[|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.
- 2019/10/29 Focus on...World Psoriasis Day 2019
- 2019/08/12 Focus on...Latin American Clinical Practice Guidelines on the Systemic Treatment of Psoriasis
- 2019/06/03 Focus on...News from our SPIN Columbian members
- 2019/05/21 Focus on...SPIN2019 is now available on your screen!
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
News from the web office
- 2017/06/05PIN becomes SPIN - Skin Inflammation & Psoriasis International Network
- 2016/10/29PSO 2016 Congress - Webcasts Available!
- 2016/05/26PIN Survey on Phototherapy
- 2016/02/20PIN Study on Therapeutic Patient Education
- 2016/02/19World Directory of Psoriasis Medical Resources - February 2016 Update
- 2019/04/18 Focus on...SPIN Congress 2019 in Paris coming soon
- 2018/07/16SPIN Symposium at the Spring continental meeting - Tehran, 25-27 April 2018
- 2018/02/222nd National Meeting of the Egyptian Society for Psoriasis
- 2018/02/211st Psoriasis Symposium - Sarajevo 2017
- 2017/06/2815th São Paulo Meeting of Psoriasis and Vitiligo
News from medical groups
- 2018/04/183rd Turkish National Psoriasis Symposium
- 2017/06/21Brazilian Center for Psoriasis Studies joins SPIN!
- 2017/06/21Costa Rica Psoriasis Group - Meet them!
- 2017/02/02Works of the 1st Senegalese Psoriasis Day published!
- 2016/07/29Swiss S1 Guidelines for Systemic treatment of psoriasis vulgaris
News from patients associations
- 2017/02/08France Psoriasis - 2016 World Psoriasis Day
- 2016/05/26Senegal Patients Association joins PIN!
- 2015/08/04Epidermia Greece: a new partner association of PIN
- 2015/08/01Canadian Association of Psoriasis Patients joins PIN!
- 2015/04/09AEPSO Argentina launches digital map to find people with psoriasis in the country
Recent publications on Psoriasis and Atopic Dermatitis
In vitro evaluation of Naltrexone HCl 1% Topical Cream in XemaTop™ for psoriasis.
Arch. Dermatol. Res.. 2020 Mar , 312, (2):145-154.
Psoriasis is a multifactorial skin disease involving abnormal cell proliferation and inflammation; an efficacious topical treatment is yet to be identified. A formulation containing 1% Naltrexone HCl in XemaTop™ base was compounded, characterized and evaluated in vitro as a possible treatment for psoriasis. A three-dimensional psoriasis tissue model was exposed to the formulation for 2 or 5 days and analyzed for the level of markers of cellular proliferation, and inflammatory cytokine IL-6. (...)see on pubmed
Hydrogen peroxide in neutrophil inflammation: Lesson from the zebrafish.
Dev. Comp. Immunol.. 2020 Apr , 105:103583.
The zebrafish has become an excellent model for the study of inflammation and immunity. Its unique advantages for in vivo imaging and gene and drug screening have allowed the visualization of dual oxidase 1 (Duox1)-derived hydrogen peroxide (HO) tissue gradients and its crosstalk with neutrophil infiltration to inflamed tissue. Thus, it has been shown that HO directly recruits neutrophils via the Src-family tyrosine kinase Lyn and indirectly by the activation of several signaling pathways (...)see on pubmed
IL-36α contributes to enhanced T helper 17 type responses in allergic rhinitis.
Cytokine. 2020 Apr , 128:154992.
T helper 17 (Th17) cell subsets, belongs to CD4+ T cell lineage, are proved to be closely related to pathophysiology of AR recently. The interleukin-36 (IL-36) had been reported to promote the up-regulation of Th17 cytokines in psoriasis. We investigated the regulation of Th17 inflammation by IL-36 family cytokines in allergic rhinitis (AR).see on pubmed
Atopic dermatitis induces anxiety- and depressive-like behaviors with concomitant neuronal adaptations in brain reward circuits in mice.
Prog. Neuropsychopharmacol. Biol. Psychiatry. 2020 Mar 02, 98:109818.
Clinically, it has been reported that atopic dermatitis (AD) has been linked with negative emotional problems such as depression and anxiety, thereby reducing the quality of life, but little is known about the molecular mechanism that underlies AD-associated emotional impairments. We sought to determine whether AD could induce anxiety- and depressive-like symptoms in mice and to identify pertinent signaling changes in brain reward circuitry. AD-like lesions were induced by the repeated (...)see on pubmed
Efficacy and safety of indigo naturalis ointment in Treating Atopic Dermatitis: A randomized clinical trial.
J Ethnopharmacol. 2020 Mar 25, 250:112477.
Indigo naturalis, a herbal medicine with a history of use dating back to ancient times, may be a good alternative topical treatment for atopic dermatitis (AD).see on pubmed
"Eczema" of the nape: A marker of pthiriasis capitis.
Parasitol. Int.. 2020 Apr , 75:102026.
Pthirus pubis usually infests the pubis, inguinal folds, buttocks and perianal region. In hairy males or when the infestation is longstanding, this louse can also occur on the thighs, abdomen, chest, axillae and beard. Eyelashes may be involved in children. The involvement of the scalp is very rare. We describe four girls with P. pubis infestation located exclusively on the scalp which was characterized by a rash on the nape that can suggest a head and neck form of atopic (...)see on pubmed