonadherent dressings favor an optimized moist and bacteria-controlled environment. Take home message: A suitable topical treatment is mandatory in TEN. Skin care procedures must be managed according to the skin condition corresponding to the initial highly exudating/necrotic phase, the secondary moderately exudating stabilized phase and the later re-epidermization phase. Bedding modalities, debridement procedures, applications of bioactive, semi-synthetic and synthetic dressings (silver-impregnated or not) and antiseptic/antibiotic creams should be adapted accordingly. © 2010 Informa UK, Ltd.


Pierard G.E.,University Hospital Sart Tilman | Pierard-Franchimont C.,University Hospital Sart Tilman | Szepetiuk G.,University Hospital Sart Tilman | Paquet P.,University Hospital Sart Tilman | Quatresooz P.,University Hospital Sart Tilman
Expert Opinion on Biological Therapy | Year: 2010

Importance of the field: Alopecia, psoriatic arthritis, the metabolic syndrome, inflammatory bowel diseases and cardiovascular diseases may occur as skin psoriatic comorbidities. TNF-α antagonists are used to treat psoriasis. Adalimumab is one of the recognized active agents for this indication. Areas covered in this review: The current peer-reviewed publications and presentation of original findings. What the reader will gain: Adalimumab is active on recalcitrant psoriasis and some of its comorbidities, particularly arthropathies and Crohn's disease. However, the progression of the radiological alterations is limited with regression of the bony erosions. Psoriatic enthesopathy also regresses. Mortality associated with psoriasis arthropathy is on the decline. Crohn's disease, the most frequent inflammatory bowel comorbidity of psoriasis, is responsive to adalimumab. The effect of adalimumab on the metabolic syndrome and cardiovascular involvement is more erratic. The spectacular effects of adalimumab may be associated with some adverse effects. In particular, despite a marked reduction in the psoriasis area-and-severity index (PASI) score some new acute lesions of cutaneous psoriasis may develop corresponding to paradoxical psoriasis. Other potential adverse effects include infections, granulomas, rapid growth of cancers and occurrence of lymphomas. Take home message: Adalimumab frequently controls moderate-to-severe forms of cutaneous psoriasis and some of its comorbidities. © 2010 Informa UK Ltd.


Pierard G.E.,University Hospital Sart Tilman | Paquet P.,University Hospital Sart Tilman
Expert Opinion on Pharmacotherapy | Year: 2010

Toxic epidermal necrolysis (TEN) is a rare but life-threatening mucocutaneous adverse drug reaction. The disease is characterized by a specific and extensive destruction of the epidermis and mucosal epithelia, particularly of the mouth, genitalia and eyes. The TEN pathomechanism is probably initiated by a toxic drug metabolism inside keratinocytes, leading to a self-activation of apoptosis and necrosis. These events are boosted by additional effects of T lymphocytes and macrophages. At present there is still a lack of validated mainstay treatment for TEN. However, a few treatment modalities have been reported to halt TEN progression in some patients. © 2010 Informa UK, Ltd.

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