Generalized pustular eruptions due to terbinafine

Terbinafine, a widely used antifungal agent, may rarely cause cutaneous side effects with an incidence of 2.7%. Generalized pustular eruptions are quite uncommon but severe adverse cutaneous reactions of terbinafine have been reported. The main pustular eruptions due to terbinafine include acute generalized exanthematous pustulosis and drug induced pustular psoriasis. In this report, two cases of acute generalized exanthematous pustulosis and one case of generalized pustular psoriasis triggered with terbinafine are presented.     

Psoriasis is independently associated with psychiatric morbidity and adverse cardiovascular risk factors,but not with cardiovascular events in a population‐based sample

Background Psoriasis may significantly reduce quality of life. Previous studies reported an association of psoriasis and cardiovascular risk factors and cardiovascular events. The extent to which psoriasis is associated with psychiatric morbidity and the role of psychiatric comorbidity as a potential confounder of the association between psoriasis and cardiovascular morbidity require further investigation. Objectives To study the association between psoriasis, psychiatric morbidity and cardiovascular morbidity. Methods Case–control study utilizing an interdisciplinary administrative outpatient database from Germany. Patients with confirmed diagnosis of prevalent psoriasis within the study period (2003–2004) (n = 3147, mean age 57 years) were individually matched for age and gender with 3147 controls without psoriasis. The relationship of psoriasis with psychiatric morbidities (depression, stress‐related disorders, behaviour disorders and schizophrenic disorders), cardiovascular risk factors (diabetes, hypertension, obesity and dyslipidaemia) and cardiovascular events [myocardial infarction (MI), stroke] was investigated using logistic and linear regression models. Results Crude analyses suggested an association of psoriasis with depression, stress‐related disorders, behaviour disorders and cardiovascular risk factors, but not with MI [odds ratio (OR) 1.14; 95% confidence interval (95% CI) 0.81–1.62] or stroke (OR 0.97; 95% CI 0.61–1.54). Multivariate models controlling for age, gender and consulting behaviour indicated that psoriasis is independently associated with depression (OR 1.49; 95% CI 1.20–1.86), stress‐related disorders (OR 1.41; 95% CI 1.22–1.62), behaviour disorders (OR 1.58; 95% CI 1.05–2.39), diabetes (OR 1.21 95% CI 1.04–1.40), hypertension (OR 1.34; 95% CI 1.18–1.51), dyslipidaemia (OR 1.29; 95% CI 1.07–1.55), and obesity (OR 1.63; 95% CI 1.39–1.90). For each psychiatric condition, the likelihood of being affected significantly increased with each physician visit due to psoriasis, suggesting that the risk of psychiatric comorbidity increases with the severity of psoriasis. Conclusion Psoriasis appears to be independently associated with major psychiatric disorders and with cardiovascular risk factors, but not with cardiovascular events.     

瘦素及瘦素受体在银屑病皮损中的表达

目的:检测银屑病皮损中瘦素及其受体的表达。方法:40例银屑病患者皮损和18名正常人皮肤标本,采用SP免疫组化法检测皮肤石蜡标本中瘦素的表达,ELISA法检测瘦素受体的表达。结果:银屑病患者皮损中瘦素表达明显高于正常皮肤(P0.01),主要分布在表皮的胞浆和胞核。患者皮损中瘦素受体含量为103.4±18.7 pg/mL高于正常对照组的76.9±13.5 pg/mL(P0.05)。结论:瘦素及其受体可能参与了银屑病的发病。     

Psoriasis and bone mineral density: Implications for long‐term patients

Psoriasis is a chronic inflammatory disease associated with several comorbidities. Osteoporosis is defined as a reduction in bone mineral density with impaired bone microarchitecture. Several mechanisms may be implicated as a possible cause for the association between psoriasis and osteoporosis, such as systemic inflammation, anti‐psoriatic drug intake and joint dysfunction for psoriatic arthritis (PsA). The aim of the present study was to assess bone mineral density (BMD) in patients with psoriasis, correlating the prevalence of osteopenia/osteoporosis with Psoriasis Area and Severity Index (PASI) score, mean duration of psoriatic disease, PsA and previous treatments for psoriasis. Forty‐three consecutive patients with psoriasis, 19 of whom were affected by the arthropathic form, were enrolled. We evaluated the severity of psoriasis as measured by PASI score, the CASPAR criteria and ultrasounds of the joints to verify the diagnosis of PsA and the age of psoriasis onset to estimate mean disease duration. Patients underwent a bone density scan of the lumbar spine and femoral neck by dual‐energy X‐ray absorptiometry to measure BMD. Patients with osteopenia/osteoporosis showed a statistically significant longer average duration of psoriatic disease (17 years), compared to patients affected by psoriasis with normal T‐score (8.8 years) (P = 0.04). The linear logistic regression confirms a significant relation between mean psoriatic disease duration and BMD alterations (P = 0.04). Our results suggest the necessity of an early diagnostic evaluation of bone metabolism in patients with psoriasis, especially if characterized by longer disease duration.     

顽癣敌软膏治疗寻常型银屑病临床疗效观察

目的观察顽癣敌软膏治疗局限性寻常型银屑病临床疗效及安全性。方法临床开放性试验,选择基线PASI评分≤10的寻常型银屑病患者100例外用顽癣敌软膏治疗,2次/d外用,疗程8周,分别于治疗后4、8周登记PASI评分。结果顽癣敌软膏能改善局限性寻常性银屑病的临床症状,3例患者用药后局部出现轻度潮红、烧灼感。治疗4周、8周后PASI评分明显下降,与治疗前比较,差异均有统计学意义(P0.01)。结论顽癣敌软膏对局限性寻常型银屑病有一定临床疗效,安全性好。可用于稳定期或静止期的患者。     

Cutaneous Crohn's disease with superimposed psoriasis: A unique case with overlapping histology

Crohn's disease (CD) is an idiopathic, chronic inflammatory disorder of the gastrointestinal tract. We recently encountered a unique case in which a patient with longstanding CD presented with skin lesions with histopathologic features of both psoriasis and granulomatous inflammation suggestive of cutaneous CD. To our knowledge, this has not been described concomitantly in the same patient, in the same lesions. Review of the literature suggests that the intersection of these 2 histopathological reaction patterns may not be pure coincidence. Clinical‐pathologic correlation of this case will be discussed, along with a review of the potential mechanisms of this unique disease presentation.