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PubMed2005

Psoriasis herpeticum: three cases of Kaposi's varicelliform eruption in psoriasis.

BACKGROUND: Kaposi's varicelliform eruption (KVE), first described in 1887 by Moritz Kaposi, refers to a disseminated cutaneous infection with herpesvirus type 1 or 2, vaccinia virus, or coxsackievirus A16 in a patient with another underlying dermatosis. When herpesvirus type 1 or 2 is the pathogenic virus, the term "eczema herpeticum" is used, independent of the underlying dermatologic diagnosis that preceded the eruption. KVE is most often seen in patients with underlying atopic dermatitis, but has also been seen in association with other papulosquamous and acantholytic disorders. However, eczema herpeticum rarely occurs in patients with psoriasis. OBSERVATIONS: We present the clinical and laboratory findings of three patients in whom KVE developed during inpatient hospitalization for a psoriatic flare. These patients each had comorbidities that may have increased susceptibility to KVE. CONCLUSIONS: KVE may rarely occur in patients with psoriasis. Erythroderma, systemic sepsis, therapy with immunosuppressant drugs, such as methotrexate and systemic steroids, and therapy with systemic retinoids may possibly increase susceptibility to KVE.

Adult↗
PubMed2000

Psoriasis patients with basal cell carcinoma have more repair-mediated DNA strand-breaks after UVC damage in lymphocytes than psoriasis patients without basal cell carcinoma.

We have investigated the formation of strand-breaks following UVC irradiation in lymphocytes from psoriasis patients with or without basal cell carcinoma (BCC). Isolated lymphocytes were irradiated with UVC light at a dose of 3.6 J/m(2), and the level of DNA strand-breaks were measured 25 min after the irradiation by the alkaline comet assay. The generation of strand-breaks following UVC irradiation indicates DNA-repair-mediated incisions, as UVC light does not generate strand-breaks per se. We found that psoriasis patients with BCC had more DNA-repair incisions than non-cancer patients. The incision level correlated to two polymorphisms of the XPD gene. At present, it is not clear if the association is a primary effect that is related to differences of the XPD protein. Genes encoding for other repair proteins, namely XRCC1, ERCC1, and LIG1 are located close to the XPD gene, and it is possible that the association is due to a cosegregation with a polymorphism in one of these genes.

Alleles↗
PubMed2001

Normal proliferative responses of peripheral blood mononuclear cells to streptococcal preparation OK-432 in patients with pustulosis palmaris et plantaris constitute a distinct feature from the reduced responses observed in those with psoriasis vulgaris, pustular psoriasis, and acrodermatitis continua of Hallopeau.

It was previously reported that peripheral blood mononuclear cells (PBMC) from the patients with psoriasis vulgaris (PV) showed a reduced proliferative response in vitro to the stimulation of a lyophilized preparation of penicillin-treated low virulence Su-strain of Streptococcus pyogenes group 3, OK-432. In this study, at first it was examined whether OK-432 acts as a superantigen. By analyzing the usage of Vbeta T-cell receptor (TCR) of proliferating T cells stimulated with OK-432, it was found that OK-432 stimulated preferentially Vbeta2 TCR-bearing T cells. Next, to find differences in in vitro responses of PBMC among various types of sterile pustular dermatoses such as pustulosis palmaris et plantaris (PPP), acrodermatitis continua of Hallopeau (AC), and generalized pustular psoriasis (GPP), the proliferative responses of PBMC obtained from these patients under the stimulation of OK-432 were compared. When the PBMC was stimulated with interleukin (IL)-2, no significant difference was found in their proliferative responses among those obtained from the patients with these sterile pustular dermatoses, PV or healthy controls. However, like those from PV patients, PBMC from AC and GPP patients showed significantly smaller responses to OK-432 than those from the healthy controls. In contrast, the proliferative responses of PBMC from the patients with PPP to OK-432 was comparable to those from healthy controls. These results, in addition to its unique clinical and histopathological characteristics, suggest that PPP has a different pathogenetic background from that underlying PV, AC, or GPP.

Acrodermatitis↗
PubMed1997

Progress in psoriasis. Psoriasis: from gene to clinic. London, UK, 5-7 December 1996.

In a meeting dedicated to a single common complex disease such as psoriasis, it is not surprising that many unanswered questions were raised. However, the meeting highlighted the impressive progress being made in psoriasis research at both the investigative and the therapeutic levels. A follow-up meeting is to take place in 1999, when further characterization of susceptibility gene loci should be available, together with data concerning the selective nature of disease-causing T cells and the antigens that trigger the disease. Identification of these critical factors should allow development of highly specific therapeutic agents, some of which are beginning to find their way into clinical development.

Cell Differentiation↗
PubMed2000

Clinical evaluation of a more rapid and sensitive Psoriasis Assessment Severity Score (PASS), and its comparison with the classic method of Psoriasis Area and Severity Index (PASI), before and after climatotherapy at the Dead-Sea.

BACKGROUND: The Psoriasis Area and Severity Index (PASI) is used to quantify the extent of the disease, and to evaluate its improvement with treatment. It is considered to be a slow, rough, nonsensitive, and complex tool, with high interobserver variability and low reproducibility. OBJECTIVES AND METHODS: To develop a simpler, more sensitive, and more rapid end-point determination for evaluating the psoriatic condition, and to compare its sensitivity with that of the classic PASI score in psoriatic patients undergoing 4-week climatotherapy at the Dead-Sea (Israel). RESULTS: This study describes a new, rapid, and simple Psoriasis Assessment Severity Score (PASS), whose readings are spread over a longer scale, making the test more sensitive than PASI, and allow better differentiation. CONCLUSIONS: The comparison between the classic PASI and our new PASS emphasizes the weight of the "sensitivity to change" (responsivity) in selecting a better evaluation method for psoriatic patients.

Adolescent↗
PubMed2001

Psoriasis vulgaris and acute guttate psoriasis in a family.

A 33-year-old man (Case 1) developed scaling and erythema on the extensor side of his extremities, head, and back, 3 years before his first visit to our hospital. The lesions spread out to form several plaques and became persistent (Fig. 1a). Serum antistreptolysin O (ASO) was within the normal range and a pharyngeal culture showed normal flora. Histologic findings were compatible with psoriasis vulgaris (Fig. 1b). Topical steroid therapy was effective; however, scaling and erythema persisted. The 8-year-old daughter (Case 2) of Case 1 had suffered severe tonsillitis 2 months prior to the skin eruptions. Numerous rain drop-like scaly papules appeared on her legs and generalized rapidly (Fig. 2a). Her tonsils were swollen and reddish. Streptococcus pyogenes was detected by pharyngeal smear. The ASO value was at a high level. Histologic examination showed slightly elongated rete ridges, focal lack of the granular layer, parakeratosis, mild spongiosis, and exostosis of neutrophils (Fig. 2b). She was diagnosed with acute guttate psoriasis. Administration of oral antimicrobials reduced the ASO value and led to remission of the disease. After 1 month of antimicrobial treatment, the erythematous papules disappeared. The human leukocyte antigen (HLA) typing of the father was HLA-A24, A31, B7, B39, and Cw7, and that of the daughter was HLA-A24, A31, B39, and Cw7. Both possessed HLA-A24, B39, and Cw7. The HLA typing of other family members was also studied. The mother had HLA-A11, A24, B39, B62, Cw4, and Cw7, and her son had HLA-A11, A24, B7, B62, Cw4, and Cw7. The result of HLA typing is shown in Table 1. Lymphocyte stimulating test was performed using heat-killed S. pyogenes which were boiled at 70 degrees C for 10 min and sonicated. The stimulation index was twofold higher in the daughter than in the father (Fig. 3).

Acute Disease↗
PubMedDate not supplied

Annular pustular psoriasis--most common form of pustular psoriasis in children: report of three cases and review of the literature.

Annular pustular psoriasis (APP) is a rare form of pustular psoriasis with a chronic recurrent course and good prognosis. We report three cases of APP in children, two of whom were siblings. Review of the medical literature reveals that a disproportionately high percentage of cases of APP occur in children. In some cases topical therapy can clear the condition, although in severe or recalcitrant disease, systemic therapy may be necessary.

Child↗
PubMed2005

Psoriasis care consumption and expectations from a gender perspective in a psoriasis population in northern Sweden.

The aim was to analyse use of psoriasis care and expectations from a gender perspective in a psoriasis population. The study is based on questionnaire data from 1,060 subjects. The response rate was 74%. The relation between care consumption and studied variables was measured using regression and chi-square analysis. Care consumption was strongly influenced by age, quality of life, income and joint symptoms. Men visited a dermatologist more often, while women visited a general practitioner and treated themselves topically more frequently. Important expectations among both women and men concerned the receiving of professional care and amelioration, while more women wanted to be treated politely. Expectations were fulfilled, except those regarding amelioration, especially among men. Awareness of gender differences is important among professionals. In order to decrease such differences decision-makers should provide for a maintained specialized care as well as a local health care system of high standard.

Adolescent↗
PubMed1975

The age-of-onset of psoriasis and the relationship to parental psoriasis.

In series of 419 consecutive patients with psoriasis the peak age-of-onset was between 5 and 9 years of age in girls and between 15 and 20 years in boys. Subsequently, there was a gradual decline in relation to age. The incidence of psoriasis in a parent of a proband was shown to be significantly higher in those patients where a detailed exmination of the family was undertaken, as compared with the information obtained only from case records.

Adolescent↗
PubMed2004

Why is psoriasis uncommon in Africans? The influence of dietary factors on the expression of psoriasis.

Psoriasis is uncommonly seen in Africans, probably partly due to genetic factors. However, the dietary habits of Africans may provide another explanation, which is explored in this paper. Maize, the staple diet in most parts of Africa, is high in linoleic acid but low in other polyunstaturated fatty acids and riboflavin. Linoleic acid is a precursor of prostaglandin E2 (PGE2) and its high intake, especially in the absence of other polyunsaturated fatty acids (PUFAs) and riboflavin, results in high tissue production of PGE2. PGE2 is known to suppress cellular immunity, resulting in decreased expression of psoriasis.

Black People↗
PubMed1995

IgA deficiency and psoriasis: relevance of IgA in the pathogenesis of psoriasis.

A psoriatic patient with absolute deficiency of IgA is reported. The manifestations of psoriasis appeared at the age of 6 months and proved to be resistant to various treatments. The present case report and the data available in the literature on IgA and psoriasis all converge on the hypothesis that IgA is a systemic factor which belongs to the 'off switches' of the psoriatic process.

Adult↗
PubMed1993

Cyclosporin versus etretinate: Italian multicenter comparative trial in severe plaque-form psoriasis. Italian Multicenter Study Group on Cyclosporin in Psoriasis.

Seventy-six patients with severe diffuse plaque-form psoriasis and a baseline PASI score > or = 18 were enrolled in a randomized open study comparing cyclosporin 5 mg/kg/day (36 patients) with etretinate 0.75 reduced to 0.5 mg/kg/day (40 patients) over a period of 3 months (phase 1). The rate, severity and time to relapse after the withdrawal of therapy in the 54 patients achieving remission were evaluated over the following 6 months (phase 2). Twelve of these patients entered an open, uncontrolled phase aimed at defining the safety and the strategy of cyclosporin 2.5-5 mg/kg/day maintenance therapy over a further period of 9 months (phase 3). Patient tolerability, laboratory parameters and blood pressure were carefully monitored every week for the first 3 months and then monthly. The only concomitant therapy allowed was white petrolatum. Not only the number (35/36 vs. 29/40) but also the speed of remission (20/36 vs. 1/40 at the fourth week of treatment) was higher in the cyclosporin than in the etretinate group. Both the tolerability and safety of cyclosporin proved to be adequate for short-term treatment, all altered clinical or laboratory parameters being completely reversible after the withdrawal of therapy. Only 1 of the 36 patients in the cyclosporin group prematurely stopped taking the medication because of an adverse reaction, as against 7/40 in the etretinate group (1 case of inefficacy, 1 case of adverse reaction and 5 cases of non-compliance). Six months after the discontinuation of the trial drugs, relapses occurred in 13/29 patients in the cyclosporin group and in 3/25 in the etretinate group; no 'rebound' was observed in any of the relapsing patients. Long-term cyclosporin treatment was both efficacious and well tolerated. In conclusion, cyclosporin at doses of 2.5-5 mg/kg/day administered to reliable, carefully selected patients closely monitored in terms of both clinical and laboratory parameters currently produces the quickest and more constantly favourable results in patients with severe psoriasis.

Adolescent↗
PubMed1977

[Psoriasis: A general disease? Can psoriasis be explained biochemically?].

The biochemical problems of psoriasis are discussed, especially two modern hypothesis about the pathogenesis of this skin disease. 1. DHEA-deficiency leading to an increase of G-6-PDH inaugurated by Holzmann et al. 2. cAMP deficiency in psoriatic lesions as a cause of psoriasis hypothized by Voorhees and Duell. A synopsis of the physiology of the steroid hormone DHEA (synthesis, regulation, conjugation and excretion) is given. There are doubts that this hypothesis is correct. Recent findings have indicated, that there is no decrease of cAMP in the psoriatic lesion--in contrast there is an increase of this cyclic nucleotid. It means that this theory is also doubtfull. Treatment of an hypothetical decrease of cAMP by AMP is not possible, because this AMP will not penetrate in the cell and cannot be metabolized to cAMP.

Adolescent↗
PubMed1990

[The combination of psoriasis with different types of lipoproteinemias. 2. The characteristics of the dyslipoproteinemias caused by disorders in triacylglyceride transport in psoriasis].

The findings of examination of patients with disseminated psoriasis vulgaris evidence a reduction of high-density lipoprotein (HDLP) cholesterol in women and of low-density lipoprotein cholesterol in men with type IV hyperlipoproteinemia (HLP) as against the normolipidemic patients. Correlation of serum triacylglycerides and HDLP cholesterol concentration was discovered only in men with type IV HLP (r = -0.72, p less than 0.01), administered lipid-reducing and cytostatic drugs. The period of hospitalization was longer and the remissions less frequent in these patients in comparison with normolipidemic groups. No correlation of these indexes with serum levels of triacylglycerides was detectable. The authors come to a conclusion that type IV HLP in patients with psoriasis is of a multifactorial origin and that sex-associated differences characteristic of hypertriacylglyceridemia may be explained by the specific influence of male and female hormones on lipoprotein metabolism.

Adult↗
PubMed1989

[Concomitant psoriasis vulgaris and atopic dermatitis. A study of 1,065 patients with psoriasis].

The simultaneous presence of psoriasis and atopic dermatitis was checked for in 1065 patients with psoriasis and was found in 18 of them (1.7%), which is in keeping with the statistical probability. In these 18 the efflorescence was also examined histologically. All 18 (100%) reported marked pruritus; white dermatographism was observed in 16 patients (89%); in 15 patients (83%) psoriatic phenomenas could be produced, and 11 patients (61%) also had allergic rhinitis or bronchial asthma. Immunologically, 16 of the 18 patients (89%) showed elevated IgE levels, the geometric mean level being 888 IU/ml. The HLA-Cw6 was positive in 9 patients (50%).

Adult↗
PubMed1986

Treatment of psoriasis. Results achieved by the Johannesburg Hospital Psoriasis Clinic.

Eighty patients with severe and widespread psoriasis who had not responded to treatment at the Dermatology Outpatient Department were referred for specialized therapy to the Johannesburg Hospital Psoriasis Clinic. Here treatment consisted of phototherapy (topical coal tar or dithranol plus ultraviolet light (UVL], psoralen and ultraviolet A (PUVA) therapy or chemotherapy with methotrexate or etretinate (Tigason; Roche). The best results were obtained with etretinate, either given alone or together with UVL (midrange sunbeam spectrum) or PUVA. Most patients required the use of two or more treatment regimens for successful control.

Adult↗
PubMed1975

Deposition of fibrinogen (FR-antigen) in skin diseases. I. Psoriasis vulgaris and Psoriasis arthropathica (with special reference to heparin-precipitable fraction).

Twenty-five in-patients with psoriasis arthropathica (ps.a.) and 18 in-patients with psoriasis vulgaris (ps.v.) were examined for cryofibrinogen as heparin-precipitable fraction (HPF), for total fibrinogen in plasma and by immuno-fluorescence (IF) technique for FR-antigen in tissue sections of affected and unaffected skin. A control group of 14 in-patients with various non-psoriatic dermatoses were examined with if for FR-antigen in unaffected skin. Pathological quantities of HPF were found in 6% in ps.v. and in 48% in ps.a. Total fibrinogen in plasma was normal in ps.v. (365 mg%), and moderately elevated in ps.a. (471 mg%). In psoriatics, FR-antigen was found in unaffected skin ps.v. in 50%, in ps.a. in 72%. In affected skin, the figures were 67% and 84% respectively. No direct relationship could be found between the incidence and the degree of HPF, and depositions of FR-antigen in the tissue sections in the skin at the time of the examination. In the control group, no FR-antigen could be found in unaffected skin, except in one case of acne cystica, with traces of FR-antigen in a few areas of the tissue section.

Adult↗