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.

     

A multicenter,randomized, open-label pilot trial assessing the efficacy and safety of etanercept 50 mg twice weekly followed by etanercept 25 mg twice weekly,the combination of etanercept 25 mg twice weekly and acitretin,and acitretin alone in patients with moderate to severe psoriasis

Background

Etanercept, a soluble tumor necrosis factor receptor, and acitretin have been shown to be effective in treating psoriasis. Acitretin is widely used in Korea. However, the combination of etanercept plus acitretin has not been evaluated among Korean patients with psoriasis. The objective of this study was to investigate the efficacy and safety of combination therapy with etanercept and acitretin in patients with moderate to severe plaque psoriasis.

Methods

Sixty patients with psoriasis were randomized to receive etanercept 50 mg twice weekly (BIW) for 12 weeks followed by etanercept 25 mg BIW for 12 weeks (ETN-ETN); etanercept 25 mg BIW plus acitretin 10 mg twice daily (BID) for 24 weeks (ETN-ACT); or acitretin 10 mg BID for 24 weeks (ACT). The primary efficacy measurement was the proportion of patients achieving 75 % improvement in Psoriasis Area and Severity Index (PASI 75) at week 24. Secondary end points included 50 % improvement in PASI (PASI 50) at week 24 and clear/almost-clear by Physician Global Assessment (PGA) at each visit through week 24.

Results

The proportions of patients achieving PASI 75, PASI 50, and PGA clear/almost-clear at week 24 in the ETN-ETN (52.4, 71.4, and 52.4 %, respectively) and ETN-ACT groups (57.9, 84.2, and 52.6 %, respectively) were higher than in the ACT group (22.2, 44.4, and 16.7 %, respectively). The incidence of adverse events was similar across all arms. This was an open-label study with a small number of patients.

Conclusion

In Korean patients with moderate to severe plaque psoriasis, etanercept alone or in combination with acitretin was more effective than acitretin. All treatments were well tolerated throughout the study.

Trial registration

This study was registered on July 7, 2009 at ClinicalTrials.gov, NCT00936065.

     

Long-term (1 year) efficacy of etanercept in moderate-to-severe psoriasis. Results of a multicentric observational study in Spain

Background

Information on the long-term efficacy of etanercept (ETN) treatment of moderate-to-severe psoriasis according to the Summary of Product Characteristics (SmPC) is scarce.

Objectives

We report the efficacy results of an observational clinical trial including 202 patients treated for 12 months with ETN according to SmPC.

Methods

Concomitant topical treatment was permitted throughout the study period. Efficacy assessment was done by intention-to-treat analysis with last observation carried forward.

Results

Mean%Body Surface Area (BSA) and Psoriasis Area and Severity Index (PASI) decreased from 39.0% and 22.2% at baseline to 7.9% and 4.4%, respectively, at 12 months. Throughout the study duration, PASI 50, PASI 75 and PASI 90 response rates ranged from 72.8% to 95.7%, 55.6% to 84.3%, and 36.1% to 62.2%, respectively. Body mass index and body weight had minor effects on treatment efficacy.

Conclusion

ETN treatment according to the SmPC provided sustained improvement of psoriasis throughout one year.

     

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.

     

Association of <Emphasis Type="Italic">IL36RN</Emphasis> mutations with clinical features,therapeutic response to acitretin,and frequency of recurrence in patients with generalized pustular psoriasis

Background

Previous studies have revealed that IL36RN mutations play a pivotal role in the pathogenesis of generalized pustular psoriasis (GPP), however, the clinical relevance is unclear.

Objectives

To investigate the correlation between IL36RN mutations and clinical features, recurrence frequency, and therapeutic response to acitretin in GPP patients with long-term follow-up.

Materials & Methods

This retrospective cohort study, lasting 2-4 years, included 61 GPP and 48 psoriasis vulgaris (PV) patients.

Results

Sequence analysis of all five exons of the IL36RN gene revealed two genetic variants (c.115+6 T>C and c.227C>T). The cohort was divided into three subgroups according to the c.115+6 T>C mutation (present in 52.5% of the patients): homozygous mutation group (HOMG), heterozygous mutation group (HEMG), and non-mutation group (NMG). Initially, 21/25 HOMG patients were diagnosed with GPP with provocative factors, but 13 developed erythrodermic psoriasis after the pustular phase. Patients in the HEMG (5/7) and NMG (23/29) maintained PV diagnosis before and after the pustular phase. Most patients exhibited a marked response to acitretin, but patients who were prescribed a maintenance dosage (10-30 mg/d) had mild recurrence (0-2 times/year) during follow-up. IL36RN mutations were strongly linked with early onset and hyponychial pustules, but not with therapeutic efficacy of acitretin or recurrence frequency.

Conclusions

Early onset and hyponychial pustules may be specific to IL36RN mutation, however this alone is an insufficient biomarker for acitretin therapy. Other provocative factors play important roles in disease onset, clinical manifestations, and disease outcome. Low-dose maintenance therapy with acitretin might help reduce the recurrence of GPP.

     

Insurance Coverage of Biologics for Moderate-to-Severe Psoriasis: A Retrospective,Observational 5-Year Chart Review

Background

With the variability in health insurance coverage for psoriasis systemic therapies, recent changes in coverage for biologics have yet to be evaluated.

Purpose

To determine changes in insurance coverage of biologics for moderate-to-severe psoriasis between 2009 and 2014, with a focus on insurance policies as stated in prior authorization (PA) forms, coverage denials, and time course of approval process.

Methods

A retrospective chart review was performed on patients with a diagnosis of psoriasis (International Classification of Diseases [ICD], Ninth Edition, code ICD 696.1) seen at the Department of Dermatology, Medical Faculty Associates, George Washington University between January 1, 2009 and December 31, 2014. Exclusion criteria included <9 % body surface area, loss to follow-up, lack of biologic treatment, biologic treatment via a clinical trial, and lack of health insurance. For all other patients, metrics collected included age, sex, body surface area, health insurance plan, prior therapies, prescribed biologic, PA necessity, time in days between PA submission and coverage decision, and denial justifications.

Results

Eight hundred and sixty-four patients with a diagnosis of psoriasis within the time period were identified, 114 of who met the inclusion criteria. PA requirement increased from 16 % of patients prescribed a biologic in 2009 to 75 % of patients prescribed a biologic in 2014. The mean duration in days between PA submission and coverage decision from the insurance company increased from 3.7 days in 2009 to 6.7 days in 2014. PA denial rates increased from 0 % in 2009 to 19 % in 2014. The most common reason for coverage denial was failure to attempt alternative therapies prior to requesting biologics.

Conclusion

Insurance coverage of biologics for moderate-to-severe plaque psoriasis has become increasingly regulated between 2009 and 2014. Given both the cost burden and potential benefits of these therapies, further examination of healthcare coverage and treatment accessibility is warranted for optimal patient outcomes.

     

Effects of Curcuma extract and visible light on adults with plaque psoriasis

Introduction

We conducted a phase IV randomized, double-blind, placebo-controlled, pilot clinical trial to investigate the safety and efficacy of oral curcumin together with local phototherapy in patients with plaque psoriasis.

Materials and methods

Patients with moderate to severe psoriasis received Curcuma extract orally with real visible light phototherapy (VLRT) or simulated visible light phototherapy (VLST) in the experimental area, while the rest of the body surface was treated with ultraviolet A (UVA) radiation. The endpoints were the number of responders and the temporal course of the response. The secondary outcomes were related to safety and adverse events.

Results

Twenty-one patients were included in the study. In the intention-to-treat analysis, no patients included in the VLRT group showed “moderate” or “severe” plaques after the treatment, in contrast to the patients included in the VSLT group (p<0.01). Parallelisms in the evolution of PGA, BSA, and PASI scores were observed in the two groups following the treatment. At the end of the study period, 76% of all patients showed a response in the BSA exposed to UVA. Lesions on the experimental area showed a response in 81% of the patients in the VLRT group and 30% of the patients in the VLST group. There were no study-related adverse events that necessitated participant withdrawal.

Conclusion

The results suggested that moderate to severe plaque psoriasis should showa therapeutic response to orally administered Curcuma if activated with visible light phototherapy, a new therapeutic method that would be safer for patients than existing treatments.

     

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.

     

Cardiovascular comorbidities in childhood psoriasis

Background

Psoriasis is a common, chronic, systemic inflammatory skin disease associated with numerous cardiovascular comorbidities. Much evidence of this association exists in the adult population, data available in childhood psoriasis is more limited.

Objectives

To analyze the prevalence of excess adiposity, cardiovascular risk factors, metabolic syndrome and lipid profile in children with psoriasis comparing to control group with similar age and sex distribution.

Materials & methods

A case-control study was conducted with children, 5–15 year-sold, with moderate-to-severe plaque-type psoriasis and a control group comprising children with other skin diseases without systemic inflammatory diseases.

Results

Psoriatic children had a significantly higher prevalence and greater odds of excess adiposity compared to controls: BMI (≥85^th percentile; OR 4.4; 95%CI 1.2–15.6), waist circumference (>75^th percentile; OR 7.4; 95%CI 2.0–27.7) and waist-to-height ratio (>0.490; OR 4.6; 95%CI 1.3–17.0). A higher prevalence of metabolic syndrome was observed in children with psoriasis compared to controls (25% vs 3.7%;P=0.07), and two components of the metabolic syndrome were significantly higher in the psoriasis group: waist circumference (75% vs 29.6%; P = 0.002) and the high blood pressure component (30% vs 3.7%P=0.032). Finally, an altered and more atherogenic lipid profile was observed among psoriatic patients without excess adiposity.

Conclusion

This study demonstrates that comorbidities known to be associated with adult psoriasis are also observed in childhood psoriasis, reinforcing the need for screening cardiovascular comorbidities in children with psoriasis and promoting healthy lifestyle choices in these patients. Moreover, it also suggests that its association with psoriasis may be in part genetically determined rather than uniquely acquired.

     

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.

     

Study of T helper (17) and T regulatory cells in psoriatic patients receiving live attenuated varicella vaccine therapy in a randomized controlled trial

Background

The use of live attenuated varicella vaccine (Varilrix^®) as an adjuvant treatment in severe cases of psoriasis has recently been postulated. Its efficacy raised questions regarding its possible mechanisms of action.

Objective

To compare the efficacy and safety of combining Varilrix^® and cyclosporine to cyclosporine alone in the treatment of severe psoriasis. Furthermore, to study the expression of T helper (Th)17 and T regulatory (Tregs) cells before and after therapy.

Materials and methods

This randomized controlled trial included 24 psoriatic patients, randomly divided into 2 groups (A and B). All patients received cyclosporine at a daily dose of 2.5 mg/kg/day. In addition, group A received 4 doses of Varilrix^® once/3 weeks, and group B received 4 doses of subcutaneous saline. Skin biopsies were obtained from all patients before and after therapy and from all controls for estimation of interleukin (IL)-17, IL-22 and Forkhead boxP3 (FoxP3) using RT-PCR.

Results

Group A patients showed a significantly higher % of clinical improvement (P = 0.011), which occurred earlier than group B. At baseline, levels of IL-17 and IL-22 were significantly higher while the level of FoxP3was significantly lower in patients (P<0.001) compared to controls. After therapy, both groups showed significant reductions in both IL-17 and IL-22 levels, and significant elevation in FoxP3 (P<0.001). This change was significantly more evident in group A patients.

Conclusion

Live attenuated varicella vaccine could play a role in the treatment of psoriasis when combined with low dose cyclosporine through accentuating the influence on the Th17/Treg balance.

     

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.

     

Diagnosis of nail psoriasis: evaluation of nail-derived microRNAs as potential novel biomarkers

Background

MicroRNA levels in sera or hair may potentially be useful biomarkers for various diseases. The diagnosis of nail diseases is sometimes difficult, and nail psoriasis without skin lesions is indistinguishable from nail changes caused by other diseases.

Objectives

We evaluated nail microRNA levels as biomarkers for the diagnosis of psoriasis patients.

Materials & methods

MicroRNA levels were examined in psoriasis patients with (11 patients) and without (six patients) nail changes. Normal control nails were collected from 17 healthy subjects. Eight patients with other diseases who also had nail changes were also included as disease controls.

Results

Microarray, real-time PCR, and in situ hybridisation indicated that the expression levels of nail miR- 4454 were decreased in psoriasis patients with nail changes, compared to those patients with other diseases involving nail change, or healthy subjects. The miR-4454 levels in nails showed a significant inverse correlation with the Nail Psoriasis Severity Index (NAPSI) score, suggesting that nail miR-4454 levels reflect nail condition.

Conclusion

The levels of microRNAs in nails may be suitable biomarkers for diagnosis or evaluation of disease activity of psoriasis.

     

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.

     

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.

     

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.

     

Reduced frequency of melanoma 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 the chronic inflammation and immunosuppressive medications. However, the relationship between psoriasis and the risk of melanoma is still controversial.

Objective

To compare the occurrence of melanoma in a cohort of 72,739 psoriasis patients and in 25,956 non-dermatological patients.

Methods

A record-linkage was performed between records of hospitalizations and access to day-hospital and day-surgery clinics and outpatient clinics. The frequency of melanoma was compared between psoriasis patients and vascular surgery patients. Occurrence of melanoma was compared by computing the relative risk (RR) and modelled using multiple logistic regression.

Results

Overall, occurrence of melanoma was 1.8% (95% CI 1.5–2.2%) in psoriasis patients and 4.5% (95% CI 3.8–5.4%) in non-dermatological patients (RR = 0.40, 95% CI 0.31–0.51). The simultaneous adjustment for gender, age, and phototherapy yielded a RRadj = 0.54(95% CI 0.41–0.70. For patients who underwent phototherapy, vs. those who did not, the RRadj was 1.50 (95% CI 0.56–4.15).

Conclusions

In this large retrospective study, patients with psoriasis had a significantly lower probability of having melanoma when compared to a group of non-dermatological patients. Further studies, preferably with a concurrent longitudinal design to estimate incidence with more complete information, are needed to corroborate our findings.

     

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.

     

Tongue lesions in psoriasis: a controlled study

Background

Our objective was to study tongue lesions and their significance in psoriatic patients.

Methods

The oral mucosa was examined in 200 psoriatic patients presenting to Razi Hospital in Tehran, Iran, and 200 matched controls.

Results

Fissured tongue (FT) and benign migratory glossitis (BMG) were the two most frequent findings. FT was seen more frequently in psoriatic patients (n = 66, 33%) than the control group (n = 19, 9.5%) [odds ratio (OR): 4.69; 95% confidence interval (CI): 2.61–8.52] (p-value < 0.0001). BMG, too, was significantly more frequent in psoriatic patients (28 cases, 14%) than the control group (12 cases, 6%) (OR: 2.55; 95% CI: 1.20–5.50) (p-value < 0.012). In 11 patients (5.5%), FT and BMG coexisted.FT was more frequent in pustular psoriasis (7 cases, 53.8%) than erythemato-squamous types (56 cases, 30.4%). On the other hand, the frequency of BMG increased with the severity of psoriasis in plaque-type psoriasis assessed by psoriasis area and severity index (PASI) score.

Conclusions

Nonspecific tongue lesions are frequently observed in psoriasis. Further studies are recommended to substantiate the clinical significance of these seemingly nonspecific findings in suspected psoriatic cases.

     

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.