Vulvar intraepithelial neoplasia (VIN) is a premalignant condition of vulvar skin caused in most patients by infection by oncogenic human papillomaviruses (HPV). HPV-16 is involved in about 75% of cases of VIN. Only 1.5% of patients with VIN will show a spontaneous regression, and in some of them it can evolve to an invasive carcinoma. Treatment of VIN includes surgical procedures such as excision, laser ablation, or electrosurgery, and also topical imiquimod.

In a recent study published in the November 5, 2009 issue of the New England Journal of Medicine a group of researchers from the Netherlands report the effectiveness of a vaccine against HPV-16 in patients with HPV-16–associated VIN. Twenty women with HPV-16–positive, grade 3 VIN were vaccinated with a mixture of long peptides (30 to 40 amino acids in length) derived from HPV-16 oncoproteins E6 and E7 in incomplete Freund’s adjuvant. Strong T-cell and interferon gamma responses were generated in all patients, and at 12 months of follow-up, 15 of 19 patients showed an objective clinical response (with symptoms improvement and reduction in size or disappearance of the lesions), and disapearance of HPV-16 DNA. Nine women (47%) had a complete response and remained disease-free at 24 months of follow-up.

The vaccine used in this study is different from the vaccines that are currently used for prevention (Gardasil from Merck, and Cervarix from GlaxoSmithKline), that are not therapeutic and induce protective antibodies in persons that have not been exposed to HPV. This study is important because it demonstrates for the first time that vaccines against oncogenic HPV can induce complete responses and prevent the development of invasive vulvar carcinomas in women with HPV infections.

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Over the last years, biologic therapies have emerged in the treatment of psoriasis. T lymphocytes and several cytokines responsible for the inflammation in psoriasis are the target of these molecules. One of these cytokines is tumor necrosis factor (TNF), a key molecule in several inflammatory and immune responses that can be blocked by fusion proteins such as etanercept (Enbrel), or monoclonal antibodies such as infliximab (Remicade) or adalimumab (Humira). Anti-TNF agents are considered immunosuppressants, and there are concerns and precautions that have to be kept in mind in patients treated with them. There is an increased risk of some opportunistic infections (such as latent tuberculosis), and there is also a concern that there may be an increased risk of cancers with the long-term use of these drugs.

In a recent study published in the October issue of Arthritis and Rheumatism, a group of Swedish researchers analyzed data from 6,366 rheumatoid arthritis patients who started treatment with either infliximab, adalimumab, or etanercept between January 1999 and July 2006. This group was compared with other groups of patients: 61,160 not taking any medication, 4,015 taking methotrexate, and 4,105 taking combinations of disease-modifying anti-rheumatic drugs (but not anti-TNF agents). The authors found a total of 240 first primary cancers occurred among 6,366 patients treated with anti-TNF agents. Among the anti-TNF naïve patients the authors found 4,244 cancers in patients who did not have a history of cancer at start of the study. The relative risk was 1.00 (95% confidence interval, 0.87-1.17). This relative risk remained unchanged for those taking immunosuppressant drugs for up to six years. The authors conclude that the overall cancer risk was the same for rheumatoid arthritis patients on immunosuppressant therapies and those not taking medications for the disease. These results are interesting for dermatologist as they may also be applicable to patients with psoriasis treated with anti-TNF agents. (more…)

The 2nd Congress of the Internacional Dermoscopy Society (IDS) will be held in Barcelona, Spain from November 12 to November 14, 2009.