RESUMEN
Psoriasis is a chronic inflammatory skin disease with a profound effect on quality of life and psychosocial stress. The relationship between clinical improvement and psycho-social impact after treatment is complex. The objective of this study was to compare changes in quality of life and psychosocial distress, and overall cost-effectiveness, in patients with psoriasis receiving the modified Goeckerman regimen (UV irradiation and coal tar) with those receiving conventional treatment. Patients with moderate/severe psoriasis receiving the Goeckerman regimen were followed from admission to discharge. Clinical severity, was evaluated weekly using the Psoriasis Area and Severity Index (PASI). Psoriasis Disability Index (PDI) and Hospital Anxiety and Depression Scale (HADS) questionnaires were applied at admission and one month after discharge. Thirty-six patients with psoriasis receiving conventional treatment and 48 patients receiving the Goeckerman regimen were recruited to the study. The mean PASI score in the Goeckerman group decreased from 27.1 to 6.9 and PDI scores decreased from 25.3 to 13.8. HADS scores for anxiety and depression decreased significantly from 9.8 to 6.3 and 9.1 to 6.8, respectively. In comparison with conventional therapy, the modified Goeckerman regime showed similar clinical efficacy, with additional benefits in improving overall quality of life and psychosocial distress in patients with moderate/severe psoriasis, and more cost-effectiveness.
Asunto(s)
Alquitrán/uso terapéutico , Queratolíticos/uso terapéutico , Psoriasis/terapia , Calidad de Vida , Estrés Psicológico/prevención & control , Terapia Ultravioleta , Adulto , Ansiedad/etiología , Ansiedad/prevención & control , Estudios de Casos y Controles , Alquitrán/economía , Terapia Combinada , Análisis Costo-Beneficio , Depresión/etiología , Depresión/prevención & control , Evaluación de la Discapacidad , Femenino , Costos de la Atención en Salud , Humanos , Estimación de Kaplan-Meier , Queratolíticos/economía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Psoriasis/diagnóstico , Psoriasis/economía , Psoriasis/psicología , Índice de Severidad de la Enfermedad , Estrés Psicológico/economía , Estrés Psicológico/etiología , Encuestas y Cuestionarios , Taiwán , Factores de Tiempo , Resultado del Tratamiento , Terapia Ultravioleta/economíaRESUMEN
BACKGROUND: Minimal invasive treatment with liposuction-curettage for axillary osmidrosis has lead to clinical improvement with lower risk of complications. The incidence of skin necrosis and hematoma in the literature is very limited. Recently, arthroscopic shaver has been used for the treatment of osmidrosis with better efficacy, but associated with variable degrees of complications. OBJECTIVE: To evaluate clinical effect and complication from arthroscopic shaver with preservation of fibrovascular cords. To our knowledge this modification has not been previously described. METHOD: Thirty patients were recruited during a 1-year-period for the treatment of axillary malodor. Incision was made for the arthroscopic shaver and subcutaneous fibrovascular cords were carefully preserved. We evaluated the clinical efficacy (excellent, good, fair, and poor), complications, and subsequent recurrences. RESULTS: Among patients receiving the arthroscopic shaving for axillary osmidrosis, 93% of the patients had achieved excellent to good results, 7% with fair result and none had poor clinical efficacy. None of the patient had any skin necrosis or recurrences during clinical follow up. CONCLUSION: Arthroscopic shaving for axillary osmidrosis has been associated with variable complication rates. Our experience has indicated that preservation of fibrovascular cords protected epidermis from necrosis and such refinement will allow for more optimal clinical result and lower complications.