Severe flares are usually treated with steroid medications to obtain remission, but steroids have many undesirable side effects, so some gastroenterologists are now advocating the use of infliximab as the first drug to try to get patients into remission. This has been called the top-down approach to treatment. Ulcerative colitis
Infliximab targets TNF, thought to be more related to Th1 cytokines. Ulcerative colitis was thought to be a Th2 disease, and infliximab would be of limited use. However, patients with ulcerative colitis have begun to be treated with infliximab on the basis of two large clinical trials conducted in 2005 by Paul Rutgeerts and William Sandborn. The Acute ulcerative Colitis Treatment trials (ACT1 and ACT2) to evaluate the utility of infliximab in ulcerative colitis showed 44-45% of patients treated with infliximab for a year maintained a response to the medication, compared with 21% of patients who were treated with placebo medication. At two months, the response was 61-69% for patients treated with infliximab, and 31% for those treated with placebo.Newer drugs such as Etrolizumab have similar efficacy to Infliximab with fewer adverse effects for treatment of ulcerative colitis. Psoriatic arthritis
In psoriatic arthritis (PsA), inhibitors of TNF, such as infliximab, improve the signs and symptoms. Several therapies with modest efficacy have been studied in nail psoriasis. Among available agents, higher quality data are available to support the efficacy of cyclosporine and infliximab.
Chronic actinic dermatitis is a condition where a subjects skin becomes inflamed due to a reaction to sunlight or artificial light. Patients often have other related conditions of the skin that cause dermatitis in response to a variety of stimuli (e.g., flowers, sunscreens, cosmetics, etc.). Symptoms
Once affected, the symptoms may not show for several days. The symptoms can be severe burning, itching, swelling and pain in the affected areas. The areas exposed to sunlight may have the appearance of a sunburn - where clothing is worn the skin is protected. There is no known reaction to moonlight, but reflections from windows and mirrors of sunlight can still cause damage. Diagnosis
Diagnosis can occur at any age, ranging from soon after birth to adulthood. A GP may refer a patient to a dermatologist if the condition is not showing clear symptoms, and a variety of tests - usually completed at a hospital - can then determine the exact nature and cause of the patients condition. Reactions, which vary depending on the severity of the case, include rashes, flared bumpy patches, affected areas being extremely hot to touch, and outbreaks shortly (or within 24 hours) after direct or indirect exposure to UVA and/or UVB light. The skin most likely reacts on the upper chest, hands and face, however it is not unlikely for reactions to happen all over the body. The patient may feel burning, stinging or throbbing sensations in these areas, which causes mild, yet uncomfortable pain in some patients.