Successful treatment of subcorneal pustular dermatosis (Sneddon-wilkinson disease) by acitretin: report of a case

BACKGROUND: Clinical remission of atopic dermatitis (AD) after intake of a low-salt water has recently been reported. METHODS: We here investigated the effects of a low-salt water in AD patients with increased intestinal permeability to lactulose. From an initial group of 75 atopic patients, who undertook a treatment in a medical spa center, 12 were included because of abnormal urinary excretion of lactulose (>0.6%), which is absorbed in the enterocytic interspaces, at baseline. The excretion of mannitol with an extraenterocytic absorption was also studied as control. During 18 days, the patients followed a medical spa treatment course, including topical application and oral ingestion of a low-mineral water. Patients were asked not to modify their usual food regimen during the cure. At the end of treatment (day 18), the determination of the excretion of both sugars in urine was repeated. RESULTS: At baseline, the mean urine excretion of lactulose in the study population was 1.21+/-0.08 SEM. At the end of treatment (day 18), the lactulose concentration in urine diminished dramatically by 55% (mean 0.55+/-0.09 SEM, p = 0.0005). Urine mannitol was also found to be reduced over the cure period, although to a lesser extent (30%, p = 0.04). CONCLUSION: This study indicates that low-mineral water normalizes the intestinal permeability of patients with AD.     

Psoriasis and psoriatic arthritis: clinical features and disease mechanisms

Psoriasis is a chronic skin disorder affecting approximately 1% to 3% of the world's population. A considerable proportion of patients with psoriasis will develop a form of inflammatory arthritis known as psoriatic arthritis whose prevalence is poorly defined. Significant advances have been made in determining the pathophysiology of both of these diseases, with recent findings strongly implicating T cells and inflammatory cytokines such as tumor necrosis factor alpha in their pathogenesis. There exists an increasing array of therapies to benefit both skin and musculoskeletal manifestations. Newer therapies, such as the biologics, are providing more targeted approaches with potentially fewer systemic toxicities, providing control of disease symptoms and inhibiting progressive joint damage in those with arthritis, as well as improving long-term function and quality of life.     

Abrupt generalized pustules in patients with rheumatoid arthritis and interstitial lung disease

We report a case of a 30‐year‐old Chinese woman with rheumatoid arthritis and interstitial lung disease who abruptly developed generalized pustules and a high fever for 10 days. She had been taking oral prednisone, iguratimod and total glucosides of peony regularly for 5 months prior. In addition, she had taken metronidazole for 3 days 20 days prior which she had used before with no adverse reaction. She had no history of similar lesions and psoriasis. A biopsy of a pustule on the back showed spongiform pustule of Kogoj. She was suspected of having generalized pustular psoriasis or acute generalized exanthematous pustulosis. Finally, she was diagnosed with generalized pustular psoriasis (von Zumbusch type) considering the characteristics and clinical course of the rash. In addition to the above three drugs, systemic cyclosporin (5 mg/kg per day) was applied, and the lesions and fever resolved within the proceeding 2 months.     

Skin inflammation associated with arthritis,synovitis and enthesitis. Part 1: psoriatic arthritis,SAPHO syndrome,Still's disease,Behçet's disease

The coincidence of skin and joint inflammation poses a challenge for both dermatologists and rheumatologists. Adequate management of such disorders requires that physicians of both specialties have sound knowledge of the other discipline. In case of suspected joint involvement, familiarity with the diagnostic options available to rheumatologists enables dermatologists to selectively refer their patients for a rheumatology consult. The objective of the present review is to familiarize the reader with the stepwise diagnostic workup performed by rheumatologists today, including laboratory tests, musculoskeletal ultrasound, X‐ray studies, and magnetic resonance imaging. Subsequently, we will discuss a number of disorders characterized by the concurrence of skin and joint inflammation, highlighting aspects of epidemiology, etiology and pathogenesis, clinical presentation, diagnosis and treatment. These disorders include psoriatic arthritis as well as autoinflammatory disorders such as SAPHO syndrome, Still's disease and Behçet's disease.     

关节病性银屑病合并炎症性肠病一例

患者女,27岁,因全身红斑鳞屑15年,关节痛6个月,纳差3个月,于2017年2月17日到东南大学附属中大医院皮肤科就诊。15年前患者无明显诱因发现手臂伸侧散在黄豆大小红斑,其上覆有银白色鳞屑,易刮除,当地医院诊断银屑病,予外用药治疗（具体不详）。之后鳞屑减少,红斑消退,但皮疹反复发作,无腹痛、腹泻。6个月前患者出现腰背部数个黄豆大小的红斑,双侧膝、肘关节肿胀、疼痛,伴行走困难、左上肢上抬无力,予抗生素治疗,皮疹、关节痛无好转。3个月前皮疹累及小腿屈侧,出现2个黄豆大小红斑,并出现纳差,有轻度吞咽困难和呕吐,呕吐物为胃内容物,量中等,腹泻为水样便,无里急后重、黏液脓血便,体重减轻约5 kg。患者母亲有银屑病病史……     

Psoriasis and psoriatic arthritis induced in a patient treated with infliximab for Crohn's disease

The induction of psoriasis as a side effect of treatment with TNF-alpha inhibitors is one of a few rare complications of treatment, the pathogenic mechanism of which has not yet been completely clarified. The clinical presentation of these reactions may show the typical characteristics of psoriasis, palmoplantar pustulosis and psoriasiform exanthema; the individual variations of which may combine to give different presentations in individual patients. We present the case of a patient who, after administration of infliximab indicated for Crohn's disease, developed not only skin manifestations but also those of psoriatic arthritis.     

Assessment of osteoporosis in psoriasis with and without arthritis: correlation with disease severity

Background The most frequent extracutaneous association with psoriasis is arthritis. Because proinflammatory cytokines are increased in psoriasis, patients with this disease may be more prone to osteoporosis than the healthy individuals. Methods We evaluated 50 patients with psoriasis, with or without psoriatic arthritis (PsA), for the presence and degree of osteoporosis by performing dual energy x‐ray absorptiometry (DEXA) and obtaining serum osteoprotegrin (OPG) levels. In addition, we correlated these results with the extent of skin and joint disease. Psoriasis area and severity index (PASI) was determined in all 50 patients with psoriasis, and total joint score (TJS) was recorded in the 16 patients who also had PsA. Results of DEXA and serum OPG were also obtained for 20 healthy individuals who served as controls. Results Osteoprotegrin level was significantly increased in psoriasis patients (with or without PsA) vs. controls. However, DEXA revealed that PsA patients had a higher degree of osteoporosis in the femur neck and wrist. In PsA patients, TJS correlated positively with both disease duration and PASI but correlated negatively with Z score of the femur. Conclusion Psoriasis patients with or without arthritis may suffer from osteoporosis as evidenced by significantly increased serum OPG. Prolonged and extensive cutaneous disease is an important risk factor for the development and severity of PsA. Patients with a greater number of affected joints are at higher risk of osteoporosis.     

Letter: An adult case of severe hand-foot-mouth disease accompanying persistent fever and systemic arthritis

This paper reports a case of adult HFMD with vesicles scattered on the whole body and severe oral lesions. In addition, a long-lasting elevated level of C-reactive protein (CRP) was a feature of this case. Our case is unusual for HFMD with long-lasting joint pain and high fever.     

Psoriasis and arthritis

The exact association between psoriasis and arthritis remains an enigma. Some investigators consider that the two disorders constitute a disease entity, psoriatic arthritis, while others support the thesis that psoriasis and arthritis are common diseases and occur simultaneously by chance. The author upholds the latter view as viable. To underscore his viewpoint he presents a comprehensive overview of the controversial opinions through an historical perspective as well as reporting on his epidemiologic and clinical findings from large population studies in the Netherlands. Therapeutic regimens for the management of both skin and joint problems are presented.     

Psoriasis and arthritis

The relationship of psoriasis and arthritis is controversial. It has been reported that 7 percent of patients with psoriasis have arthritis. In approximately half of these cases, it is a sero-negative inflammatory polyarthritis, two-thirds of which clinically resemble rheumatoid arthritis. A distinctive peripheral arthropathy is displayed by 1 percent of psoriatics. One-fifth of this group, or less than 0.2 percent of psoriatics, suffer deforming arthritis multilans. The epidemiologic, clinical, radiologic, serologic, and genetic evidence for and against psoriatic arthropathy as a unique entity are reviewed. The prognosis of psoriatic arthritis appears to be better than previously suggested. Therapeutic measures are also reviewed.