Positron emission tomographic studies of the association between atherogenesis and aortitis among psoriatic patients

IntroductionThere is increased interest in the use of positron emission tomography (PET) in psoriatic patients. We used PET induced with tracer fluorine-18 (¹⁸F) fluorodeoxyglucose (FDG) to study the association between the process of early-atherogenesis (eAg) and aortitis by quantifying enhanced aortic vascular inflammation along with calculation of total coronary plaque load (TCPL) and non-calcified atherosclerotic plaque load (NcAPL). In order to study the utility of aortitis in capturing eAg, we also assessed luminal stenosis atherosclerosis (LSA) and high-risk coronary plaques (HrCP).Material and methodsThe study was conducted at our hospital between 1 April 2014 and 31 December 2017, and the analysis was done in July 2018. We recruited 180 consecutive psoriatic patients and subjected them to ¹⁸F-FDG PET. However, in order to characterise eAg, 160 out of 180 patients were also subjected to coronary angiographic computed tomographic studies (CACTS).ResultsAmong 180 psoriatic patients (76 women, 42%) (mean [SD] age, 51.1 [13.2] years), greater prevalence values of LSA (odd ratio [OR], 3.71; 95% confidence interval [CI], 1.84–7.89; p = 0.001) and HrCP (OR, 3.11; 95% CI: 1.54–6.51; p = 0.003) along with enhanced TCPL (standardised β = 0.44; p < 0.001) were observed in patients with enhanced aortitis. However, the association between aortitis and HrCP was controlled by low-attenuation plaque (LAP), while the same between aortitis and TCPL was controlled by NcAPL (β = 0.45; p < 0.001).ConclusionsAssociation between aortitis and broad coronary angiographic indices was achieved and hence predicted the possibility of a surrogate role of aortitis in eAg.     

系统性红斑狼疮并发寻常型天疱疮

报告1例系统性红斑狼疮并发寻常型天疱疮.患者女,42岁.面部出现红色斑丘疹伴四肢关节疼痛4年,同时出现光敏、血液系统异常,血清抗核抗体、抗ds-DNA抗体均阳性.2年前口腔黏膜反复出现糜烂,后躯干、四肢出现水疱,水疱破溃后形成不易愈合的糜烂面,经皮损组织病理检查、免疫荧光检查,诊断为寻常型天疱疮.     

0.1%他克莫司软膏治疗头面部银屑病临床疗效观察

目的:观察外用0.1%他克莫司软膏治疗头面部斑块状银屑病的临床疗效及安全性.方法:将40例头面部斑块状银屑病患者随机分为试验组和对照组,每组各20例.试验组外用0.1%他克莫司软膏,对照组外用5%松馏油软膏,每日2次,疗程均为8周.于治疗前及治疗后2、4、6、8周各随访1次.记录皮损变化及不良反应.结果:试验组治愈率为85%,对照组为55%(P<0.05);有效率分别为95%和60%(P<0.05);药物不良反应发生率分别为5%(1/20例)和15%(3/20例).结论:他克莫司软膏外用治疗头面部斑块状银屑病安全有效.     

308 nm准分子激光治疗斑块状银屑病临床观察

目的:观察308 nm准分子激光治疗斑块状银屑病的临床疗效及安全性.方法:用308 um准分子激光对37例斑块状银屑病患者进行每周3次,最长6周的照射治疗.初始剂量为3倍最小红斑量(MED).主要的观察项目包括治疗前后银屑病面积和严重度指数(PASI)、治疗次数、疗效满意度和不良反应自我评价.结果:有30例患者完成了本次试验,在最多18次治疗后.有5例(16.7%)患者PASI减少≥90%;16例(53.3%)患者PASI减少60%～89%.19例(63.3%)患者认为疗效满意或非常满意.未观察到严重的不良反应.结论:308 nm准分子激光治疗斑块状银屑病安全、有效,其皮损清除较传统光学疗法更快.     

大腿寻常狼疮1例

报告大腿寻常狼疮1例.患者男,68岁.右大腿红斑、丘疹、斑块伴瘙痒30年.皮损组织病理检查示真皮浅层肉芽肿性炎,部分结节中央疑有坏死物,并见多核巨细胞、淋巴细胞浸润,真皮全层小血管周围少量淋巴细胞及个别浆细胞浸润.抗酸染色阳性,T-SPOT.TB检测阳性.PPD试验(++++).诊断:寻常狼疮.     

Oral Administration of East Asian Herbal Medicine for Inflammatory Skin Lesions in Plaque Psoriasis: A Systematic Review,Meta-Analysis,and Exploration of Core Herbal Materials

Psoriasis is an inflammatory autoimmune skin disease with various clinical manifestations. The aim of this review was to systematically evaluate the efficacy and safety of oral administration of East Asian herbal medicine (EAHM) for inflammatory skin lesions in psoriasis and to explore core herbal materials for drug discovery. A comprehensive search was conducted in 10 electronic databases for randomized controlled trials from their inception until 29 July 2021. Statistical analysis was performed in R version 4.1.2 and R studio. When heterogeneity in studies was detected, the cause was identified through sensitivity analysis, meta-regression, and subgroup analysis. Methodological quality was independently assessed using the revised tool for risk of bias in randomized trials. A total of 56 trials with 4966 psoriasis patients met the selection criteria. Meta-analysis favored EAHM monotherapy on Psoriasis Area Severity Index (PASI) 70 (RR: 1.2845; 95% CI: 1.906 to 1.3858, p < 0.0001), PASI 60 (RR: 1.1923; 95% CI: 1.1134 to 1.2769, p < 0.0001), continuous PASI score (MD: −2.3386, 95% CI: −3.3068 to −1.3704, p < 0.0001), IL-17, IL-23, TNF-α, and Dermatology Life Quality Index. Patients treated with EAHM monotherapy had significantly reduced adverse events incidence rate. In addition, based on additional examination of the herb data included in this meta-analysis, 16 core materials were identified. They are utilized in close proximity to one another, and all have anti-inflammatory properties. The findings in this study support that oral EAHM monotherapy may be beneficial for inflammatory skin lesions in psoriasis. Meanwhile, the identified core materials are expected to be utilized as useful drug candidate hypotheses through follow-up studies on individual pharmacological activities and synergistic effects.     

Risk of Skin Cancer with Phototherapy in Moderate-to-Severe Psoriasis: An Updated Systematic Review

Phototherapy is a standard treatment for moderate-to-severe psoriasis. However, concern remains regarding the associated cutaneous carcinogenic risk. Our objective is to conduct a systematic review of skin cancer risk for psoriasis patients treated with phototherapy. To achieve our goal, we searched Cochrane, PubMed, and Embase databases. We aimed to evaluate existing literature (from July 1, 2010, to December 31, 2020) on phototherapy for all Fitzpatrick skin phototypes (FSP) which includes 71 articles, and eight articles being categorized in this review. Five studies did not report an increased skin cancer risk with narrowband-ultraviolet blue (UVB) and unspecified UVB for FSP II through VI, with one study not reporting FSP. Three studies did report an increased risk of skin cancer with narrowband-UVB and broadband-UVB for FSP I-VI, with one study also not specifying skin phototypes or UVB phototherapy type. Additionally, a study with psoralen and ultraviolet A with and without narrowband-UVB demonstrated an increased risk of skin cancer in phototypes III and IV. The most commonly reported secondary outcomes with phototherapy were actinic keratosis (123) and solar lentigines (10). Numerous patients were also on additional therapies including methotrexate, acitretin, and biologics. Study limitations include publication bias due to limited number of studies published on this topic in the last ten years along with heterogeneity in reporting. The relationship between phototherapy, psoriasis, and cutaneous oncogenic risk remains contradictory. While phototherapy for psoriasis is an efficacious therapy, further studies are needed to understand the cutaneous oncogenic risk based on FSP to help clinicals tailor treatment recommendations based on skin phototypes.     

Itolizumab,a novel anti-CD6 monoclonal antibody: a safe and efficacious biologic agent for management of psoriasis

Introduction: Psoriasis, a chronic immune-mediated skin disorder is associated with significant physical, psychological, and quality of life impairments. Along with well-documented genetic and environmental factors, immunological factors also contribute to the pathogenesis of psoriasis. Among the immunological factors, CD6 – dependent T-cell proliferation to form Th1 and Th17 cells play a major role in the pathogenesis of psoriasis. Itolizumab is the first humanized IgG1 monoclonal antibody, which selectively targets CD6.

Areas covered: The current article presents the pharmacology of itolizumab and provides a review of the currently available data on the efficacy and safety of itolizumab for management of moderate to severe plaque psoriasis.

Expert opinion: The use of biologics to attenuate the immune-mediated pathological events in psoriasis is a relatively well-established clinical practice. However, the safety and efficacy of biologics continues to be an unsettled topic of ongoing research. While available data seems to suggest that itolizumab may be a safer option, additional studies with higher sample sizes and active comparators are needed before definitive conclusions can be drawn on the place of itolizumab in the management of psoriasis.     

皮肤病血毒丸联合迪银片治疗银屑病疗效观察

目的观察皮肤病血毒丸联合迪银片治疗银屑病临床疗效。方法将60例患者分为2组,对照组口服迪银片,治疗组在口服迪银片的基础上加皮肤病血毒丸,均连续服药1个月,观察两组疗效及毒副反应。结果治疗组痊愈7例,基本痊愈11例,显效4例,进步7例,无效1例,临床治愈率为60．0％,总有效率73．3％;对照组痊愈3例,基本痊愈4例,显效9例,进步10例,无效4例,临床治愈率为23．3％,总有效率53．3％;两组总有效率比较,差异无显著性（X^2=0．27,P〉0．05）;临床痊愈率比较,差异有显著性（X^2=6．48,P〈0．05）,治疗组毒副反应明显低于对照组（t=5．27,P〈0．05）。结论迪银片配合中药皮肤病血毒丸治疗银屑病,见效快,疗效高,毒副反应小,较单用迪银片好。     

理血消银汤治疗银屑病临床疗效及对血浆内皮素的影响

目的观察理血消银汤治疗寻常型银屑病的临床疗效及对血浆内皮素（ET）的影响。方法将220例患者分为两组。治疗组118例口服理血消银汤,对照组102例口服复方青黛胶囊,疗程8周后评价其临床疗效;并用放免法检测治疗前后ET含量。结果两组效率分别为73．7％、54．9％,两组比较差异有显著性（X^2=8．52,P〈0．01）;银屑病患者血浆ET水平明显高于健康对照组,经治疗后两组ET均下降,治疗组下降更明显,与对照组比较差异有显著性（P〈0．01）。结论理血消银汤治疗银屑病有较好临床疗效,能改善微循环,抑制上皮细胞分裂,促进表皮细胞分化,对血浆ET有调节作用。