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Pediatric psoriasis
Published in M. Alan Menter, Caitriona Ryan, Psoriasis, 2017
Pustular and erythrodermic psoriasis are rare but severe variants of pediatric psoriasis,35 occurring in about 1% of pediatric cases.8 Erythrodermic psoriasis involves greater than 90% of the total body surface area. Pustular psoriasis has a mean onset at 6 years of age.36–39 In children (vs. adults), pustular psoriasis is often the first manifestation of disease. Generalized pustular psoriasis is often annular (60%) and is more common than pustulosis palmaris et plantaris (limited to the palms and soles).36,38,40 Pustules in infancy can begin in intertriginous areas, especially the neck fold, and is misdiagnosed as dermatitis, bacterial, or candida infection.38 Pustules are sterile unless secondarily infected. Biopsy shows parakeratosis, elongated rete ridges, spongiotic pustules and Munro's abscesses, and can confirm the clinical diagnosis. Patients often have fever, malaise, and anorexia, and require hospitalization. Courses may be complicated by cutaneous infection and bacterial septicemia. Relapses are common, and frequent recurrences can be associated with failure to thrive. The onset of psoriasiform pustules during the first year of life raises concern about deficiency of interleukin-1 receptor antagonist (DIRA), which results from inappropriate activation of interleukin-1. Sterile multifocal osteomyelitis or periostitis, joint swelling, stomatitis, and pyoderma gangrenosum are other features.41 Patients respond rapidly to subcutaneous administrations of anakinra 2–4 mg/kg/day. Deficiency of interleukin-36 receptor antagonist (DITRA) is the major known genetic cause of generalized pustular psoriasis in patients of any age without initial plaque psoriasis. DITRA is associated with irritability, tender skin, diarrhea, dysphagia, and failure to thrive. Laboratory evaluation may reveal neutrophilia and thrombocytosis. Skin biopsies in DIRA and DITRA show features similar to those seen in pustular psoriasis.42 A genetic variant of psoriasis seen in patients with CARD14 mutations may also present with pustules overlying erythroderma. Typical presentation for patients with CARD14 mutation is a recalcitrant plaque-type psoriasis or pityriasis rubra pilaris, with onset during infancy or early childhood. Patients may be fairly recalcitrant to systemic medications but respond rapidly to ustekinumab.
Evidence and potential mechanisms of traditional Chinese medicine for the treatment of psoriasis vulgaris: a systematic review and meta-analysis
Published in Journal of Dermatological Treatment, 2022
Dan Dai, Haoran Wu, Chunyan He, Xinmiao Wang, Yiqi Luo, Ping Song
This review was stated according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies were identified by searching the relevant articles published from January 2010 to February 2020 in the following databases: PubMed, Medline, Embase, Web of Science, Cochrane Library, China National Knowledge Internet (CNKI), WanFang, Sinomed and VIP. Search terms included the following: (‘psoriasis’ or ‘psoriasiform’ or ‘psoriatic’ or ‘papulosquamous’ or ‘palmoplantar pustulosis’ or ‘pustulosis palmaris et plantaris’ or ‘acrodermatitis continua’ or ‘impetigo herpetiformis’) and (‘RCT’ or ‘randomized controlled trial’ or ‘random’ or ‘randomized’ or ‘randomly’ or ‘controlled clinical trial’) and (‘TCM’ or ‘traditional Chinese medicine’ or ‘formula’ or ‘decoction’ or ‘prescription’ or ‘Chinese herbal compound prescription’ or ‘Chinese herbal medicine’ or ‘Chinese patent medicine’ or ‘Chinese patent drug’).
The impact of shrunken pore syndrome in patient with rheumatic diseases on bone mineral metabolism
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Ichiro Yoshii, Susumu Nishiyama
A total of 831 patients with rheumatic diseases (515 with rheumatoid arthritis, 110 with psoriatic arthritis, 67 with Sjogren syndrome, 66 with systemic lupus erythematosus, 17 with pustulosis palmaris et plantaris, 16 with ankylosing spondylitis, 13 with systemic sclerosis, 11 with ulcerative colitis, 8 with Behçet’s disease, 3 with polymyositis/dermatomyositis, 2 with mixed connective tissue disease, 2 with familial Mediterranean fever, and 1 with polyarteritis nodosa) were recruited from the two institutes with which the authors are affiliated. We measured BMD using dual-energy X-ray absorptiometry (DXA) and calculated the levels of CysC, Cr, creatinine phosphokinase (CPK), serum PTH, serum albumin (Alb), serum calcium (Ca) after calculating Alb, serum phosphorus (IP), and tartrate-resistant acid phosphatase-5b (TRACP-5b). Both eGFRcysC and eGFRCr were also calculated. Dual-energy X-ray absorptiometry measurements were made with the DPX® Bravo ME9309 Bone Densitometer (GE Health Care, Chicago, IL, USA: Coefficients of variation; CV: 1.1% (LS), 0.9% (FN)) at one institute and with the Horizon Wi® (Hologic, Bedford, MA, USA: CV: 1.4% (LS), 1.0% (FN)) at the other. The minimum BMD of the first to fourth lumbar spine was calculated as the BMD_LS, and the average BMD of the bilateral femoral neck was calculated as the BMD_FN. We also calculated the T-score by means of standard deviation from the mean value of the BMD of patients aged 30–39 years and for each sex.
Guselkumab for the treatment of palmoplantar pustulosis
Published in Expert Opinion on Biological Therapy, 2020
Palmoplantar pustulosis, or pustulosis palmaris et plantaris (PPP), is a chronic, recurrent inflammatory skin disease associated with erythema, scales, and sterile pustules on the palms and soles[1]. PPP significantly reduces quality of life, and is commonly encountered in dermatology clinics[2]. PPP can be difficult to treat via conventional therapy. In Japan, such therapies include topical steroids, retinoin, vitamin D3 [3], phototherapy (PUVA, narrow-band UVB [4], and excimer light treatment [5]); all costs are partially reimbursed by the Japanese insurance system. Sometimes, these treatments are useful, but many patients do not respond and the detailed pathomechanism of PPP remains unclear. On the other hand, several systemic therapies, including acitretin and methotrexate, as well as antagonists against TNF-α, interleukin (IL)-12/23, IL-23, and IL-17, have been used for the treatment of otherwise refractory PPP, though the vast majority of this use is off label, with only acitretin approved for PPP in some countries.