In this review we focus on 3 of the non-infectious granulomatous dermatitides, interstitial granulomatous drug reaction, rheumatoid nodules, and cutaneous sarcoidosis, with an overview of their clinical and histological presentations, differential diagnoses, and treatment options. The disorders we discuss are polymorphic in their clinical and histopathological presentations, follow chronic or undulating disease courses, and are typically recalcitrant to therapeutic interventions. Although the clinical history may be helpful, careful and thorough histopathological examination is required. Established treatment algorithms for these disorders are lacking, and very few randomized, placebo-controlled studies have been published. Future investigations should focus on the evaluation of larger cohorts, not only to establish treatment recommendations in randomized, placebo-controlled trials, but also to reach a greater understanding of disease pathogenesis and clinical-pathological presentation.
Semin Cutan Med Surg 32:e7-e11 © 2013 Frontline Medical Communications
Since the identification of high levels of interleukin 23 (IL-23) in psoriasis lesional skin, as well as finding that IL-23 was the most important source of the p40 subunit shared by IL-12 and IL-23, significant effort has been made in identifying potential new drugs that specifically block the unique IL-23 p19 subunit.
Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin condition that is associated with immune dysregulation and epidermal barrier dysfunction. The imbalance of the Th2 and Th1 pathways and their associated cytokines in AD presents as one facet of the pathogenic mechanisms. Changes in the T-cell populations and the associated cytokines during the acute and chronic phases of AD can cause variations in disease presentations and treatment responses. Continued discoveries in the immunopathogenesis of AD provide optimism for the development of efficacious therapeutic agents. Novel immunomodulatory
therapies include apremilast, dupilumab, IL-37, omalizumab, rituximab, mepolizumab, infliximab, allergen-specific immunotherapy, Mycobacterium vaccae, and leflunomide. These agents serve as examples of how modulation in immunopathogenesis of AD can lead to therapeutic discoveries.
Semin Cutan Med Surg 32:132-139 © 2013 Frontline Medical Communications
This chapter reviews etanercept (Enbrel®, Amgen and Wyeth, Thousand Oaks, CA), the first TNF- inhibitor approved by the Food and Drug Administration (FDA) for the treatment of not only plaque psoriasis but also psoriatic arthritis (PsA). Both efficacy and safety data for etanercept will be discussed, and a practical approach for the use of this drug in the dermatologic practice will be outlined.