不同严重程度银屑病对患者生活质量的影响

目的：探讨不同严重程度银屑病对患者生活质量的影响。方法：设计生活质量问卷，从日常生活、工作和学习、社会交往、心理等几个方面，调查504例18岁以上寻常性银屑病患者，由医生完成银屑病的严重度评价（PASI积分）。最后用SPSS统计软件对资料进行分析和整理。结果：498例银屑病患者因病情轻重不同，对患者日常生活、社会交往、心理的影响不同。表现为饮食受限占63．3％，睡眠差占40．2％，穿衣受限占59．0％，使用公共交通工具及公用设施受影响占26．5％，理发或美容时遭到拒绝占15．1％，患者收入受到影响占31．2％；这些表现在病情严重的患者中更明显。皮损发生在阴股部的患者性生活受到极严重影响。银屑病患者在社交或其他公共场所感到不自在者占58．8％，与人交往的愿望受限占43．3％，不愿参加社会活动占29％，尽量避免与他人握占占25．8％；随病情加重愈加明显。54．9％的患者觉得自尊心受到伤害，总觉得别人在有意回避自己者占26．6％。64．4％的患者因为自己的银屑病焦虑不安，83．1％的患者经常担心银屑病会复发或加重。15．9％的患者曾有轻生的想法，中重度患者中比例增加。结论：随着病情严重程度的增加，银屑病对患者的日常生活、工作学习、社会交往和心理的影响较大；应在生理－心理－社会医学的模式上治疗银屑病，除皮肤科躯体治疗外，传授疾病知识，指导患者应付疾病所带来的问题以及心理治疗，有助于提高生活质量。     

Impact of Psoriasis on Quality of Life: Relationship between Clinical Response to Therapy and Change in Health-related Quality of Life

Background

Psoriasis exerts significant, negative, impact on patients'' quality of life (QOL). Recently, the relationship between QOL and skin lesion improvement has been emphasized in the treatment of psoriasis patients.

Objective

The purpose of study was to compare the QOL in psoriasis and other skin diseases, and to evaluate the generic QOL, skin specific QOL, stress, depression and anxiety before and after treatment in patients.

Methods

A total of 138 patients with psoriasis were recruited in this study and 83 patients complete the questionnaire at week 16. Questionnaires were comprised of generic WHO QOL scale, dermatology specific questionnaires (Skindex-29), psoriasis life stress inventory (PLSI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Clinical response was assessed by the PASI.

Results

After treatment, health-related QOL was improved and PASI improvement showed smaller correlation with Skindex-29, compared with the correlations between self-reported severity score (SRSS) improvement and Skindex-29. Regression analysis revealed that duration, SRSS, stress, and depression were factors affecting baseline HRQOL in patients, and age, duration, and SRSS were predictors associated with HTQOL score changes.

Conclusion

Treatment improved HRQOL, BAI, BDI, and PLSI scores. Psoriasis may become more burdensome in groups of patients who suffer long disease duration, high SRSS, depression, and stressful environments.     

Quality of Life and Body Region Affected by Psoriasis: A Systematic Review

PurposePsoriasis is a chronic skin condition that affects approximately 1–3% of the world's population and is known to decrease patients’ quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life.MethodsA systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review.FindingsPsoriatic patches and plaques in different areas of the body were not found to influence patients’ quality of life to differing extents.ConclusionsWhile the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients’ quality of life, with neither one region doing so to a significantly greater extent than another.     

Impact of Pediatric Alopecia Areata on Quality of Life of Patients and Their Family Members: A Nationwide Multicenter Questionnaire Study

BackgroundPediatric alopecia areata (AA) can affect the quality of life (QoL) of patients and their family members. Research on the QoL and burden on family members in pediatric AA is limited.ObjectiveThis nationwide multicenter questionnaire study described the QoL and burden of the family members of patients with pediatric AA.MethodsThis nationwide multicenter questionnaire study enrolled AA patients between the ages of 5 and 18 years from March 1, 2017 to February 28, 2018. Enrolled patients and their parents completed the modified Children’s Dermatology Life Quality Index (CDLQI) and the modified Dermatitis Family Impact (mDFI). The disease severity was measured using the Severity of Alopecia Tool (SALT) survey scores.ResultsA total of 268 patients with AA from 22 hospitals participated in this study. Our study found that the efficacy and satisfaction of previous treatments of AA decreased as the severity of the disease increased. The use of home-based therapies and traditional medicines increased with the increasing severity of the disease, but the efficacy felt by patients was limited. CDLQI and mDFI scores were higher in patients with extensive AA than those with mild to moderate AA. The economic and time burden of the family members also increased as the severity of the disease increased.ConclusionThe severity of the AA is indirectly proportional to the QoL of patients and their family members and directly proportional to the burden. Physicians need to understand these characteristics of pediatric AA and provide appropriate intervention to patients and their family members.     

Which Areas Are Still Left in Biologics Responsive Korean Patients with Moderate to Severe Plaque Psoriasis

BackgroundPsoriasis localized to certain body areas, such as the scalp, nails, palms, soles, intertriginous regions, and genital regions, is reportedly difficult to treat.ObjectiveTo investigate the biologics-resistant areas in South Korean patients with psoriasis treated with biologics.MethodsThe study included 50 patients with chronic moderate to severe plaque psoriasis from the Pusan National University Hospital and Chosun University Hospital between October 2019 and September 2020. The patients had at least one psoriatic lesion, were treated with biologics for more than six months, and exhibited a partial or good response (reaching a Psoriasis Area and Severity Index [PASI] score of 1~5 after biologics treatment).ResultsA total of 50 patients with psoriasis (32 male, mean±standard deviation 47.8±11 years), with a median PASI score of 1.8, were included. The most common biologics-resistant areas were the anterior lower leg (56.0%), followed by the knee (48.0%) and posterior lower leg (42.0%). The proportion of biologics-resistant areas were obtained for body regions traditionally considered as difficult-to-treat entities, including the fingernails (10.0%), toenails (14.0%), scalp (38.0%), palm (12.0%), sole (14.0%), and genital areas (10.0%).ConclusionThis study determined the biologics-resistant areas in South Korean patients, successfully treated with biologics, in a real-world clinical setting.     

Internalized stigma in psoriasis: A multicenter study

Internalized stigma is the adoption of negative attitudes and stereotypes of the society regarding a person's illness. It causes decreased self‐esteem and life‐satisfaction, increased depression and suicidality, and difficulty in coping with the illness. The primary aim of this study was to investigate the internalized stigma state of psoriatic patients and to identify the factors influencing internalized stigma. The secondary aim was to identify the correlation of internalized stigma with quality of life and perceived health status. This multicentre, cross‐sectional study comprised 1485 patients. There was a significant positive correlation between mean values of Psoriasis Internalized Stigma Scale (PISS) and Psoriasis Area and Severity Index, Body Surface Area, Dermatological Life Quality Index and General Health Questionnaire‐12 (P < 0.001 in all). Lower percieved health score (P = 0.001), early onset psoriasis (P = 0.016), family history of psoriasis (P = 0.0034), being illiterate (P < 0.001) and lower income level (P < 0.001) were determinants of high PISS scores. Mean PISS values were higher in erythrodermic and generalized pustular psoriasis. Involvement of scalp, face, hand, genitalia and finger nails as well as arthropathic and inverse psoriasis were also related to significantly higher PISS scores (P = 0.001). Our findings imply that psoriatic patients experience high levels of internalized stigma which are associated with psoriasis severity, involvement of visible body parts, genital area, folds or joints, poorer quality of life, negative perceptions of general health and psychological illnesses. Therefore, internalized stigma may be one of the major factors responsible from psychosocial burden of the disease.     

银屑病的治疗及与5-羟色胺关系的对比观察

目的　探讨 5 羟色胺 (5 HT)相关药物治疗银屑病的疗效 ,揭示 5 HT在银屑病发病机制中的作用。方法　A组 3 5例患者采用赛庚啶、复方丹参注射液、胸腺肽注射液、普鲁卡因静脉封闭和中药治疗 ;B组 3 3例患者采用胸腺肽注射液和中药治疗 ;C组 3 2例患者采用维生素C、维生素E治疗。治疗前 3 6例、治疗痊愈后 2 5例患者抽静脉血检测全血 5 HT含量。结果　A、B、C三组总有效率分别为 77.14 %、5 4.5 4%、9.2 8% ,三组比较差异有显著性 ;治疗前全血 5 HT含量低于正常对照组 (P <0 .0 1) ,治疗痊愈后全血 5 HT含量接近正常对照组 (P >0 .0 5 )。结论　 5 HT相关药物是治疗寻常性银屑病的有效药物 ,5 HT通过与CD+ 4 淋巴细胞表面上 5 HT受体结合而参与银屑病的发病。     

竹黄颗粒剂Ⅱ号对寻常性银屑病患者生活质量影响的研究

目的　探讨竹黄颗粒剂Ⅱ号对寻常性银屑病患者生活质量的影响。方法　纳入了 5 8例生活质量受明显影响的寻常性银屑病患者 ,随机分为竹黄组、银屑组 ,分别于治疗前、治疗后用皮肤病生活质量表 (DQOLS)、银屑病皮损面积与严重程度指数 (PSAI)进行评价。结果　竹黄组的患者DQOLS和PASI积分均得到明显改善 ,显著优于银屑组 (P<0 .0 1) ;竹黄组DQOLS的改善程度与PASI的改善程度显著相关 (P <0 .0 5 )。结论　竹黄颗粒剂Ⅱ号有利于皮损症状的改善从而提高寻常性银屑病患者的生活质量。     

[Artículo traducido] Calidad de vida y región corporal afectada por la psoriasis: una revisión sistemática

PurposePsoriasis is a chronic skin condition that affects approximately 1–3% of the world's population and is known to decrease patients’ quality of life. However, it is yet to be ascertained whether the specific location of psoriatic lesions on the body influences one's quality of life.MethodsA systematic review was conducted with a search of MEDLINE, EMBASE, and Web of Science databases. Only non-case report and non-review studies with explicitly stated body regions affected by psoriasis were included in the review.FindingsPsoriatic patches and plaques in different areas of the body were not found to influence patients’ quality of life to differing extents.ConclusionsWhile the body of evidence is limited and presents unstandardized results, the results of this review point to the fact that all psoriatic patches and plaques decrease patients’ quality of life, with neither one region doing so to a significantly greater extent than another.     

Association of Metabolic Comorbidities with Pediatric Psoriasis: A Systematic Review and Meta-Analysis

BackgroundAn evident relationship has been shown between psoriasis and metabolic comorbidities. However, the results in pediatric psoriasis vary from study to study, and no meta-analysis exists on the association of metabolic comorbidities with pediatric psoriasis.ObjectiveTo evaluate the association between psoriasis and metabolic comorbidities in pediatric patients.MethodsWe searched articles published in PubMed, EMBASE, and Cochrane Library databases from inception to April 30, 2019. All observational studies reporting the prevalence of obesity or metabolic comorbidities in pediatric patients with psoriasis were included.ResultsThe meta-analysis included 16 unique studies meeting the inclusion criteria. The pooled odds ratios in pediatric patients with psoriasis was 2.40 (95% confidence interval [CI], 1.60~3.59) for obesity (13 studies), 2.73 (95% CI, 1.79~4.17) for hypertension (8 studies), 2.01 (95% CI, 1.09~3.73) for diabetes mellitus (8 studies), 1.67 (95% CI, 1.42~1.97) for dyslipidemia (7 studies), and 7.49 (95% CI, 1.86~30.07) for metabolic syndrome (4 studies).ConclusionPediatric patients with psoriasis showed a significantly higher prevalence of obesity, hypertension, diabetes, dyslipidemia, and metabolic syndrome. Adequate monitoring and timely management of metabolic comorbidities should be considered in these patients.     

IL-33在银屑病发病机制中的研究进展

银屑病是一种炎症性皮肤病,其发病与多种细胞因子有关。白细胞介素(IL)-33是IL-1细胞因子超家族的成员,与多种疾病关系密切,尤其是在急、慢性炎症的发生与发展中发挥着重要的作用。近年来,越来越多的研究发现IL-33在银屑病的发病中起着重要的作用,基于IL-33的治疗也取得了一定的进展。本文就IL-33在银屑病中的研究进展作一综述。     

银屑病患者血清和皮损中血管内皮细胞粘附分子的对比研究

目的 探讨银屑病患者血清和皮损中4种血管内皮粘附分子表达与银屑病疾病活动性之间的关系。方法 采用ELISA法检测36例银屑病患者治疗前后和36例健康人的血清中可溶性粘附分子（sICAM-1、sICAM-3、sVCAM-1、sELAM）的浓度。同时用ABC免疫组化染色技术检测了36例银屑病患者皮损和临床治愈处皮肤粘附分子（ICAM－1、ICAM－3、VCAM－1、ELAM）的表达情况。结果 与正常人相比，银屑病患者皮损部位4种粘附分子的原位表达呈明显上调（P＜0.005），同时患者血清中4种可溶性粘附分子浓度也明显升高（P＜0.001）。经治疗后银屑病患者皮损部位4种粘附分子的原位表达明显下调（P＜0.05），同时血清中4种可溶性粘附分子浓度比前也下降（P＜0.05）；血清中4种可溶性粘附分子的浓度与银屑病疾病活动严重指数（PASI）均呈正相关，但治疗前后sVCAM-1的水平上升和下降的幅度最大，且与PASI的相关性最好。结论 血管内皮细胞粘附分子参与银屑病的发病机制；患者血清中可溶性粘附分子浓度的升高可能与皮损部位血管内皮细胞上相应的粘附分子高表达有关；血清VCAM－1的水平可以作为反映银屑病疾病活动的一个新的敏感指标。     

Quality of Life Assessment in Male Patients with Androgenetic Alopecia: Result of a Prospective, Multicenter Study

Background

Androgenetic alopecia (AGA) is a common hair loss disease with genetic predisposition among men and women, and it may commence at any age after puberty. It may significantly affect a variety of psychological and social aspects of one''s life and the individual''s overall quality of life (QoL).

Objective

This study aimed to investigate the QoL of AGA patients and discover the factors that can influence the QoL of AGA patients, including previous experience in non-medical hair care, reasons for hospital visits, age, duration, and the severity of AGA.

Methods

A total of 998 male patients with AGA were interviewed, using the Hair Specific Skindex-29 to evaluate the QoL of AGA patients.

Results

The results of the Hair Specific Skindex-29 on patients with AGA were as follows: symptom scale: 26.3±19.5, function scale: 24.0±20.1, emotion scale: 32.1±21.8, and global score: 27.3±19.1. According to this assessment, QoL was more damaged if the patient had severe alopecia, a longer duration of AGA, younger age, had received previous non-medical hair care, and visited the hospital for AGA treatment.

Conclusion

This study showed that AGA could harmfully affect the patients'' QoL. These findings indicate that dermatologists should address these QoL issues when treating patients with alopecia.     

Clinical Manifestations of Pediatric Psoriasis: Results of a Multicenter Study in the United States

The clinical features of pediatric psoriasis warrant further attention. A national study was conducted to determine the prevalence of scalp and nail involvement and a history of guttate psoriasis at onset according to age, sex, and disease severity. One hundred eighty‐one children ages 5 to 17 years with plaque psoriasis were enrolled in a multicenter, cross‐sectional study. Subjects and guardians were asked about a history of scalp and nail involvement and whether the initial presentation was guttate. Peak psoriasis severity was assessed and defined historically as mild psoriasis (MP) or severe psoriasis (SP) according to the Physician's Global Assessment and body surface area measures. One hundred forty‐three (79.0%) subjects reported a history of scalp involvement, and 71 (39.2%) described a history of nail involvement. Boys were less likely than girls to report a history of scalp involvement (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.19–0.84) but more likely to have had nail involvement (OR = 3.01, 95% CI = 1.62–5.60). Scalp and nail involvement was not related to psoriasis severity. In contrast, subjects with SP (35.9%) more often reported a history of guttate lesions than did those with MP (21.8%) (p = .02). Antecedent streptococcal infection was more common in children with guttate than those with plaque psoriasis at onset (p = .02) but did not correlate with severity. Sex‐related differences in scalp and nail involvement suggest koebnerization. Preceding streptococcal infection predicts guttate morphology but not severity, and initial guttate morphology is associated with eventual greater severity of disease. More aggressive monitoring and management should be considered for guttate psoriasis, given its later association with more severe disease.     

气质联用技术检测正常人与银屑病患者血清脂肪酸成分的差异

目的探讨正常人与银屑病患者的血清脂肪酸差异。方法采用气质联用(GC-MS)技术测定36例银屑病患者与22名正常对照组血清游离脂肪酸成分,利用主成分分析法与Logistic回归建立数学模型。结果银屑病患者主要脂肪酸成分棕榈酸甲酯和硬脂酸甲酯低于正常人(P<0.05),而其余主要成分脂肪酸与正常人差异无显著性(P>0.05)。采用Logistic回归方法将正常人与银屑病患者峰值建立模型,其W ald检验P<0.05。其中36例银屑病患者中35例被成功确认,符合率为97.2%。同样,正常人组22个样本中17例被成功确认,符合率为77.3%。结论银屑病患者存在游离脂肪酸代谢紊乱,其中棕榈酸甲酯和硬脂酸甲酯的变化可能与病情发展有关。     

Psoriasis y depresión: el papel de la inflamación

Psoriasis is a chronic, systemic inflammatory disorder with multiple comorbidities.The most common comorbidities are mental disorders, especially depression, which can interact negatively with psoriasis to produce a dangerous vicious circle. Depression in psoriasis has traditionally been explained as a response to psychosocial factors and impaired quality of life.However, a new hypothesis linking depression and psoriasis through chronic inflammation offers insights that should help to understand and treat these diseases. In this approach, new drugs and lifestyle have an important role.     

[Translated article] Moderate to Severe Psoriasis in Pediatric and Young Patients: The BIOBADADERM Registry Experience

Childhood-onset psoriasis generally follows an indolent course but patients with moderate or severe disease may require systemic treatment. The aim of this study was to determine the relative proportion of children and young people aged up to 21 years with moderate to severe psoriasis in the BIOBADADERM registry and to analyze the characteristics of these patients, treatments used, and adverse events. Of the 3946 patients in the registry, 24 were aged 21 years or younger. The mean age of this group when they started treatment upon registration on Biobadaderm was 16.1 years and the mean Psoriasis Area and Severity Index was 9.4. In 67% the first treatment recorded was with a conventional systemic drug. Treatment was discontinued in 14 patients (58%) due to adverse events or a loss or lack of effectiveness. In conclusion, the BIOBADADERM registry shows that young people account for a small proportion of psoriasis patients receiving systemic treatment, and they are more likely to be treated using conventional systemic drugs.     

银屑病患者血清中链球菌抗体的研究

为了进一步证实链球菌感染与银屑病的关系,我们应用免疫印迹法测试了银屑病患者血清中抗链球菌、抗金黄色葡萄球菌及抗白念珠菌抗体含量.发现点滴型银屑病患者的抗链球菌抗体含量不仅显着高于正常人对照组(P<0.01),亦高于慢性斑块型银屑病患者(P<0.05);但其抗金黄色葡萄球菌、抗白念珠菌抗体含量与对照组相比,结果均无显着性差异(P>0.05).本研究证明了链球菌感染与点滴型银屑病密切相关.