ABSTRACT
BACKGROUND: Dupuytren contracture (DC) is a fibrocontractile disease of the palms, affecting approximately 4% of the population, while psoriasis is an immune-mediated disease, affecting 2% of the population. Through clinical observation in our psoriasis clinic, we found an apparent increased prevalence of DC in patients with psoriasis compared with the general population. This has not previously been statistically verified in a clinical study. AIM: To evaluate the prevalence of DC in the full range of clinical psoriasis phenotypes. METHODS: In total, 98 patients with psoriasis attending our psoriasis clinic were examined for DC, based on predetermined criteria. In addition, 84 patients with DC, obtained from a specialist hand clinic, were assessed using a validated psoriasis questionnaire. We utilized Bayes theorem and bootstrap simulation to calculate the conditional prevalence of DC, then we used the results to compare the prevalence of DC between patients with psoriasis and a nonpsoriasis population. RESULTS: The percentage of patients with DC was 19.6% in the psoriasis population and 3.6% in the nonpsoriasis population. Development of DC showed a phenotypic predilection, with 39.1% of patients with predominantly palmoplantar involvement and 38.9% of patients with intertriginous psoriasis developing DC compared with 12.7% of patients with psoriasis who did not have these two phenotypical presentations. CONCLUSIONS: Our data show a positive correlation between psoriasis and DC. Patients with the palmoplantar phenotype of psoriasis were more likely to develop DC. By understanding this relationship, dermatologists may diagnose DC early in its onset in patients with psoriasis, prompting referral to hand surgeons when appropriate.
Subject(s)
Dupuytren Contracture/epidemiology , Psoriasis/epidemiology , Adult , Aged , Bayes Theorem , Cohort Studies , Female , Humans , Male , Middle Aged , Prevalence , Sex Distribution , United States/epidemiologyABSTRACT
In the Waikato, Tauranga, Bay of Plenty and Taumarunui area there were 2878 new cases of skin cancers over a two-year period; 1632 were basal cell carcinomas, 880 squamous cell carcinomas, 134 had both lesions, 71 had suspect keratoses, and there were 161 melanomas. A single lesion was present in 81 percent. The age-specific risk for non-melanoma skin cancer rose to a peak at ages 75 and over. The average age for melanoma was 50.1 years in males and 46.5 in females, and for non-melanoma skin cancer the peak was in the 60s. The sex ratio for non-melanoma cancer was 1.6 male: 1 female, and for melanoma was 1 male: 1.6 female. No melanoma occurred in Maoris or Pacific islanders. There were nine non-melanoma skin cancers in Maoris. For Europeans the non-melanoma incidence was 384/100 000, the melanoma rate was 23/100 000, and the total lesion rate was 517/100 000 population.
Subject(s)
Carcinoma, Basal Cell/epidemiology , Carcinoma, Squamous Cell/epidemiology , Melanoma/epidemiology , Skin Neoplasms/epidemiology , Adolescent , Adult , Age Factors , Aged , Child , Female , Humans , Keratosis/epidemiology , Male , Middle Aged , New Zealand , Sex FactorsABSTRACT
The ultimate evolution of our case and its atypical features of unilateral blindness, bilateral involvement, and extensive involvement of the trigeminal nerve revealed the pathogenesis of this case of alternating painful ophthalmoplegia resembling the Tolosa-Hunt syndrome to be that of a parasellar pituitary adenoma. Similar cases of painful recurrent ophthalmoplegia should alert the clinician to the strong possibility of a parasellar syndrome involving a mass, even if the patient carries the clinical diagnosis of Tolosa-Hunt syndrome.
