Crohns Disease and Hidradenitis Suppurativa CoOccurrence A Rationale for AntiTNF Therapy

with disruption of the immune system's ability to compartmentalize the bacilli in granulomas and inhibition of macrophage apoptosis. Thus the FDA requires that patients have a negative purified protein derivative (PPD) test prior to the onset of infliximab therapy. Infusion-associated anaphylactoid reactions, while rare, can be avoided by slowing the infusion rate and pre-treating the patients with antihistamines and steroids.

Antibody formation can be seen with long-term use and is inversely proportional to total infliximab dose. The concern regarding the development of antibodies to infliximab with long-term use follows the observation that 13% of Crohn's patients treated with repeated infusions had indeed formed antibodies [22]. As expected, loss of clinical efficacy accompanies the antibody formation, as does the development of infusion-related chest pain, bronchospasm, and anaphylactic shock. The development of antibodies can be reduced by treating the patients on a scheduled, regular basis (i.e., every 8 weeks) and with the concomitant use of low-dose im-munosuppressants [16].

In the reported cases of HS treated with inf-liximab therapy, the demographics for ten patients are known (one case was reported without specifications) (see Table 20.1) [5, 8-11]. Four patients were reported to have had concurrent CD. Patients' age ranged from 17 to 57 years with a mean age of 35.4 years. There were four men and six women. HS disease duration was reported as being between 1.5 and 44 years, with a mean duration of 14 years. As the majority of the reports are single case reports of successful therapy, long-term effects were not known or described. Importantly, 9 of the 11 patients reported a significant reduction in disease activity within 5 weeks of infliximab infusion therapy. The five patients treated in a dermatological inpatient ward were observed to have marked or moderate improvement within 3-7 days after each infusion [11].

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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