Jacinto Orgaz-Molina

Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: A case-control study

BACKGROUND Some autoimmune conditions have been associated with reduced vitamin D levels, including systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus, and multiple sclerosis. OBJECTIVE The main objective of this study was to analyze the 25-hydroxyvitamin D (OHD) status of patients with psoriasis in comparison with control subjects without this disease. METHODS This case-control study included 86 patients (43 with psoriasis and 43 age- and sex-matched control subjects) from the outpatient clinic of our hospital dermatology department in Granada, Spain. All patients and control subjects were studied during one 4-week period to avoid seasonal variations in vitamin D levels. RESULTS Serum 25-OHD levels were significantly lower in psoriatic patients than in control subjects even after adjusting for confounding factors in a multivariate analysis (odds ratio 2.89, 95% confidence interval 1.02-7.64, P < .03 for vitamin D insufficiency). Low 25-OHD levels were negatively associated with C-reactive protein (inflammatory activation marker) and body mass index in multiple linear regression analysis. Psoriatic patients with body mass index greater than or equal to 27 kg/m(2) had a higher risk of 25-OHD insufficiency (sensitivity of 82.3% and specificity of 51.7%). LIMITATIONS Further studies with larger numbers of patients are required to analyze the pathogenic mechanisms underlying the relationship between 25-OHD deficiency and psoriasis. CONCLUSIONS The 25-OHD values are significantly lower in psoriatic patients than in control subjects. Low 25-OHD levels are negatively associated with C-reactive protein, an inflammatory activation marker, and with obesity. Psoriatic patients with a body mass index of 27 or more are likely to have vitamin D insufficiency.

Atheroma plaque, metabolic syndrome and inflammation in patients with psoriasis

BACKGROUND Chronic inflammation plays an important role in the development of cardiovascular risk factors. Although the prevalence of comorbidities and cardiovascular events has been described in patients with psoriasis, few studies have examined subclinical atherosclerosis in psoriasis patients. OBJECTIVE Our objective was to investigate the prevalence of atheroma plaques in patients with severe psoriasis compared with control subjects and to analyze the association with metabolic syndrome, homocysteine levels and inflammatory parameters. PATIENTS AND METHODS This case-control study included 133 patients, 72 with psoriasis and 61 controls consecutively admitted to the outpatient clinic in Dermatology Departments (Granada, Spain.) RESULTS Carotid atheroma plaques were observed in 34.7% of the psoriatic patients versus 8.2% of the controls (p=0.001) and metabolic syndrome was diagnosed in 40.3% of the psoriatic patients versus 13.1% of the controls (p<0.001). Significantly higher mean values of insulin, aldosterone, homocysteine and acute phase parameters (fibrinogen, D-dimer, C reactive protein and erythrocyte sedimentation rate) were found in psoriatic patients. Binary logistic regression showed a strong association between psoriasis and atheroma plaque and metabolic syndrome after controlling for confounding variables. LIMITATIONS The absence of longitudinal quantification of metabolic syndrome parameters and intima-media thickness in psoriatic patients. CONCLUSION 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.

Increased gene expression of Toll-like receptor 4 on peripheral blood mononuclear cells in patients with psoriasis

Background  A role for the innate immune system in driving the autoimmune T cell cascade in psoriasis has been proposed. Toll‐like receptors‐(TLR)‐2 and ‐4 play a role in inflammation, atherosclerosis, and their specific role in psoriasis remains unclear.

Association of 25-hydroxyvitamin D with metabolic syndrome in patients with psoriasis: a case-control study.

Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.

Vitamin D insufficiency is associated with higher carotid intima-media thickness in psoriatic patients.

BackgroundPsoriasis has been associated with vitamin D insufficiency and cardiovascular risk factors. Reports show that serum 25-hydroxyvitamin D (25-OHD) levels are inversely associated with chronic inflammatory systemic diseases, cardiovascular risk factors and cardiovascular outcomes.ObjectiveTo analyze the association between 25-hydroxyvitamin D serum levels and subclinical carotid atherosclerosis (maximal intima-media thickness (MIMT)) in psoriasis patients and controls. MIMT was compared and associated factors were analyzed.Patients and MethodThis was a case-control study with 44 psoriatic patients without arthritis from a Dermatology outpatient clinic in Granada (Spain) and 44 controls. Confounding factors related to 25-OHD serum levels and cardiovascular risk factors were also analyzed.Results25-OHD levels were significantly lower in the psoriatic than in the control group (29.20 vs. 38.00 ng/mL p<0.0001) and a significant negative correlation was found between serum 25-OHD levels and the MIMT (rs = −0.678, p<0.0001) in psoriatic patients. No correlation was found in healthy controls. This association remained after adjusting for confounders. Serum 25-OHD levels were significantly lower (p = 0.003) in psoriatic patients with carotid atheromatous plaque (22.38 ± 10.23 ng/mL) than in those without (31.74 ± 8.62 ng/mL). Patients with a longer history of psoriasis presented significantly higher MIMT than controls (638.70 ± 76.21 vs 594.67 ± 80.20 μm; p = 0.026 for ≥6 yrs with psoriasis).ConclusionsIn psoriasis patients, lower serum 25-OHD levels were associated with higher MIMT after adjusting for selected confounding factors. The MIMT risk increases with a longer history of psoriasis, regardless of the patient’s age.

Increased expression of microRNA-155 in peripheral blood mononuclear cells from psoriasis patients is related to disease activity.

MicroRNAs (miRNAs) gene expression regulators are altered in psoriasis suggesting their role in the pathogenesis.

Persistent swollen lip: cheilitis granulomatosa.

A 23-year-old woman presented to our hospital for evaluation of a 6 month history of asymptomatic swelling of her lower lip. Her medical history included two episodes of peripheral facial nerve paralysis without other symptoms. There was no history of exposure to applied irritants, dermal fi llers, or local trauma. She had been treated unsuccessfully with oral antihistamines for suspected chronic angioedema. Physical examination showed a swollen and indurated lower lip with normal tongue and gums (fi gure). Microscopic Lancet 2013; 381: 2280

[Asymptomatic indurated skin plaque in the back: scleredema of Buschke].

Paciente de 68 anos que acudia a Urgencias por cuadro de cefalea de tipo tensional. No referia antecedentes de interes ni otros sintomas. A la inspeccion se apreciaba una placa en zona cervicodorsal de al menos 5 anos de evolucion, sin limites bien diferenciados respecto a la piel sana circundante (fig. 1). A la palpacion se encontraba indurada y no se podia pellizcar. El examen histopatologicomostraba una dermis gruesa y con ligero engrosamiento de los haces de colageno; la tincion azul alcian evidencio el aumento de mucina (fig. 2), todo lo cual era compatible con escleredema de Buschke. Entre las pruebas complementarias se encontro aumento de la glucemia (145 y 159 mg/dl) en dos determinaciones de glucemia en ayunas, sin otros hallazgos en las pruebas analiticas. Fue clasificado, por tanto, comoun escleredema tipo 3 (asociacion a diabetes mellitus). Figura 1. Figura 2. www.elsev ier .es /medic inac l in ica

A pregnant woman with a nodule on the tongue: a quiz. Lobular capillary haemangioma (pyogenic granuloma).

A 34-year-old woman, in her fourth month of pregnancy, presented with an isolated exophytic lesion of the tongue, which had developed 2 months previously and which caused discomfort when swallowing. On examination, we found a pink nodule (diameter 15 mm) of hard consistency on the dorsutn of the tongue (Fig. 1 A). A cutaneous examination revealed nothing abnormal. Analysis of a biopsy sample revealed multiple separate vascular lobules within the dermis, each composed of aggregates of endothelial cells (Fig. IB). Cells were positive for CD34 (Fig. lC), and negative for Factor Vlll, HHV-8 and androgen, estrogen and progesterone receptors.

Multiple superficial and pigmented basal cell carcinomas: do these represent a type of multiple non‐syndromic basal cell carcinoma?

nevus anemicus, recalcitrant chronic stasis ulcers, unilateral lipohypoplasia, and bone infarction. In addition to vascular problems, our patient has lipohypoplasia of the right lower extremity, which to the best of our knowledge has only been reported previously by Castori et al. in phacomatosis and pigmentary nevi, cesioflammea. This constellation does not fit any of the traditional categories of PPV. Our literature review indicates this is the first report of a case of PPV with the pentad of nevus flammeus, nevus anemicus, recalcitrant chronic stasis ulcers, unilateral lipohypoplasia, and bone infarction, and it may represent a heretofore undescribed variant of PPV.