Transcript Lejupielādēt - Dermatologs

''Vienotā pieeja psoriāzes
izaicinājumu risināšanā''
Ādas psoriāzes izplatība Eiropā un pasaulē,
diagnostiskās un ārstēšanas problēmas.
Psoriāzes klīniskās vadlīnijas.
Jānis Ķīsis
RSU Infektoloģijas un dermatoloģijas katedra
Asociētais profesors
Psoriāze .
Jau 200 gadus .
Willan R. Cutaneous Diseases. London: J. Johnson; 1808.
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Saturs .
► 1.
► 2.
Epidemioloģija.
Diagnostika .
► 3.Terapija .
► 4 .Psoriāzes terapija.
Epidemioloģija.
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Telefonaptaujā Kanādā tika indicēti 500 psoriāzes pacienti
ar ādas bojājumu >3 plaukstas un viņu vidū 18 % tika
konstatēts PsA ,bet 51% (256 of 500 ) bija sāpes
,stīvums locītavās
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J Cutan Med Surg. 2009 Sep-Oct;13(5):235-52.The burden of
psoriasis in Canada: insights from the pSoriasis Knowledge IN
Canada (SKIN) survey.Lynde CW, Poulin Y, Guenther L, Jackson C.
Epidemioloģija .
► ASV
diagnosticētas psoriāzes prevalence ir
3.15%.ar pieaugumu pēdējās 2 dekādēs .
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J Autoimmun. 2010 May;34(3):J314-21. Epub 2009 Dec
24.Geoepidemiology and environmental factors of psoriasis and
psoriatic arthritis.Chandran V, Raychaudhuri SP.
Vēsture
Edward Calvin Kendall
Tadeus Reichstein
Philip Showalter Hench
The Nobel Prize in Physiology or Medicine 1950 was awarded jointly to
Edward Calvin Kendall, Tadeus Reichstein and Philip Showalter Hench
"for their discoveries relating to the hormones of the adrenal cortex,
their structure and biological effects".
www.nobelprize.org
Vēsture .
►Hidrokortizons –pirmais lokāli efektīvais
KS tika ieviests 1952. gadā . To veica
Sulzberger un Witten .
► 60.jubileja.
1. Sulzberger MB, Witten VH. Effect of topically applied compound F in
selected dermatoses.
J Invest Dermatol 1952; 19: 101–2.
Epidemioloģija . Bērniem.
► Saslimstība
ar psoriāzi bērniem ir
palielinājusies zīmīgi no 29.6 uz
100,000 1970 līdz 1974 uz 62.7 no
100,000 jau 1995 līdz 1999 (P < .001).
J Am Acad Dermatol. 2009 Dec 3. [Epub ahead of print]Incidence of
psoriasis in children: A population-based study.Tollefson MM, Crowson
CS, McEvoy MT, Kremers HM.Department of Dermatology, College of
Medicine, Mayo Clinic, Rochester, Minnesota.
Epidemiology of Psoriasis in Germany Analysis of Secondary Health Insurance Data.
► 33
981 no 1 344 071 apdrošinātām personām
2005 gadā un psoriāzes diagnozi ,tādejādi viena
gada prevalence šai kohortā bija 2.53%. Līdz 80
gv prevalence palielinājās un bija augstākā
vecuma grupā 50 to 79 g.v ( 3.99-4.18%).
Apdrošinātās personas līdz 20 gv.bija ar
prevalenci 0.73%. Zemākie rādītātāji bija
dienvidos (2.17%) un augstākie (2.78%)
Vācijas ziemeļos .
Gesundheitswesen. 2010 Jun 11. [Epub ahead of print]
Schäfer I, Rustenbach SJ, Radtke M, Augustin J, Glaeske G,
Pētnieki uzskata ,ka psoriāze var
samazināt iespējamo dzīves ilgumu
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MedPage Today (10/14, Bankhead) ir citējis,ka
"psoriāzes pacientiem ir koincidentas saslimšanas
,kas saīsina iespējamo dzīvildzi par 10 un vairāk
gadiem" Kanādas pētnieku komanda no NewLab ir
atraduši ,,,ka pacienti ,kuriem psoriāze ir diagnosticēta
pirms 25 gv.,nedzīvo līdz 60 gv.“, kamēr psoriāze
diagnosticēta 25 un vēlākā laika periodā ir asociēta ar
vidējo dzīvildzi virs 70 gv. Datu analīze parādīja ,ka,,
psoriāzes pacientiem risks nomirt pašnāvībā ,ievainojumu
,saindēšanās dēl ir 1 gadījumā no 600 ,bet
kardiovaskulārās nāves risks ir aptuveni 1 no 75 "
Genital Psoriasis: A Systematic Literature
Review on this Hidden Skin Disease.
► Ģenitāliju
āda bojājums sastopams 29–40%
pacientiem ar psoriāzi ;
► No 48 pacientiem ar inversu psoriāzi , ārējās
ģenitālijas bija iesaistītas 38 (79.2%).
► Vulvāro psoriāziar psoriasis bieži novēro bērnu
vecumā .Izvērtējot 130 prepuberātes vecuma
meitenes ar vulvārām sūdzībām – psoriāze
(17%) bija 3. biežākais ādas stāvoklis pēc
AD un iritanta D(33%) un lichen sclerosus
(18%)
Acta Derm Venereol. 2010 Oct 7. doi: 10.2340/00015555-0988. [Epub ahead
of print] .Meeuwis KA, de Hullu JA, Massuger LF, van de Kerkhof PC,.
Globālā epidemioloģija .
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53 pētījumi no 385 bija globāli pētījumi , caurskatīti laika
posmā lidz 2011 gada jūlijam.
Bērnu prevalence 0% (Taivānā ) līdz 2.1% (Itālija)
pieaugušie no 0.91% (Amerika ) līdz 8.5% (Norvēģija
Bērnu psoriāzes incidence (Amerika) bija 40.8/100,000
person-gadi ,pieaugušajiem variācijas no 78.9/100,000
person-gadiem (Amerika )līdz 230/100,000 persongadiem (Itālijā ).
Tas nozīmē ,ka psoriāzes sastopamība un saslimstība variē
atbilstoši vecumam un ģeogrāfiskajam reģionam.
Psoriāze biežāka ir rajonos attālinātos no ekvatora .
J Invest Dermatol. 2012 Sep 27. doi: 10.1038/jid.2012.339. [Epub
ahead of print] Global Epidemiology of Psoriasis: A Systematic
Review of Incidence and Prevalence.Parisi R, Symmons DP,
Griffiths CE, Ashcroft DM;
Heterosexual women with psoriasis 0.03) compared with
those without = had 1.13 times more unprotected
sex (RR 1.13, 95% CI 1.02-1.24, P psoriasis . Conclusion.
Psoriasis is associated with a significantly reduced
number of sexual partners in nonheterosexual
women.
► Psoriasis may differentially impact sexual behavior based
on sexual orientation in women.
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J Sex Med. 2012 Nov 21. Psoriasis and Sexual Behavior in U.S.
Women: An Epidemiologic Analysis Using the National Health
and Nutrition Examination Survey (NHANES).
Armstrong AW, Follansbee MR, Harskamp CT, Schupp CW.
Neatpazīta psoriāze.
Neatpazīta psoriāze.
► Agrīns
sākums ,neregulāra gaita
,tendence smagai gaitai .
► J Dermatolog Treat. 2012 Dec 5. [Epub
ahead of print]
► Current therapeutic approaches of
psoriasis are affected by age at disease
onset.
► Di Lernia V, Ficarelli E.
Arch Dermatol. 2012 Aug;148(8):918-24. The association between
physical activity and the risk of incident psoriasis.
Frankel HC, Han J, Li T, Qureshi AA.
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a cohort of 116,430 women aged 27 to 44 years in 1991.
The study population included 86,655 US female nurses who reported
After adjusting for age, smoking, and alcohol use, increasing physical
activity was inversely associated with the risk of psoriasis. The most
physically active quintile of women had a lower multivariate relative
risk (RR) of psoriasis (0.72 [95% CI, 0.59-0.89; P < .001 for trend])
compared with the least active quintile.
Vigorous physical activity (≥6 metabolic equivalents) was associated
with a reduced risk of psoriasis (multivariate RR for the highest
quintile, 0.66 [95% CI, 0.54-0.81; P < .001 for trend]); this association
remained significant after adjusting for body mass index (RR, 0.73
[95% CI, 0.60-0.90; P = .009 for trend]).
J Drugs Dermatol. 2012 Apr;11(4):466-73.
Top dermatologic conditions in patients of color: an analysis of
nationally representative data.Davis SA, Narahari S, Feldman SR,
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in patient visits to U.S. dermatologists from 1993 to 2009. The leading
diagnoses were tabulated for each racial and ethnic group, and the top
conditions were compared between groups.
The top five diagnoses for African-American patients in dermatology
clinics were acne, unspecified dermatitis or eczema, seborrheic
dermatitis, atopic dermatitis, and dyschromia.
For Asian or Pacific Islander patients, the top five were acne,
unspecified dermatitis or eczema, benign neoplasm of skin, psoriasis,
and seborrheic keratosis.
Caucasian patients, the top five were actinic keratosis, acne, benign
neoplasm of skin, unspecified dermatitis or eczema, and nonmelanoma
skin cancer.
In Hispanic patients of any race, the leading diagnoses were acne,
unspecified dermatitis or eczema, psoriasis, benign neoplasm of skin,
and viral warts.
Saturs .
► 1.Epidemioloģija.
► 2.
Diagnostika .
► 3.Psoriāzes terapija.
► 4. Vadlīnijas
Eur J Pharm Sci. 2012 Nov 15. S0928-0987(12)00408-3.
Diagnostic opportunities based on skin biomarkers.
Paliwal S, Hwang BH, Tsai KY,
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Source Santa Barbara, CA 93106, United States.
Abstract
Systemic as well as localized skin diseases modify the
molecular composition of human skin. Changes in skin
chemistry have been observed in diseases such as cancer,
psoriasis, eczema, diabetes, and atherosclerosis. Skin
chemistry, represented by an enormous wealth of disease
biomarkers including lipids, structural proteins,
inflammatory mediators, nucleic acids and small molecules,
therefore, can serve as a "window to body's health".
Various methods including tape-stripping, iontophoresis,
microneedles and ultrasound, among others, are being
developed to access skin biomarkers and understand skin's
detailed molecular composition.
Clin Chem Lab Med. 2012 Aug 22..
Serum kallikrein-8 correlates with skin activity, but
not psoriatic arthritis, in patients with psoriatic
disease.
Eissa A, Cretu D, Soosaipillai A,
► Kallikreins
(KLKs) are secreted serine
proteases implicated in skin desquamation
and inflammation. joint counts.
► Increased KLK8 serum level in PsA patients
reflects disease activity in the skin but not in
the joints. Serum KLK levels are not useful
for screening psoriasis patients for Ps
Diagnostika .
► Cathepsin
S (CATS) ir cisteīna
proteāze,kas parasti konstatējama
dermā makrofāgos,bet tikai pie
psoriāzes atrodama ir nosakāma
keratinocītos .
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Exp Dermatol. 2009 Oct 22. Upregulation of
cathepsin S in psoriatic keratinocytes.Schönefuß
A, Wendt W, Schattling B, at al .
Diagnostika .
► Cilvēku
antimikrobais peptīds betadefensin-2 (hBD-2) ir stingri saistīts ar
psoriāzes izsitumu epidermu . Augsts
beta defensīnu kopiju skaits ir saistīts ar
uzņēmību pret psoriāzi .
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PLoS One. 2009;4(3):e4725.Beta-defensin-2 protein is a
serum biomarker for disease activity in psoriasis and
reaches biologically relevant concentrations in lesional skin.
Jansen PA, Rodijk-Olthuis D, Hollox EJ, Kamsteeg M The
Netherlands
Identification of 15 new psoriasis susceptibility loci
highlights the role of innate immunity.
Tsoi LC, Spain SL, Knight J,
.
Nat Genet. 2012 Nov 11;44(12):1341-8
► To
gain further insight into the genetic architecture
of psoriasis, we conducted a meta-analysis of 3
genome-wide association studies (GWAS) and 2
independent data sets genotyped on the
Immunochip, including 10,588 cases and 22,806
controls. We identified 15 new susceptibility
loci, increasing to 36 the number associated
with psoriasis in European individuals. We also
identified, using conditional analyses, five
independent signals within previously known loci.
Clin Exp Dermatol. 2012. Feb 2.
Serum lipocalin-2 levels are increased in
patients with psoriasis.
Kamata M, Tada Y, Tatsuta A
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The protein lipocalin (LCN)-2 is known to be related to insulin
resistance, obesity and atherosclerotic diseases. Psoriasis is an
inflammatory skin disease related to metabolic syndrome. The aim of
this study was to examine the relationship between serum LCN2 levels
and indicators for metabolic syndrome and inflammatory cytokine
levels in patients with psoriasis. Serum LCN2 levels were also
compared with several indicators for metabolic syndrome, and with
serum levels of interleukin (IL)-6 and tumour necrosis factor (TNF)-α,
two markers of inflammation. Serum LCN2 levels in patients with
psoriasis were significantly higher than those of healthy controls, but
there was no significant correlation between serum LCN2 and body
mass index. Serum LCN2 levels also correlated with serum IL-6 and
TNF-α levels in patients with psoriasis. Serum LCN2 levels are a
general indicator for increased inflammation in the patients
with psoriasis.
► Dis
Markers. 2012 Nov 14. Psoriasin: A
novel marker linked obesity with
psoriasis.
► Salama RH, Al-Shobaili HA, Al Robaee AA,
Alzolibani AA
Tohoku J Exp Med. 2012;228(4):325-32.
Psoriasis Is Associated with Low Serum Levels of
Hydrogen Sulfide, a Potential Anti-inflammatory
Molecule.
K H Alshorafa A, Guo Q, Zeng F
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Although hydrogen sulfide (H(2)S) has been shown to be
a signaling molecule with both pro- or anti-inflammatory
effects, its relationship with psoriasis has not been
elucidated.
In the present study, 15 patients with chronic progressive
psoriasis and 15 healthy volunteers were investigated.
Serum H(2)S levels in psoriasis patients were significantly
lower than those of healthy controls (16.69 ± 5.47 μM vs.
34.5 ± 6.39 μM)..
In conclusion, H(2)S may play a protective role in the
pathogenesis of psoriasis. H(2)S-releasing agents may be
promising therapeutics for psoriasis.
Eur J Dermatol. 2012 May-Jun;22(3):337-44.
Atheroma plaque, metabolic syndrome and inflammation in
patients with psoriasis.
Arias-Santiago S, Orgaz-Molina J, Castellote-Caballero L,
► The
chronic inflammation and
hyperhomocysteinemia found in psoriatic
patients may explain the association with
atheroma plaque and metabolic syndrome.
Cardiovascular screening by metabolic
syndrome criteria assessment and carotid
ultrasound in psoriasis may be useful to
detect individuals at risk and start
preventive treatment against the
development of cardiovascular disease
Homocysteine, vitamin B12 and folic acid
levels in psoriatic patients and correlation
with disease severity. I
Hyperhomocysteinēmija ir neatkarīgs riska
faktors aterosklerotiskai kardiovaskulārāi
slimībai, insultam, perifēro artēriju oklūzijai
un venozai trombozei ,paaugstinātai
atertrombozei un kardio vaskulārā riska
profilam.
Pacientiem ar psoriāzi plazmas homocisteīna
līmenis ir augstāks 57% nekā kontrolē 27%
(p< 0.0001)
Homocysteine, vitamin B12 and folic acid
levels in psoriatic patients and correlation
with disease severity. II
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Folskābe un vitamīns B12 plazmā bija zemāks
psoriāzes pacientiem nekā kontrolē ,viszemākie B12
līmeņi bija pacientiem ar hiperhomocisteinemiju
salīdzinot pacientiem ar normālu homocisteīna
līmeni (p = 0.0009).
PASI tieši nekorelēja ar augstāku homocisteīna līmeni ,vai
B12 vai folskābes līmeni .
Int J Immunopathol Pharmacol. 2010 Jul-Sep;23(3):911-6.
Homocysteine, vitamin B12 and folic acid levels in psoriatic
patients and correlation with disease severity.Brazzelli V, Grasso
V, Fornara L, Moggio E, Gamba G, Villani S, Borroni G.
Diagnostika .
►3
jautājumu kopa dod sensitivitāti 96.4% un
specifitāte 97.3% psoriāzei.
► Pievienojot jautājumu ar bildi sensitivitāte
palielinājās līdz 98.2% Šī studija palielina iespēju
atšķirt psoriāzi indivīdiem ar psoriāzi no indivīdiem
bez psoriāzes .
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Br J Dermatol 2009 Oct:161(4):778-84 Development and
pilot testing of psoriasis screening tool .Domininguez ar
al.Boston,USA,
1. Man ir diagnosticējuši psoriāzi nedermatologi – reimatologs, gimenes
ārsts, citi ārsti.
Jā.
Nē.
2. Man ir diagnosticējuši psoriāzi māsiņa, ārsta asistents.
Jā.
Nē.
3. Man ir diagnosticējis psoriāzi dermatologs.
Jā.
Nē.
Jā.
Nē.
Jā.
Nē.
Jā.
Nē.
7. Man ir bijuši izsitumi vai apsārtums/kairinājumu manā cirkšņu rajonā,
starp gurniem vai padusēs, kas ilgst vairāk kā 2 nedēļas .
Jā.
Nē.
8. Man ir diagnosticēti citas ādas saslimšanas kā ekzēma vai nātrene.
Jā.
Nē.
4. Man ir līdzīgi izsitumi uz manas ādas.
5. Man ir līdzīgas nagu izmaiņas.
6. Man ir bijuši līdzīgi izsitumi galvā.
Indian J Dermatol Venereol Leprol. 2012 May-Jun;78(3):2908.
Role of nail biopsy as a diagnostic tool.
Grover C, Chaturvedi UK, Reddy BS
► Nail biopsy (NB) is an investigation that is not routinely
resorted to by most of the dermatologists. The commonly
cited reasons are the complexity of the procedure, risk of
scarring and the reluctance of the patient. However, in
cases with isolated nail psoriasis, isolated nail lichen
planus, onychomycosis not confirmed on direct microscopy
and culture, or longitudinal melanonychia, the treating
dermatologist is left with no choice but to resort to this
procedure. Nail as a unit, is capable of projecting only a
limited number of clinical manifestations. This is
responsible for the more or less similar clinical presentation
of many different nail disorders.
An Bras Dermatol. 2012 Dec;87(6):910-3.
Norwegian scabies mimicking rupioid psoriasis.
Costa JB, Sousa VL, Trindade Neto PB
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Source , Brazil.
Norwegian scabies is a highly contagious skin infestation
caused by an ectoparasite, Scarcoptes scabiei var. Hominis,
which mainly affects immunosuppressed individuals.
Clinically, it may simulate various dermatoses such as
psoriasis, Darier's disease, seborrheic dermatitis, among
others. This is a case report of a 33-year-old woman,
immunocompetent, diagnosed with generalized anxiety
disorder (cancer phobia), who had erythematous, welldefined plaques, covered with rupioid crusts, on her neck,
axillary folds, breast, periumbilical region, groin area,
besides upper back and elbows, mimicking an extremely
rare variant of psoriasis, denominated rupioid
Prevalence and relevance of secondary contact
sensitizers in subjects with psoriasis.
Krupashankar DS, Manivasagam SR. Indian Dermatol Online
J. 2012 Sep;3(3):177-81
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.Psoriasis may be complicated by contact dermatitis due to an
impaired cutaneous barrier. Patch testing helps elucidate sensitizers
if any.
AIMS:
To determine the prevalence and relevance of secondary contact
dermatitis in subjects with psoriasis.
MATERIALS AND METHODS:
Patch testing with Indian Standard Series was done and readings
interpreted after 48 and 96 hours.
RESULTS:
Among 110 subjects 47 (42.7%) showed reactions to at least one
antigen. Fifteen (13.6%) reacted to fragrance mix, 10 (9.1%) to
nickel sulfate, seven (6.4%) to parthenium, and six (5.5%) to
balsam of Peru. Palmoplantar psoriasis was the commonest type of
psoriasis patch tested. Fragrance mix was the commonest antigen
showing 100% current relevance as an aggravating factor of
psoriasis.
Autoimmun Rev. 2012 Nov 24. Immunomodulation in
psoriatic arthritis: Focus on cellular and molecular
pathways.
► Complement
system can be considered part
of the acute phase response as
demonstrated by higher plasma levels of
C3 and C4 complement components in
PsA patients compared with healthy
subjects. These abnormal levels are then
reverted by anti-TNF drugs.
Dermatol Online J. 2012 Jan 15;18(1):11.
Psoriasis and oral lesions: multicentric study of Oral Mucosa
Diseases Italian Group (GIPMO).
Germi L, De Giorgi V, Bergamo F,
► Out
,
of a total of 535 psoriatic patients and 436
control group patients, oral mucosal lesions were
detected in 188 (35.1%) and 86 (19.7%) cases,
respectively, and the difference is statistically
significant. Fissured tongue (FT) and
geographic tongue (GT), which were most
frequently detected, were seen more frequently
in psoriatic patients (FT: 22.6%; GT: 9.1%) than
the control group (FT: 10.3%; GT: 5.2%)
(p<0.05).
Saturs .
► 1.
► 2.
Epidemioloģija.
Diagnostika .
► 3.Terapija .
► 4.Vadlīnijas .
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Dermatol Ther (Heidelb). 2012 Dec;2(1):15. Inverse
Psoriasis Involving Genital Skin Folds: Successful
Therapy with Dapsone.
Guglielmetti A, Conlledo R, Bedoya J
, The authors present a 42-year-old female patient
with erythematous plaques in the vulva, groin, and
perianal region. The patient had previously received
a broad range of topical and systemic therapies that
had to be discontinued due to ineffectiveness or
side effects. She was treated with 100 mg dapsone
daily for 10 months, showing a significant
improvement of her cutaneous and mucous lesions.
Complete clearance of psoriatic lesions was
observed after 4 weeks of treatment. She has
remained in remission for up to 2 years, using only
topical therapy with tacrolimus 0.1% and
calcipotriol.
J Dermatolog Treat. 2012 Dec 5. Evaluation of the effect of
tacrolimus-loaded liquid crystalline nanoparticles on psoriasislike skin inflammation.
.
Thapa RK, Yoo BK
► Liquid
crystalline nanoparticle (LCN) is one of the
potential drug delivery systems for topical drug
delivery.
► Tacrolimus-loaded LCNs were more effective in the
treatment of psoriasis-like skin inflammation as
compared to tacrolimus dissolved in propylene
glycol. Hence, this study provides a basis for
possible applicability of tacrolimus-loaded LCNs in
the treatment of psoriasis.
Dermatol Ther (Heidelb). 2012 Dec;2(1):1. A Delphi Consensus
Approach to Challenging Case Scenarios in Moderate-toSevere Psoriasis: Part 1.
Strober BE, Clay Cather J, Cohen D,
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Six of the 24 discussed case scenarios are presented in this
article (another five are presented in Part 2): (1) psoriasis
with human papilloma virus-induced cervical or anogenital
dysplasia; (2) concomitant psoriasis and systemic lupus
erythematosus; (3) severe psoriatic nail disease causing
functional or emotional impairment; (4) psoriasis therapies
that potentially reduce cardiovascular morbidity and
mortality; (5) older patients (≥65 years of age) with
psoriasis; and (6) severe scalp psoriasis that is
unresponsive to topical therapy.
A Delphi Consensus Approach to Challenging Case
Scenarios in Moderate-to-Severe Psoriasis: Part 2.
Strober BE, Clay Cather J, Cohen D
► Five
,
of the 24 discussed case scenarios are
presented in this article: (1) moderate-to-severe
psoriasis that has failed to respond to all currently
approved therapies for psoriasis; (2) palmoplantar
psoriasis that is unresponsive to topical therapy
and phototherapy; (3) erythrodermic psoriasis; (4)
pustular psoriasis; and (5) the preferred
therapeutic choice to combine with low-dose
methotrexate.
► The Delphi exercise resulted in guidelines for
practicing physicians to utilize when confronted
with patients with challenging cases of psoriasis.
Acta Derm Venereol. 2012 Nov 9.
Treatment Patterns, Treatment Satisfaction, Severity of Disease
Problems, and Quality of Life in Patients with Psoriasis in Three
Nordic Countries.
Ragnarson Tennvall G, Hjortsberg C,
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Biological drugs are expensive, but can reduce symptoms and increase
quality of life for patients with psoriasis. The aim of this study was to
examine quality of life, disease severity and treatment satisfaction in
Danish, Finnish and Swedish patients with psoriasis.
Based on 12 months' data from patient surveys and chart reviews, 3
treatment groups were identified: topical, systemic and/or biological
<12 months, and biological for 12 months.
Patients treated with biological drugs for 12 months showed the
highest treatment satisfaction and the lowest Dermatology Life Quality
Index score.
A number of patients with topical treatment reported low quality of
life, severe or very severe disease problems, and low treatment
satisfaction.
Single administration of lesion-limited high-dose (TURBO)
ultraviolet B using the excimer laser: clinical clearing in
association with apoptosis of epidermal and dermal T cell
subsets in psoriasis.
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Kagen M, Cao LY, Oyetakin-White P,
,.
Development of effective therapy for psoriasis is confounded by numerous factors contributing to
disease pathogenesis, including pathogenic immunocytes which appear to drive epidermal
keratinocyte hyperproliferation. Our objective was to study clinical and biomarker effects of a single
dose of TURBO laser UVB (308 nm) applied directly to psoriatic plaques.
METHODS:
Eighteen patients with chronic plaque psoriasis received a single dose of 10 minimal erythema dose
(MED) UVB and were followed for 8 weeks. Keratome and punch biopsies were assessed for T cell
depletion and apoptosis following a single 308-nm dose of UVB.
RESULTS:
Patients demonstrated clinical improvement as indicated by decreased global Psoriasis Area and
Severity Index scores and reduced numbers of pathogenic memory/effector T cells infiltrating lesional
epidermis and dermis. Consistent with apoptosis induction, caspase activation increased in lesional T
cells after treatment.
CONCLUSION:
We conclude that a single 10 MED dose of TURBO UVB is effective at reducing the severity and extent
of psoriatic lesions. We hypothesize that the reason a single treatment is sufficient to clear a psoriatic
plaque is that the 10 MED dose is able to deliver sufficient photons to a microanatomic area of the
lesion where susceptible pathogenic T cell mechanisms are operative
Saturs .
► 1.
► 2.
Epidemioloģija.
Diagnostika .
► 3.Terapija .
► 4.Vadlīnijas .
Vadlīnijas
European Board of Dermato-Venereology
► UNION EUROPÉENNE DES MÉDECINS
SPÉCIALISTES
► EUROPEAN UNION OF MEDICAL SPECIALISTS
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Section de Dermato-Vénéréologie
► Section of Dermato-Venereology
► President: Prof. Dr. Magdalena Czarnecka-Operacz (PL)
► Past President: Prof. Dr. Harald Gollnick (DE
► Secretary: Prof . Dr. Peter Steijlen (NL)
► Treasurer: Prof. Dr. Veli-Matti Kähäri (Fi)
► www.uems-ebdv.org/ebdv
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Evidence-based (S3) guidelines for the treatment of
psoriasis vulgaris 2007
Alexander Nast1, Ina B. Kopp2,Matthias Augustin3, KirstinBenita Banditt4,Wolf-Henning Boehncke5,
Markus Follmann6,Markus Friedrich7,Matthias Huber8,
Christina Kahl1, Joachim Klaus9, Joachim Koza9,
Inga Kreiselmaier10, Johannes Mohr11, Ulrich Mrowietz10,
Hans-Michael Ockenfels12,
Hans-Dieter Orzechowski8, Jörg Prinz13, Kristian
Reich14,Thomas Rosenbach15, Stefanie Rosumeck1,
Martin Schlaeger16, Gerhard Schmid-Ott17,Michael
Sebastian18,Volker Streit19,Tobias Weberschock5,
► Systemic
Treatment of Psoriasis
vulgaris.
► Developed by the Guideline Subcommittee
of the European Dermatology Forum
► Darba grupa no 2008 gada .
Vadlīnijas veltītas papulozas psoriāzes ts.
vulgārās formas aprūpei .
►
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Vadlīnijas veltītas papulozas psoriāzes ts. vulgārās formas
aprūpei .
Psoriāzes vadlīniju projekts satur 92 , kopā ar literatūru
105 lapaspuses .Saturā - ievads(1) ,informācija par
psoriāzes nozoloģiju un tās pamatterapiju (2,3) .Terapijas
izvēles algoritmi tiek izskatīti 4. nodaļā .ādas aprūpe un
lokālā terapija izklāstīta 5, nodaļā . 6 nodaļa fototerapija
bet 7. nodaļa klimatoterapija balstīta uz vispārējām
atziņām un Latvijas kūrortu iespējām. 8. nodaļā izkatīta
vispārējā terapijas , tai skaitā bioloģiskā terapija . Seko
vēres (197 autori) un pielikumi.
Secinājumi .
Psoriāzes uzskaiteIndividualizēta terapija .
12 12 12
21 21 21