Unraveling oral psoriasis and its relationship with geographic tongue: A literature review

Differentiating between oral psoriasis and geographic tongue is difficult and controversial because some patients with geographic tongue do not necessarily have psoriasis. Furthermore, the number of clinical studies, reporting histopathological and genetic evidence for the definitive diagnosis of oral psoriasis, is limited. The aim of this literature review was to obtain data for supporting the diagnosis of oral psoriasis with particular emphasis on the relationship between psoriasis and geographic tongue. Based on the current data, it can be concluded that geographic tongue is the most common oral lesion in psoriasis, and histopathological, immunohistochemical, and genetic similarities have been observed between the two diseases. This review also emphasizes the importance of conducting oral examinations in patients with psoriasis and skin examinations in patients with geographic tongue.     

Evaluation of the Th17 pathway in psoriasis and geographic tongue

BackgroundPsoriasis is a skin-articular disease with unclear etiopathogenesis. It has been suggested that the disease is immune-mediated by T-lymphocytes, predominantly Th17 cells. Similar to psoriasis, geographic tongue is an inflammatory disease with participation of Th17 cells and direct correlation with psoriasis.ObjectiveTo investigate and compare the inflammatory responses and the Th17 pathway in psoriasis and geographic tongue.MethodsThis was a cross-sectional study with 46 participants that were categorized into three groups: (A) patients with psoriasis vulgaris; (B) patients with geographic tongue and psoriasis; (C) patients with geographic tongue without psoriasis. All patients underwent physical examination, and a skin and oral biopsy for histopathological examination and immunohistochemical analysis with anti-IL6, anti-IL17, and anti-IL23 antibodies.ResultsHistological analysis of all lesions showed mononuclear inflammatory infiltrate. However, moderate intensity was prevalent for the patients with geographic tongue and psoriasis and geographic tongue groups. Immunopositivity for the antibodies anti-IL6, anti-IL17, and anti-IL23 revealed cytoplasmic staining, mainly basal and parabasal, in both psoriasis and geographic tongue. Regarding IL-6, in patients with geographic tongue and psoriasis cases the staining was stronger than in patients with geographic tongue without psoriasis cases. IL-17 evidenced more pronounced and extensive staining when compared to the other analyzed interleukins. IL-23 presented similar immunopositivity for both geographic tongue and psoriasis, demonstrating that the neutrophils recruited into the epithelium were stained.Study limitationThis study was limited by the number of cases.ConclusionThe inflammatory process and immunostaining of IL-6, IL-17, and IL-23 were similar in geographic tongue and psoriasis, suggesting the existence of a type of geographic tongue that represents an oral manifestation of psoriasis.     

Electron microscopy of composite and intranuclear keratohyalin granules in geographic tongue of psoriasis

Composite and intranuclear keratohyalin granules were observed in an electron-microscopic study of geographic tongue of psoriasis. The significance of intranuclear keratohyalin is not known, but it seems to be related to the disturbed proliferation and differentiation of keratinocytes in psoriasis.     

The relationship of psoriasis to malignancy: a clinical report

A large variety of cutaneous reactions to malignancy have been described but to our knowledge none include psoriasis. Two cases of psoriasiform reactions in association with malignancy were first documented by Braverman,¹ and Bazex's syndrome is now well documented in the literature.^2–4 Both conditions, although clinically psoriasiform, are said to demonstrate an eczematous histology. A number of patients with psoriasis and malignancy have presented to us in the Dermatology Department. The appearance or behaviour of their psoriasis appeared to be linked to their malignancy. We have collected them together to report on this phenomenon which appears infrequently in the literature.     

Quality of life and clinical features in Swedish children with psoriasis

Psoriasis is a common, chronic disease and in one-third of the patients it begins during the first 2 decades of life. The burdens of psoriasis are many, and some can be assessed with quality of life questionnaires. The aim was to investigate the impact of childhood psoriasis on quality of life in children and their parents and to correlate certain clinical findings with quality of life. Forty-five Swedish children (4-16 years, 28 girls) with psoriasis, and their parents, were investigated with the validated questionnaires Children's Dermatology Life Quality Index (5-16 years, n = 42), The Infant's Dermatitis Quality of Life Index (4 years, n = 3), and Dermatitis Family Impact (n = 45), the two latter with the word eczema replaced by psoriasis. Clinical examination was performed, and psoriasis severity was scored with Psoriasis Area and Severity Index. Chronic plaque psoriasis was the most common clinical type (87%). Four of the children had joint complaints. Ninety-three percent had pruritus the preceding 3 days. Ninety-three percent were receiving treatment. Median Psoriasis Area and Severity Index score was 3.3 (range 0.5-12.3). Median score for the Infant's Dermatitis Quality of Life Index was 4.0 (range 2-12), for Children's Dermatology Life Quality Index 4.0 (0-24), and for Dermatitis Family Impact questionnaire 4.0 (0-25). No significant gender difference existed. The Children's Dermatology Life Quality Index scores were higher for younger (5-8 yrs) than older (9-16 yrs) children and higher for those with joint complaints. The Dermatitis family impact scores correlated significantly with Children's Dermatology Life Quality Index and Psoriasis Area and Severity Index scores, but the Children's Dermatology Life Quality Index did not correlate with Psoriasis Area and Severity Index. The Visual Analog Scale and quality of life scores were significantly correlated. Psoriasis in children affects quality of life in the subjects and their parents. Joint complaints and pruritus significantly impair quality of life.     

Epidemiology and clinical features of pediatric psoriasis in tertiary referral psoriasis clinic

Few epidemiological studies of pediatric patients with moderate to severe psoriasis have been available despite there being no approved systemic therapy for these patients. The aim of the present study was to elucidate clinical features of pediatric psoriasis in a tertiary referral psoriasis clinic. We analyzed the clinical data of 358 patients under 18 years of age referred to our clinic from other private clinics and medical centers. Our data showed a male :female ratio of 1.06:1 and a peak age of onset of 10-11 years. Of the patients, 32.4% had a positive family history. The most prevalent phenotype was plaque type (67.3%) and the mean Psoriasis Area and Severity Index score was 17.2 ± 12.7. The most frequently affected body part was the trunk (69.5%), followed by the legs (65.3%). Exposure to sunlight and summer season improved psoriatic lesions, while stress and winter season aggravated the clinical course. Only 26.0% of patients received systemic therapy or phototherapy during the therapeutic course. Oral acitretin (11.2%) was most frequently used followed by ultraviolet B phototherapy (7.3%). The childhood group (<13 years) showed higher prevalence of guttate and generalized pustular phenotypes and more severe clinical course compared with the adolescent group (13-18 years). In conclusion, our patients showed distinctive features in clinical phenotypes, disease severity and affected body parts compared with previous reports. We also found that clinical application of systemic therapies were limited considering the severe disease state of our patients, demanding a need for more research on treatment of pediatric psoriasis.     

The treatment of geographic tongue with topical Retin-A solution.

A new treatment for geographic tongue with topically applied tretinoin is suggested and its effective use on three patients is described.     

Nail involvement in adult patients with plaque-type psoriasis: prevalence and clinical features

BACKGROUND:

Psoriasis is a disease of worldwide distribution with a prevalence of 1 to 3%. Nail psoriasis is estimated in 50% of patients with psoriasis, and in the presence of joint involvement, it can reach 80%.

OBJECTIVE:

To study the nail changes - and their clinical implications - presented by patients with psoriasis vulgaris under surveillance in a university hospital from the south of Brazil.

METHODS:

his cross-sectional study evaluated 65 adult patients from January 2012 to March 2013. Cutaneous severity was assessed according to the Psoriasis Area and Severity Index (PASI). The Nail Psoriasis Severity Index (NAPSI) was used to evaluate patient''s nails. The diagnosis of psoriatic arthritis was established according to the Classification Criteria for Psoriatic Arthritis (CASPAR).

RESULTS:

The prevalence of NP was 46.1%. These patients had a median [interquartilic range (IQR)] NAPSI of 1 (0-15). A total of 63.3% of patients reported aesthetic discomfort or functional impairment related to their nails. Onycholysis was the most common feature (80%). When compared with patients without nail involvement, patients with NP had lower mean age at psoriasis onset [21 (18-41) vs. 43 (30-56) years, p=0,001]; longer disease duration [15.5 (10-24) vs. 6 (2-12) years, p=0.001]; higher PASI [9.2 (5-17) vs. 3.7 (2-10), p=0.044], higher frequency of psoriatic arthritis (43.3 vs. 3.7, p = 0.002) and more often reported family history of psoriasis (40% vs. 7.4%, p = 0.011).

CONCLUSION:

Onycholysis was the most frequent finding and most patients feel uncomfortable with the psoriatic nail changes that they experience.     

Update on pediatric psoriasis, part 1: clinical features and demographics

Pediatric psoriasis consists of infantile psoriasis, a self-limited disease of infancy; psoriasis with onset in childhood; and psoriasis with psoriatic arthritis. Approximately one-quarter to one-third of cases of psoriasis begin before 18 years of age. A variety of lesion types are seen in childhood, including plaque-type, guttate, nail-based, napkin, and erythrodermic disease. This article reviews current concepts in pediatric psoriasis. Part 2 will review therapeutics for psoriasis.     

The evaluation of the sociodemographic and clinical features of Turkish psoriasis patients

BACKGROUND: Psoriasis is a common, chronic and recurrent, inflammatory disease of the skin. With no sociodemographic psoriasis data available in Turkey, we decided to investigate the clinical features and distribution of this disease in our country. METHODS: The records of 329 patients with psoriasis were retrospectively reviewed. RESULTS: Psoriasis constituted 1.3% of the total dermatological disorders. Sixty-one per cent of the patients were female, and 39% were male. The mean age at onset of disease was 25 +/- 16 years in females, and 28 +/- 15 years in males. Family history was positive 30% of the patients. A positive family history was observed in 25% of the females and 37% of the males. 312 cases (95%) had psoriasis vulgaris, 17 cases (5%) had pustular psoriasis. Of the patients with psoriasis vulgaris, 212 (68%) had plaque, 73 (23%) guttate, 18 (6%) palmoplantar, 9 (3%) inverse type. The mean and median PASI score were 3.7 +/- 3.8 & 2.7 for females, 5.4 +/- 6.1 & 3.5 for males, respectively. 1.5% of patients had psoriatic arthropathy. Nail changes were seen in 54 (16%) of the cases. The various nail involvement types observed in descending frequency were: pitting (13%), subungual hyperkeratoses (7%), onycholysis (2%), discoloration (1.5%), oily spot (1%) and splinter hemorrhages (0.3%). CONCLUSIONS: The prevalence of psoriasis in Turkey is similar to numbers reported in South America and Germany. Females were predominant, and the mean age of onset was lower in women. Positive family history was more frequent in males. Plaque type psoriasis was the most common presentation. The difference between mean PASI scores of female and male patients was not statistically significant. Psoriatic arthritis was extremely rare in Turkish psoriasis patients. Pitting was the most common abnormality of the nails.     

银屑病患者血浆内皮素含量检测的临床意义

为探讨内皮素 (ET)在银屑病发病机理方面的作用及关系,采用放射免疫分析法检测了 35例银屑病患者的 ET含量,并与 30名健康者进行了对照。结果银屑病组的 ET水平明显高于正常对照组 P< 0.01,但寻常型进行期与静止期、病程≤ 1年与 >1年,局限型与泛发型、寻常型与掌跖脓疱型之间无明显差异 (P >0.05)。     

Treatment of psoriasis with oral liarozole: a dose-ranging study

BACKGROUND: Liarozole is an inhibitor of the metabolism of all-trans-retinoic acid. Systemic administration increases tissue levels of this endogenous retinoid and has been reported to improve psoriasis in an open, uncontrolled study. OBJECTIVES: A multicentre, double-blind, placebo-controlled, dose-ranging study was therefore undertaken to determine the lowest effective oral dose of liarozole in the treatment of psoriasis vulgaris. PATIENTS/METHODS: Adult male and postmenopausal female patients requiring systemic treatment for psoriasis were randomized to receive placebo or liarozole at total daily doses of 50 mg, 75 mg or 150 mg for 12 weeks. The daily doses were each divided into two equal (morning and evening) doses. Response was assessed using an eight-point global scale to assess improvement and by monitoring the Psoriasis Area and Severity Index (PASI). The primary end-point was the proportion of subjects in each treatment group demonstrating 'marked improvement' or better as assessed on the eight-point scale. The tolerability of the treatment was assessed by recording mucocutaneous effects of retinoids and all adverse events. Biochemical and haematological monitoring were also performed. RESULTS: One hundred and thirty-nine subjects were randomized (118 male and 21 female) and 116 completed the study. A marked improvement or better response was observed in 6% of subjects on placebo, 18% on liarozole 50 mg, 11% on 75 mg and 38% on 150 mg. Only in the 150-mg group was the response rate significantly different to placebo (P < 0.001). Over the treatment period the mean PASI changed from 15.9 to 15.4 on placebo, from 17.4 to 13.8 on liarozole 50 mg, from 17.5 to 14.5 on 75 mg and from 15.8 to 8.8 on 150 mg. Again, only in the group receiving 150 mg was the response significantly better than placebo (P < 0.001). Liarozole was generally well tolerated. Mucocutaneous retinoid effects were generally infrequent and mild. Five subjects were withdrawn from treatment as a result of adverse events that may have been treatment related. These events were abnormalities of liver enzymes in two cases, an episode of erythema multiforme (in a patient receiving placebo), an allergic reaction in one and a rash accompanied by deterioration of the psoriasis in another. There was mild elevation of triglycerides in the groups receiving liarozole 75 mg and 150 mg daily. In males, the serum luteinizing hormone and testosterone levels rose significantly in all the active treatment groups. CONCLUSIONS: The data confirm that liarozole is an effective treatment for psoriasis and indicate that the lowest effective dose is 75 mg twice daily. The drug seems generally to be well tolerated.     

银屑病的遗传率及其家庭内聚集性的研究

本文对3149例银屑病病人家族史进行了统计分析,通过4次总结计算,估计银屑病的遗传率及其标准误在38±1.2~48±1.2%之间.初步认为银屑病符合多基因遗传性疾病,环境因素对发病的影响不容忽视.用Poisson分布法对吉林省长春市部分地区408户银屑病家庭作了分布拟合,银屑病家庭有极显著的家庭内聚集性.推测银屑病发病与遗传易感(患)素质、感染或其他环境因素有关.     

The relationship between oxidative stress,smoking and the clinical severity of psoriasis

Background Recent studies suggested that increased oxidant products and decreased antioxidant system functions may be involved in the pathogenesis of psoriasis. In this study, we investigated total oxidative status, Paraoxonase (PON)1/arylesterase enzyme activities and severity of the disease in smoker and non‐smoker psoriatic patients. Methods Fifty‐four patients with plaque type psoriasis (28 smokers and 26 non‐smokers) and 62 healthy volunteers (16 smokers and 46 non‐smokers) were enrolled in the study. Serum total oxidant status (TOS), total antioxidant capacity (TAC) and arylesterase levels were measured, and oxidative stress index (OSI) was calculated in all participants. Results Psoriasis Area and Severity Index scores were significantly higher in smoker patients than in non‐smoker patients (P = 0.014). Both smoker and non‐smoker patients had significantly increased TOS levels and OSI values and decreased TAC levels than healthy subjects (all P values = 0.000). The TAC and TOS levels, OSI values and arylesterase activities were similar between smoker and non‐smoker patients. The levels of triglyceride (TG), total cholesterol (TC), low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) were not significantly different between smoker and non‐smoker psoriasis patients. When compared with non‐smoking controls, only smoking psoriasis patients had significantly higher TG (P = 0.005), lower HDL (P = 0.022) and lower arylesterase levels (P = 0.015). There were no significant correlations with Psoriasis Area and Severity Index (PASI) scores and TAC, TOS, OSI, TG, TC, HDL and LDL levels in all psoriasis patients. Conclusions Oxidative stress is increased in psoriasis patients regardless of their smoking status. The decreased arylesterase activity in smoker psoriasis patients suggested that smoking may be a considerable risk factor that increases the severity of psoriasis by increasing oxidative stress in these patients.