ABSTRACT
Skin, the body’s largest organ, protects from deleterious environmental impacts (physical, chemical, microbiological) and is crucial for the maintenance of temperature, electrolyte and fluid balance and tactile sensation, it sets a boundary between the organism and the environment. Any change in the normal skin texture disturb the patient both mentally and physically. Psoriasis is a common, chronic, recurrent inflammatory disease of the skin, characterized by circumscribed, erythematous, dry, scaly plaques of varying sizes. The severity of psoriasis is found to be ever fluctuating. Individuals are likely to cycle between differing levels of severity throughout lifetime. The course of the disease is punctuated by spontaneous flare-ups and remissions. Psoriasis being a chronic and often disfiguring condition, cause a marked impairment in quality of life. There is no certain cure for this disease. Ayurvedic diagnosis is as Vatha-Kapha predominant Mahakushta namely Sidhma kushta. Here an effort to treat a 13-year-old child having plaque psoriasis by Samsodhana and Samsamana therapy. Initially 6 days Virechana was performed and then followed by Samsamana with intermittent Virechana karma. PASI score is used to assess the severity of psoriatic lesions and the patient’s response to treatment. PASI score before the treatment was found to be 15.7 which became 0 at the end of the treatment. This case report showed the treatment modalities done in the patient obtained great result with no recurrence in the last 1.5 years.
ABSTRACT
Background@#Psoriasis vulgaris is a chronic immune-mediated inflammatory multi-system disease characterised by keratinocyte hyperproliferation. Data regarding patients’ disease severity, knowledge and quality of life (QOL) is important to optimize treatment strategies for psoriasis. This study aims to evaluate and investigate the relationship between disease severity, knowledge and QOL of patients with psoriasis. @*Methods@#A cross-sectional multicentre study utilizing a socio-demographic data collection form, Psoriasis Knowledge Assessment Questionnaire (PKAQ), Dermatology Life Quality Index (DLQI) and Psoriasis Area and Severity Index (PASI was conducted. Correlations between PKAQ, DLQI and PASI were analysed using Spearman’s test. @*Results@#A total of 114 subjects participated in this study. Majority of them had mild psoriasis (n=73, 64%) based on PASI. The mean score of PKAQ was fourteen out of a total possible score of twenty-five, whereas the DLQI had a non-parametric distribution with a median (interquartile range) of 7 (10). Most subjects (32.5%) stated that psoriasis had a ‘moderate effect’ on their QOL, while only 3.5% said that it had an ‘extremely large effect’ on their QOL. There was a statistically significant correlation between PASI and DLQI (rs = 0.264, p = 0.004), with higher PASI scores corresponding to higher DLQI scores. No statistically significant correlation was found between DLQI and PKAQ (rs = -0.048, p= 0.612), and between PASI and PKAQ (rs = 0.058, p= 0.542).@*Conclusion@#Impairment of QOL was positively associated with severity of psoriasis. However, there was no significant relationship between knowledge and quality of life, as well as between knowledge and psoriasis severity.
Subject(s)
Patient Acuity , Patient Health QuestionnaireABSTRACT
ABSTRACT BACKGROUND: Psoriatic arthritis is the most frequent and impactful comorbidity among psoriatic patients and appears in most cases after skin disease. Dermatologists play a key role in its early diagnosis and treatment. OBJECTIVE: To determine the prevalence of psoriatic arthritis and associated variables among patients with plaque psoriasis seen at a reference center for treating psoriasis. DESIGN AND SETTING: Retrospective cross-sectional study conducted among 300 patients at an outpatient clinic in a university center in Juiz de Fora, MG, Brazil. METHODS: Standardized records of 300 patients with plaque psoriasis were examined. Demographic data and medical variables relating to psoriasis (Psoriasis Area and Severity Index (PASI), family history, age at onset and disease progression) and psoriasis arthritis (CASPAR criteria) were evaluated. Laboratory and radiographic tests in the medical records were reviewed. RESULTS: Seventy-three (24.3%) of these 300 patients with plaque psoriasis had psoriatic arthritis. Asymmetric oligoarthritis (58.9%) was the most common clinical form, followed by polyarthritis (20.5%), distal interphalangeal arthritis (15.2%) and spondyloarthritis (5.4%). Dactylitis was present in 21.9% and enthesitis in 35.6% of patients. Compared with patients without arthritis, patients with arthritis had higher average age, higher frequency of positive family history of psoriasis, longer duration of evolution and higher PASI rates. CONCLUSION: Psoriatic arthritis is often underdiagnosed. Since dermatologists perform the initial approach, these professionals need to be trained to diagnose this comorbidity and treat it, together with rheumatologists.
Subject(s)
Humans , Psoriasis/complications , Psoriasis/epidemiology , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/epidemiology , Brazil/epidemiology , Prevalence , Cross-Sectional Studies , Retrospective StudiesABSTRACT
Objective To investigate the correlation between plasma-soluble urokinase plasminogen activator receptor (suPAR) levels and disease severity in psoriasis patients.Method 60 psoriasis patients and 60 healthy controls were enrolled from Jan.2013 to Dec.2015 in the hospital.The plasma suPAR of all objects were measured by ELISA.Kruskal-Wallis and Mann-Whitney U test were used to compared plasma suPAR in the difference groups.Correlation between clinical data and plasma suPAR were analyzed by Spearmans's rho method.Result The plasma suPAR of psoriasis patients (3.92± 1.74 ng/ml) were higher than controls (3.03 ± 1.08 ng/ml,Z=13.05,P=0.009).The plasma suPAR of mild patients (PASI＜ 10) were lower than moderate patients (10≤ PASI≤ 20,3.90 ± 1.67 ng/ml,Z =8.00,P =0.035) and severity patients (PASI＞20,4.55 ± 1.88 ng/ml,Z=48.5,P=0.031).Positive correlation were found between plasma suPAR and psoriasis area and severity dndex (PASI) score (r=0.264,P=0.041).The plasma suPAR of the patients with disease duration＞10years (n=35,4.43 ± 1.98 ng/ml) were higher than the patients with disease duration＜10 years (n=25,3.41 ± 0.69 ng/ ml,Z=-2.064,P=0.035).Conclusion There was a positive correlation between the plasma suPAR and psoriasis disease severity.The Plasma suPAR can be the biomarker of psoriasis disease severity.It facilitate the clinical diagnosis of psoriasis.
ABSTRACT
Objective To investigate the characteristics and the clinical significance of relevant parame-ters of blood in psoriasis vulgaris(PV). Methods A retrospective analysis among 38 PV patients and 40 normal controls was done. The comparing parameters contained NLR,CRP,total cholesterol,triglyceride,serum uric acid.Pearson correlation analysis was used to detect the correlations.Results NLR,total cholesterol,triglyceride, serum uric acid in psoriasis vulgaris patients were significantly higher than in the normal controls(P < 0.05). There was a statistically significant correlation between NLR and PASI in the PV patients,but no correlation of CRP with NLR and PASI(P > 0.05). In the patients with PASI ≥ 7,the serum uric acid level was significantly higher than in those with PASI < 7. Conclusions NLR is indicateive of the severity and state of inflammation. The severer PV,the higher the level of serum uric acid.
ABSTRACT
Objetivo: Estimar o custo por resposta dos medicamentos biológicos no tratamento da psoríase moderada a grave sob as perspectivas do Sistema de Saúde Suplementar (SSS) e Sistema Único de Saúde (SUS), representado pela Secretaria de Estado da Saúde de São Paulo, no Brasil. Métodos: Quatro medicamentos biológicos foram considerados na análise: adalimumabe, etanercepte, infliximabe e ustequinumabe. Os dados de eficácia foram obtidos de uma metanálise publicada, que avaliou a resposta PASI 75 dos medicamentos na semana 24 de tratamento. O custo do tratamento foi obtido considerando o preço de aquisição dos medicamentos, conforme perspectiva analisada, e a posologia preconizada na bula de cada um deles. Análise de sensibilidade foi conduzida a fim de avaliar o impacto das incertezas nos resultados encontrados. Resultados: A análise mostrou que, sob a perspectiva do SSS, ustequinumabe apresentou o menor custo por resposta PASI 75 (R$ 66.371) por ano de tratamento, seguido por infliximabe (R$ 139.605), adalimumabe (R$ 152.501) e etanercepte (R$ 179.812). Resultado semelhante foi observado na perspectiva do SUS, no qual ustequinumabe apresentou custo por resposta PASI 75 de R$ 47.229, seguido por infliximabe (R$ 75.145), adalimumabe (R$ 90.292) e etanercepte (R$ 130.523). Ajuste de dose para ustequinumabe mostrou ser o parâmetro mais sensível na análise de sensibilidade. Conclusão: Avaliações econômicas são ferramentas importantes para auxiliar gestores de saúde no processo de tomada decisão. A presente análise mostrou que, dentre as alternativas comparadas, ustequinumabe é o medicamento biológico que apresenta o menor custo por resposta PASI 75 (mais custo-efetivo), independentemente da perspectiva analisada (público ou privado).
Objective: To estimate the cost per responder of biologic drugs in moderate to severe psoriasis treatment from the private and public (State Health Secretariat of São Paulo) perspectives in Brazil. Methods: Four biologic drugs were considered in the analysis: adalimumab, etanercept, infliximab and ustekinumab. Efficacy data was obtained from a published metanalysis, which evaluated PASI 75 response after treatment with biologic drugs after 24 weeks of treatment. The cost of treatment was obtained considering drug acquisition cost, according to the analyzed perspective, and dosage according to each drug information label. Sensitivity analysis was performed to evaluate the impact of uncertainty in the results. Results: The analysis demonstrated that, from the private perspective, ustekinumab presented lower cost per PASI 75 response (R$ 66,371), in one year of treatment, followed by infliximab (R$ 139,605), adalimumab (R$ 152,501), and etanercept (R$179,812). Similar results were found from public perspective, with ustekinumab presenting a cost per PASI 75 response of R$ 47,229 per year of treatment, followed by infliximab (R$ 75,145), adalimumab (R$ 90,292) and etanercept (R$ 130,523). Dose adjustment for ustekinumab was shown to be the most sensitive parameter in the sensitivity analysis. Conclusion: Economic evaluations are important tools to support payers during the decision making process. The current analysis demonstrated that, among compared options, ustekinumab is the biologic with the lowest cost per PASI 75 responder (more cost-effective), regardless the perspective considered (public or private).
Subject(s)
Humans , Psoriasis , Unified Health System , Biological Products , Supplemental HealthABSTRACT
T lymphocytes are important in the pathogenesis of psoriasis, and increasing evidence indicates that B cells also play an important role. The mechanisms of action, however, remain unclear. We evaluated the ratios of CD19+ B cells in peripheral blood mononuclear cells (PBMCs) from 157 patients with psoriasis (65 patients with psoriasis vulgaris, 32 patients with erythrodermic psoriasis, 30 patients with arthropathic psoriasis, and 30 patients with pustular psoriasis) and 35 healthy controls (HCs). Ratios of CD19+ B cells in skin lesions were compared with non-lesions in 7 erythrodermic psoriasis patients. The Psoriasis Area Severity Index (PASI) was used to measure disease severity. CD19+ B cell ratios in PBMCs from psoriasis vulgaris (at both the active and stationary stage) and arthropathic psoriasis patients were higher compared with HCs (P<0.01), but ratios were lower in erythrodermic and pustular psoriasis patients (P<0.01). CD19+ B cell ratios in erythrodermic psoriasis skin lesions were higher than in non-lesion areas (P<0.001). Different subsets of CD19+CD40+, CD19+CD44+, CD19+CD80+, CD19+CD86+, CD19+CD11b+, and CD19+HLA-DR+ B cells in PBMCs were observed in different psoriasis clinical subtypes. PASI scores were positively correlated with CD19+ B cell ratios in psoriasis vulgaris and arthropathic psoriasis cases (r=0.871 and r=0.692, respectively, P<0.01), but were negatively correlated in pustular psoriasis (r=-0.569, P<0.01). The results indicated that similar to T cells, B cells activation may also play important roles in different pathological stages of psoriasis.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Psoriasis/blood , B-Lymphocyte Subsets/immunology , Antigens, CD19/blood , Psoriasis/immunology , Severity of Illness Index , Lymphocyte Activation , Biomarkers/blood , Lymphocyte Count , Antigens, CD19/immunology , Flow CytometryABSTRACT
Background: Systemic therapy with methotrexate is a very useful modality in psoriasis, but relapses can occur soon after stopping it. Aim: To compare the relapse rates in psoriasis with two different tapering regimens of methotrexate after control is achieved. Methods: This was a randomized open-label controlled study, and patients of chronic plaque psoriasis with psoriasis area and severity index (PASI) >10 were included. Methotrexate 0.3 mg/kg weekly was given and the PASI calculated every 2 weeks. After achieving a 75% reduction in the PASI (PASI-75), patients were assigned randomly in to one of three groups. In the half-dose group, the dose of methotrexate was reduced to half and given weekly; in the 2-weekly group, the same dose was given at 2-week intervals; in the control group, methotrexate was stopped. Patients were followed up for 12 weeks. Results: Out of 141 registered patients, 81 were included: 27 in the half-dose group, 28 in the 2-weekly group, and 26 in the control group. After further exclusions due to adverse effects and loss to follow-up, the results were analysed for 16, 17 and 19 patients respectively in the 3 groups. There was statistically a highly signifi cant difference in relapse rates between the half-dose and control groups (P < 0.001), and a signifi cant difference between the 2-weekly and control groups (P = 0.001). Relapse rates in the half-dose and 2-weekly groups did not show a signifi cant difference (P = 0.680). Limitation: Many (35.8%) patients were excluded and only 52 (64.2%) completed the study. Conclusion: There appears to be no signifi cant difference in the frequency of relapse in psoriasis whether methotrexate is tapered by halving the weekly dose or by doubling the interval between two doses, and both methods led to fewer relapses than abrupt cessation of the drug.
Subject(s)
Adult , Dose-Response Relationship, Drug , Humans , Methotrexate/administration & dosage , Psoriasis/drug therapy , Randomized Controlled Trials as Topic , Recurrence , Severity of Illness IndexABSTRACT
Objective To detect the level of IL-10 and IL-21 in serum of patients with psoriasis and explore its significance of judge the extent of serious condition and treatment of psoriasis.Methods According to clinical dermatology edited by Zhao Bian diagnostic criteria,selected 65 cases of patients with psoriasis during the period from March to September in 2014 ad-mitted to Department of Dermatology of out-patient and hospitalization.25 cases were progressive stage (group A),20 pa-tients with stable stage (group B),20 patients were in recovery period (group C),and 25 cases of control group (group D). With ELISA method detect the expression level of IL-10 and IL-21 in serum of each group respectively.PASI score will take to all psoriasis patients meanwhile.Results The expressionlevels of IL-21 in serum of A (127.59 ± 16.09 pg/ml),B (105.74±21.08 pg/ml)two groups were significantly higher than that in D group (85.46±14.25 pg/ml),and the differ-ence were statistically significant (t=5.174,4.863,both P <0.01),while the expression levels of IL-10 in A (10.64±3.23 pg/ml)and B (12.27±2.18 pg/ml)were both lower than D group (20.29±2.51 pg/ml),and the difference were statisti-cally significant (t=2.031,2.027,both P <0.05).The expression of IL-21 (94.03±8.90 pg/ml)in C group was higher than that in D group,and the difference was statistically significant (t=2.033,P <0.05).The level of IL-21 in A group was higher than that in group C,and the difference was statistically significant (t=2.352,P <0.05),while the expression level of IL-10 was lower than that in C group (19.69±1.54 pg/ml),and the difference was statistically significant (t=2.071,P<0.05).The expression level of IL-21 in the serum of patients with psoriasis and PASI score was positively correlated (r=0.508,P =0.027),while the expression level of IL-10 and PASI score was negatively correlated (r=-0.413,P =0.039). Conclusion The progression of psoriasis is related to the increasion of IL-21 or the decreasion of IL-10.The detection of IL-21 and IL-10 was beneficial to judge the severity and efficacy evaluation of psoriasis.
ABSTRACT
Background: Psoriasis is a common and recurrent proliferative inflammatory skin disease that has been associated with abnormal plasma lipid metabolism and with high frequency of cardiovascular morbidity and mortality. The prevalence seems to be related to the severity of psoriasis, as it occurs more frequently in patients presenting with large areas of the body affected with lesions. The aim of our work was to evaluate the development of dyslipidemia in psoriasis, and to look for a correlation between their levels and severity of diseases in which the risk factors and secondary causes of hyperlipidemia were excluded. Methods: We evaluated the fasting lipid profile in twenty-four patients with mild to moderate psoriasis and twenty-four age and gender matched healthy subjects as the control group. Results: Patients presented risk changes in lipid profile, serum total cholesterol (p<0.001), triglyceride (p<0.01), LDL-cholesterol (p<0.001), VLDL-cholesterol (p<0.01) and TC/HDL ratio (p<0.01) were found to be significantly higher than in control group. No significant statistical difference was observed between HDL levels of the two groups. Significant positive correlation in total cholesterol and LDL-cholesterol was found between mild and moderate psoriasis (PASI score) as compared with controls. Conclusion: Our data suggest that psoriasis patients must be considered as a group at high risk for cardiovascular, since psoriasis per se seems to be associated with risk changes in the lipid profile. We conclude that psoriatic patients should be evaluated and followed up for the risk of hyperlipidemia and cardiovascular diseases.
ABSTRACT
BACKGROUND: Evidence for superior outcome by adhering to therapy guidelines is imperative to their acceptance and adaptation for the optimal management of disease variants. OBJECTIVE: Comparative study of prospective outcomes in simultaneous consideration of independent variables in groups of 150 patients of plaque psoriasis either treated adhering to or in digression of standard guidelines. METHODS: The psoriasis area severity index (PASI) and the dermatology life quality index (DLQI), prior to and after three months of uninterrupted therapy were examined in treatment groups among 150 patients. Recovery rates of 75% or more in PASI were compared. Independent variables were also examined for their bearing on the outcome. RESULTS: The vast majority was early onset disease phenotype. All three treatment regimens when administered in adherence to the guidelines yielded significantly superior rates of defined recovery both in PASI and DLQI. Compromise of the therapeutic outcome appeared in high stress profiles, obesity, female sex and alcohol, tobacco or smoking habit. CONCLUSION: Conventional drug therapy of plaque psoriasis yields superior outcome by adhering to the consensus guidelines. Psychiatric address to stress must be integral and special considerations for phenotypic/syndromic variants is emphasized for effective therapy of psoriasis.
Subject(s)
Female , Humans , Consensus , Dermatology , Obesity , Phenotype , Prospective Studies , Psoriasis , Quality of Life , Smoke , Smoking , Tobacco , UrsidaeABSTRACT
Introduction: Smoking is a risk factor for development of psoriasis. The severity of psoriasis has also been associated with smoking. Smoking may be an important modifiable factor in psoriasis treatment. Reduction or cessation of smoking in psoriasis patients is relevant as psoriasis is also associated with cardiovascular disease. Objectives: This study aims to determine the association between smoking and severity of psoriasis, and to investigate the frequency of concomitant cardiovascular risk factors in our psoriasis patients. Method: A 6-month prospective, controlled study. Consecutive patients with chronic plaque psoriasis attending Dermatology Clinic, Kuala Lumpur Hospital were screened. Smokers were identified, age, gender and ethnic matched non-smokers were recruited. Patients were evaluated for Psoriasis Severity Index (PASI) and body surface area (BSA) affected by psoriasis. Results: A total of 89 chronic plaque psoriasis patients were screened. Twenty four smokers and 24 matched non-smokers were included in the study. There were no significant differences in the presence of medical co-morbidities, blood pressure, body mass index (BMI), age of psoriasis onset and duration of disease in both groups. The mean age patients started smoking was 20.2±5.6 years, the mean duration of smoking was 16.3±11.1 years, the number of cigarette per day 11.9±6.1 sticks and the number of cigarette pack years was 10.7±9.2. BSA affected by psoriasis and PASI score were significantly higher in the subjects who smoked compared to the non smokers. Conclusion: Smoking is associated with more severe psoriasis in terms of BSA and PASI. Cardiovascular risk factors are common in psoriasis patients. These patients (smokers and non-smokers) require interventions to reduce their cardiovascular risks.
ABSTRACT
Background: Methotrexate has been widely used as an effective systemic therapy for psoriasis. Retrospective data showed efficacy rate of 70-80% but recent RCTs using PASI 75 as primary endpoint showed wide variations in efficacy. Different dosing regimens for methotrexate may explain this variation. Objectives: To compare the efficacy and tolerability of two different dosing regimes of oral methotrexate in patients with moderate to severe plaque psoriasis. Methods: A prospective comparative study was conducted from October 2009 to June 2010. Patients with moderate-to-severe plaque psoriasis were randomized to receive either a ‘step-up dose’ regime (starting dose 7.5mg) or a ‘step-down dose’ regime (starting dose 20mg) of oral methotrexate for 16 weeks. The primary efficacy endpoint was PASI 75. Tolerability and safety were assessed. Results: Forty patients received oral methotrexate with equal numbers in each arm. After 16-week, 55% (11) of patients in ‘step-up dose’ group and 65% (13) of patients in ‘step-down dose’ group achieved PASI 75 (p > 0.05). Significantly higher number of patients in ‘step-down dose’ group achieved PASI 75 at week 4 and week 8 (p < 0.05) compared to ‘step-up dose’ group. One patients from ‘step-down dose’ group discontinued study prematurely due to adverse effect but no significant difference in rate of adverse events was noted. Conclusion: There was no significant difference in efficacy between both regimes at the end of 16 weeks but significant efficacy was observed in patients on ‘step-down dose’ regime as early as week 4. The side effect profile and tolerability were similar.
ABSTRACT
BACKGROUND: Psoriasis is a chronic relapsing skin disorder that is characterized by abnormal epidermal proliferation, inflammation and angiogenesis. It causes emotional and social consequences that go far beyond the skin; therefore, many methods to measure and monitor the severity of psoriasis have been reported. OBJECTIVE: This study aims to evaluate the usability of the flow cytometric analysis of the T cell subsets and their chemokine receptors in the peripheral blood of the psoriasis patients as a severity index. METHODS: The T cell subsets and their chemokine receptor expression (CXCR3, CCR4) in the circulating blood of thirty psoriasis patients (PASI score:2.2~44.2) and twenty healthy controls were examined by flow cytometry. The relationship between the PASI score and the T cell subsets/chemokine receptors was also analyzed. RESULTS: The patients showed significantly higher number of Tc1 (CD8+CXCR3+), Tc2 (CD8+CCR4+) and CXCR3/CCR4 expressing cells than did the control group. Especially, the moderate to severe patients (a PASI score greater that 5) showed a higher number of Tc1, Tc2 and CCR4 expressing cells than did the control group. In the severe patients (a PASI score greater than 10), the frequency of circulating Tc2 cells and CCR4 expressing cells was directly correlated with the PASI score. CONCLUSION: Our findings suggest that flow cytometric analysis of the circulating T cell subsets with further classification could serve as an indicator of the disease severity in psoriasis patients.
Subject(s)
Humans , Flow Cytometry , Inflammation , Organothiophosphorus Compounds , Psoriasis , Receptors, Chemokine , Skin , T-Lymphocyte Subsets , T-Lymphocytes, CytotoxicABSTRACT
OBJETIVO: Evaluar el índice de severidad del área de psoriasis (PASI) en 349 pacientes nuevos que ingresaron al programa de Psoriasis del Hospital Nacional Daniel Alcides Carrión (HNDAC) en el período 1996-2005. MATERIAL Y MÉTODOS: Estudio descriptivo, retrospectivo y observacional. Se recolectó los informes de las evaluaciones del PASI realizadas en la primera consulta del paciente psoriásico que ingresaba al programa y se correlacionó con la edad, sexo y tiempo de enfermedad. Se realizó estadística univariada y bivariada con las pruebas estadísticas del Chi Cuadrado y U de Mann Whitney con un nivel de confianza del 95 por ciento. RESULTADOS: La edad promedio de los pacientes fue de 42.6 años, con predominio de psoriasis tipo II. Se obtuvo un promedio general de PASI de 12.3 (Psoriasis leve). En los varones el PASI promedio fue de 15.04 y en las mujeres de 9.37 (p menor que 0.0001). El tiempo de enfermedad promedio fue de 9.6 años, existió diferencia estadísticamente significativa para el tiempo de enfermedad en pacientes PASI severo en comparación con aquellos que tenían PASI leve y moderado. CONCLUSIÓN: En el HNDAC la psoriasis severa muestra mayor severidad en varones con un tiempo de enfermedad mayor.
AIM: To evaluate the psoriasis area and severity index (PASI) in 349 new patients admitted to the Psoriasis Program of the National Hospital Daniel Alcides Carrion (HNAC) since 1996 to 2005. MATERIAL AND METHODS: Descriptive, retrospective and observational study. The reports of the evaluations made of Psoriasis Area and Severity Index, (PASI) in patients of the Hospital Daniel Alcides Carrion that income by the first time to the program and were correlated with the age, sex and time of illness. It has been revised with the statistical test of the Chi square and Mann Whitney (comparation of averages). RESULTS: The average age was 42,6, with prevalent of psoriaris type II. The average of PASI was 12.3 (mild psoriasis); for males the average arose to 15.04 and for women 9.37; with a significant statistical difference of p = 0001 It was 42.6 years old average, talking about the age in which prevails the psoriasis type II. The average last of illness was 9.6 years. There was a significant statistical difference for time of illness in severe PASI patients in comparison with these with mild or moderated PASI. CONCLUSION: At the HNDAC, severe psoriasis showed major severity in males with a major time of sickness.
Subject(s)
Humans , Psoriasis , Severity of Illness Index , Epidemiology, Descriptive , Retrospective Studies , Observational Studies as TopicABSTRACT
Ceramides play major roles in maintaining the epidermal barrier. It has been sus-pected that the depletion of ceramides, associated with disrupted barrier function in the epidermis, leads to the clinical manifestation of dryness and inflammation seen in patients with psoriasis. The aim of the present study was to determine the relation-ship between the level of ceramide synthesis in the epidermis and the clinical severity in patients with psoriasis. Samples from lesional and unlesional epidermis obtained from psoriasis patients were incubated with [14C]serine, an initiator of ceramide syn-thesis. otal ceramide was fractionated using high performance thin layer chromato-graphy, and the radioactivity was measured. The clinical severity of psoriasis was graded according to the psoriasis area and severity index scoring system. The level of ceramide synthesis in the lesional epidermis of patients was significantly lower than that in the unlesional epidermis and bore a negative correlation with the clinical severity of psoriasis. The present results suggest that the decreased level of ceramide synthesis in the epidermis contributes to the clinical severity of psoriasis.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Biomarkers , Ceramides/metabolism , Fatty Acids/metabolism , Korea/epidemiology , Psoriasis/classification , Severity of Illness Index , Skin/metabolism , StatisticsABSTRACT
BACKGROUND: Psoriasis is one of the relatively common chronic relapsing cutaneous disorders. The etiology and pathogenesis of the psoriatic skin lesion are still unknown. A colonization of microbacterial organisms especially Staphylococcus aureus (S. aureus) have been considered as a factor for development and exacerbation of psoriatic skin lesion. OBJECTIVES: The purpose of this study was to observe the bacteria on the skin of the patients with psoriasis and healthy normal persons, and evaluate the relations between bacterial density, S. aureus colonization, and severity of psoriatic skin lesions. MATERIALS & METHODS: Twenty two psoriasis patients and 25 healthy normal persons were involved for this study. Psoriasis patients were classified according to a severity estimated by PASI (Psoriasis Area and Severity Index) and activity of psoriatic skin lesions. Microbial sampling by tape method (3M, 5x5 cm) were performed on the psoriatic skin lesion and uninvolved skin in the patients of psoriasis, and on the inner forearm of the normal healthy person. Microbial sampling by a swab were also carried out from nasal mucosa. The tapes were gently contacted on the blood agar plate, and cultured in aerobic condition(30 degrees C) during 2-5 days and the numbers of colony forming unit (CFU) were estimated. RESULTS: The results were as follows; Total numbers of CFU in the lesion and uninvolved skin of psoriasis patients were significantly higher than those of the healthy controls (p0.05). The activity of psoriasis was relatively correlated with PASI score and total number of CFU (p0.05). There was a significant correlation between the numbers of S. aureus on the lesional and uninvolved skin and that on the nasal mucosa. (p<0.05). CONCLUSION: This study demonstrates that bacterial density is significantly higher on the psoriatic skin lesions, which suggests that bacterial colonization on the skin has a role in the development and exacerbation of the psoriatic lesion.