Internalized Stigma in Pediatric Psoriasis: A Comparative Multicenter Study.

BACKGROUND: Internalized stigma, adoption of negative attitudes and stereotypes of the society regarding persons' illness, has not been studied previously in pediatric psoriasis patients. OBJECTIVE: We aimed to investigate the internalized stigma in pediatric psoriasis patients and to determine differences according to factors affecting internalized stigma compared to adult psoriasis patients. METHODS: This multicenter, cross-sectional, comparative study included 125 pediatric (55 female, 70 male; mean age±standard deviation [SD], 14.59±2.87 years) and 1,235 adult psoriasis patients (577 female, 658 male; mean age±SD, 43.3±13.7 years). Psoriasis Internalized Stigma Scale (PISS), Dermatology Life Quality Index (DLQI), Perceived Health Status (PHS), and the General Health Questionnaire (GHQ)-12 were the scales used in the study. RESULTS: The mean PISS was 58.48±14.9 in pediatric group. When PISS subscales of groups were compared, the pediatric group had significantly higher stigma resistance (p=0.01) whereas adult group had higher scores of alienation (p=0.01) and stereotype endorsement (p=0.04). There was a strong correlation between mean values of PISS and DLQI (r=0.423, p=0.001). High internalized stigma scores had no relation to either the severity or localization of disease in pediatric group. However, poor PHS (p=0.007) and low-income levels (p=0.03) in both groups, and body mass index (r=0.181, p=0.04) in the pediatric group were related to high PISS scores. CONCLUSION: Internalized stigma in pediatric patients is as high as adults and is related to poor quality of life, general health, and psychological illnesses. Unlike adults, internalized stigma was mainly determined by psoriasis per se, rather than disease severity or involvement of visible body parts, genitalia or folds.

Variables affecting interpretation of skin prick test results.

BACKGROUND: Both performer- and device-dependent variabilities have been reported in sizes of wheal responses to skin prick tests. OBJECTIVE: We aimed to evaluate whether or not variabilities in sizes of wheal responses influence the final interpretation of skin prick tests; in other words, the decision on whether or not there is an allergy to a given antigen. METHODS: Skin prick tests with positive and negative controls and extracts of Dermatophagoides farinae and Dermatophagoides pteronyssinus were done for 69 patients by two different persons, using two different puncturing devices- disposable 22-gauge hypodermic needles and metal lancets. RESULTS: Among four different skin prick tests, the average coefficients of variation in sizes of wheal responses were near to or higher than 20% for all of them. On the other hand, in the final interpretation of results, kappa values indicated substantial or almost perfect agreements between these tests. However, the frequency of establishing allergy to the house dust mites widely ranged in these tests (20.8-35.8% for D. farinae and 20.8-28.3% for D. pteronyssinus). LIMITATIONS: The conduction of the study in a single center and the comparisons of results of only two performers. CONCLUSION: We feel that variabilities in sizes of wheal responses of skin prick test can influence its categorical results.

The Value of Etiological Tests and Skin Biopsy in the Management of Prurigo Simplex Subacuta.

It has been emphasized that prurigo simplex subacuta may be associated with various disorders and may be clinically confused with dermatitis herpetiformis. Aim of the study was to evaluate the value of our set of tests for finding possible associations and for the aforementioned differential diagnosis. Rates of implementations and abnormal results in our set of tests, including skin prick test, skin biopsy, complete blood count, blood chemistry panel, and psychiatric evaluation were analyzed retrospectively between the years of 2010 and 2015 in 130 patients clinically diagnosed with prurigo simplex subacuta. The set of tests was implemented completely in 43.8% patients and with only a single missing test in 31.5% of the patients. The least implemented procedure was psychiatric evaluation (66.9%). The most commonly found issues were psychiatric abnormalities (55.2% of 87 psychiatrically evaluated patients) and atopy (53.8% of 104 skin prick tested patients). The most common finding suggestive of internal diseases was hyperglycemia (25.4% of 130 patients). It was a striking result that hematological malignancies were suspected upon complete blood count and peripheral blood smear and confirmed by further investigations in 4 of 102 patients. Dermatitis herpetiformis was diagnosed in 2 of 120 skin biopsied patients. Because of the substantial rate of implementation, the high frequencies of psychiatric abnormalities and atopy, and detection of hematological malignancies and dermatitis herpetiformis even in just a few patients, we recommend our set of tests for patients clinically diagnosed as prurigo simplex subacuta.