Keratoses in patients with psoriasis: a prospective study in fifty-two inpatients

Twenty-eight of 52 consecutive psoriasis inpatients admitted for therapy with the modified Goeckerman regimen had discrete, gray-white, asymptomatic, keratotic lesions approximately 4 mm in diameter at discharge from the hospital. In 18 of these 28 patients no keratoses were noted on admission. In 9 of 10 patients who had keratoses at admission, there was an increase in number at discharge. All patients with keratoses on admission had multiple, closely spaced previous admissions. No age, sex, or skin type predominance was evident in the group with keratoses compared with the remainder of the group (24 patients) who did not have keratoses. The development of keratoses was not related to the type or duration of psoriasis. Statistically significant predisposing factors were the number of UVB and PUVA treatments and the number of inpatient admissions. Fifty-two percent were located on the extremities, 33% on the trunk, and 15% on the face, head, and neck. Histologic examination of these lesions suggested that they may be a variant of seborrheic keratoses. We have not seen these lesions on patients receiving UVB, PUVA, or tar therapy for other diseases. This raises the possibility that these lesions may be unique to psoriasis and most likely are related to long-term therapy.     

Clinical characteristics of Japanese pustular psoriasis: A multicenter observational study

Generalized pustular psoriasis (GPP) is a rare and severe subtype of psoriasis. Because of its rarity, GPP studies with a large sample size have been scarce. We studied the characteristics of GPP and pustular psoriasis using data from the West Japan Psoriasis Registry that had been registered until the end of December 2020. The dataset included 104 patients with pustular psoriasis and 1290 patients with other subtypes of psoriasis. Multivariate analysis revealed a significantly greater number of female patients, a significantly lower mean body mass index, and a significantly lower ratio of habitual drinkers in pustular psoriasis, compared to other subtypes of psoriasis. Of the 104 patients, 102 had GPP, including 88 von Zumbusch, 10 juvenile-onset, and four annular pustular psoriasis. Although the male : female ratio of GPP with psoriasis vulgaris (GPP+PsV) (47/20) was similar to that of psoriasis in Japan, the GPP without PsV (GPP?PsV) group highlighted a female predominance (13/22). The mean age at GPP onset was 45.3 years, and the mean interval from PsV onset to GPP onset was 12.5 years. Four of nine patients with GPP had an IL36RN gene mutation. Infection, medicine, and pregnancy were the precipitating factors for GPP. A family history of psoriasis was present in eight (7.8%) patients with GPP. Twenty-four patients with GPP had psoriatic arthritis. Biologics were used in 76.5% of patients with GPP, followed by etretinate (37.3%), cyclosporine (24.5%), methotrexate (13.7%), apremilast (8.8%), and granulocyte and monocyte adsorption apheresis (6.9%). Etretinate was used in 17 (51.5%) of 33 patients with GPP with less than 10-year history. Thus, etretinate remains a good treatment option for GPP even in the era of biologics. Hypertension was the most commonly identified comorbidity, followed by diabetes. We believe that the characteristics revealed in this study can further contribute to effective GPP management.     

An observational,prospective study of monthly adalimumab therapy for disease maintenance in psoriasis patients: a possible new therapeutic option for good responders to the initial induction treatment

Background While adalimumab is a mainstay of treatment for moderate to severe chronic plaque psoriasis, the data regarding optimal treatment intervals for therapeutic maintenance are limited. Objective We compared the clinical efficacy of biweekly maintenance administration of adalimumab with that of monthly treatment. Methods 17 psoriasis patients treated with adalimumab 40 mg every other week with initial loading dose of 80 mg until week 24 were assigned to the maintenance therapy with adalimumab 40 mg either every other week (n = 7), or every month (n = 10). The treatment efficacy was evaluated by the proportion of patients who achieved PASI 75 from the baseline at weeks 36, 48 and 60. There was no selection bias between the two groups. Results At week 24, all the patients except for one in each group achieved PASI 75. In both groups, all the patients who achieved PASI 75 at week 24 maintained PASI 75 responses at week 60. Regarding two patients who did not achieve PASI 75 at week 24, one biweekly treated patient experienced a gradual increase in therapeutic response while one monthly treated patient showed exacerbation after week 24. Conclusion Monthly adalimumab treatment seems to be a reasonable treatment option for patients who responded well to initial standard adalimumab treatment for 24 weeks. Since there are several limitations in this study, including the number of patients, observation period, and patients’ characteristics, large randomized controlled trials are needed to confirm these results.     

Sequential liver biopsies during long-term methotrexate treatment for psoriasis: a reappraisal

Summary One hundred and eighty-two liver biopsies were performed over a l0-year period on patients receiving long-term, low-dose, once weekly oral methotrexate (MTX) for severe psoriasis. Forty-nine patients had two or more biopsies during continued treatment and formed the study population for our analysis. The first and last biopsies were compared to determine progression of any hislological abnormalities. Liver biopsies were assessed without knowledge of the MTX dose and allocated to one of five groups according to the severity of the histological abnormalities. These were defined as: (11 normal: (2) steatosis alone: (3) inflammation without fibrosis: (4) librosis: and (51 cirrhosis. The mean cumulative dose of MTX at the time of the first biopsy was 2743 mg (range 315–10,024), given over 275 weeks (range 26–738). In the interval between the lirst and last biopsies, patients received, on average, a further 2362 mg (range 390–7155) over 225 weeks (range 60–460). There was improvement in the hislological assessment in 12 patients, no change in 28 patients, and deterioration in nine patients. None developed cirrhosis. Liver biopsy findings prompted discontinuation of MTX in four of the 49 patients on king-term treatment. This has to be weighed against the cost and morbidity of the 124 biopsies performed in these patients. Our results suggest that, wilh careful follow-up, the risk of development or progression of liver disease in patients receiving long-term, low-dose, once weekly oral MTX for psoriasis is modest, and that the requirement for performing routine liver biopsies in these patients needs to be reconsidered.     

Frequency of patch-test positivity in patients with psoriasis: a prospective controlled study

Current information on the incidence of patch-test positivity and the spectrum of allergens in psoriatics is conflicting. We compared the rates of patch-test positivity to common allergens and topical medicaments in 200 patients suffering from chronic plaque psoriasis (group I) with 51 patients with other non-allergic skin complaints (group II) and 54 patients suspected of having allergic contact dermatitis (group III). Positive patch-test results to one or more allergens were detected in 21.6% of patients in group I, 23.5% in group II and 50.0% in group III. Psoriatics with > or = 5 years old disease had a higher rate of patch-test positivity than those with shorter disease duration (p<0.01). The site of lesions showed no correlation with patch-test positivity. The commonest allergens showing positivity in group I were dithranol (6.5%), nickel (6%), fragrance mix (5%), neomycin (2%) and nitrofurazone (2%). In spite of the comparable rates of patch-test positivity in psoriatics and general dermatology outpatients, the predominance of sensitivity to topical medicaments and fragrance in the former group was striking. A separate psoriasis series focusing on topical agents may give more accurate information on this subject.     

Renal function during long-term cyclosporin treatment of psoriasis

INTRODUCTION: The goal of this retrospective study was to evaluate the effects of cyclosporin A on renal function in patients treated for five years or more. PATIENTS AND METHODS: Two hundred twenty-four psoriasis patients were treated with cyclosporin at St. Louis Hospital, in Paris, from 1988 to 1997. Eleven patients (5 p. 100 of the total) took cyclosporin for at least five years. Nine case histories were available for the analysis. RESULTS: The group studied consisted of eight men and one woman, ranging in age from 28 to 48 with an average age of 38 years. The average cyclosporin dosage was 3.6 mg/kg/day (2.0-5.0 mg/kg/day). The changes in renal function were not significant as compared to the baseline level. The patients did not show persistent increases of serum creatinine more than 30 p. 100 of the pre-treatment value. Two patients had to discontinue treatment after 6 years because of a 20 p. 100 decrease in glomerular filtration rate. DISCUSSION: Previous studies have shown that cyclosporin A is not a suitable long-term continuous monotherapy for psoriasis. However, with precise and regular monitoring of kidney function, a minority of patients can benefit from prolonged treatment without experiencing side effects.     

Serum adenosine deaminase levels in patients with psoriasis: a prospective case-control study

Adenosine deaminase (ADA) activity is a nonspecific marker of T cell activation. T cell activation is thought to play an important role in the pathogenesis of psoriasis. Our purpose was to assess the significance of serum ADA activity in psoriasis and its relevance to disease activity. ADA activity was determined with an enzymatic method in 25 patients with psoriasis and in 15 healthy subjects. These measurements were repeated for 10 patients after either PUVA or cyclosporin A treatments. Disease activity was estimated by the PASI scoring system. Serum ADA level was significantly elevated in patients with psoriasis compared to healthy subjects (p<0.05). There was a significant decrease in the ADA levels after treatment compared to pretreatment values in the same patients (p<0.05). There was no correlation between ADA levels and PASI scores.These results support the evidence that T cell activation is involved in the pathogenesis of psoriasis and that ADA may be valuable in the assessment of disease activity in psoriasis.     

英夫利西单抗治疗重度银屑病17例临床观察

研究发现,肿瘤坏死因子α（TNF-α）在银屑病的发病中起重要作用［１］。近年来,生物制剂在中、重度银屑病尤其既往治疗中疗效不佳的银屑病患者中应用日益广泛。英夫利西单抗（IFX）是一种人鼠嵌合性抗TNF-α单克隆抗体,美国FDA在2006年批准该药用于治疗银屑病。现将我科自2013年12月以来应用IFX治疗的17例银屑病患者情况报道如下……     

Hair in psoriasis: a prospective, blinded scanning electron microscopic study

We examined hairs from psoriatic plaques by scanning electron microscopy, and compared the morphological changes in the hairs with those from the corresponding nonlesional skin of the same patients and those from healthy subjects, in a observer-blinded prospective study. Micropits or macropits (sharply demarcated defects on the cuticle < 0.5 µm or > 0.5 µm, respectively, in diameter), dystrophy (areas showing generalized roughness and ragged appearance of the cuticle), upturned edges of cuticular cells, transverse and longitudinal fissures were seen in varying frequency in all three groups. Micropits were significantly more frequent in the lesional hair compared with hair from the nonlesional area and controls. Dystrophic changes were significantly more severe in lesional hairs compared with hair from the nonlesional area. Upturning of cuticular edges was more frequent (but not significantly so) in hair from psoriatic plaques. The presence of micropits and hair dystrophy could contribute to the thinning and loss of hair in the psoriatic plaques.     

Mucocutaneous adverse effects of hydroxyurea: a prospective study of 30 psoriasis patients

Hydroxyurea is an anti-tumour agent most commonly used to treat chronic myeloproliferative disorders in doses up to 4 g per day. Dermatological adverse effects reported so far have been observed predominantly in these patients. As we are treating selected psoriasis patients with low dose hydroxyurea we attempted to define the spectrum and chronology of dermatological adverse effects in this group of patients prospectively. Of the 29 evaluable patients, 19 (65.5%) developed a mucocutaneous adverse reaction after a mean duration of 6.4 weeks of treatment. Pigmentation of nails, skin or mucosa was the most common observation and was seen in 17 (58.6%) patients. Other less common findings were xerosis, diffuse alopecia, oedema of the legs, oral ulcers and actinic psoriasis. Adverse effects subsided in 11 (57.9%) patients during a mean follow up of 18 weeks. Three hitherto unreported side-effects - scleral pigmentation, acquired ichthyosis and pigmentation of lunula of the nails - were noted. This first study of dermatological adverse effects of hydroxyurea therapy on Asian psoriatic patients reveals several new findings. Pigmentation of skin, nails and mucosa appears to be very common and occurs early. Serious dermatological side-effects probably do not occur with low dose (up to 1.5 g per day) hydroxyurea in patients with psoriasis.     

Infliximab for severe, treatment-resistant psoriasis: a prospective, open-label study

BACKGROUND: Infliximab, a mouse-human chimeric monoclonal antibody directed against tumour necrosis factor-alpha, has been shown to be effective for moderate to severe psoriasis, but there are few data published on its use in recalcitrant, treatment-resistant disease or in combination with other antipsoriatic therapies. OBJECTIVES: To report our experience with infliximab in the treatment of patients attending a tertiary referral service with severe recalcitrant disease. METHODS: All patients attending a tertiary referral service for severe psoriasis who were treated with infliximab between 2002 and July 2005 were entered into a prospective, open-label study. Details on disease phenotype, clinical course and adverse events were recorded together with measures of disease severity [Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index, clinical photography] at baseline, weeks 2 and 6, and then at 2-monthly intervals throughout the treatment period. RESULTS: Twenty-three patients were treated with infliximab during the study; one patient had pustular psoriasis and was therefore excluded from statistical analysis. All had severe disease (baseline PASI 26.5+/-6.7, mean+/-SD, n=22) and had received at least two systemic therapies for psoriasis in the past; 16 were taking one or more concomitant therapies at the time of treatment initiation. At week 10, 95% had achieved a 50% or greater improvement in baseline PASI (PASI 50), and 77% had achieved a 75% or greater improvement (PASI 75). Efficacy was sustained in the longer term, with eight of 10 patients on treatment for more than 11 months maintaining at least a PASI 50. Only one patient had treatment withdrawn due to lack of efficacy, two suffered severe systemic infections including extrapulmonary tuberculosis (splenic abscess) and cellulitis, and six have discontinued due to adverse effects including infusion reactions (two), severe thrombocytopenia (one), hepatitis (one) and malignancy (two). CONCLUSIONS: Data from this open-label study suggest that infliximab is a rapidly effective treatment for patients with severe, treatment-resistant disease, although approximately 25% of patients had to discontinue therapy due to the development of serious adverse effects. Long-term follow-up, continued pharmacovigilance, and further controlled comparative studies will be required to evaluate fully the risks associated with infliximab in the context of this already difficult to treat population.