Porphyria cutanea tarda in Scotland: underlying associations and treatment approaches.

BACKGROUND: Despite its rarity, porphyria cutanea tarda (PCT) is globally recognized as the most common form of cutaneous porphyria. This study aims to review the underlying associations and treatment of PCT in Scotland. METHODS: We retrospectively reviewed data on 27 patients diagnosed with PCT between 1987 and 2022 at the Scottish Cutaneous Porphyria Service. RESULTS: Males slightly predominated (66.7%). The mean ± standard deviation (SD) age at diagnosis was 55.6 ± 12.5 years. Common associated factors were heavy alcohol intake (88.5%), genetic hemochromatosis (72%), smoking (45.5%), and hepatitis C virus infection (16%). Most had multiple associated factors (70.4%). Patients with genetic hemochromatosis with the C282Y genotype exhibited higher median transferrin saturation (69.5 vs. 35, P = 0.004) and ferritin levels (observed in males only) (1175 vs. 339; P = 0.014) than those with the H636D genotype. Most (52%) received combination therapy of venesection and antimalarials, followed by venesection monotherapy (32%) and antimalarial monotherapy (16%). Overall, 95.2% achieved biochemical improvement. Median time to improvement was 7, 5, and 9 months with venesection, antimalarial, and combined treatments, respectively (P = 0.173). Biochemical remission was achieved in 50% of patients. Remission occurred in 2/4 of patients with antimalarial monotherapy (median time 19 months) and 9/13 patients with combined treatment (median time 26 months). Biochemical relapse was found in three patients, all of whom received combination therapy. CONCLUSION: Excess alcohol intake and genetic hemochromatosis were the most common underlying associations with PCT in our Scottish cohort. Treatment for PCT should be individualized, and long-term follow-up is needed to monitor for disease relapse.

The Steatosis-Associated Fibrosis Estimator (SAFE) score for assessing significant liver fibrosis in patients with psoriasis.

BACKGROUND: There is an urgent need for noninvasive tests to identify patients with psoriasis at risk of significant liver fibrosis. OBJECTIVES: To externally validate the ability of the Steatosis-Associated Fibrosis Estimator (SAFE) score to detect significant liver fibrosis in patients with psoriasis using transient elastography (TE) as a reference. METHODS: We analysed data from 75 patients with psoriasis, including TE, SAFE score, Fibrosis-4 Index (FIB-4) and Nonalcoholic Fatty Liver Disease Fibrosis Score (NFS). Significant liver fibrosis was defined as TE values ≥ 7.1 kPa. Diagnostic accuracy was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: Fifteen patients (20%) exhibited significant liver fibrosis. The AUROCs for the SAFE and FIB-4 scores were 0.82 [95% confidence interval (CI) 0.67-0.97] and 0.62 (95% CI 0.45-0.79), respectively. The SAFE score outperformed the FIB-4 Index (P = 0.01) but was comparable with the NFS (P = 0.05) in predicting significant fibrosis. Using thresholds of < 0, 0 to < 100 and ≥ 100, the SAFE score categorized 36, 24 and 15 patients into low, intermediate and high-risk groups for significant fibrosis, respectively. The negative predictive value for excluding significant fibrosis with a SAFE score of < 0 was 94.4%, and the positive predictive value for diagnosing significant fibrosis with a SAFE score of > 100 was 53.3%. The duration of psoriasis, joint involvement and methotrexate treatment did not affect the diagnostic ability of the SAFE score whereas age of the patient did. CONCLUSIONS: The SAFE score demonstrated good accuracy in assessing clinically significant fibrosis among patients with psoriasis. This score should prove valuable for risk stratification and patient management in dermatology practice.

Allergic contact dermatitis to footwear in Thailand: Prevalence, clinical characteristics and common allergens.

BACKGROUND: Footwear contact allergy is caused by exposure to allergens in shoes. The prevalence and common allergens vary by region and time due to differences in customs and lifestyle. OBJECTIVES: To determine the clinical characteristics and common allergens of patients with footwear-related allergic contact dermatitis (ACD) who attended Siriraj Hospital in Bangkok, Thailand, between 2001 and 2020. METHODS: The medical records of 247 patients with clinically suspected footwear dermatitis who underwent patch testing were reviewed. RESULTS: The prevalence of ACD to footwear was 1.8%. Females were predominant (71.6%). The three most common allergens were carba mix (7.7%), mercapto mix (6.9%) and potassium dichromate (6.9%). According to the allergens found, rubber (14.2%), adhesives (7.7%) and leathers (6.9%) were the three most common groups. Dorsal-limited skin lesions were significantly associated with footwear ACD. CONCLUSION: Rubber and leather allergens were still the most common culprit allergens. Dermatologists should keep up-to-date on common allergens in footwear and emerging allergens to include in patch test series.

Dermatologists Should Encourage and Resume Photoprotection in Patients with Photodermatoses and Melasma Following the COVID-19 Pandemic.

Background: The COVID-19 pandemic may alter individuals' perspectives and behaviors regarding sun exposure and photoprotection. Presently, there is a paucity of information about how the pandemic influences photoprotection in photodermatoses and melasma. Objective: To compare the photoprotection attitudes and behaviors of individuals with photodermatoses and melasma with those of a control group (other dermatologic patients) before and during the COVID-19 pandemic. Methods: A questionnaire-based, cross-sectional study was conducted among Thai patients with photodermatoses, melasma, and other dermatological conditions between August 2021 and November 2022. Each of the three groups consisted of 35 patients. Results: Among the 105 patients, 81.9% were female, and the mean age was 45.83 years. Over 80% of individuals who used surgical masks daily for 4 to 8 hours believed that these masks provided skin protection from the sun. The duration of sun exposure and the frequency of photoprotection practices decreased significantly in all groups during the COVID-19 pandemic compared to the pre-pandemic period. Sunscreen was the most prevalent form of photoprotection, but its usage declined considerably during the pandemic. Upon physical examination, the photodermatoses and control groups exhibited unchanged skin conditions, while the patients with melasma demonstrated improved skin conditions during the pandemic. Conclusion: Owing to increased indoor activities and the perception that face masks could block sunlight, the COVID-19 pandemic led to notable reductions in sun exposure and photoprotective practices. Despite the absence of photodermatoses exacerbation and the observed improvements in patients with melasma, consistent and effective photoprotection must continue to be promoted.

Prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in patients with psoriasis: a cross-sectional study.

Despite the significant prevalence of pruritus in psoriasis, its pathogenesis remains unknown, and research on pruritus in Thai psoriasis patients is limited. Objectives: The objective was to investigate the prevalence and clinical characteristics of pruritus, and the factors significantly associated with high pruritic intensity in Thai psoriasis patients. Material and methods: In a cross-sectional study design, pruritus data were collected from the medical records of patients who attended an outpatient psoriasis clinic in Thailand between 2020 and 2021. Results: The overall prevalence of pruritus was 81.2% among 314 psoriasis patients. Psoriasis patients with pruritus had higher Psoriasis Area Severity Index and Dermatology Life Quality Index scores than those without pruritus. The legs, back, arms, and scalp were the most common areas for pruritus. Pruritus was relieved with topical emollients, topical corticosteroids, and oral antihistamines in 66.3, 63.1, and 52.9% of patients, respectively. Female sex, psoriasis body surface area greater than or equal to 10%, and genital psoriasis were factors that independently predicted high pruritus intensity. Conclusion: Psoriasis patients should be screened and treated for pruritus to improve both psoriasis treatment outcomes and patient quality of life. Further studies are needed to clarify the most effective medications for pruritus in patients with severe psoriasis.

The efficacy of bimatoprost ophthalmic solution combined with NB-UVB phototherapy in non-segmental and segmental vitiligo: a single-blind randomized controlled study.

Bimatoprost ophthalmic solution 0.03% (PGF2α analogues) combined with narrowband ultraviolet B (NB-UVB) was reported to be an effective treatment for vitiligo. To investigate the efficacy and safety of treatment for non-segmental/segmental vitiligo compared among bimatoprost ophthalmic solution 0.01% combined with NB-UVB phototherapy, bimatoprost monotherapy, and placebo. This single-blind randomized controlled study enrolled stable Thai vitiligo patients with at least three similarly sized lesions in the same anatomical area. The treatment duration was 6 months with 1- and 2-month post-treatment follow-ups. The 3 selected lesions on each patient were randomized to receive combination therapy, monotherapy, or placebo. The Vitiligo Area Scoring Index (VASI) was used to evaluate lesion response. Of the 25 initially enrolled subjects, 19 patients were analyzed. There were 13 and 6 non-segmental and segmental vitiligo cases, respectively. Eight and 11 cases had face/neck and non-face/neck lesions, respectively. Non-segmental vitiligo and non-face/neck vitiligo patients in the combination group had significant improvement in VASI score at 3 months, 6 months, and at the 2-month follow-up. No side effects were observed/reported. Bimatoprost combination therapy was shown to be safe and effective for treating Thai patients with non-segmental vitiligo in non-face/neck areas of the body.

Do different platforms of coronavirus vaccines have different impacts on psoriasis flares?

This study evaluated the impacts on psoriasis flares of 3 vaccine platforms: inactivated, viral vector and mRNA. Respectively, 198 and 96 psoriasis patients with and without COVID-19 vaccination during the study period. Group comparison revealed no increased risk of psoriasis flaring after COVID-19 vaccination. The vaccinated group received 425 doses of vaccine (140 inactivated, 230 viral vector and 55 mRNA). Patients' self-reported symptoms included all three platforms causing psoriasis flare, but the highest was among patients administered with mRNA vaccines. Most flares were mild to moderate, and most patients (89.8%) managed their flare-up lesions without rescue therapy. In conclusion, our study showed that the rate of psoriasis flare was not significantly different between vaccinated and unvaccinated groups. Factors that might explain psoriasis flare include vaccine-related psychological stress and side effects from vaccination. Different platforms of corona vaccines seemed to have different impact of psoriasis flares. Based on our results and the recommendations of several consensus guidelines, the benefits of COVID vaccinations outweigh the risks to patients with psoriasis. Patients with psoriasis should receive a COVID vaccine as soon as one is available.

An analysis of psoriasis hospitalisation in Thailand.

Psoriasis hospitalisation is not frequently reported. The objective of this study was to determine (1) the clinical, laboratory and treatment features of patients with psoriasis hospitalised due to flare-up and (2) other causes of admission of patients with psoriasis. We retrospectively reviewed data on 48 patients admitted due to psoriasis flare-up and 1908 patients with psoriasis admitted due to concomitant illnesses or comorbidities. The study period was 2005-2021. The latter group was compared with 821,804 patients without psoriasis admitted during the period. Of the 48 cases, 37.5% had erythroderma, and 62.5% had generalised pustular psoriasis (GPP). Women (68.8%) predominated, especially in the GPP group (76.7%). The mean age of admission with erythroderma (44.8 years) was higher than for GPP (32.1 years). Infection was the main trigger for psoriasis flare-up (46%). Abnormalities in liver function tests were found in 33.3% of the cases. These abnormalities usually subsided 1-2 months after skin improvement (83.4%). Acitretin was the most prescribed drug for GPP (81.4%), whereas topical treatment alone (50%) was the most frequent erythroderma therapy. Intensive care was needed by 9.3% of patients with GPP. In the psoriasis group admitted due to concomitant illnesses or comorbidities, admission due to digestive and infectious causes was significantly higher for psoriasis patients. Our study showed that trend of psoriasis admission due to disease flare-up was not significantly changed even in the era of biologics. We believed that patient education on avoiding the common precipitating factors of psoriasis flare-up and good self-care is mandatory to reduce the risk of hospitalisation.

Trends in formaldehyde and formaldehyde-releaser contact allergies as compared with market exposure in Thailand.

BACKGROUND: Formaldehyde and formaldehyde releasers (FRs) are common preservatives in cosmetics and household products. Their contact allergy trends are decreasing in Europe and America, but trend data for Asia are limited. OBJECTIVES: The first objective was to determine the prevalences of and trends in contact allergies to formaldehyde and FRs. The second objective was to establish how often formaldehyde and FRs were mentioned on the labels of products sold in the Thai market. METHODS: Twenty years of data on patch test results for formaldehyde and FRs were reviewed. Their frequency of mention on the labels of 5855 products was analysed. RESULTS: The trends in contact allergy to formaldehyde and FRs were decreasing. The overall prevalence of formaldehyde contact allergy was 2.5%. The most common FR to cause contact allergy was quaternium-15. Formaldehyde and FRs were identified as ingredients in 10.2% of the products surveyed. Dimethylol dimethyl hydantoin was the most common FR (5.2%). The highest use of formaldehyde and FRs (15.5%) was in hair care products. CONCLUSION: Although contact allergy trends in Thailand were decreasing, the proportion of products with FRs remained high. Comprehensive and universal legislation is needed to control the presence of formaldehyde and FRs.

Characteristics and common ultraviolet filter usage of sunscreens purchased online: Cross-cultural analysis across 5 continents.

BACKGROUND: A wide range of sunscreen products are available globally. Designed to meet various customer needs, they differ in formulations type, textures, ingredients, ultraviolet (UV) protection capabilities, and other properties. Knowing the factors influencing the purchase of sunscreens and the UV filters commonly used in each global region would be beneficial for dermatologists, consumers, and regulators. METHODS: Data on 50 best-selling sunscreens from each of 20 countries on 5 continents (1000 products in all) were retrieved from Amazon Marketplace during the period from January to July 2021. RESULTS: Among the 5 continents, Asia had the highest proportion of consumers (71.1%) choosing high sun protection factor (SPF) sunscreens (SPF ≥50). In contrast, Europe had the highest percentage (11.8%) purchasing <30 SPF sunscreens. The lack of standard UVA protection labeling was significantly highest in South America. The use of inorganic-based sunscreen was highest in North America, and across all continents, those products were significantly more expensive than organic-based sunscreens. Globally, lotions were the most favored formulation type. "Nongreasy/dry touch" (45.1%) and "lightweight texture" (40.4%) were the most common promotional terms used. The most common UV filters differed among regions. Iron oxide, which can function as a visible light filter, was most frequently found in sunscreens in South America (20%) and North America (19.3%). CONCLUSIONS: The regional factors influencing the purchase of sunscreen products differed. A considerable number of sunscreens may not provide adequate sun protection for consumers. Dermatologists should recommend sunscreens with sufficient UV protection that suit the skin of individual consumers.

The Anti-Psoriatic Efficacy and Safety Profile of Topical and Intralesional Methotrexate: A Literature Review.

Methotrexate (MTX) has long been considered the first-line oral systemic pharmacotherapy for psoriasis. The drug has several well-known systemic side effects, such as bone marrow suppression and hepatotoxicity. To avoid them, the use of topical or intralesional administrations of MTX has become an interesting option. With the advent of novel drug delivery systems, especially nanocarriers, the usage of a high-efficacy and safe topical MTX for psoriasis has nearly been attained. This review examined the development, anti-psoriatic efficacy and adverse effects of topical forms of MTX (plain MTX; MTX with chemical enhancer; MTX using nanotechnology; MTX with protein transduction domains; MTX with liquid crystalline systems; and MTX with physical enhancer/laser) and intralesional MTX in psoriasis patients and psoriasis-induced animals. The efficacy of topical MTX varied with the drug delivery technology employed. Nevertheless, the overall safety profile of the topical forms was favourable. A 25 mg/mL MTX solution injected intralesionally at the nail matrix worked well for nail psoriasis recalcitrant to topical treatment. To improve the standard of care for patients with psoriasis, randomized controlled trials that establish the most effective MTX-delivery system are needed.

Characteristics of HIV/sexually transmitted infections among men who have sex with men and women in Bangkok, Thailand.

BACKGROUND: Men who have sex with men (MSM) are a key HIV target population in Thailand. An important subgroup is men who have sex with men and women (MSMW) as they can sexually transmit infections between individuals with different gender identities. This study compared the sexually transmitted infection risk behavior of different types of men in Thailand. METHODS: We retrospectively reviewed the medical records of 839 consecutive male patients who visited an STI clinic in Bangkok, Thailand, between 2014 and 2020. RESULTS: Men who have sex with women only (MSWO) predominated (58.0%), followed by men who have sex with men only (MSMO, 32.2%) and MSMW (9.8%). MSMW and MSMO shared similar sexual risk behaviors, such as significantly higher median numbers of sex partners (10 and 8, respectively) than MSWO (5; Kruskal-Wallis, p < 0.001). MSMW had the highest prevalence of concurrent sexual partnerships (91.4%), significantly different from MSWO (61.2%) and MSMO (76.7%; chi-squared, p < 0.001). HIV and syphilis prevalence was significantly higher for MSMO (48.9% and 51.1%) and MSMW (42.7% and 48.8%) than MSWO (12.3% and 20.9%; chi-squared, p < 0.001). CONCLUSIONS: MSMW exhibited similar sexual risk behavior and high HIV/STI prevalence comparable to MSMO.

Retrospective study of psoriasis in people living with HIV: Thailand's experience.

Psoriasis in people living with HIV (PLHIV) has been reported as having particular clinical characteristics. However, most of the source data was derived from descriptive studies in Europe and the USA. This study was conducted to compare the characteristics of psoriasis in PLHIV to general psoriasis patients. We retrospectively reviewed the records of 73 cases of psoriasis in PLHIV and of 232 general psoriasis patients who visited a psoriasis clinic in Bangkok, Thailand. Psoriasis in PLHIV predominated in males (78.1%), with an older age of onset, significantly lower rates of nail involvement and psoriatic arthritis, but higher rates of co-infectious diseases than for general psoriasis patients. A low nadir CD4 T-cell count (<100 cells/µl) and CD4 T-cell count at psoriasis diagnosis were associated with a high body surface area (BSA) involvement. The mean BSA involvement in PLHIV was 24. Although 64.4% (47/73) of the PLHIV had moderate-to-high psoriasis severity, 29.8% of those (14/47) only received topical treatment. Acitretin was the most common drug used. Other therapies were rarely used, and no biologics were administered. In conclusion, psoriasis in PLHIV has several clinical features that differ from general psoriasis. PLHIV tend to receive substandard care for psoriasis, even in upper-middle-income countries.

Patient-ready syringes containing 25 mg/mL methotrexate can be kept at temperature ranging from 4 °C to 37 °C for up to 12 weeks for use in psoriatic and rheumatologic conditions.

BACKGROUND: Methotrexate (MTX) is a mainstay drug in the treatment of psoriatic and rheumatologic conditions. Subcutaneous MTX has become a feasible treatment alternative with the development of prefilled syringes or autoinjectors containing MTX solution that can be self-administered by the patient at home. However, MTX prefilled auto-injector pens are still not available in some countries. OBJECTIVE: This study aimed to investigate the stability and sterility of 25 mg/mL MTX solution in a disposable plastic syringe over a 12-week period under light protection at temperatures of 4 °C, 25 °C, and 37 °C. METHODS: This study was conducted during November 2019 to February 2020 at the Faculty of Medicine Siriraj Hospital, Mahidol University. Stability was evaluated using ultra-high-performance liquid chromatography technique, and sterility was assessed by cultures for bacterial and fungal contamination. RESULTS: Our results revealed that patient-ready syringes containing 25 mg/mL MTX solution can be prepared in advance and kept for up to 12 weeks under light protection, and they can be kept at temperatures ranging from 4 to 37 °C. CONCLUSION: This system for delivering MTX to patients that are refractory to or intolerant of oral MTX via a self-administered pre-filled syringe is both efficient and easy to implement in care settings where commercially alternatives are not yet available.

The Value of Patch Testing With Shoe Material Samples in Patients Suspected of Shoe Allergic Contact Dermatitis.

BACKGROUND: Patch testing is the standard diagnostic tool for shoe allergic contact dermatitis (ACD). As shoe materials change over time, utilizing commercial allergen series might be ineffective. However, because testing with patients' shoe samples is laborious, its value is questioned. OBJECTIVE: The aim of this study was to ascertain the benefits of patch testing with patients' shoes by comparing the frequencies of patch-test positivity of shoes and shoe-related allergens in baseline series for suspected shoe ACD patients. METHODS: A retrospective study was conducted of patients with clinically suspected shoe ACD who underwent patch testing with baseline series and shoe samples 2000 to 2019. RESULTS: Almost half of the cohort (77 of 178; 43.3%) was diagnosed with shoe ACD. Of those 77, 48 (62.3%) were positive to shoe-related allergens from the baseline series, whereas 53 (68.8%) were positive to their shoe materials. The prevalence of tests positive to shoe material but negative to shoe-related allergens was 29 of 77 (37.7%). The most common shoe-related allergens were potassium dichromate (7.9%), carba mix (6.8%), and mercapto mix (6.7%). CONCLUSIONS: Patch testing with shoe materials increased the diagnostic yield by 37.7 percent. To diagnose shoe ACD, testing of shoe materials may compensate for unknown, scarce, or novel allergens not in the baseline series.

Dietary habits and perceptions of psoriatic patients: Mediterranean versus Asian diets.

BACKGROUND: Mediterranean diets have been reported to improve psoriasis. Asian food has a unique character and differs from Mediterranean diets. METHODS: This study compared the dietary intake of psoriatic patients and individuals without psoriasis, and investigated the association between diet and psoriasis severity. Data were collected on the frequency of consumption of Mediterranean and Asian diets. RESULTS: One-hundred psoriatic patients and 100 individuals (age- and sex-matched controls) was conducted. In the case of the anti-inflammatory diets, the psoriatic patients consumed significantly less olive oil, berry fruits, fish, seafood, tree nuts, and eggs than the controls. As to the pro-inflammatory diets, greater quantities of dairy products and soft drinks were consumed by the psoriatic patients than the controls. Regarding Asian food, the patients consumed significantly less pickled foods and brown rice/Riceberry (a rice variety), but more coconut milk, than the controls. In terms of psoriasis severity, the patients with lower severities consumed significantly more vegetables; in contrast, a higher consumption of red meat, belly meat, and instant noodles was associated with greater psoriasis severities. CONCLUSIONS: Our study adds further information on the role of diets-especially Asian diets-and psoriasis. These data should help patients and clinicians to focus more clearly on diet management.

Using the patient-acceptable symptom state to evaluate patients' perspectives of living with psoriasis: A cross-sectional study.

BACKGROUND: Taking the perspectives of patients into consideration is of the utmost importance when defining treatment goals for psoriasis. The patient-acceptable symptom state (PASS) is a dichotomised question that captures patients' perceptions of their overall health state. OBJECTIVES: To evaluate PASS and determine the factors associated with a satisfactory PASS for psoriatic patients. METHODS: Three questions were asked: (Q1) Considering the ways that your skin symptoms affect your functioning, is your current skin psoriasis satisfactory? (Current PASS), (Q2) Considering the ways that your psoriasis is affecting you, if you were to remain in this state for the next few months, would this be satisfactory? (Future PASS) and (Q3) If you were to remain for the rest of your life as you were during the last 48 hours, would this be satisfactory? (Lifelong PASS). Disease severity, symptoms and health-related quality of life (HRQoL) were collected. RESULTS: Of 140 patients, 74.3%, 70.0% and 85.7% expressed satisfaction with their current, future and lifelong skin psoriasis conditions respectively. A satisfactory PASS was significantly associated with older and married patients; lower disease severity; fewer skin symptoms; and a higher HRQoL. A multivariate analysis revealed that the independent factors associated with a satisfactory PASS were being older than 40 years, being married, practising meditation, not having extensive lesions at sensitive areas and having a high HRQoL. CONCLUSIONS: PASS is a simple and easily administered questionnaire that reflects both disease severity and HRQoL. Understanding patients' needs and satisfaction levels will result in better care for psoriatic patients than otherwise.