M. Alan Menter

PSORIASIS AND PREGNANCY: HORMONE AND IMMUNE SYSTEM INTERACTION

Background. Various hormonal states are known to be associated with the waxing and waning of psoriasis. Patients with psoriasis commonly experience changes in their cutaneous disease during pregnancy or post partum.

SUCCESSFUL TREATMENT OF PEDIATRIC PSORIASIS WITH INFLIXIMAB

Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, typewritten double spaced, and must not exceed two pages of text including references. Two copies of all letters should be submitted along with one copy on disk. Letters ahould not duplicate material submitted or published in other journals. Prepublication proofs with not be provided.

Resistant Childhood Psoriasis: An Analysis of Patients Seen in a Day‐care Center

Abstract: During a three‐and‐one‐half‐year period, 54 children aged 1 to 16 years, all of whom had resistant psoriasis, were seen at a day‐care center. The female: male ratio was 3:2. In 74% of the patients, the onset of psoriasis occurred when they were below 10 years of age. Papules and plaques occurred in 78% of cases, guttate lesions in 16%, and nail involvement in 21%. A family history of psoriasis was present in 69% of cases, preceding upper respiratory tract infections occurred in 35%, and prior cradle cap and/or diaper rash in 50%. In the day‐care center, Goeckerman therapy was given to 31 children. The average duration of treatment was 12 days, producing maximum clearing of over 90% in 64% of patients, with substantial improvement in the remainder. After three months, the psoriasis in 83% of these patients was over 90% clear; 43% showed maximum clearing at one year. Two patients were treated with anthralin and ultraviolet light alone, one with good results. One patient with nail psoriasis alone was not treated. The remaining 20 patients were either unable to attend for treatment at the center or had less extensive psoriasis. Home treatment was prescribed for them, with less satisfactory results.

Psoriasiform lesions on trunk and palms.

A34-year-old man presented with a 2-week history of a relatively asymptomatic truncal rash with gradual spread to involve his face, limbs, palms, and soles. Approximately 10 days before onset of the rash, he experienced a flulike episode with mild arthralgias, sore throat, and mild headache that had reappeared intermittently prior to his evaluation.

Hyperpigmented macules and streaks

Phytophotodermatitis is an ultraviolet-induced contact dermatitis due primarily to plant- (= phyto), fruit-, or vegetable-derived photosensitizing compounds such as furocoumarins (psoralens). Two prerequisites must be filled for phytophotodermatitis to occur: 1) the skin must have had contact with a sensitizing phototoxin (allergen), and 2) there must be subsequent exposure to ultraviolet radiation (1). Psoralens may be transferred directly when leaves, rinds, or juice come into contact with the skin or indirectly through person-to-person contact. The majority of these phototoxins are activated by ultraviolet light in the long-wave or ultraviolet A (UVA) spectrum (320–400 nm) (2). n nFigures u200bFigures11 and u200b22 are examples of “margarita photodermatitis” in 2 different patients (1). While sunbathing at the beach and preparing margaritas, our patients squeezed limes, which left juice on their skin. Juice on the hands is easily spread or even dripped onto distant sites or other people. Lime juice contains furocoumarin, a lipid-soluble 8-methoxypsoralen. After sunbathing (a potent source of UVA), the 8-methoxypsoralen covalently binds to keratinocyte DNA (forming cyclobutane dimers), producing irreversibly damaged DNA (3). n n n nFigure 1 n nBizarre streaks and linear erythematous vesicular plaques with hyper- pigmentation on the abdomen. n n n n n nFigure 2 n nLinear erythematous vesicular plaques with hyperpigmentation on the arm.

Therapeutic and Immunologic Advances in Psoriasis

Psoriasis is a common skin disorder with varied clinical presentations, ranging from small localized plaques to widespread inflammatory disease with marked exfoliation. Advances in therapy now allo...

Diverse cutaneous manifestations associated with a single disease

Three patients had diverse clinical manifestations, all relating to the same disease (Figures u200b(Figures11–3). A representative skin biopsy is seen in Figure u200bFigure4.4. What is the diagnosis, and what therapeutic options should be considered? n n n nFigure 1 n nScaly, red pruritic patches on the buttocks. n n n n n nFigure 3 n nGeneralized exfoliative erythroderma. n n n n n nFigure 4 n nRoutine histopathology slide from the patient shown in Figure u200bFigure11 (hematoxylin-eosin stain, ×40). n n n nDIAGNOSIS: Mycosis fungoides.

Hair loss and plaquelike skin lesions.

A healthy 35-year-old African American woman presented for evaluation of hair loss (Figure u200b(Figure11). Examination of her scalp revealed areas of alopecia with absent hair follicles, erythematous papules, and a few pustules, consistent with a scarring (cicatricial) form of alopecia. Additionally, there were hypopigmented lesions on her arms (Figure u200b(Figure22) and targetoid plaquelike lesions on her legs (Figure u200b(Figure33). n n n nFigure 1 n nPosterior scalp with areas of scarring alopecia and erythematous papules and plaques n n n n n nFigure 2 n nHypopigmented macules on the arm. n n n n n nFigure 3 n nLower legs with targetoid plaques. n n n nWhat is your diagnosis? n nDIAGNOSIS: Sarcoidosis.

Purplish, pruritic papules on the limbs

A 46-year-old white man presented with an acute 3- to 4-week history of an intensely pruritic eruption that mainly involved the limbs. Individual lesions appeared to predominate around the wrist flexures. Examination revealed multiple, flat, purplish lesions, 5 to 15 mm in diameter, with coalescence in areas of scratching (Figure u200b(Figure11). Whitish plaques were seen on the oral mucous membrane (Figure u200b(Figure22). The patient was otherwise well, although on further questioning he stated that he felt less energetic than usual. He reported no recent illness or medication ingestion. n n n nFigure 1 n nPurplish, flat-topped papules on the wrist; a few are in a linear arrangement. n n n n n nFigure 2 n nA white reticulated pattern can be seen inside the right cheek; lesions cannot be removed with a tongue blade. n n n nWhat is the diagnosis, and what further laboratory tests are indicated? n nDIAGNOSIS: Lichen planus.

Diffuse eruption of pigmented papules

A 33-year-old African American woman presented for evaluation of an itchy eruption of approximately 6 months duration that began on the hand dorsa before spreading to the arms, ears, and knees. Initial examination revealed clusters of pigmented, 1-mm papules on the hand dorsa, especially the knuckles, and on the distal forearms. Multiple lesions were present in areas of scratching (Koebners phenomenon), producing a linear pattern. After the initial evaluation, these lesions continued to spread and involved the forehead (Figure u200b(Figure11), the back of neck (Figure u200b(Figure22), and the distal extremities (Figure u200b(Figure33). On further questioning, the patient stated that she had suffered a flulike illness 2 months previously and that her muscles felt sore, particularly in her arms and legs. n n n nFigure 1 n nClusters of pigmented papules on the forehead. n n n n n nFigure 2 n nMultiple pigmented papules on the back of the neck. n n n n n nFigure 3 n nPigmented papules with a linear distribution. n n n nWhat is your diagnosis? n nDIAGNOSIS: Papular mucinosis (scleromyxedema).