Patients with early‐onset psoriasis achieve better results following Dead Sea climatotherapy

Background Plaque psoriasis has recently been divided in two types, which differ in severity and inheritance according to the age of the patient at the onset of the disease. Aim To compare the effect of Dead Sea climatotherapy (DSC) on these two types of disease, with early vs. late onset, and to determine the impact of this treatment on the response rate. Methods The files of 605 patients who were suffering from plaque psoriasis were retrieved from the database of the Research Institute at the Dead Sea (RIDS) and divided in two groups, types I and II, according to whether the age at the onset of the disease was under or over 40 years, respectively. The primary outcome for the assessment of DSC was Psoriasis Assessment of Severity Index of 95 (PASI 95), which indicates that the PASI improvement percentage reached 95%. Logistical regression was used to identify the factors that related to the observed outcome. Results By the end of the study, 74% of the patients in group 1 reached PASI 95 in comparison to 62% in group 2. The 95% confidence interval for the odds ratio (OR) of the effect in group 2 in comparison to that of group 1 was [0.31, 0.99], which implies that group 1 responded better to treatment in comparison to group 2. Cut‐off values for patients who were aged 30 and 20, respectively, exhibited similar trends; 75% vs. 65% and 78% vs. 68% for groups 1 and 2, respectively. Conclusions Efficacy rates following DSC were impressively high for plaque psoriasis patients. Contrary to our hypothesis, the treatment effect was found to inversely correlate with the age of the patient at disease onset.     

An investigation of rheumatoid arthritis loci in patients with early‐onset psoriasis validates association of the REL gene

Background Phenotypically diverse autoimmune conditions share common genetic susceptibility loci and underlying molecular pathways. Objectives By systematically searching for single nucleotide polymorphisms (SNPs) associated with another autoimmune disease, rheumatoid arthritis (RA), we aimed to elucidate novel genetic markers of psoriasis. Methods We investigated 18 SNPs, previously confirmed as being associated with RA, in a U.K. cohort of 623 patients with early‐onset psoriasis (presenting before age 40 years), comparing them with 2662 control subjects. Results Our findings confirm the association of early‐onset psoriasis with REL (rs13031237, P = 0·0027). The minor allele of REL had opposing effects upon susceptibility to disease in patients with psoriasis and RA. Conclusion Similar exploration of additional autoimmune loci and fine mapping of such regions may provide further insight into the genetics and molecular pathophysiology of psoriasis.     

HLA‐C*12:02 is a susceptibility factor in late‐onset type of psoriasis in Japanese

Psoriasis is thought to be a multifactorial disease triggered by both genetic and environmental factors. The HLA‐C locus on chromosome 6p21.33 remains the strongest susceptibility candidate locus in psoriasis. The strong association between psoriasis and the HLA‐Cw6 allele has been well documented in various races. It is known that psoriatic patients with early onset are more likely to be familial and associated with HLA‐Cw6. Familial occurrence of Japanese psoriasis is smaller than other populations. Furthermore, males are predominant over females in Japanese psoriasis. We investigated the relation between HLA‐C alleles and age of onset, and in each gender for Japanese psoriasis, and discuss male predominance in the incidence of psoriasis in Japan. Four hundred forty six unrelated Japanese patients with psoriasis vulgaris and 557 sex‐ and age‐matched unrelated Japanese healthy controls were investigated by genotyping. We confirmed the association between early‐onset type of psoriasis with HLA‐C*06:02 allele in Japanese. In addition, we detected the association between the late‐onset type of psoriasis and the HLA‐C*12:02 allele in Japanese. No significant differences in allele frequency were observed between females and males. Our results suggest that there is no genetic factor effect on male predominance in Japanese. In contract, the effect of environmental risk factors on the onset of Japanese psoriatic patients is stronger in males than in females. As a result, male predominant in psoriasis may occur in Japan.     

Possible association of hepatitis C virus infection with late‐onset psoriasis: A hospital‐based observational study

Psoriasis is a chronic inflammatory disease mainly involving the skin and joints, mediated by pro‐inflammatory cytokine tumor necrosis factor (TNF)‐α. In hepatitis C, continuous inflammation mediated by TNF‐α leads to liver cirrhosis and diabetes mellitus. Hence, psoriasis and hepatitis C have pathophysiological factors in common. An epidemiological association between the two conditions has been reported, but no detailed research has yet been performed. Frequency of hepatitis C virus (HCV) infection was assessed in 717 patients with psoriasis and 38 057 with all other dermatological diseases who visited Fukuoka University Hospital in 1998–2011. HCV⁺ and HCV^? psoriatic patients were further compared. Frequency of HCV infection was significantly higher in psoriasis (7.5%) than in controls (3.3%) in overall ages. When stratified by age at the first visit, the frequency was significantly higher in patients with psoriasis than in controls aged in their 60s (11.8% vs 6.6%, respectively, P = 0.0215) and 70s (19.5% vs 7.3%, P < 0.0001). HCV⁺ psoriatic patients were significantly older at onset than HCV^? ones (median, 54 vs 39 years), stronger male predominance (male/female ratio, 4.4:1), similar family history of psoriasis, higher association of diabetes mellitus and hypertension, and significantly lower body mass index (22.4 ± 2.73 vs 24.2 ± 4.61), in age‐stratified (≥40 years) analysis. HCV⁺ psoriatic patients were less obese, but still had a higher frequency of diabetes mellitus and hypertension, possibly due to chronic inflammation in the liver and other organs. HCV infection may trigger psoriasis, especially late‐onset psoriasis, possibly via overproduction of TNF‐α, a common mediator of the two conditions.     

Hypertension and aldosterone levels in women with early‐onset androgenetic alopecia

Background Few studies have analysed the relationship between androgenetic alopecia (AGA) in women and cardiovascular disease. There is reported to be an elevated prevalence of hypertension among men with AGA, and it has been proposed that both phenomena may be explained by the presence of hyperaldosteronism. However, no data on blood pressure (BP) and aldosterone levels in women with AGA have been published to date. Objectives The objective of this study was to evaluate aldosterone levels and the presence of systolic and diastolic hypertension in women with early‐onset AGA and in healthy controls. Patients and methods This case–control study included 40 women with AGA and 40 healthy controls from the Department of Dermatology of San Cecilio Hospital, Granada, Spain. Results Patients with AGA showed significantly higher systolic BP values (139·43 vs. 107·80 mmHg; P < 0·0001), diastolic BP values (87·65 vs. 67·48 mmHg; P < 0·0001) and aldosterone levels (249·55 vs. 155·14 pg mL^?1; P = 0·002) vs. controls, respectively. A positive correlation between aldosterone levels and systolic and diastolic BP values is described. Conclusions A higher prevalence of hypertension in women with AGA has been found. The elevated aldosterone values in these patients may contribute, alongside other mechanisms, to the development of AGA and may also explain the higher prevalence of hypertension. BP screening of women with AGA will permit earlier diagnosis of an unsuspected hypertension and initiation of appropriate treatment.     

Clinicopathologic characteristics of early‐onset Becker's nevus in Korean children and adolescents

Background

Becker's nevus (BN) presents as a hairy patch or plaque with or without proliferation of the dermal smooth muscles. BN has been described as acquired as found in a similar entity, congenital smooth muscle hamartoma (CSMH). This study was aimed at evaluating the clinicopathological aspects of BN in Korean cases in differential diagnosis with CSMH.

Methods

We performed a retrospective study of 103 patients histopathologically diagnosed as having BN or CSMH. The cases included 40 cases diagnosed with BN or CSMH before the age of 10 years who had clinical monitoring and a second skin biopsy after puberty to determine the disease course.

Results

Among cases of children to adolescents (<18 years), we observed a slight male predominance. Among children aged <14 years, sex ratio converged at 1:1. Early‐onset BN showed a female predominance and hyperpigmented skin lesions. All BN cases showed hyperpigmentation, and face and neck involvement tended to make severe cosmetic concerns. In contrast, hypertrichosis was more frequent in CSMH. Either skin‐colored lesion or pseudo‐Darier's sign was not seen in early‐onset BN. BN showed less dermal smooth muscle than CSMH.

Conclusions

Androgens themselves do not seem to be related to the development of BN but play only an aggravating role especially in male patients. Considering high occurrence in exposed areas, BN may distress patients severely. As early laser treatment may be helpful in some patients with BN, early‐onset BN in comparison to CSMH should be diagnosed appropriately.     

The aging male – diagnosis and therapy of late‐onset hypogonadism

Managing the clinical features of hormone insufficiency in aging men is an important field of activity for dermatologists and in particular for dermatologists specialized in andrology. Potential consequences of age‐associated decrease in plasma testosterone levels include long‐term changes in diverse organ systems including changes of bone architecture, body composition, muscular strength, cognitive functions, and mood as well as negative effects on skin and hair. Indications and contraindications for a hormone replacement therapy as well as therapy monitoring are well‐defined. Replacement of testosterone in the case of late‐onset hypogonadism is not a standardized therapy. Previous studies suggest that testosterone replacement therapy has positive clinical effects. Dermatologic effects of testosterone replacement therapy have not yet been investigated. Further research is required to identify potential benefits and risks of hormone replacement therapy in aging men.     

Successful treatment of late‐onset nevus comedonicus with Er:YAG laser

Nevus comedonicus, a rare congenital hamartoma of the pilosebaceous unit, is characterized by keratotic plugging. It usually occurs after birth and during early childhood. It rarely appears in adulthood. Despite the benign nature of the condition, it usually requires treatment due to aesthetic reasons. Several treatments have been reported in nevus comedonicus, most of them resulting with recurrences. Here, we report a case of nevus comedonicus with adult onset, successfully treated with erbium‐doped yttrium aluminum garnet (Er:YAG) laser therapy.