Narumol Silpa-archa

Metabolic syndrome and psoriasis severity in South-East Asian patients: An investigation of potential association using current and chronological assessments

Although studies regarding prevalence of metabolic syndrome (MS) in Asian psoriatic patients are limited and show varying results, a previous report describes a significant increase in prevalence of MS in Thai psoriatic patients, as compared with rates in the general population. However, no significant association between MS and psoriasis severity using the Psoriasis Area and Severity Index (PASI) was found, which differs from the findings of Korean and Japanese studies. This study aimed at re‐evaluating the association between MS and psoriasis severity in Thai patients using current assessment (PASI) and chronological assessment (historical course and interventions). A total of 273 psoriatic patients were recruited. After controlling for age and sex, 96 patients were assigned to the MS group and 96 patients to the non‐MS group. Similar to the previous study, no significant differences were identified between metabolic and non‐metabolic patients regarding PASI, age of onset, disease duration and family history of psoriasis. However, the numbers of hospitalizations (P = 0.018) and interventions (P = 0.028) were significantly higher in metabolic patients than in non‐metabolic patients. Further, a greater number of metabolic components was significantly associated with a higher number of hospitalizations (P = 0.012), pustular or erythrodermic psoriasis episodes (P = 0.049), and interventions (P = 0.005). Body mass index of 23 kg/m2 or more, abdominal obesity and high blood pressure were associated with an increased risk of treatment failure. Using chronological assessment, our study supported that MS negatively affects psoriasis severity and treatment outcomes. Screening for MS is highly recommended for psoriatic patients.

Clinical differences between early- and late-onset psoriasis in Thai patients.

There is a paucity of data regarding clinical differences between early‐onset psoriasis (EOP) and late‐onset psoriasis (LOP) in Asian populations. This study aimed to investigate clinical differences between EOP (onset at the age of <40 years) and LOP (onset at the age of ≥40 years) in Thai patients.

Polymorphic Eruption of Pregnancy Presented with Targetoid Lesions: A Report of Two Cases

Background: Skin lesions in pregnant women could be caused by physiologic or pathologic changes. Polymorphic eruption of pregnancy (PEP), which manifests as various types of skin lesions, is the most common pregnancy dermatosis. Thus, PEP could mimic other skin diseases related to unfavorable maternal and fetal outcomes. Main Observations: Two PEP patients with targetoid lesions are presented here. One of them was a primigravida, whereas the other was a secundigravida. Both patients had singleton pregnancies and skin rash which started during the third trimester. The lesions began on the abdomen and then spread to the trunk and extremities. The face, palms, soles, and mucosa were not affected. Pruritus was observed but no other systemic symptoms were reported. Both patients delivered healthy, term infants without complications. Conclusion: Targetoid lesions in PEP are an uncommon presentation, and the differential diagnosis of PEP along with other dermatoses should be considered. However, the prognosis for this type of PEP is not different from that for classic PEP.

Home Phototherapy in Vitiligo

Vitiligo is a disorder characterized by the development of depigmented macules and patches. Narrowband ultraviolet B phototherapy is a standard of care treatment and is used both as monotherapy and in combination with other treatment modalities to induce repigmentation. Although phototherapy is safe and effective, its use is limited due to the significant time commitment required and associated costs. Home phototherapy is a safe and effective alternative to make phototherapy more accessible to patients. However, it is often underutilized due to lack of physician experience and comfort as well as misconceptions regarding its safety and efficacy. This article provides a brief overview of the use of phototherapy in vitiligo with a focus on home phototherapy in order to increase awareness and use of this treatment modality.

Effectiveness of and factors associated with clinical response to methotrexate under daily life conditions in Asian patients with psoriasis: A retrospective cohort study

Given the relative scarcity of data concerning the efficacy of methotrexate under daily life conditions in psoriasis, this study aimed to investigate the effectiveness of methotrexate in Asian psoriatic patients and to identify factors associated with clinical response. This observational retrospective cohort study included adult psoriatic patients who had been treated with or were going to start methotrexate. Psoriasis Area and Severity Index (PASI) scores at baseline and at 3, 6 and 12 months were recorded. At 3 months, patients achieving 50% or more reduction from baseline PASI score were defined as responders. One hundred, 74 and 61 patients were followed for 3, 6 and 12 months, respectively. Mean follow‐up time was 15.3 ± 10.2 months. A reduction in PASI score of at least 75% was achieved in 26%, 32.5% and 45.2% at 3, 6 and 12 months, respectively. At 12 and 24 months, Kaplan–Meier analysis showed 68.7% and 52.1% probability of drug survival, respectively. Male sex, body mass index (BMI) of less than 25 kg/m2 and absence of abdominal obesity were factors associated with response to treatment in univariate analysis. Male sex was the only significant factor in multivariate analysis. The effectiveness of methotrexate in clinical practise seemed to be lower than in clinical trials, but effectiveness increased with longer duration of treatment. Problems associated with methotrexate use in clinical practise may be due to medication adherence rather than lack of medication effectiveness. Female sex, abdominal obesity and BMI of 25 kg/m2 or more might decrease response to methotrexate.

Sunscreen Application to the Face Persists Beyond 2 Hours in Indoor Workers: An Open Label Trial

Abstract Background: The American Academy of Dermatology recommends reapplication of sunscreen every two hours for adequate sun protection when outdoor. However, the frequency of reapplication needed to achieve adequate protection in indoor workers remains unknown. Objective: To investigate the persistence of sunscreen applied once in the morning on the face of indoor workers throughout a normal 8-hour workday. Methods: This open-label trial included 20 healthy volunteers who work indoors. Volunteers applied 1 g of sunscreen (2 mg/cm2) mixed with 2% invisible blue fluorescent agent on the face in the morning. Photographs were taken by VISIA-CR booth in UV mode at 8 am and then every 2 hours thereafter until 4 pm with limited outdoor activity less than 1 hour. Six areas of the face were analyzed using digital image analysis software. The primary outcome was the total amount of sunscreen diminution during the 8-hour study period. Results: The amount of sunscreen decreased with mean peak reduction of 16.3% at 2 hours, and minimal reduction thereafter. Total sunscreen reduction was 28.2% at the end of the 8-hour day. Limitations: Small study population. Conclusion: For indoor workers who applied adequate amount of sunscreen once in the morning, reapplication of sunscreen may be unnecessary.

A randomized comparison of efficacy and safety of intralesional triamcinolone injection and clobetasol propionate ointment for psoriatic nails

Abstract Background: Even though the traditional therapy for nail psoriasis has been used for decades, no randomized, controlled trial of such treatment has been conducted to date. Objective: To evaluate the efficacy and safety of intralesional triamcinolone injections compared with 0.05% clobetasol ointment for psoriatic nails. Materials and methods: Psoriasis patients, each with three fingernails with similar degrees of severity, were randomly recruited for intralesional triamcinolone injection group, 0.05% clobetasol ointment group, and a control group. The target Nail Psoriasis Severity Index (NAPSI) score of each finger was evaluated, any adverse effects were recorded, and photographs were taken. Results: Forty-eight affected nails were analyzed. At the second month, a significantly greater reduction of the target NAPSI score was observed in the injection group compared to the control group (p = .003). There was a greatest reduction of the score in the following two month-period, which showed significant difference from the topical group (p = .003) and the control group (p = < .001). The score of the injection group, however, subsequently rose at the six-month visit so that there was no longer any statistically-significant difference between the three groups. Conclusions: In spite of its temporary effect, the intralesional triamcinolone injection is an effective and safe treatment for psoriatic nails.

The humoral immunity to epidermal and dermal antigens in psoriasis: a downstream rather than an upstream event

The presence of immunoglobulin G (IgG) and complement in upper epidermis of psoriatic skin lesions has been reported for more than 40 years [1, 2]. Recently, a number of antigenic proteins have been observed in psoriatic skin lesions, in association with IgG and complement deposition [3]. Some of them have increased levels in both skin and serum samples of psoriatic patients [4, 5]. However, functional validation and systematic analysis of epidermal antigens that immunoreact to IgG from psoriatic serum are very scarce. Moreover, it is still unclear whether antigenautoantibody interaction in psoriatic skin lesions is an upstream event (i.e., an early or primary mechanism that subsequently causes disease pathogenesis) or only a downstream phenomenon (i.e., a secondary effect or consequence of psoriatic plaque formation, which can induce secondary humoral immunity to the exposed epidermal antigens). Hence, this hazy mechanism of antigen recognition in psoriatic skin should be elucidated. Our present study thus aimed to evaluate whether the humoral immunity to epidermal and dermal antigens, if any, is the upstream or downstream disease mechanism in psoriasis. The study protocol was approved by the Institutional Ethical Committee (Approval No. 599/2016) and was conducted in accordance with the Declaration of Helsinki Principles. Psoriatic patients who had received only topical treatment or systemic retinoids were enrolled. Venous blood samples were obtained from 10 psoriatic patients (including seven females and three males, aged 38–68 years with a mean Psoriasis Area and Severity Index or PASI of 7.7 ± 6.9) and 10 genderand age-matched healthy controls (including seven females and three males, aged 29–50 years). Normal skin samples were obtained from two healthy individuals who underwent abdominoplasty to serve as the source of target tissue antigens. Note that only normal skin samples were used in this study because we aimed to evaluate tissue antigens that might be involved in the disease pathogenesis, whereas antigens in lesional skin from psoriatic patients would more likely be effector molecules rather than causative antigens for the disease pathogenesis. Epidermis and dermis were dissected and washed several times with PBS to remove contaminated blood. The tissues were then chopped into small pieces, snap frozen with liquid nitrogen, and ground into powder using a pre-chilled mortar and pestle. Proteins from the ground tissues were extracted using Laemmli’s buffer and their concentrations were measured by Bradford’s method using Bio-Rad Protein Assay (Bio-Rad Laboratories; Hercules, CA, USA). Equal amount of total protein (30 μg/sample) was resolved by 12% SDS-PAGE and transferred onto nitrocellulose membranes. After blocking non-specific bindings with 5% skim milk in PBS for 1 h, the membranes were incubated with pooled sera from either psoriatic patients or healthy controls (each was diluted 1:1000 with 1% skim milk in PBS) at 4 °C overnight. After three washes with PBS, the membranes were incubated with horseradish peroxidase (HRP)-conjugated rabbit antihuman IgG antibody (Dako; Glostrup, Denmark) or mouse monoclonal anti-human IgM (Invitrogen; Camarillo, CA, USA) (each was diluted 1:3000 with 1% skim milk in PBS) at room temperature for 1 h. The immunoreactive protein bands were visualized by SuperSignal West Pico chemiluminescence substrate (Pierce Biotechnology, Inc.; Rockford, IL, USA) and autoradiography. * Visith Thongboonkerd thongboonkerd@dr.com; vthongbo@yahoo.com

A Guide to the Ingredients of Over-the-Counter Moisturizers for Psoriasis

It is believed that moisturizers can improve the efficacy of treatment for psoriasis. This study sought to analyze the active ingredients and properties of moisturizers that claimed to be suitable for psoriasis. Moisturizers for psoriasis were identified on electronic markets using the search terms “moisturizers” and “psoriasis.” Forty-seven moisturizers that claimed to be suitable for psoriasis were identified. Vitamin E was the most common ingredient used for emollient properties. Of the 47 moisturizers, 35 (74%) contained anti-inflammatory properties and 12 (26%) contained keratolytic properties. Coal tar, low-potency corticosteroids, and botanical extracts were added for anti-inflammatory properties while salicylic acid, lactic acid, and ≥ 10% urea cream were used for keratolytic effect. Although it seems that each active ingredient added into moisturizers for psoriasis can decrease the severity of psoriasis, there is a lack of well-done studies on the over-the-counter preparations. Therefore, the recommendations to use them are currently not evidence-based.

Cutaneous Miliary Tuberculosis in a Chronic Kidney Disease Patient

A 79-year-old Thai woman with advanced renal failure, dyslipidemia and anemia of chronic disease was admitted to hospital with prolonged fever, productive cough and multiple discrete small pustules on her face, trunk and extremities. A chest X-ray revealed diffuse miliary infiltration. Mycobacterium tuberculosis complex DNA was detected by polymerase chain reaction in sputum and scrapings of pustules from her skin. Blood culture identified M. tuberculosis complex. Pulmonary and cutaneous miliary tuberculosis was diagnosed. The patients symptoms improved after 3 weeks of treatment with isoniazid, rifampicin, ethambutol and pyrazinamide. This report details a case of cutaneous miliary tuberculosis in a non-dialysis chronic kidney disease patient.