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The cost of hospital-related care of patients with psoriasis in Italy based on the AISP study. Associazione Italiana Studi Psoriasi.

The objective of this study was to assess the cost of caring for patients with psoriasis in Italy according to the AISP study (Associazione Italiana Studi Psoriasi or Italian Association for Studies on Psoriasis), involving 104 university and hospital centres and 7992 patients in 1994. The mean yearly cost of care for a single patient was calculated at 905 Euros. Hospitalization accounted for more than four-fifths of the costs, therapy for about one-eighth (systemic therapies were the most expensive) and office visits and day hospitals for the remainder. In our study series less than 20% of patients accounted for more than 90% of the total costs.

Drug Costs↗

Autoimmunity in psoriasis. Relation of disease activity and forms of psoriasis to immunofluorescence findings.

Immunofluorescence (IF) studies using the test providing information on the reactivity of stratum corneum (SC) antibodies and their in vivo binding have been performed in 193 cases of psoriasis and 89 cases with other dermatoses. It has been shown that: 1. Essentially all fully developed, active psoriatic lesions had IgG deposits in the stratum corneum at the sites of the SC antigen, presumably due to in vivo binding of SC antibodies. 2. In various forms of psoriasis SC antigen sites appeared to be completely or almost completely satured with in vivo deposits of IgG as seen in tests with SC antibodies. 3. In most but not all lesions complement components C3 and/or C4 was found in a comparable pattern in the SC, especially when multiple specimens of single cases were studied. Partial or complete saturation of the SC antigen could be observed by the performance of complement indirect IF tests for SC antibodies in such specimens. 4. In lesions with typical histology of psoriasis the above-mentioned immunologic characteristics appeared to be a constant finding. However, in specimens of recent lesions which had not yet developed typical histology a proportion (2 of 17) were negative both for IgG and complement deposits. In receding lesions weak deposits of IgG were present only in a few specimens and complement deposits were as a rule negative. 5. In a group of 89 control specimens of other dermatoses only occasional cases gave the psoriasiform IF pattern, but about 30% of the specimens gave positive reactions in the SC though these were usually of a different pattern.

Antibody Formation↗

[Health economic aspects of psoriasis therapy. Is inpatient topical treatment of plaque-type psoriasis in this age of biologics still appropriate from both medical and economic viewpoints?].

BACKGROUND: We tried to clarify whether the treatment of plaque psoriasis as an inpatient with dithranol and narrow band UV-B 311 nm is still appropriate and economical when compared to biologics such as efalizumab. PATIENTS AND METHODS: In a 15 month period, all patients admitted to the hospital after unsuccessful outpatient treatment of psoriasis were evaluated prospectively according to medical and economical criteria. RESULTS: PASI-score was reduced by 89% in 74 patients. The direct cost to improve one in-patient by 75% in PASI score (PASI-75) was 4342.27 EUR; the total costs for employed patients were 7441.81 EUR. Direct costs of treatment with efalizumab would come to 15048.89 EUR per patient with PASI-75 in a 12 weeks period. CONCLUSION: Topical inpatient therapy for plaque psoriasis is well tolerated and a less expensive option than biologics in those who fail ambulatory treatment.

Adult↗

Safe psoriasis control: a new outcome measure for the composite assessment of the efficacy and safety of psoriasis treatment.

BACKGROUND: PASI is an inadequate outcome measure for the assessment of psoriasis treatments. No currently used endpoints provide a benefit: risk assessment of treatment taking into consideration all available efficacy and safety data. OBJECTIVE: To propose a new outcome measure called "safe psoriasis control" (SPC), which assesses multiple dimensions of the disease in a clinically meaningful way through the combined use of appropriate efficacy, quality of life, and safety data. METHODS: Data from 3,500 subjects were used for the purpose of derivation and validation of the SPC endpoint. Advanced statistical methodology was used to evaluate and validate important components in the assessment of therapeutic benefit. RESULTS: SPC was shown to be a simple but meaningful combined endpoint showing the proportion of patients who had treatment benefit without major side effects. CONCLUSION: The SPC endpoint may be a step-forward in providing a composite tool for the evaluation of treatments for psoriasis.

Antibodies, Monoclonal↗

Intraoral psoriasis associated with widespread dermal psoriasis.

A case believed to represent true intraoral psoriasis has been presented and documented with clinicopathologic material. Intraoral lesions in patients with cutaneous psoriasis should be investigated to determine whether these lesions represent psoriasis or another coexisting entity.

Adult↗

[Analysis of psoriasis susceptibility regions in the Spanish population: evidence of a major gene involved in psoriasis in the 6p21 region].

BACKGROUND: Identification of the susceptibility regions to psoriasis in Spanish population. Analysis of the chromosomal regions 6p, 17q, 4q and 1cen-q21. PATIENTS AND METHOD: Analysis of 27 Spanish families with psoriasis. Parametric and non-parametric linkage analysis with 22 polymorphic microsatellite markers in the candidate regions. RESULTS: Evidence of linkage (p < 0,05) using non-parametric methods in chromosome 6p. Absence of linkage in 17q, 4q and 1cen-q21 regions. CONCLUSION: We present the evidence of a major gene in 6p21.3 involved in psoriasis in Spanish population.

Adult↗

Dominant lesional T cell receptor rearrangements persist in relapsing psoriasis but are absent from nonlesional skin: evidence for a stable antigen-specific pathogenic T cell response in psoriasis vulgaris.

In a previous study we reported that clonally expanded T cell receptor beta-chain rearrangements characterized the T cell receptor usage in skin lesions of psoriasis vulgaris and indicated antigen-specific T cell selection. To assess the relevance of clonal T cell expansion for disease progression, we now determined if select clonal T cell receptor rearrangements persisted over time and were present in nonlesional skin. Sequential biopsies were taken from psoriatic skin lesions of two patients. V-D-J junctional regions of T cell receptor beta-chain variable region gene families 2, 3, 6, 13S1, and BV17 were cloned and sequenced, as these particular BV gene families are preferentially selected in psoriatic skin lesions. The lesional T cell receptor rearrangements were compared with the T cell receptor usage in nonlesional skin and in blood. Several T cell receptor beta-chain rearrangements with high transcript frequency in the first lesional biopsy were again found in sequential lesional biopsies taken as much as 3 y later from psoriasis relapses. Only T cell receptor beta-chain rearrangements with low transcript abundance showed variability in that several clones appeared for the first time or disappeared. Although nonlesional skin also exhibited a restricted T cell receptor usage with clonal T cell receptor rearrangements, the T cell receptor usage in lesional and nonlesional skin differed nearly completely. The select lesional recurrence of identical T cell receptor rearrangements reveals that inflammation in psoriasis involves the same clonally expanded T cell populations and the same antigens over prolonged periods of time. It hereby suggests that specifically recruited and locally expanded T cell clones are permanently involved in psoriatic inflammation and may play a crucial part in disease perpetuation.

Epitopes↗

Treatment of psoriasis in the Nordic countries: a questionnaire survey from 5739 members of the psoriasis associations data from the Nordic Quality of Life Study.

The data from a questionnaire-based study of 5,739 members of the psoriasis associations of Denmark, Finland, Iceland, Norway, Sweden and the Faeroe Islands showed that the two most commonly used active agents were topical steroids (89.7% total use and 49.4% present use) and calcipotriol (73.1% total use and 35.8% present use), with only small variations between the countries. Marked differences between the countries were, however, found within all other types of psoriasis therapy, including the so-called alternative treatments. Significant priorities varied between the different countries. The use of dithranol in Finland was almost twice the average. While 14.2% of Danish members had received grenz-rays within the last week only 0.1% of the Finns had been given the same treatment. Psoralen plus ultraviolet A (PUVA) was being used by 13.1% of the Finnish psoriatics compared with 3.8% of Danes, while PUVA was almost non-existent on the Faeroe Islands. The use of non-PUVA phototherapy was highest in Norway and Sweden. Almost 10% of the Danes were presently on methotrexate, which was used far more than etretinate/acitretin or cyclosporine. In contrast, Finnish patients more often received etretinate than other systemic agents, and in Iceland there was a higher present use of cyclosporine than of etretinate. The popularity of alternative therapies was highest in Iceland, where 26.6% had taken such medication during the last week. The results of the study suggest that different treatment patterns should be taken into consideration when discussing the prognosis of psoriasis in different countries.

Administration, Topical↗

Psoriasis disease severity measures: comparing efficacy of treatments for severe psoriasis.

Measurement of psoriasis disease severity and effectiveness of treatment involves both objective and subjective assessments.1 Comparing the efficacy of different treatments is complicated by the use of different metrics for measuring outcomes.2 Because these measures are not used routinely in clinical practice, interpreting these data, in particular assessing the degree of clinically meaningful improvement, is difficult. The drug approval process and product labeling reflect historical changes in standards of efficacy measurement.3 This paper reviews the metrics used to evaluate psoriasis treatment and compares available information on approved treatments for severe psoriasis. It further attempts to elucidate the value of these metrics and provide some guidance in properly evaluating the relative efficacy of current proven therapy with new treatments. While clinical trials are somewhat artificial, they provide proof that a drug is more effective than placebo. Efficacy in clinical practice, however, may be very different from the clinical trial setting. Comparison of efficacy under the current circumstances of varying evaluative metrics scales is possible with proper knowledge of the functionality of these methods.

Clinical Trials as Topic↗

Remission of pustular psoriasis after cholecystectomy: role of focal infection in pustularization of psoriasis.

We report an 81-year-old male with long lasting psoriasis with exacerbation who showed remission of skin lesions after cholecystectomy. He consulted our clinic for impetiginous skin lesions and was treated with oral antibiotics without improvement. Several days later, he developed right hypochondralgia and was diagnosed with acute cholecystitis with gallstones. After cholecystectomy, the skin lesions significantly improved and disappeared within three weeks. Laboratory examination data indicated that acute inflammatory parameters normalized simultaneously. Although the role of focal infection in psoriasis is obscure, our case emphasizes the importance of focal infection in the pathogenesis of unstable psoriasis.

Aged↗

Granulocyte pyruvate kinase in psoriasis vulgaris and psoriasis arthropathica.

The activity of granulocyte pyruvate kinase in 46 patients with psoriasis vulgaris and eight patients with psoriasis arthropathica was investigated. It was found that in both groups of patients the activity of pyruvate kinase was significantly higher than in healthy individuals. This suggests that the rate of glycolysis in granulocytes of patients with psoriasis is markedly increased. The activity of granulocyte pyruvate kinase in 11 psoriatic patients with actively spreading lesions was compared with the activity of this enzyme when the patients were in remission. The activity of the enzyme was significantly increased during the active stage of the disease and returned to normal during remission.

Adolescent↗

An association between psoriasis and hereditary multiple exostoses. A clue for the mapping of a psoriasis susceptibility gene?

Chronic plaque psoriasis affects approximately 1.6% of the U.K. population. Population, family and twin studies all strongly suggest an important genetic component in the pathogenesis of the disease, although genetic linkage studies have, so far, failed to identify susceptibility genes. We describe a family in which psoriasis cosegregates through three generations with a known autosomal dominant disorder, hereditary multiple exostoses (HME). A major locus for HME has recently been mapped to chromosome 8q. Observations in this family may provide a mapping clue for a psoriasis susceptibility gene.

Adult↗

The bodily suffering of living with severe psoriasis: in-depth interviews with 22 hospitalized patients with psoriasis.

Psoriasis is one of the most common chronic skin diseases. The author presented results from a qualitative study focusing on patients with severe psoriasis in an acute phase and their experience of living with the disease. Twenty-two hospitalized patients with psoriasis were interviewed in depth. The interviews were consecutively analyzed according to grounded theory methodology. Bodily suffering emerged as a core variable in the data. Bodily suffering includes the following categories: the visible body, staying on an even keel, coping with an all-consuming disease, and social vulnerability. The results of this study indicate that the criterion for the management of soriasis should be the patients' own perception of the consequences of the disease.

Adaptation, Psychological↗

Induction of generalized pustular psoriasis by topical use of betamethasone-dipropionate ointment in psoriasis.

Three patients with chronic discoid psoriasis are described as having a generalized pustular eruption provoked by the topical use of betamethasone-dipropionate ointment (0.05%) over extensive skin areas for two or three weeks. All the lesions were nearly healed when the rash erupted. It is suggested that the potent topical steroid was absorbed through the damaged psoriatic skin, resulting in a systemic effect and a generalized pustular psoriasis (GPP). It was estimated that the patients absorbed at least 1.5 mg betamethasone per day during the application period.(i.e. 3 tablets of CelestonaR 0.5 mg). Just as steroids systemically are contraindicated in chronic discoid psoriasis by the risk of GPP, potent topical steroids must be avoided over large psoriatic skin areas.

Aged↗

[Different types of blood lipoproteins in psoriasis patients. 1. The relationship of dyslipoproteinemias due to disordered cholesterol transport and the course of psoriasis].

Comparison of the course of psoriasis in patients with hypo- and hyperalphacholesterolemia, hypo- and hyperbetacholesterolemia (Type IIA hyperlipoproteinemia) with that in the patients without identified lipid metabolism disturbances has been carried out. Blood lipoproteins were typed in the progressive stage of psoriasis. In hypoalphacholesterolemia patients the period of the psoriatic process stabilization was prolonged. Furthermore the frequency of coming remissions in women correlated (q = 0.90) with the concentration of high density lipoprotein cholesterol. In men similar correlation (q = 0.97) was observed only in the range between the lowest (under 0.5 mmol/l) and the upper thresholds of the mean level (1.4-1.7 mmol/l) of high density lipoprotein cholesterol and then it was undetectable. Type IIA hyperlipoproteinemia had no unfavorable effect on the course of psoriasis. Possible mechanisms responsible for these results are discussed.

Adolescent↗

Beta-blocking drugs and psoriasis. A review of cutaneous side effects and retrospective analysis of their effects on psoriasis.

beta-Adrenergic receptor blockers have been prescribed widely since their introduction 20 years ago. Noncardiac indications for beta-blockers have been expanded. Dermatologic manifestations of beta-blockers are reviewed in conjunction with their more liberal use. A retrospective analysis of our experience with beta-blockers in patients with psoriasis is presented. A 1-year study of 588 psoriatic patients who received treatment revealed that 26 patients were taking beta-blockers. Exacerbations of psoriasis were noted in 72.4% of these patients. beta-Blockers may worsen psoriasis and should be carefully evaluated in the management of these patients.

Adrenergic beta-Antagonists↗

Is UVB treatment of psoriasis safe? A study of extensively UVB-treated psoriasis patients compared with a matched control group.

The aim of the study was to investigate whether or not extensively UVB-treated psoriatics ran a greater risk of developing skin cancer than did controls. The 85 most extensively UVB-treated psoriasis patients during recent decades have been investigated with regard to premalignant and malignant skin lesions and compared with a population matched for age, sex, and geographic region. The prevalence of persons who had or had had premalignant/malignant skin lesions was 5.9% (n = 85) in the psoriasis group, vs. 10.1% in the control group (n = 338). This difference is not statistically significant and the confidence limits are such that it is unlikely that the psoriasis patients treated in the past have an increased prevalence of premalignant and malignant skin lesions. A multiple regression analysis has been conducted among the controls, showing a correlation between premalignant/malignant skin changes and advanced age and outdoor occupations. No such correlation was found for the factors: sex, skin type, or travel to southern latitudes.

Adult↗

[Illness-related stress in psoriasis vulgaris. Validation of the "Psoriasis Daily Stress Inventory"].

BACKGROUND AND OBJECTIVE: Illness specific stress plays an important part in the daily life of psoriatic patients. Until now for the measurement of relevant aspects of daily stress only the "Psoriasis Life Stress Inventory" (PLSI) of Gupta & Gupta exists; with the "Psoriasis-Alltagsstress-Inventar" (PAI), a German version of the PLSI is presented and its psychometric properties are discussed. PATIENTS/METHODS: 385 in-patients completed the PAI. The internal validity was examined by factor analysis. Moreover, the correlations between the PAI total score and sociodemographic parameters (ANOVA) and extent of skin involvement (multiple regression) were determined. RESULTS: The PLSI score proves to be sufficiently independent of age, sex, age at onset, and general extent of skin involvement. However, affections of the hands, the lower abdomen and the genitals show a strong influence on the total score. We found marked interrelations with the stigmatization feeling ("Questionnaire on Experience with Skin Complaints" QES, Schmid-Ott et al. 1998). CONCLUSIONS: The results suggest that the PAI is a useful and psychologically relevant questionnaire for psoriatic patients.

Adult↗