Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based cross-sectional study.

BACKGROUND:: Emerging epidemiological evidence suggests independent associations between psoriasis and metabolic syndrome. Objectives: The aim of the study was to examine the prevalence of metabolic syndrome and its components in patients with psoriasis, and to assess which factors may predict metabolic syndrome in these patients. METHODS:: A hospital-based, cross-sectional study with 244 psoriatic patients and 163 control subjects with skin diseases other than psoriasis was conducted at the Clinic of Dermatovenerology, Clinical Center of Serbia, Belgrade, from October 2011 to October 2012. Metabolic syndrome was defined using the revised National Cholesterol Education Program Adult Treatment Panel III. Severity of psoriasis was measured by Psoriasis Area and Severity Index and Body Surface Area. RESULTS:: The adjusted odds ratios (ORs) and 95% confidence intervals (CI) for psoriasis patients vs. non-psoriasis patients were 2.66 (95% CI, 1.58-4.42) for metabolic syndrome, 3.81 (95% CI, 2.30-6.31) for hypertension, 2.29 (95% CI, 1.39-3.78) for central obesity, 1.92 (95% CI, 1.08-3.41) for hyperglycemia, 1.87 (95% CI 1.18-2.96) for low high-density lipoprotein cholesterol level, and 1.42 (95% CI, 0.87-1.04) for hypertrigliceridemia. We failed to find any statistically significant association between the metabolic syndrome and clinical severity of psoriasis. Later onset and longer duration of psoriasis were predicting factors for metabolic syndrome in our patients. Study limitations: The cross-sectional design of the study does not allow us to draw directional causal inferences concerning the association between psoriasis and metabolic syndrome. Factors such as diet, alcohol consumption or mental health, which have not been evaluated in this study, may be confounders in this relation. CONCLUSION:: A higher prevalence of metabolic syndrome and its components in patients with psoriasis than in controls, regardless of disease severity, emphasizes the need for early treatment and follow-up of all psoriatic patients with respect to metabolic diseases.

Pemphigus herpetiformis - a case report of a rare form of pemphigus and review of the literature.

Introduction: Pemphigus herpetiformis is the rare variant of pemphigus with characteristic clinical features, histopathological findings different from the convectional pemphigus, and immunological findings consistent with pemphigus. Case report: We presented a 65-year-old woman with initial pruritus followed by pruritic urticarial papules and plaques, some with annular rings of tense vesicles on the periphery, on the trunk and extremities, with no mucous lesions. Histopathological examination demonstrated spongiosis and intraepidermal vesicles in the mid or subcorneal epidermis in some biopsy specimen, with neutrophil and eosinophil infiltrate. Direct immunoflorescent microscopy revealed intercellular IgG deposition, most prominent in the upper layers of epidermis. Indirect immunoflorescent microscopy showed intercellular binding of IgG autoantibodies in the patient's sera. Initially the patient was threated with systemic corticosteroids and azathioprine, but dapson provided complete clinical remission. Conclusion: This entity was established 40 years ago, and around 100 patients have been reported worldwide. It is important to be aware of this particular form of pemphigus because clinical presentation, course of the disease and therapeutic approach are different from conventional forms of pemphigus.

Assessment of quality of life in patients with psoriasis: a study from Serbia.

BACKGROUND: Psoriasis has a substantial impact on patients' quality of life. OBJECTIVES: The aims of this study were to assess the impact of the clinical severity of psoriasis on patients' quality of life and to determine the effects of psoriasis-related stress on patients' everyday life. METHODS: The cross-sectional study was conducted at the Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade. The study included 201 patients (124 men and 77 women), aged 18-70 with a diagnosis of psoriasis, hospitalized or treated as outpatients during 2009. For the assessment of patients' quality of life, the psoriasis disability index (PDI) was used. The stress related to psoriasis was measured with the psoriasis life stress inventory (PLSI) and disease severity with the psoriasis area and severity index (PASI). RESULTS: We found moderate correlation between PLSI and all PDI subscales and overall score (correlation coefficients ranged from 0.334 to 0.521). The correlation between PASI and PDI subscales was weak, while we failed to find any significant correlation between PASI and the PLSI. The results of multiple regression analysis indicated that stress, more severe disease, and lower educational level are significant determining factors of a poorer quality of life in patients with psoriasis. CONCLUSION: Our results support the importance of assessing the quality of life in psoriasis and effects of stress in patients' adjustment to their condition and may have important implications for a psychological stress management approach in the clinical management of psoriasis.

Clinical effects of topical pimecrolimus in a patient with Fox-Fordyce disease.

Fox-Fordyce disease (FFD) is characterized by a pruritic eruption of skin-coloured or yellowish papules in areas rich in apocrine glands. The histology comprises dilatation of follicular infundibula with hyperkeratosis, acanthosis, and spongiosis of the infundibular epithelium with perifollicular infiltration of lymphocytes and foamy histiocytes. We treated a 12-year-old girl with FFD with topical pimecrolimus for 12 weeks, this resulted in a complete clearance of lesions. After the therapy, the patient was followed for an additional 19 months without signs of relapse. The effects of pimecrolimus in FFD might imply that an inflammatory process inducing secondary reactive hyperkeratosis could be involved in the pathogenesis of FFD.