General practice recommendations for the topical treatment of psoriasis: a modified-Delphi approach.

BACKGROUND: Although GPs are usually the first port of call for patients with psoriasis, there is a lack of consistent and up-to-date clinical recommendations for interventions for patients with mild-to-moderate disease. AIM: To provide practical recommendations for GPs to optimise psoriasis treatment with topical therapies in four key areas: patient identification; treatment decision making with topical theory; topical treatment outcomes; and optimising patient adherence. DESIGN & SETTING: A consensus-seeking programme (modified-Delphi approach) was undertaken to assess the literature and develop recommendations for GPs, based on evidence and expert opinion. METHOD: Three dermatologists compiled 47 questions that were subsequently ranked and refined according to clinical relevance or importance using an online survey. Thereafter, 19 dermatologists from different European countries developed statements and clinical recommendations for the top seven ranked topical treatment and GP-relevant questions based on literature research and clinical experience. The final recommendations were based on 100% agreement among a final panel of seven experts. RESULTS: The clinical effectiveness, fast onset of action, tolerability, cosmetic acceptability, and practicability of topical therapy, in addition to good physician-patient communication, are important for optimising patient adherence and maximising efficacy. Topical treatments combining corticosteroids and vitamin D analogues (administered as fixed combination) are well-established first-line treatments in mild-to-moderate psoriasis. CONCLUSION: Simple but detailed practical guidance is provided, which is formed from evidence and expert clinical recommendations, to assist GPs with the optimal use of topical agents based on efficacy, tolerability, disease severity, site of psoriasis, patient lifestyle and preferences, and intended duration of treatment.

Systemic Inflammation and Evidence of a Cardio-splenic Axis in Patients with Psoriasis.

The spleen is thought to play a role in atherosclerosis-associated immunity and cardiovascular research has indicated the existence of a cardio-splenic axis. The aim of this study was to assess splenic 18F-fluorodeoxyglucose uptake as a measure of systemic inflammation in patients with untreated psoriasis compared with historical controls assessed by positron emission tomography-computed tomography. Patients with moderate-to-severe psoriasis (n = 12, age 61.4 ± 4.1 years, 83% men, mean Psoriasis Area Severity Index score of 14.5) and controls (n = 23, age 60.4 ± 4.5 years, 87% men) were included in the study. Splenic inflammation was measured using the background-corrected spleen-liver-ratio (SLR) based on mean standardized uptake values. Mean ± SD SLR was increased in patients with psoriasis compared with controls (0.94 ± 0.11 vs. 0.82 ± 0.08; p = 0.001). SLR was significantly associated with aortic inflammation. These results support the existence of systemic inflammation in patients with psoriasis, and provide the rationale for a mechanistic link between psoriasis-driven inflammation and cardiovascular comorbidity through a spleen-atherosclerotic axis.

[Allergic contact dermatitis caused by temporary black henna tattoos in two siblings].

Para-phenylenediamine (PPD) in black henna tattoo mixes is widely recognised as a cause of type-IV allergic contact dermatitis. Legislation in Western countries prohibits the use of PPD on the skin and limits the use in hairdye. In this report, we present a case of two brothers aged five and eight years with classical sensitization and illustrative contact dermatitis after repeatedly exposure to black henna. The hyper-sensitivity reaction to PPD was confirmed in later patch testing. The case serves as a reminder on the potential consequences of a seemingly harmless skin drawing.