Federica Ricceri

Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair

Minimally ablative fractional laser devices have gained acceptance as a preferred method for skin resurfacing. Notable improvements in facial rhytides, photodamage, acne scarring, and skin laxity have been reported. The aim of the present work was to compare how different CO2 laser fluences, by modulating the secretory pathway of cytokines, are able to influence the wound‐healing process, and how these fluences are associated with different clinical results. Eighteen patients, all with photodamaged skin, were treated using a fractional CO2 laser (SmartXide DOT, Deka M.E.L.A., Florence, Italy) with varying laser fluences (2.07, 2.77, and 4.15 J/cm2). An immunocytochemical study was performed at defined end points in order to obtain information about specific cytokines of the microenvironment before and after treatment. The secretory pathway of cytokines changed depending on the re‐epithelization and the different laser fluences. Different but significant improvements in wrinkles, skin texture, and hyperpigmentation were definitely obtained when using 2.07, 2.77, and 4.15 J/cm2, indicating fractional CO2 laser as a valuable tool in photorejuvenation with good clinical results, rapid downtime, and an excellent safety profile.

Tumour necrosis factor-α antagonists in patients with concurrent psoriasis and hepatitis B or hepatitis C: a retrospective analysis of 17 patients.

Introduction  Tumour necrosis factor (TNF)‐α antagonists are effective for the treatment of plaque‐type psoriasis and psoriatic arthritis, but concerns remain about the safety of these agents in the presence of chronic infections, including past hepatitis B (HBV) and chronic hepatitis C virus (HCV) infections.

Deficiency of serum concentration of 25-hydroxyvitamin D correlates with severity of disease in chronic plaque psoriasis

To the Editor: We read with interest the article by Orgaz-Molina et al regarding the vitamin D status in patients with chronic plaque psoriasis. The authors report a high prevalence (25.6%) of vitamin D deficiency [25(OH)D levels\20 ng mL ] in a cohort of 43 psoriatic patients, independently of age, sex and Psoriasis Area and Severity Index (PASI) score. Low 25(OH)D levels were negatively associated with markers of inflammatory activation (C-reactive protein) and body mass index (BMI). We conducted a case-control study over 4months ( fromSeptember to December) including 68 patients affected by chronic plaque psoriasis and 60 healthy controls. 25(OH)D serum levels were measured in a centralized laboratory using the LIAISON 25OH Vitamin D TOTAL Assay. Logistic regression analysis of the relationship of 25(OH)D levels to demographic data (age, sex and body mass index), alcohol consumption and smoking habit data, exposure time to sunlight, dairy intake, disease duration and severity was performed. Psoriatic patients had significantly lower serum levels of 25(OH)D than healthy controls (P \ .05) with 68% and 97% being vitamin D deficient (\20 ng/mL) and insufficient (\30 ng/mL), respectively (Fig 1). In the logistic regression analysis, vitamin D deficiency was associated with psoriasis independently of age, sex, BMI, alcohol consumption, and smoking habit. Interestingly, serum 25(OH)D had significant negative correlations with PASI score (P\ .001), which signifies a possible link between the extent of vitamin D deficiency and the degree of the severity of psoriasis (Fig 2). Recently, vitamin D deficiency has been implicated as a potential environmental factor triggering some immune-mediated disorders. Our study confirms that vitamin D deficiency may be common in patients with psoriasis and adds some important information concerning a possible link between this deficit and the severity of disease. We conclude that psoriatic patients could be screened for vitamin D insufficiency for a more comprehensive management. Future studies looking at a potential role of oral supplementation of vitamin D in the treatment of psoriasis are warranted.

Measuring psoriatic disease in clinical practice. An expert opinion position paper

Psoriasis is a common, immune-mediated chronic inflammatory disease with a primary involvement of skin and joints, affecting approximately 2% of the population worldwide. Up to one third of patients with psoriasis are diagnosed with psoriatic arthritis (PsA). Psoriasis and PsA are heterogeneous diseases whose severity depends on a number of clinical factors, such as areas affected and pattern of involvement, and are associated with a range of comorbid diseases and risk factors, including obesity, metabolic syndrome, cardiovascular disease and liver disease. Thus measuring the severity of psoriatic disease needs to take into account the multidimensional aspects of the disease. Subjective measures including the impairment in quality of life or in daily living activities as well as the presence of cardio-metabolic comorbidities, are important for the outcome and add further levels of complexity that, to a certain extent, need to be assessed. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented for a most effective managing of psoriasis patients. A joint dermatologist-rheumatologist roundtable discussion was convened to share evidence on the real-life use of methods for measuring psoriasis severity comprehensively. Our objective was to provide an expert position on which clinical variables are to be taken into account when considering patients affected by psoriasis and/or PsA globally and on the assessment tools more suitable for measuring disease activity and/or severity in clinical practice.

Etanercept restores a differentiated keratinocyte phenotype in psoriatic human skin: a morphological study.

Tumor Necrosis Factor‐α (TNF‐α) plays a pivotal role in psoriasis, an immuno‐mediated and genetic skin disease. Anti‐TNF‐α inhibitors, such as etanercept, are widely used in clinical practice. By immunofluorescence, we investigated the expression of junctional transmembrane proteins in desmosomes (desmocollin‐1, Dsc1; desmoglein‐1, Dsg1), adherens junctions (E‐cadherin), tight junctions (occludin), biomarkers of keratinocyte differentiation (keratin‐10, K10; keratin‐14, K14; keratin‐16, K16; involucrin), epithelial proliferation and apoptosis in psoriatic skin before/after etanercept treatment (n = 5) and in control skin samples (n = 5). Occludin, K14, K16 and involucrin expressions were altered in psoriatic epidermis, while Dsc1, Dsg1, E‐cadherin and K10 localisations were comparable to controls. Etanercept promoted the restoration of the physiological condition as suggested by a more differentiated keratinocyte phenotype and a reduced epidermal proliferation rate.

Development of MGUS in psoriatic patients: a possible undiagnosed event during anti-TNF-α-treatment

Background  Monoclonal gammopathies are haematological conditions characterized by the clonal proliferation of plasma cells which produce a monoclonal immunoglobulin that accumulates in the blood. They have already been reported during treatment with a range of drugs but never before during treatment with the anti‐TNF‐α treatments: adalimumab, etanercept and infliximab currently used in the therapy of moderate‐severe psoriasis and psoriatic arthritis.

Treatment of severe nail psoriasis with acitretin: an impressive therapeutic result

Nail psoriasis is common in adult psoriatic patients. Although several new drugs have recently been introduced for the treatment of skin psoriasis, treatment of nail psoriasis still remains a challenge. Topical treatments (e.g., corticosteroids, tazarotene, 5‐fluorouracil, calcipotriol) are the first line in the management of skin psoriasis. The efficacy of these drugs in nail disease, however, is limited, mainly due to the difficulty in penetrating the nail bed and nail matrix. In cases of nail disease resistant to topical treatment, methotrexate, ciclosporin, acitretin, or biological agents can be used. The present authors introduce a 73‐year‐old patient affected by impressive psoriatic nail disease involving all her fingernails and toenails treated by acitretin, a traditional systemic treatment. After 2 months of treatment there was a marked improvement. The clinical improvement of the nails was progressive and 6 months later it was stable and satisfactory. The remarkable response to treatment in this case suggests that oral acitretin, in association to urea nail lacquer, might be useful in the management of disabling severe nail psoriasis even in absence of severe cutaneous involvement.

Development of monoclonal gammopathy in 12 patients receiving efalizumab treatment for chronic plaque psoriasis

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Quantity, distribution and immunophenotypical modification of dendritic cells upon biological treatments in psoriasis.

Psoriasis is an immune-mediated disease which affects a large world population. It has long been considered a dermatological disorder in which keratinocytes and lymphocytes play a relevant pathogenic role. The aim of our study is to more closely observe and better define the role of dendritic cells (DCs) in psoriasis. We made a comparative analysis of the antigenic profile and the number, by immunohistochemical and electron microscopical study, of skin biopsy samples from psoriatic patients before and 4 months after biological treatments. Our results demonstrate an abundant distribution of activated DCs in lesional skin of psoriatic plaques and a marked decrease after biological therapies [a decrease of 70% for Langerhans cells (LCs) and mature myeloid dendritic cells (mDCs) and of 50% for plasmocytoid dendritic cells (pDCs)]. Both previous reports and the results of the present study support an underlying persistent immune response involving DCs in the onset and persistence of psoriasis. As DCs play a pivotal role in pathogenesis of psoriasis by presenting antigens via major histocompatibility complex class (MHC) II molecules, the present study supports the view that biological therapies are also effective in clearing psoriatic lesions as well as in reducing the number of DCs.

Retrospective analysis of systemic treatments for psoriasis patients attending a Psocare center in Florence. Relevance of biological drugs use and comorbidities

Background  Psoriasis is a chronic inflammatory skin condition associated with several risk factors and comorbidities.