Phototherapy for the treatment of prurigo nodularis: a review.

BACKGROUND/PURPOSE: Review the available literature on phototherapy for treatment of prurigo nodularis (PN). METHODS: Literature search was conducted on MEDLINE. RESULTS:  6 prospective trials, 2 retrospective studies, and 3 case series were found investigating efficacy and safety of phototherapy for treatment of PN. CONCLUSION: Although large randomized clinical trials are necessary, phototherapy appears to be a safe and efficacious treatment for PN, alone and in combination with other common treatment modalities for PN.

Narrowband UVB-induced iatrogenic polymorphous light eruption: a case and suggestions to overcome this rare complication.

Polymorphous light eruption (PMLE) is the most common photodermatosis characterized by pruritic papules and papulovesicles, which appear hours to days following ultraviolet (UV) exposure. Herein, the authors report successful treatment of generalized plaque psoriasis with Goeckerman regimen in a patient despite new onset iatrogenic PMLE following narrowband (NB) UVB therapy. Although further studies are necessary, this case suggests that the co-existence of psoriasis and PMLE should not prevent the use of phototherapy; phototherapy, especially as part of the Goeckerman regimen, remains a valuable treatment option for psoriasis in patients with PMLE.

Social impact of the burden of psoriasis: effects on patients and practice.

The raised, scaly, and erythematous plaques associated with psoriasis can be cosmetically disfiguring, which may provoke disgust, fear, and aversion in others. Consequently, the social stigma of psoriasis can be devastating for patients, evoking feelings of shame and anxiety about how they are perceived. In recent years, appreciation of psoriasis as a disease that can cause social distress and impairment has increased. This review discusses the manifold social burdens of psoriasis; different and emerging therapies that may mitigate these burdens by improving outcomes associated with the underlying disease; and psoriasis management in the context of healthcare reform changes focused on assessing the quality and value of patient care. The social impact of psoriasis is substantial (eg, affecting interpersonal relationships, sexual function, intimacy, occupational success). Undertreatment of psoriasis continues, despite evidence that biologic agents may lessen the physical and social burdens and provide greater patient satisfaction than conventional therapy. Changes in healthcare place an even greater emphasis on measurable outcomes, including patient satisfaction. Increased understanding of the social burden of psoriasis may lead to provision of more comprehensive, holistic care that is in concordance with the evolving restructured reimbursement system.

Primary psychiatric conditions: dermatitis artefacta, trichotillomania and neurotic excoriations.

Primary psychiatric conditions encountered in dermatology include dermatitis artefacta, trichotillomania (TTM) and neurotic excoriations. For these disorders, the primary pathologic condition involves the psyche; therefore, any cutaneous findings are self-induced. Herein, we review common primary psychiatric conditions in dermatology - dermatitis artefacta, neurotic excoriations and TTM - and examine their epidemiology, clinical presentation, differential diagnosis and treatment strategies. For all primary psychiatric disorders, the most effective underlying strategy is to first establish a strong therapeutic rapport with the patient. Various pharmacologic and non-pharmacologic therapies can then be attempted afterwards to successfully manage these patients.

Delusions of parasitosis.

Patients with delusions of parasitosis (DOP) are more commonly recognized in dermatology practices today. However, dermatologists may feel uncomfortable treating these patients because of the psychiatric nature of their disorder. As a result of the fact that DOP patients strongly prefer to seek treatment from dermatologists rather than mental health professionals, it is important for dermatologists to be well equipped with a basic understanding of the disorder and with tools to assist this patient population. In this review, we discuss the epidemiology, presentation, differential diagnosis and treatment strategy for patients with DOP.

The role of tumor necrosis factor-alpha and other cytokines in depression: what dermatologists should know.

Recent studies have suggested that inflammatory responses may play an important role in the pathophysiology of depression. In fact, depressed individuals have been found to have higher levels of pro-inflammatory cytokines, especially tumor necrosis factor-alpha (TNF-α) and interleukin-6. This appears to be independent of any pre-existing chronic inflammatory disorders. In this article, various studies correlating increased levels of cytokines to depression are reviewed. As much as 60% of individuals with psoriasis also suffer from clinical depression. TNF-α antagonists, frequently used in the treatment of psoriasis, may be helpful in directly reducing depressive symptoms for patients with psoriasis and other chronic inflammatory conditions.