Cutaneous Psoriasis Research Articles

Behavioral profiles of Cutaneous T-cell lymphoma and Psoriasis (P6.193)

Behavioral profiles of Cutaneous T-cell lymphoma and Psoriasis (P6.193)

Identifying and Managing Complications and Comorbidities in Patients With Psoriasis.

The common comorbidities of cutaneous psoriasis include psoriatic arthritis (PsA), Crohn's disease, uveitis, and depression. In addition, cardiovascular disease risk factors (including metabolic syndrome) are seen more frequently among patients with psoriasis, and strong epidemiologic evidence has demonstrated that psoriasis is independently associated with myocardial infarction. Because these comorbid conditions and other medical complications adversely affect morbidity and mortality in patients with psoriasis, dermatologists can play an important role in promptly identifying and, when necessary, referring patients for further workup and treatment when signs or symptoms of these comorbidities or complications are observed. Semin Cutan Med Surg 34(supp2):S30-S33 © 2015 published by Frontline Medical Communications.

Vasoactive Intestinal Peptide in Early Spondyloarthritis: Low Serum Levels as a Potential Biomarker for Disease Severity.

Spondyloarthritis (SpA) is a family of inflammatory diseases sharing clinical, genetic, and radiological features. While crucial for tailoring early interventions, validated prognostic biomarkers are scarce in SpA. We analyze the correlation between serum levels of vasoactive intestinal peptide (VIP) and disease activity/severity in patients with early chronic inflammatory back pain. The study population comprised 54 patients enrolled in our early chronic inflammatory back pain register. We collected demographic information, clinical data, laboratory data, and imaging findings. VIP levels were measured by enzyme immunoassay in serum samples from 162 visits. The association between independent variables and VIP levels was analyzed using longitudinal multivariate analysis nested by patient and visit. No significant differences were observed in VIP levels between these two groups. Lower levels of VIP were significantly associated with a higher Bath Ankylosing Spondylitis Disease Activity Index (BASFI) score, presence of bone edema in magnetic resonance imaging (MRI) scan, and lower hemoglobin levels. Coexistence of cutaneous psoriasis was independently associated with lower VIP levels, and similar trend was observed for enthesitis. We conclude that SpA patients with low serum VIP levels had worse 2-year disease outcome, suggesting that serum VIP levels could be a valid prognostic biomarker.

Analysis of periarticular bone changes in patients with cutaneous psoriasis without associated psoriatic arthritis

ObjectivesTo search for structural bone changes in the joints of psoriasis patients without psoriatic arthritis (PsA).Methods55 psoriasis patients without any current or past symptoms of arthritis or enthesitis and 47...

Co-existence of psoriasis and melanoma in a large urban academic centre population: a cross-sectional retrospective study.

Psoriasis has been linked to increased malignancy risk, particularly lympho-haematopoietic and non-melanoma skin cancers; however, its association with cutaneous melanoma remains unclear. The aim of this study was to determine if there is an association between melanoma and psoriasis in a large, urban academic population through an electronic medical record database. We searched our institution's electronic medical record database (EDW-Electronic Data Warehouse) from 1/2001 to 11/2013. Subjects were identified by ICD-9 codes. Melanoma diagnosis was included only if documented at least 1 month after the psoriasis diagnosis was documented. Odds ratio (OR) was obtained for association between cutaneous melanoma and psoriasis. The OR was then adjusted for phototherapy and age. To minimize detection bias, we also obtained the OR for association between cutaneous melanoma and atopic dermatitis. We identified 10 947 patients with psoriasis, 64 of whom had a subsequent diagnosis of cutaneous melanoma. We detected a significant association between melanoma and psoriasis (OR = 1.77; 95%CI 1.38-2.26; P < 0.0001; total n = 1 525 252). After adjusting for phototherapy and age, a statistically significant association between melanoma and psoriasis remained detectable (OR = 1.9; 95%CI 1.55-2.55; P < 0.0001 and OR = 1.64; 95%CI 1.17-2.26; P = 0.003 respectively). The OR for melanoma with atopic dermatitis in the same patient database showed a statistically significant inverse association between the two diseases (OR = 0.35; 95%CI 0.16-0.73; P = 0.005). Our findings show a statistically significant association between psoriasis and melanoma. After adjusting the OR for phototherapy and age, a statistically significant association remained. Further investigations exploring these associations are warranted in order to establish the relative risk for melanoma in psoriasis patients.

Pneumopathie à éosinophiles chez un patient atteint de psoriasis en plaques traité par ustékinumab

Ustekinumab (Stelara(®)) is efficacious in severe cutaneous psoriasis. Numerous adverse effects have been reported but treatment withdrawal is rarely required. The present case concerns eosinophilic pneumonia treated with ustekinumab. A 71-year-old male patient presented severe plaque psoriasis with an indication for biotherapy. Pre-treatment investigations showed a highly positive interferon gamma test without any anomalies in the CT chest scan. The patient was treated with anti-tuberculosis agents and ustekinumab was then introduced. Seven months later, the patient presented a cough resistant to antibiotics. A CT scan showed frosted-glass-like shadows and mediastinal lymphadenopathy. The bronchoalveolar lavage fluid contained 800elements/mm(3), of which 34% eosinophils. There were 1480G/L eosinophils in peripheral blood. There was nothing evocative of infectious or tumoral causes, and a diagnosis of eosinophilic pneumonia was made. Ustekinumab was stopped and 10weeks later, the patient's condition worsened; after further examination, systemic corticosteroids were given, beginning with prednisone 1mg/kg. Seven months later, the patient was symptom-free, without eosinophilia, and his chest scan was normal. The corticosteroids were stopped. Eosinophilic pneumonia includes various disorders characterized by eosinophilic infiltration of lung tissue, with or without the presence of eosinophils in peripheral blood. Eosinophilic pneumonia can be caused by many different drugs. Diagnosis is difficult because clinical and radiological abnormalities may develop at different times after treatment initiation and they are non-specific. A favourable outcome may occur spontaneously on treatment withdrawal or a short course of corticosteroid therapy may be needed. A case of eosinophilic pneumonia under ustekinumab has already been reported, supporting the causal involvement of this drug in our patient. Eosinophils in peripheral blood have also been reported with anti-TNF-alpha. In conclusion, where a patient on biologic treatment for psoriasis presents persistent cough, once infectious disease has been ruled out, eosinophilic pneumonia should be considered.

Prevalence of metabolic syndrome in psoriatic arthritis compared with psoriasis: a cross-sectional study in a South Indian population

Objective The objective of this study was to assess and compare the prevalence of metabolic syndrome (MetS) in patients with psoriasis (PsO) and in those with psoriatic arthritis (PsA). Materials and methods This was a cross-sectional study with no follow-up and was performed among outpatients attending the speciality clinics of an institutional tertiary referral centre. A consecutive sample of 100 patients with PsO was included in the study. Height, weight, BMI, blood pressure and waist circumference of patients were measured at the time of enrolment. Venous samples were taken after 8 h of overnight fasting for the estimation of serum cholesterol, triglycerides and plasma glucose levels. Results MetS was seen in 62.9% (17) of patients with PsO and in 32.8% of patients with PsA. This difference was statistically highly significant (P < 0.001). Conclusion MetS is common in Asian Indian patients with PsA than in patients with cutaneous PsO only.

Evaluation of performance of BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in a Brazilian cohort of 1492 patients with spondyloarthritis: data from the Brazilian Registry of Spondyloarthritides (RBE)

ObjectiveTo analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. MethodsA common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applied. The total values of BASDAI were compared to the presence of the different variables. ResultsThe mean score of BASDAI was 4.20±2.38. The mean scores of BASDAI were higher in patients with the combined (axial+peripheral+entheseal) (4.54±2.38) clinical presentation, compared to the pure axial (3.78±2.27) or pure peripheral (4.00±2.38) clinical presentations (P<0.001). BASDAI also presented higher scores associated with the female gender (P<0.001) and patients who did not practice exercises (P<0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (P<0.049), alternating buttock pain (P<0.001), cervical pain (P<0.001) and hip involvement (P<0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (P=0.004) and upper limbs (P=0.025). The presence of enthesitis was also associated to higher scores of BASDAI (P=0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (P<0.001). ConclusionIn this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate “disease activity” in patients with axial as well as peripheral disease.

Molecular characterization of the skin fungal microbiome in patients with psoriasis.

The skin surface is colonized by a wide variety of fungi and bacteria. While many of these organisms, including Malassezia, Candida, Streptococcus and Staphylococcus species, are associated with provocation and/or exacerbation of psoriasis, a detailed analysis of the cutaneous fungal microbiome in psoriatic patients has yet to be performed. To identify the disease-specific fungal microbiota on psoriatic scale samples, fungal rRNA gene sequences from 12 psoriatic patients and 12 healthy controls were analyzed by pyrosequencing. A total of 317 806 high-quality sequences were obtained, representing 142 genera. Malassezia species were the most abundant sequences in both populations (46.9 ± 14.0% in psoriasis vs. 76.0 ± 14.6% for healthy controls). Principal coordinate analysis revealed that the fungal microbiomes were independent. Although an association between the cutaneous fungal microbiome and psoriasis has yet to be established, our data indicate that the microbiome in patients with psoriasis is independent of that in healthy controls.

Quantitative comparison of angiogenesis and lymphangiogenesis in cutaneous lichen planus and psoriasis: Immunohistochemical assessment

Recent experimental studies revealed that angiogenesis and lymphangiogenesis are closely related to chronic inflammation. The present study aims to evaluate quantitative changes of blood and lymphatic microcirculatory beds in cutaneous lichen planus (CLP) and psoriatic lesions using immunohistochemical analysis with antibodies to CD34, D2-40 and VEGF. Morphometric software was used to determine the area of blood and lymphatic vessels (BVA and LVA) and also the VEGF positive area. Statistical analysis of these parameters confirmed a significant enlargement of both the blood and lymphatic microcirculatory beds in psoriatic and CLP lesions. BVA in CLP lesions was increased by 56% however this augmentation was not as great as in psoriatic lesions where BVA was increased by 123%. Interestingly, LVA in psoriatic and CLP lesions was increased equally by 85%. The strongest VEGF expression was detected in psoriatic lesions, with lower, but still significant, overexpression in CLP lesions. VEGF-C was significantly increased in both psoriatic and CLP lesions in comparable level. Noticeably higher VEGF and VEGF-C expression was observed in the epidermis than in the dermis. Finally, our results indicate that the level of angiogenesis is considerably greater in psoriatic lesions than in CLP lesions, but the level of lymphangiogenesis is equal in both psoriatic and CLP lesions.

Cardiovascular risk in psoriatic patients detected by heart rate variability (HRV) analysis.

Patients affected by severe psoriasis have an increased prevalence of cardiovascular () diseases as documented by several studies. Heart rate variability (HRV) is a noninvasive method to evaluate the autonomic control of the sinus node. In this study, HRV analysis has been used to evaluate whether young patients with moderate cutaneous psoriasis have increased cardiovascular (CV) risk, in absence of CV comorbidities. Our data indicate an imbalance toward the sympathetic arm of the autonomic cardiac modulation. As the increase in sympathetic activity may be associated with a higher CV risk, moderate psoriasis could be considered to be an independent CV risk factor.

Epidemiologic profile of juvenile-onset compared to adult-onset spondyloarthritis in a large Brazilian cohort

ObjectiveTo analyze the clinical and epidemiologic characteristics of juvenile-onset spondyloarthritis (SpA) (< 16 years) and compare them with a group of adult-onset (≥ 16 years) SpA patients. Patients and methodsProspective, observational and multicentric cohort with 1,424 patients with the diagnosis of SpA according to the European Spondyloarthropathy Study Group (ESSG) submitted to a common protocol of investigation and recruited in 29 reference centers participants of the Brazilian Registry of Spondyloarthritis (RBE – Registro Brasileiro de Espondiloartrites). Patients were divided in two groups: age at onset<16 years (JOSpA group) and age at onset ≥ 16 years (AOSpA group). ResultsAmong the 1,424 patients, 235 presented disease onset before 16 years (16.5%). The clinical and epidemiologic variables associated with JOSpA were male gender (p<0.001), lower limb arthritis (p=0.001), enthesitis (p=0.008), anterior uveitis (p=0.041) and positive HLA-B27 (p=0.017), associated with lower scores of disease activity (Bath Ankylosing Spondylitis Disease Activity Index – BASDAI; p=0.007) and functionality (Bath Ankylosing Spondylitis Functional Index – BASFI; p=0.036). Cutaneous psoriasis (p<0.001), inflammatory bowel disease (p=0.023), dactylitis (p=0.024) and nail involvement (p=0.004) were more frequent in patients with adult-onset SpA. ConclusionsPatients with JOSpA in this large Brazilian cohort were characterized predominantly by male gender, peripheral involvement (arthritis and enthesitis), positive HLA-B27 and lower disease scores.

Avaliação do desempenho do BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) numa coorte brasileira de 1.492 pacientes com espondiloartrites: dados do Registro Brasileiro de Espondiloartrites (RBE)

To analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applicated. The total values of BASDAI were compared to the presence of the different variables. The mean score of BASDAI was 4.20 ± 2.38. The mean scores of BASDAI were higher in patients with the combined (axial + peripheral + entheseal) (4.54 ± 2.38) clinical presentation, compared to the pure axial (3.78 ± 2.27) or pure peripheral (4.00 ± 2.38) clinical presentations (p<0.001). BASDAI also presented higher scores associated with the female gender (p<0.001) and patients who did not practice exercises (p < 0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (p<0.049), alternating buttock pain (p<0.001), cervical pain (p<0.001) and hip involvement (p<0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (p=0.004) and upper limbs (p=0.025). The presence of enthesitis was also associated to higher scores of BASDAI (p=0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (p<0.001). In this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate "disease activity" in patients with axial as well as peripheral disease.

Comment reconnaître et traiter un psoriasis unguéal

Psoriasis is an inherited chronic hyper proliferative autoimmune disease. Nail involvement is common and is found in 61% of cases of cutaneous psoriasis, with lifetime incidence of 90%; 80 to 90% in patients with psoriatic arthritis. Classical manifestations on the nail apparatus are correlated with the origin site of the disease. The proximal matrix produces pitting, trachyonychia and Beau's lines, transverse grooves. The distal matrix (lunula) may appear spotted or erythematous in color. Inflammation of the mid or distal matrix causes leuconychia due to nail incorporation of parakeratotic cells. Nail bed and hyponychium can show onycholysis, oil drops (salmon patches) subungual hyperkeratosis and at the distal nail bed splinter hemorrhages. Induction or severe exacerbation of psoriasis may be due to drugs, such as β-blockers, lithium, antimalarial agents, anti-TNF and interferon.

Perfil epidemiológico da espondiloartrite de início juvenil comparada com a espondiloartrite de início na vida adulta em uma grande coorte brasileira

ObjectiveTo analyze the clinical and epidemiologic characteristics of juvenile‐onset spondyloarthritis (SpA) (< 16 years) and compare them with a group of adult‐onset (≥ 16 years) SpA patients. Patients and methodsProspective, observational and multicentric cohort with 1,424 patients with the diagnosis of SpA according to the European Spondyloarthropathy Study Group (ESSG) submitted to a common protocol of investigation and recruited in 29 reference centers participants of the Brazilian Registry of Spondyloarthritis (RBE – Registro Brasileiro de Espondiloartrites). Patients were divided in two groups: age at onset<16 years (JOSpA group) and age at onset ≥ 16 years (AOSpA group). ResultsAmong the 1,424 patients, 235 presented disease onset before 16 years (16.5%). The clinical and epidemiologic variables associated with JOSpA were male gender (p<0.001), lower limb arthritis (p=0.001), enthesitis (p=0.008), anterior uveitis (p=0.041) and positive HLA‐B27 (p=0.017), associated with lower scores of disease activity (Bath Ankylosing Spondylitis Disease Activity Index – BASDAI; p=0.007) and functionality (Bath Ankylosing Spondylitis Functional Index – BASFI; p=0.036). Cutaneous psoriasis (p<0.001), inflammatory bowel disease (p=0.023), dactylitis (p=0.024) and nail involvement (p=0.004) were more frequent in patients with adult‐onset SpA. ConclusionsPatients with JOSpA in this large Brazilian cohort were characterized predominantly by male gender, peripheral involvement (arthritis and enthesitis), positive HLA‐B27 and lower disease scores.

Influence of Cutaneous Involvement in Deciding how to Treat Psoriatic Arthritis

Background Cutaneous psoriasis precedes joint disease in 84% of patients with psoriatic arthritis. We believe that skin involvement should be considered when deciding how to treat psoriatic arthritis. Objective The goal of our study was to investigate how the severity of skin disease influenced the management of psoriatic arthritis. Methods Fifty patients with psoriatic arthritis and cutaneous involvement were studied. The severity of joint and skin involvement was evaluated. Treatment decisions for each patient were based on the most severe presentation between skin and joint involvement. Results Treatment decisions were guided and were compared by the most severe skin involvement in 22/50 patients (44%), by the most severe joint involvement in 16 patients (32%), and by both skin and joint involvement in 12 patients (24%). There were no statistically significant differences (p &lt;0.472). Conclusion Treatment decisions in patients with psoriatic arthritis should be made in conjunction with decisions about skin treatment.

Fine Mapping Major Histocompatibility Complex Associations in Psoriasis and Its Clinical Subtypes

Psoriasis vulgaris (PsV) risk is strongly associated with variation within the major histocompatibility complex (MHC) region, but its genetic architecture has yet to be fully elucidated. Here, we conducted a large-scale fine-mapping study of PsV risk in the MHC region in 9,247 PsV-affected individuals and 13,589 controls of European descent by imputing class I and II human leukocyte antigen (HLA) genes from SNP genotype data. In addition, we imputed sequence variants for MICA, an MHC HLA-like gene that has been associated with PsV, to evaluate association at that locus as well. We observed that HLA-C∗06:02 demonstrated the lowest p value for overall PsV risk (p = 1.7 × 10−364). Stepwise analysis revealed multiple HLA-C∗06:02-independent risk variants in both class I and class II HLA genes for PsV susceptibility (HLA-C∗12:03, HLA-B amino acid positions 67 and 9, HLA-A amino acid position 95, and HLA-DQα1 amino acid position 53; p < 5.0 × 10−8), but no apparent risk conferred by MICA. We further evaluated risk of two major clinical subtypes of PsV, psoriatic arthritis (PsA; n = 3,038) and cutaneous psoriasis (PsC; n = 3,098). We found that risk heterogeneity between PsA and PsC might be driven by HLA-B amino acid position 45 (pomnibus = 2.2 × 10−11), indicating that different genetic factors underlie the overall risk of PsV and the risk of specific PsV subphenotypes. Our study illustrates the value of high-resolution HLA and MICA imputation for fine mapping causal variants in the MHC.

Environmental factors in benign migratory glossitis and psoriasis: retrospective study of the association of emotional stress and alcohol and tobacco consumption with benign migratory glossitis and cutaneous psoriasis.

The association between benign migratory glossitis (BMG) and psoriasis (PS) has been reported in the literature. This study aimed to determinate the environmental factors related to BMG and PS and to investigate their interactions. The study population included 129 patients with PS, 399 patients with BMG and a control group (CG) of 5472 individuals with neither PS nor BMG. The environmental factors evaluated in this study included alcohol and tobacco consumption and emotional stress. The Pearson's chi-squared test was used for analysing the association of the environmental factors with PS and BMG. The prevalence of alcohol consumption in the PS group was significantly higher than that in the CG. Tobacco consumption had a weak negative association with the BMG group. With respect to the PS group, no statistically significant association was observed. Emotional stress was the most important factor in the two study groups. Emotional stress and alcohol use together presented a higher incidence in the study groups than in the CG. Emotional stress and tobacco consumption together had a three times higher incidence in the PS group than in the BMG group. The association of emotional stress, alcohol and tobacco consumption in the PS group was four times higher than that in the CG. This study was limited by the lack of the information about frequency, type and length time of use of tobacco and alcohol, and by difficult to measure stress thought self-report questionnaire. The interactions between PS and environmental factors differ from those between BMG and environmental factors. These differences among interactions may be responsible for different forms of manifestations of these diseases, considering being both the same disease.

A Painful Case of Debilitating Cutaneous Psoriasis

Psoriasis is an immune mediated, chronic inflammatory, incurable condition of the skin that affects 2-3% of the population globally. It is associated with red, thick, scaly lesions [1], is more common in patients on higher latitudes, in Caucasians and may manifest itself with an underlying arthropathy. Psoriasis has a spectrum of presentations ranging from localized, mild disease to involvement of more than 90% of the body's surface called erythrodermic form [2]. In as many as 4% of the patients with psoriatic the first sign of disease involves changes to the nail, however, these nail changes are seen in about half patients at some point in the course of the disease. Arthropathy, specifically, Psoriatic arthritis is also seen in about 5-10% of this patient population [3].

The exacerbation of cutaneous psoriasis induced by anti - TNF therapy - case report

The tumor necrosis factor (TNF) blockers are highly effective therapy for numerous autoimmune inflammatory diseases, including rheumatoid arthritis, psoriatic arthropathy (PsA), spondyloarthropathies, juvenile idiopathic arthritis and inflammatory bowel disease. Paradoxically, these agents can induce cutaneous and systemic autoimmune diseases; the most common are psoriasis skin lesions and systemic lupus erythematosus (SLE) induced by TNF blockers. We present the case of a 59 years-old female, diagnosed at 32 years with cutaneous psoriasis vulgaris and psoriatic arthropathy at 54 years-old. After treatment failure with conventional Disease-Modifying Antirheumatic Drugs (DMARDs), biologic therapy with infliximab was started. After 3 years of treatment, the patient suffers an exacerbation of skin lesions and worsening joint damage. We decided to stop the infliximab and initiate the therapy with another anti-TNF agent (adalimumab), with improvement of the skin lesions and joint manifestations.