Clinical Goals and Barriers to Effective Psoriasis Care.

Engaging global key opinion leaders, the International Psoriasis Council (IPC) held a day-long roundtable discussion with the primary purpose to discuss the treatment goals of psoriasis patients and worldwide barriers to optimal care. Setting clear expectations might ultimately encourage undertreated psoriasis patients to seek care in an era in which great gains in therapeutic efficacy have been achieved. Here, we discuss the option for early treatment of all categories of psoriasis to alleviate disease impact while emphasizing the need for more focused attention for psoriasis patients with mild and moderate forms of this autoimmune disease. In addition, we encourage policy changes to keep pace with the innovative therapies and clinical science and highlight the demand for greater understanding of treatment barriers in resource-poor countries.

Feasibility of daylight-mediated photodynamic therapy for actinic keratosis throughout the year in Central and South America: a meteorological study.

BACKGROUND: Daylight-mediated photodynamic therapy (DL-PDT) is an efficacious treatment option for thin actinic keratosis (AK) that offers advantages over conventional PDT in terms of tolerability, treatment duration, and cost. A clinical study conducted in Australia determined the mean irradiance during a 2-hour exposure to be 305.8 W/m(2) (range: 40-585 W/m(2) ). The protoporphyrin IX light dose is influenced by latitude, weather conditions, and time of year. A recent study of meteorological data concluded that DL-PDT can be performed effectively throughout the year in Australia. OBJECTIVES: Based on the same hypothesis and applying the same methodology, the present study investigated the suitability of daylight to perform DL-PDT in Central and South America. METHODS: Solar radiation and weather data were gathered and analyzed to assess daylight irradiance (light intensity) throughout a full year across 32 geographical locations in Central and South America. RESULTS: The minimum average daily solar irradiance reported was above 305.8 W/m(2) in all locations investigated throughout the year. Annual averages of daily irradiance ranged from 578 W/m(2) in Chihuahua, Mexico, to 321 W/m(2) in Puerto Montt, Chile. CONCLUSIONS: Daylight-mediated PDT for AK can be performed effectively throughout the year in Central and South America given that weather conditions permit a comfortable 2-hour direct exposure to daylight.

Psoriasis in Latin America.

During the last few decades, management of psoriasis has changed worldwide, owing to a better understanding of its pathophysiology and the introduction of new treatments. As experts in the field of dermatology, specialists from Latin America collaborated to develop this review and further provide an update on the current state of psoriasis management in Latin America. With the goal of summarizing the latest information on psoriasis in most countries in Latin America, we conducted a literature search to obtain relevant articles published in the medical/scientific literature in Latin American countries over the last 10 years; in addition, we completed a questionnaire comprised of 20 questions on important issues related to psoriasis. The aim of this final document isto help improve understanding and management of the disease and to help patients gain better access to new approaches and medical solutions.

Daylight-mediated photodynamic therapy for actinic damage in Latin America: consensus recommendations.

Although conventional photodynamic therapy (c-PDT) using methyl aminolevulinate cream (MAL) is effective for the treatment of grade I-II facial and scalp actinic keratosis (AK), it is associated with treatment-related pain for some patients. Daylight-mediated PDT (DL-PDT) has shown similar efficacy to c-PDT, was nearly painless, and was well tolerated. Overall, DL-PDT effectively treats AK and offers a simpler and better tolerated treatment option than c-PDT. This consensus panel provided recommendations on the use of DL-PDT in Latin America (LATAM) for the treatment of actinic damage associated with few or multiple AKs. The panel was comprised of eight dermatologists from different LATAM countries who have experience using PDT for the treatment of actinic damage. The panel reviewed the relevant literature and provided personal expertise with regard to using DL-PDT for the treatment of photodamage with or without AK. The recommendations formulated by the expert panel provide evidence-based guidelines on all aspects of DL-PDT for the treatment of actinic damage associated with AK in different regions of LATAM. These recommendations provide guidance for dermatologists to ensure maintenance of efficacy and safety of DL-PDT when treating actinic damage, associated with few or multiple AKs in sun-exposed skin.

Estudio del perfil epidemiológico del paciente con psoriasis en diferentes países de latinoamérica 2011 - 2014 / Epidemiological study of patients with psoriasis in different countries of latin america 2011-2014

La psoriasis es una enfermedad inflamatoria crónica, sistémica, que afecta la calidad de vida y sobrevida del paciente. La incidencia a nivel mundial oscila entre el 1,5% - 3%. Objetivo: Mejorar el conocimiento del paciente con psoriasis concerniente a factores clínicos, sociales y tratamientos indicados en Latinoamérica. Material y Métodos: Estudio multicéntrico, colaborativo, longitudinal, descriptivo y cuali-cuantitativo. Encuesta indirecta desarrollada entre 2011 ­ 2014. Resultados: Fueron incorporados 1672 registros. El 47,7% femenino y el 52,3% masculino. 57,3% de Argentina, 19% de Ecuador, 13,1% de Colombia, 4,7% de Cuba, 3,5% de México y con 1% Bolivia, Chile, Honduras, Paraguay, Perú y Uruguay. La psoriasis en placa estuvo presente en el 80,5% y el 95,2%, Guttata entre el 6,5% y 15,2%, y eritrodérmica (2,8%), invertida (2,2%) y pustulosa (1,3%). Comorbilidades: diabetes alrededor del 8%, resaltando Cuba con un valor del 1,3%. México con la mayor prevalencia de dislipemias (45,5%) e Hipertensión Arterial (33,9%). La calidad de vida y su afectación en el 42,3% de los pacientes y un 57,7% la encuentra alterada entre moderada y significativamente. Conclusión: Estudios colaborativos (registros regionales) como el presente son herramientas útiles para determinar características de presentación de la psoriasis en los pacientes de diferentes regiones y países. (AU)

Psoriasis is a systemic, chronic inflammatory disease that affects the quality of life and survival of patients. The worldwide incidence ranges from 1.5% - 3%. Objective: To raise awareness of psoriasis patient concerning clinical, social and treatments indicated in Latin factors. Material and Methods: A multicenter, collaborative, longitudinal, descriptive and qualitative and quantitative study. Indirect survey carried out between 2011 - 2014. Results: They were built 1672 records. 47.7% female and 52.3% male. 57.3% in Argentina, 19% in Ecuador, 13.1% of Colombia, 4.7% of Cuba, 3.,5% and 1% in Mexico and Bolivia, Chile, Honduras, Paraguay, Peru and Uruguay. Plaque psoriasis was present in 80.5% and 95.2%, Guttata between 6.5% and 15.2%, and erythrodermic (2.8%), inverted (2.2%) and pustular (1.3%). Comorbidities: diabetes around 8%, highlighting Cuba with a value of 1.3%. Mexico with the highest prevalence of dyslipidemia (45.5%) and hypertension (33.9%). The quality of life and their involvement in 42.3% of patients and 57.7% find it moderate and significantly altered. Conclusion: Collaborative studies (regional registers) as the present are useful tools for determining characteristics of presentation of psoriasis in patients from different regions and countries. (AU)

The efficacy and safety of etanercept when used with as-needed adjunctive topical therapy in a randomised, double-blind study in subjects with moderate-to-severe psoriasis (the PRISTINE trial).

OBJECTIVE: To assess the efficacy and safety of two etanercept dose regimens for psoriasis treatment. METHODS: Subjects were ≥18 years old with stable moderate-to-severe plaque psoriasis. Subjects were randomised to etanercept 50 mg once weekly (QW) or 50 mg twice weekly (BIW) double-blind for 12 weeks, followed by 50 mg QW open label in all subjects through week 24. Only mild topical corticosteroids were permitted on scalp, axillae and groin for first 12 weeks; topical medications (corticosteroids of all potencies, vitamin D analogues and combination products) were allowed as needed for second 12 weeks at physicians' discretion, consistent with "real-world" therapeutic practice. An independent ethics committee reviewed and approved the study protocol. RESULTS: At week 24, 59.9% and 78.2% in the QW/QW and BIW/QW groups achieved PASI 75 improvement. Mean percentage PASI improvement in these groups was 58.5% and 74.1% at week 12 and 70.7% and 81.3% at week 24. Although permitted from weeks 12 to 24, topical agents were used in only 27.7% and 22.6% in the QW/QW and BIW/QW groups by week 24. CONCLUSION: Both etanercept regimens were efficacious in moderate-to-severe psoriasis, although the BIW/QW regimen consistently provided higher response rates than the QW/QW regimen. More potent topical medications were used electively in <25% of subjects in each group.

High prevalence of psoriatic arthritis in a cohort of patients with psoriasis seen in a dermatology practice.

BACKGROUND/OBJECTIVES: The prevalence of psoriatic arthritis (PsA) is expected to range from 5 to 40% in individuals with psoriasis. The objective of this study was to quantify the prevalence of PsA in psoriasis patients seen in a dermatology practice and to define their characteristics using the validated Psoriatic Arthritis Screening Questionnaire (PASQ). METHODS: Patients with definite plaque psoriasis (as determined by a dermatologist) completed the self-administered PASQ tool, and patients with a score ≥ 7 or ≥ 9 were assessed by a rheumatologist to ascertain the diagnosis of PsA according to the CASPAR (Classification Criteria for Psoriatic Arthritis) criteria. RESULTS: Using a PASQ cutoff of 7, the estimated prevalence (95% CI) of PsA was 40.9% (29.0-52.8%), whereas a prevalence (95% CI) of 36.4% (24.8-48.0%) was estimated when a PASQ cutoff of 9 was used. CONCLUSION: Our estimated prevalence of PsA in psoriasis patients from a population of patients drawn from a dermatology practice is greater than most previous estimates. This finding illustrates the importance of screening for PsA in psoriasis patients as this comorbidity may affect the course of treatment and, if left untreated, may have a profound effect on the disability and quality of life of a large number of psoriasis patients.

[Lichen nitidus. Report of two cases, one of them with a generalized distribution]. / Liquen nitidus. Presentación de dos casos, uno de ellos generalizado.

Lichen nitidus is a dermatosis of unknown origin, characterized by the presence of shiny, pinpoint, skin-colored papules that may be asymptomatic or slightly pruriginous. They usually affect forearms, abdomen, buttocks and genitals. We report two cases, one of them with a generalized presentation. Both were treated with topical steroids with good results. A review of this pathology and its therapeutic options is held.

Liquen nitidus. Presentación de dos casos, uno de ellos generalizado / Lichen nitidus. Report of two cases, one of them with a generalized distribution

El liquen nitidus es una dermatosis de origen desconocido caracterizada por pequeñas pápulas brillantes, color piel normal, del tamaño de la cabeza de un alfiler, asintomáticas o ligeramente pruriginosas, que se localizan principalmente en antebrazos,abdomen, glúteos y genitales. Presentamos dos casos, uno de ellos generalizado. En ambos pacientes se indicaron corticoides tópicos y emolientes; con buena respuesta.Se realiza una revisión de esta patología y sus posibilidades terapéuticas

Liquen nitidus. Presentación de dos casos, uno de ellos generalizado / Lichen nitidus. Report of two cases, one of them with a generalized distribution

El liquen nitidus es una dermatosis de origen desconocido caracterizada por pequeñas pápulas brillantes, color piel normal, del tamaño de la cabeza de un alfiler, asintomáticas o ligeramente pruriginosas, que se localizan principalmente en antebrazos,abdomen, glúteos y genitales. Presentamos dos casos, uno de ellos generalizado. En ambos pacientes se indicaron corticoides tópicos y emolientes; con buena respuesta.Se realiza una revisión de esta patología y sus posibilidades terapéuticas (AU)

Liquen nitidus. Presentación de dos casos, uno de ellos generalizado / Lichen nitidus. Report of two cases, one of them with a generalized distribution

El liquen nitidus es una dermatosis de origen desconocido caracterizada por pequeñas pápulas brillantes, color piel normal, del tamaño de la cabeza de un alfiler, asintomáticas o ligeramente pruriginosas, que se localizan principalmente en antebrazos,abdomen, glúteos y genitales. Presentamos dos casos, uno de ellos generalizado. En ambos pacientes se indicaron corticoides tópicos y emolientes; con buena respuesta.Se realiza una revisión de esta patología y sus posibilidades terapéuticas (AU)

Unusual variants of mycosis fungoides.

Unusual variants of mycosis fungoides (MF) differ substantially from the classical presentation, and most of them resemble other dermatologic diseases. The authors reviewed files of patients with MF who consulted our clinic between November 1995 and June 2010 to evaluate the relative frequency and clinical behavior of these variants. Among 98 patients with MF, 32 (32.65%) had unusual variants. The most common types included follicular MF (31.25%), hypopigmented MF (18.75%), poiquilodermic MF (15.6%), and erythrodermic MF (12.5%). Less common variants included unilesional MF, bullosa MF, ichthyosiform MF, granulomatous slack skin, and pigmented purpura-like MF. Progressive disease and MF-related death were most commonly associated with follicular MF, bullosa MF, and erythrodermic MF.

[Urticaria pigmentosa: two different clinical presentations in pediatric patients]. / Urticaria pigmentosa: dos presentaciones clínicas diferentes en pediatría.

Urticaria pigmentosa (UP) is the most frequent clinical feature of cutaneous mastocytosis. It usually begins in a bimodal way: a peak of incidence from birth to the age of 3 and the other one between 2(nd) and 6(th) decades of life. Darier's sign is constant over the affected skin without affecting the surrounding skin. When UP starts early, it has a good prognosis disappearing into adolescence, while late onset is often associated with persistent or systemic involvement. This article reports two cases of UP, one with the classic description of the disease and the other with an unusual clinical presentation, prompting the pediatrician to incorporate both forms as different manifestations of the same entity.

Urticaria pigmentosa: dos presentaciones clínicas diferentes en pediatría / Urticaria pigmentosa: two different clinical presentations in pediatric patients

La urticaria pigmentosa es la forma más común de mastocitosis cutánea. Suele iniciarse de manera bimodal: un pico de incidencia desde el nacimiento hasta los 3 años de vida y otro entre la 2ª y 6ª décadas de la vida. El signo de Darier es constante sobre el área afectada, sin extenderse a piel vecina. La forma de comienzo precoz tiene buen pronóstico y desaparece hacia la adolescencia, pero la de comienzo tardío suele ser persistente o asociarse a afectación sistémica. Se comunican dos casos de urticaria pigmentosa, uno con la descripción clásica de la enfermedad y otro con presentación clínica infrecuente, por lo cual el pediatra debe incorporar ambas formas como manifestaciones distintas de una misma entidad.

Urticaria pigmentosa (UP) is the most frequent clinical feature of cutaneous mastocytosis. It usually begins in a bimodal way: a peak of incidence from birth to the age of 3 and the other one between 2nd and 6th decades of life. Darier's sign is constant over the affected skin without affecting the surrounding skin. When UP starts early, it has a good prognosis disappearing into adolescence, while late onset is often associated with persistent or systemic involvement. This article reports two cases of UP, one with the classic description of the disease and the other with an unusual clinical presentation, prompting the pediatrician to incorporate both forms as different manifestations of the same entity.

Epidemiología y genética de la psoriasis / Epidemiology and genetics of psoriasis

La psoriasis es una enfermedad multifactorial, condicionada por numerosos genes que influencian las distintas manifestaciones clínicas de la enfermedad, así como su prevalencia e incidencia en distintas poblaciones étnicas. En los países con mejores estadísticas, la prevalencia oscila entre el 0,2 y el 4,8%, mientras que la incidencia en los Estados Unidos es de 150.000 casos nuevos por año y en el Reino Unido, de 14 por 10.000 personas por año. Se han descripto numerosos locus que confieren susceptibilidad a la enfermedad, conocidos como PSORS; el PSORS I es el de mayor frecuencia en la población de ascendencia europea, y está relacionado con el MHC (complejo mayor de histocompatibilidad). Otros locus menos frecuentes están relacionados también con distintos aspectos de la inmunidad innata y adquirida, así como con el control de la queratinización. Mediante la detección de polimorfismos de un solo nucleótido, se han descripto otros genes que podrían influenciar y conferir riesgo de padecer psoriasis, aunque ninguno de ellos es patognomónico de la enfermedad ni sirve como biomarcador ya sea para el diagnóstico, pronóstico o como respuesta terapéutica a un medicamento en particular.

Psoriasis is a multi-factorial disease regulated by numerous genes influencing the varied clinicalmanifestations of the entity, as well as their prevalence and incidence in different ethnic populations.In countries with trustworthy statistics, prevalence oscillates between the 0, 2 and the 4,8%, whereas the incidence in the United States of America is of 150,000 new cases per year and inthe United Kingdom is of 14 /10,000 person-year. Numerous locus have been described that confersusceptibility to the disease, known as PSORS, being PSORS I the one with greatest frequencyin the population of European ancestry and related to the MHC. Others loci, less frequent, are alsorelated to different aspects from the innate and acquired immunity, as well as to the control of thekeratinization. By means of the detection of polymorphisms of a single nucleotide, other geneshave been described that could influence and confer risk of suffering psoriasis, although none ofthem is specific of the disease nor serve as biomarker for the diagnosis, prognosis or therapeuticresponse to a specific treatment.

Enfermedad de Darier diseminada / Extended Darier´s disease

La enfermedad de Darier o disqueratosis folicular es una genodermatosis poco frecuente. Se caracteriza por presentar pápulas hiperqueratósicas aisladas o con tendencia a confluir en áreas seborreicas del tronco y rostro. Pueden estar comprometidas las manos, pliegues, uñas y mucosas. Comienza generalmente en la pubertad y tiene un curso crónico con respuesta variable al tratamiento. Presentamos una paciente de 20 años de edad con enfermedad de Darier, que compromete áreas seborreicas del tronco, rostro y cuero cabelludo, así como miembros superiores e inferiores en casi toda su superficie. Recibió como tratamiento isotretinoína 40 mg/día vía oral durante 16 semanas con excelente respuesta y sin recidiva durante un año de seguimiento.

Efalizumab in the Treatment of Scalp, Palmoplantar and Nail Psoriasis: Results of a 24-Week Latin American Study.

INTRODUCTION: Plaque-type psoriasis affecting the nails, scalp, hands or feet can often be difficult to treat; for example, topical treatments and phototherapy may not penetrate the nail plate or scalp. The objective of this large, international, multicentre study was to investigate the efficacy of efalizumab in a Latin American population of adult patients with moderate-to-severe chronic plaque psoriasis who were candidates for systemic therapy or phototherapy. METHODS: Eligible patients were enrolled in a 24-week, open-label, single-arm, Phase IIIb/IV study of continuous treatment with subcutaneous efalizumab, 1.0 mg/kg/wk. Involvement of the nails, scalp, or hands or feet was assessed using the Nail Psoriasis Severity Index (NAPSI), the Psoriasis Scalp Severity Index (PSSI), or the Palmoplantar Pustulosis Psoriasis Area and Severity Index (PPPASI), respectively. Missing data were handled using a last observation carried forward or nonresponder imputation approach. RESULTS: Of the 189 patients who received treatment, 112 patients had nail involvement, 172 had scalp involvement, and 19 had palmoplantar disease at baseline. At Week 24, >/=50% improvement on the NAPSI, PSSI and PPPASI was observed in 31%, 71% and 68% of patients, respectively, whereas >/=75% improvement on these scores was observed in 17%, 52% and 63%, respectively. Descriptive statistics showed lower NAPSI-75 and higher PSSI-75 and -50 response rates among patients with higher baseline scores. CONCLUSIONS: This open-label, uncontrolled study provides supportive evidence of the potential of efalizumab as a treatment for nail, scalp and palmoplantar psoriasis.

Control of Moderate-to-Severe Plaque Psoriasis with Efalizumab: 24-Week, Open-Label, Phase IIIb/IV Latin American Study Results.

INTRODUCTION: Psoriasis is a debilitating, chronic inflammatory systemic disease affecting around 2% of the South American population. Biological therapies offer the possibility of long-term therapy with improved safety and efficacy. METHODS: We conducted a multicentre, open-label, single-arm, Phase IIIb/IV study of adult patients (18-75 years) with moderate-to-severe plaque psoriasis who were candidates for systemic therapy or phototherapy. Patients received efalizumab subcutaneously (1.0 mg/kg/wk). The primary endpoint was the proportion of patients achieving a Physician Global Assessment (PGA) rating of "excellent" or "cleared" at Week 24. Safety outcomes were adverse events (AEs), serious AEs (SAEs) and abnormalities on laboratory tests. RESULTS: Of 189 patients included in the intent-to-treat and safety populations, 104 (55.0%) were of Hispanic or Latino ethnicity. At Week 24, 92/189 (48.7%) patients achieved or maintained a PGA rating of "excellent" or "cleared". AEs were reported by 161/189 (85.2%) patients, SAEs by 21/189 (11.1%). One patient died during the study (meningoencephalitis). Laboratory findings were consistent with previous experience. CONCLUSIONS: Efalizumab demonstrated sustained control of psoriasis up to 24 weeks in patients from Latin America, confirming results seen in Phase III studies conducted in North America and Europe.