Moderate to Severe Psoriasis in Older Adults: Recommendations on Management from the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV). / Recomendaciones del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología sobre el manejo del paciente de edad avanzada con psoriasis en placas moderada-grave.

Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.

Adherence to Mediterranean diet in Spanish patients with psoriasis: Cardiovascular benefits?

Several studies have evaluated the role of individual nutrients on psoriasis. Only a few of them have evaluated the benefits of healthy dietary patterns and the effect of the Mediterranean diet on psoriasis with promising results. Moderate-severe psoriasis is associated with chronic systemic inflammation and increased cardiovascular risk. In this study the present authors measure the adherence to the Mediterranean diet to determine the grade of association with severity of psoriasis, a cardiovascular profile, and systemic inflammation. Our aim was to determine a cut-off point that approximates the real clinical practice by differentiating patients with systemic or biological treatment.

Sexual dysfunction in psoriasis: a systematic review.

BACKGROUND: Psoriasis has been associated with numerous psychological disorders such as low self-esteem, depression, anxiety, sexual dysfunction or suicidal ideation. Recently, there has been a progressive increase in studies examining the impact of psoriasis on sexual function. This alteration seems to be considerable and can cause significant changes in quality of life. OBJECTIVE: The aim of this study was to elaborate recommendations for psoriasis and sexual function supported by a systematic review, to facilitate the application of new scientific findings into clinical practice and to serve as a basis for conducting future research. METHODS: We performed a systematic review of the available studies on psoriasis and sexual dysfunction. RESULTS: Scientific evidence shows that psoriasis patients have a higher risk of sexual dysfunction as compared to the general population. The risk of erectile dysfunction is also higher in psoriasis patients. The risk factors associated with sexual dysfunction in psoriasis patients are disease severity, female gender, psoriatic arthritis and age.

Elevated prevalence of Type D (distressed) personality in moderate to severe psoriasis is associated with mood status and quality of life impairment: a comparative pilot study.

BACKGROUND: Psoriasis may imply a remarkable psychological impairment, which can influence patient's personality. The Type D personality is defined by the combination of social inhibition and negative affectivity. Furthermore, Type D personality has been associated with impaired health-related quality of life (HRQOL) and increased cardiovascular risk, both facts being associated with moderate to severe psoriasis. OBJECTIVES: To explore the prevalence of Type D personality in moderate to severe psoriasis patients; To analyse the relationship between Type D personality and the most common physical and psychological comorbidities in moderate to severe psoriasis and To explore the impact of Type D personality on HRQOL. METHODS: A prospective comparative study matched to age and sex. Eighty patients with moderate to severe psoriasis and 80 healthy volunteers were included in the study. The participants completed the DS14 test, the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, the SF-36 and the Psoriasis Disability Index. RESULTS: The prevalence of Type D personality was higher in patients with moderate to severe psoriasis as compared to healthy volunteers: 38.7% vs. 23.7%, P < 0.001. Psoriasis patients with Type D personality had a 3.2-fold risk of anxiety when compared to patients without Type D personality; odds ratio 3.2 (1.3-8.83 P = 0.01). Type D personality was significantly associated with an impaired general, sexual and psoriasis-related HRQOL (P < 0.01). CONCLUSION: Because Type D personality could represent a frequent type of personality among individuals with moderate to severe psoriasis, it could serve as a 'marker' of more psychologically vulnerable patients, probably related to dysfunctional coping strategies. The Type D personality could represent a profile more frequently encountered among patients with psoriasis, and might therefore help identify subjects physiologically more vulnerable to disease, most likely due to inadequate adaptation mechanisms.

A study of Internet searches for medical information in dermatology patients: The patient-physician relationship.

BACKGROUND: The use of the Internet to search for medical information is considered by some physicians as an invasion of their medical domain and a reflection of a lack of trust in their advice and recommendations. OBJECTIVE: The main objective of this study was to estimate the amount of medical information gathered from the Internet and to establish whether these online searches reflect a lower degree of patient satisfaction. PATIENTS AND METHODS: A survey was conducted among 175 patients seen at the melanoma and psoriasis units of San Cecilio University Hospital in Granada, Spain between May 2010 and December 2011. RESULTS: Online searches for medical information were performed by 44.4% of patients who returned correctly completed questionnaires. The main reasons given for these searches were to complement appropriate information provided by the physician (67.3%) and to gather information before consultation with the physician (36.5%). Variables associated with the search for medical information on the Internet in the multivariate analysis were a higher educational level, a higher score on two items in the Need for Cognition Scale, and consultation of mass media other than the Internet. LIMITATIONS: Studies with larger numbers of patients and other diseases, however, are required to confirm these results. CONCLUSIONS: The search for medical information is a widespread reality among patients with psoriasis and melanoma and it is not associated with a poor relationship with the physician. Dermatologists can play a beneficial role by recommending trustworthy Internet sites during the patient's visit and by promoting the development of pages by scientific societies to provide high-quality information.

Adherence and patient satisfaction with topical treatment in psoriasis, and the use, and organoleptic properties of such treatments: a Delphi study with an expert panel and members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology.

BACKGROUND: Topical therapy is key to the successful management of psoriasis, and patient adherence to treatment contributes to its effectiveness in the long-term. OBJECTIVES: To establish consensus on adherence to topical treatment in psoriasis, draw up recommendations on how adherence could be improved, and evaluate the properties of the main vehicles used. METHOD: We designed a questionnaire on adherence to topical treatments in psoriasis and another on the properties of the main vehicles used; the 2 questionnaires were evaluated using the Delphi method by a panel of experts and members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology, respectively. RESULTS: Consensus was reached on the following statements: a) treatment adherence increases the effectiveness of topical treatments in psoriasis; b) to improve adherence, it is necessary to improve communication between patients and health care staff, provide written instructions, and simplify treatment with easy-to-use, pleasant products that are preferably applied only once a day; c) treatment satisfaction increases adherence and tends to improve the health-related quality of life of the patient. Ointment was rated the worst vehicle, while foams and solutions were rated the best. Creams and lipophilic gels were considered to be better than ointment in several respects. CONCLUSION: To improve adherence to topical regimens in psoriasis and the effectiveness of such therapy, we need to give patients more information, simplify treatment regimens, and prescribe easy-to-use products that will ensure satisfaction.

Vessel resistance to blood flow in the nailfold in patients with psoriasis: a prospective case-control echo Doppler-based study.

BACKGROUND: Psoriasis is a disease in which endothelial cells seem to play an important pathogenic role. No report published to date has examined nail vascularity in patients with psoriasis. OBJECTIVES: To evaluate the vascularity in the nails of patients with psoriasis treated with classic and biologic therapies for comparison with disease-free controls, and to evaluate whether there are differences in nail vascularity among patients with and without nail involvement. METHODS: We performed a prospective study with two cohorts comprising 23 patients with moderate-to-severe psoriasis and 23 controls without psoriasis. We measured the nailfold vessel resistance index (NVRI) in each subgroup. RESULTS: We found significant differences in the NVRI between patients and controls (P<0·001). Among patients with psoriasis, those with nail involvement showed a higher mean±SD NVRI (0·58±0·10) than those without (0·52±0·45). CONCLUSIONS: Psoriasis decreases the blood flow in nails, suggesting that this skin disease confers an independent risk for microvascular changes. This outcome may be associated with greater risk of nail-related signs.

[Analysis of unofficial consultations in a tertiary-level hospital]. / Estudio de las consultas extraoficiales en un hospital de tercer nivel.

BACKGROUND: Dermatologists are regularly consulted in their place of work by patients without an official appointment (individuals accompanying other patients, doctors from other specialties, hospital workers, etc). OBJECTIVES: To describe the characteristics of consulting patients, reasons for consultation, severity of complaint, diagnostic and therapeutic approach taken, and level of care provided by the consulted professionals. RESULTS: The typical patient would be a middle-aged female nurse consulting for the first time for a benign melanocytic lesion. In general, the dermatologist will take an empirical or informative therapeutic approach and consider the care provided to be similar to that offered to patients with an official appointment. CONCLUSIONS: Unofficial appointments, although commonly for trivial complaints, represent an additional workload in daily clinical practice.

[The lymphocyte: protagonism in the new era of the biological therapies]. / El linfocito: protagonista en la nueva era de los biológicos.

Psoriasis is a systemic type T cell mediated immune system chronic inflammatory skin disease. These cells play an important role in the immune system and in the inflammatory response that determines the development and maintenance of the psoriasis lesions. However, greater understanding of the pathophysiology of this disease has led to the development of specific and selective biological treatments. Efalizumab is a humanized IgG1 monoclonal antibody that binds to the Leukocyte-Function-Associated Antigen 1 (LFA-1). When it binds to the CD11a--alpha subunit of LFA1--it inhibits the binding of this ligand to the intercellular adhesion molecule 1. This inhibits several processes related with the T cells that are fundamental in the pathogenesis of psoriasis: activation of the T cells in the lymph nodes, the migration of the T cells towards the dermis and epidermis and finally the reactivation of these in the inflammatory focus. The clinical studies have demonstrated that efalizumab, administered subcutaneously only once a week, provides a clinical benefit as well as improvement in the quality of life in patients with psoriasis with chronic, moderate or severe plaques. Long-term treatment studies suggest that continuous therapy with efalizumab is more beneficial in the maintenance of the improvement of the response and demonstrate that efalizumab may be administered safely for prolonged periods. Given its efficacy, rapid onset action, safety profile due to its selective action mechanism and convenience in its subcutaneous self-administration weekly, efalizumab offers a new therapeutic option, especially of interest for the treatment of psoriasis.