Mark Goodfield

Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study)

Background  Multiple questionnaires to screen for psoriatic arthritis (PsA) have been developed but the optimal screening questionnaire is unknown.

Genome-wide association study identifies three novel susceptibility loci for severe Acne vulgaris

Acne vulgaris (acne) is a common inflammatory disorder of the cutaneous pilo-sebaceous unit. Here we perform a genome-wide association analysis in the United Kingdom, comparing severe cases of acne (n=1,893) with controls (n=5,132). In a second stage, we genotype putative-associated loci in a further 2,063 acne cases and 1,970 controls. We identify three genome-wide significant associations: 11q13.1 (rs478304, Pcombined=3.23 × 10(-11), odds ratio (OR) = 1.20), 5q11.2 (rs38055, P(combined) = 4.58 × 10(-9), OR = 1.17) and 1q41 (rs1159268, P(combined) = 4.08 × 10(-8), OR = 1.17). All three loci contain genes linked to the TGFβ cell signalling pathway, namely OVOL1, FST and TGFB2. Transcripts of OVOL1 and TFGB2 have decreased expression in affected compared with normal skin. Collectively, these data support a key role for dysregulation of TGFβ-mediated signalling in susceptibility to acne.

Development and testing of new candidate psoriatic arthritis screening questionnaires combining optimal questions from existing tools

Several questionnaires have been developed to screen for psoriatic arthritis (PsA), but head‐to‐head studies have found limitations. This study aimed to develop new questionnaires encompassing the most discriminative questions from existing instruments.

Linear pitting and splinter haemorrhages are more commonly seen in the nails of patients with established psoriasis in comparison to psoriatic arthritis.

Background: Recently the role of several ligament and tendon insertions around the nail matrix and nail plate have been identified as possible contributory factors that explain the higher prevalence of nail involvement in psoriatic arthritis (PsA). The purpose of this study was to determine whether such anatomical factors might also be associated with different patterns of nail involvement in skin psoriasis and PsA. Methods: A total of 173 patients were recruited: 121 PsA cases and 52 psoriasis cases. All patients had a standardised assessment of the nails for lesions including pitting, splinter haemorrhages and onycholysis. Results: The overall modified Nail Psoriasis Severity Index scores did not differ between the two groups (psoriasis mean 8.5, SD 7.1; PsA mean 8.3, SD 9.4). In the nail matrix, linear pitting appeared to be more common in skin psoriasis (OR 0.27, 95% CI 0.18–0.41). There were no significant differences in the distribution of nail plate abnormalities other than splinter haemorrhages which were more commonly seen in psoriasis cases (OR 0.23, 95% CI 0.14–0.39). Conclusion: The pattern of nail disease in psoriasis and PsA differed with respect to the frequency of linear pitting and splinter haemorrhages, with both features occurring more often in psoriasis.

Systemic lupus erythematosus or infection with HIV, or both?

The features of both HIV infection and connective tissue disease are often nonspecific and may mimic other disorders as well as each other. We treated a patient with presumed systemic lupus erythematosus (SLE) for 4 years, who finally admitted to longstanding infection with HIV. The coexistence of SLE and HIV is unusual and has, although reported in the rheumatological journals, not often been discussed in the dermatological literature.

A randomised, controlled trial of a 4% cutaneous emulsion of sodium cromoglicate in treatment of atopic dermatitis in children

ABSTRACT Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease. Sodium cromoglicate (SCG) is a chromone with anti-inflammatory, anti-itch and anti-allergic activity. This trial is a 12-week comparison (RCT) of a 4% SCG cutaneous emulsion with its vehicle in AD. Materials and methods: 208 children aged 2–12 years participated, 104 in each group. The primary endpoint was change in SCORAD score. Secondary endpoints included SASSAD score, topical steroid usage and global assessments. Results: SCORAD was reduced by 28% (SCG group) and by 19% (vehicle): difference was statistically significant (p = 0.03) after 8 weeks and nearly significant (p = 0.09) after 12. A similar result occurred in SASSAD (p = 0.001 at 8 weeks). In subjects without major protocol deviations (SCG-64, vehicle-63), difference in SCORAD remained significant at 12 weeks (p = 0.04). Weight of topical steroids reduced in both groups: −0.60 ± 1.3 g/day (35%), SCG and −0.05 ± 1.1 g/day vehicle (p = 0.04). Treatment success, defined as investigator global opinion graded very or moderately effective, was significantly more frequent in SCG group (p = 0.025). Application site discomfort reported by 12.5% of subjects in SCG group and 16.5% in vehicle group. Conclusions: SCG 4% cutaneous emulsion provides an effective, well-tolerated, steroid-sparing treatment for AD in children.

Treatment of severe, chronic hand eczema: results from a UK-wide survey.

Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first‐line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first‐line treatment for vesicular HE, followed by PUVA and alitretinoin. In terms of potential adverse effects of long‐term or repeated use, oral steroids and ciclosporin A were reported to cause most concern. There is uncertainty about which treatment gives the best short and long‐term outcomes, because of a lack of definitive randomised controlled trials evaluating the effectiveness of different treatment pathways in severe HE.

Detection of IL-36γ through noninvasive tape stripping reliably discriminates psoriasis from atopic eczema

This report demonstrates that sampling and detection of IL-36γ protein by non-invasive tape stripping of skin lesion provides a highly sensitive and selective diagnostic for psoriatic inflammation.

Use of optical coherence tomography for the diagnosis of preclinical lesions of circumscribed palmar hypokeratosis

Circumscribed hypokeratosis of palms and soles is a rare dermatosis, usually affecting women. Diagnosis is mainly based on the clinical characteristics, including the clinical appearance and anatomical site of the skin lesions and on the demographic features of the affected patients, usually middle‐aged to elderly women. Skin biopsy may be performed to confirm clinical diagnosis. Optical coherence tomography (OCT) is a technique that has been undergone substantial development in dermatology in recent years, and its use in clinical practice has been growing progressively. Several dermatological conditions have been studied with this tool, but to our knowledge, it has not been used to investigate this form of hypokeratosis. We report a case of circumscribed palmar hypokeratosis for which diagnosis was confirmed by OCT, which was performed as the patient was reluctant to undergo skin biopsy because of its invasiveness. We highlight the potential use of OCT in obtaining a virtual skin biopsy to confirm clinical diagnosis and identify preclinical skin lesions amenable to early treatment.

SAT0007 Group 3 innate lymphoid cells numbers in peripheral blood predict ustekinumab (STELARA) therapy responsiveness in psoriatic disease cases with subclinical imaging enthesopathy

Background Ustekinumab1 targets the common p40 sub-unit of interleukin-12 (IL-12/interleukin-23 (IL-23). In patients treated with Ustekinumab for psoriasis where patients were selected on the basis of subclinical imaging enthesopathy, we have noted an improvement in subclinical imaging enthesopathy (Savage LJ et al submitted), raising the possibility that it may be possible to find a biomarker for predicting response to therapy in psoriatic disease. Innate lymphoid cells may be centrally involved in the pathogenesis of psoriatic skin and joints disease2, since they express IL-23R receptor and are associated with IL-17/IL-22 production. Objectives This work was performed to test the hypothesis that peripheral blood ILC perturbations may be useful in defining response in psoriasis cases with imaging confirmed subclinical enthesopathy. Methods Peripheral blood collected at baseline (before therapy, 24weeks, 54 weeks) from patients in the MUSTEK trial (Ustekinumab in psoriasis cases who had ultrasound imaging confirmed subclinical enthesopathy) (n=23). Cellular immunophenotyping was performed density gradient separated PBMCs. Innate lymphoid cells were identified as lineage negative (CD3- TCRγδ- TCRαβ- CD19- CD14- CD11c- CD1a- CD303- FcɛRI- CD34- CD123-) with positive expression of CD45, CD127. ILC2 cells were identified as Lineage- CD127+ and CRTH2 positive, while ILC3 were identified as Lineage- CD127+, CRTH2 – and CD117 (c-Kit) positive and further subdivided of NKp44+ and NKp44-. ILC1 were identified as lineage- CD127+ CD117-and CRTH2-. For data analysis we separated cases into PASI>90% or PASI <90% responders. The subclinical enthesopathy scores also fell significantly under therapy (Savage LJ data submitted) Results No correlation was found with total ILCs (ILC1,2, AND 3) (R=0.104, p=321, Spearman R) and therapy response. While, The absolute numbers of baseline ILC3s was inversely correlated in with the reduction in the PASI score (R -0.404, p=0308, Spearman R). The ILC3s also fell progressively under therapy. All the patients respond with reduction of PASI score mean 92.6% (range 65.8–100%), Interestingly, those patients with reduction below 90% of PASI score has a significantly higher absolute numbers of ILC3+ cells in peripheral blood at the baseline than PASI (n=6/23) than super-responder group (n=17/23) Conclusions Only peripheral blood ILC3s, but not other ILCs changes, correlate with the PASI score (disease activity), Furthermore, excellent responders (PASI reduction >90%) showed strong correlated with higher ILC3 population at the baseline. This may help to use ILC3 enumeration as predictive parameter for ustekinamab clinical therapeutic response and may be relevant to assessing novel biomarkers for subclincal arthropathy in psoriasis. References Kreuger et al. N Engl J Med. 2007 Feb 8; 356(6):580–92. Vallinova et al. 2014 Apr;134(4):984–91. Disclosure of Interest None declared