New articles from Acta Dermato-Venereologica http://www.medicaljournals.se/acta/ Acta Dermato-Venereologica is an international peer-review journal for clinical and experimental research in the field of dermatology and venereology. 95:5 2015 - Self-healing Eyelid Nodule: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2001
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2014-11-18 Quiz
95:5 2015 - Widespread Crusted Skin Ulcerations in a Man with Type II Diabetes: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1999
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2014-11-17 Quiz
95:5 2015 - A Painful Nodule on the Leg: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2007
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2014-12-05 Quiz
95:5 2015 - Multiple Perianal Nodules in an HIV-positive Man: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2025
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2015-01-07 Quiz
95:5 2015 - Localised Dominant Dystrophic Epidermolysis Bullosa with a Novel de Novo Mutation in COL7A1 Diagnosed by Next-generation Sequencing http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2019
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2014-12-11 Shortcom
95:5 2015 - Contact Urticaria Due to a Face Mask Coated with Disinfectant Liquid Spray http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1962
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2015-01-26 Shortcom
95:5 2015 - Successful Elimination of Methotrexate by Continuous Veno-venous Haemofiltration in a Psoriatic Patient with Methotrexate Intoxication http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2041
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2015-01-26 Shortcom
95:5 2015 - Melasma Improving Spontaneously upon Switching from a Combined Oral Contraceptive to a Hormone-releasing Intrauterine Device: A Report of Four Cases http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2013
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2014-11-24 Shortcom
95:5 2015 - Recurrent Finkelstein-Seidlmayer Disease in Four First-degree Relatives http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2017
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2015-01-21 Shortcom
95:5 2015 - TRPS1 Haploinsufficiency Results in Increased STAT3 and SOX9 mRNA Expression in Hair Follicles in Trichorhinophalangeal Syndrome http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1948
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2015-01-07 Shortcom
95:5 2015 - Epidermal Cyst Formation and Hyperkeratosis in a Patient Treated with Vismodegib for Locally Advanced Basal Cell Carcinoma http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2020
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2015-01-07 Shortcom
95:5 2015 - Bilateral Auricular Involvement: A Rare Presenting Sign of Chronic Lymphocytic Leukemia, and Successful Treatment with Electron Beam Therapy http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2012
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2014-11-24 Shortcom
95:5 2015 - A Male with Group B Streptococcal Necrotizing Fasciitis at Multiple Sites Secondary to Multifocal Septic Arthritis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2015
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2014-12-03 Shortcom
95:5 2015 - Adult Staphylococcal Scalded Skin Syndrome Successfully Treated with Plasma Exchange http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2033
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2015-01-15 Shortcom
95:5 2015 - Bullous Pemphigoid in Infancy Showing Epitope-spreading Phenomenon: Recovery with Topical Therapy http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2026
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2015-01-09 Shortcom
95:5 2015 - Lipoid Proteinosis Resulting from a Large Homozygous Deletion Affecting Part of the ECM1 Gene and Adjacent Long Non-coding RNA http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2036
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2015-01-15 Shortcom
95:5 2015 - Stevens-Johnson Syndrome Associated with Mogamulizumab-induced Deficiency of Regulatory T cells in an Adult T-cell Leukaemia Patient http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2027
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2015-01-09 Shortcom
95:5 2015 - Counting Actinic Keratosis – Is Photographic Assessment a Reliable Alternative to Physical Examination in Clinical Trials? http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2040
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2015-01-20 Shortcom
95:5 2015 - Disseminated Primary Cutaneous CD8+ Small/Medium-sized Pleomorphic T-cell Lymphoma Responding to Hydroxychloroquine http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2002
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2014-12-03 Shortcom
95:5 2015 - Comparison of CD163+ Macrophages and CD206+ Cells in Lesional Skin of CD30+ Lymphoproliferative Disorders of Lymphomatoid Papulosis and Primary Cutaneous Anaplastic Large-cell Lymphoma http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2016
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2014-12-01 Shortcom
95:5 2015 - Mepacrine in Recalcitrant Cutaneous Lupus Erythematosus: Old-fashioned or Still Useful? http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2031
Treatment of recalcitrant cutaneous lupus erythematosus (CLE) is challenging. In situations where conventional treatment approaches fail mepacrine – an antimalarial/antiinflammatory drug that has fallen into oblivion in the last decades – might still be a promising option. We retrospectively analysed medical records of 10 patients with refractory CLE that were treated with mepacrine (100–200 mg/day) as mono- or combination therapy
for various time intervals between 2001 and 2013 at the University Hospital Würzburg. Mepacrine was generally well tolerated. Side effects were mild and usually resolved after reduction or cessation. Over 50% of the patients experienced amelioration of their symptoms despite a previously recalcitrant clinical course. Altogether, our data demonstrate that mepacrine still remains a useful and effective therapeutic option for other-wise treatment-resistant CLE.]]>
2015-01-14 Clinical
95:5 2015 - Cyclosporine Treatment in Severe Gestational Pemphigoid http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2032
Gestational pemphigoid, a rare autoimmune skin disease typically occurring during pregnancy, is caused by autoantibodies against collagen XVII. Clinically it is characterised by severe itching followed by erythematous and bullous lesions of the skin. Topical or oral glucocorticoids usually relieve symptoms, but in more severe cases systemic immunosuppressive treatments are needed. Data on immunosuppressive medication controlling gestational pemphigoid are sparse. We report 3 intractable cases of gestational pemphigoid treated with cyclosporine.]]>
2015-01-15 Clinical
95:5 2015 - Comparison of Moisturizing Creams for the Prevention of Atopic Dermatitis Relapse: A Randomized Double-blind Controlled Multicentre Clinical Trial http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2051
Atopic dermatitis (AD) affects adults and children and has a negative impact on quality of life. The present multicentre randomized double-blind controlled trial showed a barrier-improving cream (5% urea) to be superior to a reference cream in preventing eczema relapse in patients with AD (hazard ratio 0.634, p = 0.011). The risk of eczema relapse was reduced by 37% (95% confidence interval (95% CI) 10–55%). Median time to relapse in the test cream group and in the reference cream group was 22 days and 15 days, respectively (p = 0.013). At 6 months 26% of the patients in the test cream group were still eczema free, compared with 10% in the reference cream group. Thus, the barrier-improving cream significantly prolonged the eczema-free time compared with the reference cream and decreased the risk of eczema relapse. The test cream was well tolerated in patients with AD.]]>
2015-02-04 Clinical
95:5 2015 - Children with Atopic Dermatitis Should Always be Patch-tested if They Have Hand or Foot Dermatitis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1995
Atopic dermatitis is the most common chronic inflammatory disease among children in industrialised countries. Many factors influence this disease in a negative way and contact allergy is one such factor. The aim of the study was to examine the frequency of contact allergy among children with the diagnosis atopic dermatitis. Contact allergy was found in 22/82 children (26.8%), the most common from Amerchol L101 (11.0%), potassium dichromate (7.3%), and nickel sulfate (4.9%). A statistically significant difference in contact allergy frequency was demonstrated for those with hand and/or foot eczema compared to those without. Children with atopic dermatitis who suffer from hand and/or foot dermatitis should always be patch-tested to evaluate whether they have a relevant contact allergy and thus allergic contact dermatitis.]]>
2015-01-16 Clinical
95:5 2015 - Empowering Heliotherapy Improves Clinical Outcome and Quality of Life of Psoriasis and Atopic Dermatitis Patients http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2028
Empowering heliotherapy aims at clinical healing and improved coping with psoriasis and atopic dermatitis, but evidence of long-term effects is scarce. We studied the effect of 2-week empowering heliotherapy in the Canary Islands on clinical outcome and quality of life in 22 psoriasis and 13 atopic dermatitis patients. Empowerment consisted of meeting peers, sharing experiences and performing physical and mental practices. Using the self-administered PASI (SAPASI) psoriasis was alleviated statistically significantly during heliotherapy (p < 0.001), and the treatment effect was still detectable 3 months later (p < 0.001). Atopic dermatitis was improved (p < 0.001) when assessed with the patient-oriented SCORAD (PO-SCORAD), and the effect was still obvious 3 months later (p = 0.002). During heliotherapy the dermatology life quality index (DLQI) improved in both groups (p < 0.001), persisting in atopic patients for up to 3 months (p = 0.002), but not in psoriasis patients. In conclusion, a 2-week empowered heliotherapy showed a long-lasting improvement in psoriasis and atopic dermatitis disease activity, and also in the quality of life of atopic patients.]]>
2015-01-09 Clinical
95:5 2015 - Treatment Satisfaction of Patients with Psoriasis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2011
Treatment satisfaction of patients with psoriasis largely depends on the treatment modality, but evidence on preferences for specific medications is scarce. Here we assessed treatment satisfaction of 200 participants with moderate-to-severe psoriasis from a German University hospital with a 5-point scale and the Treatment Satisfaction Questionnaire for Medication (TSQM) and determined sociodemographic and disease-related influence factors. Participants obtaining biologicals and traditional systemic medications were significantly more satisfied than those receiving phototherapy or topical agents (TSQM = 323.3, 288.0, 260.6 or 266.8; p < 0.001). The highest TSQM score was calculated for ustekinumab (350.1), followed by acitretin (338.1), adalimumab (323.0), fumaric acid esters (304.7), infliximab (300.2), etanercept (298.8), and methotrexate (272.3; p < 0.001). High disease-related quality of life impairment (β = –0.437, p < 0.001) and psoriatic arthritis (β = –0.185, p = 0.005) were associated with decreased satisfaction. Optimising satisfaction is essential to improve adherence and outcome. We show high preferences for biologicals, particularly ustekinumab, but also good satisfaction with certain traditional medications.]]>
2015-01-14 Clinical
95:5 2015 - Clinical Spectrum of Skin Manifestations of Lyme Borreliosis in 204 Children in Austria http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2000
The spectrum of skin manifestations of Lyme borreliosis in children is not well characterized. We conducted a retrospective study to analyze the clinical characteristics, seroreactivity to Borrelia burgdorferi sensu lato, and outcome after treatment in 204 children with skin manifestations of Lyme borreliosis seen in 1996–2011. Solitary erythema migrans was the most common manifestation (44.6%), followed by erythema migrans with multiple lesions (27%), borrelial lymphocytoma (21.6%), and acrodermatitis chronica atrophicans (0.9%). A collision lesion of a primary borrelial lymphocytoma and a surrounding secondary erythema migrans was diagnosed in 5.9% of children. Rate of seroreactivity to B. burgdorferi s.l. was lower in solitary erythema migrans compared to other diagnosis groups. Amoxicillin or phenoxymethylpenicillin led to complete resolution of erythema migrans within a median of 6 (solitary) and 14 days (multiple lesions), respectively, and of borrelia lymphocytoma within a median of 56 days. In conclusion, erythema migrans with multiple lesions and borrelial lymphocytoma appear to be more frequent in children than in adults, whereas acrodermatitis chronica atrophicans is a rarity in childhood. The outcome after antibiotic therapy was excellent in children, and appears to be better than in adults.]]>
2015-01-20 Clinical
95:5 2015 - Autoantibody Levels and Clinical Disease Severity in Patients with Pemphigus: Comparison of Aggregated Anti-desmoglein ELISA Values and Indirect Immunofluorescence Titres http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2023
Detecting serum-autoantibodies by anti-Desmoglein-1 (anti-Dsg1) and anti-Dsg3 ELISAs as well as indirect immunofluorescence (IIF) are established complementary methods to diagnose pemphigus. Whether autoantibody levels also reflect clinical disease activity is still a matter of debate, as head-to-head comparisons of ELISA values and IIF titres with clinical activity over a longer treatment period are scarce. In our retrospective study, we compared aggregated repetitive intra-patient ELISA values and IIF titres with grades of clinical disease (1 = remission, 2 = moderate activity, 3 = exacerbation) in 47 patients suffering from pemphigus vulgaris (PV, n = 36) and pemphigus foliaceus (PF, n=11). We found that anti-Dsg1 ELISA values in PF and mucocutaneous PV as well as anti-Dsg3 ELISA values in PV best reflect disease activity. IIF titres, by contrast, did not show a significant association with disease severity. From these data we conclude that ELISA index values can be a valuable tool to monitor disease in patients with pemphigus, whereas IIF titres reflect clinical activity only insufficiently.]]>
2015-01-07 Investigative
95:5 2015 - Stigmatisation, Avoidance Behaviour and Difficulties in Coping are Common Among Adult Patients with Vitiligo http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1981
Vitiligo is a non-contagious skin disorder with loss of pigmentation, often impairing patients’ well-being. This study used Dermatology Life Quality Index (DLQI), Adjustment to Chronic Skin Disorders Questionnaire (ACS), Beck Depression Inventory (BDI) and additional questions to explore quality of life (QoL), coping, depression and stigmatisation and included 96 patients with vitiligo and 23 controls. Stigmatisation was common: 87/96 patients (90%) reported questions/approaches, 23/96 (24%) experienced nasty comments. Sixty-four out of 96 (66.7%) had avoided situations because of vitiligo or concealed their white spots. Sixty patients (62.5%) implied psychological stress as influential on disease’s course. Patients scored higher in all questionnaires than controls (DLQI?=?4.9/1.6, ACS-social anxiety/avoidance?=?36.9/22.1, ACS-helplessness?=?27.3/16.0, ACS-anxious-depressive mood?=?19.4/15.6), except BDI (6.8/7.3). QoL of 65 patients (67.7%) was hardly impaired, 70 (72.9%) were not depressed. Treatment with pro-pseudocatalase PC-KUS reduced social anxiety/avoidance, anxious-depressive mood and depression. Patients without low-key stigmatisation scored highest in DLQI and social anxiety/avoidance. Avoidance and concealing behaviour correlated with all questionnaires’ scores.]]>
2015-01-26 Investigative
95:5 2015 - Delineating Margins of Lentigo Maligna Using a Hyperspectral Imaging System http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2010
Lentigo maligna (LM) is an in situ form of melanoma which can progress into invasive lentigo maligna melanoma (LMM). Variations in the pigmentation and thus visibility of the tumour make assessment of lesion borders challenging. We tested hyperspectral imaging system (HIS) in in vivo preoperative delineation of LM and LMM margins. We compared lesion margins delineated by HIS with those estimated clinically, and confirmed histologically. A total of 14 LMs and 5 LMMs in 19 patients were included. HIS analysis matched the histo­pathological analysis in 18/19 (94.7%) cases while in 1/19 (5.3%) cases HIS showed lesion extension not confirmed by histopathology (false positives). Compared to clinical examination, HIS defined lesion borders more accurately in 10/19 (52.6%) of cases (wider, n = 7 or smaller, n = 3) while in 8/19 (42.1%) cases lesion borders were the same as delineated clinically as confirmed histologically. Thus, HIS is useful for the detection of subclinical LM/LMM borders.]]>
2015-01-13 Investigative
95:5 2015 - Topical TrkA Kinase Inhibitor CT327 is an Effective, Novel Therapy for the Treatment of Pruritus due to Psoriasis: Results from Experimental Studies, and Efficacy and Safety of CT327 in a Phase 2b Clinical Trial in Patients with Psoriasis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2047
Pruritus is an important symptom in psoriasis with no targeted treatment. Tropomyosin-receptor kinase A (TrkA) is associated with pruritus and psoriatic plaque formation. We report the efficacy of a TrkA inhibitor, CT327, on pruritus in psoriasis. A randomised, double-blind, vehicle-controlled Phase 2b clinical trial was conducted in 160 subjects. No effect was found on psoriasis severity using Investigator’s Global Assessment (primary endpoint). However, clinically and statistically significant reductions in pruritus were observed in the 108 patient subset reporting at least moderate pruritus at baseline (37.1 mm visual analogue scale improvement (95% CI [–37.5, –6.2], p = 0.0067) for lowest dose; secondary endpoint). Significant modified Psoriasis Area and Severity Index reductions were found in this subset (p < 0.05). Experiments exploring capsaicin-mediated calcium influx, important in pruritus signalling, were performed in sensory neurons. CT327 inhibited capsaicin responses, indicating action at the nerve growth factor-TrkA-TRPV1 pathway. TrkA is a key target in pruritus, and CT327 has potential to become an effective and safe first-in-class treatment]]>
2015-02-26 Investigative
95:5 2015 - Experimentallu Induced Psoriatic Lesions Associate with Rapid but Transient Decrease in Interleukin-33 Immunostaining in Epidermis http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2018
A slight epidermal damage can induce the Köbner reaction in psoriasis, and the “alarmin”, interleukin-33 (IL-33), may be involved in this process. Therefore, the uninvolved psoriatic skin was tape-stripped, and skin biopsies were collected at 0d, 2h and 3d or at 0d, 1d and 7d for immunohistochemistry. Eight patients out of 18 with the positive Köbner reaction showed a decrease in epidermal thickness and revealed transient reduction in epidermal nuclear immunostaining of IL-33 in 2h-1d-3d biopsies compared to the 10 Köbner-negative patients. In keratinocyte cultures, the full-length 32-kDa IL-33 was detected after damaging the cells with freeze-thawing. Interestingly, a very low concentration of rh-IL-33 (0.001–0.01 ng/ml) significantly stimulated 3H-thymidine uptake by human LAD2 mast cells, but not by psoriatic peripheral blood mononuclear cells. The results show that epidermal IL-33 associates with positive Köbner response, and only a small amount of the IL-33 apparently released may induce proliferation in dermal mast cells.]]>
2015-01-12 Investigative
95:5 2015 - A Retrospective Analysis of Skin Bacterial Colonisation, Susceptibility and Resistance in Atopic Dermatitis and Impetigo Patients http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1996
Atopic dermatitis (AD) and impetigo are skin conditions where bacterial colonisation and infection, especially with Staphylococcus aureus play an important role. We compared skin bacterial population, resistance patterns and choice of antimicrobial agents in patients diagnosed with AD and impetigo during 2005 and 2011 in our department. Number of positive cultures in the AD group were 40 and 53 in 2005 and 2011, with S. aureus found in 97.5% and 100%, respectively. Differences in resistance were marginal. In impetigo, S. aureus was found in all 70 patients in 2005 and all 40 patients in 2011. Antibiotic resistance to specifically fusidic acid was more common in 2005 impetigo patients (22.8%) versus 2011 (5%) (p = 0.078). The most commonly used oral antimicrobial was cefadroxil (in 57.5% and 52.8% of AD and 58.6% and 35% of impetigo patients in 2005 and 2011, respectively). Our observations confirm the high prevalence of S. aureus in both diseases and, interestingly, show a declining resistance trend in impetigo.]]>
2014-11-26 Investigative
95:5 2015 - Effective Strategies for the Management of Pyoderma Gangrenosum: A Comprehensive Review http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2008
Pyoderma gangrenosum (PG) is an inflammatory disease characterized by painful skin ulcerations with undermined and erythematous borders. The etiology of PG is not well understood, but it is generally considered to be an aberrant immune response characterized by a dermal neutrophilc infiltrate. Given the existence of only a few PG clinical trials, treatment options are largely based upon anecdotal data and small case studies. In addition to classic immunosuppressive medications, PG has been reported to respond well to the anti-TNF agents, infliximab, etanercept, adalimumab. Newer biologics such as ustekinumab (anti-IL-23), ixekizumab (anti-IL-17) and brodalumab (anti-IL-17R) are promising given the effect of IL-17 on neutrophil migration. However, the effectiveness of these newer agents remains to be rigorously evaluated. Multi-drug regimens have not been well described in the literature but are an excellent alternative for patients with refractory disease. Herein, we provide a comprehensive review of the pathophysiology of PG and of the different treatments available for managing PG patients, including the theoretical benefit of initiating multidrug regimens. We also provide one possible treatment algorithm for patients with refractory disease and give examples of refractory PG cases successfully treated with multidrug regimens.]]>
2014-11-27 Review
95:5 2015 - Metastatic Melanoma – A Review of Current and Future Treatment Options http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2035
Despite advances in treatment and surveillance, melanoma continues to claim approximately 9,000 lives in the US annually (SEER 2013). The National Comprehensive Cancer Network currently recommends ipilumumab, vemurafenib, dabrafenib, and high-dose IL-2 as first line agents for Stage IV melanoma. Little data exists to guide management of cutaneous and subcutaneous metastases despite the fact that they are relatively common. Existing options include intralesional Bacillus Calmette–Guérin, isolated limb perfusion/infusion, interferon-α, topical imiquimod, cryotherapy, radiation therapy, interferon therapy, and intratumoral interleukin-2 injections. Newly emerging treatments include the anti-programmed cell death 1 receptor agents (nivolumab and pembrolizumab), anti-programmed death-ligand 1 agents, and oncolytic vaccines (talimogene laherparepevec). Available treatments for select sites include adoptive T cell therapies and dendritic cell vaccines. In addition to reviewing the above agents and their mechanisms of action, this review will also focus on combination therapy as these strategies have shown promising results in clinical trials for metastatic melanoma treatment.]]>
2015-01-13 Review
95:5 2015 - Paper vs On-line Publication - Taking Advantage of Both! http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-2112
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2015-04-20 Editorial
95:4 2015 - A Solitary Red Nodule on the Back: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1919
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2014-10-20 Quiz
95:4 2015 - Vegetating Inguinal and Perianal Lesions: A Quiz http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1984
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2014-11-20 Quiz
95:4 2015 - Tonic Water-induced Generalized Bullous Fixed Eruption http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1947
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2014-11-04 Shortcom
95:4 2015 - Drug-induced Hypersensitivity Syndrome in Association with Varicella http://www.medicaljournals.se/acta/content/?doi=10.2340/00015555-1993
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2014-11-12 Shortcom