Prevalence and Associated Factors of Erectile Dysfunction in Patients With Moderate to Severe Psoriasis and Healthy Population: A Comparative Study Considering Physical and Psychological Factors.

Recent studies have shown that psoriasis is associated with an increased prevalence of erectile dysfunction. To our knowledge, no comparative study has considered simultaneously the role of organic factors and psychological factors in this process. We performed a prospective case series study matched by age to explore the prevalence of erectile dysfunction in psoriasis patients compared to a healthy population and to investigate the role of anxiety, depression, and cardiovascular risk factors in the relationship between psoriasis and erectile dysfunction. The healthy group was matched by frequency to cases by age. Seventy-nine patients with moderate to severe psoriasis and 79 healthy controls participated in the study. Participants completed the Massachusetts General Hospital Sexual Functioning Questionnaire and the Hospital Anxiety and Depression Scale. Psoriasis patients had an increased prevalence of erectile dysfunction in comparison to controls, 34.2 vs. 17.7 % (p < .05). Multivariate analysis showed a significant association between erectile dysfunction and age, smoking and anxiety/depression, but not with psoriasis per se. In conclusion, the higher prevalence of smoking and anxiety/depression among patients with moderate to severe psoriasis probably explains the higher prevalence of erectile dysfunction in this population.

Distribution pattern of psoriasis affects sexual function in moderate to severe psoriasis: a prospective case series study.

INTRODUCTION: Psoriasis may significantly impair sexual function. Depression and organic factors appear to play a key role in this relationship. However, beyond genital psoriasis, the importance of the distribution pattern of the disease has not been considered. AIM: To investigate the role of the distribution pattern of psoriasis in sexual dysfunction. METHODS: A prospective case series study was carried out on 133 patients with moderate to severe psoriasis. MAIN OUTCOME MEASURES: The participants completed the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, and the Self-Administered Psoriasis Area and Severity Index. RESULTS: Forty-four women (mean age 42.0 ± 14.1) and 79 men (mean age 47 ± 11.7) were included in the study. Psoriasis lesions on abdomen, genitals, lumbar region, and buttocks in women and chest, genitals, and buttocks in men were associated with an increase in sexual dysfunction. Multivariate logistic regression analysis showed that the involvement of these specific areas may be independent risk factors for sexual dysfunction in patients with moderate to severe psoriasis. CONCLUSIONS: This is the first study identifying body areas other than genitals as potentially related to sexual dysfunction in psoriasis patients. The results suggest that the assessment of sexual dysfunction and the involvement of these body areas should be considered as disease severity criteria when deciding on treatment for psoriasis patients.

The role of accessibility policies and other determinants of health care provision in the initial prognosis of malignant melanoma: a cross-sectional study.

BACKGROUND: The prognostic benefit of health care service provision and delivery policies for patients with malignant melanoma (MM) is not yet clear. OBJECTIVE: To analyze the role of health care provision determinants in the initial prognosis of MM. METHODS: A multicenter cross-sectional study was conducted at 14 public hospitals and recruited 3550 patients with MM between 2000 and 2009. The study variables were analyzed using univariate and multivariate models to identify their role in the variations observed. RESULTS: In a 10-year period, the number of patients with MM increased by 78.54%, with primary in situ MM (Tis) or MMs with a Breslow thickness <1 mm (T1) representing 51.72% of the total number of MMs in 2000, increasing to 62.23% by the end of the study period (P = .005). Among the variables that explained the variation in MM frequency the year of diagnosis after 2004 (univariate odds ratio [OR], 1.43 [P < .001]; multivariate OR, 1.36 [P = .005]) and diagnosis in centers with specific fast-track referral systems (univariate OR, 1.24 [P = .01]; multivariate OR, 1.59 [P = .025]) were shown to explain the increasing frequency of Tis-T1 MM. LIMITATIONS: The primary potential limitation of this study is its retrospective nature. CONCLUSION: Health care provision policies and interventions aimed at improving accessibility to specialized care appear to explain the increasing frequency of Tis-T1 MM.

Safety and effectiveness of ustekinumab for treatment of moderate to severe psoriasis: a prospective study in a clinical setting.

BACKGROUND: There are few studies analyzing the behavior of ustekinumab in the complex management of psoriasis within diary clinical practice setting. OBJECTIVE: To assess the utility of ustekinumab in a psoriasis unit. METHODS: Analysis of the prospective data gathered during the follow-up of 30 consecutive psoriasis patients treated with ustekinumab at a single referral centre. Three effectiveness endpoints were defined 12 weeks, 28 and "long-term treatment". The main outcome measure was improvement from baseline PASI at week 28 and at a point of adjustment of prolonged treatment signed as "long-term treatment". RESULTS: Overall 82.1% and 42.8% patients achieved respectively PASI75 and PASI90 response rates at week 28. Long-term treatment maintained efficacy outcomes 81.5% and 40.7% PASI75 and PASI90, respectively were observed. At week 28, patients naïve to TNFα- blockers agents and patients with a baseline PASI >10 had better PASI75 and PASI90 response rates than previously treated patients. CONCLUSIONS: In clinical practice, the efficacy and patient adherence to ustekinumab are excellent and even better to the data obtained in clinical trials. Clinical indicators of psoriasis severity: previous treatments with tumor necrosis factor α blockers agents and active treatment beside small increases in PASI determine a delayed maximal response.

Psoriasis comprehensive care: an evaluation of a web site.

Psoriasis is a disease that affects many facets of life. Psoriasis patients have needs that cannot be addressed within the traditional consultation structure. Although the Internet provides a number of health resources, the quality of the information is variable, and many sites are not editorially independent. After reviewing the contents available on the Internet related to psoriasis, the staff of the psoriasis unit at San Cecilio University Hospital (Granada, Spain) developed a Web site to meet the needs of psoriasis patients. A group of 241 patients who attended a follow-up visit to our psoriasis unit evaluated the Web site and provided feedback through an online survey. The result of the Web development process was the creation of "Psoriasis365" (https://sites.google.com/site/psoriasis365/). Overall, the Web site achieved high scores, the most popular section being "research." These results suggest that the Web site can complement the healthcare of psoriasis patients and is potentially useful for research purposes.

Widespread eosinophilic pustular folliculitis in a nonimmunocompromised patient.

OBJECTIVE: We present a case of eosinophilic pustular folliculitis, a rare dermatosis which is often associated with HIV infection or internal malignancies. CLINICAL PRESENTATION AND INTERVENTION: We report the case of a 66-year-old man with a medical history of hypertension. Histopathological examination showed a dense follicular inflammatory infiltrate with abundant eosinophils. The clinical response to indomethacin was excellent with no recurrence during the follow-up. CONCLUSION: The patient responded well to indomethacin treatment.

[A case of lichenoid sarcoidosis with characteristic clinical and histopathological findings]. / Descripción de un caso de sarcoidosis liquenoide con hallazgos clínicos e histopatológicos característicos.

Sarcoidosis is a multisystem inflammatory disease characterized by the formation of noncaseating granulomas in various organs and tissues. The majority of patients with systemic sarcoidosis will present with lung and lymph node involvement. In addition, 20% have skin involvement that may be the only manifestation of the disease or may be an important prognostic marker for involvement of other organs. There are multiple forms of presentation of cutaneous sarcoidosis, which may be a true challenge.We report a patient with a one month history of an eruption of skin colored papules. Some were grouped in a symmetrical distribution on the trunk, inner arms, and lumbar region. Pathologic examination revealed an infiltrate in the papillary dermis showing a band of noncaseating granulomas along with disruption of the basal lamina and lichenoid changes. The clinicopathological correlation confirmed the diagnosis of lichenoid sarcoidosis. We consider our case interesting owing to the clinical presentation and the lichenoid distribution of granulomas.

Ulcerated upper lip tumour: diagnostic procedure.

A Mediterranean Spanish woman, aged 56 years and in good health, presented with a nodule above her upper lip, which had rapidly evolved to central ulceration with crusting. As part of the work-up, samples were taken for microbiological and histopathological investigation. At the follow-up appointment the lesion had almost disappeared and a small fibrotic area of scarring remained. The diagnostic procedure to distinguish between localised cutaneous leishmaniasis and keratoacanthoma, both characterised by rapidly growing nodules on the face, is presented in this case-based article.

Androgenetic alopecia as an early marker of benign prostatic hyperplasia.

BACKGROUND: Androgenetic alopecia (AGA) and benign prostatic hyperplasia are both androgen-dependent entities that respond to the blocking of 5-alpha-reductase. OBJECTIVES: The objective of this study was to determine whether prostatic volumes and urinary flow changes were higher in patients with early-onset AGA than in healthy control subjects. METHODS: This was an observational case-control study of 87 men: 45 with early-onset AGA diagnosed in the dermatology department and 42 control subjects. End-point variables were prostatic volume, measured by transrectal ultrasound, and urinary flow, measured by urinary flowmetry. A hormone study was performed on all participants, and the International Prostate Symptom Score and International Index of Erectile Function score were determined. RESULTS: The groups did not significantly differ in mean age (cases, 52.7 years vs control subjects, 49.8 years; P = .12). Patients with AGA had significantly higher mean prostate volume (29.65 vs 20.24 mL, P < .0001), International Prostate Symptom Score (4.93 vs 1.23, P < .0001), and prostate-specific antigen value (1.53 vs 0.94 ng/mL, P < .0001) and significantly lower maximum urinary flow (14.5 vs 22.45 mL/s, P < .0001) versus control subjects. Binary logistic regression analysis showed a strong association between the presence of AGA and benign prostatic hyperplasia after adjusting for age, urinary volume, urination time, International Prostate Symptom Score, abdominal obesity, glucose levels, systolic blood pressure, insulin levels, fibrinogen, and C-reactive protein (odds ratio = 5.14, 95% confidence interval 1.23-47.36, P = .041). LIMITATIONS: The study of larger sample sizes would facilitate stratified analyses according to the Ebling type of androgenetic alopecia. CONCLUSION: There is a relationship between the presence of AGA and prostate growth-associated urinary symptoms, likely attributable to their pathophysiological similarity. This study suggests that early-onset AGA may be an early marker of urinary/prostatic symptomatology. Future studies may clarify whether treatment of patients with AGA may benefit the concomitant benign prostatic hypertrophy, which would be present at an earlier stage in its natural evolution.

Effect of non-steroidal anti-inflammatory drugs on the histology of basal cell carcinomas.

BACKGROUND: Aggressive histology is not rare in BCC. Large studies from referral centers report incidences of aggressive histology BCC ranging from 2.5- 44%. These aggressive BCC are characterized by subclinical extension, invasive behavior, local recurrence and challenging treatment. OBJECTIVES: To examine the association between non-steroidal anti-inflammatory drug (NSAID) use and the different histological subtypes of basal cell carcinoma (BCC). METHODS: The design was a nested case-control study. The two population-based cohorts were of patients with a primary BCC diagnosis during January and May 2010 (n=136) and NSAID use in the 15 years prior to baseline. All the lesions were excised and analyzed to determinate the histological subtype of BCC as aggressive or non-aggressive. Odds ratios (ORs) and 95% confidence intervals (CIs), using conditional logistic regression, were calculated with the SPSS software to estimate the association of aggressive histological subtypes of BCC and use of NSAID. We controlled the potential confounding factors. RESULTS: The rate of non-aggressive BCC associated with exposure to NSAID was increased (OD: 0.34; 95% CI: 0.14-0.84) after adjusting for covariants. LIMITATIONS: our sample is small. We collected data regarding use of NSAID over a wide time ranges, so that we are unable to propose when the potential benefits of NSAID on the histology of BCC would happen. CONCLUSION: According to our data, NSAID exposure is associated with a decreased risk of aggressive BCC.

Atheroma plaque, metabolic syndrome and inflammation in patients with psoriasis.

BACKGROUND: Chronic inflammation plays an important role in the development of cardiovascular risk factors. Although the prevalence of comorbidities and cardiovascular events has been described in patients with psoriasis, few studies have examined subclinical atherosclerosis in psoriasis patients. OBJECTIVE: Our objective was to investigate the prevalence of atheroma plaques in patients with severe psoriasis compared with control subjects and to analyze the association with metabolic syndrome, homocysteine levels and inflammatory parameters. PATIENTS AND METHODS: This case-control study included 133 patients, 72 with psoriasis and 61 controls consecutively admitted to the outpatient clinic in Dermatology Departments (Granada, Spain.) RESULTS: Carotid atheroma plaques were observed in 34.7% of the psoriatic patients versus 8.2% of the controls (p=0.001) and metabolic syndrome was diagnosed in 40.3% of the psoriatic patients versus 13.1% of the controls (p<0.001). Significantly higher mean values of insulin, aldosterone, homocysteine and acute phase parameters (fibrinogen, D-dimer, C reactive protein and erythrocyte sedimentation rate) were found in psoriatic patients. Binary logistic regression showed a strong association between psoriasis and atheroma plaque and metabolic syndrome after controlling for confounding variables. LIMITATIONS: The absence of longitudinal quantification of metabolic syndrome parameters and intima-media thickness in psoriatic patients. CONCLUSION: The chronic inflammation and hyperhomocysteinemia found in psoriatic patients may explain the association with atheroma plaque and metabolic syndrome. Cardiovascular screening by metabolic syndrome criteria assessment and carotid ultrasound in psoriasis may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.

Sex hormone-binding globulin and risk of hyperglycemia in patients with androgenetic alopecia.

BACKGROUND: Low circulating levels of sex hormone-binding globulin (SHBG) are a strong predictor of the risk of type 2 diabetes. Androgenetic alopecia (AGA) has been related to an increase in cardiovascular risk, but the mechanism of this association has not been elucidated. AGA can be associated with low levels of SHBG and insulin resistance, which could be related to hyperglycemia and type 2 diabetes. OBJECTIVE: The objective of this study was to evaluate SHBG and blood glucose levels in men and women with early-onset AGA and control subjects to determine whether low levels of SHBG are associated with hyperglycemia. METHODS: This case-control study included 240 patients consecutively admitted to the outpatient clinic (Dermatology Department of San Cecilio University Hospital, Granada, Spain), 120 with early-onset AGA (60 men and 60 women) and 120 control subjects (60 men and 60 women) with skin diseases other than alopecia. RESULTS: Of patients with AGA, 39.1% presented with hyperglycemia (>110 mg/dL) versus 12.5% of controls (P < 0.0001). AGA patients with hyperglycemia or diabetes presented lower significant levels of SHBG than alopecic patients without hyperglycemia or type 2 diabetes, respectively. Patients with AGA and hyperglycemia presented significantly lower levels of SHBG than controls with hyperglycemia (22.3 vs 39.4 nmol/L for AGA patients and controls, respectively, P = .004). No significant differences in SHBG levels were noticed between patients and controls without hyperglycemia. Binary logistic regression showed a strong association between lower SHBG levels and glucose levels greater than 110 mg/dL in patients with AGA even after additional adjustment for sex, abdominal obesity, and free testosterone (odds ratio = 3.35; 95% confidence interval = 1.9-5.7; P < .001). LIMITATIONS: The study of a wider sample of AGA patients would confirm these findings and would permit analysis of the pathogenic mechanisms underlying the increase in cardiovascular risk in patients with AGA. CONCLUSION: An association between early-onset AGA, hyperglycemia/diabetes, and low levels of SHBG was observed in the current study. Low levels of SHBG could be a marker of insulin resistance and hyperglycemia/diabetes in patients with AGA.

Androgenetic alopecia and cardiovascular risk factors in men and women: a comparative study.

BACKGROUND: Numerous studies in recent decades have associated male androgenetic alopecia (AGA) with the risk of cardiovascular disease. However, only 3 studies have addressed this association in female patients. Most studies considered the risk of myocardial infarction or mortality as a result of heart disease, without analyzing cardiovascular risk factors. OBJECTIVES: The objectives of this study were to analyze the presence of cardiovascular risk factors included in the Adult Treatment Panel-III criteria for metabolic syndrome, the prevalence of carotid atheromatosis, hormonal (aldosterone, insulin, testosterone, and sex hormone-binding globulin) factors, and acute phase reactant (C-reactive protein, fibrinogen, D-dimers, erythrocyte sedimentation rate) variables in male and female patients with AGA and in a control group, and to analyze differences among the groups. METHODS: This case-control study included 154 participants, 77 with early-onset AGA (40 male and 37 female) and 77 healthy control subjects (40 male and 37 female) from the dermatology department at a university hospital in Granada, Spain. RESULTS: Metabolic syndrome was diagnosed in 60% of male patients with AGA (odds ratio [OR] = 10.5, 95% confidence interval [CI] 3.3-32.5), 48.6% of female patients with AGA (OR = 10.73, 95% CI 2.7-41.2), 12.5% of male control subjects, and 8.1% of female control subjects (P < .0001). Atheromatous plaques were observed in 32.5% of male patients with AGA (OR = 5.93, 95% CI 1.5-22.9) versus 7.5% of male control subjects (P = .005) and 27% of female patients with AGA (OR = 4.19, 95% CI 1.05-16.7) versus 8.1% of female control subjects (P = .032). Aldosterone and insulin levels were significantly higher in the male and female patients with AGA versus their respective control subjects. Mean values of fibrinogen were significantly higher in male patients with AGA, whereas values of fibrogen, C-reactive protein, and D-dimers were significantly higher in female patients with AGA versus their respective control subjects. LIMITATIONS: The study of a wider sample of patients with AGA would confirm these findings and allow a detailed analysis of the above factors as a function of the degree of alopecia or between menopausal and premenopausal women. CONCLUSION: The determination of metabolic syndrome and ultrasound study of the carotid arteries may be useful screening methods to detect risk of developing cardiovascular disease in male and female patients with early-onset AGA and signal a potential opportunity for early preventive treatment.

A comparative study of dyslipidaemia in men and woman with androgenic alopecia.

Several studies have analyzed the relationship between androgenetic alopecia and cardiovascular disease (mainly heart disease). However few studies have analyzed lipid values in men and women separately. This case-control study included 300 patients consecutively admitted to an outpatient clinic, 150 with early onset androgenetic alopecia (80 males and 70 females) and 150 controls (80 males and 70 females) with other skin diseases. Female patients with androgenic alopecia showed significant higher triglycerides values (123.8 vs 89.43 mg/dl, p = 0.006), total cholesterol values (196.1 vs 182.3 mg/dl, p = 0.014), LDL-C values (114.1 vs 98.8 mg/dl, p = 0.0006) and lower HDL-C values (56.8 vs 67.7 mg/dl, p <0.0001) versus controls respectively. Men with androgenic alopecia showed significant higher triglycerides values (159.7 vs 128.7 mg/dl, p = 0.04) total cholesterol values (198.3 vs 181.4 mg/dl, p = 0.006) and LDL-C values (124.3 vs 106.2, p = 0.0013) versus non-alopecic men. A higher prevalence of dyslipidemia in women and men with androgenic alopecia has been found. The elevated lipid values in these patients may contribute, alongside other mechanisms, to the development of cardiovascular disease in patient with androgenic alopecia.

Exophytic and ulcerated lesion on the leg.

A healthy, 34-year-old male presented with a 1-year history of an exophytic lesion on the leg during. On physical examination there was a 2 cm x 3 cm diameter nodule with pinkish, crusted ulceration on its surface; it was attached to skin by a pedicle. It had grown rapidly in the last month. After surgical excision the histological study confirmed the diagnosis of a polypoid dermatofibroma.

Homogeneous blue pattern: A rare presentation in an acral congenital melanocytic nevus.

Acral melanocytic nevi are relatively frequent in the palmoplantar location. In congenital nevi various characteristic dermoscopic patterns have been described, such as reticular and globular patterns, brown pigmented areas, and areas with peripilar depigmentation. However, there are few reports on the dermoscopic pattern of acral congenital nevi. The homogeneous blue pattern is typical of blue nevus and is not typical of acral localization and metastasis of cutaneous melanoma. However, this pattern should be considered characteristic of acral congenital nevus.