Tailor systemic therapy to the patient with severe psoriasis.

There is no standard definition regarding the severity of psoriasis, and a number of factors should be considered, including the extent and stability of skin disease, involvement of joints, response to treatment, and impact on quality of life. Erythrodermic psoriasis and pustular psoriasis are severe conditions and the patient may be systemically unwell and febrile. NICE recommends that four key areas should be evaluated and recorded when assessing patients: severity, using the static Physician's Global Assessment (sPGA); disease impact on physical, psychological and social wellbeing using the Dermatology Life Quality Index (DLQI); the presence of psoriatic arthritis; and comorbidities. Ideally, patients should be assessed annually for psoriatic arthritis: the Psoriasis Epidemiology Screening Tool is a validated tool to screen for psoriatic arthritis in primary and secondary care. Patients with severe psoriasis should undergo cardiovascular risk assessment at presentation and every five years, or more frequently if indicated. Referral to secondary care should be made for patients with any type of psoriasis with poor response to topical therapy (after 2 or 3 months according to SIGN) and for extensive psoriasis. Cases where the psoriasis is having a significant physical or psychological impact on an individual's quality of life warrant early referral, as do those where the diagnosis is uncertain. Patients with generalised pustular psoriasis or erythroderma should be referred urgently for same-day specialist input. Patients with acute guttate psoriasis who may require phototherapy should also be referred. Children and adolescents with any type of psoriasis should be referred to a specialist at initial presentation.

Estudio epidemiológico de la PUVAterapia en la comunidad valenciana / Use of psoralen plus UV-A therapy in the autonomous Community of Valencia, Spain

Introducción. La fotoquimioterapia con 8-metoxipsoraleno y radiación ultravioleta de longitud de onda larga A (PUVA) es frecuentemente utilizada para el tratamiento de diferentes enfermedades cutáneas desde que en 1982, la Food and Drug Administration aprobase su uso. Métodos. En este estudio retrospectivo se han analizado los pacientes tratados con PUVA, incluyendo tratamiento tópico y sistémico durante 14 años. Todos estos pacientes recibieron un régimen de terapia PUVA estándar. Resultados. Durante el período de 1982 a 1996 se analizaron 877 pacientes. Un total de 41 dermatosis recibieron el tratamiento entre las que destacamos 341 casos de psoriasis y 71 casos de linfomas cutáneos de células T. El trabajo tiene como finalidad describir las características de los pacientes tratados con terapia PUVA durante estos años y comparar los resultados con los procedentes de otros ámbitos. Conclusiones. Aunque la terapia PUVA está ampliamente distribuida en un gran número de países para el tratamiento de diferentes enfermedades cutáneas, existen pocos estudios que indiquen las características de estos pacientes y las variaciones en los parámetros de PUVA dependiendo de las diferentes enfermedades

Background. Photochemotherapy with 8-methoxypsoralen and long-wavelength UV-A (PUVA) has been extensively used for the treatment of various skin diseases since its approval in 1982 by the US Food and Drug Administration. Methods. A retrospective study was performed of patients treated with PUVA, including topical and systemic treatment, over a period of 14 years. All patients were treated using a standard PUVA therapy regimen. Results. A total of 877 patients were analyzed for the period 1982 to 1996. Forty-one skin diseases were treated, including 341 cases of psoriasis and 71 cutaneous T-cell lymphomas. The aim of the study was to describe the characteristics of the patients treated with PUVA therapy during that period and compare the results with those observed in other regions. Conclusions. Although PUVA therapy is widely used in a large number of countries for the treatment of various skin diseases, few studies have described the characteristics of the patients and the differences in the parameters of PUVA according to the disease

[The excimer laser in dermatology and esthetic medicine]. / Der Excimer-Laser in der Dermatologie und ästhetischen Medizin.

First reports about the use of the excimer laser in dermatology date back to 1997. It is seen as an improvement on conventional phototherapy and photochemotherapy because of the lower cumulative UV-dose involved, the shorter time frame required for treatment and the option of targeting individual lesions without affecting the surrounding healthy skin. In addition to the indications of psoriasis vulgaris, vitiligo and atopic eczema (for which there is now FDA approval in the US), the spectrum of possible uses for the excimer laser is growing rapidly, especially in the field of light-sensitive dermatoses. Case studies so far have ranged from post-operative hypopigmentation to acne vulgaris and from alopecia areata to parapsoriasis en plaque. The foremost priorities in the future will be to evaluate reproducible therapeutic regimens with realistic prospects of success in large-scale studies; assess potential iatrogenic risks in treatment; develop pathogenetic models for the mechanism of action; and define therapeutic approaches to new indications. This paper summarizes the publications to date and discusses our observations and experiences.

Balneophototherapy in small plaque parapsoriasis--four case reports.

Four patients suffering from small plaque parapsoriasis were treated successfully with balneophototherapy. Within 4 weeks salt-water baths and UV irradiation resulted in clinical clearing of more than 90% of lesions with a duration of total clinical response between 8 and 12 weeks without further maintenance treatment.

Tratamiento de Linfoma T cutáneo ( Micosis fungoide ) con Interferon Alfa intralesional / Cutaneous T-cell Lymphoma (Mycosis fungoides): treatment with Interferon Alpha intralesional

Se presenta el caso de un paciente de 63 años de edad, portador de Linfoma T (Micosis Fungoide) de dos años de evolución, en todos sus estadíos (máculas, parches, placas y tumores); quien luego de haber recibido todas las opciones terapéuticas (algunas, por diversas razones, sólo parcialmente) sin resultado, inicia Interferon alfa intralesional, en dosis de 1.000.000 de U. por centímetro cuadrado de superficie cutánea que provocó remisión completa de las lesiones en seis meses, sin recaída en nueve meses de control. Presentamos una nueva modalidad terapéutica, en corto lapso de tiempo muy efectiva para una enfermedad de curso inexorable, en la que todos los resultados terapéuticos son muy poco efectivos.(AU)

Tratamiento de Linfoma T cutáneo ( Micosis fungoide ) con Interferon Alfa intralesional / Cutaneous T-cell Lymphoma (Mycosis fungoides): treatment with Interferon Alpha intralesional

Se presenta el caso de un paciente de 63 años de edad, portador de Linfoma T (Micosis Fungoide) de dos años de evolución, en todos sus estadíos (máculas, parches, placas y tumores); quien luego de haber recibido todas las opciones terapéuticas (algunas, por diversas razones, sólo parcialmente) sin resultado, inicia Interferon alfa intralesional, en dosis de 1.000.000 de U. por centímetro cuadrado de superficie cutánea que provocó remisión completa de las lesiones en seis meses, sin recaída en nueve meses de control. Presentamos una nueva modalidad terapéutica, en corto lapso de tiempo muy efectiva para una enfermedad de curso inexorable, en la que todos los resultados terapéuticos son muy poco efectivos.

[Lichenoid pityriasis (parapsoriasis guttata) in children. Report of 17 cases]. / Pityriasis lichénoïde (parapsoriasis en gouttes) de l'enfant. A propos de dix-sept cas.

Seventeen cases of pityriasis lichenoides diagnosed over a nine-year period in children under 15 years of age are reported. Patients with this benign disease develop papular skin lesions covered with thick, coherent scales which detach in a single piece (reminiscent of sealing wax). Pruritus is not marked. Lesions may be necrotic (Mucha Habermann's small pox-like form, n = 6) or mild (leukodermic form, n = 2). Half of the patients studied developed several episodes and total duration of the disease exceeded two years in one third of cases. Recovery occurred after one or two episodes in half the children. Scars developed in some patients with severely necrotic lesions. None of the patients developed lymphoma. All patients with lymphomatoid papulosis progressing to lymphoma reported in the literature were adults. Pathogenesis of pityriasis lichenoides remains unknown but may involve lymphocytic vasculitis. No truly effective therapy is available. However, oral macrolides can be used especially in patients with early manifestations suggesting an infectious disease. Emollients, heliotherapy and ultraviolet therapy may also be recommended.

[Preliminary results of Re-PUVA therapy in cutaneous T-cell lymphomas]. / Vorläufige Ergebnisse der Re-PUVA-Therapie bei kutanen T-Zell-Lymphomen.

Eight patients with T-cell-lymphoma of the skin (6 mycosis fungoides, 2 parapsoriasis variegata) were treated with Tigason in combination with PUVA-therapy. The daily dose of Tigason was 50-100 mg. There was complete regression of skin lesions in three patients, partial regression in three patients, and an improvement in two patients.