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PubMed2006

[Advances in pathogenesis of psoriasis].

OBJECTIVE: The pathogenesis of psoriasis recently made great advancement due to the introduction of transgenic mouse model. K14-VEGF transgenic mouse showed many of the cellular and molecular features of psoriasis, including angiogenesis in dermis, altered epidermal proliferation and differentiation. Psoriasis of early onset and severe disease showed significantly increased frequency of the +405CC genotype and the C allele. Transgenic mice with keratinocytes expressing active Stat3 (K5. Stat3C mice) developed a skin phenotype closely resembling psoriasis. Stat 3 may link activated keratinocytes and immunocytes required for development of psoriasis. More recently, a novel mouse model with epidermal specific double-knockout of the c-Jun and JunB genes showed developments of psoriasis-like skin phenotype and arthritic lesions. All these data provided more profound understanding in pathogenesis and therapy of psoriasis.

Animals↗
PubMed1999

Patients with psoriasis and their compliance with medication.

BACKGROUND: Poor compliance with treatment advice in chronic conditions, such as psoriasis, represents a major challenge to health care professionals. Previous research suggests that the rate of noncompliance in chronic conditions may be as high as 40%. OBJECTIVE: This study was designed to examine self-reported compliance in patients with psoriasis. METHODS: We undertook an anonymous postal survey sent to consecutive patients with psoriasis attending a tertiary psoriasis specialty clinic. RESULTS: Thirty-nine percent of participants reported that they did not comply with the treatment regimen recommended. The noncompliant group had a higher self-rated severity of psoriasis (t = -2.16, P =. 03), were younger (t = 3.28, P =.001), and had a younger age at onset (t = 2.35, P =.02) than those who were compliant. The noncompliant group reported that psoriasis had a greater impact on daily life (t = -2.23, P =.028), but general well-being was not significantly different from those who complied (t =.47, P = not significant). CONCLUSION: Patients who reported intentional noncompliance with treatment advice were more likely to believe that both psoriasis and its treatment interfered with their quality of life but not overall well-being. The impact of treatment on daily life highlights the importance of joint decision making in planning treatment.

Adolescent↗
PubMed2000

Sex-specific differences in the treatment of severe psoriasis.

BACKGROUND: Psoriasis treatment requires consideration of patient-specific concerns in addition to the severity of skin involvement. There may be sex-specific differences in the treatment of severe psoriasis. OBJECTIVE: The purpose of this study was to determine whether there are sex-specific differences in the treatment of severe psoriasis. METHODS: We analyzed the medications prescribed to patients with a primary and only diagnosis of psoriasis recorded in the 1990-1994 National Ambulatory Medical Care Survey. RESULTS: There were 8.5 million visits to physicians for the treatment of psoriasis in the years 1990-1994. These visits were made by approximately 4.3 million women and 4.1 million men. Only 39% of patients receiving systemic treatments were women. Women received less methotrexate (23% women) and etretinate (35% women) than men, but more psoralen photochemotherapy (PUVA) (63% women) and isotretinoin (100% women) than men. In contrast, there was no notable difference by sex in the potency of topical corticosteroid agents prescribed. CONCLUSION: For mild disease treated with topical agents alone, there is no notable difference in the treatment of men and women. Men are more likely than women to receive intensive treatments for severe psoriasis, at least in part because of the teratogenic potential of these treatments. There is a need for development of new treatments for severe psoriasis that are safe for women of childbearing potential.

Abnormalities, Drug-Induced↗
PubMed1975

Psoriasis: a review. Part I.

The recent literature relating to pathogenesis, clinical features and management of psoriasis has been reviewed. The features of the accelerated epidermopoiesis are described and its relationship to a possible primary fault in keratinisation or dermal influences discussed. The present position on the genetics and epidemiology of psoriasis is summarised. Recent observations on the relationship of histocompatibility system antigens to ordinary and pustular psoriasis could lead to important advances. Clinical discussion is confined to psoriasis in childhood, the hair, nails and mucosal psoriasis; pustular psoriasis and psoriasis arthropathica.

Age Factors↗
PubMed2001

[Study on the risk factors of psoriasis].

OBJECTIVE: To investigate psoriasis patients with family history and non-family history on their age and season of onset, disease severity and predisposing factors. METHODS: Two hundred and twenty psoriasis patients with family history and 547 psoriasis patients without, together with 647 normal controls have been investigated through questionnaires. EPI info 6.0 method was applied for data analysis. RESULTS: (1) In 220 psoriasis patients with family histories, morbidity rates of the first and second-degree relatives were 16.98% and 2.7% respectively. (2) Both mean age and age of onset were younger in females than that in males with family histories (t = 1.715 0, P < 0.05). The mean age of onset was younger in males with family histories than those without. However, there was no significant difference found in females (t = 0.739 2, P > 0.05). The mean age of onset seemed to be younger in females with family histories than that without, but with no significant statistical difference. (3) There were no significant differences in the age and season of onset, disease severity, and predisposing factors between groups with family histories and without. However, environment factors seemed to influence not only psoriasis patients with family histories but also those without, which showed significant difference (chi(2) = 0.23, P < 0.05). CONCLUSIONS: There was no significant difference in the following aspects as season of onset, disease severity and predisposing factors between the ones with family history and those without, except the age of onset and age of average. The results showed that genetic factor might play an important role in psoriasis patients with family history. It also demonstrated that psoriasis is a multifactor hereditary disease.

Adolescent↗
PubMed2002

Advances in experimental studies on treatment of psoriasis by traditional Chinese medicine.

Traditional Chinese medicine has demonstrated its strength in treating psoriasis, which is characterized by a variety of methods of treatment, flexible use of drugs, high efficacy, low recurrence, and few side-effects. Experimental studies on the mechanism governing the TCM treatment of psoriasis have been conducted at the cellular level and the molecular level. The studies on proliferation and differentiation of keratinocytes and the inhibitory effect against them, apoptosis, intercellular adhesion molecules, cytokine, and haemorheology indicate that the laboratory studies on the treatment of psoriasis have now entered a very high stage since the eighties. The studies on relationship between typing of psoriasis based on TCM differentiation of symptoms and signs and changes in some laboratory indexes have been carried out by some researchers to explore the inherent pathological changes in typing of psoriasis based on TCM differentiation of symptoms and signs and to provide scientific basis for the differentiation and typing under a unified standard. However, the present studies lack depth and scope in the methods. In future, the laboratory studies should be enhanced to go further into the principles governing the TCM treatment of psoriasis and to seek new drugs that will be even more effective for psoriasis and can bring its relapse under control.

Animals↗
PubMed2002

Association of psoriasis vulgaris with HLA class I and class II antigens in the Turkish population, according to the age at onset.

BACKGROUND: Association of psoriasis vulgaris with HLA antigens reference to age at onset has been reported in different racial or ethnic populations. OBJECTIVE: Our purpose was to determine the distribution of HLA markers in the Turkish population according to the age at onset of the psoriasis vulgaris. METHODS: HLA class I and class II antigens were performed by serologic methods in a group of 100 Turkish patients with psoriasis and 201 control subjects. Patients with psoriasis were subdivided into two groups based on age at onset (below or above 40 years of age) and family history. RESULTS: The frequency of HLA A30, Cw3, Cw6, DR7, DR14, DQ8, and DQ9 antigens were significantly increased in the Turkish psoriatic patients whereas HLA A66, Cw2, Cw4 and DR11 were found to be negatively associated with psoriasis. However, there were striking differences in HLA antigens according to the age at onset of the disease. Type I, early onset was associated with a high frequency of A30, B50, Cw6 and DR7 antigens whereas patients with type II, late onset had an increased frequency of Cw7. CONCLUSIONS: We conclude that psoriasis is probably a genetically determined disease and suggest that HLA-Cw6 antigen seems to associate commonly with early onset of psoriasis in Turkish patients.

Adolescent↗
PubMed2001

The efficacy of 308nm laser treatment of psoriasis compared to historical controls.

UVB treatment with a 308nm excimer laser has shown promise in the treatment of localized psoriasis. There is no placebo or comparison treatment controlled trial studying efficacy of the laser, however. The purpose of this report is to compare the results of a study of 308nm laser treatment of psoriasis to published results of other psoriasis treatments. Data on the efficacy of 308nm laser treatment of psoriasis were obtained from a previously published case series, supplemented by reanalysis of the data to estimate the median time to success using Kaplan-Meier methods. These results were compared to those from other studies identified by a Medline search. Treatment success was measured by estimating the percentage of patients who achieve 75% improvement in the severity of psoriasis. Patients treated in the 308nm laser study had similar disease severity as those in topical treatment studies and less severe disease than those treated in studies using standard phototherapy or systemic therapy. A greater percentage of patients achieved 75% improvement with the UVB laser treatments than was reported for other forms of phototherapy or systemic therapy with acitretin or low dose cyclosporine, and did so more rapidly. The UVB laser study patients achieved the 75% improvement endpoint in an average of 46% fewer treatments than was observed in other phototherapy studies. Laser treatment and topical calcipotriene had similar efficacies, and both were more effective than topical tazarotene or topical fluocinonide. As compared to topical therapies, the time to achieve 75% improvement favored the UVB laser. 308nm laser treatments for psoriasis are clearly more effective than placebo and are comparable to or more effective than many other standard treatments for psoriasis.

Antibodies, Monoclonal↗
PubMed2003

Terbinafine exacerbates psoriasis: case report with a literature review.

Oral terbinafine is a widely used antifungal agent. Adverse effects occur in about 11% of patients taking terbinafine. A rare case of the exacerbation of pre-existing psoriasis after oral terbinafine treatment is reported. A 63-year-old male patient with stable psoriasis vulgaris developed extensive tinea cruris. For this reason, he was treated with oral terbinafine 250 mg/day and topical 1% terbinafine cream. After 6 days of this therapy, a widespread flare-up of psoriasis developed. Oral terbinafine was discontinued, and the psoriasis was treated with topical corticosteroids and tacalcitol. Tinea cruris was cured with topical terbinafine. This case points out that terbinafine can influence the course of psoriasis. Moreover, the literature data indicate that terbinafine may not only exacerbate pre-existing psoriasis, but may also be responsible for de novo development of psoriasis. Therefore, oral terbinafine should not be considered the first line drug for superficial fungal infections in psoriatic individuals.

Aged↗
PubMedDate not supplied

[Experimental study on efficacy of thermal muds of Ischia Island combined with balneotherapy in the treatment of psoriasis vulgaris with plaques].

A lot of studies show the efficacy of thermal therapy in psoriasis. The main indications concern all forms of psoriasis (except for pustolosa and eritrodermic) especially diffuse psoriasis, intensive itchy, artropatic psoriasis and gutted psoriasis child. Benefit effects of thermal water and muds, which are important parameters in psoriasis' treatment, they are excellent to reduce inflammation, scaling, and erythema. In this study we evaluated the clinical efficacy of thermal bath plus muds in patients affected by psoriasis. 18 patients has been examined and randomly divided in 3 group (A-B-C). All the patients received thermal therapy for 4 weeks. To evaluate the behaviour of the disease we performed (corneometry, sebometry, phmetry), as well as evaluation of P.A.S.I. At the end of the study, values of P.A.S.I. showed a reduction from 10 to 6 unites P.A.S.I. for patients belong to group A, more 12 to less 10 for patients belong to group C e no significant variations for group B (because represent control group). Results obtained can be considered useful, considering that thermal treatment was used alone in the treatment of all patients.

Adult↗
PubMedDate not supplied

Psoriasis during therapy with olanzapine.

The role of several drugs (lithium, betablockers, clonidine, digoxin, nonsteroidal anti-inflammatory agents, interferon and tetracyclines) in inducing or exacerbating psoriasis is not completely understood. We report two cases of psoriasis in patients treated with olanzapine, a new drug used for psychotic disorders. In the first patient worsening of a pre-existing mild psoriasis occurred shortly after starting olanzapine treatment, followed by a relapse of the dermatological disease after a new administration of the anti-psychotic drug. In the second case we observed the onset of psoriasis during olanzapine treatment in an individual without any previous history of psoriasis but with a family history of the disease. Although the mechanism by which psoriasis may be induced or exacerbated by olanzapine remains unknown, these observations underline the need for caution and close follow-up in the pharmacological management of patients with psoriasis or a family history of the disease.

Adult↗
PubMed1992

Diagnosis of drug-induced psoriasis.

Certain drugs have been reported to precipitate or to exacerbate psoriasis. These cases occur mostly in patients with a history of psoriasis, although occasionally the new onset of psoriasis has followed treatment with certain drugs. The suspect drugs include lithium, beta adrenergic antagonists, antimalarials, and non-steroidal anti-inflammatory drugs (NSAID), in addition to various miscellaneous agents, including tetracycline. Evidence for these reports must be critically examined based on clinical and histological data, time course between drug intake and psoriasis exacerbation or resistance to psoriasis therapy, and response to drug rechallenge when available. The clinical context must be taken into consideration, including effects of concomitant antipsoriatic therapy, and the possible role of other triggering factors, such as infection. Controlled, prospective studies of the use of NSAID in patients with psoriasis may help to clarify their varied cutaneous effects. Further knowledge of the mechanisms involved in drug exacerbation of psoriasis may help to elucidate the etiopathogenesis of this chronic skin disorder.

Adrenergic beta-Antagonists↗
PubMed1992

Photosensitive psoriasis.

Photosensitive psoriasis is rare. The prevalence among psoriasis patients was estimated to be 5.5%. Photosensitive psoriatics have a statistically significant higher frequency of skin type I, a heredity of photosensitivity, advanced age, and psoriasis affecting hands compared with nonphotosensitive psoriatics. Half of the patients with photosensitive psoriasis have polymorphous light eruption (PLE), with psoriasis appearing as a secondary phenomenon in the PLE lesions. The other half slowly develop psoriasis after sun exposure but without preceding PLE. These reaction patterns may be confirmed with phototesting. Photochemotherapy is effective treatment for photosensitive psoriasis.

Humans↗
PubMed2004

Salivary immunoglobulin A and lysozyme in patients with psoriasis.

INTRODUCTION: We compared the salivary immunoglobulin A (IgA) and lysozyme concentration and secretion rates among mild and severe psoriasis patients and controls in Singapore. MATERIALS AND METHODS: Fifty-one psoriasis patients and 24 controls participated in the study. None of the patients were on immunosuppressive therapy. The Psoriasis Area and Severity Index (PASI) was used to assess the severity of psoriasis. Patients were divided into mild and severe groups by the median PASI score. Each subject contributed a 5-minute unstimulated salivary sample. Enzyme-linked immunosorbent assay method was used to determine the salivary IgA and lysozyme levels. RESULTS: Psoriasis patients had lower concentration and secretion rate of IgA (geometric mean [GM], 97.5 micro g/mL and 32.3 micro g/min) and lysozyme (GM, 127.6 micro g/mL and 42.1 micro g/min) than controls (IgA GM 256.3 micro g/mL, 79.1 micro g/min; lysozyme GM 180.9 micro g/mL, 55.8 micro g/min) [P = 0.000 (IgA concentration), P = 0.000 (IgA secretion rate), P = 0.015 (lysozyme concentration) and P = 0.150 (lysozyme secretion rate)]. However, no significant differences were observed between mild and severe patients for both IgA and lysozyme concentrations and secretion rates. PASI score showed negative, but non-significant, correlations with either log salivary IgA (r = -0.22, P = 0.13) or log lysozyme (r = -0.09, P = 0.53) secretion rates. CONCLUSION: Psoriasis patients had lower concentrations and secretion rates of salivary IgA and lysozyme compared to controls. However, among patients, the salivary IgA and lysozyme levels are variable and not related to severity of psoriasis.

Adult↗
PubMed2004

Serum angiotensin converting enzyme in patients with psoriasis.

Serum angiotensin-converting enzyme (ACE) was measured in 60 patients with psoriasis and in 16 healthy individuals. According to clinical forms ofpsoriasis, the patients were further divided into three groups: psoriasis with solitary lesions (n=20), psoriasis with multiple disseminated lesions (n=20) and erythrodermic psoriasis (n=20). The serum ACE activity was determined before and after therapy, by the spectrophotometric method using hippuryl-l-histidyl-l-leucine as a substrate. Before therapy, serum ACE activity was significantly increased in patients with psoriasis (47.20 +/- 2.06 U/L) in comparison to healthy individuals (28.33 +/- 1.32 U/L). The greatest increase in serum ACE activity was observed in patients with multiple disseminated lesions (78%), followed by those with solitary psoriatic lesions (76%) and erythrodermic psoriasis (31%). After therapy, serum ACE activity was significantly decreased in all clinical forms of the disease. In conclusion, the determination of serum ACE activity may be helpful in the diagnosis of psoriasis and one of the discriminators to assess the effects of used therapy.

Adult↗
PubMed2004

The need for health education among patients with psoriasis.

Psoriasis is one of the most common skin diseases with a chronic and recurrent course. The disease requires systematic treatment and appropriate care. Therefore, in the care of the patient with psoriasis, there must also be place for health education. The aim of this study was to determine the need for health education among patients with psoriasis by determining knowledge gaps occurring most frequently. Materials for this study were collected using an anonymous questionnaire created on the basis of the Psoriasis Disability Index (PDI). The study group included 149 patients with psoriasis. It has been proven in previous studies that patients with psoriasis see the need to improve their knowledge of the disease and self-care methods, and the greatest deficit of their education refers to the factors activating the process of the disease and to the methods of prophylactics in psoriasis.

Activities of Daily Living↗
PubMed2004

Trigger factors in childhood psoriasis and vitiligo.

Psoriasis and vitiligo are very common skin disorders that may have a profound impact upon the affected individuals; the etiology of both diseases includes genetic factors and triggers, which could be endogenous or exogenous. Two groups of children population consisting of 153 patients suffering from skin disorder (65 with vitiligo and 88 with psoriasis) have been examined at the Department of Dermatovenerology, University Hospital Osijek, during three years period. Basic methods of data collection were: questionnaire, clinically examination and histological proven diagnosis. The aim of this investigation were to determine the most common triggers, which play a role at onset of disease among young patients with vitiligo and psoriasis, and to establish familial distribution among both groups of patients. The results of investigations showed that the onset of vitiligo was mostly connected with psychological factors (56.9%), but the most frequently trigger in childhood psoriasis was inflammatory focus (38.6%). According to morphologic patterns the authors separated two groups of patients among psoriatics: group I with plaque psoriasis, which pointed the inflammatory focus and physical trauma as trigger before onset of disease (each 25.0%) and group II with psoriasis guttata and inflammatory focus as trigger at even 62.5% cases. Familial distribution among psoriatic children was 55.6%, and among children with vitiligo only 16.9%. Ours children patients showed significantly disparity in structure of triggers according diagnosis and gender distributions and about familial occurrence. Also some difference has been established according to age of onset between psoriasis and vitiligo at early childhood.

Adolescent↗
PubMedDate not supplied

Psoriasis exacerbated by interferon-alpha in a patient with chronic myeloid leukemia.

Interferon-alpha can exacerbate existing psoriasis and induce de novo psoriasis and psoriatic arthritits. The exact underlying mechanism is not very well understood. It is not a contraindication to treat patients with pre-existing psoriasis with interferon-alpha. In these patients interferon-alpha should be used with care and only if the potential benefits justify the potential risk. Control of psoriasis prior to initiation of interferon-alpha and simultaneous antipsoriatic therapy while on interferon-alpha are essential. We would like to report a 61-year-old male patient with stable psoriasis for over 20 years, who experienced exacerbation of his psoriasis after receiving interferon-alpha for chronic myeloid leukemia. The association between the interferon-alpha therapy and the exacerbation of his psoriasis was only recognized on rechallenge at the stage he was referred to our department.

Humans↗