PASI 100 response rates in moderate to severe psoriasis: a systematic literature review and analysis of clinical practice guidelines.

BACKGROUND: Response to treatments in psoriasis can be assessed using the PASI response 50, 75, 90 or 100. Achieving a PASI 100 response would mean a complete resolution of the patient's basal lesions. Therefore, PASI 100 score has been increasingly used in the context of research, but its role in daily practice is currently controversial. OBJECTIVE: (1) To analyze PASI 100 response rates to pharmacological treatments; (2) To examine clinical practice guidelines (CPGs) recommendations/comments on PASI 100. METHODS: We conducted a systematic literature review (SLR). Selection criteria concerned patients with psoriasis, reporting PASI 100. RESULTS: Overall, 65 studies were included. Patients on methotrexate achieved at 16 weeks a PASI 100 of 7.3%. For TNF inhibitors rates were: 3.7-11.1% at 12 weeks, 13.7-20% at 16 weeks, 10.7-24% at 24 weeks and 21.8-34.8% at 1 year. IL-17 inhibitors achieved 23.3-44% at 12 weeks, 44.3-57.2% at 16 weeks, 39.7-67.5% at 24 weeks and 41.4-67.5% at 1 year. And the reported by IL-12/23 inhibitors were 12%/23.8% at 12 weeks, 32.7%/50% at 16 weeks, 44% at 24 weeks and 41.8%/56.3% at 1 year. PASI 100 response is scarcely commented in the CPGs. CONCLUSIONS: PASI 100 response rate is an endpoint fundamentally restricted to research.

Therapeutic goals and treatment response evaluation in moderate to severe psoriasis: an experts opinion document.

OBJECTIVE: To critically analyse and define therapeutic objectives, response to treatment evaluation and related decisions in psoriasis. METHODS: Expert consensus meetings, a systematic and narrative reviews and a collaborative Delphi procedure were carried out. A steering committee from the Spanish Group of Psoriasis was established who based on the reviews generated a set of related statements. Subsequently, a group of 40 experts tested their agreement with the statements, through 3 Delphi rounds. RESULTS: We found a great variability in clinical guidelines regarding to the definition of treatment goal and the response. In general, treatment failure was considered if a PASI50 is not achieved. The panel of experts agreed on (1) clearly differentiate between ideal and a realistic goals when establishing the therapeutic goal in moderate to severe psoriasis; (2) treatment goals should be in general established regardless of the type of drug for psoriasis; (3) treatment failure if PASI75 response is not reached; (4) an absolute PASI is in general preferred to the rate of PASI improvement from baseline; (5) disease characteristics, patients and physicians opinions/needs and treatment adherence influence treatment goals. CONCLUSIONS: A clear treatment decision making framework is vital to improve management of psoriasis.KEY MESSAGESPsoriasis characteristics, patients and physicians opinions/needs and treatment adherence influence treatment goals.Different disease indexes could be used to assess treatment response but absolute PASI is preferredIn general psoriasis treatment failure should be considered if PASI75 response is not reached.

[Impact of psoriasis on health-related quality of life]. / Impacto de la psoriasis en la calidad de vida relacionada con la salud.

BACKGROUND AND OBJECTIVE: Different studies have reported of physical, social and psychological disadvantages in patients with psoriasis. Nevertheless, its impact on the health-related quality of life is not clarified sufficiently. Our objective is to know the repercussion of the moderate-severe psoriasis on the health-related quality of life with the Psoriasis Disability Index (PDI). PATIENTS AND METHOD: An observational, cross-sectional, international study developed in dermatology practices in Spain and Portugal. During a period of 9 months, 332 participating dermatologist included a minimum of 10 consecutive patients with moderate to severe psoriasis. The date report form includes information about the health-related quality of life (PDI), as well as objective variables of severity as body surface area and PASI (Psoriasis Area and Severity Index), pruritus, costs and willingness to pay. RESULTS: A total of 3,320 patients were assessed. The majority of cases were males (57%) and the mean age at study inclusion time was 47 years. The mean value of the PDI was 8.93 (95% confidence interval, 7.83-9.21), which represents a percentage of global disability lower than 20%. The floor effect varies between 8.3% and 61.2%, and the ceiling effect varies between 0% and 3%. The correlations between the PDI and objective variables of severity (PASI and body surface area) were weak though statistically significant (p < 0.001) They all indicate that to higher severity of the psoriasis, upper negative impact in the health-related quality of life. CONCLUSIONS: Psoriasis causes a negative impact in the health-related quality of life, though the magnitudes are weak and suggest some problems with the questionnaire. Possibly, the PDI reflects more the disability that the form in which the patients perceive and react to their state of health, and, several items seem to have a scanty applicability in the Spanish and Portuguese population. The PDI doesn't seem the appropriate instrument for this type of patients in our environment.

Impacto de la psoriasis en la calidad de vida relacionada con la salud / Impact of psoriasis in health-related quality of life

Fundamento y objetivo: Diversos estudios han informado de las desventajas físicas, sociales y psicológicas que presentan los pacientes con psoriasis. El objetivo del presente estudio es conocer la repercusión de la psoriasis moderada-grave en la calidad de vida relacionada con la salud, evaluada por medio del Índice de Discapacidad de la Psoriasis (Psoriasis Disability Index, PDI). Pacientes y método: Se ha realizado un estudio observacional, transversal e internacional en consultas de dermatología de España y Portugal. Participaron 332 investigadores, cada uno de los cuales incluyó a 10 pacientes consecutivos diagnosticados de psoriasis moderada-grave. Se recogieron, entre otras, las siguientes variables: calidad de vida relacionada con la salud, medida por el PDI, variables objetivas de gravedad como la superficie corporal afectada (body surface area, BSA) y el índice de gravedad y de área de la psoriasis ­PASI (Psoriasis Area and Severity Index)­, prurito, costes y disposición a pagar. Resultados: Se incluyó a un total de 3.320 pacientes. La mayoría eran varones (57%) y la edad media era de 47 años. El PDI presentó un valor medio de 8,93 (intervalo de confianza del 95%, 7,83-9,21), lo que representa un porcentaje de discapacidad global inferior al 20%. El efecto suelo osciló entre el 8,3 y el 61,2% y el efecto techo, entre el 0 y el 3%. Las correlaciones entre el PDI y las variables objetivas de gravedad (PASI y superficie corporal afectada) fueron débiles, aunque estadísticamente significativas (p < 0,001). Todas indican que cuanto mayor es la afección o la gravedad de la psoriasis, mayor es el impacto negativo en la calidad de vida relacionada con la salud. Conclusiones: La psoriasis tiene un impacto negativo en la calidad de vida relacionada con la salud, aunque las magnitudes halladas son débiles e indican algunos problemas con el cuestionario. Posiblemente el PDI refleje más la discapacidad que la forma en que los individuos perciben y reaccionan ante su estado de salud, y algunos ítems parecen tener una escasa aplicabilidad a la población española y portuguesa. El PDI no parece el instrumento idóneo para este tipo de pacientes en nuestro entorno sociocultural

Background and objective: Different studies have reported of physical, social and psychological disadvantages in patients with psoriasis. Nevertheless, its impact on the health-related quality of life is not clarified sufficiently. Our objective is to know the repercussion of the moderate-severe psoriasis on the health-related quality of life with the Psoriasis Disability Index (PDI). Patients and method: An observational, cross-sectional, international study developed in dermatology practices in Spain and Portugal. During a period of 9 months, 332 participating dermatologist included a minimum of 10 consecutive patients with moderate to severe psoriasis. The date report form includes information about the health-related quality of life (PDI), as well as objective variables of severity as body surface area and PASI (Psoriasis Area and Severity Index), pruritus, costs and willingness to pay. Results: A total of 3,320 patients were assessed. The majority of cases were males (57%) and the mean age at study inclusion time was 47 years. The mean value of the PDI was 8.93 (95% confidence interval, 7.83-9.21), which represents a percentage of global disability lower than 20%. The floor effect varies between 8.3% and 61.2%, and the ceiling effect varies between 0% and 3%. The correlations between the PDI and objective variables of severity (PASI and body surface area) were weak though statistically significant (p < 0.001) They all indicate that to higher severity of the psoriasis, upper negative impact in the health-related quality of life. Conclusions: The psoriasis causes a negative impact in the health-related quality of life, though the magnitudes are weak and suggest some problems with the questionnaire. Possibly, the PDI reflects more the disability that the form in which the patients perceive and react to its health's state and, several items seem to have a scanty applicability in the Spanish and Portuguese population. The PDI doesn't seem the appropriate instrument for this type of patients in our environment

Larva migrans cutánea. Presentación de 8 casos / Cutaneous larva migrans. A report of eight cases

El término larva migrans cutánea se aplica a la infestación de la piel por larvas de helmintos. Se caracteriza en la clínica por lesiones serpiginosas que avanzan por uno de sus extremos. Es un proceso endémico en áreas tropicales y subtropicales, aunque últimamente su frecuencia ha aumentado en otras zonas geográficas debido al incremento de los viajes a aquellas áreas. Se presenta una serie de 8 pacientes, 4 mujeres y 4 varones con edades comprendidas entre los 22 y los 45 años, que con el diagnóstico de larva migrans cutánea se han recogido en nuestro servicio durante los últimos 11 años. Siete de ellos acababan de regresar de una zona endémica cuando las lesiones aparecieron, mientras que uno negaba haber viajado al extranjero. En 4 de ellos se realizó una biopsia cutánea. Las lesiones curaron tras la biopsia en un caso y tras el tratamiento con tiabendazol y albendazol oral en 4 y tres casos, respectivamente. Uno de ellos había sido tratado inicialmente sin éxito con mebendazol oral. No se observaron efectos secundarios.La presentación clínica de esta entidad en forma de lesiones pruriginosas y serpiginosas que avanzan por uno de sus extremos, es característica y permite un fácil diagnóstico. Los fármacos más aceptados para el tratamiento por su eficacia y la menor frecuencia de efectos secundarios son el albendazol y la ivermectina (AU)

Dermatosis erosivopustulosa del cuero cabelludo. Descripción de siete casos / Erosive pustular dermatosis of the scalp: report of seven cases

Se describen siete pacientes afectos de una dermatosis erosivopustulosa del cuero cabelludo. Las lesiones, localizadas en el cuero cabelludo y de evolución muy tórpida, consistían en placas erosivas y húmedas, cubiertas por costras amarillentas, que finalmente conducían a una alopecia cicatrizal. Ocasionalmente en los bordes de estas placas pudieron observarse pústulas aisladas. Los estudios microbiológicos fueron esencialmente negativos y los hallazgos histopatológicos inespecíficos. La aplicación de glucocorticoides tópicos de moderada y elevada potencia resultó muy eficaz. En todos los pacientes se pudo recoger el antecedente de una agresión de diversa índole en la zona del cuero cabelludo donde se inició la dermatosis, con más frecuencia un herpes zoster en la vertiente oftálmica del nervio trigémino o el tratamiento tópico de queratosis actínicas con ácido retinoico o crioterapia. De acuerdo con otros autores creemos que la agresión previa del cuero cabelludo constituye un factor desencadenante, fundamental en el desarrollo de esta dermatosis (AU)