Methotrexate in psoriatic arthritis: a retrospective study

The response of psoriatic arthritis to methotrexate was evaluated retrospectively in 59 consecutive patients. Initially almost all received 15 mg weekly. When clinical improvement occurred, the dose was gradually reduced. In 7 patients methotrexate had to be discontinued within a year due to adverse reactions. The remaining 52 patients were treated from 1 to 11 years, median 3 years. Among these a modest improvement was seen in 21, while in 22 the signs of inflammatory joint disease almost disappeared. The favourable response was related to the short duration of arthritis, but unrelated to the severity of the disease.     

Lichen planus patients and stressful events

Purpose To evaluate the possible role of stress before the onset/extension of lichen planus. Patients and method Forty‐six outpatients with lichen planus were enrolled. The design was a case‐control study (controls had skin diseases with low psychosomatic component). Stressful situations were evaluated using Holmes and Rahe's social readjustment rating scale. Results Lichen planus had an incidence of 0.36% among dermatological conditions. In the lichen planus group, there was a female predominance (76%) and a median age around 50 years. More than 67% of cases experienced at least one stressful event, compared with 21% of controls (χ² = 17.58, P < 0.001). The odds ratio was 7.44. There was a borderline significant difference in the mean number of stressful events between lichen planus patients and controls (P = 0.06). We divided the situations described by Holmes and Rahe into three categories: family, personal, and job or financial problems. The presence of major life events was significant different in patients and controls (P = 0.005). Family matters were described by 43.6% of lichen planus patients, statistically significant compared with controls (P = 0.002). In almost 25% of cases of lichen planus, ‘the stressful event’ was represented by the illness or death of someone dear. ‘Personal problems’ seemed to be important compared with controls (P = 0.04), exams representing 25% of these matters. There was no difference between the patients and controls regarding the importance of job or financial changes. Conclusion Stressful situations, especially related to family, may have a role in the onset and extension of lichen planus lesions.     

Arthritis as an important determinant for psoriatic patients to develop severe vascular events in Taiwan: a nation‐wide study

Background Psoriasis is an important systemic inflammatory disease that often leads to severe vascular diseases. This study was launched to determine if joint involvement affects incidence of vascular comorbidities in psoriatic patients. In addition, potential vasculo‐protective effects of methotrexate in psoriatic patients were also evaluated. Method A population‐based retrospective cohort study was conducted using the Taiwanese National Health Insurance database spanning from 1996 to 2006. Accordingly, 7648 and 284 psoriatic patients without or with arthritis, respectively, were identified. To ensure the temporal relationship between different events, those with date of first diagnosis psoriasis during the year of 1996 were excluded from subsequent analyses. In addition, those with diagnosis of cerebrovascular or cardiovascular diseases prior to onset of psoriasis were also excluded from relevant subsequent analyses. Result Taking psoriatic patients without arthritis as the referent group, the hazard ratio for incident cerebrovascular disease was 1.82 (95% CI = 1.17–2.82) for psoriatic patient with arthritis. In addition, psoriatic patients without arthritis who had methotrexate treatment showed reduced risks for incident cerebrovascular disease as compared with those with no arthritis and had received no methotrexate/retinoid treatment. Similar analyses were performed on cardiovascular diseases, and equivalent results were obtained. Conclusion Our study indicated that arthritis is a potential determinant for psoriatic patients in terms of incident vascular comorbidities. In addition, methotrexate treatment may be associated with reduced risks for development of severe vascular diseases in psoriatic patients without arthritis. Further studies should focus on the clinical complications associated with psoriatic patients with or without arthritis.     

The prevalence of onychomycosis in psoriatic patients: a systematic review

We systematically reviewed all available literature concerning the prevalence of onychomycosis in patients with nail psoriasis and the distribution of pathogens causing onychomycosis in this specific group of patients. Databases searched were Pubmed, EMBASE and the Cochrane Controlled Clinical Trial Register. All studies reporting on the prevalence of onychomycosis in nail psoriasis were obtained, and quality assessment was determined by the STrengthening the Reporting of OBservational studies in Epidemiology checklist. Literature search revealed 720 studies, of which 10 studies met the inclusion criteria. The major limitation of the review was the heterogeneity of the included studies, which prevented the possibility to conduct a meta analysis. However, the average prevalence of 18.0% of onychomycosis in psoriatic patients seems to be increased when compared with control groups and literature on healthy population, even though the ultimate evidence remains lacking. As in the literature hypothesized shift in causative agents from dermatophytes to yeasts and/or moulds could not be confirmed. The clinical consequence of the relatively high prevalence of onychomycosis in psoriasis may be a general advice to rule out onychomycosis or concomitant onychomycosis in these patients with (suspected) nail psoriasis. This advice is stressed by the relative simplicity of treating the contribution of onychomycosis in the nail dystrophy but also the fact that nail psoriasis mostly is treated by immunosuppressive drugs, like steroids, methotrexate or biologics which may aggravate mycotic nail infections.     

The sequence of events in psoriatic plaque formation after tape-stripping

The sequence of events leading to the formation of a psoriatic plaque induced by tape-stripping was studied using light and electron microscopy. Among the earliest changes noted were increased mobility of the epidermal Langerhans cells across the basement membrane, evidence of Langerhans cell-lymphocyte interaction, and increased Langerhans cell ‘activity’ or ‘cytotoxicity’. These changes were seen as early as 2 min after stripping and remained until the development of clinical psoriasis. Collections of epidermal lymphocytes showing the features of blastoid transformation while in contact with processes from activated Langerhans cells, suggest the involvement of la antigens in this process. We postulate that these findings are a manifestation of an increased immune responsiveness to trauma, controlled by genes located at the HLA-D locus of the major histocompatibility complex, and mediated by enhanced cellular interactions. The appearance of basal keratinocyte herniations (BKH) at 1–3 weeks after stripping, coincided with the development of clinical psoriasis. Neutrophils made their appearance at the same time as, or slightly before, the appearance of BKH, and are suspected to play a role in the development of these structures. We believe that BKH maintain epidermal proliferation through the persistence of the epidermal-stromal interaction.     

Cutaneous adverse events to systemic antineoplastic therapies: a retrospective study in a public oncologic hospital

BackgroundMucocutaneous adverse events are common during anticancer treatment, with variable consequences for the patient and their therapeutic regimen.ObjectiveTo evaluate the most common adverse events, as well as the drugs associated with their appearance and the consequences for cancer treatment.MethodsA retrospective study was carried out through the analysis of patients treated at the Clinical Dermatology Unit of a public oncologic hospital.ResultsA total of 138 patients with 200 adverse events were evaluated. The most commonly identified adverse events were nail and periungual changes (20%), papulopustular eruptions (13%), acneiform eruptions (12%), hand-foot syndrome (6.5%), hand-foot skin reaction (6%), and xerosis (6%). The most frequently associated antineoplastic treatment groups were classical chemotherapy (46.2%), target therapy (32.3%), and other non-antineoplastic drugs used in neoplasia protocols (16.5%). Of the total number of patients, 17.4% had their treatment suspended or changed due to a dermatological adverse event.Study limitationsRetrospective study and analysis of patients who were referred for specialized dermatological examination only, not allowing the assessment of the actual incidence of adverse events.ConclusionA wide variety of dermatological manifestations are secondary to antineoplastic treatment with several different drugs resulting, not rarely, in the interruption or modification of therapeutic regimens.     

Not simply a matter of psoriatic arthritis: epidemiology of rheumatic diseases in psoriatic patients

This study investigated the occurrence of rheumatic conditions (RCs) in a psoriasis (PSO)-dedicated dermatological clinic. PSO subjects with musculo-skeletal discomfort, and/or carrying signs (articular/systemic, even asymptomatic) of RCs; and/or suffering flares of previously established psoriatic arthritis (PsA) were referred to rheumatologist for evaluation. Laboratory tests/imaging were performed as needed. Categorization adhered to RCs classification endorsed by the Italian Society of Rheumatology. Of the 1,200 psoriatic subjects, 277 (23.1?%) were enrolled (146 females). The mean age was 55.7?years (range 21–81), PSO duration was 13.5?years (range 0–62). Thirty-seven patients (13.4?%) were asymptomatic. On an average, 92 (7.6?%) patients/year were evaluated, of whom 79.4?% n?ive to rheumatological consultations (NRC). Osteoarthritis (OA) and PsA (isolated or combined) showed the highest prevalence, with 156 (56.3?%) and 110 cases (39.7?%), respectively. Among NRC subjects, the mean PsA annual incidence was 29.5?% (standard error of the mean?±5.4?%). Other RCs, isolated or associated with PsA/OA, were diagnosed in 31 cases (11.2?%). Thirty-two subjects (11.5?%) had arthralgias, 20 of whom due to congenital/mechanical disorders, the remaining were unclassifiable. In conclusion, the largest part (88.5?%) of PSO subjects referred to rheumatologist showed some RCs. On annual basis, 29.5?% of n?ive enrolled patients were diagnosed as PsA.     

银屑病患者皮纹学研究

为了探索银屑病患者手的皮纹学变化，采用钱防法对１８０例银屑病病人和对照组手的皮纹学进行了研究，结果表明，斗型花纹在男性患者第３指和女性病人双手第５指是增加的，两性患者手指中节弓型花纹减少，真实花纹在男性患者右手Ｔｈ／Ｉ１、女性右手Ｈｙ和两性右手Ｉ４增加，在两性患者总指嵴纹计数和绝对嵴纹计数增加。     

Bullous pemphigoid in young patients: a retrospective study of 74 cases

INTRODUCTION: Bullous pemphigoid usually affects elderly people. Only a few isolated cases among people younger than 65 years have been reported. OBJECTIVES: Describe the clinical and biological characteristics of patients younger than 60 years suffering from bullous pemphigoid, compare them with the usual characteristics known among elderly people and search for potential pathological associations. PATIENTS AND METHODS: Retrospective, national, multicenter study. Clinical, biological and histological characteristics were recorded with a standardised questionnaire as well as treatments and associated pathologies. RESULTS: Seventy-four cases of bullous pemphigoid diagnosed between June 1970 and March 2002 were analyzed. Mean age at the beginning of the disease was 46 +/- 11.6 years. Further explorations by indirect immunofluorescence of separated skin and/or immuno-electron microscopy and/or immunoblotting were performed for 42 patients (56.8 p. 100). Clinical characteristics among this restricted population were comparable to those found among the 32 other cases. Compared to usual data on bullous pemphigoid in elderly people, we observed a greater proportion of extensive form of disease (75 p. 100), a more frequent head and neck involvement (39.2 p. 100) and an overexpression of anti-BP180 autoantibodies (48 p. 100). Neoplasm was notified for 7 patients (9.5 p. 100), 18 (24.3 p. 100) suffered from a pathology of the basement membrane zone (6 psoriasis, 6 atopic dermatitis and 6 lichen) and 13 from neurological disease, among which 4 were bedridden. Fourty-six patients (62.2 p. 100) received drugs for the long term (mean 2.12 +/- 2.43), 4 patients were treated by PUVAtherapy and 2 by radiotherapy. DISCUSSION: Our results suggest that bullous pemphigoid among young people is more severe and more active than the usual form in the elderly. This particular form could be the result of a higher expression of anti-BP180 autoantibodies, which are considered as a marker of poor prognosis in this disease. We also found a high frequency of pathological associations and physical treatment, all responsible for damage to the basement membrane zone, which can involve auto-immunization against hemidesmosome components.     

Dermatitis artefacta: retrospective study in 31 patients

BACKGROUND: The outcome for patients with dermatitis artefacta is not well known. The primary objective of this single-centre retrospective study was to describe the initial clinical aspects and the prognosis of the disease. The secondary objective was to describe the somatic and psychological management and long-term treatment of these patients. PATIENTS AND METHODS: Records of patients with dermatitis artefacta followed in the dermatology department over the 15 last years were reviewed independently by 2 dermatologists. Diagnostic criteria consisted of evocative clinical pictures and the exclusion of other forms of dermatosis. Data collection included: file analysis, photographs, review questionnaires sent to general practitioner or completed during a phone call to patients (follow-up data). RESULTS: Thirty-one patient files were selected: 23 women and 8 men, mean age 31 years (SD = 14.8). Clinical aspects included: erythema (50%), ulceration (37%), crust (23%) and blisters (17%). The main sites were the face (67%) and arms (43%). Topical treatment was prescribed in all cases and systemic treatment was prescribed in 23% of cases. Psychological support was offered to 65% of the patients and was accepted by 50%. A follow-up study was performed for 17 patients and showed serious complications in 4 cases consisting of psychosis (n=2) and/or severe self-mutilation (n=3) occurring over several years following diagnosis (5 years for one patient and 12 years for 2 patients). DISCUSSION: The results confirm the usual and characteristics of dermatitis artefacta such as predominance in young female patients, with lesions affecting visible areas (face, upper legs). In contrastwith published studies, no cases of attempted suicide were observed in our series, although severe dermatitis artefacta was evidenced in only a minority of patients.     

PUVA treatment of vitiligo: a retrospective study of Turkish patients

BACKGROUND: Psoralen plus ultraviolet A (PUVA) is considered to be the treatment of choice for subtotal vitiligo; however, it is time consuming and carries certain health risks for both patients and physicians. This study attempts to evaluate the efficacy of the treatment in Turkish vitiligo patients. METHODS: We have performed a retrospective study of 33 patients with vitiligo who received systemic PUVA therapy during the period 1985 to 1997, and have evaluated their response to treatment. RESULTS: Overall, 28 patients (84%) showed some improvement; 12 patients experienced a repigmentation of 51-75% and six patients achieved greater than 75% repigmentation. Face and trunk lesions showed better repigmentation than other areas, whereas hands, feet, perioral, and periorbital areas were generally refractory to treatment. The age of the patient, age at onset of the disease, sex, disease duration, and degree of depigmentation prior to initiation of therapy had no influence on PUVA-induced repigmentation. CONCLUSIONS: The distribution of vitiliginous skin must be taken into consideration before the initiation of PUVA therapy, as the response to treatment varies greatly with different body sites; hands, feet, perioral, and periorbital regions are particularly treatment resistant.     

Sweet's syndrome: a retrospective study of 42 admitted patients in a Portuguese hospital

Background  Sweet's syndrome is the most common neutrophilic dermatosis, but its pathophysiology is still largely unknown and different subgroups can be defined.
Objectives  To assess the clinical/laboratory factors in a series of patients with Sweet's syndrome and search for significant differences between defined subgroups.
Methods  A retrospective study of inpatient files with this diagnosis was made, and patients were included if they fulfilled the classical diagnostic criteria. Data were analyzed with the SPSS package, with a significance level of 5%.
Results  Forty-two patients fulfilled the inclusion criteria, with a median age of 50 years. Females comprised 88% of patients, and disease onset occurred in autumn or spring in over 70% of cases. A previous oropharyngeal infection was described by 38% of patients, and a previous or concomitantly diagnosed neoplasm by 10%. In contrast with the literature, the lower extremities were also involved in the majority of patients, and arthralgia was the most frequent extracutaneous manifestation. On bivariate analysis, in patients who reported a previous oropharyngeal infection, the lesions were significantly more frequent in autumn, and a shorter inpatient stay as well as a lower temperature on admission and lower prevalence of arthralgia were observed in the same group.
Conclusions  The subgroup of patients with a previous oropharyngeal infection had a less severe form of this syndrome.