Sungat K. Grewal

Psoriasis and comorbid diseases: Epidemiology

Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis.

Compliance by California tanning facilities with the nation’s first statewide ban on use before the age of 18 years

BACKGROUND Exposure to indoor tanning, especially at younger ages, is associated with increased risk of skin cancer. Even in states with parental consent requirements, teenagers used tanning facilities at high rates. In 2011, California became the first state to pass a complete ban on indoor tanning by those younger than 18 years. OBJECTIVE We sought to determine whether tanning facilities in California were in compliance with the new law. METHODS In a cross-sectional study, telephone calls were placed in May 2013 to a statewide random sample of tanning facilities by a study investigator indicating that she was 17 years old. RESULTS Of 600 advertised indoor tanning facilities, 338 met inclusion criteria. A majority of respondents (77%, 95% confidence interval 72%-81%) told the underage caller that she could not use their ultraviolet tanning facility. Most facilities, however, denied any dangers from ultraviolet tanning (61%) and made unlawful claims of specific health benefits, including vitamin-D production (44%), skin disease treatment (22%), prevention of future sunburns (17%), and prevention or treatment of depression (8%). LIMITATIONS Tanning facilities may respond differently to a 17-year-olds request to tan in person versus by telephone. CONCLUSION Given strong evidence linking indoor tanning to skin cancer, and the tanning industrys documented history of marketing specifically to teenagers, this study suggests that laws banning indoor tanning younger than 18 years can meaningfully impact access. Additional enforcement, however, may be required to bring about accurate disclosure of risk and prevent claims of unproven health benefits.

Increased prevalence of HCV and hepatic decompensation in adults with psoriasis: a population-based study in the United Kingdom

The hepatitis C virus (HCV) is a major cause of global morbidity and mortality, with conflicting evidence regarding a possible association with psoriasis.

The risk of IgA nephropathy and glomerular disease in patients with psoriasis: A population based cohort study.

Psoriasis, particularly when moderate to severe, is associated with an increased risk of incident chronic kidney disease (CKD)1, although specific renal diseases observed in psoriasis patients remain poorly defined. Of special interest is IgA nephropathy (IgAN), which presents with episodic macroscopic hematuria and can lead to CKD and end-stage kidney disease. This article is protected by copyright. All rights reserved.

Patient-reported outcomes of electrodessication and curettage for treatment of nonmelanoma skin cancer.

We have shown that electrodessication and curettage (ED&C) cures most (>95%) basal cell and cutaneous squamous cell carcinomas (nonmelanoma skin cancers, NMSCs) for which it is used,(1) but skin-related quality of life after ED&C does not improve as much as after excision or Mohs surgery.(2) Our goal was to determine other patient-reported outcomes (PROs) after treatment of NMSC with ED&C. We studied all patients with primary NMSCs treated with ED&C, excision, or Mohs surgery in 1999–2000 at a university hospital or its affiliated Veterans Affairs clinic, and who responded to a survey before treatment. The final sample consisted of 149 patients treated with ED&C and 568 treated with excision or Mohs surgery. Three months after treatment, we used an adapted version of the Patient Satisfaction Questionnaire (PSQ-18) to measure satisfaction with care, including its technical quality, interpersonal manner, communication, financial aspects, time with clinician, and accessibility.(4) Responses vary from 1 to 5, with higher scores indicating greater satisfaction. One year after treatment, we used global items to measure patients’ description of cosmetic appearance, bother from appearance, bother from scar, judgment of treatment worth, and overall satisfaction with treatment. The response rate for PROs varied from 65% to 92%. We used the chi-squared test for categorical variables and the Wilcoxon rank sum test for continuous variables. We used multivariable logistic regression models to determine if treatment independently predicted PROs better or worse than the median; these models adjusted for patient characteristics (age, gender, number of tumors at enrollment), tumor characteristics (histological type, diameter, invasiveness, location on the head and neck), practice site, and clinician training level. Tumors treated with ED&C were less likely than those treated with excision or Mohs surgery to be located on the head and neck, to be invasive, to have histological risk factors for recurrence, and to have been treated by an attending physician (Table 1). Table 1 Characteristics of study sample of patients with nonmelanoma skin cancera Three months after treatment, both groups were similarly satisfied with all domains of care except that patients treated with ED&C were somewhat less satisfied with the time spent with the clinician and the accessibility and convenience of their care. A year after treatment, patients treated with ED&C described worse cosmetic appearance and were more bothered by the appearance (Table 2). In adjusted analyses, patients treated with ED&C remained twice as likely to report more frequent bother from appearance (p=.002), but did not differ in any other PRO. Table 2 Patient reported outcomes that differed in treatment groups after treatment of non-melanoma skin cancera,b Patients treated with ED&C for NMSC were as satisfied as those treated with excision or Mohs surgery with much of their care, but they were more frequently bothered by the appearance even in adjusted analyses that controlled for patient and tumor characteristics and training level of clinician. Interviews would be required to understand patients’ responses fully, but the results support the clinical impressions of many dermatologists: although overall outcomes are good, patients treated with ED&C may be more bothered by the treatment site. The findings highlight the importance of PROs after NMSC, and the need for thoughtful decision making for this most common cancer.

Ulcers of the Ventral Aspect of Fingers

A 42-year-old African American male presented with a 7-month history of fatigue, exertional dyspnea, arthralgias, hand swelling, tender ulcerations, hair loss, and a 50-pound weight loss. He had been hospitalized 6 months prior for hypoxia. Chest computed tomography (CT) showed hilar lymphadenopathy, interstitial thickening, and perilymphatic ground glass opacities. Bronchoscopy revealed plaquelike lesions, and transbronchial nodal aspiration of mediastinal nodes was negative for carcinomas and/or granulomas. Prednisone was initiated for presumed sarcoidosis. Antineutrophil cytoplasmic antibodies, antinuclear antibodies, angiotensin-converting enzyme, rheumatoid factor, and Aspergillosis antigen were negative and/or normal. The patient was referred for a second opinion. On presentation he had symmetric swelling of metacarpophalangeal joints (MCPs) and interphalangeal joints (IPs), preventing fist formation. Dorsal MCPs had ulcers distal fingers were dyspigmented and atrophic, capillaroscopy was normal, and palmar IP creases had ulcerated lichenoid papules (Figure, A and B). Oxford Scale muscle strength was 5 of 5 throughout. Auscultation revealed bibasilar rales. He had normal aldolase levels (4.5 U/L [to convert to μkat/L, multiply by 0.0167]), depressed creatine kinase (32 U/L), hyperferritinemia (1543 ng/ml), and T lymphocytopenia (absolute CD3, CD4, and CD8 counts, 328 μL, 233 μL, and 85 μL, respectively); the patient also had anti-SSA (Ro) antibodies, and immunoglobulin G anticardiolipin antibodies (19.5 units). The patient tested negative for HIV, anti–Scl-70 antibodies, anti–β2-glycoprotein 1 antibodies, lupus anticoagulant, cryoglobulins, and anti–Mi-2 antibodies; prothrombin time, partial thromboplastin time, and tissue thromboplastin were normal. Edematous hands A Ulcerating papules B