Clinical Features Of Psoriasis Research Articles

Polymorphisms of the GCLC Gene Are Novel Genetic Markers for Susceptibility to Psoriasis Associated with Alcohol Abuse and Cigarette Smoking.

The aim of this pilot study was to investigate whether single nucleotide polymorphisms (SNP) in the gene encoding the catalytic subunit of glutamate cysteine ligase (GCLC) are associated with the risk and clinical features of psoriasis. A total of 944 unrelated individuals, including 474 patients with a diagnosis of psoriasis and 470 healthy controls, were recruited for the study. Six common SNPs in the GCLC gene were genotyped using the MassArray-4 system. Polymorphisms rs648595 (OR = 0.56, 95% CI 0.35-0.90; Pperm = 0.017) and rs2397147 (OR = 0.54, 95% CI 0.30-0.98; Pperm = 0.05) were associated with susceptibility to psoriasis in males. In the male group, diplotype rs2397147-C/C × rs17883901-G/G was associated with a decreased risk of psoriasis (FDR-adjusted p = 0.014), whereas diplotype rs6933870-G/G × rs17883901-G/G (FDR-adjusted p = 0.045) showed an association with an increased disease risk in females. The joint effects of SNPs with tobacco smoking (rs648595 and rs17883901) and alcohol abuse (rs648595 and rs542914) on psoriasis risk were observed (Pperm ≤ 0.05). We also found multiple sex-independent associations between GCLC gene polymorphisms and various clinical features such as earlier disease onset, the psoriatic triad, and specific localizations of skin lesions. The present study is the first to show that polymorphisms of the GCLC gene are significantly associated with the risk of psoriasis and related to its clinical features.

Psoriasis in children Study of 463 patients

o illustrate the epidemiological and clinical features of psoriasis in children.

Psoriasis of the external auditory canal: prevalence, clinical features and impact on quality of life.

Psoriasis of the external auditory canal (PsEAC) is often under-recognized. The aims of this study were to assess the prevalence of PsEAC, its association with a particular psoriasis subtype and its impact on quality of life (QoL). A prospective study was carried out in two Spanish university hospitals, enrolling consecutive patients who attended a consultation for psoriasis. The clinical features of psoriasis and PsEAC were recorded and the Dermatology Life Quality Index (DLQI) and Itch Numerical Rating Scale (Itch-NRS) were distributed to patients. Overall, 188 of 1000 patients (18.8%) included in the study had PsEAC, which was associated with severity of psoriasis, presence of inverse psoriasis and involvement of the scalp, nails and genitals, but not with obesity or psoriatic arthritis. PsEAC was the main reason for consultation in 27 patients, with itching being the main symptom. In this study, PsEAC had a prevalence of 18.8%. The occurrence of PsEAC was associated with poorer QoL, as measured by DLQI and Itch-NRS.

Identifying the best predictive diagnostic criteria for psoriasis in children (< 18 years): a UK multicentre case-control diagnostic accuracy study (DIPSOC study).

SummaryBackgroundIn children, psoriasis can be challenging to diagnose. Difficulties arise from differences in the clinical presentation compared with adults.ObjectivesTo test the diagnostic accuracy of previously agreed consensus criteria and to develop a shortlist of the best predictive diagnostic criteria for childhood psoriasis.MethodsA case–control diagnostic accuracy study in 12 UK dermatology departments (2017–2019) assessed 18 clinical criteria using blinded trained investigators. Children (< 18 years) with dermatologist‐diagnosed psoriasis (cases, N = 170) or a different scaly inflammatory rash (controls, N = 160) were recruited. The best predictive criteria were identified using backward logistic regression, and internal validation was conducted using bootstrapping.ResultsThe sensitivity of the consensus‐agreed criteria and consensus scoring algorithm was 84·6%, the specificity was 65·1% and the area under the curve (AUC) was 0·75. The seven diagnostic criteria that performed best were: (i) scale and erythema in the scalp involving the hairline, (ii) scaly erythema inside the external auditory meatus, (iii) persistent well‐demarcated erythematous rash anywhere on the body, (iv) persistent erythema in the umbilicus, (v) scaly erythematous plaques on the extensor surfaces of the elbows and/or knees, (vi) well‐demarcated erythematous rash in the napkin area involving the crural fold and (vii) family history of psoriasis. The sensitivity of the best predictive model was 76·8%, with specificity 72·7% and AUC 0·84. The c‐statistic optimism‐adjusted shrinkage factor was 0·012.ConclusionsThis study provides examination‐ and history‐based data on the clinical features of psoriasis in children and proposes seven diagnostic criteria with good discriminatory ability in secondary‐care patients. External validation is now needed.

Sociodemography and Clinical Features of Psoriasis in Patients Attending Dermatology Clinic in Al Diwaniyah Teaching Hospital

Sociodemography and Clinical Features of Psoriasis in Patients Attending Dermatology Clinic in Al Diwaniyah Teaching Hospital

Association of CYP2J2 polymorphism with susceptibility to psoriasis in Turkish population: a case–control study

BackgroundCytochrome P450 2J2 is mostly expressed in extrahepatic tissues; it metabolizes arachidonic acid to epoxyeicosatrienoic acids, with various cardio protective and anti-inflammatory effects. CYP2J2 polymorphism has been identified as a risk factor for cardiovascular diseases, but its association with psoriasis remains unknown. ObjectiveTo evaluate CYP2J2 polymorphism as a risk factor for psoriasis in the Turkish population. MethodsThere were 94 patients with psoriasis and 100 age- and sex-matched healthy controls included in the study. Detailed demographic and clinical characteristics were recorded, and Psoriasis Area and Severity Index (PASI) scores were calculated for psoriasis patients. Venous blood samples were collected from all the participants and CYP2J2 50G>T (rs890293) polymorphism was analyzed using polymerase chain reaction (PCR). ResultsBoth T allele and TT+GT genotype frequencies were increased in psoriasis vulgaris patients compared to the control group (p=0.024 and p=0.029 respectively, OR=2.82, 95% CI: 1.11–7.15) No association between CYP2J2 polymorphism and clinical features of psoriasis was identified. Study limitationsA limited number of patients were included in the study. ConclusionCYP2J2 50G>T (rs890293) polymorphism was associated with an increased risk for PsV in the Turkish population.

Psoriatic lesions are characterized by higher bacterial load and imbalance between Cutibacterium and Corynebacterium

Several studies have found that the microbiota of psoriatic lesions is different from that of healthy skin. To characterize the microbiota of lesional and unaffected skin in patients with psoriasis and controls and investigate the correlation between cutaneous microbiota and clinical features of psoriasis. Using quantitative polymerase chain reaction and 16S rRNA sequencing, we assayed the profiles of cutaneous microbiota in controls, unaffected skin, and psoriatic lesions. We also investigated the correlation of psoriasis-associated taxa with clinical characteristics. High bacterial load was identified in the psoriatic lesions compared with unaffected skin and controls. There was an imbalance between Cutibacterium (also known as Propionibacterium) and Corynebacterium in psoriatic skin. Lesions showed a higher proportion of Corynebacterium and a lower proportion of Cutibacterium compared with unaffected skin and controls. Corynebacterium was correlated with the severity of local lesions, whereas Cutibacterium showed correlation with the abnormity of skin capacitance. We did not conduct a longitudinal study. Psoriatic lesions are characterized by higher bacterial load and imbalance between Cutibacterium and Corynebacterium.

Псориаз: клинические особенности, факторы риска и ассоциированные коморбидные состояния

Псориаз: клинические особенности, факторы риска и ассоциированные коморбидные состояния

Autoimmune Diseases in Patients with Cushing’s Syndrome after Resolution of Hypercortisolism: Case Reports and Literature Review

Introduction Cushing's syndrome (CS) is a clinical condition characterized by excessive cortisol production, associated with metabolic complications, such as diabetes mellitus, dyslipidemia, metabolic syndrome, hypertension, and cardiovascular diseases. Nowadays, the occurrence of autoimmune diseases in CS have not been completely evaluated in the previous studies. Objective The aim of this study was to evaluate the occurrence of autoimmune diseases in CS patients after successfully treated. Materials and Methods From January 2001 to December 2017, in our Secondary Hypertension Unit, we evaluated 147 CS patients (91 with ACTH-independent disease, 54 with ACTH-dependent disease, and 2 patients with ectopic ACTH production. Results 109 CS patients (74.1%) were surgically treated (67 ACTH-independent CS patients (61.5%) undergone adrenalectomy and 42 ACTH-dependent CS (38.5%) undergone transsphenoidal surgery) and evaluated after 6, 12, and 24 months after clinical and biochemical remission of disease. In 9 (8.3%) of overall treated CS patients (8.3%), during follow-up, we observed the onset of some manifestations of autoimmune diseases. In particular, one patient had a systemic lupus erythematosus, one patient had rheumatoid arthritis, 4 patients reported autoimmune thyroiditis (Basedow-Graves' disease and Hashimoto's thyroiditis), one patient had clinical features of psoriasis, one patient showed myasthenia gravis, and one patient had giant cell arteritis. Conclusions Our results demonstrate that patients successfully treated for CS could develop autoimmune diseases. Therefore, after treatment, CS patients need to be strictly monitored in order to evaluate the possible onset of autoimmune diseases.

Иммунологические и клини­ческие особенности псориаза у ВИЧ-инфицированных больных

Иммунологические и клини­ческие особенности псориаза у ВИЧ-инфицированных больных

GENIPSO: a French prospective study assessing instantaneous prevalence, clinical features and impact on quality of life of genital psoriasis among patients consulting for psoriasis

Genital psoriasis is often under-recognized. To assess the instantaneous prevalence of genital psoriasis and describe its clinical features, association with a particular subtype of psoriasis and its impact on general and sexual quality of life (QoL). GENIPSO is a prospective study conducted by private and hospital-based dermatologists. This study featured the consecutive inclusion of patients consulting for extragenital psoriasis. The clinical features of psoriasis and genital psoriasis were recorded and QoL and sexual health questionnaires were distributed to patients. Overall, 335 of 776 patients (43·2%) included in the study had genital involvement. All were aware that they had genital lesions but only 135 patients (40%) declared that they had been previously examined. Genital lesions were associated with male sex, severity of psoriasis, age of onset > 20 years, inverse psoriasis and involvement of scalp, nail and external auditory canal, but were not associated with obesity, psoriatic arthritis and active sex life. Itching was the main symptom. Genital psoriasis was associated with impairment of QoL and sexual health according to the Dermatology Life Quality Index and the Female Sexual Function Index. Genital psoriasis has a high prevalence in patients consulting for extragenital psoriasis, which affects QoL, and should be taken into account by dermatologists in order to optimize global care.

Psoriasis: clinical and epidemiological features and therapy issues

Aim. This study sets out to establish the demographic and clinical features of psoriasis and its co-morbidities; to describe approaches to treating patients in Russia, to whom the systemic therapy of drugs has been recommended; to assess the effects of this dermatosis on the patients' quality of life and work productivity; to assess the degree of consistency between dermatologists' and patients' estimates concerning the severity of the disease, complaints/objective manifestations and treatment satisfaction.Methods. Data from the GfK Disease Atlas was used. This ATLAS was filed within a global programme Growth from Knowledge that collected reliable data in the context of everyday clinical practice in 9 countries. The paper presents the results solely for the Russian sample. The study involved patients with moderate or severe psoriasis who were receiving systemic therapy for this disease. Using specially developed forms, ATLAS specialists registered data about patients, their disease and received treatment. The patients affected by psoriasis, who participated in the study, were questioned about their disease. Dermatologists assessed the severity of psoriasis, the patients' complaints, co-morbidities and received treatment. The patients completed questionnaires aimed at assessing the quality of their life [Dermatology Life Quality Index, DLQI] and their work productivity [Work Productivity and Activity Impairment, WPAI]. The concordance between the patients' and the dermatologists' estimates was assessed using Cohen's kappa coefficient.Results. Overall, 3,821 patients participated in the ATLAS programme, out of whom 300 patients were Russians. The average time since psoriasis diagnosis amounted to 9.9 years. 51 % of the patients complained about itching in the lesion areas. Psoriatic arthritis was registered in 19 % of the cases. Among co-morbidities, anxiety or depression was most often recorded (11 %, respectively). The proportion of patients with pruritus and related comorbid conditions increased with psoriasis severity. The disease negatively affected the quality of patients’ life (the average value of DLQI was 7.1) and their work productivity (a decrease in the work productivity reached 33.2 %), with these indicators deteriorating with psoriasis severity. Despite the dominance of moderate and severe psoriasis forms among the participants, 60 % of the patients received therapy only with topical medications. The concordance rate between the patients and the dermatologists concerning the estimation of psoriasis severity and treatment satisfaction was low.Conclusion. Despite the therapy with systemic drugs, the patients' quality of life affected by severe or moderate psoriasis forms remained low. The consistency between the views on the treatment success between the patients and the dermatologists was low.

Ethnicity affects the presenting severity of psoriasis

Ethnicity affects the presenting severity of psoriasis

Clinical and Epidemiological Features of Psoriasis in Patients Visiting Lumbini Medical College

Background: Psoriasis is a worldwide disease and varies in its clinical profile and epidemiology in different regions of the world. The disease is common and few epidemiological data are available in our country. Objective: The purpose of this study was to evaluate the epidemiologic and clinical features of Psoriasis in Lumbini Medical College.&#x0D; Methods: A retrospective investigation of a total of 240 patients visiting Out Patient Department (OPD) of Dermatology and Venereology of Lumbini Medical College with Psoriasis was done. The parameters included were age at onset of disease, age at first treatment, current age, sex, type of disease and distribution of lesions. Data and statistical analysis was done with SPSS 17.0.&#x0D; Results: The mean age of patients at onset of disease was 26.4 (SD = 14.3) years. M:F ratio was 1.16. Psoriasis vulgaris (PV) was the most common variety of the disease. Extensor surface of the body was most commonly involved.&#x0D; Conclusion: Psoriasis is a common dermatological disease accounting 2.9% of all dermatology patients in our center. PV is the most common clinical subtype. The disease is more frequent in the third decade of life and has a male predominance in our region. Treatment compliance has been found to be poor.

Clinical study on psoriasis patients for past 30 years (1982–2012) in Seoul National University Hospital Psoriasis Clinic

Psoriasis is a chronic relapsing disorder which shows variable clinical features. The long-term clinical study with many patients is important to elucidate the epidemiologic characteristics and clinical features of psoriasis. The purpose of this study was to analyze the epidemiologic characteristics and clinical features of psoriasis in Korean patients. Epidemiologic and clinic data and assessments for severity of extent and activity of psoriasis were collected from the medical records of 5084 patients, who had been newly diagnosed with psoriasis in the Psoriasis Clinic of Seoul National University Hospital between 1982 and 2012. The sex ratio of the psoriasis patients was 1.2:1 (male 54.6%, female 45.4%). The peak age of onset in males was 20s, while it was the teenage years in females. A total of 63.5% of patients developed psoriasis before 30years of age. Family history of psoriasis was observed in 26.0% of patients. Moderate to severe extent of involvement were more frequently observed in male patients and patients under 30years of onset age than in females and patients 30years or over of onset age, respectively. Moderate to severe disease activity were also more frequently presented in male patients, but not in patients under 30years of onset age. The most common morphological type was nummular (56.7%), followed by large plaque (28.5%) and guttate (8.5%). Nail involvement accompanied in 26.4% of patients. We demonstrated the epidemiologic and clinical characteristics of psoriasis in Korean patients.

Prevalence and risk factors of psoriasis in Hainan province: an epidemiological survey

Objective To estimate the prevalence of psoriasis in resident population in Hainan province through a large-scale,multi-center epidemiological survey.Methods Ten small towns or communities were selected from each of 18 cities or counties in Hainan province as survey sites.Multi-stage sampling strategies (including stratified sampling,simple random sampling and cluster sampling) were used in this study.After respondents signed an informed consent form,investigators completed a registration form containing information regarding clinical features of psoriasis,environmental factors,character trait,aggravating factors,trauma history,infection history,etc.Statistical analysis was carried out by the EpiData 3.1 and SPSS 17.0 software.Results This study recruited 35 314 subjects,and 30 935 responded with a return rate of 87.60％.The ratio of man to women was 1.2 ∶ 1,with an average age of (33.86 ± 17.78) years.Forty-six cases of psoriasis were confirmed in these respondents.The overall and standardized prevalence rate of psoriasis was 1.49‰ and 1.42‰ respectively.A significant increase was observed in the standardized prevalence rate of psoriasis in males compared with females (1.85‰ vs.0.84‰,x2 =6.86,P ＜ 0.01).The average age of onset was (33.49 ± 14.61) years,and the most common clinical type was psoriasis vulgaris (82.60％,38/46).Anxiety was the risk factor of psoriasis.The impact of psoriasis on the quality of life included barriers to social (89.13％) and physical activity (73.91％) as well as psychological disorders (86.97％).Conclusions The prevalence rate of psoriasis in resident population in Hainan province is lower than the national average level in China.It seems that multiple factors are implicated in the initiation and progression of psoriasis. Key words: Psoriasis; Epidemiology; Hainan

Reduced Number of Circulating Endothelial Progenitor Cells (CD133+/KDR+) in Patients with Plaque Psoriasis

Background: Psoriasis is associated with an increased cardiovascular risk. Circulating endothelial progenitor cells (CEPCs) play a significant role in the maintenance of vascular homeostasis. Objective: The aim of this study was to evaluate the number of CEPCs in patients with psoriasis compared to controls and assess possible correlations between the number of these cells and the plasma levels of vascular endothelial growth factor (VEGF), soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and clinical features of psoriasis. Methods: The number of CEPCs, identified as CD133+/KDR+ cells, was determined with flow cytometry in peripheral blood of psoriatic patients (n = 63) and controls (n = 31). The plasma levels of VEGF and sVEGFR-1 were measured with enzyme-linked immunosorbent assay. Results: The number of CEPCs was significantly reduced in psoriatic patients compared with controls (p = 0.000026) and inversely correlated with disease severity (R = –0.283; p = 0.0248). Conclusion: A reduced number of CEPCs may contribute to endothelial dysfunction in patients with psoriasis.

IL-17A is essential for cell activation and inflammatory gene circuits in subjects with psoriasis

In subjects with psoriasis, inflammation and epidermal hyperplasia are thought to be controlled by T cell-derived cytokines. Evidence suggests that the T(H)17 cell cytokine IL-17A (IL-17) might play a role in disease pathogenesis. We sought to understand the effect that neutralization of IL-17 has on the clinical features of psoriasis and to understand the role that IL-17 has in inflammatory pathways underlying psoriasis in human subjects. We examined skin lesions obtained from 40 subjects participating in a phase I, randomized, double-blind, placebo-controlled trial of the anti-IL-17 mAb ixekizumab (previously LY2439821) in which subjects received 5, 15, 50, or 150 mg of subcutaneous ixekizumab or placebo at weeks 0, 2, and 4. There were significant dose-dependent reductions from baseline in keratinocyte proliferation, hyperplasia, epidermal thickness, infiltration into the dermis and epidermis by T cells and dendritic cells, and keratinocyte expression of innate defense peptides at 2 weeks. By week 6, the skin appeared normal. Quantitative RT-PCR and microarrays revealed an ablation of the disease-defining mRNA expression profile by 2 weeks after the first dose of study drug. The effect of IL-17 blockade on expression of genes synergistically regulated by IL-17 and TNF-α was of higher magnitude at 2 weeks than in prior studies with TNF-α antagonism. Our data suggest that IL-17 is a key "driver" cytokine that activates pathogenic inflammation in subjects with psoriasis. Neutralizing IL-17 with ixekizumab might be a successful therapeutic strategy in psoriasis.

Heterogeneity of Inflammatory and Cytokine Networks in Chronic Plaque Psoriasis

The clinical features of psoriasis, characterized by sharply demarcated scaly erythematous plaques, are typically so distinctive that a diagnosis can easily be made on these grounds alone. However, there is great variability in treatment response between individual patients, and this may reflect heterogeneity of inflammatory networks driving the disease. In this study, whole-genome transcriptional profiling was used to characterize inflammatory and cytokine networks in 62 lesional skin samples obtained from patients with stable chronic plaque psoriasis. We were able to stratify lesions according to their inflammatory gene expression signatures, identifying those associated with strong (37% of patients), moderate (39%) and weak inflammatory infiltrates (24%). Additionally, we identified differences in cytokine signatures with heightened cytokine-response patterns in one sub-group of lesions (IL-13-strong; 50%) and attenuation of these patterns in a second sub-group (IL-13-weak; 50%). These sub-groups correlated with the composition of the inflammatory infiltrate, but were only weakly associated with increased risk allele frequency at some psoriasis susceptibility loci (e.g., REL, TRAF3IP2 and NOS2). Our findings highlight variable points in the inflammatory and cytokine networks known to drive chronic plaque psoriasis. Such heterogeneous aspects may shape clinical course and treatment responses, and can provide avenues for development of personalized treatments.

Clinical study of psoriasis occurring over the age of 60 years: is elderly‐onset psoriasis a distinct subtype?

Previous studies demonstrated clinical differences of early- and late-onset psoriasis. However, epidemiological data and clinical characteristics of psoriasis occurring in geriatric patients have been rarely studied. Assessment of epidemiology and clinical features of psoriasis first occurring over the age of 60 years, so-called elderly-onset psoriasis, based on clinical data. Among 4049 patients visiting our psoriasis clinic for the last 27 years, patients were first divided into early- (onset age before 30 years) and late-onset psoriasis (onset age after 30 years) based on our previous studies. Then, patients of late-onset psoriasis were further divided into middle age-onset group (onset age between 30 and 60 years) and elderly-onset group (onset age over 60 years). Clinical characteristics of elderly-onset psoriasis were compared with early- and middle age-onset groups. We acquired the data both by physician's assessments and patients' responses. Elderly-onset patients comprised 3.2% of total patients, 129 out of 4049. They have shown a lower incidence of family history (P < 0.05). The severity assessed by PASI score, body surface extent, and activity of individual lesions demonstrated that psoriasis of the elderly-onset group was generally milder compared with early- and middle age-onset groups (P < 0.05). In clinical phenotypes, the proportion of guttate type and generalized pustular psoriasis type decreased remarkably, while that of erythroderma type increased (P < 0.05). There was a significant change in the body part of origin comparing early- and middle age-onset groups (P < 0.05). The proportion of scalp increased, while that of knee-elbow and trunk decreased significantly (P < 0.05). Patients' subjective sensation of disease course improved statistically comparing early- and middle age-onset groups (P < 0.05). There was no significant change in the degree of pruritus on psoriatic lesions and nail involvement (P > 0.05). The elderly-onset group demonstrated milder disease courses and some changes in clinical phenotypes and body part of origin compared with early- and middle age-onset groups. Therefore, it seems that patients whose onset of psoriasis was over the age of 60 years might have distinct clinical features in some clinical aspects.