Practical recommendations for systemic treatment in psoriasis in case of coexisting inflammatory, neurologic, infectious or malignant disorders (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis; part 2).

BACKGROUND: Psoriasis patients carry an increased risk for associated comorbidities. Dermatologists have to be aware of the effects of systemic treatments not only on psoriasis but also on co-occurring diseases. In case of other coexisting inflammatory diseases, the right psoriasis treatment may improve both disorders. For infectious and malignant disorders, some treatments have to be avoided as they may be harmful. OBJECTIVE: The primary objective of this project was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis). METHODS: Evidence-based recommendations were formulated using a quasi-Delphi methodology after a systematic search of the literature and a consensus procedure involving eight psoriasis experts. RESULTS: Recommendations are given on the use of systemic treatment in psoriatic arthritis, inflammatory bowel disease, demyelinating disorders, hepatitis B and C, HIV and cancer. CONCLUSION: This expert opinion is a practical guide for dermatologists when handling psoriasis patients with these specific conditions.

Practical recommendations for systemic treatment in psoriasis according to age, pregnancy, metabolic syndrome, mental health, psoriasis subtype and treatment history (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis; part 1).

BACKGROUND: Impressive progress in new therapeutic options has been made for psoriasis. Treatments include topical steroids, phototherapy, conventional, synthetic disease-modifying drugs and an expanding list of biologics. OBJECTIVE: The primary objective of this work was to collect evidence for the creation of practice guidelines for systemic treatment of psoriasis (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis). METHODS: Evidence-based recommendations were formulated using a quasi-Delphi methodology after a systematic search of the literature and a consensus procedure involving 8 psoriasis experts. RESULTS: In this part, the use of systemic treatment in different age groups, during pregnancy, in metabolic syndrome, in patients with mental health problems, in different psoriasis subtypes and in previously systemically treated patients treatment is discussed. CONCLUSION: Guidance on therapeutic choice in specific clinical situations in psoriasis is provided in order to facilitate the decision-making in clinical practice.

A Belgian consensus on the definition of a treat-to-target outcome set in psoriasis management.

OBJECTIVE: Treat-to-target (T2T) is an algorithm to reach a predefined outcome. Here, we define a T2T outcome for moderate-to-severe psoriasis vulgaris. METHODS: Briefly, the study included a literature review, discussions with key opinion leaders, recruitment of additional dermatologists with experience in managing moderate-to-severe psoriasis, 3 eDelphi survey rounds and a patient focus group. Relevant topics were selected during discussions prior to the survey for the statements. Surveys were based on the eDelphi methodology for consensus-building using a series of statements. Consensus was defined as at least 80% of participants agreeing. A psoriasis patient focus group provided feedback on topic selection and outcome. RESULTS: A total of 5 discussions were held, and 3 eDelphi rounds were conducted with an average of 19 participants per round. The T2T outcome was set assuming shared decision between patient and dermatologist, awareness and referral for comorbidities by the dermatologist and appropriate treatment adherence by the patient. We defined 'ideal' and 'acceptable' targets; the latter referring to conditions restricting certain drugs. The T2T outcome was multidimensional, including ≥ ΔPASI90/75 or PGA ≤ 1, itch VAS score ≤ 1, absence of disturbing lesions, DLQI ≤ 1/3, incapacity daily functioning VAS score ≤ 1, safety ≤ mild side-effects and full/mild tolerability of treatment for the ideal and acceptable target, respectively. Finally, time to achieve the T2T outcome was set at 12 weeks after initiation for all treatments. At all times, safety should not exceed the presence of mild side-effects. CONCLUSION: With this novel T2T composite outcome for psoriasis, clinicians and patients can make shared decisions on the treatment goals they envisage, as a guidance for future treatment steps - leading to a tight control management of the disease.

[Psoriasis in 2016 : Co-morbidities and therapeutic update]. / Psoriasis en 2016 : Co-morbidités et nouveautés thérapeutiques.

Recognition of psoriasis as a chronic systemic inflammatory condition rather than just a skin disease is now widely accepted in the medical community. Association with joint involvement and depressive symptoms has been established for many years and several studies demonstrated an increased risk for comorbidities. These include the metabolic syndrome, obesity, hypertension, diabetes, dyslipidemia, non-alcoholic fatty liver disease, inflammatory bowel disease, and an increased incidence of cardiovascular events among those patients.

La reconnaissance du psoriasis comme un état inflammatoire systémique chronique plutôt qu'une simple maladie de la peau est actuellement largement admise dans la communauté médicale. A côté de l'atteinte articulaire et des symptômes dépressifs connus de longue date, de nombreuses études établissent un risque accru de comorbidités. Celles-ci incluent le syndrome métabolique, l'obésité, l'hypertension artérielle, le diabète, les dyslipidémies, la stéatose hépatique non alcoolique, les maladies inflammatoires du tube digestif et une survenue plus importante chez ces patients de maladies cardiovasculaires.

THz magnetoelectric atomic rotations in the chiral compound Ba3NbFe3Si2O14.

We have determined the terahertz spectrum of the chiral langasite Ba3NbFe3Si2O14 by means of synchrotron-radiation measurements. Two excitations are revealed that are shown to have a different nature. The first one, purely magnetic, is observed at low temperature in the magnetically ordered phase and is assigned to a magnon. The second one persists far into the paramagnetic phase and exhibits both an electric and a magnetic activity at slightly different energies. This magnetoelectric excitation is interpreted in terms of atomic rotations and requires a helical electric polarization.

[Psoriasis: a chronic skin disease]. / Le psoriasis: au sujet d'une dermatose chronique.

Psoriasis is a frequent chronic inflammatory skin disease. Physiopathological mechanisms are still partially unclear. Psoriasis results of the influence of environmental factors on a complex genetic background. Clinical presentations are various, from the classical erythematous plaques-type to the pustulosis forms. Psoriasis can be associated with some other inflammatory diseases like psoriatic arthritis and Crohn's disease. Considered for long as a benign entity, psoriasis can significantly impair patient's quality of life. Some serious forms like generalized erythrodermia and generalized pustulosis can affect the vital prognosis. The treatment of the patient requires a slight collaboration between the patient, the dermatologist and the attending physician.

[The treatment of psoriasis: basic principles and new options]. / Le traitement du psoriasis: sa stratégie et les nouvelles options.

Psoriasis is a frequent chronic disease with a typical cutaneous expression described as erythemato-squamous lesions, and sometimes, joint involvement. This disorder rarely causes death in patients, but often alters their quality of life. A better understanding of the pathophysiology of psoriasis has led to the development of new therapeutic options among which are treatments targeted on blocking T-cell activation. Thanks to these therapies we can offer the patients long lasting remission, albeit not a curative approach. The therapeutic approach towards psoriasis will be selected in a multidisciplinary spirit, and after considering the patient himself, his disease and his lifestyle.

Fatal varicella in an immunocompromised adult.

A fatal case of disseminated varicella in a 28-year-old immunocompromised woman is reported. Abdominal pain was the first manifestation of the disease, generalized vesicular eruption developed later. The cutaneous lesions became purpuric, and spontaneous hematomas appeared as a result of disseminated intravascular coagulation. Primary varicella infection remains a serious problem in immunocompromised patients.