[Show abstract][Hide abstract] ABSTRACT: Abstract Psoriasis is an immune-mediated inflammatory disease (IMID) which may have a major impact on a patient's life, especially when the disease is moderate to severe. There is evidence that treatment of psoriasis during the first years is conservative and frequently based on topical agents which rarely clear lesions. Treatment with systemic agents including biologics is often undertaken only when topical agents have proved unsuitable, even in patients with moderate to severe disease. However, there is evidence that in other IMIDs (rheumatoid arthritis and Crohn's disease), targeted systemic treatment given early in the treatment pathway may improve long-term patient outcomes. We hypothesize that a patient-centered therapeutic approach, undertaken early in the psoriasis treatment pathway ("early intervention") with the goal of complete clearance, may improve control of cutaneous symptoms and may also modify disease course and burden. Critical points to address when designing an early intervention study would include: the definition of psoriasis disease activity; patient selection; intervention selection; and dosing strategies.
Full-text · Article · Feb 2014 · Journal of Dermatological Treatment
[Show abstract][Hide abstract] ABSTRACT: Psoriatic arthritis (PsA) is a spondyloarthritis with a comorbid association with psoriasis. Without appropriate treatment it can be progressive, severe, deforming and destructive. It has long been recognized that subsets of PsA patients exist, characterized by different patterns of joint involvement. Associations between development of PsA and certain human leukocyte antigens (HLA) have been established. Evidence now suggests that progression of PsA is also genetically determined. The presence of one allele (HLA-B*27) has been associated with a distinct phenotype characterized by early joint involvement, whereas development of musculoskeletal symptoms is much slower in patients with another allele, C*06. Dermatologists need to consider what these differences in genotypes and phenotypes mean for clinical practice. Delay in the diagnosis of PsA is a significant contributor to poor patient outcomes, but there is evidence that PsA is underdiagnosed among psoriasis patients attending dermatology clinics. Dermatologists need to identify PsA symptoms among their psoriasis patients and refer for rheumatological assessment where appropriate. Treatment should address all aspects of the disease, including skin, nail and joint symptoms as well as physical functioning and quality of life. The existence of distinct phenotypic and genetic PsA subsets means dermatologists need to consider which drugs are likely to be most efficacious in which patient populations. Stratification of PsA according to susceptibility genes may in future help identify patients requiring more aggressive treatment to prevent progression. Biologic therapies show efficacy in PsA, but the patient populations of clinical trials are not always representative of patients treated with biologics in clinical practice.
No preview · Article · Aug 2013 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: Corticosteroids are the mainstay of topical therapies for the treatment of mild to moderate psoriasis. Selection of vehicle, concentrations of corticosteroid and coadministered medications, and frequency of administration are critical factors that enhance bioavailability of topical corticosteroids. Topical corticosteroids are commonly used as polytherapy and combination therapy with other agents, such as salicylic acid, vitamin D analogues and tazarotene. Combinations are selected for the ability to enhance efficacy while minimizing corticosteroid-related side-effects, such as cutaneous atrophy. New, innovative products such as sprays, foams and nail lacquers provide opportunities to tailor treatment for individuals, which promotes patient adherence to medications. This review covers features of topical corticosteroid formulations that affect bioavailability, efficacy and safety when used as monotherapy and in combination with other agents for the treatment of mild to moderate psoriasis.
No preview · Article · May 2011 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: Palmoplantar pustulosis (PPP) is difficult to treat. There is little hard evidence for the efficacy of any treatment and no published guidelines for its management. A number of exacerbating factors are well documented and there is some evidence for the importance of others. Smoking is the most recognized environmental trigger and recent research has concentrated on the role of eccrine sweat glands in this regard. Other factors, including tonsillar streptococcal infection and gluten sensitivity, may be important in selected cases. The aim of this review is to challenge dermatologists to consider alternative management strategies for PPP and design clinical trials that will enable the development of useful therapeutic guidelines.
No preview · Article · May 2011 · British Journal of Dermatology
[Show abstract][Hide abstract] ABSTRACT: Dermatological diseases in psychiatric patients are common; however, epidemiological data on this subject are scarce and to our knowledge integral studies of dermatological disease in psychiatric inpatients are not available yet.
The aim of this study was to describe the incidence of dermatological problems in psychiatric inpatients.
This study evaluates the consultations for new dermatological problems by inpatients of a general psychiatric hospital of over 700 beds during a 6-month period.
A total of 255 patients consulted their physician because of a new dermatological problem. Diagnoses (n=360) included skin infections (32%), accidents (7%), decubitus ulcers (7%), complications of medical treatment (3%), auto mutilation (1%) and neoplasms of the skin (1%). Patients with skin infections were likely to have diabetes [odds ratio (OR)=3.6; 95% confidence interval (CI): 1.56-8.40]. Patients with decubitus ulcers were likely to have an addiction problem (OR=6.4; 95% CI: 1.46-28.00). Dermatitis was associated with affective disorder (OR=2.5; 95% CI: 1.12-5.43) but not with psychosis (OR=0.5; 95% CI: 0.23-0.90). Only a poor correlation existed between the length of hospital stay and skin problems.
Dermatological problems are common in hospitalized psychiatric patients. Patients with diabetes mellitus are at high risk for skin infections. There are significant relationships between the psychiatric and the dermatological diagnoses. The length of the admission to a psychiatric hospital does not seem to play a major role in skin diseases.
Full-text · Article · Apr 2011 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: The cumulative exposition to biologics is increasing with prolonged treatment with a certain biologic or consecutive biological treatment. However, long-term safety data are limited available.
The aim of this study was to prospectively evaluate the 5-year safety of biological treatment for psoriasis in daily practice.
A cohort of 173 psoriasis patients on biologics was prospectively followed for 5 years. All adverse events reported were documented and analysed. Primary endpoint was the percentage of patients reporting at least one serious adverse event. The rate of malignancies, serious infections and serious cardiovascular events was compared with the general population incidence rate. The nature and rate of dermatological adverse events was compared with a group of prospectively followed rheumatoid arthritis patients on TNF-α blocking therapy.
Between February 2005 and April 2010, 173 patients were enrolled in the registry and went through a total number of 263 treatment episodes. The total number of patient-years of follow-up in the registry was 409. The number of patient-years was the highest for etanercept. Forty-nine patients (28%) reported 88 serious adverse events. Only one serious adverse event was certainly causally related to the biologic and 21 events (24% of SAEs) were considered possibly related. The incidence of malignancies, serious infections and serious cardiovascular events was comparable with the population incidence rate, except for skin malignancies. The incidence of skin malignancies was significantly higher than the general population incidence rate. The nature and rate of dermatological adverse events differed from the rheumatoid arthritis cohort.
In this cohort, the safety of biological therapies for psoriasis was favourable with a low incidence of therapy-related serious adverse events.
Preview · Article · Mar 2011 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: Chronic diseases can have a great influence on health-related quality of life. Nevertheless, only little research has been carried out on childhood psoriasis. The perception of quality of life by adults with psoriasis of their childhood psoriasis has never been investigated.
The aims of this study were to (i) investigate retrospectively the influence of psoriasis as experienced in childhood as compared with the current quality of life in adulthood; (ii) assess retrospectively the impact of childhood psoriasis on daily life; and (iii) compare the current quality of life in patients with childhood onset psoriasis (COP) and adult onset psoriasis (AOP).
A survey was performed among all members of the Dutch Psoriasis Society. Validated questionnaires on quality of life, impact on daily life and clinical severity were used.
Questionnaires of 1762 patients were suitable for analysis. Adults with an onset of psoriasis before the age of 18 years retrospectively rate their quality of life during childhood much less as compared with their current quality of life (intrapatient comparison). Influence of psoriasis in childhood particularly had a high degree of limitations on recreational and social activities in 15-30% of patients. Quality of life in adulthood is not determined by age of onset of psoriasis.
In childhood, the quality of life is greatly influenced by psoriasis. The social development domain, which is one of the developmental milestones in a child, is particularly impaired. The current quality of life of patients with COP is equal to that of patients with AOP.
No preview · Article · Oct 2010 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: A two-compound scalp formulation containing calcipotriol (50 μg/g) and betamethasone (0.5mg/g; as dipropionate) (Xamiol, Taclonex Scalp) has been shown to be an effective and safe treatment for scalp psoriasis. OBJECTIVE: The aim of this study was to investigate the clinical efficacy of the two-compound scalp formulation after 1 week of treatment. methods: Pooled data from two large pivotal phase III trials with 2920 patients receiving once-daily treatment for up to 8 weeks with either the two-compound scalp formulation (n = 1108), betamethasone dipropionate (n = 1118), calcipotriol (n = 558), or the vehicle (n = 136) were analysed. Results: The percentage of patients who had 'absent' or 'very mild' disease according to Investigator's Global Assessment after 1 week of treatment was significantly higher with the two-compound scalp formulation (30.6%) compared to betamethasone (24.1%; P < 0.001), calcipotriol (10.0%; P < 0.001) or vehicle (6.9%; P < 0.001). Conclusion: This data indicates that the two-compound scalp formulation demonstrated significant efficacy already after 1 week, with a faster onset of effect than either of the individual components in the same vehicle, in the treatment of scalp psoriasis.
No preview · Article · Apr 2010 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce.
To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients.
Ninety-one randomly chosen patients of the residential wards of a general psychiatric hospital completed a short, structured interview concerning skin disease and underwent a physical examination of the skin.
Of the examined patients, 69% reported symptoms of skin disease in the month prior to the interview and 77% had skin disorders at physical examination. In 34 (37%) patients, skin disorders were diagnosed, which were not mentioned in the interview. Patients with diabetes had infectious skin disease more often than their fellow patients [odds ratio (OR) 10.9; 95% confidence interval (CI): 2.40-49.75]. Moreover, overweight patients had infectious skin disease more often (OR 7.4; 95% CI: 1.38-39.3). Women reported more skin complaints (OR 6.4: 95% CI: 1.67-24.2), and also had skin problems other than infection, tumours or dermatitis more frequently (OR 3.7; 95% CI: 1.34-10.14). Clozapine use was associated with benign neoplasms of the skin. The nature of this association remains unclear and merits further investigation.
Many chronic psychiatric patients have skin problems. Clinical examination of the skin is important to discover these problems. Patients with diabetes mellitus are particularly at risk for skin infections. Because of their relationship with overweight and diabetes mellitus, atypical antipsychotics may be partly responsible for these serious complications. Only a few other relationships between psychiatric medication and specific skin problems were found.
Full-text · Article · Mar 2010 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: Safety and clinical effectiveness of clobetasol-17 propionate 0.05% shampoo have been shown in patients with scalp psoriasis.
First, to evaluate treatment satisfaction, user convenience safety and effectiveness of clobetasol-17 propionate 0.05% shampoo treatment in daily clinical practice. Second, to identify subgroup variables that may predict treatment success or failure.
A total of 56 patients with scalp psoriasis were treated with short-contact clobetasol-17 propionate 0.05% shampoo once daily for 4 weeks. Data on treatment satisfaction, user convenience, safety and effectiveness were assessed on a 7-point Likert scale using postal questionnaires. Subgroup analyses were performed to identify variables that may predict treatment outcome.
A total of 41 patients returned both questionnaires (73%). Positive treatment satisfaction and user convenience were reported by 66% and 79% of patients respectively. Patient-rated indicators for disease severity improved by 39-46% (P < 0.05%). No major side-effects were reported. Subgroup analyses did not reveal any statistically significant patient variable that may predict treatment outcome. However, a tendency towards improved treatment satisfaction was observed in patients who had received fewer topical antipsoriatic treatments previously (P > 0.05).
Short-contact treatment with clobetasol-17 propionate 0.05% shampoo has high user convenience and patient satisfaction rates. Moreover, the treatment is well-tolerated and efficacious from patients' perspective. Subgroup analyses did not reveal factors predicting treatment outcome, although treatment success tended to be more evident in patients who had received fewer treatments previously.
No preview · Article · Oct 2009 · Journal of the European Academy of Dermatology and Venereology
[Show abstract][Hide abstract] ABSTRACT: A 71-year-old man with a 13-year history of idiopathic Parkinson’s disease (PD) was referred to us because of severe and intractable drooling. His complaints started 4 years earlier with nocturnal drooling, but this had progressed to profuse drooling throughout the day. By that time he also suffered from severely impaired swallowing and severe hypokinetic dysarthria. The corners of his mouth were persistently wet, and this had produced a debilitating dermatitis in the perioral region, which is illustrated in Fig. 1. At investigation we observed erythematous plaques, in part sharply demarcated. The lesions showed some rhagades and mild scaling. Moreover, despite use of handkerchiefs, saliva was constantly dripping onto the patient’s clothes and feet, destroying the leather of his shoes and necessitating him to purchase new shoes every 3 months. Symptomatic treatment with anticholinergics had been tried, but this was stopped because of systemic side effects. Injection of botulinum toxin into the submandibular and parotid glands effectively suppressed saliva production, and the perioral skin lesions improved considerably. This case history underscores that drooling can have a tremendous impact on the quality of life of affected patients . The exact pathophysiology remains to be determined, but is more likely related to reduced automatic swallowing frequency than to increased production of
Full-text · Article · Jun 2009 · Journal of Neurology
[Show abstract][Hide abstract] ABSTRACT: There is evidence to suggest that genetic factors play an important role in the development of basal cell carcinomas (BCCs), and that skin neoplasms might be a sign for a genetic predisposition to cancer. We investigated whether the incidence of visceral and skin malignancies among first-degree relatives of BCC-patients was increased. Postal questionnaires were sent to 249 BCC-patients, who were divided into two groups (young = BCC under the age of 51 years and older = BCC over the age of 50 years), and asked them about cancer in their first-degree relatives. The reported numbers of cancer among the relatives were compared with the expected numbers based on sex and age-specific population-based incidence rates. The accuracy of the reported diagnoses was verified. A total of 157 BCC-patients reported 277 malignancies in 1,272 relatives. The incidence of the following cancers was higher than expected in relatives from young BCC-patients: bone and soft tissue (O/E = 3.91; 95% CI: 1.43-8.66), skin (O/E = 2.13; 95% CI: 1.30-3.29) and digestive tract (O/E = 1.59; 95% CI: 1.10-2.23). In relatives of older BCC-patients, only the incidence of digestive tract cancer was higher than expected (O/E = 1.44; 95% CI: 1.08-1.89). Diagnoses that were verified turned out to be accurate in 87% of the cases. This study suggests that the risk of certain cancers, particularly that of the digestive tract, in first-degree relatives of BCC-patients is increased. These findings may indicate a genetic predisposition to both skin and visceral malignancies in this patient group.
Preview · Article · Dec 2008 · Archives for Dermatological Research
[Show abstract][Hide abstract] ABSTRACT: In this study the safety and efficacy of imiquimod 5% cream for the treatments of actinic keratoses in kidney, heart and liver transplant recipients is evaluated.
Growing populations of organ transplant recipients face increased risk of developing actinic keratosis (AK) and skin cancer secondary to continuous systemic immunosuppressive therapy. Imiquimod 5% cream is an effective option for the treatment of AK, but the safety of topical immune stimulation in immunocompromised patients has not been widely evaluated.
A total of 43 patients in six European transplant centres applied two sachets of topical imiquimod or vehicle cream three times per week to a 100 cm(2) field. Dosing continued for 16 weeks regardless of lesion clearance. Patients were assessed for safety variables that included adverse events, local skin reactions, laboratory results, vital signs, dosage of immunosuppressive medication and indication of graft rejection. A blinded independent expert committee was responsible for safety monitoring and final safety assessment.
No graft rejections or trends for a deterioration of graft function were detected. No meaningful trends were observed in laboratory results. Among patients randomized to imiquimod, the complete clearance rate was 62.1% (18/29); for vehicle patients, the complete clearance rate was 0% (0/14). Clinical clearance was confirmed histologically in all cases.
Imiquimod appears to be a safe alternative for the treatment of multiple actinic keratoses in patients with solid organ transplants. Efficacy was within the range previously observed in nontransplanted populations.
Full-text · Article · Jan 2008 · British Journal of Dermatology
[Show abstract][Hide abstract] ABSTRACT: The Dutch Society of Dermatology and Venereology and the American Academy of Dermatology (AAD) recommend a liver biopsy every 1500 mg cumulative dose of methotrexate (MTX). In patients with risk factors a liver biopsy at or near the beginning of MTX therapy is advised. However, a retrospective chart study with 125 of our patients with psoriasis on low dose MTX treatment showed that MTX-induced liver fibrosis was relatively infrequent in this population. Diabetes and overweight were significantly correlated with liver injury. By means of a pilot-study we tried to evaluate the accuracy and feasibility of two novel non-invasive methods, the Fibroscan and Fibrotest, to assess MTX-induced hepatic fibrosis. Fibrotest accurately predicted the presence of significant liver fibrosis while Fibroscan accurately predicted the absence of significant liver fibrosis in our population. Based on our own research and data found in literature we advise to focus on patients with risk factors and continue monitoring liver injury in those patients by means of serial liver biopsies as suggested by the guidelines. In case of patients without risk factors less frequently performed liver biopsies would be justified. First of all, screening in these patients could be done by one of the above called or in literature described non-invasive methods. Second, if a test is positive, a liver biopsy can be performed.
No preview · Article · May 2007 · Nederlands Tijdschrift voor Dermatologie en Venereologie