Discomfort and adaptation in psoriatic patients: an inchoate supportive care trial.

INTRODUCTION: Psoriasis produces functional and aesthetic damages which cause psychosocial discomfort and require new adjustment factors. AIMS: We describe the correlation among discomfort and personality factors as traits, coping, defense mechanism (DM) and resilience in Ps (skin psoriasis) and PsA (psoriatic arthritis) patients. MATERIALS AND METHODS: A random sample, age between 45-60, with 1:1 female/male, includes 3 groups each of 90 subjects: - single psoriasis (Ps, average 50.11, SD 4.9928) - Ps and psoriatic arthritis (PsA, average 50.61, SD 4.8765) - controls (C, average 50.0 and SD 4.8019). We evaluated traits by the 16PF-5, coping by Cope Scale, defence mechanism (DM) by DMRS, dysmorphophobia by BDDE and resilience by CR-RISC scales. Statistical analysis was performed by SPSS 14 version, p < 0.05 and t, F, W and P tests and clinical analysis. RESULTS: We recorded a reduction in traits and coping and an increase in DM, dysmorphophobia and resilience. PsA patients showed a greater distress and adjustment factors than Ps alone. Tests showed a valid significance (p < 0.00001), an effect size from 0.30 to > 0.50 in comparison patients-C and η2 = 1.4 in comparison Ps-PsA. In all patients- controls OR, PAR and NNT registered very high values. DISCUSSION: Reduction in autonomy and imperfections cause an internal damage. The adaptation process searches coping factors (to integrate traits) when lesions appear. It selects DM when stressful dynamics require a further adaptation. Finally it results in adequate resilience when damages and dysmorphophobia are offset by traits, coping and DM. CONCLUSIONS: Clinical signs increase more then traits in severity, coping decrease in resources, resilience and DM grow in use and dismorphophobia just increases in intensity.

Female lichen sclerosus genitalis: discomfort and adaptation.

INTRODUCTION: Female genitalis lichen sclerosus (FGLS) occurs on skin and mucous membranes and shows inflammatory lesions, chronic atrophic, itching and pain. These physical damages produce a decline in sex and a resulting relational couple discomfort. AIM: We describe the discomfort and the relationship between physical and psychological damage. MATERIALS AND METHODS: A random sample, between 35-55 years (average 44.55, SD 6.00) includes 2 groups of 55 subjects: - the first with LSAG diagnosis since 24 months - the latter with controls. We evaluated personality by the MMPI-2, discomfort by short SF-36, couple relationship by ISS, coping by Cope and resilience by CR-RISC scales. Statistical analysis was performed by SPSS 14 version. P-values <0.05, 95% confidence limits, t, F, W and P tests and two by two table, compare two rates and Cohort/RTC were employed. RESULTS: Discomfort makes same personality factors changed. 50 FGLS recorded higher scores than 50 controls in MMIP-2, ISS and CD-RISC scales, lower in ISF-36 and COPE scale. Statistical tests show a valid significance (p<0.00001), a 94.3% of exposed with outcome, an etiological fraction in exposed of 96,15% and a 26 risk / prevalence ratio. DISCUSSION: The psychological distress arises as a result of somatic damage and reduces expression and thought of self. Lesion and pain produce depression, anxiety, negative emotionality and decline of sex. High values of t, F and W tests indicate a good validity of results. CONCLUSIONS: The psychological distress grows from somatic damages and, in progressive way, it reduce expressions and thoughts of ego in increasingly tight limits: through successive stages, it involves social relations, couple relationships and individual identity.

Melainomania: a study on 100 subjects.

AIM: The melainomania is a psychological and skin syndrome and it expresses the obsessive need of tanned skin in a complete and constant way. We searched for the psycho-patogenetic factors of the syndrome and the psychological and skin ends point useful to evaluate the psychic and skin damages. METHODS: Seventy-two women and 28 men, aged 38-56 years, who were used to a constant photo exposure have been examined. We have considered the psychosocial damages by Rorschach e Machover tests and by psychologist-subject interviews, skin damages by Glogau signs and by echography. Furthermore, the subjects have been submitted to a psychotherapeutic treatment. RESULTS: The tests and the interviews have underlined obsessive lines, dependence, bodily misperception, low index of reality. The Spearman correlations among clinical signs and echographic findings shows high significance. The psychotherapy has reduced the uneasiness in 66 women and 24 men. Each event that produces uneasiness requires a rationalization process that individualizes in successive phases logical justifications for the lived uneasiness and for the perceived consequences. The rational psycho mechanics is a new method that has identified the phase of the thought-deviation and it has planned the corrective therapy. CONCLUSION: The psychological tests, the interviews, the clinical signs and the ultrasound have allowed us to appraise the psychic and skin damages, while the method of the rational psycho mechanics seems to have brought a satisfactory therapeutic result.

[Photoaging of the skin and occupation: correlation between clinical ultrasound and histological findings]. / Il fotoinvecchiamento cutaneo e le attività lavorative: una correlazione tra i reperti clinici, ecografici ed istologici.

OBJECTIVES: We described the ultrasound (US) signs that can define occupational photoaging of the skin. We also studied the clinical importance of these signs, so as to aid the specialist in the diagnosis and evaluation of "anti-aging" treatments. PATIENTS AND METHODS: The dermis and hypodermis of 180 subjects (6 groups of 15 men and 15 women each), were studied with US test (echograph Sonora 400 MD). We used a 10 MHz probe and recorded the thickness and echogenicity of the dermis and hypodermis. US images were correlated with the histological findings of 60 patients. RESULTS: In skin not exposed to sunlight aging produces an increase in thickness and a reduction in echogenicity, whereas in photoaging there is a reduction in thickness and an increase in echogenicity of the skin. CONCLUSION: Photoaging produces an increase in elastic fibres and consequently hyperechogenicity of the dermis, while, in the advanced phase, the loss of collagen and elastic fibres justify the reduction in thickness and echogenicity of the dermis. These observations allow as to classify the US signs of the photoaging of the skin into four clinical/ultrasound stages.

[Hypermobile syndrome: functional and aesthetic damages. Observations on 50 cases]. / La sindrome ipermobile: danni funzionali ed estetici. Osservazioni su 50 casi.

BACKGROUND: Type III Ehlers-Danlos syndrome (EDS III) is a collagen defect and manifests as hypermobile joints, which cause dislocations, and fragile skin, which causes scars. There are three clinical-ultrasound (US) stages. OBJECTIVES: Diagnostic techniques are described that permit assessment of cutaneous and phalangeal impairment, and job fitness of patients with EDS III. METHODS: The Beighton scoring system (Bss) and the ultrasound test (US) of the skin and phalanxes (with Sonora Logic 400 MD and 7.5-10 MHz probes) were used in the diagnosis of 50 patients. Dislocations and scars were considered as end-point surrogates and were correlated (in a graph) to clinical-US stages and phalangeal mobility, in order to assess job fitness. RESULTS: Bss and US results agreed with the literature and differentiated the EDS III into 3 clinical stages. Dislocations involved the wrist-hand (52%), shoulder-arm (16%) and foot-ankle (32%) joints. Spearman test for correlation between joint space and scars, dislocations and phalangeal mobility showed high significance (p<0.0001%). CONCLUSION: Dislocations and scars are useful end-point surrogates in the assessment of job fitness. The correlation between Bss and US findings offers a qualitative clinical evaluation (3 clinical stages), while the graph expresses a quantitative evaluation of the biological impairment. The increase in joint mobility produces positive physiological effects (increase in agility) and negative effects (dislocations, scars) that recommend avoiding excessive load on the joints.

Type III Ehlers-Danlos syndrome: correlations among clinical signs, ultrasound, and histologic findings in a study of 35 cases.

BACKGROUND: Patients with type III Ehlers-Danlos syndrome show hypermobile joints, luxation, and minimal atrophic scars. The disease has an incidence of 9-16% and the molecular defect that underlies this subtype is unknown. In order to widen diagnostic investigations in type III Ehlers-Danlos syndrome, skin and articular areas were studied by ultrasound (US) test. METHODS: Thirty-five patients, 20 women and 15 men, aged from 18 to 25 years, with type III Ehlers-Danlos syndrome were enrolled in this study. Patients showed hypermobile joints (35 cases), minimal atrophic wrinkled scars (35 cases), and a few ice-pick acne scars. Hypermobility of phalangeal joints was studied by means of the Beighton scoring system and by a US test (performed by Sonora Logic 400 MD unit with 10 MHz probe). The following US parameters were considered: the distance of the intra-articular space and the thicknesses of the extensor tendon and of the overhanging dermis and subcutis. RESULT: US reports showed an increase in distance of the intra-articular space and a reduction in the thickness of the extensor tendon and of the dermis and subcutis covering it. The dermis showed high and homogeneous echogenicity with irregular hyperechogenic lines. CONCLUSION: The Beighton scoring system, the US findings, and the aspect and diameter of the scars suggested that the disease can be divided into three different stages which allow the correlation, over progressive intervals of values, of the articular hypermobility and atrophic wrinkled scars. Our results showed that US test is able to confirm the clinical diagnosis and to evaluate the seriousness of hypermobile joints.

[Correlations between acne and polycystic ovary. A study of 60 cases]. / Acne e ovaio policistico.

BACKGROUND: In this paper we correlated the clinical severity of the polycystic ovary with the clinical manifestation of acne. Acne is an inflammatory process of follicle sebaceous unites. Polycystic ovaries (PCOS) are characterized by several subcapsular cystic follicles with an increased production of androgens. Onset of polycystic ovaries in women with acne, ranges from 45 to 84% of cases. METHODS: Sixty patients, aged from 19 to 28 years, with acne and polycystic ovaries were enrolled. The clinical severity of acne was appraised by millimetric macrophotography. This technique evaluated subsequent phases of acne like comedo, papules or pustules, nodular or scarring lesions. Polycystic ovaries were studied by ultrasound and hormonal assay. Sonora Logic 500 MD, by GE Echography, with 3.5 MHz convex probe, were employed. US examination was performed, in each patient, on day 6th, 10th, 15th and 22th of the menstrual cycle. The following US parameters were considered: dimension of the ovaries, thickness of albuginea and number of cysts. Serum levels of FSH, LH, 17-b-estradiol, progesterone, DHEA-S, testosterone and LH/FSH ratio were determined. Furthermore, the presence of premenstrual syndrome (PMS) was evaluated. RESULTS: We found that in PCOS the increased levels of androgens can cause the onset of acne. Photographic score and ovaries ultrasonography may be useful in the assessment of the clinical association between acne and polycystic ovaries. We observed that the subsequent phases of acne were correlated with the clinical severity of polycystic ovaries and to the presence of Premenstrual Syndrome in 93% of the cases (56 of 60 patients). CONCLUSIONS: US images, compared with visual score, established the clinical association between acne and PCOS in three phases with a progressive severity.

[Ultrasound patterns of rheumatoid and psoriatic arthritis in finger joints]. / I segni ecografici dell'artrite reumatoide e psoriasica nelle articolazioni falangee.

PURPOSE: Rheumatoid and psoriasic arthritis involve proximal joints symmetrically and distal joints asymmetrically, respectively, the differential diagnosis between these two types of arthritis is not easy. Therefore we investigated which US signs could help the diagnosis and/or treatment of these conditions and compared them with radiographic patterns and articular and physical symptoms. MATERIAL AND METHODS: Fifty-one patients, 30 women and 21 men aged 19-42 years were enrolled in this study. Thirty patients had rheumatoid and 21 psoriasic arthritis. US of the skin and joints of the fingers was performed with a GE Sonora Logic 500 MD unit with 7.5 and 10 MHz scanheads. We studied the shape of articular bone heads, the intra-articular space distance and the thickness of extensor tendon and of the dermis and hypodermis covering it. These findings show the extent of damage in articular bone heads and intra-articular space and they indicate cutaneous and articular inflammation. US patterns were also compared with radiographic findings in all patients. RESULTS: US showed bone and joint and/or inflammatory damage in both types of arthritis. Articular bone heads had a bodkin-like appearance in proximal phalanges in rheumatoid arthritis, versus a hook-like appearance in distal phalanges in psoriasic arthritis. Inflammatory damage was indicated by intra-articular space thinning and by tendon, dermis and hypodermis thickening. These signs, confirmed radiographically, account for finger deformation and functional impairment, swelling and pain. CONCLUSION: US signs can help the diagnosis of rheumatoid and psoriasic arthritis. US can show inflammatory damage and the disease evolution.

[Assessment of microvascularization around the plaques in Peyronie's disease with Doppler color ultrasonography, power Doppler and ultrasonography contrast media]. / Valutazione della microvascolarizzazione intorno alla placca nella malattia di La Peyronie con eco color Doppler, power Doppler e mezzo di contrasto ecografico.

INTRODUCTION: The origin of Peyronie's disease remains obscure although the first report of this condition dates back to 1743. The disease prevalence in 388.6 in 100,000 population and little physiopathologic information is available. Repeated microtrauma to the tunica albuginea appears to favor the onset of inflammatory phenomena which result in fibrosis and calcification. The disease activity produces a microvascularization around the fibrocalcific plaques. We studied the evolution of the inflammatory process in Peyronie's disease relative to clinical symptoms, in order to optimize treatment follow-up. MATERIAL AND METHODS: We examined 20 patients with Peyronie's disease aged 34 to 56 years using a GE Sonora Logic 500 MD US scanner with linear probes of 7.5 and 13 MHz. The microvascularization around the plaques was studied with color and power Doppler investigations before contrast agent administration and with combined color and power Doppler after contrast agent administration. We injected Levovist (300 mg/mL) and 10 micrograms prostglandin E1 (PGE1). Examinations were repeated after 2-4 months in the patients with evidence of microvascularization around the plaques. RESULTS: US demonstrated fibrocalcific plaques in all the patients. The microvascularization around the plaques was seen with color Doppler in 3 cases (15%), with power Doppler in 5 cases (25%) and with contrast-enhanced color and power Doppler in 7 cases (35%). At 2-4 months' follow-up, we observed slight plaque enlargement and worsened symptoms in 5 of 7 patients (71%) with evidence of some microvascularization around the plaque. CONCLUSIONS: The plaque presence allows to define the condition and the microvascularization provides information on its evolution. The disease activity can be distinguished into 3 stages which can be related to the painful symptoms. US exhibits a better cost/benefit ratio than contrast-enhanced MRI.

[Argon laser in dermatology: indications suggested by a 4-year experience]. / Il laser ad argon in dermatologia. Indicazioni suggerite da quattro anni di esperienza.

The Argon laser has been used in the treatment of port wine stains, telangiectasias, spider ectasias, ruby spots, venous lakes, pyogenic granulomas, tattoos, keloids, verrucous naevus, angiokeratomas, verrucous hemangiomas. The outcome results have been compared with those achievable using other treatments in order to give right indications to the use of the Argon laser. The comparison point out that Argon laser is the treatment of choice only in port wine stains, while in all the other diseases it doesn't give any advantage with regard to conventional therapies, less sophisticated, easier and sometime more effective.

[Evaluation of the efficacy and tolerability of a cream soap and a non-alcoholic tonic in the therapy of rosacea]. / Valutazione dell'efficacia e della tollerabilità di un latte detergente e di un tonico non-alcolico nella terapia della rosacea.

The results of a clinical study in evaluating the effectiveness and tolerance of a detergent cream and a non-alcoholic tonic lotion are reported. The study was carried out on 20 patients affected by rosacea.