A case of lymphomatoid papulosis limited to Becker's melanosis.

Regional lymphomatoid papulosis (LyP) accounts for 2-27% of all LyP cases. Several localized dermatoses have been reported in association with Becker's melanosis (BM), e.g. acneiform lesions or lichen planus. Here, we report on regional LyP confined to the area of BM. A 56-year-old man presented with a 1-year history of a steadily increasing number of multiple pruritic red papules developing on the area of BM, which had occurred on his left shoulder during puberty. Histopathological analysis was consistent with regional LyP. Potent topical steroids followed by oral doxycycline did not achieve improvement, while long-term oral bexarotene treatment ameliorated the skin condition. Recently, the proposed entity of 'persistent agmination of LyP' (PALP) has extended the clinicopathological observations of regional LyP. Since PALP remains controversial, a unifying concept of localized LyP and PALP will be discussed.

Evaluation of methylprednisolone aceponate, tacrolimus and combination thereof in the psoriasis plaque test using sum score, 20-MHz-ultrasonography and optical coherence tomography.

BACKGROUND: Despite new treatment options with systemic disease modifiers, topical therapy - especially as combination therapy - plays an important role in psoriasis treatment. METHODS: Antipsoriatic efficacy of methylprednisolone aceponate ointment (MPA), tacrolimus 0.1% ointment (FK506) and their combination (MPA+FK506) were investigated in a double-blind randomized pilot study using the psoriasis plaque test. Agents and corresponding placebos were applied once daily under occlusion for 11 days. Test sites were evaluated by sum score (erythema, scaling, infiltration), objective assessment by 20-MHz-sonography and optical coherence tomography (OCT). RESULTS: After 11 days, the sum score significantly improved from baseline value in FK506-treated skin (9.6 vs. 2.9, p < 0.0001). MPA led to a significant improvement of the sum score (9.4 vs. 0.6, p < 0.0001). Combination therapy showed results similar to MPA monotherapy (9.4 vs. 0.4, p < 0.0001). These findings were confirmed by 20-MHz-sonography and OCT data. CONCLUSION: FK506 is moderately effective in chronic plaque-type psoriasis in our model. Combination therapy with FK506+MPA has no additive effect compared to MPA alone.

Psoriatic arthritis: a diagnostic challenge?

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis vulgaris. Making the diagnosis is not trivial even today. In contrast to older data, relatively high rates of disease progression and joint damage have been found in recent trials. Whether this originates from erroneously included patients with rheumatoid arthritis or true severity of PsA needs to be confirmed. The ClASsification criteria for Psoriatic Arthritis criteria are now widely accepted and used in the setting of clinical studies. Their further validation and development is conducted by Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Correct diagnosis and classification is a prerequisite for valid conclusions from therapeutic and prognostic clinical trials and optimal care for individual patients. This article reviews clinical presentation, diagnostic tools, classification criteria, differential diagnosis and treatment options in PsA.