Ting-Shun Wang

Role of breast tumour kinase in the in vitro differentiation of HaCaT cells

Background  Breast tumour kinase (BRK) is a newly identified non‐receptor protein tyrosine kinase from a metastatic breast tumour. Its biological functions are still under extensive investigation. The mouse homologue Sik (Src‐related intestinal kinase) has been implicated in mouse keratinocyte differentiation; however, not much is known about the functions of BRK in human cutaneous biology.

Clinical experience of ustekinumab in the treatment of erythrodermic psoriasis: A case series

patch in our case included a giant café-au-lait spot, as well as a Becker’s nevus. However, the pigmented patch was not hypertrichotic and no elongated rete ridges or increased smooth muscle bundles were noted on the histopathological evaluation. Café-au-lait spots tend to be more oval or round. The presence of a giant café-au-lait spot as large as 30 cm has been previously reported, but in a patient with neurofibromatosis. The differential diagnosis of the hypopigmentation included nevus anemicus, nevus depigmentosus and segmental vitiligo. However, by comparison,ourpatientexhibitedhypopigmentedmacules and patches within the hyperpigmented patch. The termsegmentalpigmentationdisorderhasbeen recently reintroduced by Hogeling and Frieden to defineagroupofpatientswithpatternedhypo-andhyperpigmentation with a low risk of associated abnormalities. Histologically, the hyperpigmented area shows increased melanin in the basal layer, and the hypopigmented area shows decreased melanin content and normal or decreased number of melanocytes. Segmental pigmentation disorder may be explained by mosaicism; however, evidence has not been proven. Happle explained mosaicism to account for the mechanism of various pigment disorders. Four clinical pigmentary patterns of human mosaicism have been suggested: (i) bands following the lines of Blaschko; (ii) checkerboard pattern; (iii) phylloid pattern; and (iv) patchy pattern without a midline separation. The idea of a lethal gene that survives by mosaicism and the random distribution of mutant cells explain the asymmetrical and scattered distribution of the cutaneous lesions. Of the four clinical pigmentary patterns of human mosaicism, however, the pattern of previously reported segmental pigmentation disorders most resembles the checkerboard pattern, rather than the patchy pattern without a midline separation as manifested in our case. Treatment of segmental pigmentation disorder has not been reported, but some cases of segmental pigmentation disorder were observed to fade gradually with time. The hypopigmented areas in our patient were treated with 1% pimecrolimus cream for 4 months after informed consent, but no noticeable changes occurred. Further studies may help clarify the possible pathogenesis involved in the pigmentary changes in this patient.

Concomitant Sleep Disorders Significantly Increase the Risk of Cardiovascular Disease in Patients with Psoriasis

Background The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown. Methods Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs. Results Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22–1.28) and stroke (aHR, 1.24; 95% CI, 1.16–1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults. Conclusions The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.

Etanercept use for psoriasis in Taiwan: a case series study

Background  The reported efficacy and safety of some biologic agents for psoriasis vary between Caucasians and Asians. Few reports of etanercept exist in psoriasis patients within the Asia‐Pacific region.

Epidemiology of psoriatic disease and current treatment patterns from 2003 to 2013: A nationwide, population-based observational study in Taiwan

BACKGROUND Recent global data show an increasing prevalence of psoriasis and psoriatic arthritis in western countries. OBJECTIVE The current study analyzed the trend of prevalence rates of psoriasis and psoriatic arthritis in Taiwan and examined biologic prescription patterns by different specialties. METHODS Data were accessed from the national payer National Health Insurance Research Database in Taiwan. This study protocol was approved by Joint Institutional Review Board established by Medical Research Ethics Foundation (No 13-S-001). RESULTS Between 2003 and 2013, the prevalence of psoriasis and psoriatic arthritis increased by 41% (from 15.54 to 21.90 per 10,000 population) and 191% (from 0.45 to 1.31 per 10,000 population), respectively, while the prevalence of psoriatic arthritis among patients with psoriatic disease increased from 6.3% to 12.7%. Dermatologists are the main caregivers for patients with psoriasis and psoriatic arthritis; however, data suggest a decreasing trend in the proportion of dermatologists for psoriasis patients from 24.7% between 2003 and 2008 to 10.74% between 2008 and 2013, with a corresponding decrease in dermatologists for psoriatic arthritis patients from 62.30% to 44.65% during the same periods, respectively. In 2013, of the 51,191 patients with psoriasis, only 596 (1.16%) received biologics (73.3% by dermatologists and 25.8% by rheumatologists), while 1120 of the 7470 (14.99%) psoriatic arthritis patients received biologics (72.8% by rheumatologists and 22.3% by dermatologists). The proportion of biologics use was 1.12% and 7.75% among all patients with only psoriasis and 8.01% and 26.70% among all patients with psoriatic arthritis seen by dermatologists and rheumatologists, respectively. CONCLUSION The prevalence of psoriasis and psoriatic arthritis is increasing in Taiwan. The use of biologics in patients with psoriatic arthritis was comparable to that reported in previous studies in the United States and Europe; however, the use of biologics remained low in patients with psoriasis in Taiwan.

Remission of Bullous Pemphigoid after Rituximab Treatment in a Psoriasis Patient on Regular Low- dose Methotrexate

© 2014 The Authors. doi: 10.2340/00015555-1619 Journal Compilation

Intralesional therapy for psoriasis.

Abstract Localized resistant plaques of psoriasis often remain despite highly effective anti-psoriasis treatment. Intralesional therapy is often used to treat various malignant, infectious or inflammatory cutaneous diseases, including psoriasis. Despite the presence of many review articles on the treatment of psoriasis, no articles exist which review the use of intralesional therapy for psoriasis. In this article, we review the published literatures of intralesional therapy for psoriasis. Corticosteroids, methotrexate, cyclosporin, biologics, botulinum toxin type-A, 15-hydroxyeicosatetraenoic acid, and chemotherapy agents such as 5-fluorouracil are discussed. Also, agents which may be used intralesionally and have the potential to treat psoriasis will also be reviewed such as bleomycin, vincristine or vinblastine, mitomycin-C, aminophylline, 5-aminolevulinic acid, rituximab, bevacizumab and pentoxifylline are included.

Serial QuantiFERON-TB Gold testing in patients with psoriasis treated with ustekinumab

Background There is increasing concern about the risk of latent tuberculosis infection (LTBI) reactivation during the use of biologics for psoriasis. Although ustekinumab had been documented with low risk of tuberculosis, the long-term follow-up of LTBI as determined by QuantiFERON-TB Gold (QFT-G) testing in patients treated with ustekinumab is limited. Objectives This study aims to use serial QFT-G testing as a screening method for detecting LTBI in patients with psoriasis from an intermediate tuberculosis burden country. Methods This retrospective review investigated 134 psoriatic patients in whom ustekinumab was prescribed for at least one year between 2010 and 2016 in National Taiwan University Hospital. All patients underwent annular QFT-G testing during ustekinumab therapy. Results Among the 134 enrolled patients, baseline LTBI rate was 13.4% (18/134). Indeterminate QFT-G result was noted in 5.2% (7/134) of patients and 71.4% (5/7) of them turn to be QFT-G negative during the next testing. 81.3% (109/134) of patients had a negative QFT-G at baseline and the seroconversion rate was 7.3% (8/109) in the serial QFT-G. All the patients in the conversion group were referred to a pulmonologist for evaluation and 81.5% (22/27) of them underwent chemoprophylactic therapy while on ustekinumab. No active TB infection was noted during further follow-up with or without chemoprophylaxis. Conclusions This study revealed that psoriatic patients receiving long-term ustekinumab therapy had a low QFT-G conversion rate (7.3%). The clinical significance of QFT-G conversion remains controversial and needs larger scale trials to investigate.

Cutaneous irritancy of water

Abstract Water is an ubiquitous irritant that exerts its irritancy through different mechanisms. Water passage and optimal water content is a highly controlled process of human skin and changes in the water gradient may lead to skin diseases. The pH, osmolarity, and temperature of water can all be attributes of water irritancy. In addition, the irritancy of water is also determined by individual susceptibility.

Occurrence of psoriatic plaques on previous adalimumab injection sites during disease relapse in a patient with pustular psoriasis

B, Drug reaction. Hematoxylin and eosin section showing a mildly atrophic epidermis with focal basal vacuolar change. There is dysmaturation of the keratinocytes likely related to chemotherapy effect. Melanin is present within the stratum corneum. Within the dermis a scant infiltrate of lymphocytes surround the superficial vessels and there are scattered melanophages. J AM ACAD DERMATOL JULY 2014 e24 Letters