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Shaheen MA, Dakhli AO, Hassen SI. Comparison between the Efficacy of Intense Pulsed Light (I.P.L.) versus Photo-dynamic Therapy (P.D.T.) with Methylene-Blue in the Treatment of Psoriatic nails. Photodiagnosis Photodyn Ther 2023; 41:103298. [PMID: 36682430 DOI: 10.1016/j.pdpdt.2023.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/12/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Nail affection is seen in up to 50 % of patients with skin psoriasis, although up to 5% of nail psoriatic patients do not complain of skin affection. Various treatment options are emerging for nail psoriasis such as intense pulsed light [1]. Methylene-blue (M.B) is a phenothiazine dye which is suggested to mediate cell cyto-toxicity by the generation of hydroxyl-radicals which change the intra-cellular calcium homeo-static mechanisms [2]. OBJECTIVES Evaluation and comparing the efficacy of I.P.L. and methylene-blue assisted photo-dynamic therapy for treating psoriatic nails. PATIENTS AND METHODS 20 patients with mild to moderate psoriasis with nail involvement. Sessions were performed once every 2 weeks on all the affected nails for a maximum of 3 months (6 sessions). Nail Psoriasis Severity Index (N.A.P.S.I.) score and photo-documentation were done for all the patients to assess the nail status at the first visit, after two, six sessions and three months after finishing the six session (0 m., 1 m., 3 m. and 6 m.). Nails of the right hand were treated with methylene-blue mediated photo-dynamic therapy using the Intense Pulsed Light (IPL) as the light source, while the left hand received conventional IPL (430-1200 nm) alone. RESULTS The present study showed that both treatments were effective on nail psoriasis, but MB-PDT was more effective in nail-bed lesions. There was no significant difference regarding patient satisfaction. CONCLUSION Both Intense Pulsed Light and methylene-blue assisted photo-dynamic therapy were safe, nearly pain-free, easy to use, and effective for treating nail psoriasis. MB-PDT is a new promising strategy for the treatment of nail psoriasis.
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Affiliation(s)
- Maha Adel Shaheen
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine - Ain Shams University
| | | | - Samah Ibrahim Hassen
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine - Ain Shams University.
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2
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Pouw JN, Jacobs ME, Balak DMW, van Laar JM, Welsing PMJ, Leijten EFA. Do Patients with Psoriatic Arthritis Have More Severe Skin Disease than Patients with Psoriasis Only? A Systematic Review and Meta-Analysis. Dermatology 2022; 238:1108-1119. [PMID: 35551372 DOI: 10.1159/000524231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early identification of patients at risk of psoriatic arthritis (PsA) is essential to facilitate early diagnosis and improve clinical outcomes. Severe cutaneous psoriasis has been proposed to be associated with PsA, but a recent assessment of the evidence is lacking. Therefore, in this systematic review, we address the association of psoriasis skin severity with the presence and development of PsA. SUMMARY We included articles from a review published in 2014 and supplemented these with recent literature by performing an additional systematic search to identify studies published between 1 January 2013 and 11 February 2021. A meta-analysis was performed when sufficient comparable evidence was available. Of 2,000 screened articles, we included 29 in the analysis, of which 16 were identified by our updated search. Nineteen studies reported psoriasis severity as psoriasis area and severity index (PASI), ten studies as body surface area (BSA), and two studies as "number of affected sites." Most studies show that more extensive skin disease is associated with the presence of PsA. The quantitative pooled analyses demonstrate higher PASI (mean difference [Δ] 1.59; 95% confidence interval [CI] 0.29-2.89) and higher BSA (Δ 5.31; 95% CI 1.78-8.83) in patients with PsA as compared to psoriasis patients without PsA. Results from prospective studies - that assess the risk of future development of PsA in psoriasis patients - were inconclusive. KEY MESSAGES In patients with psoriasis, more severe skin involvement is associated with the presence of PsA, underpinning the importance of optimal dermatology-rheumatology collaboration in clinical care. There are insufficient data to support the use of psoriasis skin severity to predict the future development of PsA in psoriasis patients.
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Affiliation(s)
- Juliëtte N Pouw
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marleen E Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Deepak M W Balak
- Department of Dermatology, LangeLand Hospital, Zoetermeer, The Netherlands
| | - Jacob M van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Emmerik F A Leijten
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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3
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Chen K, Puri V, Michniak-Kohn B. Iontophoresis to Overcome the Challenge of Nail Permeation: Considerations and Optimizations for Successful Ungual Drug Delivery. AAPS JOURNAL 2021; 23:25. [PMID: 33439400 DOI: 10.1208/s12248-020-00552-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 12/22/2020] [Indexed: 12/18/2022]
Abstract
Iontophoresis is a widely used drug delivery technique that has been used clinically to improve permeation through the skin for drugs and other actives in topical formulations. It is however not commonly used for the treatment of nail diseases despite its potential to improve transungual nail delivery. Instead, treatments for nail diseases are limited to relatively ineffective topical passive permeation techniques, which often result in relapses of nail diseases due to the thickness and hardness of the nail barrier resulting in lower permeation of the actives. Oral systemic antifungal agents that are also used are often associated with various undesirable side effects resulting in low patient compliance. This review article discusses what is currently known about the field of transungual iontophoresis, providing evidence of its efficacy and practicality in delivering drug to the entire surface of the nail for extended treatment periods. It also includes relevant details about the nail structure, the mechanisms of iontophoresis, and the associated in vitro and in vivo studies which have been used to investigate the optimal characteristics for a transungual iontophoretic drug delivery system. Iontophoresis is undoubtedly a promising option to treat nail diseases, and the use of this technique for clinical use will likely improve patient outcomes.Graphical abstract.
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Affiliation(s)
- Kevin Chen
- Ernest Mario School of Pharmacy, Department of Pharmaceutics, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.,Center for Dermal Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Vinam Puri
- Ernest Mario School of Pharmacy, Department of Pharmaceutics, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA.,Center for Dermal Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA
| | - Bozena Michniak-Kohn
- Ernest Mario School of Pharmacy, Department of Pharmaceutics, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA. .,Center for Dermal Research, Rutgers, The State University of New Jersey, Piscataway, New Jersey, USA. .,Life Sciences Building, Rutgers, The State University of New Jersey, 145, Bevier Road, Piscataway, New Jersey, 08854, USA.
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4
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Chauhan A, Singal A, Grover C, Sharma S. Dermoscopic Features of Nail Psoriasis: An Observational, Analytical Study. Skin Appendage Disord 2020; 6:207-215. [PMID: 32903967 DOI: 10.1159/000508165] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Nail involvement in psoriasis occurs in up to 30-50% of patients, and 5-10% may have isolated nail disease. Onychoscopy, a noninvasive tool, might obviate the need for nail biopsy, which is a diagnostic gold standard. Objective The aim of this study was to evaluate onychoscopic features of nail unit in patients with nail psoriasis. Methods Fifty-five patients with clinically diagnosed and histologically documented nail psoriasis were recruited. Onychoscopy was performed for each nail (excluding the 5th toenail). Clinically, 443/550 fingernails and 101/440 toenails were involved. The frequency distributions of various onychoscopic features was assessed and compared using the χ2 test (p value <0.05 was considered significant). Results With onychoscopy, additional 52 fingernails and 64 toenails showed psoriatic involvement. Pitting was the commonest finding in fingernails (60.5%) followed by subungual hyperkeratosis (SUH) (52.8%), onycholysis (40.8%), and dotted capillaries in hyponychium, proximal, and lateral nail folds (38.6 vs. 35.8 vs. 35.8%). In toenails, we observed SUH (85.1%), nail plate thickening (82.1%), onycholysis (77.2%), and dotted capillaries in hyponychium and nail folds (59.4 vs. 53.4 vs. 45.5%). Fuzzy lunula was a novel onychoscopic finding noted in 33.6% fingernails and 4.95% toenails (p < 0.00001). Limitations Small sample size. Conclusions Onychoscopy may aid in diagnosing nail lesions even before the clinical signs are apparent.
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Affiliation(s)
- Ankita Chauhan
- Department of Dermatology & STD, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology & STD, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - Chander Grover
- Department of Dermatology & STD, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India
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Diani M, Perego S, Sansoni V, Bertino L, Gomarasca M, Faraldi M, Pigatto PDM, Damiani G, Banfi G, Altomare G, Lombardi G. Differences in Osteoimmunological Biomarkers Predictive of Psoriatic Arthritis among a Large Italian Cohort of Psoriatic Patients. Int J Mol Sci 2019; 20:ijms20225617. [PMID: 31717649 PMCID: PMC6888436 DOI: 10.3390/ijms20225617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 12/13/2022] Open
Abstract
(1) Background: In literature it is reported that 20–30% of psoriatic patients evolve to psoriatic arthritis over time. Currently, no specific biochemical markers can either predict progression to psoriatic arthritis or response to therapies. This study aimed to identify osteoimmunological markers applicable to clinical practice, giving a quantitative tool for evaluating pathological status and, eventually, to provide prognostic support in diagnosis. (2) Methods: Soluble (serum) bone and cartilage markers were quantified in 50 patients with only psoriasis, 50 psoriatic patients with psoriatic arthritis, and 20 healthy controls by means of multiplex and enzyme-linked immunoassays. (3) Results: Differences in the concentrations of matrix metalloproteases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), receptor activator of nuclear factor kappa-B- ligand (RANK-L), procollagen type I N propeptide (PINP), C-terminal telopeptide of type I collagen (CTx-I), dickkopf-related protein 1 (DKK1), and sclerostin (SOST) distinguished healthy controls from psoriasis and psoriatic arthritis patients. We found that MMP2, MMP12, MMP13, TIMP2, and TIMP4 distinguished psoriasis from psoriatic arthritis patients undergoing a systemic treatment, with a good diagnostic accuracy (Area under the ROC Curve (AUC) > 0.7). Then, chitinase-3-like protein 1 (CHI3L1) and MMP10 distinguished psoriasis from psoriatic arthritis not undergoing systemic therapy and, in the presence of onychopathy, MMP8 levels were higher in psoriasis than in psoriatic arthritis. However, in these latter cases, the diagnostic accuracy of the identified biomarkers was low (0.5 < AUC < 0.7). (4) Conclusions. By highlighting never exploited differences, the wide osteoimmunological biomarkers panel provides a novel clue to the development of diagnostic paths in psoriasis and psoriasis-associated arthropathic disease.
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Affiliation(s)
- Marco Diani
- Department of Dermatology and Venereology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (M.D.); (P.D.M.P.); (G.A.)
| | - Silvia Perego
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.P.); (V.S.); (M.G.); (M.F.); (G.B.); (G.L.)
| | - Veronica Sansoni
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.P.); (V.S.); (M.G.); (M.F.); (G.B.); (G.L.)
| | - Lucrezia Bertino
- Department of Clinical and Experimental Medicine, section of Dermatology, University of Messina, 98122 Messina, Italy;
| | - Marta Gomarasca
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.P.); (V.S.); (M.G.); (M.F.); (G.B.); (G.L.)
| | - Martina Faraldi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.P.); (V.S.); (M.G.); (M.F.); (G.B.); (G.L.)
| | - Paolo Daniele Maria Pigatto
- Department of Dermatology and Venereology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (M.D.); (P.D.M.P.); (G.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milano, Italy
| | - Giovanni Damiani
- Department of Dermatology and Venereology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (M.D.); (P.D.M.P.); (G.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milano, Italy
- Department of Dermatology, Case Western Reserve University, Cleveland, OH 44106, USA
- Young Dermatologists Italian Network, Centro Studi GISED, 24121 Bergamo, Italy
- Correspondence: ; Tel.: +39-0266214068
| | - Giuseppe Banfi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.P.); (V.S.); (M.G.); (M.F.); (G.B.); (G.L.)
- Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Gianfranco Altomare
- Department of Dermatology and Venereology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (M.D.); (P.D.M.P.); (G.A.)
| | - Giovanni Lombardi
- Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy; (S.P.); (V.S.); (M.G.); (M.F.); (G.B.); (G.L.)
- Department of Physiology and Pharmacology, Gdańsk University of Physical Education and Sport, 80336 Gdańsk, Poland
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Ranugha PSS, Bishnoi P, Chandrashekar L. Facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome: A cross-sectional study. Indian J Dermatol Venereol Leprol 2019; 87:522-527. [PMID: 31317874 DOI: 10.4103/ijdvl.ijdvl_655_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/01/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Face was often thought to be spared in psoriasis possibly due to the protective effect of sebum and low-dose ambient ultraviolet radiation exposure. Some have suggested that facial involvement is common and indicates disease severity. There is a paucity of data on this, particularly from India. Psoriatics have a higher prevalence of metabolic syndrome, and patients with severe disease are at greater risk. OBJECTIVE A study of the frequency and type of facial involvement in Indian psoriatic patients and its association with disease severity and metabolic syndrome. METHODS A total of 250 consecutive psoriatic patients were screened and these yielded 188 patients with facial involvement. Facial psoriatics were divided into peripherofacial, centrofacial and mixed facial types. Disease severity was assessed using whole body, scalp, facial psoriasis area severity index scores and nail area psoriasis severity index scores. Patients were evaluated for the presence of metabolic syndrome using NCEP-III criteria. All parameters were compared both between facial and nonfacial psoriatics and between cases with different types of face involvement. RESULTS The mean age (P = 0.04) and age of onset of disease (P = 0.02) was lower and median whole-body psoriasis area severity index score was higher in psoriatics with facial involvement (P < 0.001) than those without. No significant association was found between facial involvement and metabolic syndrome. Mixed facial was the commonest type of facial involvement and there was a significant association of mixed facial involvement with increased total body psoriasis area severity index scores (P < 0.001). LIMITATIONS Dietary habits, physical activity level, family history of diabetes and obesity were not enquired for in our patients. Centrofacial cases were too few in number, hence statistical comparisons are not relevant. CONCLUSION Facial involvement in psoriatics is associated with severe disease but not metabolic syndrome. Mixed facial type might be considered a marker of overall psoriasis disease severity in the Indian population.
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Affiliation(s)
- P S S Ranugha
- Department of Dermatology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Priya Bishnoi
- Dermatology Services Department, KK Women's and Children's Hospital, Singapore
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Platonova AV, Zhukov AS, Khairutdinov VR, Samtsov AV. Psoriatic onychodystrophy: clinical manifestations (part 1). VESTNIK DERMATOLOGII I VENEROLOGII 2018. [DOI: 10.25208/0042-4609-2018-94-6-7-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Psoriatic onychodystrophy is quite common in patients with psoriasis. Changes in psoriatic nails have a wide range of clinical manifestations, including symptoms of damage of the nail bed and/or nail matrix. The article presents information about clinical and pathological manifestations of psoriatic onychodystrophy, the mechanisms of formation of pathological changes. The existence of the relationship between the change of nail plates in patients with psoriasis and the development of psoriatic arthritis is explained, the prognostic value of individual symptoms is analyzed. The diagnostic criteria for the histological diagnosis of psoriatic onychodystrophy are described. The information about the occurrence of each symptom in patients with psoriasis with dystrophic nail changes is given.
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Nail Involvement in Patients with Psoriatic Arthritis in Northern Iran. Autoimmune Dis 2018; 2018:4608490. [PMID: 30410794 PMCID: PMC6205104 DOI: 10.1155/2018/4608490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/09/2018] [Accepted: 09/26/2018] [Indexed: 01/28/2023] Open
Abstract
Background Psoriatic arthritis (PsA) results in an increased burden of psoriasis and impairs both quality of life and an individual's functional capacity. The relationship between nail involvement and PsA in psoriasis is not fully characterized. Aim To evaluate the frequency and characteristics of nail involvement in psoriatic patients and to assess the relationship with joint involvement. Methods A total of 197 patients with moderate-to-severe psoriasis were consecutively invited to participate in this cross-sectional study. The patients are divided into two groups: those with and those without psoriatic arthritis. Results 69.5% of psoriatic (137 out of 197) patients had nail involvement. The most common nail abnormality was onycholysis, followed by pitting and oil droplet changes. Nail involvement was more common in patients with psoriatic arthritis (82.1% versus 57.8%, p=0.001). Conclusion Nail involvement is commonly associated with PsA. Onycholysis, splinter hemorrhage, and oil drop were significantly more common in the PsA group as opposed to patients with just skin findings. In general, psoriatic patients with arthritis had more severe disease.
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Mokni S, Ameur K, Ghariani N, Sriha B, Belajouza C, Denguezli M, Nouira R. A Case of Nail Psoriasis Successfully Treated with Intralesional Methotrexate. Dermatol Ther (Heidelb) 2018; 8:647-651. [PMID: 30255281 PMCID: PMC6261120 DOI: 10.1007/s13555-018-0261-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Indexed: 12/01/2022] Open
Abstract
Psoriasis is a chronic inflammatory disease affecting the skin, nails, and joints. About 61% of psoriatic patients have nail involvement that can cause a significant social problem. Treating nail psoriasis is challenging but can improve the health outcomes and quality of life of patients. Treatment options available for nail psoriasis including topical therapy, intralesional injections, and systemic and biologic agents have various side effects and some benefits. Management is currently inconclusive. Intralesional injection of methotrexate in nail psoriasis was previously documented in few cases. We present a case of nail psoriasis successfully treated with low-dose intralesional methotrexate with no significant side effects in a 48-year-old psoriatic patient. Given the various side effects of conventional topical and systemic therapies limiting their use, we conclude that intralesional methotrexate injection seems to be a safe and effective treatment option for nail psoriasis. However, large controlled studies are needed.
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Affiliation(s)
- Sana Mokni
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Khaoula Ameur
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia.
| | - Najet Ghariani
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Badreddine Sriha
- Department of Anatomopathology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Colandane Belajouza
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Denguezli
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
| | - Rafiaa Nouira
- Department of Dermatology, Farhat Hached University Hospital, Sousse, Tunisia
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Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 2018; 80:251-265.e19. [PMID: 29928910 DOI: 10.1016/j.jaad.2018.06.027] [Citation(s) in RCA: 299] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 05/30/2018] [Accepted: 06/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Wide-ranging prevalence estimates of psoriatic arthritis (PsA) in patients with psoriasis have been reported. OBJECTIVES To assess the prevalence and incidence of PsA in patients with psoriasis. METHODS Two authors independently searched 3 databases for studies reporting on the prevalence or incidence of PsA in patients with psoriasis. A proportion meta-analysis was performed to calculate the pooled proportion estimates of PsA in patients with psoriasis. RESULTS A total of 266 studies examining 976,408 patients with psoriasis were included. Overall, the pooled proportion (95% confidence interval [CI]) of PsA among patients with psoriasis was 19.7% (95% CI, 18.5%-20.9%). In children and adolescents (<18 years of age), the pooled prevalence was 3.3% (95% CI, 2.1%-4.9%). The PsA prevalence was 22.7% (95% CI, 20.6%-25.0%) in European patients with psoriasis, 21.5% (95% CI, 15.4%-28.2%) in South American patients with psoriasis, 19.5% (95% CI, 17.1%-22.1%) in North American patients with psoriasis, 15.5% (95% CI, 0.009%-51.5%) in African patients with psoriasis, and 14.0% (95% CI, 95% CI, 11.7%-16.3%) in Asian patients with psoriasis. The prevalence of PsA was 23.8% (95% CI, 20.1%-27.6%) in studies in which the Classification Criteria for Psoriatic Arthritis were applied. The incidence of PsA among patients with psoriasis ranged from 0.27 to 2.7 per 100 person-years. LIMITATIONS Between-study heterogeneity may have affected the estimates. CONCLUSIONS We found that 1 in 4 patients with psoriasis have PsA. With the growing recognition of the Classification Criteria for Psoriatic Arthritis, more homogenous and comparable prevalence estimates are expected to be reported.
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Abstract
Psoriasis is an autoimmune inflammatory skin disease. In the past several decades, phototherapy has been widely used to treat stable psoriatic lesions, including trunk, scalp, arms and legs, and partial nail psoriasis. A variety of light/lasers with different mechanisms of action have been developed for psoriasis including ultraviolet B (UVB), psoralen ultraviolet A (PUVA), pulsed dye laser (PDL), photodynamic therapy (PDT), intense pulsed light (IPL), light-emitting diodes (LED), and so on. Because light/laser each has specific therapeutic and adverse effects, it is important to adequately choose the sources and parameters in management of psoriasis with different pathogenic sites, severities, and duration of the disorder. This review aims at providing most updated clinic information to physicians about how to select light/laser sources and individual therapeutic regimens. To date, UV light is primarily for stable plaque psoriasis and PDL for topical psoriatic lesions with small area, both of which are safe and effective. On the other hand, PUVA has better curative effects than UVB for managing refractory psoriasis plaques, if its side effects can be better controlled. PDL provides optimal outcomes on nail psoriasis compared with other lasers. Although the trails of low-level light/laser therapy (LLLT) are still small, the near infrared (NIR) and visible red light with low energy show promise for treating psoriasis due to its strong penetration and encouraging photobiomodulation. IPL is rarely reported for psoriasis treatment, but PDT-IPL has been found to offer a moderate effect on nail psoriasis. In brief, various phototherapies have been used either in different combinations or as monotherapy. The modality has become a mainstay in the treatment of mild-to-moderate psoriasis without systemic adverse events in today's clinical practice.
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Tsentemeidou A, Vyzantiadis TA, Kyriakou A, Sotiriadis D, Patsatsi A. Prevalence of onychomycosis among patients with nail psoriasis who are not receiving immunosuppressive agents: Results of a pilot study. Mycoses 2017; 60:830-835. [DOI: 10.1111/myc.12681] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/02/2017] [Accepted: 08/12/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Aikaterini Tsentemeidou
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
| | | | - Aikaterini Kyriakou
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
| | - Dimitrios Sotiriadis
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
| | - Aikaterini Patsatsi
- 2nd Department of Dermatology; Faculty of Medicine; Aristotle University; Papageorgiou General Hospital; Thessaloniki Greece
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Abstract
Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and occupational activities and contribute to a worse quality of life. Almost 50% of patients with psoriasis vulgaris and up to 80% of patients with psoriatic arthritis are afflicted with nail lesions. The important correlation between psoriatic arthritis and nail changes is well established - the presence of the latter is a strong predictor of the development of arthritis. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting, subungual hyperkeratosis and loosening of the nail plate to less frequent discolouration and splinter haemorrhages. Some of these symptoms are also observed in other nail diseases, and further diagnostics should be performed. The assessment tools NAPSI (Nail Psoriasis Severity Index), mNAPSI (Modified Nail Psoriasis Severity Index), and PNSS (Psoriasis Nail Severity Score) are most commonly used to grade the severity of nail involvement in psoriasis and enable the evaluation of therapy effectiveness. The treatment of nail psoriasis is a major clinical challenge. It should be adjusted to the extent of dermal, articular and ungual lesions. Systemic therapies of psoriasis, especially biological agents, are most likely to be effective in treating nail psoriasis. However, as their use is limited in scope and safety, topical therapy remains a mainstay, and the combination of corticosteroids and vitamin D3 analogues is considered to be most helpful.
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14
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Merola JF, Elewski B, Tatulych S, Lan S, Tallman A, Kaur M. Efficacy of tofacitinib for the treatment of nail psoriasis: Two 52-week, randomized, controlled phase 3 studies in patients with moderate-to-severe plaque psoriasis. J Am Acad Dermatol 2017; 77:79-87.e1. [DOI: 10.1016/j.jaad.2017.01.053] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/13/2017] [Accepted: 01/29/2017] [Indexed: 12/30/2022]
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15
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Marina EM, Botar-Jid C, Bolboaca SD, Roman II, Senila CS, Mihu CM, Tataru DA. Patterns of clinical nail appearances in patients with cutaneous psoriasis. ACTA ACUST UNITED AC 2017; 90:22-27. [PMID: 28246493 PMCID: PMC5305083 DOI: 10.15386/cjmed-679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 05/17/2016] [Accepted: 06/13/2016] [Indexed: 11/25/2022]
Abstract
Background and aim Nail manifestations are often an overlooked aspect in psoriatic disease, cutaneous and joint involvement being far more often reported and investigated. The reported prevalence of nail changes varies in literature, specific fingernail clinical features having different degrees of occurrence. The aim of this study was to describe specific clinical patterns of fingernail alterations in adult patients with plaque-type psoriasis in a university hospital in the North-West of Romania. Methods Clinical data of 35 patients with fingernail psoriasis were collected and analyzed. Psoriasis Area and Severity Index (PASI) and Nail Psoriasis Severity Index (NAPSI) scores were used to quantify disease extension in each patient. Results PASI score proved linearly correlated with NAPSI score (p<0.05). The age of onset of fingernail psoriasis was positively correlated with age of onset cutaneous psoriasis (p<0.0001). Furthermore, the duration of cutaneous involvement and NAPSI proved significantly related (p<0.05). The third fingernail in the right hand and first fingernail in the left hand were in most of the cases severely affected. The most common observed nail pattern was pitting, followed by salmon patches and subungual hyperkeratosis. Conclusion Important nail changes appear even in moderate forms of cutaneous psoriasis. Particular localization of specific fingernail psoriasis pattern enables the possibility of detecting early stage disease.
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Affiliation(s)
- Elena Mihaela Marina
- Histology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carolina Botar-Jid
- Department of Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana Daniela Bolboaca
- Medical Informatics and Biostatistics Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulia Ioana Roman
- Physiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Corina Simona Senila
- Dermatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carmen Mihaela Mihu
- Histology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dumitru Alexandru Tataru
- Dermatology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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