Psoriasis registry in public health hospital.

BACKGROUND: The Institute of Dermatology Thailand in cooperation with the hospitals across the country had conducted the psoriasis patient registry in Thailand between 2005 and 2008. OBJECTIVE: To explore the epidemiology of psoriasis, distribution of disease and type of psoriasis in Thailand, and establish the systematic psoriasis database in Thailand. MATERIAL AND METHOD: This patient registry recorded the demographic, severity and quality of life of psoriasis patients. The patients will be assessed for the severity and asked to complete the questionnaire only one time of enrollment. RESULTS: There have been 11,548 patients enrolled from 32 dermatological centers across Thailand. The male:female ratio was 1.3:1. The chronic plaque type is the majority of psoriasis type (85.6%). The average age of onset is 32.88 years and females have an earlier age of onset than males. Mostly is early onset type of psoriasis (64.2%). Head, body, and leg are the first three ranks of area of skin lesion at first onset. Twenty-five percent of patients have been rated as moderate-to-severe psoriasis as rated by BSA. Fifty-six point six percent of patients report that psoriasis has an impact to their quality of life. The most exacerbating factors are weather, stress, and alcohol drinking. About half of the population reported that they feel embarrassed and are distressed. CONCLUSION: This registry establishes the first systematic psoriasis patient database in Thailand. With it, the epidemiology of psoriasis in Thailand is better understood.

Efficacy of a far erythemogenic dose of narrow-band ultraviolet B phototherapy in chronic plaque-type psoriasis.

The aim of the present study was to examine the effect of far erythemogenic dose of narrow-band ultraviolet B (NB-UVB; starting dose at 35% minimal erythematous dose [MED]) on clinical response by measuring the severity, extent of disease and the changes in quality of life. Fifty patients with chronic plaque-type psoriasis were enrolled. Therapy was held for 3 days a week. The severity of the disease was assessed based on the Psoriasis Area and Severity Index (PASI) score and Dermatology Life Quality Index (DLQI) scores. The percentage improvement of PASI at 30 sessions was 68.99%. The improvement in DLQI scores at 30 sessions was 79.67%. Pearson correlation coefficients showed that PASI scores were not correlated with DLQI scores at the beginning of treatment (P = 0.330, r = 0.14), but after the 30th session of NB-UVB therapy improvements in quality of life were correlated (P < 0.05, r = 0.399). Therefore, far erythemogenic dose of NB-UVB is considered to be effective treatment for plaque-type psoriasis in our patients. However, we cannot confirm that it is safer than higher MED starting dose in term of cumulative UV irradiation.

Adult-onset actinic prurigo in Thailand.

BACKGROUND: Actinic prurigo (AP) is one of the rare idiopathic photodermatosis. It is said to be a familial disease and is usually seen in certain specific geographical areas. The adult-onset type of AP is reported less frequently in the Asian population and has never been reported in Thailand. METHODS: The study population comprised 30 patients. Demographic data were collected. Photo-tests and photo provocation tests for UVA, UVB and visible light were carried out on non-exposed skin. The other investigations included antinuclear antibody, anti-HIV antibody and urine porphyrin level. Histopathology studies were also carried out. RESULTS: There were 18 males and 12 females. The mean age of onset was 36.86 years. The duration of disease was from 1 month to 20 years. Forearms (27 patients) were the most frequently affected site. Other screening tests showed negative results. Five patients had abnormal MED to UVA and one patient had abnormal MED to UVA as well as UVB. Photo provocation tests showed positive responses to both UVA and UVB in 12 cases (40%), a positive response to UVA in 11 cases (37%), a positive response to UVB alone in four cases (13.3%) and a normal response in three patients (10%). None of the patients had a positive response to visible light. Skin biopsies were performed on nodular lesions in 23 cases. Histopathology from these 23 cases showed hyperkeratosis ortho- or parakeratosis and acanthosis in 20 of the 23 cases. CONCLUSIONS: Adult-onset AP in our country may have different geographic and racial distribution from previous reports or may be the tropical variant as described by Tham et al. It may not be an uncommon disease in our country, if there is increased awareness of this disease. Only 16.6% of patients had reduced MED. Photo provocation tests were positive in 90% of cases. Most of the positive wavelengths were UVA or both UVA and UVB. Therefore, photo provocation tests should be performed in cases suspected of AP. The prognosis for AP is not good, despite combinations of treatment. The disorder may run a chronic course. This may be because of our sunny climate and the sun-exposed occupations of patients.