Aleksandra G. Florek

Effect of tonsillectomy on psoriasis: a systematic review.

BACKGROUND Streptococcal infection is associated with psoriasis onset in some patients. Whether tonsillectomy decreases psoriasis symptoms requires a systematic review of the literature. OBJECTIVE We sought to determine whether tonsillectomy reduces psoriasis severity through a comprehensive search of over 50 years of literature. METHODS We searched MEDLINE, CINAHL, Cochrane, EMBASE, Web of Science, and OVID databases (from August 1, 1960, to September 12, 2013) and performed a manual search of selected references. We identified observational studies and clinical trials examining psoriasis after tonsillectomy. RESULTS We included data from 20 articles from the last 53 years with 545 patients with psoriasis who were evaluated for or underwent tonsillectomy. Of 410 reported cases of patients with psoriasis who underwent tonsillectomy, 290 experienced improvement in their psoriasis. Although some patients who underwent tonsillectomy experienced sustained improvement in psoriasis, others experienced psoriasis relapse after the procedure. LIMITATIONS Fifteen of 20 publications were case reports or series that lacked control groups. Publication bias favoring reporting improved cases needs to be considered. CONCLUSION Tonsillectomy may be a potential option for patients with recalcitrant psoriasis associated with episodes of tonsillitis. Studies with long-term follow-up are warranted to determine more clearly the extent and persistence of benefit of tonsillectomy in psoriasis.

Effectiveness of Online vs In-Person Care for Adults With Psoriasis: A Randomized Clinical Trial

IMPORTANCE Innovative, online models of specialty-care delivery are critical to improving patient access and outcomes. OBJECTIVE To determine whether an online, collaborative connected-health model results in equivalent clinical improvements in psoriasis compared with in-person care. DESIGN, SETTING, AND PARTICIPANTS The Patient-Centered Outcomes Research Institute Psoriasis Teledermatology Trial is a 12-month, pragmatic, randomized clinical equivalency trial to evaluate the effect of an online model for psoriasis compared with in-person care. Participant recruitment and study visits took place at multicenter ambulatory clinics from February 2, 2015, to August 18, 2017. Participants were adults with psoriasis in Northern California, Southern California, and Colorado. The eligibility criteria were an age of 18 years or older, having physician-diagnosed psoriasis, access to the internet and a digital camera or mobile phone with a camera, and having a primary care physician. Analyses were on an intention-to-treat basis. INTERVENTIONS Participants were randomized 1:1 to receive online or in-person care (148 randomized to online care and 148 randomized to in-person care). The online model enabled patients and primary care physicians to access dermatologists online asynchronously. The dermatologists provided assessments, recommendations, education, and prescriptions online. The in-person group sought care in person. The frequency of online or in-person visits was determined by medical necessity. All participants were exposed to their respective interventions for 12 months. MAIN OUTCOMES AND MEASURES The prespecified primary outcome was the difference in improvement in the self-administered Psoriasis Area and Severity Index (PASI) score between the online and in-person groups. Prespecified secondary outcomes included body surface area (BSA) affected by psoriasis and the patient global assessment score. RESULTS Of the 296 randomized participants, 147 were women, 149 were men, 187 were white, and the mean (SD) age was 49 (14) years. The adjusted difference between the online and in-person groups in the mean change in the self-administered PASI score during the 12-month study period was –0.27 (95% CI, –0.85 to 0.31). The difference in the mean change in BSA affected by psoriasis between the 2 groups was –0.05% (95% CI, –1.58% to 1.48%). Between-group differences in the PASI score and BSA were within prespecified equivalence margins, which demonstrated equivalence between the 2 interventions. The difference in the mean change in the patient global assessment score between the 2 groups was –0.11 (95% CI, –0.32 to 0.10), which exceeded the equivalence margin, with the online group displaying greater improvement. CONCLUSIONS AND RELEVANCE The online, collaborative connected-health model was as effective as in-person management in improving clinical outcomes among patients with psoriasis. Innovative telehealth delivery models that emphasize collaboration, quality, and efficiency can be transformative to improving patient-centered outcomes in chronic diseases. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02358135

First case of symmetrical drug‐related intertriginous and flexural exanthema (SDRIFE) due to Berberine, an over‐the‐counter herbal glycemic control agent

tast tosilate to treat patients with EAE or WS. However, this drug was used successfully to treat a patient with recurrent cutaneous eosinophilic vasculitis, an eosinophilic cutaneous disease. Suplatast tosilate inhibits the production of Th2 cytokines, such as interleukin (IL)-4 and IL-5, selectively suppresses IgE synthesis, and suppresses Th2 cell-dependent eosinophils in cellular infiltrates. Therefore, the effectiveness of suplatast tosilate in our patient suggests that the pathogenesis in this patient was likely related to local eosinophil infiltrates. However, we could not rule out the possibility that the disappearance of lesions was because of the natural course of this disorder. Findings in our patient suggest that suplatast tosilate has potential therapeutic benefits in patients with EAE. Further use of this agent in additional patients may clarify its role in the management of EAE and its ability to distinguish EAE from WS.

Micropapular Cutaneous Sarcoidosis Reviewed

Background: Micropapular cutaneous sarcoidosis (MPCS) is a rare variant of sarcoidosis. Herein we review the literature and include a recent case of MPCS discussing pathogenesis, diagnosis, treatment, and prognosis. Method: A review was conducted using the terms “micropapular sarcoidosis” and “micropapular sarcoid.” A recent case of a 50-year-old male patient with biopsy-identified MPCS was also included in the review. Results: In total, 12 cases with an aggregate of 18 patients were included in the review. Presentation among all patients was consistent, with scattered, occasionally pruritic, faintly erythematous shiny white papules. Skin biopsy demonstrated noncaseating granulomas. Systemic prednisone, oxytetracycline, and hydroxychloroquine, as well as topical betamethasone, were used for therapy. Conclusion: In our review there does not seem to be a clear link as to the definite cause of the MPCS. While the relationships to tuberculosis and autoimmunity seem to be often emphasized, there was no clear association with either etiology.

Allergic contact dermatitis caused by propolis-enriched honey: A case of severe penile oedema

covered skin site, exposed repeatedly to relatively high temperatures from a charcoal-lit pocket hand warmer over many years. A 65-year-old man presented with a scar-like plaque on his right lateral thigh measuring 21 mm (Fig. 1a). A punch biopsy demonstrated basal cell carcinoma. He had no relevant past medical history, but on further questioning, he reported regular use of a charcoal hand warmer placed in his right pocket whilst playing golf over many decades. This would always sit directly overlying the skin where his BCC developed. We reviewed current literature in relation to pocket hand warmers and possible mechanisms leading to carcinogenesis from prolonged exposure of the skin to high temperatures. Many older reusable versions of hand warmer provide heat by burning charcoal, lasting up to 6 h. These had an outer felt case with underlying metal (Fig. 1b). One or both ends of a charcoal stick were lit and then extinguished to create a hot ember, before being placed inside the case. This method of providing warmth is similar to that used by Kashmir residents, using Kangri baskets. These are earthenware pots, enclosed in a basket filled with ignited coal (Fig. 1c). Once lit, the basket is held between the abdomen and thighs. Prolonged use has been associated with the development of cutaneous malignancy, where the basket is cradled. Whilst described cases of Kangri cancer are typically squamous cell carcinoma, it is possible the effect of prolonged heat exposure from charcoal may also contribute to basal cell carcinoma development in some circumstances. It is worth noting reports of industrial charcoal exposure leading to basal cell carcinoma development; however, the charcoal in hand warmers is not in direct contact with skin. The isolated effect of heat has been difficult to assess in real-life studies due to the inherent relationship with ultraviolet exposure, but mouse models have demonstrated that increased temperature can augment the effect of irradiation by ultraviolet and also induce skin carcinogenesis. Persistent elevated temperature has been shown to break DNA strands and induce lower rates of DNA repair. Freedman and colleagues studied the effect of long-term temperature levels on basal cell carcinoma incidence in the United States, finding increased rates of basal cell carcinoma in individuals exposed to the highest quintile of ambient temperatures after controlling for ultraviolet exposure. In summary, we found supportive evidence that prolonged heat exposure may play a role in the development of basal cell carcinoma, although this is not yet conclusive. We propose our patient’s basal cell carcinoma may have been predisposed by prolonged periods of exposure to charcoal generated heat.

Treatment preferences and treatment satisfaction among psoriasis patients: a systematic review

A critical gap exists in determining treatment preferences and treatment satisfaction from patient perspectives, which is paramount to achieving therapeutic success. The objective of this systematic review is to determine factors influencing treatment preferences and treatment satisfaction among psoriasis patients. PubMed, EMBASE, and Web of Science databases were searched between November 1, 2010, and December 1, 2017. Observational and interventional research studies published in the English language that discussed patient preferences and patient satisfaction in the treatment of psoriasis were reviewed and synthesized. We utilized data on treatment preferences and treatment satisfaction from 35,388 psoriasis patients based on 60 articles from the years 2010 to 2017. Treatment preferences were heterogeneous and changed over time among psoriasis patients. Across all treatment modalities, the most important treatment attributes were treatment location, probability of improvement, and delivery method. For biologics specifically, the most important attributes were risk of adverse events and probability of treatment benefit. Factors that influenced patients’ preferences for certain treatments included age, sex, comorbidities, disease duration, and prior treatments. Notably, some psoriasis patients placed higher importance on a treatment’s process attributes (e.g., access and delivery) over its outcome attributes (e.g., efficacy). Overall, patient satisfaction with existing therapies remains modest; however, those treated with biologic agents exhibited highest treatment satisfaction over oral therapy, phototherapy, and topical therapy.