The impact of itch symptoms in psoriasis: results from physician interviews and patient focus groups

Background  

The objective of this qualitative study was to better understand the impact of psoriasis symptoms using a 3-part process: 1) develop a disease model for psoriasis to identify the most important concepts relevant to psoriasis patients; 2) conduct interviews with dermatologists to identify key areas of clinical concern; and 3) explore psoriasis patients' perceptions of the impact of psoriasis.     

银屑病患者全血和皮肤谷胱甘肽过氧化物酶活力关系的研究

探讨了谷胱甘肽过氧化物酶（ＧＳＨ－Ｐｘ）与银屑病发病之间的关系。采用二巯基二硝基苯甲酸显色法，研究正常健康人和银屑病患者全血及皮肤ＧＳＨ－Ｐｘ活力的变化，结果表明，与正常健康人比较，银屑病患者全血和皮肤ＧＳＨ－Ｐｘ活力均明显降低（Ｐ＜０．００１，Ｐ＜０．０５），提示：ＧＳＨ－Ｐｘ活力的降低，特别是皮肤中ＧＳＨ－Ｐｘ活力的降低，可能是银屑病的重要原因之一。     

Marked by visibility of psoriasis in everyday life

In this study, the authors aimed at a sociological approach to the individual's everyday life with psoriasis and to this end conducted qualitative interviews with 18 persons from a county in northern Sweden. The most difficult aspects of living with psoriasis were being marked by the visibility of psoriasis, especially in the younger ages, and the visibility of joint changes. Therefore, those with both rashes and joint changes felt marked and discredited in a twofold way. Commonly used coping strategies were routinization of both the treatment and the adjustment to the marking process, and acceptance, and these strategies developed with age. Most participants experienced a good quality of life but still could find nothing positive about psoriasis. The authors suggest efforts toward increased awareness among health care professionals of the marking process and future qualitative studies about experiences of psoriasis during adolescence.     

Perception and knowledge of a common skin disorder among university students in Jordan

Background Psoriasis is one of the most common dermatological diseases. Improving public awareness of the different aspects of psoriasis is important to improve the overall knowledge about the disease and enhance public attitude towards sufferers. A sample consisting primarily of university students was undertaken to understand public perception of this disease. Aims The objective of this investigation is to assess the level of public awareness of various aspects of psoriasis including possible risk factors, affected body areas, best persons to manage the disease, and other issues. Methods Selected individuals of the sample were interviewed by well-trained senior pharmacy students. Each individual was asked to fill in a questionnaire consisting of six sections on his/her knowledge of various aspects of psoriasis. Results Of the respondents, 63.8% agreed that psoriasis makes patients’ lives uncomfortable. One third of participants believed that the exact etiology of the disease is still unclear. A positive family history for psoriasis was selected by the highest percentage of respondents as a triggering factor for the disease and the scalp was selected as the major body site affected by psoriatic lesions. Differences in public attitude toward sufferers were detected when results were analyzed according to sample gender, age, nature of job, educational level, and ethnicity. A dermatologist was selected by a clear majority of participants as the best person to treat psoriasis. Conclusion It can be concluded that a high degree of public awareness of psoriasis exists among different ethnicities in Jordan. However, community education is needed to improve the population’s knowledge regarding the nature of psoriasis, important risk factors, and the best source of health services. This paper illuminates a perceptual gap between what people think they understand of this disease and the scientific literature.     

Nutritional Therapy in Persons Suffering from Psoriasis

Psoriasis is a chronic inflammatory skin disease. Immunological, genetic, and environmental factors, including diet, play a part in the pathogenesis of psoriasis. Metabolic syndrome or its components are frequent co-morbidities in persons with psoriasis. A change of eating habits can improve the quality of life of patients by relieving skin lesions and by reducing the risk of other diseases. A low-energy diet is recommended for patients with excess body weight. Persons suffering from psoriasis should limit the intake of saturated fatty acids and replace them with polyunsaturated fatty acids from the omega-3 family, which have an anti-inflammatory effect. In diet therapy for persons with psoriasis, the introduction of antioxidants such as vitamin A, vitamin C, vitamin E, carotenoids, flavonoids, and selenium is extremely important. Vitamin D supplementation is also recommended. Some authors suggest that alternative diets have a positive effect on the course of psoriasis. These diets include: a gluten-free diet, a vegetarian diet, and a Mediterranean diet. Diet therapy for patients with psoriasis should also be tailored to pharmacological treatment. For instance, folic acid supplementation is introduced in persons taking methotrexate. The purpose of this paper is to discuss in detail the nutritional recommendations for persons with psoriasis.     

趋化因子CCL27在寻常型银屑病患者血清的表达以及与PASI的相关性

目的观察寻常型银屑病患者血清CCL27表达水平与PASI的相关性。方法采用ELISA方法，比较试验组（寻常型银屑病患者）与对照组（健康人）血清中CCL27表达水平；并比较试验组血清CCL27水平与PASI评分的相关性。结果寻常型银屑病组血清CCL27表达水平明显高于健康组，P〈0．01，CCL27在寻常型银屑病组血清的表达水平与PASI呈明显正相关（r=1000，P〈001）。结论患者血清CCL27水平与寻常型银悄病病情发生发展密切相关。     

Management of severe psoriasis: about 50 cases

BACKGROUND: With its varied clinical presentation, psoriasis is actually considered as a public health care problem. Severe psoriasis remains difficult to treat. METHODS: Our study was retrospective involving 50 patient with severe psoriasis treated in the dermatology unit of military hospital of Tunis from January 1990 to December 2003. Aim of our study was to evaluate actual different therapeutic attitudes and new treatments in case of severe psoriasis. RESULTS: During the 14 years studied the frequency of severe psoriasis was about 19.5%. Extended psoriasis was noticed on 64% of the patients. Arthropatic psoriasis was found on only 6% of the patients. Erythrodermic psoriasis, pustular psoriasis and palmoplantar psoriatic keratoderma were equally noticed in 10% of the patients. PUVA-therapy was firstly prescribed on 96.6% of the patients with extended psoriasis, bettering was noticed on 71% of all them during the 3 first cures. From the 20 patients that have received acitretin, 65% have noticed improvement. Méthotrexate and Re-PUVA was secondarily used (only for the cases of psoriasic arthritis amd méthotrexate) on respectively 18% and 10% of the patients. All our patients reported worsening on thems quality of life. CONCLUSION: Cyclosporin is more and more used initially in cases of rebellious psoriasis. Actually therapeutic hope leans on biological therapies.     

Associations between Skin Diseases and Quality of Life: A Comparison of Psoriasis, Vitiligo, and Alopecia Areata

The goal of this study was to compare depression and quality of life in three auto immune diseases: psoriasis, vitiligo, and alopecia areata. From January 2009 until January 2010, 300 patients (100 with alopecia areata, 100 with psoriasis and 100 with vitiligo) who were randomly selected (by simple random selection) from outpatient clinic of Razi Hospital (Center of Skin Diseases of Tehran University of Medical Sciences) were asked to answer to Beck Depression Inventory (BDI), SF-36 and Dermatology Life Quality Index (DLQI) questionnaires. DLQI scores were significantly higher in psoriasis cases than others (12.8 ± 6.1, P<0.0001) and SF-36 score were significantly lower (59.8 ± 19.5, P=0.007), both indicating poor quality of life. Significant correlation was found between DLQI and BDI in all disease groups (r=0.44, P<0.001). BDI scores were the highest in psoriasis group but this difference was not significant (P=0.2). Based on these results, dermatologists should consider psychological aspects of autoimmune skin diseases.     

银屑病患者血浆内皮素-1检测及其临床意义

目的　探讨血浆内皮素 - 1在银屑病进行期和静止期水平的变化及其与银屑病发病机制的关系。方法　用放射免疫分析法检测 6 9例寻常型银屑病患者血浆中内皮素 - 1的水平 ,其中进行期 4 1例 ,静止期 2 8例 ,并与 2 2例健康者进行对照。结果　银屑病患者血浆内皮素 - 1高于正常对照组 (P <0 .0 5 ) ,且进行期银屑病患者血浆内皮素 - 1高于正常对照组 (P <0 .0 5 ) ,也高于静止期银屑病患者 (P <0 .0 5 )。结论　血浆内皮素 - 1水平异常可能与银屑病的发病有一定关系     

Immunogenetics of psoriasis: Update

Bachground: Psoriasis is a chronic inflammatory skin disease often benign, affecting 2-3% of the total world population. Psoriasis is a multifactorial disease. Aim: To present recent advances in the immunologic mechanisms and susceptibility genes involved in the pathogenesis of psoriasis. Methods: We presented a literature review of recent genetic and immunological basis of psoriasis to better understand the pathomecanisms of this disease and discuss the contribution of the Tunisian work in this area. Results: Recent works focalized mainly in immunology and genetics. Current progresses in molecular biology have allowed to better characterize the immunogenetic abnormalities in psoriasis. Conclusion: Psoriasis is a multifactorial disease model in which environmental factors (psychological, climate, traumatic, infectious, and viral) seem to be triggering factors when associated with a particular immunogenetics predisposition.     

红皮病型银屑病56例诱因分析与治疗

目的探讨红皮病型银屑病的诱发因素及治疗方法。方法对56例红皮病型银屑病患者进行临床回顾分析。结果多种因素可诱发或加重红皮病型银屑病,不规则使用糖皮质激素、中药的不合理应用、感染、精神因素为其主要诱因,合理规范治疗效果好、预后好。结论加强对寻常型银屑病患者的健康指导,能够有效降低红皮病型银屑病发病率,合理规范的治疗可以取得满意疗效,并且是影响其预后的重要因素。     

银屑病与白细胞介素-17和白细胞介素-10表达水平的相关研究

目的 探讨银屑病与白细胞介素（IL）-17、IL-10表达的相关性.方法 采用酶联免疫吸附试验法检测32例银屑病患者（银屑病组）和30例健康体检者（对照组）血清IL-17和IL-10水平,并进行相关性分析.结果 银屑病组血清IL-17水平高于对照组[（57.59±11.99） ng/L比（33.27 ±6.49） ng/L],IL-10水平低于对照组[（25.38 ±4.32） ng/L比（32.01±5.54）n g/L],差异均有统计学意义（￡=9.84,5.27,P＜0.01）.银屑病患者血清IL-17与IL-10呈负相关（r=-0.70,P＜0.01）.结论 银屑病发病可能与IL-17、IL-10水平的失衡存在一定关联.     

Oral Vitamin D Therapy in Patients with Psoriasis

Vitamin D treatment is effective when applied topically to the skin for plaque-type psoriasis. Oral vitamin D supplementation might be effective as an adjuvant treatment option in psoriasis. This umbrella review aimed to highlight the current knowledge regarding the use of oral vitamin D for treatment of patients with psoriasis. We performed a literature search and identified 107 eligible full-text articles that were relevant to the research interest. Among these, 10 review articles were selected, and data were extracted. A data synthesis showed that only a few studies monitored oral vitamin D efficacy in patients with psoriasis. No studies investigated the optimal dose of systemic vitamin D in psoriasis. However, most studies did not observe side effects for doses within a relatively narrow range (0.25 to 2 μg/day). These results suggest that more large-scale studies are needed to determine the efficacy, optimal dose, and adverse effects of vitamin D administration in patients with psoriasis.     

银屑病住院患者合并败血症分析

目的分析银屑病住院患者合并败血症的临床特点,做到早期诊断和治疗。方法回顾性分析2006年1月-2008年12月,在医院皮肤科住院714例银屑病患者中合并败血症的临床资料。结果 714例患者中,发生败血症7例,发生率为0.98%,其中5例为红皮病型银屑病患者,占红皮病型银屑病患者的6.85%;2例为脓疱型银屑病患者,占脓疱型银屑病患者的2.41%;从临床送检的各类标本中,共检出金黄色葡萄球菌12株,其中甲氧西林敏感金黄色葡萄球菌6株,耐甲氧西林金黄色葡萄球菌2株;凝固酶阴性葡萄球菌1株,为耐甲氧西林凝固酶阴性葡萄球菌;败血症治愈6例,治愈率85.71%。结论严重型银屑病患者合并败血症并非罕见,应引起临床皮肤科和感染科医师的重视;应监测血培养,进行脓疱的细菌培养和药物敏感性试验,首先给予经验治疗,根据药物敏感性结果再调整抗菌药物的使用,耐甲氧西林金黄色葡萄球菌感染首选万古霉素。     

Psoriasis in patients older than 65 years. A comparative study with younger adult psoriatic patients

Objectives

To examine the clinical characteristics of psoriasis, prevalence of comorbidities and quality of life in psoriasis patients older than 65 years and to compare them with younger adult psoriatic patients.

Design

Prospective observational study of prevalence.

Setting and participants

Patients older than 18 years with diagnosis of psoriasis attended at the Dermatology Department of the University Hospital of A Coru?a (Galicia, Spain). A total of 371 patients were included (218 males and 153 females) with ages ranging from 18 to 85 years, of whom 70 were older than 65 years.

Measurements

Demographic data, clinical characteristics and psoriasis treatment, history of hypertension, diabetes mellitus, smoking and alcohol consumption and quality of life impairment were registered. Body mass index, waist-hip ratio, left ventricular hypertrophy, average value of systolic and diastolic blood pressure, cholesterol, triglycerides and glucose blood levels were also measured.

Results

Patients older than 65 years have statistically significant higher prevalence of hypertension, left ventricular hypertrophy, waist-hip ratio, diabetes mellitus and raised blood glucose levels. There was also association between clinical severity of psoriasis and smoking and alcohol intake as well as between quality of life and type of psoriasis treatment.

Conclusions

Psoriasis in patients older than 65 years represents a significant proportion of cases and its prevalence is expected to increase. Because these patients are more prone to suffer comorbidities and to develop adverse effects due to psoriasis treatment, attention to pharmacologic interactions and correction of cardiovascular risk factors and toxic habits should be especially taken in mind in this age group.     

Phase II randomized, placebo-controlled trial of M. vaccae-derived protein (PVAC) for the treatment of psoriasis

The treatment effect against psoriasis of an antigen (delipidated, deglycolipidated form of M. vaccae-PVAC) was investigated. One hundred and sixty-five patients were enrolled in three arms (50 or 15 microg or placebo), each receiving a total of two intradermal injections (days 0 and 21). At week 12, a 75% decrease in psoriasis area and severity index was similar among the studied groups (13, 9 and 18%, p=0.429). The overall incidence of adverse events was significantly higher in the PVAC treated groups when compared to placebo (98.2, 87.3 and 70.9%; p<0.001) largely due to local reactions that were limited for the most part to grades 1 and 2 in severity and were self-limiting. Despite its overall safety, PVAC was not clearly indicated to be superior to placebo in the treatment of psoriasis in this study.     

The prevalence of obesity is increased in patients with late compared with early onset psoriasis

PurposeWe compared the clinical and epidemiologic characteristics of early and late onset psoriasis with an emphasis on potential differences in the comorbidities associated with each subtype.MethodsAn observational, multicenter study was performed, and associations between the age at the time of diagnosis and binary comorbidity outcomes were evaluated using multiple logistic regression analysis adjusted for age and other relevant confounders.ResultsAn increased prevalence of positive family history, psoriatic arthritis, and depression was observed in patients with early onset psoriasis. On the other hand, late onset psoriasis was more frequently associated with obesity and elevated waist circumference compared with early onset form. Elderly psoriatic patients (at the age of 75 years) with late onset psoriasis are at an especially high risk for obesity compared with individuals at the same age with an early onset disease.ConclusionsThe increased frequency of psoriasis in the family of early onset patients may suggest that manifestation of psoriasis at younger age is driven by strong genetic influence. However, such a remarkable association of abdominal obesity with late onset psoriasis may suggest that obesity can be one of the acquired factors that may predispose for the development of psoriasis in the elderly.     

Psoriasis is a risk factor for hip-prosthesis infection

Risk factors for hip and knee prosthesis infection have been described, but not psoriasis. Eighty five infected patients from different centers and 202 non infected patients were included in a case-control study. Fifteen of 85 infected patients (17.6%), and 2 of 202 (1%) non infected patients had psoriasis. Odds ratio for infection in patients with psoriasis is 21.4 (4.7-- 195.5), and 39.7 (5.3--1718.8) in patients with hip prosthesis and psoriasis. No significant difference was found in patients with knee prosthesis. These data indicate that psoriasis is a risk factor for hip prostheses infection.     

The pathogenesis of inflammatory dermatoses, especially psoriasis

The skin contains a variety of cell types and mediators, which together constitute the skin's immune system and play a key role in protecting the human body against dangers from outside. Dysregulation of the skin's immune system, however, frequently occurs and can result in undesirable inflammatory processes in the skin. A typical example of an undesirable inflammation in the skin is the chronic inflammatory skin disease psoriasis. In the pathogenesis of psoriasis, both genetic and environmental factors play a key role. In psoriasis, the complex interactions between T-lymphocytes, antigen-presenting cells, keratinocytes and pro-inflammatory cytokines and chemokines are disturbed. The two most widely accepted hypotheses are: (a) psoriasis is a T-cell mediated autoimmune disease, and (b) psoriasis is the result of a too finely adjusted system for regulating inflammation in the skin. The result of both mechanisms is a chronic inflammatory reaction fuelled by pro-inflammatory type-I cytokines that lead to the psoriasis-skin phenotype. With the development ofbiologicals, it has become feasible to target specific molecules in the immune process, for example type-I cytokines and the molecules present on pathogenic T-cells. This approach has already proved successful in the treatment of rheumatoid arthritis and Crohn's disease, creating novel therapeutic options for psoriasis and other inflammatory dermatoses.