Combination Therapy in Psoriasis : An Evidence-Based Review.
Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1071, USA. American Journal of Clinical Dermatology
(Impact Factor: 2.73).
02/2013; 14(1):9-25. DOI: 10.1007/s40257-012-0003-7
BACKGROUND: Psoriasis is a chronic, systemic, inflammatory condition for which a variety of treatment modalities exist. Combinations of therapies are used often in clinical practice to enhance efficacy and reduce drug toxicities. PURPOSE: The purpose of this review is to assess the literature on the efficacy and safety of combination therapy in the treatment of psoriasis. METHODS: MEDLINE was reviewed to identify English-language publications from 1966 to 2011 examining combination therapy in psoriasis. Fifty-three articles met inclusion criteria and were included in this review. Randomized controlled trials addressing various combinations of treatment modalities for psoriasis were included. Data from these clinical studies were summarized and the outcomes were discussed. RESULTS: Large-scale, randomized controlled trials investigating the use of various combination therapies in psoriasis are limited. The strongest data support the use of combinations of vitamin D derivatives and corticosteroids as topical combinations and, to a lesser extent, the combination of other topical agents. Phototherapy and topical vitamin D derivatives as well as phototherapy in combination with oral retinoids are well supported in the literature. Combinations of systemic medications, though often used clinically, have little data to support their efficacy or safety. LIMITATIONS: Our data were limited by the small number of clinical trials examining the multiple available combinations that are used in clinical practice. CONCLUSIONS: The use of combination treatments falls within the standard of care for psoriasis, even if these combinations have not been extensively studied in clinical trials.
Available from: Slobodanka Lj Mitrovic
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ABSTRACT: Introduction: The presence of two concomitant genital malignant tumours is a rare phenomenon with an incidence of 0.7%. They are typically localised in the uterus and ovary, and approximately 50% are identical endometrioid - endometrioid histological type. In the presence of two different histological types of tumours, diagnosis is easier, but because of the small number of reported cases, there are no precise data on their clinical course. Generally, women with synchronous endometrial and ovarian tumours have a better prognosis and are more frequently younger, obese, multiparous and in menopause compared with women who have metastatic ovarian cancer or endometrial cancer. Case Report: In this work, we present a 53-year-old woman who contacted a gynaecologist because of irregular uterine haemorrhaging. The gynaecological exam revealed a tumour protruding through the cervical canal. The biopsy with initial histopathological diagnosis and additional ECHO and CT evaluations indicated the presence of a cervical tumour spreading over the uterus and both uterine adnexa. After surgical intervention, macroscopic and microscopic analyses of the postoperative material showed the simultaneous presence of two different malignancies, ovarian endometrioid carcinoma and poorly differentiated endometrial stromal sarcoma, which infiltrated all layers of the uterus, cervix and both fallopian tubes. Conclusion: The prognosis of synchronous tumours of the ovary and the uterus is primarily dependent on the stage and histological type of each tumour. Because of the rather small number of reported cases, a large part of this phenomenon remains unknown. Our report is the first description of the synchronous occurrence of endometrial ovarian carcinoma and uterine stromal sarcoma.
Available from: scindeks-clanci.ceon.rs
Available from: Slobodanka Lj Mitrovic
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