Acquired idiopathic generalized anhidrosis (AIGA) is a rare disorder in which systemic anhidrosis/hypohidrosis occurs without causative dermatological, metabolic or neurological disorder. For the diagnosis of AIGA, the iodine-starch test (Minor test) with systemically applied iodine is generally utilized. However, this systemic approach is time-consuming and requires considerable expense for both patients and medical staff. Furthermore, the iodine application may disturb observation of cholinergic urticaria, which is frequently accompanied by AIGA. To overcome these issues, we developed a modified Minor test, in which the test is performed at 12 spot sites instead of the whole body. This Spot Minor test is considered more convenient than the conventional whole-body one. In our analysis of 30 cases of AIGA diagnosed with the spot Minor test, we found that the most predilection sites in AIGA of anhidrosis/hypohidrosis are the arms and legs.
Dupilumab was highly effective for refractory AD. There were no differences among the clinical effects for anatomical regions in the clinical trials. However, we did have cases that did not respond as well to dupilumab on the head and neck. In this study, we analyzed the EASI improvement rates at 4 weeks and 16 weeks after treatment in 34 patients who used dupilumab at our hospital for each of the following regions; head and neck, upper limbs, trunk and lower limbs. Our results showed that the EASI improvement rate at 16 weeks was significantly lower in the head and neck than in the other three regions. There were also cases in which only the head and neck were exacerbated. We discuss our results with consideration from the published reports.
The cost-effectiveness of anti-onychomycosis drugs, including fosravuconazole L-lysine ethanolate (F-RVCZ), was evaluated using complete cure rate and quality-adjusted life years (QALY) as outcome measures.
The cost and complete cure rate of F-RVCZ were higher than those of the most economical generic, terbinafine, at 48 weeks after the start of treatment for the respective drugs' standard treatment period, by 57,361 yen and 20.7 percentage points, respectively. For F-RVCZ, the incremental cost-effectiveness ratio per person with complete cure was 277,155 yen and that per QALY was 1,979,681 yen, which was lower than the generally acceptable upper limit (5-6 million yen per QALY). Therefore, F-RVCZ was found to be a highly cost-effective drug.
Biologics are efficacious for treating psoriasis vulgaris (PsV) and psoriatic arthritis (PsA), but sometimes they are terminated or changed for various reasons, including ineffectiveness or adverse events. To find the optimal choice of biologics for treating psoriasis and psoriatic arthritis, we previously reported the real-world data on drug survival and the reason for terminating or switching biologics, summarizing data from 2010 to 2017. We updated our conclusions with the 2018 data, including the newly released guselkumab. By analyzing medical records from patients with PsV or PsA. Who visited the Department of Dermatology, Fukuoka University Hospital from 2010 to 2018. A total of 229 patients (168 men and 61 women) received biologics. The total number of patients treated with biologics fell for the first time since 2010 in 2018, and 147 patients (64%) were treated with only one biologic; 82 patients (36%) were switched to different products. Frequently used biologics in PsV were ustekinumab (UST), infliximab and adalimumab when calculated by total patient-year. Tumor necrosis factor inhibitor (TNFi) use decreased while UST and interleukin (IL) -17 inhibitors increased in newly introduced patients. Within the IL-17 inhibitors, use of secukinumab was reduced, and newer IL-17 inhibitors were more frequently introduced. In patients with PsA, TNFi's were more frequently employed than in those with PsV, but IL-17 inhibitors shared more than half of the total use. Further research is needed to find the optimal choice of biologics with larger samples at multiple facilities.