Obesidad y piel / Obesity and skin

Introduction: Obesity is a growing global health problem; it may even be one of the worst public health issues. In Chile, 34.4% of the population is obese, therefore, is it important for clinicians to be aware of all the consequences of obesity. In this review, we will address the relation of four main dermatologic conditions with obesity: psoriasis, hidradenitis suppurativa, acanthosis nigricans and malignant melanoma. Material and methods: Search in pubmed for obesity and psoriasis, hidradenitis suppurativa, acanthosis nigricans and malignant melanoma. Results: Obesity has a direct impact in the prevalence and severity of psoriasis, hidradenitis suppurativa, acanthosis nigricans. The reduction on body weight has proven to reduce severity of psoriasis and hidradenitis suppurativa. Obese patients with psoriasis have a higher risk on adverse effects due to medication and less effectiveness of biological medications. Acanthosis nigricans is a clinical indicator of insulin resistance and a risk predictor for those with greater risk to develop diabetes in the future. The relationship between obesity and malignant melanoma is not clear and needs further research. Conclusion: Obesity is increasing, dermatologist will face this condition more frequently, it has a great impact over psoriasis, hidradenitis suppurativa, acanthosis nigricans and malignant melanoma, thus it should be considered in treatment decisions. (AU)

Cardiovascular Risk in Psoriasis Patients: Clinical, Functional and Morphological Parameters / Risco Cardiovascular em Pacientes Psoriásicos: Avaliação de Parâmetros Clínicos, Funcionais e Morfológicos

Abstract Background: Psoriasis correlates with metabolic disorders, early atheromatosis and increased cardiovascular risk. Objectives: To assess markers of cardiovascular disease in psoriatic patients. Methods: Cross-sectional, observational study involving 11 psoriatic participants and 33 controls. Anthropometric, biochemical, hemodynamic and imaging parameters were evaluated. Arterial stiffness was assessed by oscillometric measurement of the brachial artery. Intima-media thickness (IMT) and left ventricular diastolic function were assessed by Doppler echography and echocardiography. Between-group comparisons of numerical variables were performed by the Student's t-test or Wilcoxon Mann-Whitney test for independent samples. Significance level was set at 5%. Results: Psoriatic patients showed increased pulse wave velocity (PWV) (9.1 ± 1.8 vs 8.0 ± 2 m/s, p = 0.033), IMT of the left common carotid artery (p = 0.018) and a higher percentage of patients above the 75th percentile according to the ELSA table when compared with controls (54.5 vs 18.2%, p = 0.045). Psoriatic patients also showed an increase in peripheral/central systolic blood pressure (137.1 ± 13.2 vs 122.3 ± 11.6 mmHg, p = 0.004)/(127 ± 13 vs 112.5 ± 10.4 mmHg, p = 0.005), peripheral/central diastolic blood pressure (89.9 ± 8.9 vs 82.2 ± 8, p = 0.022)/(91 ± 9.3 vs 82.2 ± 8.3, p = 0.014), total cholesterol (252 ± 43.5 vs 198 ± 39.8 mg/dL, p < 0.001), LDL cholesterol (167 ± 24 vs 118 ± 40.8 mg/dL, p < 0.001) and C-reactive protein (7.6 ± 35.4 vs 1 ± 1.2 mg/L p < 0.001) compared with controls. Conclusion: Psoriasis patients show increased PWV, IMT, peripheral and central blood pressures, and serum cholesterol and C-reactive protein levels, denoting a higher cardiovascular risk.

Resumo Fundamento: A psoríase correlaciona-se a distúrbios metabólicos, ateromatose precoce e aumento do risco cardiovascular. Objetivos: Avaliar marcadores de doença cardiovascular na população psoriásica. Métodos: Estudo observacional transversal, envolvendo 11 participantes psoriásicos e 33 controles. Foram avaliados parâmetros antropométricos, laboratoriais, hemodinâmicos e de imagem. A rigidez arterial foi avaliada por oscilometria da artéria braquial. A espessura médio-intimal (EMI) e a função diastólica do ventrículo esquerdo foram avaliadas por meio da ecografia e ecocardiografia Doppler. As comparações de variáveis numéricas entre grupos foram realizadas por teste t-Student e Wilcoxon Mann-Whitney para amostras independentes, adotando-se o nível de significância de 5%. Resultados: Os pacientes psoriásicos apresentaram aumento de VOP (9,1 ± 1,8 e 8 ± 2 m/s, p = 0,033), EMI da artéria carótida comum esquerda (p = 0,018) e maior proporção de percentil > 75 pela tabela ELSA (54,5 e 18,2%, p = 0,045) e) quando comparados aos controles. Pacientes psoriásicos também mostraram aumento nos seguintes parâmetros em relação ao grupo controle, respectivamente: pressão arterial sistólica periférica/central (137,1 ± 13,2 e 122,3 ± 11,6 mmHg, p = 0,004)/(127 ± 13 e 112,5 ± 10,4 mmHg, p = 0,005), pressão arterial diastólica periférica/central (89,9 ± 8,9 e 82,2 ± 8 mmHg, p = 0,022) / (91 ± 9,3 e 82,2 ± 8,3 mmHg, p = 0,014), colesterol total (252 ± 43,5 e 198 ± 39,8 mg/dL, p < 0,001), colesterol LDL (167 ± 24 e 118 ± 40,8 mg/dL, p < 0,001) e proteína C reativa (7,6 ± 35,4 e 1 ± 1,2 mg/L, p<0,001). Conclusão: Pacientes psoriásicos apresentam elevações de VOP e EMI, além de maiores pressões arteriais periféricas e centrais, níveis séricos de colesterol e de proteína C reativa, denotando maior risco cardiovascular.

The association between psoriasis and health-related quality of life, work productivity, and healthcare resource use in Brazil

Abstract: Background: Psoriasis is a chronic, immune mediated inflammatory condition that affects a significant amount of the global population. Yet geographic variability in the consequences of psoriasis warrants region-level analyses. Objective: The current study contributes to the psoriasis outcomes literature by offering a comprehensive assessment of the humanistic and economic burden in Brazil. Methods: The 2012 Brazil National Health and Wellness Survey (N=12,000) was used to assess health-related quality of life (Short Form-12, version 2), work productivity, and healthcare resource use associated with experiencing psoriasis vs. no psoriasis, along with varying levels of psoriasis severity. Results: A total of 210 respondents reported diagnosis of psoriasis (N=157, 42, and 11 reporting mild, moderate, and severe psoriasis, respectively). Compared with controls, respondents with psoriasis reported diminished mental component summary scores and health utilities, as well as increased presenteeism, activity impairment, and physician visits over the past six months, adjusting for covariates. Among those with psoriasis, physical health decreased as psoriasis severity increased. Although work productivity and healthcare resource utilization did not differ with psoriasis severity, the high rates of productivity loss (e.g. 45.5% presenteeism in the severe psoriasis group) suggest an economic burden. Study limitations: Cost analyses were not performed, and cross-sectional patient-reported data limit causal conclusions and may reflect reporting biases. Conclusions: Nevertheless, these results suggest a significant burden to patients with psoriasis across both humanistic and economic outcomes. The association between psoriasis and mental health aspects and health utilities were particularly strong and exceeded what would be considered clinically meaningful.

Inmunopatogenia de la psoriasis: nuevos avances / Inmunopatogenia of psoriasis. New progress

La psoriasis es una enfermedad inflamatoria crónica de la piel. Su etiología es multifactorial e incluye susceptibilidad genética, factores inmunológicos y múltiples elementos ambientales, que pueden desencadenar y/o exacerbar la enfermedad. En las últimas décadas se han realizado investigaciones minuciosas sobre la patogénesis de la psoriasis, han sido reconocidos varios subtipos de células T que tienen un papel fundamental en el establecimiento de la inflamación en lesiones cutáneas. Los estudios genéticos brindan las bases para la construcción del modelo de la enfermedad, demostrando que las células dendríticas, los linfocitos T y los queratinocitos desempeñan un rol clave en la patología de esta entidad, así como también un conjunto de citoquinas que impulsan la inflamación psoriásica, dentro de las que se incluyen TNFα, IL-22, IL-23 e IL-17, las cuales promueven la respuesta inflamatoria de queratinocitos, y la producción de péptidos antimicrobianos, citoquinas y quimiocinas, perpetuando así la respuesta inflamatoria. En la actualidad, el desarrollo de varios fármacos biológicos altamente eficaces ha revolucionado el tratamiento de la psoriasis en placas de moderada a severa. Estos medicamentos son un reflejo de una mayor comprensión de la patogénesis de la psoriasis, incluyendo la importancia central de IL-23 e IL17 y las diferentes vías de señalización. El objetivo de este trabajo es realizar una revisión crítica de la literatura sobre la psoriasis y los mecanismos implicados en su imnunopatogenia(AU)

Psoriasis is a chronic inflammatory disease of the skin. Its etiology involves several agents such as genetic susceptibility, immunological factors and multiple environmental elements, which can trigger and / or exacerbate the disease. In recent decades thorough research has been conducted on the pathogenesis of psoriasis, several T-cell subtypes that play a key role in the establishment of inflammation in skin lesions have been recognized. Genetic studies provide the basis for the construction of the disease model, demonstrating that dendritic cells, T lymphocytes and keratinocytes play a key role in the pathology of this entity, as well as a set of cytokines that drive psoriatic inflammation , such as include TNF , IL-22, IL-23 and IL-17, which promote the inflammatory response of keratinocytes, and the production of antimicrobial peptides, cytokines and chemokines, thus perpetuating the inflammatory response. At present, the development of several highly effective biological drugs has revolutionized the treatment of moderate to severe plaque psoriasis. These drugs are a reflection of a greater understanding of the pathogenesis of psoriasis, including the central importance of IL-23 and IL-17 and different signaling pathways. The objective of this work is to perform a critical review of the literature on psoriasis and the mechanisms involved in its imnunopathogenesi(AU)

How relevant are vascular endothelial growth factor and intercellular adhesion molecule in the systemic capillary leak syndrome of psoriasis?

Abstract: Psoriasis is a chronic disease, characterized by erythematous scaly lesions, presented in eight different forms: plaques, guttate, pustular, erythrodermic, inverse, nail and scalp psoriasis, and psoriatic arthritis. Its development depends on genetic factors, external stimulus and immune response alteration.1 Proinflammatory cytokines such as TNF-alpha, IL-12 and 23 may also be involved. In the worst cases, systemic complications linked to endothelial alterations may occur. A literature review was conducted for a better understanding of what roles VEGF (vascular endothelial growth factor) and ICAM-1 (intercellular adhesion molecule) have, among other cytokines, in systemic capillary leak syndrome, involved in erythrodermic and pustular psoriasis, the most unstable forms of the disease.

Tear osmolarity and ocular surface parameters in patients with psoriasis / Parâmetros de osmolaridade lacrimal e da superfície ocular em pacientes com psoríase

ABSTRACT Purpose: The aim of this study was to evaluate tear osmolarity, tear film function, and ocular surface changes in patients with psoriasis. Methods: At a single center, 30 eyes of 30 patients with psoriasis (group 1) and 30 eyes of 30 healthy individuals (group 2) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT) test, scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity measurement. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309.8 ± 9.4 mOsm, 38.9 ± 1.1, and 0.7 ± 1.1, respectively) than in group 2 (292.7 ± 7.7 mOsm, 4.2 ± 0.3, and 0.1 ± 0.3, respectively; p<0.01 for all). TBUT was significantly lower in group 1 (8.7 ± 3.6 s) than in group 2 (18.1 ± 2.8 s; p<0.001). No significant differences were detected in Schirmer I test values between the groups (16.2 ± 2.5 mm in group 1 and 16.6 ± 2.3 mm in group 2; p=0.629). Conclusions: The results of this study showed that psoriasis may influence tear osmolarity and tear film function. Patients with psoriasis showed tear hyperosmolarity and tear film dysfunction.

RESUMO Objetivo: O objetivo deste estudo foi avaliar a osmolaridade da lágrima, função do filme lacrimal e alterações da superfície ocular em pacientes com psoríase. Método: Em um único centro, 30 olhos de 30 pacientes com psoríase (grupo 1) e 30 olhos de 30 indivíduos saudáveis (grupo 2) foram avaliados pelo questionário do Índice de Doença da Superfície Ocular (OSDI), teste de Schirmer tipo I, tempo de ruptura do filme lacrimal (TBUT), coloração por fluoresceína da superfície ocular utilizando a escala de Oxford modificada e osmolaridade lacrimal. Resultados: Os valores de osmolaridade lacrimal, OSDI e escores da escala de Oxford foram significativamente maiores no grupo 1 (309,8 ± 9,4 mOsm, 38,9 ± 1,1 e 0,7 ± 1,1, respectivamente) em comparação com o grupo 2 (292,7 ± 7,7 mOsm, 4,2 ± 0,3 e 0,1 ± 0,3, respectivamente) (p<0,01 para todos). TBUT no grupo 1 (8,7 ± 3,6 s) foi significativamente menor em comparação com o grupo 2 (18,1 ± 2,8 s) (p<0,001). Não foram detectadas diferenças significativas nos valores de teste de Schirmer (16,2 ± 2,5 mm no grupo 1 e 16,6 ± 2,3 mm no grupo 2, p=0,629). Conclusões: Este estudo mostrou que a psoríase pode influenciar osmolaridade lágrima e função do filme lacrimal. Os pacientes com psoríase apresentaram hiperosmolaridade lágrima e disfunção do filme lacrimal.

Psoriasis: new comorbidities

Abstract Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases.

Relationship between retinal sensitivity and disease activity in patients with psoriasis vulgaris

OBJECTIVES: Psoriasis is a hyperproliferative chronic inflammatory skin disease of unknown etiology and ocular structures and visual pathways can also be affected during the course of this disease. Subclinical optic neuritis has previously been observed in psoriatic patients in visual evoked potential studies. This trial was designed to evaluate retinal sensitivity in patients with psoriasis vulgaris. METHODS: A total of 40 eyes of 40 patients with chronic plaque-type psoriasis and 40 eyes of 40 age- and sex-matched control subjects were included in this study. The diagnosis of psoriasis was confirmed by skin biopsy. The severity was determined using the Psoriasis Area and Severity Index and the duration of the disease was recorded. After a full ophthalmological examination, including tests for color vision and pupil reactions, the visual field of each subject was assessed using both standard achromatic perimetry and short wavelength automated perimetry. RESULTS: The mean Psoriasis Area and Severity Index was 22.05±6.40′. There were no significant differences in the visual field parameters of subjects versus controls using either method. There were correlations between disease severity and the mean deviations in standard achromatic perimetry and short wavelength automated perimetry and between disease severity and the corrected pattern standard deviation and pattern standard deviation of short wavelength automated perimetry (r = -0.363, r = -0.399, r = 0.515 and r = 0.369, respectively). CONCLUSIONS: Retinal sensitivity appears to be affected by the severity of psoriasis vulgaris. .

Psoriasis and subclinical atherosclerosis: a significant association

To identify the presence of subclinical atherosclerosis by measuring carotid intima medial thickness [IMT] in patients with psoriasis attending the dermatology clinic of a tertiary care hospital. 30 patients who fulfilled the exclusion and inclusion criteria were recruited. 5 healthy persons devoid of known cardiovascular risk factors were registered as controls. Intima medial thickness of common carotid and vertebral arteries of both sides were measured by B mode ultrasound. Result showed that IMT and velocity of left common carotid artery and velocity in right vertebral artery were significantly greater in psoriatic patients than control group and psoriatic patients had 0.8 times greater risk of developing atherosclerosis than control group. Subclinical atherosclerosis remains undiagnosed in patients of psoriasis who usually lack the established risk factors for cardiovascular disease

Psoriasis severity and hypothalamic-pituitary-adrenal axis function: results from the CALIPSO study

Psoriasis is a chronic inflammatory disease that significantly impacts life quality, being associated with stress and mental disorders. We investigated whether the activity of the hypothalamic-pituitary-adrenal (HPA) axis was associated with psoriasis severity, daily life stress and anxiety, and depressive symptoms. In this ancillary study, which was part of the CALIPSO (coronary artery calcium in psoriasis) study, saliva was collected from 102 patients with psoriasis immediately upon awakening, 30, and 60 min after awakening, at 2:00 pm and at bedtime (five time points) to determine salivary cortisol levels. We used Pearson's correlation coefficient to evaluate the association of clinical and psychopathological variables with HPA activity. We found a direct correlation between bedtime cortisol and psoriasis severity evaluated by the psoriasis area severity index (PASI; r=0.39, P<0.001). No correlations between other clinical and psychopathological variables or with other cortisol assessments were observed. The findings indicated that HPA dysfunction may be present in psoriasis, as bedtime cortisol was correlated with psoriasis severity. Our study is limited by the lack of a control group; therefore, we were not able to explore whether these cortisol values were different compared with a concurrent, healthy sample.

Psoriasis pustulosa generalizada / Generalized pustular psoriasis

Introducción: la psoriasis pustulosa generalizada (PPG) es una forma grave de psoriasis asociada a manifestaciones sistémicas. Es una enfermedad infrecuente y potencialmente letal. En las últimas décadas, se ha avanzado mucho en la comprensión de su fisiopatología, gracias a estudios inmunológicos y genéticos. Objetivo y método: El objetivo de esta revisión es actualizar los conceptos respecto a la fisiopatología, diagnóstico y tratamiento de la PPG. Se realizó una revisión del tema mediante una búsqueda bibliográfica en Pubmed y LILACS en los últimos 10 años, y además se agregaron referencias relevantes que no se encontraran en los resultados. Resultados: La PPG podría comprenderse como una enfermedad del grupo de las enfermedades autoinflamatorias, cuya causa es una mutación en el gen IL36RN, que produciría una falla estructural o una secreción inadecuada del antagonista del receptor de IL36, lo que conduciría a un desbalance en la contra-regulación de las citoquinas pro-inflamatorias de la familia IL-1. Su gatillante más frecuente es la interrupción abrupta del uso de corticoides, aunque existen numerosos factores reportados. El tratamiento de primera línea es la hospitalización, manejo con terapia tópica y sistémica con retinoides o terapia biológica, para luego continuar con un esquema de mantención. Conclusión: Dado los avances en su investigación, la PPG podría considerarse una entidad etiológicamente distinta a la psoriasis común.

Introduction: generalized pustular psoriasis (GPP) is a severe form of psoriasis associated with systemic manifestations. It is a rare and potentially lethal disease. In recent decades, much progress has been made in understanding its pathophysiology, thanks to immunological and genetic studies. Objective and Methods: The aim of this review is to update the concepts regarding the pathophysiology, diagnosis and treatment of GPP. A review was performed by searching in PubMed and LILACS databases in the last 10 years, also relevant references that were not in the results were aggregated. Results: GPP could be understood as a disease of the group of autoinflammatory diseases, caused by a mutation in the gene IL36RN that produce structural failure or an inadequate secretion of IL36 receptor antagonist, leading to an imbalance in the counter-regulation of the pro-inflammatory cytokines from the IL-1 family. Its most common trigger is the abrupt discontinuation of corticosteroids, although there are numerous factors reported. The first line treatment is hospitalization, management with topical and systemic retinoid therapy or biological therapy, and continue with a scheme of maintenance afterwards. Conclusion: Due to the progress in its investigation, GPP could be regarded as an etiologically distinct entity to psoriasis vulgaris.

Pathophysiology of psoriasis.

Psoriasis is a chronic inflammatory papulosquamous disease characterized by multiple remissions and relapses. For long, it was believed to be primarily a disorder of keratinization. However, the successful use of traditional immunosupressants and newer immunomodulatory agents in the treatment of psoriasis led to the belief that psoriasis is primarily a disease of Th1 cell immune dysregulation. Recent developments have brought up several new findings such as the role of Th17 cells and evidence of skin barrier dsysfunction in psoriasis, akin to atopic dermatitis. The present review aims to focus on these new developments and explain the pathogenesis of psoriasis on the basis of currently available information.

Pathophysiology of psoriasis.

Psoriasis is a chronic inflammatory papulosquamous disease characterized by multiple remissions and relapses. For long, it was believed to be primarily a disorder of keratinization. However, the successful use of traditional immunosupressants and newer immunomodulatory agents in the treatment of psoriasis led to the belief that psoriasis is primarily a disease of Th1 cell immune dysregulation. Recent developments have brought up several new findings such as the role of Th17 cells and evidence of skin barrier dsysfunction in psoriasis, akin to atopic dermatitis. The present review aims to focus on these new developments and explain the pathogenesis of psoriasis on the basis of currently available information.

Periungual capillaroscopy in psoriasis / Capilaroscopia periungueal em psoríase

BACKGROUND: Nailfold capillaroscopy is a useful technique for evaluating changes in microcirculation. OBJECTIVE: To investigate changes at nailfold capillaroscopy in psoriatic patients compared with controls. METHODS: Nailfold capillaroscopy was performed in 46 psoriatic patients and 50 controls to assess microscopic morphological changes, capillary density and the presence of areas with devascularization. RESULTS: Patients with psoriasis had lower capillary density (p=0.0005), increased avascular areas (p=0.0035) and an increased number of morphologically abnormal capillaries (coiled, p<0.0001) compared to controls. No association was found between capillary density and the duration of the disease (p = 0.92) or the extent of skin involvement, as measured by the psoriasis area and severity index (PASI) score (p = 0.59). The presence of avascular areas was more common in psoriatic individuals whose nails were affected by the condition (p = 0.047). CONCLUSION: Patients with psoriasis have decreased capillary density and a greater presence of morphologically abnormal capillaries when compared to controls.

FUNDAMENTOS: A capilaroscopia periungueal é um método utilizado no estudo de alterações da microcirculação. OBJETIVO: Verificar alterações na capilaroscopia periungueal de pacientes com psoríase, comparando-os com controles saudáveis. MÉTODOS: A capilaroscopia periungueal foi realizada em 46 pacientes com psoríase e 50 controles, utilizando-se um estereomicroscópio e observando-se alterações morfológicas, densidade capilar e presença de áreas com desvascularização. RESULTADOS: Pacientes com psoríase tinham menor densidade capilar (p=0,0005), maior presença de áreas avasculares (p=0,0035) e de capilares morfologicamente alterados (enrodilhados; p<0.0001) do que os controles. Não se encontrou associação entre densidade capilar e tempo de doença (p=0.92) ou grau de envolvimento cutâneo medido pelo PASI (p=0.59). A presença de áreas avasculares foi mais comum em indivíduos com psoríase que tinham envolvimento ungueal (p=0,047). CONCLUSÃO: Pacientes com psoríase têm menor densidade capilar e presença de capilares morfologicamente alterados em relação aos controles.

Enfoque terapéutico de la psoriasis en la infancia / Therapeutic approach to psoriasis in children

La psoriasis infantil es una enfermedad multifactorial, con múltiples aristas. Las lesiones características son placas eritematoescamosas bien definidas, localizadas en codos, rodillas, región sacra y cuero cabelludo; pueden afectar todo el tegumento, incluyendo palmas, plantas, semimucosas, uñas y articulaciones. La predisposición genética queda demostrada por la clara agregación familiar (uno de cada tres pacientes tiene un familiar afectado), la concordancia en gemelos y la asociación con determinados HLA. Se trata de una enfermedad de difícil tratamiento, sobre todo en los casos graves y formas diseminadas y, en especial, en los niños. Las terapéuticas a utilizar deben ser minuciosamente evaluadas y consensuadas con la familia. En numerosas ocasiones se utilizan tratamientos combinados, de rotación o de ambos tipos. El objetivo del tratamiento debe ser suprimir las manifestaciones clínicas, inducir remisiones prolongadas, procurar efectividad con alto perfil de seguridad y posibilitar una mejor calidad de vida

DermaMan: scoring dermatology in your palm.

Personal Digital Assistants (PDAs) have become a part of everyday life. DermaMan is a freely available, Java-based, dermatology-specific calculator for handheld devices. It includes modules to compute PASI, MASI, SCORAD, and for calculations related to topical PUVA and Botox (R) administration.

Terapia Biológica en Psoriasis / Biologic therapy in psoriasis

La psoriasis es una enfermedad inflamatoria crónica, medida inmunológicamente, de etiología desconocida que afecta del 1 al 3 por ciento de la poblalción mundial. Se caracteriza por la Hiperproliferación de queratinositos causada por la estimulación persistente de celulas T por inmunogenos de origen epidermico. Se asocia información dermica y secundariamente hiperplasia epidermica, suceptible de control mediante tratamiento médico prolongado, no curable, con grados diferentes de afectación. Existen múltiples tratamientos como son la terapia tópica, fototerapia y sistémica, con resultados variables. El desarrollo de la biología molecular, la ingeniería genética y biotecnología ha permitido la creación de moléculas dirigidas a etapas específicas de la patogenia de varias enfermedades mediadas por el sistema inmunitario. Estos elementos así obtenidos se denominan productos biológicos, y al uso de estos, terapia biológica. La terapia biológica en pacientes con psoriasis ha mostrado beneficios significativos con perfiles de tolerabilidad y seguridad satisfactorios. La limitación que la terapia biológica presenta dentro de las estrategias de tratamiento es definitivamente, su costo.

Psoriasis is a chronic inflammatory disease, immunologicaly mediated, of unknown etiology, affecting 1 to 3 per cent of the worldÆs population; is characterized by hiperproliferación of keratinocytes, caused by persistent stimulation of T cells by immunogens of epidermal origin, which associates skin inflammation and secondarily epidermal hyperplasia, which could control through prolonged medical treatment, not curable, with varying degrees of involvement. There are multiple treatments such as topical and systemic therapy, with varying results. The development of molecular biology, genetic engineering and biotechnology has enabled the creation of molecules aimed at specific stages of the pathogenesis of several diseases mediated by the immune system. These elements thus obtained are called biological products, and its use biological therapy. Biological therapy in patients with psoriasis has shown significant benefits with profiles of successful safety and tolerability. The restriction that the biological therapy introduced in the treatment strategies is definitely its cost.

Role of complements C5, C6 in the pathogenecity of psoriasis

Psoriasis lesion/scale contains C5a des Arg and C5b-9 [Takematsu et al., 1992; Terui et al., 2000 and Uyemura et al., 1993]. These activation products may have arisen from C5-C9 produced supposedly by keratinocytes [KC]. In this work we have started with C5 and C6 to prove our hypothesis. Since psoriatic lesions contain several pro-inflammatory cytokines, it is important to find out which pro-inflammatory cytokines can differentially regulate the expected synthesis of C5 and C6 by keratinocytes. Human KC have been cultured in the absence and the presence of varying concentrations of pro-inflammatory cytokines and the synthesis of C components C5 and C6 have been measured by ELISA at the protein level and RT-PCR at the mRNA level. To test whether KC also secrete these C components, the same measurements have been performed to find out if these late components are present in the supernatant of the medium where these KC were cultured. The keratinocytes cell-line A431 was also used and the monocytes cultures were considered as the positive control. The results showed that resting KC synthesize C5 mRNAs in detectable amounts. C5 mRNA which is synthesized by resting KC is not translated into detectable amount of protein. Although resting KC did not produce C6 mRNA in detectable amounts the levels of C6 protein were detectable. However, These C6 protein levels were minimally secreted by resting KC, into the culture medium. TCGF induced the secretion of C5 and C6 while TGF-beta induced only the secretion of C6. Normal KC synthesize their own C5 and C6. The synthesis of them is activated by TCGF. While TGF- 2 activated the synthesis of C6 other factors might be responsible for activating the synthesis of C5. These factors could be secreted from other cell types than KC in human skin