Cardiomyopathy and echocardiographic abnormalities in Indian patients with psoriasis: Results of a pilot study.

BACKGROUND: The relationship between psoriasis and cardiomyopathy is understudied in Indian patients. OBJECTIVE: We evaluated psoriasis patients for cardiomyopathy and other echocardiographic abnormalities. METHODS: About 98 (M:F = 67:31) patients with mild to moderate psoriasis aged 18-75 years (mean ± SD = 42.12 ± 12.79 years) having no pre-existing metabolic syndrome and cardiovascular disorders were studied. X-ray chest, electrocardiogram and echocardiography were performed and interpreted by cardiologist for size of the left and right ventricles, left ventricle ejection fraction, diastolic function, pulmonary artery pressure and valve abnormality/regurgitation and their severity as per current guidelines/recommendations. The cardiomyopathies were defined according to standard diagnostic guidelines. RESULTS: Echocardiographic abnormalities were noted in 13 (13.3%) patients aged 19-75 years (mean ± SD = 43.30 ± 15.71 years). The left ventricular diastolic dysfunction (grade 1) was observed in nine patients (moderate severe psoriasis in four patients) and one of them also had concentric left ventricular hypertrophy; a precursor of restrictive cardiomyopathy. Mild tricuspid valve regurgitation was present in other four patients. There was no statistically significant difference in age, gender, duration and the severity of psoriasis when compared with patients having normal echocardiography. The mitral or aortic valves, pulmonary artery pressure, mid-right-ventricular diameter and the left atrial volume showed no abnormality. CONCLUSIONS: Psoriasis perhaps plays a role in left ventricular dysfunction and possibly cardiomyopathy even with moderately severe disease and in the absence of clinical symptoms. However, these observations need to be interpreted with caution in the absence of any statistically significant difference between age, gender, duration and severity of psoriasis in the patients having normal and abnormal echocardiography.

The association of anti-gliadin and anti-transglutaminase antibodies and chronic plaque psoriasis in Indian patients: Preliminary results of a descriptive cross-sectional study.

BACKGROUND: Gluten sensitivity among psoriasis patients and its association with gender, age, disease duration and severity of psoriasis are under studied in Indians. OBJECTIVE: To examine association among serum levels of anti-tTG and anti-gliadin antibodies and clinical features including gender, age, duration and severity of psoriasis. METHODS: Serum levels of anti-transglutaminase and anti-gliadin antibodies were measured quantitatively in 80 (M:F 57:23) psoriasis patients aged 15 to 83 years and matched healthy subjects. RESULTS: Forty-five (56.3%) patients were aged ≥41years, duration of disease was >5years in 43(53.8%) patients, and 22 (27.5%) patients had moderate-to-severe psoriasis. Two (2.5%) patients had arthritis and elevated serum anti-gliadin antibody. Significantly more patients than controls had elevated serum anti-gliadin antibody (67.5% vs. 2.5%) and anti-transglutaminase antibody levels (62.5% vs. 0%). Two patients, each with mild and moderate-to-severe psoriasis, had highly elevated serum anti-gliadin antibody and symptoms akin to coeliac disease. Except for a longer duration of psoriasis in patients with elevated anti-gliadin antibodies, there was no statistically significant difference in gender, age, and severity of psoriasis when compared with patients having normal levels. CONCLUSION: Significant elevation of serum anti-transglutaminase and anti-gliadin antibodies levels is noted in psoriasis patients reflecting a possible link. However, results need careful interpretation for any significance of gluten sensitivity in pathogenesis of psoriasis/arthritis or as a stand-alone risk factor for chronicity/severity of psoriasis or whether gluten-free diet will be ameliorating. Small number of subjects, cross-sectional study design, lack of pathological/endoscopic diagnosis and follow-up are study limitations.

Darier's Disease - Response to Oral Vitamin A: Report of a Case and Brief Review.

Darier's disease is an uncommon chronic dermatosis of autosomal dominant inheritance with significant psychosocial morbidity and shows unsatisfactory response to several topical and systemic therapies or various resurfacing or surgical procedure. A 24-year-old woman having characteristic asymptomatic and progressive, hyperkeratotic papular lesions involving the scalp, face, upper trunk, and dorsal hands and feet was diagnosed clinicopathologically as Darier's disease. She was treated successfully with oral Vitamin A 25000 IU given twice daily. The response was apparent within 4 weeks and most lesions cleared in 2 months without any adverse effects. Oral Vitamin A provides an effective and safe low-cost therapeutic alternative in Darier's disease, especially when systemic retinoids, the only effective treatment, remain contraindicated or is not tolerated and for maintenance therapy in the long-term.