An educational programme for patients with psoriasis and atopic dermatitis: a prospective randomized controlled trial.

BACKGROUND: Patient education in addition to standard treatment, with the aim of affecting care through courses, is a relatively new concept in dermatology. Here we introduce a randomized controlled trial (RCT) regarding a previously described 12-week educational programme for chronic skin diseases. OBJECTIVES: The primary objective of the RCT was to measure the effect of an educational programme on disease severity and quality of life in patients with psoriasis or atopic dermatitis. METHODS: We recruited 50 patients from Ghent University Hospital. Patients with diagnosed psoriasis or atopic dermatitis were randomized (1 : 1) to the intervention or control group. The clinical outcome was measured by two blinded observers using the Psoriasis Area and Severity Index (PASI), Scoring Atopic Dermatitis or the Eczema Area and Severity Index. Quality of life was measured by dermatology-specific quality-of-life questionnaires. There was a follow-up period of 9 months. RESULTS: We found that disease severity and quality of life improved significantly for patients with psoriasis (n = 29) but not for patients with atopic dermatitis (n = 21) at 3 months. Patients in the intervention group showed a significant reduction in mean PASI (P = 0·036), mean Dermatology Life Quality Index (P = 0·019) and mean Psoriasis Disability Index (P = 0·015), compared with the control group at 3 months. This improvement continued for at least 6 months, i.e. 3 months after the intervention, but was lost at follow-up after 9 months. CONCLUSIONS: Evaluating this form of educational programme, by means of a single-centre RCT, indicates its added value in the longer term management of psoriasis.

Halo naevi with associated vitiligo-like depigmentations: pathogenetic hypothesis.

BACKGROUND: In analogy with melanoma-associated leucoderma, halo naevi may trigger in some patients the development of additional depigmentations which are in distribution, extent and prognosis not in accordance with classic vitiligo. OBJECTIVE: The aim of this study was to support the hypothesis that in a subset of halo naevi patients vitiligo-like lesions develop directly linked to the halo phenomenon. METHODS: Forty-one patients with halo naevi were examined for the development of depigmentations not corresponding to typical vitiligo lesions. RESULTS: We identified a subset of five halo naevi patients with additional subtle depigmentations. After the occurrence of multiple halo naevi, they developed leucoderma that showed a different disease pattern than vitiligo (variable asymmetric distribution, limited extent and lack of progression). Moreover, the characteristics of these halo naevi patients with associated leucoderma were different from classic vitiligo patients (high number of halo naevi, absence of family history for vitiligo and absence of autoimmune diseases) and the timing of occurrence of the leucoderma suggested a direct relation with the halo phenomenon. CONCLUSIONS: In this article, we describe in a limited subset of patients with multiple halo naevi discrete depigmentations at distance from halo naevi which may result from a temporary autoimmune process directly linked to the halo phenomenon. This finding illustrates the collateral damage resulting from skin immunosurveillance and may have clinical consequences as the evolution pattern in this subset of patients is less progressive compared with vitiligo. We present clinical data that support this hypothesis and suggest to call it 'halo naevi-associated leucoderma'.

Anti-Ro52 reactivity is an independent and additional serum marker in connective tissue disease.

OBJECTIVE: To determine whether anti-Ro52 is an independent serum marker in connective tissue disease. METHODS: Over a two year period, 1727 consecutive antinuclear antibody (ANA) positive serum samples were analysed in parallel by double immunodiffusion with thymus/spleen nuclear extract and by line immunoassay with recombinant Ro52, recombinant La/SSB, and natural Ro60. Sera that were only reactive towards Ro52 were further analysed by a variety of additional anti-SSA/Ro detection methods and by specific anti-Ro52 and anti-Ro60 assays. Natural purified SSA/Ro was analysed by immunoblot and protein sequencing. RESULTS: Analysis of natural purified SSA/Ro (Immunovision, Springdale, AR) showed only Ro60 and no immunoreactive Ro52. Consequently, assays based on this substrate only identify sera with anti-Ro60 reactivity. Twenty serum samples showed anti-Ro52 without anti-Ro60 and anti-SSB/La on line immunoassay. By additional testing, 2/20 sera were found positive for anti-Ro60 reactivity. The remaining 18 sera were not identified by any of the classical anti-SSA/Ro assays and were considered to be reactive only with Ro52 and not with Ro60. This anti-Ro52 reactivity was confirmed by natural and recombinant Ro52 in 16/18 cases. 12/18 sera corresponded to connective tissue diseases. CONCLUSION: Anti-Ro52 positive sera without any evidence of anti-Ro60 and anti-La/SSB reactivity can be considered as an independent group that is systematically missed by classical anti-SSA/Ro detection methods owing to a bias towards anti-Ro60 reactivity. The anti-Ro52 sera are precipitin negative, not retrieved by SSA/Ro enzyme linked immunosorbent assays (ELISAs) based on natural SSA/Ro, and show no specific ANA fluorescence staining pattern. These findings together with the clinical data indicate that anti-Ro52 should be considered as an additional and independent serum marker.

Multicenter validation of recombinant, natural and synthetic antigens used in a single multiparameter assay for the detection of specific anti-nuclear autoantibodies in connective tissue disorders.

OBJECTIVES: We investigated the feasibility of using a single multi-parameter test based mainly on recombinant autoantigens for the detection of anti-nuclear autoantibodies, and analyzed the agreement between this test format and conventional techniques. METHODS: The presence of autoantibodies was determined by a line immunoassay (LIA) in 755 sera derived from patients with different autoimmune connective tissue disorders. All sera were previously tested by standard assays that are routinely used at the 8 participating European centers. RESULTS: The overall sensitivity and specificity of autoantibody detection by LIA was similar or higher as compared to combined conventional techniques (CCT). In particular, the detection of anti-Ro52 in systemic lupus erythematosus (SLE) sera (P = 0.004) and anti-LA in both SLE (P < 0.0009) and in Sjögren's syndrome (P < 0.0009) sera was significantly more sensitive when using LIA compared to CCT. By contrast, CCT was never more sensitive than LIA for any of the markers. CONCLUSION: The LIA is a reliable alternative to a combination of conventional techniques for the detection of specific anti-nuclear autoantibodies. The multi-parameter test also reveals autoantibody reactivities that may not be detected when only a limited number of conventional techniques are applied.