Clinical characteristics and systemic therapies administered to first-time patients at a tertiary psoriasis outpatient clinic.

BACKGROUND: The aim of this study was to describe the clinical characteristics and the systemic therapies given to a cohort of patients attending for the first time our tertiary psoriasis outpatient clinic. METHODS: Data were extracted from an electronic database where the patients, mostly eligible for systemic therapies, are consecutively recorded. Based on skin disease severity the subjects were classified into three groups: group 1, mild psoriasis (MP; Psoriasis Area Severity Index [PASI]≤5); group 2, mild-to-moderate psoriasis (MMP; 510). RESULTS: Of the 289 patients studied, 88 (30.4%) presented with MP, 91 (31.5%) with MMP, and 110 (38%) with MSP, 89 (30.8%) of whom were affected by psoriatic arthritis. Of the 289 patients, 267 (92.3%) were deemed eligible for a systemic treatment, and 228 (85.4%) of them started a systemic treatment as monotherapy. The therapies administered were as follows: cyclosporine to 65 (28.5%); methotrexate to 59 (25.8%); etanercept to 33 (44%); adalimumab to 25 (33.3%); ustekinumab to 17 (22.6%); acitretin to 29 (12.7%); golimumab to one (1.3%). CONCLUSIONS: Our data show a composite distribution of patients eligible for a systemic therapy and attending for the first time our center. The traditional drugs were more frequently administered (67.1%) as compared to biological ones (32.9%).

Clinical and Contrast-Enhanced Ultrasound Echography Outcomes in Psoriatic Arthritis Patients after One Year of Continuous Therapy with Anti-TNF Drugs.

Background. We wanted to verify retrospectively the proportion of patients with psoriatic arthritis who were in remission after 1 year of continuous therapy with either etanercept or adalimumab. Remission was defined as the absence of both clinical and contrast-enhanced ultrasound (CEUS) findings suggestive of joint inflammation. Patients and Methods. The data of twenty-five patients with psoriatic arthritis were available for the clinical and CEUS evaluations before and after 1 year of continuous therapy with etanercept or adalimumab. The count of swollen (ACR66), tender (ACR68), and active inflamed joints (AJC) was used to measure the severity of joint involvement. PASI was used to score the severity of psoriasis. HAQ, DLQI, VAS pain, and VAS itching were administered to each patient before starting therapy and every 3 months, up to 1 year. Results. Eight (32%) out of twenty-five patients were in remission after 1 year of therapy with etanercept or adalimumab. A significant reduction of all clinical variables analysed was seen during the course of therapy. Conclusion. Although a significant proportion of patients achieved remission of arthritis after 1 year of effective anti-TNF therapy, the majority of them continued to have either clinical or CEUS findings suggestive of persistence of joint inflammation.

Capillaroscopy in psoriatic and rheumatoid arthritis: a useful tool for differential diagnosis.

Impairment of capillaries permeability and changes of microcirculation are associated with inflammatory arthritis. In order to demonstrate microvascular differences between psoriatic arthritis (PsA) and rheumatoid arthritis (RA) we analyzed capillaroscopic abnormalities such as megacapillaries, haemorrhages, ramifications, and avascular areas in patients affected by these two rheumatic disorders. Moreover to identify specific capillaroscopy patterns we analyzed the following parameters: venous limb diameter, arterial limb diameter, capillary loop diameter, amplitude of the capillary loop, linear density of capillaries (on 2 mm), and number of twisted capillaries (on 4 mm). Through a comparative morphometric analysis of capillaroscopy, our study demonstrated the presence of specific microvascular differences between PsA and RA providing an additional diagnostic tool for the differential diagnosis. We also suggest that capillaries structural abnormalities might reflect endothelial injury due to systemic inflammation during chronic arthritis.

Epidemiology of skin disorders in Ethiopian children and adolescents: an analysis of records from the Italian Dermatological Centre, Mekelle, Tigray, Ethiopia, 2005 to 2009.

Skin disorders are an important problem in children living in developing countries, but only a few epidemiologic investigations on pediatric dermatoses are available in the literature. Our study is an analysis of the range and frequency of skin diseases presenting to the Italian Dermatological Center in a pediatric Ethiopian population. A retrospective analysis was performed on 17,967 medical records of children aged 0 to 18 years attending the Italian Dermatological Centre in Mekele (Ethiopia) from January 2005 to December 2009. Infections and infestations accounted for 47% of the disorders seen; fungal infections were the most common (44.1%), followed by bacterial and parasitic diseases. Dermatitis constituted the second most common diagnostic category (24.7%) of the disorders seen, and contact dermatitis was the most common diagnosis (48.8%). Pigmentary disorders and disorders of skin appendages were more common in girls, whereas fungal and parasitic infections were more common in boys. Bacterial and parasitic infections were more common in children younger than 1 year old, fungal infections in those aged 1 to 5.9, and disorders of skin appendages and pigmentary disorders in those aged 15 to 18. These findings demonstrate that most of the disorders seen could be easily managed in clinical practice with appropriate skill development. It is crucial to ensure that training of medical students and pediatricians focuses on accurate recognition, diagnosis, and management of these common skin diseases and that families, teachers, health workers, and nurses be educated about the most common signs of prevalent skin diseases to help facilitate appropriate care.

Treatment of erythrodermic psoriasis in HCV+ patient with adalimumab.

Erythrodermic psoriasis is a severe and disabling variant of psoriasis. The authors present the case of a 48-year-old man with psoriasis and hemophilia presented with a history of hepatitis C virus (HCV) infection treated with pegylated interferon alpha-2a and ribavirin therapy. At the end of antiviral therapy, skin manifestation progressively worsened, becoming erythrodermic, with lack of efficacy of steroid therapy. The authors decided to start biological therapy with induction dose of adalimumab (Humira, Abbott Laboratories, Abbott Park, Chicago, IL) 80 mg at Week 0 and 40 mg weekly. In our case, this resulted in a highly effective and safe treatment.

Skin ulcers in a patient afflicted with microscopic polyangiitis.

Systemic vasculitis is a group of heterogeneous diseases characterized by inflammation and blood vessel walls necrosis. Usually the skin is one of the first organs involved, especially with damage of small to medium size vessels. The cutaneous patterns may help clinicians to diagnose these diseases at the beginning of their course, preventing complications due to internal organ involvement. The following case presents a patient with a microscopic polyangiitis that started with several skin ulcerations localized on the inferior limbs.

The use of elastocompressive therapy in a patient with acroangiodermatitis of the lower limb.

 Acroangiodermatitis is a rare vasoproliferative disorder, usually affecting the lower limbs and is associated with congenital or acquired vascular conditions. There are two variants of acroangiodermatitis-Mali type (associated with venous hypertension) and Stewart-Bluefarb type, which is associated with arteriovenous malformation, or acquired iatrogenic arteriovenous fistula in patients with chronic renal failure. Acroangiodermatitis is clinically characterized by angiomatous papules and plaques, which mimics Kaposi's sarcoma. The authors present a case of a 63-year-old man with acroangiodermatitis of the lower limbs and chronic venous insufficiency who was treated with elastocompressive therapy.