L. Misery

Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review.

Previous epidemiological studies have demonstrated a high prevalence of cardiovascular (CV) risk factors in psoriasis patients, including metabolic syndrome, cigarette smoking, obesity, hypertension, diabetes mellitus, insulin resistance and dyslipidaemia. An increase in CV morbidity and mortality attributable to psoriasis is still under question.

Carcinogenic risks of psoralen UV-A therapy and narrowband UV-B therapy in chronic plaque psoriasis: a systematic literature review.

Background  Oral 8‐methoxypsoralen–UV‐A (PUVA) and narrowband UV‐B (NB‐UVB or UVB TL‐01) are effective and widely used treatments for chronic plaque psoriasis. Although the role of PUVA therapy in skin carcinogenesis in humans with psoriasis has been clearly demonstrated, there is still controversy regarding the risk of skin cancer with NB‐UVB. Furthermore, there is no clear evidence about the maximum cumulative number of sessions not to be exceeded in a lifetime.

Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency

Background  Topical corticosteroids remain the mainstay of atopic dermatitis therapy. Many atopic dermatitis therapeutic failures appear to be attributable to poor adherence to treatment due to topical corticosteroid phobia.

The epidermis: a sensory tissue

The skin is an efficient barrier which protects our bodies from the external environment but it is also an important site for the perception of various stimuli. Sensory neurones of the peripheral nervous system send many primary afferent fibres to the skin. They pass through the dermis and penetrate the basement membrane to innervate epidermal cells or remain as free endings. Nerve fibres are clearly involved in somatosensation. However, they are not always so numerous, for example in distal parts of the limbs, and some kinds of sensors can be at a distance of hundreds of micrometers from each other. The skin can detect patterns at a very fine and smaller scale, which suggests that nerve terminals are helped by epidermal sensors. All epidermal cells (keratinocytes, melanocytes, Langerhans cells and Merkel cells) express sensor proteins and neuropeptides regulating the neuro-immuno-cutaneous system. Hence, they must play a part in the epidermal sensory system. This review will consider the epidermal components of this forefront sensory system and the stimulations they perceive. The epidermis can be considered a true sensory tissue where sensor proteins and neurone-like properties enable epidermal cells to participate in the skin surface perception through interactions with nerve fibres.

Adherence to topical treatment in psoriasis: a systematic literature review

Background  Treatment adherence has been recognized as an important issue in the management of chronic diseases such as psoriasis.

Adjuvant prophylactic regional radiotherapy versus observation in stage I Merkel cell carcinoma: a multicentric prospective randomized study.

BACKGROUND The treatment of stage I Merkel cell carcinoma (MCC) usually includes wide local excision (WLE) combined with irradiation of the tumor bed (ITB). No randomized study has ever been conducted in MCC. The purpose of this study was to assess the efficacy and safety of prophylactic adjuvant radiotherapy on the regional nodes. PATIENTS AND METHODS In this randomized open controlled study, patients for a stage I MCC treated by WLE and ITB were randomly assigned to regional adjuvant radiotherapy versus observation. Overall survival (OS) and probability of regional recurrence (PRR) were primary end points. Progression-free survival (PFS) and tolerance of irradiation were secondary end points. RESULTS Eighty-three patients were included before premature interruption of the trial, due to a drop in the recruitment mainly due to the introduction of the sentinel node dissection in the management of MCC. No significant improvement in OS (P = 0.989) or PFS (P = 0.4) could be demonstrated after regional irradiation, which, however, significantly reduced the PRR (P = 0.007) with 16.7% regional recurrence rate in the observation arm versus 0% in the treatment arm. The treatment was well tolerated. CONCLUSION The adjuvant regional irradiation significantly decreased the PRR in MCC, but benefit in survival could not be demonstrated.

Patient‐Oriented SCORAD (PO‐SCORAD): a new self‐assessment scale in atopic dermatitis validated in Europe

To cite this article: Stalder J‐F, Barbarot S, Wollenberg A, Holm EA, De Raeve L, Seidenari S, Oranje A, Deleuran M, Cambazard F, Svensson A, Simon D, Benfeldt E, Reunala T, Mazereeuv J, Boralevi F, Kunz B, Misery L, Mortz CG, Darsow U, Gelmetti C, Diepgen T, Ring J, Moehrenschlager M, Gieler U, Taïeb A, for the PO‐SCORAD Investigators Group. Patient‐Oriented SCORAD (PO‐SCORAD): a new self‐assessment scale in atopic dermatitis validated in Europe. Allergy 2011; 66: 1114–1121.

Atopic dermatitis: Impact on the quality of life of patients and their partners

Background: The impact of atopic dermatitis (AD) on the patient’s quality of life is relatively well known. However, the influence on the patient’s spouse has never been studied. Objective: To evaluate the impact of AD on the quality of life, sleeping and sexual life of patients and their partners. Methods: In this cross-sectional study, patients and their partners completed a number of questionnaires asking about their general health and their quality of life [Short Form 12, Epworth, Dermatology Life Quality Index (DLQI)] and completed an idiosyncratic measure asking about their sexual functioning. AD severity was clinician rated using Scoring atopic dermatitis (SCORAD). Results: A total of 266 patients were included. The mean DLQI score was 8.8. The physical and mental composite 12 scores were 50.7 and 39.5, respectively. These 3 scores were significantly related to SCORAD. A decrease in sexual desire due to AD was noted in 57.5% of patients. The quality of life of partners did not appear to be particularly impaired, but 36.5% reported that the appearance of eczema had an impact on their sex life. Conclusion: The influence of AD on sex life is significant both for the patients and their partners.

Risk of cancer in psoriasis: a systematic review and meta-analysis of epidemiological studies.

The relationship between psoriasis and increased cancer risk is debated.

How best to fight that nasty itch – from new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus to novel therapeutic approaches

While the enormous clinical and psychosocial importance of pruritus in many areas of medicine and the detrimental effects of chronic ‘itch’ on the quality of life of an affected individual are widely appreciated, the complexity of this sensation is still often grossly underestimated. The current Controversies feature highlights this complexity by portraying pruritus as a truly interdisciplinary problem at the crossroads of neurophysiology, neuroimmunology, neuropharmacology, protease research, internal medicine, and dermatology, which is combated most successfully if one keeps the multilayered nature of ‘itch’ in mind and adopts a holistic treatment approach – beyond the customary, frequently frustrane monotherapy with histamine receptor antagonists. In view of the often unsatisfactory, unidimensional, and altogether rather crude standard instruments for pruritus management that we still tend to use in clinical practice today, an interdisciplinary team of pruritus experts here critically examines recent progress in pruritus research that future itch management must take into consideration. Focusing on new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus, and discussing available neuropharmacological tools, specific research avenues are highlighted, whose pursuit promises to lead to novel, and hopefully more effective, forms of pruritus management.