"My friend, the pain": does altered body awareness affect the valence of pain descriptors?

Background: Pain is a marker of bodily status, that despite being aversive under most conditions, may also be perceived as a positive experience. However, how bodily states represent, define, and interpret pain signals, and how these processes might be reflected in common language, remains unclear. Methods: Qualitative and quantitative methods were used to explore the relationship between bodily awareness, pain reactions, and descriptions. A list of pain-related terms was generated from open-ended interviews with persons with spinal cord injury (SCI), and 138 participants (persons with SCI, health professionals, and a healthy control group) rated each descriptor as representative of pain on a gradated scale. A lexical decision task was used to test the strength of the automatic association of the word "pain" with positive and negative concepts. The behavioral results were related to body awareness, experience of pain, and exposure to pain, by comparing the three groups. Results: Higher positive and lower negative pain descriptors, as well as slower response times when categorizing pain as an unpleasant experience were found in the SCI group. The effect was not modulated by either the time since the injury or the present pain intensity, but it was linked to the level of subjective bodily awareness. Compared with the SCI group, health experts and non-experts both associated more quickly the word "pain" and unpleasant in the lexical decision task. However, while health professionals attributed positive linguistic qualities to pain, pain was exclusively associated with negative descriptors in healthy controls group. Conclusions: These findings are discussed in terms of their theoretical and clinical implications. An awareness of bodily signals prominently affects both the sensory and linguistic responses in persons with SCI. Pain should be evaluated more broadly to understand and, by extension, to manage, experiences beyond its adverse side.

Nail dystrophies, scalp and intergluteal/perianal psoriatic lesions: risk factors for psoriatic arthritis in mild skin psoriasis?

AIM: In the literature, clinical features of psoriasis associated with psoriatic arthritis (PsA) onset have not been clarified, even if high Psoriasis Area and Severity Index (PASI) was found to be directly related with PsA. METHODS: The study was conducted between November 2008 and April 2009 on consecutive psoriatic outpatients referred to a service of dermatological consultations, on indication of other hospital specialists. Participants were affected by mild skin psoriasis, in particular with nail dystrophies and/or scalp and/or intergluteal/perianal lesions. The questionnaire provided by the Classification of Psoriatic Arthritis (CASPAR) study group was proposed to all patients and we added a question about the time of psoriasis onset. RESULTS: Eighty-seven subjects (34 males and 53 females) aged between 18 and 91 years (mean age 48 years) with such psoriatic features were recruited. Other 30 refused to take part to the study. Forty-seven per cent of these participants were found to suffer from PsA, in particular 83% of those with nail and scalp psoriasis, 40% of subjects with intergluteal/perianal involvement and 37% of patients with just scalp lesions. We present the first exploratory and observational study focused on a population with mild skin psoriasis, in order to evaluate if nail dystrophies, scalp or intergluteal/perianal psoriatic lesions might be indicative of a higher risk of PsA even in cases with mild skin psoriasis. CONCLUSION: Nail psoriasis is probably a suggestive feature of joint involvement. The scalp psoriasis, as well as intergluteal/perianal psoriatic lesions, is likely to be less associated to PsA, but may be an important comorbidity factor for the development of PsA. Further investigations in a larger population are encouraged to assess a potential link between PsA, site-specific and mild skin psoriasis.

Diet and physical exercise in psoriasis: a randomized controlled trial.

BACKGROUND: Increased body mass index and weight gain are risk factors for psoriasis, and the prevalence of obesity in patients with psoriasis is higher than in the general population. Limited data exist regarding the role of diet in psoriasis. OBJECTIVES: To assess the impact of a dietary intervention combined with physical exercise for weight loss on improving psoriasis in overweight or obese patients. METHODS: This study included 303 overweight or obese patients with moderate-to-severe chronic plaque psoriasis who did not achieve clearance after 4 weeks of continuous systemic treatment. They were randomized to receive either a 20-week quantitative and qualitative dietary plan associated with physical exercise for weight loss or simple informative counselling at baseline about the utility of weight loss for clinical control of psoriatic disease. The main outcome was any reduction of the Psoriasis Area and Severity Index (PASI) from baseline to week 20. RESULTS: Intention-to-treat analysis showed a median PASI reduction of 48% (95% confidence interval 33.3-58.3%) in the dietary intervention arm and 25.5% (95% confidence interval 18.2-33.3%) in the information-only arm (P = 0.02). Among secondary outcomes, PASI score reduction of ≥ 50% significantly differed between study arms (49.7% with dietary intervention vs. 34.2% with information only, P = 0.006). The weight-loss target (a ≥ 5% reduction from baseline) was reached by 29.8% of patients in the dietary intervention arm compared with 14.5% in the information-only arm (P = 0.001). CONCLUSIONS: A 20-week dietetic intervention associated with increased physical exercise reduced psoriasis severity in systemically treated overweight or obese patients with active psoriasis.

Brittle nails.

Nail brittleness is a common complaint characterized by weak inelastic nails that split, flake and crumble. It may be a consequence of factors that alter nail plate production and/or factors that damage the already keratinised nail plate. It is often idiopathic. It can also be caused by many dermatological and systemic diseases, nutritional deficiencies, drugs and traumas. Environmental and occupational factors that produce progressive dehydration of the nail plate have an important role in nail brittleness. Treatment of brittle nails is often difficult. Preventative measures, together with oral supplementation of vitamins (especially biotin), oligo-elements and amino acids, can be useful in improving nail strength. Cosmetic treatment affords camouflage and a degree of protection.

Lycopenaemia.

Over the last few years, carotenoids have been studied extensively for their antioxidant activity and the supposed protective effects against cancer, in particular those of the digestive tract. Consumption of carotenoids as anti-ageing agents is also widely diffuse. Moreover, the diffusion of slimming and vegetarian diets, and thus the consumption of fruit and vegetables, which contain large amount of carotenoids, is increasing. On the other hand, the excessive dietary intake of carotenoid-containing foods may cause different afflictions characterized by a 'yellow-orange' discoloration of the skin. One of these carotenoids, the lycopene, present in high concentrations in tomatoes, may cause a rare cutaneous disease called lycopenaemia.

Acquired progressive kinking of the hair: clinical features, pathological study, and follow-up of 7 patients.

BACKGROUND: Acquired progressive kinking of the hair (APKH) is a relatively rare condition, with fewer than 20 cases reported in the literature. Whether APKH is a separate entity or a variety of androgenetic alopecia is still controversial. This study reviews the clinical and pathological features and long-term follow-up of 7 patients with APKH. OBSERVATIONS: Since January 1989, we have diagnosed APKH in 7 males aged 15 to 22 years. All patients had strong family history for androgenetic alopecia. Hair kinking affected the frontotemporal region and/or the vertex where the hair appeared curly, frizzy, and lusterless. The pathological features of the affected scalp were consistent with the diagnosis of the early stages of androgenetic alopecia. In all patients, APKH evolved into androgenetic alopecia during the follow-up period. Mean follow-up was 4.5 years (range, 2-9 years). Treatment with topical minoxidil did not prevent development of hair thinning in the scalp areas affected by hair kinking. CONCLUSIONS: The term acquired progressive kinking of the hair encompasses a number of conditions characterized by acquired curling of the scalp hair. Acquired hair kinking on the androgen-dependent areas of the scalp represents a modality of onset of androgenetic alopecia associated with poor prognosis.