Serum miR-124 up-regulation as a disease marker of toxic epidermal necrolysis

Background

Toxic epidermal necrolysis (TEN) is a lethal complication of drugs, thus early diagnosis and treatment are important. However, there are no satisfactory clinical biomarkers of TEN.

Objectives

We investigated miR-124 and miR-214 expressions in serum and skin tissues of severe drug eruptions to evaluate the possibility of biomarkers of TEN.

Materials & Methods

microRNAs were extracted from serum and skin tissues. Serum samples were obtained from 7 TEN patients, 5 Stevens-Johnson syndrome (SJS) patients, 11 erythema multiforme (EM) minor patients and 21 healthy volunteers. Skin tissues were obtained from 4 TEN patients, 3 SJS patients, 8 EM minor patients, 3 psoriasis and 3 atopic dermatitis patients. Six control skin samples were obtained. MicroRNA concentrations were determined by PCR array and real-time PCR.

Results

The concentrations of miR-124 in sera from TEN were significantly higher than those from healthy controls. In the characteristics curve analysis of serum miR-124 for differentiating TEN patients from normal subjects, the area under curve was 0.94. The serum miR-124 concentration was strongly correlated with the erosion area and the SCORTENscale. The expression of miR-214was significantly increased in the skin of TEN.

Conclusion

The serum miR-124 concentration can be used as a disease activity marker for severe drug eruptions, reflecting the severity of keratinocyte apoptosis.

     

The relationship between quality of life and the severity of psoriasis in Turkey

Background

Patients with psoriasis experience a low quality of life and high treatment burden

Objectives

To assess psoriatic patient quality of life using the Dermatology Life Quality Index (DLQI) in the Northeastern Anatolia region of Turkey. Additionally, we evaluated the correlation between the DLQI and the clinical severity of psoriasis and examined demographic data and their relationship with the DLQI and psoriasis severity

Materials and Methods

This study was a single-center, prospective, cross-sectional study at the University of Kafkas, Kars, Turkey. 127 adult patients were included in the study. TheTurkish version of the DLQI was used. To measure psoriasis severity, the Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA) were simultaneously evaluated. The patient demographics were compared with quality of life and the severity of psoriasis

Results

DLQI scores ranged from “very large” to “extremely large” in 61% of the patients. The psoriasis severity (BSA and PASI) was “mild” in 63% of patients. The quality of life was significantly affected in cigarette smokers and in patients whose disease included nail involvement. The PASI and BSA scores of patients with scalp and nail involvement were significantly higher. A significant, positive correlation was found between disease duration and the severity of psoriasis. BSA correlated with PASI

Conclusion

The quality of life of psoriasis patients is strongly reduced. A significant relationship was found for DLQI with nail psoriasis and smoking. A linear, positive correlation was detected between the DLQI and BSA but not between the DLQI and PASI.

     

Restless legs syndrome in psoriasis: an unexpected comorbidity

Background

Restless legs syndrome (RLS) is characterized by unpleasant sensations in the legs and an uncontrollable urge to move them in order to gain relief. Higher frequencies of RLS have been reported in systemic lupus, multiple sclerosis, rheumatoid arthritis and atopic dermatitis.

Objectives

Since the disease-related stress present in psoriasis is similar to the stress of those diseases, we aimed to study the frequency of RLS in a German cohort of patients with psoriasis.

Methods

300 patients with psoriasis and 300 healthy controls were evaluated for RLS symptoms in this study.

Results

While 17% (n = 51) of patients with psoriasis reported symptoms of RLS, only 4% (n = 12) of individuals without psoriasis suffered from RLS symptoms (95% confidence interval: 0.08–0.18, p<0.01). In patients with psoriasis and RLS the average RLS score was 16.0 ± 9.2 whereas individuals with RLS in the control group had an average RLS score of 13.5 ± 7.1.

Conclusions

Our findings indicate an increased frequency of RLS in patients with psoriasis, suggesting screening patients with psoriasis for the presence of RLS as a well-treatable co-morbidity.

     

Down-regulation of microRNA-196a in the sera and involved skin of localized scleroderma patients

Background

Localized scleroderma (LSc) exhibits fibrosis of the skin and subcutaneous tissue. LSc shows an excessive deposition of type 1 collagen.

Objectives

To elucidate the mechanism of type 1 collagen overexpression in LSc, we investigated the epigenetics, focusing on microRNA (miRNA).

Materials & Methods

miRNA expression profile was determined by PCR array analysis. The expression of microRNA-196a (miR-196a) in the skin tissuewas examined by in situ hybridization or real-time PCR. The serum levels of miR-196a were measured by real-time PCR.

Results

PCR array analysis demonstrated that the miR-196a level was markedly decreased in LSc skin tissue in vivo. The transfection of specific inhibitor for miR-196a into normal cultured human dermal fibroblasts led to the up-regulation of type 1 collagen protein in vitro. Furthermore, the serum levels of miR-196a were significantly decreased in LSc patients.

Conclusion

Down-regulation of miR-196a and subsequent overexpression of type 1 collagen in dermal fibroblasts may play a key role in the pathogenesis of LSc. The serum levels of miR-196a may be useful as a diagnostic marker of LSc.

     

Unzureichender Tetanusimpfschutz bei Psoriasis und systemischer Immunsuppression

Background

With a prevalence of approximately 3?% worldwide, psoriasis is one of the most frequent chronic inflammatory skin diseases. Patients with moderate to severe psoriasis are treated guideline-conform with immunomodulatory or immunosuppressive agents. According to current guidelines physicians should be vigilant about the vaccination status of immunosuppressed patients.

Objective

The aim of the study was to serologically objectify the tetanus vaccination status in systemically treated patients with moderate to severe psoriasis in Germany.

Material and methods

Within the context of this retrospective study the concentration of immunoglobulin G antibodies against Clostridium tetani was determined in 101 patients with systemic immunosuppression suffering from psoriasis.

Results

In a total of 27.7% (n?=?28; 11 male, 17 female) of the patients, insufficient immunoglobulin G antibody concentrations were detected, corresponding to a higher risk of an infection with C. tetani. Group subanalyses indicated an insufficient tetanus protection especially in patients ≥65 years old (50%).

Conclusion

The tetanus immune status of psoriasis patients was shown to be comparable with the general population. The results of our investigation underline that people suffering from psoriasis have to be tested for tetanus protection and if necessary, vaccinations have to be renewed.

     

Development of monoclonal gammopathy under biotherapy in psoriasis: a French multicenter retrospective study

Background

Biotherapies or targeted therapies are fairly new treatments indicated for moderate to severe psoriasis. The side effects appear to be mainly infectious or cancerous. The role of biotherapies in the development of a pre-cancerous condition, monoclonal gammopathy of undetermined significance (MGUS), has recently been debated in the literature.

Objectives

To evaluate the incidence of MGUS in psoriasis patients treated with biotherapy.

Materials and Methods

This study was a French multicenter retrospective study carried out through the French multicenter study group RESOPSO. Data on the results of serum protein electrophoreses performed before and within at least six months after the start of the biotherapy were collected. Demographic data, medical history, and psoriasis treatment history were specified.

Results

Four hundred and forty three patients were eligible for inclusion. Of these, three presented with monoclonal gammopathy for which the assessment was in favor of MGUS. The average treatment period was 19.7 months. Six patients presented withMGUSprior to the treatment. These patients’ immunoglobulin levels remained stable, with an average remission of 24 months. Only psoriatic rheumatism appeared to be statistically linked to MGUS.

Conclusion

The incidence and frequency ofMGUSin psoriasis patients treated with biotherapy do not appear to increase relative to the general population.

     

Hair and nail adverse events during treatment with targeted therapies for metastatic melanoma

Background

Targeted therapies for melanoma have shown clinical benefit in increasing the survival of metastatic patients. Cutaneous adverse events have been reported, but hair and nail data have been rarely detailed.

Materials and methods

Patients treated with BRAF andMEKinhibitors for metastatic melanoma underwent dermatological evaluation before the start of each treatment and after every four weeks. Pull test, global photography, dermoscopy/trichoscopy and scalp biopsy were performed. Appendages adverse events were graded using the National Cancer Institute’s Common Terminology Criteria.

Results

Of the 24 patients included, 14 underwent treatment with a selective BRAF inhibitor; 10 received a combined treatment (dabrafenib/trametinib). Adnexal adverse events were common in the group of patients receiving vemurafenib, and included hair kinking, acute hair loss, and hair colour changes, often present in association, classified as G2 in three patients and G1 in eight. Dabrafenib alone induced hair kinking and colour changes in 60% of the patients. Combined treatment with dabrafenib/trametinib did not induce hair changes. Onycholysis was the most common nail side effect, and the unique side effect of dabrafenib (alone or in combination). Vemurafenib also induced acute paronychia and brittle nails. All nail side effects were graded as G1.

Conclusion

Hair and nail side effects during targeted therapy for melanoma are not rare. The early recognition and cure of such side effects by dermatologists is of benefit to ensure the need for dose reduction or drug discontinuation.

     

Psoriasis lesions are associated with specific types of emotions. Emotional profile in psoriasis

Background

At present there is still controversy about the relationship between emotional stress and psoriasis lesions. Most of the published literature does not include the broad spectrum of emotional response.

Objective

The aim of this study was to evaluate the association between skin lesions and emotional state in a large sample of patients with psoriasis.

Methods

823 psoriasis patients were recruited (mean age 45.9 years, 55.7% female) and answered two online questionnaires: lesion severity and current extension were evaluated using a self-administered psoriasis severity index (SAPASI); emotional state was assessed using the positive and negative affect schedule (PANAS). Second order factors were calculated and correlated with the SAPASI.

Results

We found positive associations between the extent and severity of skin lesions and the negative and submissive emotions, a negative correlation with dominance emotions and no association with positive emotions.

Conclusions

Our data supports the relationship between emotions and skin lesions. It also allows for discrimination of the associations between psoriasis lesions and the specific type of emotions.

     

Comorbid autoimmune diseases in patients with pemphigus: a nationwide case-control study in Taiwan

Background

Previous studies have proposed the association between pemphigus and several autoimmune diseases, but no large-scale study has been reported.

Objectives

To delineate the association between pemphigus and autoimmune diseases including psoriasis.

Materials & Methods

A total of 1,998 patients with pemphigus and 7,992 control subjects were enrolled from the National Health Insurance Research Database in Taiwan from 1997 to 2010. The odds of comorbidities between these two groups were analysed by multivariate logistic regression.

Results

Compared with control subjects, patients with pemphigus were much more likely to have Sjögren’s syndrome (odds ratio [OR]: 15.0; 95% confidence interval [CI]: 3.16-71.5), psoriasis (OR: 7.18; 95% CI: 5.55-9.29), systemic lupus erythematosus (OR: 4.46; 95% CI: 1.88-10.6), and alopecia areata (OR: 2.68; 95% CI: 1.26-5.67). According to gender-stratified analyses, however, the association between pemphigus and Sjögren’s syndrome or alopecia areata was found to be significant only in the female patients.

Conclusion

We confirm the association between pemphigus and some autoimmune diseases, including Sjögren’s syndrome, systemic lupus erythematosus, and alopecia areata. In addition, we present the novel finding that patients with pemphigus have an increased risk of psoriasis.

     

Coexistence of Kaposi’s sarcoma and psoriasis: is there a hidden relationship?

Background

The relationship between Kaposi’s sarcoma (KS) and psoriasis is still controversial.

Objectives

To analyse the association between KS and psoriasis, address the hypothesis of a reciprocal influence between the two conditions relative to clinical presentation and evolution, and consider the best therapeutic approach to be used for the treatment of psoriasis in KS patients in order to avoid the typical induction or worsening of KS during immunosuppression.

Materials & Methods

We retrospectively reviewed clinical records of 37 patients with KS and psoriasis. Fisher’s exact test was performed in order to compare epidemiological and clinical data between subsets of patients.

Results

The prevalence of psoriasis in our KS population (n = 1407) was 2.6%. There were no statistically significant differences in terms of stage or rate of progression between KS patients with and without psoriasis, except for a higher frequency of patients with KS Stage IIB among patients with KS and psoriasis (p = 0.001).

Conclusions

Patients with psoriasis have a risk of KS comparable to that of the general population. Psoriasis and KS do not appear to influence each other. For the treatment of psoriasis in KS patients, one should take into account the KS-inducing potential of certain anti-psoriatic drugs.

     

Vitamin D insufficiency is associated with higher carotid intima-media thickness in psoriatic patients

Background

Psoriasis has been associated with vitamin D insufficiency and cardiovascular risk factors. Reports show that serum 25-hydroxyvitamin D (25-OHD) levels are inversely associated with chronic inflammatory systemic diseases, cardiovascular risk factors and cardiovascular outcomes.

Objective

To analyze the association between 25-hydroxyvitamin D serum levels and subclinical carotid atherosclerosis (maximal intima-media thickness (MIMT)) in psoriasis patients and controls. MIMT was compared and associated factors were analyzed.

Patients and Method

This was a case-control study with 44 psoriatic patients without arthritis from a Dermatology outpatient clinic in Granada (Spain) and 44 controls. Confounding factors related to 25-OHD serum levels and cardiovascular risk factors were also analyzed.

Results

25-OHD levels were significantly lower in the psoriatic than in the control group (29.20 vs. 38.00 ng/mL p<0.0001) and a significant negative correlation was found between serum 25-OHD levels and the MIMT (r_s = ?0.678, p<0.0001) in psoriatic patients. No correlation was found in healthy controls. This association remained after adjusting for confounders. Serum 25-OHD levels were significantly lower (p = 0.003) in psoriatic patients with carotid atheromatous plaque (22.38 ± 10.23 ng/mL) than in those without (31.74 ± 8.62 ng/mL). Patients with a longer history of psoriasis presented significantly higher MIMT than controls (638.70 ± 76.21 vs 594.67 ± 80.20 μm; p = 0.026 for ≥6 yrs with psoriasis).

Conclusions

In psoriasis patients, lower serum 25-OHD levels were associated with higher MIMT after adjusting for selected confounding factors. The MIMT risk increases with a longer history of psoriasis, regardless of the patient’s age.

     

Cyclosporine in Severe Psoriasis

Objective

A meta-analysis of 3 major German studies conducted between 1989 and 1994 with cyclosporine in severe psoriasis was performed to allow an integrated evaluation of the efficacy and tolerability of cyclosporine in this indication.

Design and Setting

All 3 studies were prospective, randomized, parallel group studies. The studies were conducted in 61 dermatologic centers in Germany.

Patients and Interventions

The studies involved 597 patients with severe plaque type psoriasis. Treatment consisted of cyclosporine (at a dosage of 1.25, 2.5 or 5 mg/kg/day), etretinate (at a mean daily dose of 0.53 mg/kg/day) or placebo in a total of 756 treatment cycles with a maximum duration of 12 weeks.

Main outcome measures: The main outcome measures were the psoriasis area and severity index (PASI) and

serum creatinine level.

Results

The meta-analysis revealed that cyclosporine given in a dosage of 2.5 and 5 mg/kg/day was significantly superior to etretinate. In addition cyclosporine 1.25 mg/kg/day proved to be significantly more effective than placebo. An increase in serum creatinine level that required intervention occurred in 3.4% of cyclosporine treatment cycles.

Conclusion

Cyclosporine is highly effective and well tolerated in the short term treatment of severe psoriasis.

     

Reduced frequency of non-melanoma skin cancer in 72,739 patients with psoriasis: a retrospective study

Background

Chronic inflammatory conditions, such as psoriasis, may pose an increased risk of cancer due to impaired immunosurveillance resulting from chronic inflammation and immunosuppressive medications.

Objectives

To compare the risk of non-melanoma skin cancer (NMSC) in a retrospective cohort of 72,739 psoriasis patients and 25,956 non-dermatological patients.

Materials & methods

Arecord linkagewas performed for data on hospitalizations, and the occurrence ofNMSCwas compared by computing the relative risk (RR) and modelled using multiple logistic regression.

Results

Overall, the occurrence of NMSC was 9.6‰ (95% CI: 8.9-10.3‰) in psoriasis patients and 19.6‰ (95% CI: 18.0-21.4‰) in non-dermatological patients (RR = 0.49; 95% CI: 0.44-0.55). The simultaneous adjustment for gender, age, and phototherapy yielded a RR of 0.84 (95% CI: 0.75-0.95). With regards to phototherapy, the occurrence of NMSC was significantly higher among psoriasis patients who underwent phototherapy relative to those who did not (27.0‰ vs. 9.3‰).

Conclusions

In this large retrospective study, we found that patients with psoriasis had a 16% lower probability of having NMSC when compared to a group of non-dermatological patients. Further studies, preferably with a prospective longitudinal design to collect more precise data, are needed to corroborate our findings.

     

Efficacy and safety of total glucosides of paeony combined with acitretin in the treatment of moderate-to-severe plaque psoriasis: a double-blind,randomised, placebo-controlled trial

Background

Although acitretin has been widely used for the treatment of psoriasis, additional safer and more effective approaches, including traditional Chinese medicine, are needed.

Objectives

To investigate the efficacy and safety of total glucosides of paeony (TGP) combined with acitretin in the treatment of moderate-to-severe plaque psoriasis.

Materials & methods

A randomised, double-blind, placebo-controlled, multi-centre clinical study was conducted. In total, 108 patients with moderate-to-severe plaque psoriasis were randomly assigned to treatment with “TGP plus acitretin” (group A) or “placebo plus acitretin” (group B) for 12 weeks.

Results

After 12 weeks of therapy, the percentage of patients achieving a 50% reduction in Psoriasis Area and Severity Index was 90% in group A and 70.5% in group B (p<0.05). The rate of serum alanine aminotransferase elevation was 6.25% in group A and 20.4% in group B (p<0.05).

Conclusion

TGP is conducive to enhancing anti-psoriatic efficacy and reducing liver damage due to acitretin. TGP combined with acitretin is a safe and effective treatment approach for moderate-to-severe plaque psoriasis.

     

The Frequent Use of Oral Retinoids in Combination with Other Treatments for Psoriasis: A Retrospective Analysis

Background

Combination treatment in psoriasis may be common, logical, and appropriate, even if not well tested or well documented by clinical trials. While oral retinoids such as acitretin can be used as monotherapy, efficacy can be further augmented by combination use with other agents. Similarly, because of its safety profile, acitretin can be added in low doses to help patients who have not achieved adequate control with other psoriasis treatments.

Objective

The purpose of this study was to assess how oral retinoids are used in combination with other drugs to treat psoriasis.

Methods

We assessed the use of acitretin and other oral retinoids for the treatment of psoriasis using two sources of information: nationally representative survey data from the National Ambulatory Medical Care Survey (NAMCS) and local data obtained by chart review of 518 patients seen in a university dermatology clinic.

Results

In the NAMCS, oral retinoids were prescribed with other psoriasis medications at 71% of visits. In the chart review, combination use was even more frequent (96% of subjects were on combination treatment) and included combinations of acitretin with topicals, phototherapy, and other systemic treatments. Adverse events were reported in 53% of patients treated with acitretin, although none were severe.

Conclusion

Use of acitretin in combination with many other psoriasis treatments is a common practice. Mucocutaneous side effects of oral retinoids are common but with appropriate dosing are generally mild.

     

Risk factors,clinical variants and therapeutic outcome of retronychia: a retrospective study of 18 patients

Background

Retronychia is a form of post-traumatic ingrowing nail disease that involves proximal nail plate embedding into the proximal nail fold, with multiple generations of nail plate beneath the proximal nail. This disease is probably underdiagnosed because of incomplete clinical forms.

Objectives

The aim of this study was to report clinical and aetiological variants of retronychia and to evaluate their therapeutic outcome.

Materials and Methods

A retrospective review was performed on 18 patients who were seen in our institution between 2007 and 2013. The diagnostic criteria for retronychia were paronychia and interruption of nail growth.

Results

A female predominance (83.3%) was reported. Various precipitating factors were found, including traumatisms in 10 patients (55%), pregnancy and postpartum period in two patients (11%), and compartment syndrome in one patient (5%). The mean duration of paronychia was eight months (15 days to four years). The fingers most affected were the great toes. Retronychia occurred bilaterally in five cases (27%) and unilaterally in one case (61%). The commonest signs were, in decreasing order, xanthonychia (yellow discolouration of nail plate), longitudinal nail over-curvature, swelling of proximal nail fold, elevation of the proximal nail plate, granulation tissue, subungual hyperkeratosis, superficial leuconychia, distal onycholysis, subungueal haemorrhage, and Beau’s lines. Most of the cases improved after proximal nail plate avulsion. Recurrence occurred in three cases (16.6%).

Conclusion

In our opinion, ischaemic damage is the main cause of retronychia. Evaluation of clinical variants is mandatory to propose appropriate treatment. The limitations of this study include the retrospective design.

     

Perceived impact of psoriasis on leisure-time activities

Background

Psoriasis has an influence on various aspects of patients’ everyday life. When estimating the total burden of the disease, the influence on leisure-time should also be taken into account.

Objectives

To evaluate the perceived impact of psoriasis on leisure-time activities.

Material and methods

The questionnaire study was based on 262 patients with psoriasis. The patients were asked to list their leisure-time activities, any activities they had reduced or given up completely because of psoriasis, the time spent on current leisure-time activities and the time they would have spent in a hypothetical situation if they did not have psoriasis. Using a visual analogue scale (VAS) of 0–100, the patients assessed how well they could currently perform their leisure-time activities and how well in a hypothetical situation without psoriasis. The difference between the VAS scores depicted the level of disadvantage caused by psoriasis.

Results

More than half the patients (51.9%) had reduced or completely given up at least one leisure-time activity. The disadvantage score (VAS) of psoriasis was 16.9. Younger age was associated with higher disadvantage (r = 0.154, p<0.05). Sports activities were completely given up by 30.2% and reduced by 23.7%. Social activities and those which could be expected to cause embarrassment were given up by 29.0% and reduced by 21.4% of the patients.

Conclusion

A majority of patients with psoriasis reduce or give up leisure-time activities because of their condition, so the influence of psoriasis on leisure-time is considerable.

     

Longitudinal melanonychia in childhood: a clinical and histopathological review of Korean patients

Background

Longitudinal melanonychia is not frequently observed in children, and few studies exist on longitudinal melanonychia in paediatric patients, especially in Asian populations.

Objectives

We aimed to evaluate the clinical and histological findings of longitudinal melanonychia in Korean paediatric patients.

Materials & Methods

A retrospective review of paediatric patients (≤18 years old) with longitudinal melanonychia who underwent nail biopsy between January 2010 and October 2015 was performed.

Results

Of a total of 21 patients with longitudinal melanonychia, there were 10 cases of functional melanonychia, eight of lentigo, and three of nevus, as determined by microscopic examination. Mild nuclear atypia was found in four cases, as well as a low degree of pagetoid spread in one case. No patient was diagnosed with melanoma. During the follow-up period, no signs of malignancy were noticed and one patient with nail matrix nevus showed complete spontaneous regression of the pigmented band.

Conclusion

Clinical and histological features, generally accepted as signs suggestive of melanoma in adults, were more readily observed in benign conditions in children.

     

US Perspectives in the Management of Psoriasis and Psoriatic Arthritis: Patient and Physician Results from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey

Background

The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP), a population-based survey of patients, dermatologists, and rheumatologists, was conducted for better understanding of the unmet needs of psoriasis and psoriatic arthritis (PsA) patients.

Objective

To report results from US physicians and patients.

Methods

Adults were contacted by household telephone, using random digit dialing, and asked to participate if they had ever been diagnosed with psoriasis or PsA. Physicians were identified through national databases and contacted through random sampling methods.

Results

In the USA, 1005 patients, 101 dermatologists, and 100 rheumatologists were surveyed. PsA had been diagnosed in 270 patients (26.9 %). Of those with psoriasis alone, fewer than 60 % (versus 85.6 % of PsA patients) had seen a healthcare provider within 12 months. Joint pain was reported by 51.8 % of psoriasis patients without a diagnosis of PsA, and 37.6 % of dermatologists cited their greatest challenge in managing PsA patients as being differentiating PsA from other arthritic diseases. Itching was reported by 36 % of psoriasis patients versus 12 % of dermatologists as the most important factor contributing to disease severity. Patients reported lower rates of current treatment than did dermatologists and rheumatologists. Conventional oral and biologic therapies were used by 24.9 and 17.7 % of patients, respectively. Among patients who had received injectable biologics, treatment dissatisfaction was related to long-term safety/tolerability, injection-related anxiety/fear, and cost.

Conclusion

This large, population-based survey identified unmet needs in the management of psoriasis and PsA patients in the USA, including assessment of disease severity, PsA diagnosis, undertreatment, and satisfaction with therapy.

     

Recommendations for adjunctive basic skin care in patients with psoriasis

Background

Psoriasis is a multifactorial disease involving both genetic predisposition and external triggers, resulting in epidermal and immune dysfunctions. Regardless of the severity of the disease, patients require additional basic topical treatment with emollients. Basic skin care products are well known for their role in moisture retention and symptom control in psoriasis, yet patients underuse them. Dry skin and cutaneous inflammation are associated with an impaired epidermal barrier function. This breakdown of the skin barrier causes the release of proinflammatory mediators that exaggerate inflammation.

Objectives

to provide recommendations for the use of emollients (including ceramides, urea, keratolytic agents, zinc salts, niacinamide), thermal water and skin care products in psoriasis.

Methods

A review of the current literature from 2000 to 2012 using Medline and Ovid was performed by a working group of five European Dermatologists with clinical and research experience in psoriasis.

Results

Either alone or used adjunctively, basic topical therapy can restore and protect skin barrier function, increase remission times between flare-ups and enhance the effects of pharmaceutical therapy.

Conclusion

We provide physicians with a tool to assist them in implementing basic skin care in an integrated disease management approach.