Mital Patel

Epidemiology and Treatment of Eosinophilic Fasciitis: An Analysis of 63 Patients From 3 Tertiary Care Centers

Author Contributions: Drs Hubiche and Valério had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Hubiche, Valério, del Giudice. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Hubiche, Valério, del Giudice. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Hubiche, Valério. Administrative, technical, or material support: Hubiche, Mahe, Phan. Study supervision: Hubiche, Boralevi, Bodemer Skandalis, del Giudice.

The Brigham Scalp Nail Inverse Palmoplantar Psoriasis Composite Index (B-SNIPI): A Novel Index to Measure All Non-plaque Psoriasis Subsets

Psoriasis is a chronic inflammatory disease that encompasses a large spectrum of clinically distinct subtypes. Although chronic plaque psoriasis is reported as the most common form of psoriatic skin disease, there is growing evidence that other variants including scalp, nail, inverse, and palmoplantar psoriasis are prevalent, undertreated, and associated with significant impairment in quality of life. Currently, the Psoriasis Area and Severity Index (PASI) is the standard to assess psoriasis severity as well as response to treatment; however, the PASI has several limitations. In response to this need and as a complementary objective measure to the PASI, we created the Brigham Scalp Nail Inverse Palmoplantar Psoriasis Composite Index (B-SNIPI), based on patient-surveyed, patient-reported outcomes equally weighted with physician assessment of disease activity. Herein we summarize the B-SNIPI as presented at the 2013 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).

Epidemiology of concomitant psoriasis and hidradenitis suppurativa (HS): Experience of a tertiary medical center

To the Editor: Hidradenitis suppurativa (HS) and psoriasis are chronic inflammatory disorders, which likely share immune-pathogenetic pathways, including interleukin-12/-23 and tumor necrosis factor-alfa. The overlapping therapies used in these disorders further support this hypothesis. A recent study characterizing patients with HS and spondyloarthritis revealed that 9% had plaque psoriasis and 11% had palmoplantar pustulosis. Currently, data are lacking on the co-occurrence of HS and psoriasis; therefore, we sought to examine the characteristics and comorbidities of individuals with both conditions. After institutional review board approval, we used the Partners Healthcare Research Patient Data Registry to identify individuals with both HS and psoriasis treated at Brigham andWomen’s Hospital in Boston, MA, from January 2000 through June 2010 based on a natural language search of ‘‘hidradenitis suppurativa,’’ ‘‘psoriasis,’’ and ‘‘ICD-9 codes 705.83 and 696.1.’’ Comparison groups matched for age, gender, and racewere generated andmatched 3:1 for healthy and psoriasis-only control subjects and 1:1 for HS-only control subjects. We extracted data on cigarette smoking, hypertension, depression, type 2 diabetes, inflammatory bowel disease, and body mass index (BMI) and used paired t tests (BMI) and McNemar 2 tests to compare individuals with HS/ psoriasis to psoriasis-only, HS-only, and healthy control subjects. Of 161 individuals identified, medical record review confirmed that 99 had both HS and psoriasis. In all, 56 were given a diagnosis by a boardcertified dermatologist and included in our study. Demographics are presented in Table I. Individuals with HS/psoriasis were predominantly women ([80%), and had statistically significant higher rates of smoking, obesity, hypertension, diabetes, depression, and inflammatory bowel disease compared with the healthy and psoriasis-only control subjects. In addition, there was a statistically significant difference in BMI and a trend toward statistical significance with diabetes in the HS/psoriasis group when compared with the HSonly control subjects (Table II). To our knowledge, this is the first study to characterize patients with concomitant HS and psoriasis. Smoking is known to promote inflammatory conditions, and nearly 50% of the HS/psoriasis group were current smokers. In addition, BMI was higher in the HS/psoriasis group than in all control groups. Studies have shown an increased prevalence of metabolic syndrome in patients with HS or psoriasis. Our data support this and suggest that metabolic syndrome may be more prevalent among individuals with both conditions. This underscores the importance of health maintenance and screening and consideration of interdisciplinary management in this population. Studies have demonstrated a diminished quality of life in patients with HS and psoriasis. Although our study did not address this directly, over 40% of the HS/psoriasis group had a diagnosis of depression, treatment for depression, or both. Limitations of this study include the retrospective design and small sample size from a single tertiary care center. Although our study population was limited to individuals given a diagnosis of both conditions by a board-certified dermatologist, this may be viewed as an advantage as cases were confirmed by dermatologist diagnosis rather than International Classification of Diseases, Ninth Revision code alone. In addition, we were able to obtain only 1 HS-only control for each study participant given the strict matching criteria. Further investigation is warranted to better characterize individuals with concomitant HS/psoriasis and their comorbidities.

Novel application of high-dose rate brachytherapy for severe, recalcitrant palmoplantar pustulosis.

Palmoplantar pustulosis (PPP) is a chronic pustular dermatitis of the palms and soles, which is frequently associated with significant pruritus and pain, often limiting daily activities. We present the case of a 36‐year‐old man with severe PPP who had treatment failure with multiple medical therapies but showed marked improvement with high‐dose rate brachytherapy. Brachytherapy has the advantage of providing a conformal dose distribution over complex curved surfaces, such as the foot and ankle. Our observations suggest that brachytherapy may be a well‐tolerated treatment option for patients with severe, refractory PPP.

Hidradenitis suppurativa burden of disease tool: Pilot testing of a disease-specific quality of life questionnaire

REFERENCES 1. Falabella R, Escobar C, Giraldo N, et al. On the pathogenesis of idiopathic guttate hypomelanosis. J Am Acad Dermatol. 1987; 16:35-44. 2. Fulton JEJ, Rahimi AD, Mansoor S, et al. The treatment of hypopigmentation after skin resurfacing. Dermatol Surg. 2004; 30:95-101. 3. Fitzpatrick RE. Treatment of inflamed hypertrofic scars using 5-FU. Dermatol Surg. 1999;25:224-232. 4. Arbache S, Godoy CE. Microinfusion of drugs into the skin with tattoo equipment. Surg Cosmet Dermatol. 2013;5:70-74. 5. Matias AR, Ferreira M, Costa P, Neto P. Skin colour, skin redness and melanin biometric measurements: comparison study between Antera 3D, Mexameter and Colorimeter . Skin Res Technol. 2015;21:346-362.

Characteristics and Alternative Treatment Outcomes of Antimalarial-Refractory Cutaneous Lupus Erythematosus

Centre for Cardiovascular Research (DZHK), partner site Greifswald, Germany (Gross, Völzke, Nauck); Department of Cardiology, University Medicine Greifswald, Germany (Gross); Institute for Community Medicine, University Medicine Greifswald, Germany (Völzke); German Centre for Diabetes Research (DZD), partner site Greifswald, Germany (Völzke); European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany (Haring); School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia (Haring). Corresponding Author: Hanna Kische, Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch Str D-17475 Greifswald (kischeh@uni-greifswald.de). Accepted for Publication: January 25, 2017. Published Online: April 12, 2017. doi:10.1001/jamadermatol.2017.0297 Author Contributions: Drs Kische and Haring, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Wallaschofski, Nauck, Haring. Acquisition, analysis, or interpretation of data: Kische, Arnold, Gross, Wallaschofski, Völzke, Haring. Drafting of the manuscript: Kische, Nauck, Haring. Critical revision of the manuscript for important intellectual content: Arnold, Gross, Wallaschofski, Völzke, Haring. Statistical analysis: Kische, Gross. Obtained funding: Völzke. Administrative, technical, or material support: Arnold, Völzke, Haring. Supervision: Wallaschofski, Nauck, Haring. Conflict Interest Disclosures: None reported. Funding/Support: This study was supported in part by the Federal Ministry of Education and Research (grants 01ZZ9603, 01ZZ0103, and 01ZZ0403), the Ministry of Cultural Affairs, as well as the Social Ministry of the Federal State of Mecklenburg-West Pomerania. This work is also part of the research project Greifswald Approach to Individualized Medicine. Role of the Funder/Sponsor: The funders/sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. 1. Sinclair R, Torkamani N, Jones L. Androgenetic alopecia: new insights into the pathogenesis and mechanism of hair loss. F1000Res. 2015;4(F1000 Faculty Rev):585. doi:10.12688/f1000research.6401.1 2. Kondo S, Hozumi Y, Aso K. Organ culture of human scalp hair follicles: effect of testosterone and oestrogen on hair growth. Arch Dermatol Res. 1990;282(7): 442-445. 3. Völzke H, Alte D, Schmidt CO, et al. Cohort profile: the study of health in Pomerania. Int J Epidemiol. 2011;40(2):294-307. 4. Haring R, Hannemann A, John U, et al. Age-specific reference ranges for serum testosterone and androstenedione concentrations in women measured by liquid chromatography-tandem mass spectrometry. J Clin Endocrinol Metab. 2012;97(2):408-415. 5. Sanke S, Chander R, Jain A, Garg T, Yadav P. A comparison of the hormonal profile of early androgenetic alopecia in men with the phenotypic equivalent of polycystic ovarian syndrome in women. JAMA Dermatol. 2016;152(9):986-991. 6. Narad S, Pande S, Gupta M, Chari S. Hormonal profile in Indian men with premature androgenetic alopecia. Int J Trichology. 2013;5(2):69-72.

Novel posterior auricular cutaneous reaction after anti–TNF-α infusion in young women with Crohn's disease

CD: Crohn’s disease IBD: inflammatory bowel disease TNF: tumor necrosis factor INTRODUCTION Tumor necrosis factor (TNF)-a is a cytokine critical for effective immune surveillance. Abnormally elevated TNF has been implicated in the pathogenesis of many inflammatory conditions. Anti-TNF medications are an effective targeted therapy for these conditions. Cutaneous reactions after treatment with anti-TNF medications have been well documented in the literature. Complications include hypersensitivity reactions, psoriasiform eruptions, lupuslike syndrome, and cutaneous vasculitis. The mechanism for these paradoxical immune reactions is unclear. One hypothesis is that blocking TNF-a leads to unopposed production of interferon-a, a cytokine frequently implicated in the induction of autoimmunity. We present 7 patients with inflammatory bowel disease (IBD) who had cutaneous reactions characterized by painful, fissured, erosive plaques in the postauricular region after treatment with anti-TNF therapy. After this rash, several of these patients subsequently had a similar eruption in the scalp associated with prominent alopecia.