165例红皮病临床分析

 目的:分析红皮病的病因、诱因、临床特点、治疗方法及疗效。方法：回顾性分析2017年1月至2019年1月我院165例红皮病患者的临床资料。结果：165例患者中，男116例，女49例，男女比例为2.37∶1；平均年龄(53.46±18.58)岁;93.33%继发于原有皮肤病，3.03%继发于药物过敏，1.21%继发于肿瘤，2.42%不明原因;最常见诱因为不规范使用糖皮质激素;针对不同病因，给予相应方法治疗，有效率达72.73%。结论：红皮病以中老年男性多见，病因主要为继发于银屑病，其次为湿疹。红皮病的治疗、预后与原发疾病相关。临床上应根据不同病因采取不同治疗方法,同时给予对症支持治疗,提高患者生存率。     

Warfarin‐induced erythroderma

Erythroderma is a potentially serious and life‐threatening skin disease with a number of possible aetiologies. Drug reactions are well‐documented causes, with carbamazepine, penicillin and allopurinol being the most commonly implicated. This case describes a unique presentation of warfarin‐induced erythroderma in a 78‐year‐old female patient.     

Influence of severity of the cutaneous manifestations and age on the prevalence of several cardiovascular risk factors in patients with psoriasis

Introduction Psoriasis is a disease with proinflammatory state that has been associated with an increased risk of cardiovascular disease. Method This is a cross‐sectional, observational study, with analysis of 98 patients being treated for psoriasis. Several variables were analysed: gender, age, weight, height, Psoriasis Area and Severity Index (PASI), blood pressure, blood glucose, blood lipids, obesity, metabolic syndrome (MS) and Framingham score. Results Ninety‐eight patients were analysed (51 men; 52.0%). Age ranged from 12 years to 98 years. About 67% of the patients had dyslipidaemia, 14.3% had type 2 diabetes mellitus and 59.2% had systemic arterial hypertension. Forty‐four percentage of patients had the MS and 27.6% had a body mass index >30 kg/m². The Psoriasis Area and Severiy Index were equal or over 10 in 27 patients, 18 of whom had dyslipidaemia (P = 0.929) and 14 of whom had the MS (P = 0.327). Seventy‐four patients were over the age of 40 years and, of these, 56 had dyslipidaemia (P = 0.002) and 41 had the MS (P < 0.001). For 89 patients, whose cardiovascular risk was calculated according to the Framingham criteria, 71.4% at high or moderate risk had a PASI below 10 (P = 0.945) and 100% at high or moderate risk were over the age of 40 years (P = 0.001). Conclusion There was strong evidence that psoriasis patients have an increased cardiovascular risk, chiefly those over the age of 40 years, probably because of the chronic inflammatory state. It seems that the severity of the cutaneous manifestations was not associated with a higher risk in these patients.     

A Study of Correlation Between Clinical and Histopathological Findings of Erythroderma in North Bengal Population

Background:

Erythroderma is a reaction pattern characterized by erythema and desquamation of 90% or more body surface area along with some metabolic alterations.

Materials and Methods:

Here we studied 32 patients of erythroderma at of North Bengal Medical College for a period of 1 year to find the etiology, clinical features and histological changes. Detailed history was taken from all the patients followed by relevant biochemical investigations and histological examination. To correlate the clinical and histopathological findings chi square test was used.

Results:

Male preponderance was present and most of them were in the 4^th or 5^th decade. Etiologically the patients were divided into secondary erythroderma developing over pre-existing dermatoses, and idiopathic erythroderma. Secondary erythroderma (n = 24) cases outnumbered the idiopathic cases (n = 8). Among the pre-existing dermatoses, psoriasis was found to be the most common etiologic agent. Apart from erythema the other common presenting features were scaling and itching. Histopathological categorization was possible in 59.3% cases, rest of the cases showed non-specific dermatitis. The most common histopathologic diagnosis was psoriasis (21.8% of cases).

Conclusions:

Our study of clinicopathological correlation of erythroderma patients among north bengal population corroborates with most of the previous studies done in other areas. As ours is a cross-sectional study in a undefined population so we could not determine the true incidence of erythroderma in north bengal population. We might have missed lymphoma as a cause of erythroderma in idiopathic cases due to lack of long follow-up, so we understand that further studies over a defined population with long follow-up is needed to determine the true incidence and causes of idiopathic erythroderma.     

Methotrexate/narrowband UVB phototherapy combination vs. narrowband UVB phototherapy in the treatment of chronic plaque‐type psoriasis – a randomized single‐blinded placebo‐controlled study

Background Psoriasis is a chronic, recurring inflammatory disease affecting the skin, joints and nails that has a significant negative impact on the quality of life. Efficacy of combination of methotrexate/narrowband ultraviolet B (NBUVB) phototherapy in the treatment of psoriasis has been rarely assessed. Objectives To compare the efficacy of methotrexate/NBUVB phototherapy combination vs. NBUVB phototherapy in the treatment of chronic plaque psoriasis. Methods Forty patients with chronic plaque‐type psoriasis (body surface area involvement >10%) were randomized to receive either methotrexate/NBUVB phototherapy (group A) or placebo/NBUVB phototherapy (group B). End point of treatment was 75% reduction in Psoriasis Area and Severity Index (PASI) Score or upto 6 months, whichever was earlier. Patients were then followed up for a period of 12 weeks for assessment of relapse. Results Of 40 patients, 37 completed the treatment period and 29 both the treatment period and follow‐up. PASI 75 was achieved in 19/20 patients in group A and 14/20 patients in group B (P < 0.04). The mean number of weeks(P = 0.001), the mean cumulative dose of NBUVB (P = 0.001) and the mean number of phototherapy sessions (P = 0.0001) required to achieve PASI 75 were significantly less in group A compared with group B. There was no significant difference in the number of patients who relapsed during the follow‐up period (P = 0.68). Conclusion Combination of methotrexate and NBUVB phototherapy provides more rapid clinical improvement compared with NBUVB monotherapy in the treatment for chronic plaque‐type psoriasis.     

The course and prognosis of pemphigus in 47 Tunisian patients

Background Pemphigus is a severe and life‐threatening autoimmune bullous dermatosis. Objective We have analysed parameters that may influence prognosis of pemphigus (P). Methods It was a retrospective study (2002–2010), with pemphigus considered as severe if body surface involvement ≥30%. Disease control and relapse‐free survival (Kaplan–Meier) were analysed and compared according to several parameters (P < 0.05). Results 47 cases of pemphigus were collected, mean age 51 years ± 16.8 (F/H = 3.27). There were 30 pemphigus profundus and 17 superficial pemphigus. The median remission period was of 9 months (1.2 months–5 years). The mean healing time was of 40 days (6 days–4 months), which did not depend on type of P, its severity or infectious complications, whereas it was shorter in aged patient (≥65 years) compared to non aged ones (P = 0.018). 36.2% of patients had relapsed. Relapses were significantly more frequently observed only in the presence of mucosal involvement at presentation (P = 0.015). The median overall 1st relapse‐free survival was of 2.33 years. Only mucosal involvement at presentation was associated with a shorter median 1st relapse‐free survival time (1.28 years vs. 3 years) (P = 0.0017). Mortality rate was of 10.6% (n = 5); in four patients the death was directly related to pemphigus and occurred rapidly after the onset of lesions. Conclusion Our study illustrates the poor prognosis of pemphigus by a long duration to disease control, a high initial dose of oral steroid, a high rate of relapse and a short remission period. Only mucosal involvement at presentation was identified as a poor prognostic factor.     

Induction of melasma by 1064‐nm Q‐switched neodymium:yttrium–aluminum–garnet laser therapy for acquired bilateral nevus of Ota‐like macules (Hori nevus): A study on related factors in the Chinese population

Laser treatment has emerged as a common treatment modality for acquired bilateral nevus of Ota‐like macules (ABNOM). To identify the ratio of melasma induction and exacerbation before and after laser therapy for ABNOM and to observe the risk factors related to the induction and exacerbation of melasma by laser therapy, we analyzed related factors of 1268 adult Chinese patients who underwent 1064‐nm Q‐switched neodymium:yttrium–aluminum–garnet (Nd:YAG) laser (QNYL) treatment using case series and case–control studies. Overall, 24.0% of the ABNOM patients had mixed melasma. Among the ABNOM patients without melasma, after laser therapy the development of melasma was more frequently noted in patients older than 35 years (P < 0.0001), as well in patients whose ABNOM was less than 10 cm² (P = 0.027), ABNOM were light (similar to yellow‐brown) in color (P = 0.021) and skin types were closer to type IV (P < 0.0001). New melasma lesions also appeared most frequently in the zygomatic region (P < 0.0001). Among the ABNOM patients with melasma, 89.5% experienced worsening of their melasma, irrespective of their related factors above. We concluded that the risk of inducing melasma is great after 1064‐nm QNYL treatment in ABNOM patients, and particularly in the patients with both ABNOM and melasma. ABNOM patients should be treated as early as possible and before the age of 35 years.     

A randomized,double‐blind,placebo‐controlled trial to determine the efficacy and safety of lactoferrin with vitamin E and zinc as an oral therapy for mild to moderate acne vulgaris

Lactoferrin is an iron‐binding milk‐derived protein that has shown antibacterial and anti‐inflammatory effects in vitro and in vivo. The objective of this study was to determine the efficacy and safety of lactoferrin, combined with vitamin E and zinc, for mild to moderate acne vulgaris. In this randomized, double‐blind, placebo‐controlled trial, 168 subjects aged 13–40 years old were randomly assigned to take either a capsule formulation containing lactoferrin with vitamin E and zinc or placebo twice a day for 3 months. The primary outcome measure was a reduction in the number of acne lesions compared to placebo. A total of 164 subjects completed the study per protocol. The lactoferrin group (n = 82) showed a significant median percent reduction in total lesions as early as 2 weeks (14.5%, P = 0.0120), with the maximum reduction occurring at week 10 (28.5%, P < 0.0001) compared to placebo group (n = 82). Maximum reduction in comedones (32.5%, P < 0.0001) and inflammatory lesions (44%, P < 0.0001) was also seen at week 10 compared to placebo. Sebum scores were improved by week 12. No adverse events were observed during the trial. A twice daily regimen of lactoferrin with vitamin E and zinc significantly reduced acne lesions in people with mild to moderate acne vulgaris.     

Erythroderma in the era of biological therapies

Erythroderma is a scaling erythematous dermatitis involving 90% or more of the cutaneous surface. Psoriasis and eczema are the most common dermatoses underlying erythroderma. Cutaneous T cell lymphomas can also cause erythroderma. Differential diagnosis between psoriatic erythroderma and lymphomatous erythroderma is often challenging. Tumour necrosis factor-alpha inhibitors are a new class of drugs used in the treatment of psoriasis, even in erythrodermic psoriasis. The effects of anti-tumour necrosis factor-alpha in cutaneous T cell lymphomas have not yet been established. Consequently, it is mandatory to treat an erythrodermic psoriatic patient with tumour necrosis factor-alpha blockers only if a lymphoproliferative cutaneous disorder has been excluded.     

Assessment of selected angiogenesis markers in the serum of middle‐aged male patients with plaque psoriasis

Local angiogenesis accompanies inflammation in psoriasis‐affected skin. To determine the serum concentrations of selected pro‐ and anti‐angiogenic factors and their interrelationships in patients with plaque psoriasis. The study included 41 men diagnosed with psoriasis, aged 43.5 ± 11.7 years. The Psoriasis Area and Severity Index score was 23.4 ± 5.2 points. The control group consisted of 38 healthy, age‐matched men. The levels of pro‐angiogenic cytokines and angiogenesis inhibitors, including fibroblast growth factor 1 (FGF‐1), vascular endothelial growth factor A (VEGF‐A), endostatin, and angiostatin, were determined from the serum of patients and controls using enzyme‐linked immunosorbent assays. Compared with controls, patients with psoriasis had a significantly lower concentration of FGF‐1 (P = .01) but higher concentrations of endostatin (P = .04) and angiostatin (P = .02). The concentration of VEGF‐A was also higher in patients with psoriasis but not significantly (P = .25). The concentration of C‐reactive protein (CRP) was significantly higher among patients with psoriasis than controls (P < .0001). Among controls, CRP concentrations did not correlate significantly with the concentrations of FGF‐1, VEGF‐A, endostatin, or angiostatin. Among patients with psoriasis, CRP concentrations correlated moderately with the concentrations of VEGF‐A (r = .35; P = .02) and angiostatin (r = .31; P = .04). The concentration of VEGF‐A correlated positively with PASI (r = .05; P = .0009) and BSA values (r = .39; P = .01). Psoriasis is associated with an altered systemic balance between pro‐angiogenic and anti‐angiogenic factors. The increase in serum angiogenesis inhibitors may be associated with unfavorable changes in the development of coronary collateral circulation. However, the clinical significance of this has not yet been established.     

Vitamin D deficiency and rickets in children and adolescents with ichthyosiform erythroderma in type IV and V skin

Background Ichthyosiform erythroderma due to keratinizing disorders may suppress cutaneous vitamin D synthesis, leading to vitamin D deficiency and rickets. Objectives To determine the prevalence of vitamin D deficiency and rickets in children and adolescents with congenital ichthyosis and other keratinizing disorders with erythroderma and scaling. Patients and methods In this cross‐sectional study, 45 children and adolescents with ichthyosiform erythroderma due to keratinizing disorders, and 66 controls (group 1: age and sex matched, with skin diseases other than keratinizing disorders; group 2: age and sex matched, healthy volunteers) were included. Evidence of rickets was determined clinically (physical examination and radiographs) and biochemically {serum calcium, phosphorus, alkaline phosphatase, 25‐hydroxy vitamin D [25(OH)D] and parathyroid hormone (PTH)}. Results All patients in the disease group had clinical, radiological or biochemical evidence of rickets [25(OH)D < 20 ng mL^?1], and analysis was done for all subjects with the available biochemical reports. The mean serum 25(OH)D levels of the disease group was 8·38 ± 5·23 ng mL^?1 and was significantly lower than in control group 1 (11·1 ± 5·8 ng mL^?1) (P < 0·01) and control group 2 (13·5 ± 6·9 ng mL^?1) (P < 0·001). The prevalence of vitamin D deficiency [25(OH)D < 20 ng mL^?1] was significantly higher in the disease group (n = 38 of 39, 97·4%) than in control group 2 (n = 12, 70·6%) (P < 0·01), and total controls (n = 56, 84·8%) (P = 0·04). The frequency of hyperparathyroidism (PTH > 65 pg mL^?1) was also significantly higher in the disease group than in controls (P < 0·01). Conclusions Children and adolescents with various forms of ichthyosiform erythroderma, especially those with pigmented skin (types IV–VI), are at increased risk of developing vitamin D deficiency and clinical rickets.     

Safety and efficacy of adalimumab treatment in Japanese patients with psoriasis: Results of SALSA study

The safety and efficacy of adalimumab were evaluated over 24 weeks in Japanese patients with psoriasis in routine clinical practice. In this multicenter, observational, open‐label, postmarketing study, primary efficacy measures included the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) in all patients with psoriasis. In patients with psoriatic arthritis (PsA), the 28‐joint Disease Activity Score (DAS28) and the visual analog scale (VAS) pain were also evaluated. Safety was assessed based on the frequency of adverse drug reactions (ADR). Among patients with psoriasis evaluated for efficacy (n = 604), significant improvements from baseline were observed in mean PASI and DLQI scores at weeks 16 and 24 (all P < 0.0001). Furthermore, in psoriasis patients without PsA, the PASI 75/90 response rates were 55.9%/28.4% at week 16 (n = 306) and 65.6%/43.3% at week 24 (n = 270), respectively. In patients with PsA evaluable for effectiveness, significant improvements from baseline were observed in PASI, DAS28 erythrocyte sedimentation rate, DAS28 C‐reactive protein and VAS pain at weeks 16 and 24 (all P < 0.0001). ADR and serious ADR were reported by 26.1% and 3.3%, respectively, of 731 safety evaluable patients with psoriasis; no unexpected safety findings were noted. The safety profile and effectiveness of adalimumab for the treatment of psoriasis in a routine clinical setting were as expected in Japanese patients.     

Topical 3.0% diclofenac in 2.5% hyaluronic acid gel induces regression of cancerous transformation in actinic keratoses

Background Actinic keratoses (AKs) are frequently diagnosed in dermatological patients. As they represent in situ carcinomas, effective treatment is required. Objectives We investigated the effect of topical 3.0% diclofenac in 2.5% hyaluronic acid gel on AK. Methods Sixty‐five patients with AKs were clinically evaluated before and after 3 months’ treatment with topical 3.0% diclofenac in 2.5% hyaluronic gel. Biopsy specimens were taken and stained with haematoxylin‐eosin and immunohistological markers. Specimens were evaluated for histological type of AKs using the AK classification scheme suggested by Röwert‐Huber et al. [(early) in situ squamous cell carcinoma type AK Grade I–III], number of mitoses per high‐power field and expression of immunohistological markers. Results Complete clinical resolution was observed in 11 patients (16.9%). A significant (P < 0.001) downgrading of AK grade was observed. Complete histological resolution was achieved in 15 patients (23.1%). The number of mitoses per high‐power field was reduced significantly (P < 0.001). The expression of anti‐p53‐antibody decreased significantly (P = 0.009), as did the expression of anti‐MiB‐1 antibody (P = 0.021). Conclusions 3.0% diclofenac in 2.5% hyaluronic acid gel causes regression of signs of cancerous transformation after 3 months’ therapy.     

Professional risk for skin cancer development in male mountain guides – a cross‐sectional study

Objective For reasons of their outdoor work, mountain guides (MG) are heavily exposed to ultraviolet radiation during their work. Methods A standardized interview and examination were performed on 283 male MG (median 41 years) from Germany, Switzerland and Austria and 309 age‐matched controls. The median occupation time as MG was 17 years; 39.9% were working full‐time. Results The incidence of skin cancer and precancerous lesions was obtained. Precancerous lesions as solar keratosis (SK) were significantly more frequent in MG (25.4% vs. 7.4%). There was no skin cancer [BCC, SSC, melanoma (MEL)] in the control subjects. Basal cell carcinoma (BCC) was diagnosed in 20 MG (7.1%) and SSC in four MG (1.4%). There were 10 highly suspicious melanocytic lesions; one MG had a histologically confirmed malignant MEL. Risk factors for SK in the multivariate analysis included occupation (P < 0.0001), age (P < 0.0001) and skin type (P = 0.0002). Within the MG group, age (P < 0.0001) and hair colour (P = 0.0058) were independent risk factors for SK. Severe lifetime sunburns (P = 0.0007) and skin type (P = 0.041) were the significant risk factors for BCC, within the MG group in addition to the number of guiding days (P = 0.010). The risk factor for skin cancer (BCC, SCC and MEL) was the number of heavy sunburns during lifetime (P = 0.0014). Conclusion The present study demonstrates an association between high occupational ultraviolet‐exposure and an increased prevalence of precancerous skin lesions and skin cancer. MG may be considered as an example for other outdoor professionals. Skin cancer of outdoor workers is likely to be an occupational disease. Primary and secondary prevention should be enforced.     

Evaluation of sexual function in patients presenting with Behçet’s disease with or without depression

Aim Sexual dysfunction has been found in many disorders that are chronic or disabling. The aim of this study was to evaluate the sexual satisfaction levels, sexual function and their relationship with the mental state in a group of patients being followed‐up with a diagnosis of Behçet’s disease (BD). Method A total of 50 BD patients and 50 control‐group subjects were administered the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Golombok Rust Sexual Satisfaction Scale (GRISS) and Arizona Sexual Experiences Scale (ASEX). Results The ASEX, GRISS total, HDRS and HARS scores were significantly higher in the patient group than the control subjects (P = 0.0001, P = 0.007, P = 0.0001, P = 0.0001 respectively). Sexual dissatisfaction was seen in 40 (80%) of the patient‐group and 16 (32%) of the control‐group subjects according to the GRISS (P = 0.0001). Female study participants had higher mean scores than the control subjects for the ASEX, GRISS total scores and the GRISS satisfaction, avoidance, vaginismus and orgasm subscale scores (P = 0.0001, P = 0.002, P = 0.02, P = 0.001, P = 0.006, P = 0.03 respectively). Male study participants had different mean scores for the controls regarding the ASEX scores and the GRISS impotence, premature ejaculation, satisfaction and frequency subscale scores (P = 0.01, P = 0.01, P = 0.0001, P = 0.03, P = 0.007 respectively). Discussion The negative effect of the disorder on the biological and functional status and daily living activities in BD patients also influences the patients’ sexual experiences and satisfaction. The negative effects of chronic diseases such as BD should therefore be defined and the disorder evaluated from a wide perspective during the treatment process.     

Psoriasis is associated with increased risk of bullous pemphigoid: A nationwide population‐based cohort study in Taiwan

Psoriasis may coexist with bullous pemphigoid (BP); however, no cohort studies have investigated the relationship between psoriasis and the risk of BP. This study aims to investigate the relationship between psoriasis and the risk of BP in Taiwan. This cohort study consists of 109 777 psoriatic patients and 109 777 matched non‐exposed controls. Psoriatic patients diagnosed between 2002 and 2012 were identified from the Taiwan National Health Insurance Research Database. The age‐, sex‐ and index date‐matched non‐exposed group was selected from the same database. The relationship between psoriasis and the risk of BP was investigated using Cox proportional hazards analyses. Psoriasis was significantly associated with an increased risk of BP (hazard ratio, 3.05; 95% confidence interval, 2.10–4.43; P < 0.001). The mean interval between the diagnoses of psoriasis and BP was 2.86 years, with the highest occurrence in the first year after psoriasis diagnosis, and gradually decreasing with each year of observation. Psoriatic patients with BP were significantly younger than BP patients in the non‐exposed group (71.6 ± 13.9 vs 76.6 ± 7.7 years, respectively; P = 0.030). A higher proportion of patients with coexisting psoriasis and BP received phototherapy (20%). In conclusion, psoriasis was independently associated with a 3.05‐fold increased risk of BP, and psoriatic patients with BP were younger, with over one‐third of BP cases diagnosed in the first year after incident psoriasis. Therefore, clinicians treating patients with psoriasis may be aware of the possibility of the development of BP.     

The increased prevalence of non-alcoholic fatty liver disease in psoriatic patients: A study from South India

Background: Psoriasis is an inflammatory disease of the skin and joints. Previous studies have shown a higher prevalence of metabolic syndrome (MS) in psoriatic patients. Recent studies show that non‐alcoholic fatty liver disease (NAFLD) is also frequent in psoriasis patients. Objectives: To investigate the occurrence and severity of NAFLD in South Indian psoriatic patients and healthy controls. Methods: In phase 1 we performed a case control study on 333 adult psoriasis patients and 330 controls matched by age, sex and body mass index. NAFLD was diagnosed by ultrasonography and liver enzymes after excluding other liver diseases. In phase 2 we compared the NAFLD subgroups in psoriasis patients and controls by determining their fibrosis, steatosis and non‐alcoholic steatohepatitis (NASH) scores. Results: The occurrence of NAFLD was higher in psoriasis patients than in controls (17.4 vs 7.9%; P = 0.002). NAFLD patients in the psoriasis group (n = 58) were more likely to have MS (P = 0.03) and diabetes (P = 0.02) than those with psoriasis alone (n = 254). The former group had a longer duration of psoriasis and arthritis (P = 0.003 and 0.005). Psoriasis patients with NAFLD had more severe disease as per the psoriasis area and severity index scores (P = 0.02). Psoriasis patients had more severe NAFLD than controls as reflected by the steatosis, NASH and fibrosis scores (P = 0.001, 0.003, 0.03 respectively). Conclusion: NAFLD is the commonest liver disease in Indian psoriatic patients when compared to controls. As NAFLD is more severe in psoriasis patients we suggest routine screening for NAFLD in this group especially when systemic therapy is considered.     

French teenagers and artificial tanning

Background  Exposure to solar and artificial ultraviolet (UV) radiations is a major risk factor for skin cancers. France has enacted one of the strictest laws that, notably, restrict tanning‐bed access to adults ≥18 years old. Objective  We evaluated artificial tanning behaviours of French teenagers (11–17 years old): sunless‐tanning products, sunlamps and artificial tanning beds. Methods  An anonymous questionnaire evaluating sunburn history, skin phototype, behaviours with sunless‐tanning products and indoor tanning, and parents’ behaviours was distributed to students enrolled in two middle and high schools in Antony, a typical city of the middle class French population, located in the Paris suburbs. Results  Among 713 teenagers (mean age: 13.5 years: male/female: 1.1) responding, more than half declared that it was important to be tanned during the summer, 1% reported having already used tanning pills, 9.9% tanning creams and 1.4% indoor tanning. Female teenagers significantly more frequently resorted to indoor tanning (P = 0.02), cited the importance of being tanned all year long (P < 0.0001), used tanning pills (P < 0.0001) or tanning creams (P < 0.006), and their parents relied on indoor tanning (P < 0.0001). Profiles of tanning‐pill and ‐cream users were similar. Mean ages for the two groups were comparable. Conclusion  French regulations for indoor tanning seem quite effective. Our analyses revealed a typical teenager profile with sun‐exposure risk behaviours, for example, indoor tanning, and use of tanning pills or creams. They could be a selective target for sun‐protection information campaigns.     

Diagnostic value and prognostic significance of plasmatic proteasome level in patients with melanoma

Abstract: Plasmatic proteasome (p‐proteasome) also called circulating proteasome has recently been described as a tumor marker. We investigated the diagnostic and prognostic accuracies of p‐proteasome levels in a melanoma population classified according to the American Joint Committee on Cancer staging system. Using an ELISA test, we measured p‐proteasome levels in 90 patients and 40 controls between March 2003 and March 2008. The subunit composition of p‐proteasomes was determined in metastatic melanoma by proteomic analysis. The mean p‐proteasome levels were correlated with stages (P < 0.0001; r_S = 0.664). They were significantly higher in patients with stage IV and stage III with lymph node metastasis (9187 ± 1294 and 5091 ± 454 ng/ml, respectively) compared to controls (2535 ± 187 ng/ml; P < 0.001), to stage I/II (2864 ± 166 ng/ml; P < 0.001) and to stage III after curative lymphadenectomy (2859 ± 271 ng/ml; P < 0.001). The diagnostic accuracy of p‐proteasome was evaluated by receiver operating characteristic analysis. With a cut‐off of 4300 ng/ml, diagnostic specificity and sensitivity of p‐proteasome for regional or visceral metastases were respectively 96.3% and 72.2%. In univariate analysis, high p‐proteasome levels (>4300 ng/ml) were significantly correlated with an increased risk of progression [hazard ratio (HR) = 7.34; 95% CI 3.54–15.21, P < 0.0001] and a risk of death (HR = 5.92; 95% CI 2.84–12.33, P < 0.0001). In multivariate analysis, high p‐proteasome levels were correlated with a poorer clinical outcome in the subgroup analysis limited to patients with disease stages I, II and III. Proteomic analysis confirmed the presence of all proteasome and immunoproteasome subunits. Taken together, these results indicate that p‐proteasomes are a new marker for metastatic dissemination in patients with melanoma.     

Clinical study of psoriasis occurring over the age of 60 years: is elderly‐onset psoriasis a distinct subtype?

Background Previous studies demonstrated clinical differences of early‐ and late‐onset psoriasis. However, epidemiological data and clinical characteristics of psoriasis occurring in geriatric patients have been rarely studied. Objective Assessment of epidemiology and clinical features of psoriasis first occurring over the age of 60 years, so‐called elderly‐onset psoriasis, based on clinical data. Materials and methods Among 4049 patients visiting our psoriasis clinic for the last 27 years, patients were first divided into early‐ (onset age before 30 years) and late‐onset psoriasis (onset age after 30 years) based on our previous studies. Then, patients of late‐onset psoriasis were further divided into middle age‐onset group (onset age between 30 and 60 years) and elderly‐onset group (onset age over 60 years). Clinical characteristics of elderly‐onset psoriasis were compared with early‐ and middle age‐onset groups. We acquired the data both by physician’s assessments and patients’ responses. Results Elderly‐onset patients comprised 3.2% of total patients, 129 out of 4049. They have shown a lower incidence of family history (P < 0.05). The severity assessed by PASI score, body surface extent, and activity of individual lesions demonstrated that psoriasis of the elderly‐onset group was generally milder compared with early‐ and middle age‐onset groups (P < 0.05). In clinical phenotypes, the proportion of guttate type and generalized pustular psoriasis type decreased remarkably, while that of erythroderma type increased (P < 0.05). There was a significant change in the body part of origin comparing early‐ and middle age‐onset groups (P < 0.05). The proportion of scalp increased, while that of knee–elbow and trunk decreased significantly (P < 0.05). Patients’ subjective sensation of disease course improved statistically comparing early‐ and middle age‐onset groups (P < 0.05). There was no significant change in the degree of pruritus on psoriatic lesions and nail involvement (P > 0.05). Conclusion The elderly‐onset group demonstrated milder disease courses and some changes in clinical phenotypes and body part of origin compared with early‐ and middle age‐onset groups. Therefore, it seems that patients whose onset of psoriasis was over the age of 60 years might have distinct clinical features in some clinical aspects.