[|In this chapter it is
easy to disagreement by saying “yes, however…”. I think the various aspects
have been taken care of very well. But what we all miss is an overall score,
which comprises everything. Therefore, we need well-trained dermatologists for
professional decisions. I will explain what may happen if we assess disease
severity exclusively with nice scores as described in chapter 9. A patient with chronic
plaque psoriasis, PASI 7 visits the dermatologist. She has an alarming DLQI and
feels very depressed. Her psychiatrist considers adequate antidepressive
medication which is refused by the patient. As she could not stand photo
chemotherapy and none of the systemic treatments she now urges a biological
treatment. The resident was of the opinion that a biological treatment was
entirely justifiable. My view was entirely different. The patient did not need
a biological but an antidepressive drug.|auteur197]
[|This is an exceptionally well-done chapter, very broad in concept and discussion. The various outcome measures in psoriasis are well-discussed. The only addition that I would like to have seen would be a discussion on how dermatologists in clinical practice, ie non-academic centers, can assess these outcome measures in a rapid and informative way as measure such as SF36, PASI are seldom, if ever, done on a routine basis outside of clinical research or academic institutions. Is there a place for a new outcome measure that mirrors the ACR measure which uses quality of life, clinical evaluations, and even serological evaluations in one easily understood measurement? In this regard, Professor Jim Krueger will be hosting an International Psoriasis Council based Roundtable in February, 2006 with a new 4 part tool encompassing physical evaluation, quality of life, psoriatic arthritis and patient satisfaction undergoing clinical trial validations.. Two further outcome measures which have gained credibility in the United States are the PQOL (Psoriasis Quality of Life) developed by Professor John Koo from San Francisco, which has been validated in a large study with Drs. Lebwohl and Menter with over 400 patients, with concomitant clinical evaluation. From this PQOL, the Koo-Menter Psoriasis Index (KMPI) has been developed, a two-page index utilizing a series of patient-based 12 quality of life questions, and key questions relating to arthritic manifestations. This is then utilized to do a rapid body surface area evaluation after which key questions relating to access to phototherapy, etc., are discussed, with a final evaluation relating to patient applicability for systemic therapy, Yes or No. It is only by dermatologists and rheumatologists creating “easy to use” evaluations that psoriasis will finally be accepted as a systemic disease worthy of systemic treatment in those patients with moderate to severe disease, with or without associated psoriatic joint disease. This begs the question: What do we mean by mild, moderate, and severe psoriasis and how do quality of life issues relate to these artificial divisions? Thus, would somebody with palmar-plantar disease involving less than 5% BSA, with difficulties in ambulation and manual dexterity, not deserve systemic therapy as much as a patient with mild-moderate Crohn’s disease or mild-moderate rheumatoid arthritis? Again, a quality of life tool for palmar-plantar disease has been developed by our group and submitted for publication. Certainly, I would believe that such psoriatic patients have more disabling disease than the aforementioned conditions.|auteur215]
In life-threatening illnesses, it is the doctor who, with the help of scientifically validated clinical and biological markers, assesses the severity of the illness and, on the basis of this assessment, suggests the treatment with the best benefit/risk ratio.
In illnesses involving the quality of life—of which psoriasis is the prototype—only the patient can assess the illness’s repercussions on his or her quality of life, and hence its severity.
This severity, if any, justifies suggesting systemic treatments.
There is consensus or agreement between European psoriasis specialists to accept Professor Christopher Griffiths’ suggestion of assessing the severity of psoriasis by taking into consideration, in decreasing order of importance:
- the effect on the quality of life,
- the resistance of psoriasis to various treatments,
- the extent of the lesions.
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Recent publications on Psoriasis and Atopic Dermatitis
Integrated analysis of gene expression profiles identifies transcription factors potentially involved in psoriasis pathogenesis.
J. Cell. Biochem.. 2019 Aug , 120, (8):12582-12594.
Psoriasis is a common inflammatory skin disease mediated by cells and molecules in both the innate and adaptive immune systems. Recently, gene expression profile analysis revealed a large set of immune-related differentially expressed genes (DEGs) in psoriasis. However, the associations between these DEGs and their transcriptional regulation mechanisms have not been completely elucidated. In this study, several psoriasis Gene Expression Omnibus data sets were systematically analyzed using (...)see on pubmed
Models of human psoriasis: Zebrafish the newly appointed player.
Dev. Comp. Immunol.. 2019 Aug , 97:76-87.
Psoriasis is a human chronic, immune disease with severe cutaneous and systemic manifestations. Its prevalence, among the world population, highly varies with ethnicity and geography, but not sex from remarkable low levels in Asia to 2.3% in Spain, or an impressive 11.5% in Norway. The pathogenesis of psoriasis derives from complex genetic and environmental interactions, which creates aberrant crosstalk between keratinocytes and variated immune cell, resulting in open amplified inflammatory (...)see on pubmed
A vivid cytokines interaction model on psoriasis with the effect of impulse biologic (TNF-α inhibitor) therapy.
J. Theor. Biol.. 2019 Aug 07, 474:63-77.
Psoriasis is a chronic skin condition that produces plaques of condensed, scaling skin due to excessively rapid proliferation of keratinocytes. During the disease progression, keratinocyte proliferation is influenced by many immune cells and cytokines. This article deals with a five dimensional deterministic model, which has been derived using quasi-steady-state approximation for describing the dynamics of psoriasis in various cytokines environment. Equilibrium analysis of the system shows (...)see on pubmed
Prenatal perfluorooctanoic acid exposure is associated with early onset atopic dermatitis in 5-year-old children.
Chemosphere. 2019 Sep , 231:25-31.
Atopic dermatitis (AD) is the most common childhood skin disease and the first step of atopic march. Perfluoroalkyl substance (PFAS) exposure is associated with atopic diseases, including AD. However, whether PFAS exposure is related to earlier AD onset remains unclear. We aimed to investigate the association between prenatal PFAS exposure and earlier onset of AD in children in a 5-year follow-up study. From 2001 to 2005, 1264 mother-infant pairs were recruited from eight Taiwanese (...)see on pubmed
Synthesis of chitosan derivatives with organoselenium and organosulfur compounds: Characterization, antimicrobial properties and application as biomaterials.
Carbohydr Polym. 2019 Sep 01, 219:240-250.
In this study, Schiff bases of chitosan (CS) were synthesized using citronellal, citral, and their derivatives containing selenium and sulfur. Organoselenium and organosulfur compounds show attractive biological and pharmaceutical activities, which can be beneficial to CS-based materials. From the characterization analyses, it was found that the CS-derivatives containing organoselenium and organosulfur compounds exhibited the highest conversion degrees (23 and 28%). Biological assays were (...)see on pubmed
Effect of cinnamamides on atopic dermatitis through regulation of IL-4 in CD4 cells.
J Enzyme Inhib Med Chem. 2019 Dec , 34, (1):613-619.
This study aimed to evaluate the effects of cinnamamides on atopic dermatitis (AD) and the mechanisms underlying these effects. To this end, the actions of two cinnamamides, (E)-3-(4-hydroxyphenyl)-N-phenylethyl acrylamide (NCT) and N-trans-coumaroyltyramine (NCPA), were determined on AD by orally administering them to mice. Oral administration of the cinnamamides ameliorated the increase in epidermal and dermal thickness as well as mast cell infiltration. Cinnamamides suppressed serum (...)see on pubmed