寻常型银屑病皮肤及甲襞微循环变化分析

目的：研究寻常型银屑病患者皮损、非皮损、甲襞微循环血流灌注变化情况。方法：利用激光多普勒散斑血流仪检测88例寻常型银屑病患者胫前皮损、非皮损与100名对照胫前正中及两组指尖血流灌注绝对值。结果：患者皮损、非皮损与正常对照皮肤微循环灌注绝对值分别为（319.96±124.65）BPU，（100.87±19.74）BPU和（60.10±13.90） BPU，三组比较差异有统计学意义（均P＜0.05）。甲银屑病指尖微循环灌注值为（406.31±64.01BPU）,高于无甲受累患者的（270.13±69.41） BPU和对照组的（361.15±113.70） BPU，差异有统计学意义（P＜0.05）；皮损微循环灌注绝对值与PASI评分之间呈正相关（r=0.744）。结论：寻常型银屑病患者皮肤及甲襞微循环血流灌注异常，皮损部位灌注值与病情严重程度相关。     

What do we know about palmoplantar pustulosis?

Palmoplantar pustulosis is characterized by a chronic eruption of sterile pustules on palms and soles. The disease affects mainly women in the sixth and seventh decade of life. Some authors consider palmoplantar pustulosis a separate entity, whereas others consider it a condition in the spectrum of psoriasis. Aim of this study was to summarize the most recent data about PPP which aimed at establishing the nosological position of palmoplantar pustulosis. A systematic search of published literature was carried out. General characteristics of patients with PPP in different populations were present. We reviewed histological, immunological and genetic studies, as well as treatment options for PPP. PPP presents with clinical features, which are not present in psoriasis; however, the common coexistence of psoriasis vulgaris and/or positive family history for psoriasis indicates at least a close relationship between PPP and psoriasis. At present, there are not sufficient data to exclude PPP from psoriasis group.     

UVA1光疗联合卡泊三醇软膏治疗甲银屑病的临床疗效观察

目的探讨UVA1光疗联合卡泊三醇软膏治疗甲银屑病的临床疗效,进而为甲银屑病患者的治疗提供临床依据。方法将收集的60例寻常型银屑病甲损害的患者随机分为2组,均给予卡泊三醇软膏2次/d,联合治疗组予以UVA1照射(2次/周)治疗,2组治疗方案疗程均为6个月;在治疗前及治疗后,对患者进行银屑病甲严重程度指数(NAPSI)。结果 60例寻常型银屑病甲损害患者中,平均年龄(50.57±16.24)岁,2组在年龄、性别、病程比较差异无统计学意义(P0.05);2组患者病甲治疗前NAPSI评分:联合治疗组:27.07±10.86,卡泊三醇软膏组:25.93±10.73,2组比较差异无统计学意义(t=0.449,P0.05);治疗后2组NAPSI评分分别为:联合治疗组:12.67±7.60,卡泊三醇软膏组:18.10±8.93,NAPSI评分差异有统计学意义(P0.05);治疗后联合治疗组临床痊愈10例,痊愈率33.33%,有效率56.67%,卡泊三醇软膏组临床痊愈0例,痊愈率0%,有效率13.33%,2组有效率的比较有统计学意义(P0.01)。结论UVA1联合卡泊三醇软膏治疗甲银屑病的疗效优于单纯使用卡泊三醇软膏。     

A Crohn's disease-associated insertion polymorphism (3020insC) in the NOD2 gene is not associated with psoriasis vulgaris,palmo-plantar pustular psoriasis or guttate psoriasis

A C-insertion polymorphism in the NOD2 gene (3020insC) on chromosome 16 is a rare mutation associated with Crohn's disease. Crohn's disease and psoriasis are more commonly observed together than expected by chance. Furthermore a susceptibility locus for psoriasis has been identified on chromosome 16q which overlaps the recently identified susceptibility locus for Crohn's disease. Thus, NOD2 may potentially be important as a candidate susceptibility gene for psoriasis. We tested this hypothesis by genotyping psoriasis patients for the C-insertion polymorphism using the Taqman ABI 7700 sequencing system. No statistically significant differences were observed between psoriasis vulgaris (n = 216), palmo-plantar pustular psoriasis (PPP) (n = 100), guttate psoriasis (n = 118) and the control group (n = 283). In both patient and control groups, no mutant homozygotes were observed and approximately 4% were heterozygotes. This particular insertion mutation in the NOD2 gene does not appear to contribute to the genetic susceptibility of psoriasis vulgaris, PPP or guttate psoriasis. However, other mutations exist in the NOD2 gene, which may potentially have a role in psoriasis susceptibility.     

Palmoplantar lesions in psoriatic patients and their relation to inverse psoriasis, tinea infection and contact allergy

One hundred and seven psoriatics with palmoplantar involvement were clinically examined. They were selected from 921 patients filed in 1976 with the diagnosis psoriasis. Fifty per cent of the patients with palmoplantar psoriasis had flexural changes. The frequency of palmar involvement in patients with inverse psoriasis compared to patients with psoriasis vulgaris was increased 5.3 times. Pustulosis palmoplantaris (PPP) in addition to psoriasis was diagnosed in 18 patients (17%). A dermatophyte infection was observed in 1 of 48 patients examined for tinea infection. Positive patch tests were obtained in 8 of 47 patients, 7 of whom had more than one test reaction. The result gives no evidence of tinea infection and contact allergy as important factors in maintaining palmoplantar psoriasis.     

Detection of asymptomatic enthesitis in psoriasis patients: An onset of psoriatic arthritis?

Presence of asymptomatic joint involvement is recognized in patients with psoriasis. However, it remains elusive whether such patients develop psoriatic arthritis (PsA). The aim of the present study was to examine the incidence of asymptomatic joint lesions, in particular, enthesitis in patients with psoriasis vulgaris (PsV) and to further assess the clinical features. Eighteen PsV and 28 PsA patients were enrolled for examination by positron emission tomography/computed tomography (PET/CT) using ¹⁸F‐fluorodeoxyglucose (FDG). Any nail, scalp and intergluteal involvements were reported. Levels of serum C‐reactive protein (CRP), white blood cell (WBC) counts and erythrocyte sedimentation rate (ESR) were examined. All of the PsA patients showed FDG accumulation in the affected joints. Notably, asymptomatic enthesitis was detected in six out of 18 PsV patients (33%), and they were diagnosed as having subclinical PsA. Incidences of scalp, intergluteal and nail psoriasis in subclinical PsA patients were 100%, 83% and 64%, respectively, which were higher than those in PsV patients (67%, 25% and 40%, respectively). CRP, WBC counts and ESR were invariable between PsV and subclinical PsA groups. PET/CT imaging could discover asymptomatic enthesitis. Our data suggested that the subpopulation of subclinical PsA was much higher than expected. Higher prevalence of nail, scalp and intergluteal psoriasis confirmed the risk of PsA as previously described.     

Clinical and epidemiological comparison of patients affected by palmoplantar plaque psoriasis and palmoplantar pustulosis: a case series study

Summary Background In 2007 the International Psoriasis Council proposed that palmoplantar pustulosis (PPP) should be considered a separate condition from psoriasis, despite the presence of certain phenotypes common in both diseases. Objectives To describe and compare demographic and clinical characteristics among patients with PPP and palmoplantar plaque psoriasis. Methods This was a retrospective case series study from 2005 to 2010. The following data were obtained: age, sex, family history, smoking habits, nail involvement, joint involvement, disease duration, lesion morphology (plaque or pustular), histological diagnosis, comorbidities, and Physician’s Global Assessment (PGA) score for extrapalmoplantar lesions. The sample size calculation indicated that 80 patients, 40 patients for each group (palmoplantar plaque psoriasis and PPP) were needed to see clinically relevant differences between groups. Results Ninety patients were selected, 51 with palmoplantar plaque psoriasis and 39 with PPP. No statistically significant differences were registered between patients affected by PPP and palmoplantar plaque psoriasis as regards age at onset of the disease (48 vs. 44 years; P = 0·4), disease duration (6 vs. 10 years; P = 0·1), family history of psoriasis (28% vs. 33%; P = 0·7), concomitant arthritis (26% vs. 25%; P = 1·0), or smoking habits (54% vs. 41%; P = 0·2). We observed a female predominance (P = 0·01) and a lesser frequency of nail involvement (P = 0·03) in patients affected by PPP. Conclusions Our data suggest a close relationship between PPP and psoriasis. The existing data concerning epidemiology, clinical presentation, genetics, histopathology and pathogenesis do not permit a clear distinction between these two entities, which seem to coincide in many aspects. PPP appears to have a marked predilection among female smokers.     

Topical Anthralin Therapy for Refractory Nail Psoriasis

The nail is commonly involved in psoriasis; however, very few therapies are satisfactory. In this study, we treated for 20 cases of psoriasis vulgaris with nail involvement with topical anthralin therapy. An ointment of 0.4–2.0% anthralin in petrolatum was applied to the affected nail bed once a day and washed away with water after 30 minutes. Then, 10% triethanolamine cream was applied to prevent undesired pigmentation. Within five months of therapy, twelve out of twenty psoriatic patients (60%) showed moderate and obvious improvement, four patients (20%) showed no response to this regimen. Onycholysis and pachyonychia both responded clinically, and the number of pitting was markedly decreased in some cases. The main side effect of anthralin therapy was reversible pigmentation of the nail plate. Topical anthralin therapy is effective for nail psoriasis and considered to be a useful treatment for refractory nail psoriasis.     

寻常性银屑病患者甲损害临床特征分析

目的 分析寻常性银屑病患者甲损害情况及其与银屑病临床表现、实验室指标及代谢综合征的关系。方法 回顾性收集2011年9月1日至2014年4月1日就诊于北京协和医院皮肤科门诊的315例寻常性银屑病患者的临床资料,分析其甲损害情况和特点,甲损害发生与患者临床特征、实验室指标及代谢综合征的关系。结果 315例寻常性银屑病患者中,156例（49.5%）有甲损害,其中甲凹点（57.7%）最常见,甲床角化过度（37.8%）、甲纵脊（34.0%）、甲剥离（28.2%）较为常见,而油甲（12.8%）及甲营养不良（3.8%）则相对较少。与无甲损害的患者相比,有甲损害的患者病程长（> 10年）且病情重（PASI > 10）,差异有统计学意义（χ2 = 8.234、14.200,均P < 0.01）,且有甲损害者PASI评分（中位数为9.10,P25、P75为3.88、18.38）明显高于无甲损害者［4.35（2.50,11.28）］（W = 21350.50,P < 0.001）。有甲损害者头皮、上肢、躯干及下肢皮损面积大于无甲损害者（W = 21744.0、23135.0、22743.5、22797.0,均P < 0.01）,且甲损害与头皮皮损面积有相关性（Pearson列联系数rc c = 0.224,P = 0.01）。有甲损害者中代谢综合征的伴发比例（9.0%,13/145）与无甲损害者（6.5%,10/154）差异无统计学意义（χ2 = 0.643,P = 0.423）。但银屑病甲损害与性别、银屑病家族史、发病早晚及实验室指标、代谢指标、BMI等无明显关联。结论 寻常性银屑病甲损害常见,与病程长短、疾病严重程度有关。     

Pustulosis palmaris et plantaris with prominent hyperkeratosis of the soles

A 50-year-old woman developed prominent hyperkeratosis on the soles and erythema of her extremities. In this instance it was clinically difficult to distinguish the palmoplantar lesions from psoriasis vulgaris. However, our case proved to be palmoplantar pustulosis (PPP) because, on histology, the extra-palmoplantar lesions showed none of the typical findings of psoriasis vulgaris, there was a history of sternoclavicular joint pain, and the lesions improved after tonsillectomy. Herein, we consider the relationship between prominent hyperkeratosis of the sole or palm in PPP and bacterial infection.     

寻常性银屑病患者血浆肿瘤坏死因子水平检测

检测４０例银屑病患者血浆ＴＮＦ含量和ＩｇＡ、ＩｇＧ、ＩｇＭ、Ｃ_３水平。结果：银屑病组血浆ＴＮＦ较正常组显著升高，男性高于女性（Ｐ＜０．０５），进行期高于静止期，伴甲部损害者ＴＮＦ明显升高，ＴＮＦ水平与病情严重程度呈正相关，与ＩｇＡ、ＩｇＧ、ＩｇＭ、Ｃ_３无明显线性关系。结果分析表明ＴＮＦ参与银屑病病理生理变化过程，是其进展中重要影响因素。     

Therapeutic effects of a 12-week course of alefacept on nail psoriasis

BACKGROUND AND OBJECTIVES: Nail psoriasis is a common finding in psoriatic patients and it affects the quality of life in a great proportion of patients. Topical or systemic treatments have limited effectiveness or have a serious toxicity potential. Biologicals such as alefacept are the most recent treatment modalities for psoriasis. In the present study we evaluated changes in nail pathology in patients with plaque psoriasis and nail involvement during treatment with alefacept. PATIENTS AND METHODS: Digital photographs from eight patients were produced, which were analysed using the nail psoriasis severity index (NAPSI). A minimal NAPSI of 15 was chosen to divide patients into a moderate to very severe nail psoriasis group and a group with no or mild nail psoriasis. A decrease in NAPSI of at least 25% was considered a significant response to therapy. RESULTS: In the group with at least moderate nail psoriasis, two patients improved, in two patients the nail changes remained unchanged and in one patient the nail pathology was aggravated. The group with no or mild nail psoriasis showed variable results. CONCLUSIONS: Although alefacept showed some results in treating nail pathology in psoriasis, a more extensive study is required, covering both more patients and a more extensive time period. Furthermore, it would also be clinically relevant to compare the effects of alefacept on nail psoriasis with other biologicals.     

Identification of nail features associated with psoriasis severity

There are no detailed studies of the prevalence of nail psoriasis and clinical characteristics of psoriatic nail involvement, including nail features associated with disease severity. Therefore, we designed a study to investigate the prevalence and characteristics of psoriatic nail involvement in patients with psoriasis and determine the relationship between psoriatic nail features and severity of nail psoriasis and cutaneous psoriasis. The Nail Psoriasis Severity Index (NAPSI) was used for evaluation of the severity of nail lesions. The presence of nail fold psoriasis (NFP) was also assessed. The severity of psoriasis was evaluated by calculating the Psoriasis Area and Severity Index (PASI). As a result, the prevalence of nail psoriasis was 85.5%. Pitting was the most common clinical feature (55.6%). The severity of nail psoriasis was not affected by medical parameters, although patients with localized pustular psoriasis tended to have more severe nail psoriasis than did those with chronic plaque psoriasis. When comparing the mean NAPSI and the mean PASI according to nail lesions, we found that subungual hyperkeratosis (SH) and NFP were significantly associated with the severity of both nail psoriasis and cutaneous psoriasis. Psoriatic nail changes were most common in the first digit. Conclusively, the majority of patients with psoriasis had psoriatic nail involvement, and Koebner's response seems to be closely related to the induction of nail psoriasis. To limit progression of the disease, psoriatic patients with SH or NFP should be examined thoroughly because those clinical features reflect the levels of severity of both nail and cutaneous psoriasis.     

Ultrasonography reveals nail thickening in patients with chronic plaque psoriasis

Nail psoriasis is usually investigated and diagnosed by clinical examination. Ultrasonography is a non-invasive imaging technique for studying soft tissue involvement. The objective of this study was to estimate nail involvement in patients with chronic plaque psoriasis by ultrasonography. Prevalence, clinical type and severity of nail involvement according to nail psoriasis and severity index (NAPSI) were investigated in 138 patients with psoriasis. The thickness of the plate and bed of the fingernails was measured in 54 patients with psoriasis, 46 healthy controls and 37 patients with chronic eczema, using an ultrasonographic system equipped with a frequency transducer of 18?MHz. The prevalence of nail psoriasis was 73?% (102 out of 138). Onycholysis and thickening of the nail plate were the most common clinical type affecting 56 and 50?% of patients, respectively; splinter haemorrhages was the less common involving 10?% of patients. The mean NAPSI score was 18.4?±?17.5 (SD; range 0–107). The thickness of fingernail plate and bed was significantly higher in patients with psoriasis with nail disease compared to healthy controls and patients with chronic eczema (p?<?0.001). There was a linear correlation between NAPSI and plate and bed nail thickness (r?=?0.52 and r?=?0.38, p?=?0.001). Increased nail plate and bed thickness was observed also in patients with psoriasis without clinically apparent nail involvement. In conclusion, thickening of the nail is a common feature of nail psoriasis also in patients without clinically apparent nail involvement.     

汉族寻常性银屑病患者IFN-γ受体2基因多态性研究

目的 探讨IFN-γ受体2(IFN-γR2)基因氨基酸位点Gln64Arg多态性与中国汉族寻常性银屑病的相关性.方法 采用PCR-限制性片段长度多态性(RFLP)方法及DNA测序方法,检测苏皖地区182例汉族寻常性银屑病患者和114例正常人对照IFN-γR2基因Gln64Arg位点多态性.结果 寻常性银屑病患者与正常人对照组IFN-γR2基因Gln64Arg多态性位点各基因型及等位基因频率分布差异无统计学意义(P>0.05).伴甲损害银屑病组与无甲损害银屑病组之间Gln64/Gln64基因型分布频率分别为57.5%和38.1%.差异有统计学意义(X~3=5.33,P=0.02);Arg4等位基因(Gin64等位基因)分布频率分别为19.3%(80.7%)和30%(70%),差异也有统计学意义(X~2=5.03,P=0.02).伴甲损害的银屑病患者组Gln64/Arg64基因型分布频率为29.8%,正常人对照组为49.1%,两组间分布差异有统计学意义(X~2=5.48,P=0.01);Gln64/Gln64基因型分布频率在两组间分别为57.5%和35.1%,差异有统计学意义(X~2=6.23,P=0.01);无甲损害组与正常人对照组之间差异则无统计学意义.在以上呼吸道感染为诱因或加重因素的银屑病组与非上呼吸道感染银屑病组之间Arg64/Arg64基凶型分布频率分别为33.3%和15.5%,差异有统计学意义(X~2=4.94,P=0.03);Arg64等位基因(Gin64等位基因)分布频率为51.9%(48.1%)和35.2%(64.8%),差异也有统计学意义(X~2=5.46,P=0.02).结论 IFN-γR2基因Gln64Arg多态性位点可能与寻常性银屑病患者是否伴有甲损害有关,也可能与以上呼吸道感染为诱因或加重因素的寻常性银屑病有关.     

Histocompatibility antigens in plaque psoriasis and palmoplantar pustulosis

The inheritance of susceptibility to psoriasis is thought to be multifactorial; expression of the disorder being influenced by environmental factors. Studies of histocompatibility antigens (HLA) help our understanding of the genetic inheritance of susceptibility to the disease. Early HLA studies in chronic plaque psoriasis (CPP) have shown an increased incidence of B13 and B17. More recently the antigens CW6 and DR7 have also been shown to be increased. No statistical increase has been shown in patients with persistent pustular psoriasis of the palms and soles (PPP). However there are limited data on class II antigens in this group. No previous study has compared the two groups of patients in the same population or compared clinical subsets of CPP.
Eighty-five British Caucasian patients with CPP and 45 with PPP were typed for antigens of the HLA A, B, C and DR loci. Our results confirm the increased frequencies of B13, BW57 (B17), Cw6 and DR7 in CPP patients compared with controls, and we have also found a previously unreported decrease in the frequency of BW44 (B12). In contrast the PPP patient group had increased frequencies of B8, Cw7 and DR3. HLA associations of subsets of patients related with family history, age of onset, severity of disease, the presence of arthritis and nail changes have also been assessed.     

Nail psoriasis--an ignored disorder. Pathogenesis, diagnosis and therapy

Approximately 50% of all patients with psoriasis develop characteristic nail changes as a clinical correlate of psoriatic inflammation of the nail matrix and/or nail bed. The most frequent signs of nail psoriasis are pitting and distal onycholysis. The most commonly used score to assess the severity of nail involvement at present is the Nail Psoriasis Severity Index (NAPSI). Although more than half of affected patients experience a significant physical and mental impairment, this index does not include patient-reported symptoms. There is a striking association between nail psoriasis and a higher risk of psoriatic arthritis with a prevalence of nail involvement among patients with psoriatic arthritis as high as 70%. A possible explanation is the close anatomical link between the nail apparatus and the distal interphalangeal joint; enthesitis of the latter is carried by fibers to the nail and becomes clinically visible as nail psoriasis. Nail involvement is not adequately reflected in current concepts of disease management. There is limited evidence for the efficacy of topical therapies in nail psoriasis. A number of large studies document an improvement of nail psoriasis in response to biologics and, more recently, also to methotrexate.     

Finger Nail Pitting in Psoriasis and its Relation with Different Variables

Incidence of pitting, vary considerably in different types of psoriasis. In clinical practice, toe nail examination is inconvenient. There are inadequate studies which show relation of nail pitting with duration and severity of the disease. The objective was to examine the incidence of finger nail pitting in all types of cutaneous psoriasis and its relation with different variables. This is a clinico-epidemiological study. A careful clinical examination of finger nails was done in day time. Severity of disease was calculated by psoriasis area severity index (PASI). Statistical analysis was done using Microcomputer statistics software (MSTAT). In study group, 621 patients and in control group 350 people were taken. Finger nail pitting was present in 37% (total number was < 20 in 17%; 20-60 in 8% and > 60 in 12%) in study group. In control group, it was present in 10% (in all cases total number was < 20). In < 1 year duration group, pitting was present in 32% of cases, while in > 1 year duration group it was 40.5%. In mild psoriasis, pitting was present in 34.2%, while in severe cases it was 47.6%. Finger nail pitting is an important nail finding in psoriasis and its incidence increases with duration and severity of disease.     

Antideoxyribonuclease B titers in psoriasis

Psoriatic patients were examined for serologic evidence of streptococcal infections by using antideoxyribonuclease B (ADB), which has been shown to be a more sensitive screening tool than antistreptolysin O (ASO) for detecting such evidence in other clinical circumstances. Antistreptococcal antibody titers (ASO and ADB) of 71 patients with psoriasis vulgaris, 7 with guttate psoriasis, and 6 with erythrodermic psoriasis were compared with ASO and ADB antibody titers of 25 non-psoriatic dermatologic patients hospitalized at the same time and of an adult group that was used as a control for the test itself. Thirty-six of 71 patients with psoriasis vulgaris had elevated titers of ADB or ASO (41% vs. 15%). Compared with control values the ADB titers were significantly higher in patients with psoriasis vulgaris (P less than 0.02) and patients with guttate psoriasis (P less than 0.05). The ASO titers were significantly higher in patients with psoriasis vulgaris than in controls (P less than 0.04). Within the group with psoriasis vulgaris, ADB titers were significantly higher than ASO titers (P less than 0.01). Among patients with psoriasis vulgaris, histories of sudden flares of psoriasis and early recurrences of psoriasis after previous successful hospital treatment, family histories of psoriasis, and histories of potential streptococcal infections were more frequent in those with elevated antistreptococcal antibodies.     

银屑病甲损害与超声下远端指间关节改变的相关性分析

目的:分析银屑病患者甲损害与超声下远端指间关节改变的相关性。方法:纳入中重度寻常型银屑病(PsO)患者和关节病型银屑病(PsA)患者,记录患者的基本临床资料、甲损害特点以及超声下甲单元及远端指间关节情况。结果:研究共纳入中重度PsO患者38例,PsA患者35例。PsA组甲损害发生率高于中重度PsO组(85.7%vs 63.2%,P=0.028),前者mNAPSI评分(P=0.042)及甲板厚度(P<0.001)也高于后者。与中重度PsO组相比,PsA组附着点炎及骨赘形成的检出率高(77.1%vs 28.9%,P<0.001;74.3%vs 31.6%,P<0.001)。在中重度PsO患者的手指中,甲损害组指伸肌腱附着点炎及关节积液的发生率高于无甲损害组(11.4%vs 2.6%,P<0.001;35.6%vs 12.6%,P<0.001),在PsA患者的手指中,甲损害组指伸肌腱附着点炎、关节积液、滑膜炎、骨侵蚀、骨赘形成的发生率均高于无甲损害组(均P<0.05);所有患者同一手指水平mNAPSI评分、甲剥离、甲凹点均与指伸肌腱附着点炎相关,相关性最显...