Investigating Chronotype and Sleep Quality in Psoriatic Patients: Results from an Observational, Web-Based Survey.

BACKGROUND: Psoriasis is an inflammatory disease for which the implications and repercussions go far beyond the skin. Psoriasis patients suffer not only due to its skin manifestations and related symptoms but also because of comorbidities and a huge emotional impact. OBJECTIVE: The objective of this study was to investigate chronotype and sleep quality in a group of Italian psoriatic patients. MATERIALS AND METHODS: An observational, cross-sectional, web-based study was set up by the Dermatology and Clinical Medicine Sections of the Department of Medical Sciences, University of Ferrara, Italy. The web questionnaire was sent to an email list of an Italian association of psoriatic patients with the aim of recording their main demographic, social, historical, and clinical data. The survey included two questionnaires: the Morningness-Eveningness Questionnaire (MEQ) and the Pittsburg Sleep Quality Index (PSQI). RESULTS: Two hundred and forty-three psoriatic patients (mean age 52.9 ± 12.8 yrs., 32.5% males and 67.5% females) filled out the questionnaire. A good 63.8% of them were affected with psoriasis for more than 10 years, 25.9% reported having a diffuse psoriasis, and 66.7% were on treatment at the time they completed the questionnaire. With reference to chronotype, the mean MEQ score was 55.2 ± 10.7; furthermore, 44% of the patients were "morning-oriented types", M-types, or "larks", 44.5% were "intermediate-types" or I-types, and 11.5% were "evening-oriented types", E-types, or "owls". No correlations were found between chronotype and psoriasis extension. Based on the PSQI results, 72.8% of the study population was judged to have a low sleep quality. Sleep disturbance was significantly related to female sex, living alone, and the presence of comorbidities. CONCLUSIONS: Sleep disturbance is very common in psoriatic patients, especially in those with comorbidities, in females, and in patients who live alone. The chronotype in psoriatic patients does not appear different when compared to the general population, nor does it seem to have any link with psoriasis severity.

Dietary habits of psoriatic patients treated with dimethyl fumarate and drug-related side effects: results from an observational study.

BACKGROUND: Despite its favorable long-term safety profile, side effects during dimethyl fumarate (DMF) treatment for psoriasis are not uncommon and may lead to treatment suspension. The association between side effects, especially gastrointestinal, and dietary habits has not yet been specifically addressed. METHODS: This observational, cross-sectional study aimed to assess the dietary habits of patients with moderate-to-severe plaque psoriasis in treatment with DMF who attended three Italian psoriasis clinics. Demographic and clinical data, including any side effects, were collected from the patients' medical records. A self-administered questionnaire recorded and scored: 1) if meals are eaten regularly or not; 2) daily intake at meals of fatty foods, milk and dairy products, alcohol, fruit and vegetables; and 3) in the case of side effects, the time between eating and their onset. RESULTS: We included 53 patients in treatment with DMF at a daily dose of 232.4±194.1 mg for 38±29.8 weeks. Thirty-eight (71.7%) reported side effects, namely flushing (60.5%), diarrhea (44.7%), gastralgia (29%) and nausea (15.8%). Overweight seemed associated with the occurrence of side effects. In 47.4% of subjects, side effects appeared within 2 hours of having a meal. Daily fat intake appeared to protect against side effects, albeit without statistical significance; skipping meals was correlated with their onset in subjects complaining of diarrhea. CONCLUSIONS: Finding some correlation between dietary habits and occurrence of side effects during DMF treatment requires further investigation with the aim of developing possible strategies to improve its tolerability and retention rate.

Assessment of the perceived burden associated with Malignant Melanoma with Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28).

PURPOSE: The impact of malignant melanoma (MM) on patients' psychophysical well-being has been poorly addressed. We aimed to assess the perceived burden in patients with a diagnosis of MM, using two different tools, one generic and one specific for MM, such as Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28), respectively. The correlation between PRISM and MCQ-28 subscales and the relevance of disease and patient-related variables were also investigated. METHODS: This single-centre, cross-sectional study included all adult consecutive MM patients who attended our Dermatology Unit from December 2020 to June 2021. Demographics and disease-related data were recorded. PRISM and MCQ-28 were administered. RESULTS: One hundred and seventy-one patients were included (mean age: 59.5 ±14.9 years.; 48.0% males). Median time from MM diagnosis to inclusion was 36 months. Nearly 80% of the patients had in situ or stage I MM. Overall, 22.2% of the patients reported a PRISM score <100mm and similar percentages provided scores indicating impaired quality of life, as assessed with MCQ-28 subscales. A weak, albeit significant, correlation was found between PRISM scores and ACP, CON and SOC2 subscales. The most relevant association found was that between lower PRISM scores and higher-stage MM. CONCLUSIONS: In the study population, mostly affected with superficial MM, their perception of the burden associated with MM did not appear either particularly dramatic or disabling. PRISM seems a reliable system for capturing and quantifying the domains correlated with the emotive dimension of MM, especially MM-related concerns and willingness to face life.

Dimethyl fumarate treatment for psoriasis in a real-life setting: A multicentric retrospective study.

Dimethyl fumarate (DMF) is a fumaric acid esters derivate approved for plaque psoriasis as first-line systemic therapy. It has been available in Italy since 2017 and an increasing number of patients are treated with this drug. To evaluate DMF effectiveness, side effects and drug survival in a dermatological real-life setting. We performed a retrospective multi-center study in five dermatologic clinics in Emilia-Romagna, Northern Italy, which included all consecutive patients affected by moderate-severe psoriasis treated with DMF. We assessed effectiveness (in terms of PASI50 and PASI75 in an intention to treat observation) and safety (occurrence of side effects) of DMF and their association with demographic and disease characteristics, mean daily dose taken and treatment discontinuation. We included 103 patients, 78 (75.72%) had at least one comorbidity including 19 (18.44%) with a history of cancer; the mean treatment duration was 23.61 ± 17.99 weeks (min 4, max 130) and the mean daily dose was 262.13 ± 190.94 mg. Twenty-four patients (23.30%) reached PASI75 at week 12, while a further 18 patients (17.47%) reached it at week 26. Side effects occurred in 63 patients (61.16%), the most frequent were diarrhea, epigastric discomfort, nausea, and flushing. Sixteen patients (15.53%) showed an alteration of laboratory tests. In some cases side effects were transitory, while in 53 patients (51.45%) they led to cessation of therapy. The median daily dose showed a direct association with PASI50 achievement and an indirect association with treatment discontinuation. Our study shows the peculiarities of DMF in a real-world setting: effectiveness is often reached after 12 weeks of treatment and side effects could limit the continuation of the therapy but, at the same time, DMF has no major contraindications and, due to the wide range of dosage, it can allow both to manage side effects and to personalize the prescription for each patient.

Sensori-motor integration during stance: time adaptation of control mechanisms on adding or removing vision.

Sudden addition or removal of visual information can be particularly critical to balance control. The promptness of adaptation of stance control mechanisms is quantified by the latency at which body oscillation and postural muscle activity vary after a shift in visual condition. In the present study, volunteers stood on a force platform with feet parallel or in tandem. Shifts in visual condition were produced by electronic spectacles. Ground reaction force (center of foot pressure, CoP) and EMG of leg postural muscles were acquired, and latency of CoP and EMG changes estimated by t-tests on the averaged traces. Time-to-reach steady-state was estimated by means of an exponential model. On allowing or occluding vision, decrements and increments in CoP position and oscillation occurred within about 2s. These were preceded by changes in muscle activity, regardless of visual-shift direction, foot position or front or rear leg in tandem. These time intervals were longer than simple reaction-time responses. The time course of recovery to steady-state was about 3s, shorter for oscillation than position. The capacity of modifying balance control at very short intervals both during quiet standing and under more critical balance conditions speaks in favor of a necessary coupling between vision, postural reference, and postural muscle activity, and of the swiftness of this sensory reweighing process.