Tuberculosis (TB) is a socially significant disease caused by Mycobacterium tuberculosis. Latent TB represents a state of continuous immune response to stimulation by M tuberculosis and its antigens without the clinical signs of TB. Biologic agents could trigger latent TB into active TB, which is the reason why psoriasis patients should be screened for latent TB before initiating biologic therapy. The data of the efficacy of rifampicin in severe psoriasis patients treated for their coexisting active TB, along with the data of psoriasis remission after rifampicin therapy in subjects with no active TB, raise the question of whether there is a link between psoriasis and TB. There is also a question of the efficacy of the date from rifampicin, when used for treating patients having severe psoriasis as well as coexisting active TB. Is there a link between psoriasis and TB?

Pruritus is highly prevalent in the dialysis population. Its etiology however remains often unclear with uremic pruritus primarily suspected unless compelling evidence of another cause. Although bullous pemphigoid (BP) is considered idiopathic, there are growing data in the literature on BP provoked by different factors, such as medications or surgical procedures. These secondary dermatoses are described as rather mild conditions and more frequent in the elderly Caucasian. We herein describe a newly dialyzed African man of 76 years old, treated by a sulfonylurea such as an antidiabetic drug, who developed a severe BP after jugular catheter placement.

The current COVID-19 pandemic is caused by the SARS-CoV-2 coronavirus. The initial recognized symptoms were respiratory, sometimes culminating in severe respiratory distress requiring ventilation, and causing death in a percentage of those infected. As time has passed, other symptoms have been recognized. The initial reports of cutaneous manifestations were from Italian dermatologists, probably because Italy was the first European country to be heavily affected by the pandemic. The overall clinical presentation, course and outcome of SARS-CoV-2 infection in children differ from those in adults as do the cutaneous manifestations of childhood. In this review, we summarize the current knowledge on the cutaneous manifestations of COVID-19 in children after thorough and critical review of articles published in the literature and from the personal experience of a large panel of paediatric dermatologists in Europe. In Part 1, we discuss one of the first and most widespread cutaneous manifestations of COVID-19, chilblain-like lesions, and in Part 2 we expanded to other manifestations, including erythema multiforme, urticaria and Kawasaki disease-like inflammatory multisystemic syndrome. In this part of the review, we discuss the histological findings of COVID-19 manifestations, and the testing and management of infected children for both COVID-19 and any other pre-existing conditions.

Pityriasis rubra pilaris (PRP) is a rare inflammatory skin disorder of unknown etiology, initially described in 1835. It is characterized by keratotic follicular papules, well-demarcated salmon-colored erythematous scaly plaques interspersed with distinct islands of uninvolved skin, and palmoplantar keratoderma. Is PRP a systemic disease? Skin is mainly affected in PRP. Despite its clinical heterogeneity, PRP could be associated with a variety of rheumatologic, infectious, neoplastic, and other extracutaneous manifestations. We accept the hypothesis of not only an association but also a causative relation between skin and systemic manifestations with possible common underlying pathomechanisms such as systemic immunologic processes and superantigen mimicry.

Psoriasis is a multifaceted disease in terms of its pathophysiological mechanisms, inducing and aggravating factors, clinical types and clinical severity, associated comorbidities and therapeutic modalities. In recent years, an attracting perspective has emerged to identify variants of the disease with their own specific clinical course and management which could stratify the variable spectrum of the disease into different entities (such as palmo-plantar pustulosis). We hypothesize the existence of a unique Tuberculosis-related type of psoriasis that could be managed successfully with rifampicin.

Background Psoriasis is a chronic inflammatory disease of the skin and joints that may also have systemic inflammatory effects, including the development of cardiovascular disease (CVD). Multiple epidemiologic studies have demonstrated increased rates of CVD in psoriasis patients, although a causal link has not been established. A growing body of evidence suggests that sub-clinical systemic inflammation may develop in psoriasis patients, even from a young age. We aimed to evaluate the prevalence of atherosclerosis and identify specific clinical risk factors associated with early vascular inflammation. Methods We conducted a cross-sectional study of a tertiary care cohort of psoriasis patients using coronary artery calcium (CAC) score and carotid intima-media thickness (CIMT) to detect atherosclerosis, along with high sensitivity C-reactive protein (hsCRP) to measure inflammation. Psoriasis patients and controls were recruited from our tertiary care dermatology clinic. Presence of atherosclerosis was defined using validated numeric values within CAC and CIMT imaging. Descriptive data comparing groups was analyzed using Welch’s t test and Pearson Chi square tests. Logistic regression was used to analyze clinical factors associated with atherosclerosis, and linear regression to evaluate the relationship between psoriasis and hsCRP. Results 296 patients were enrolled, with 283 (207 psoriatic and 76 controls) having all data for the hsCRP and atherosclerosis analysis. Atherosclerosis was found in 67.6 % of psoriasis subjects versus 52.6 % of controls; Psoriasis patients were found to have a 2.67-fold higher odds of having atherosclerosis compared to controls [95 % CI (1.2, 5.92); p = 0.016], after adjusting for age, gender, race, BMI, smoking, HDL and hsCRP. In addition, a non-significant trend was found between HsCRP and psoriasis severity, as measured by PASI, PGA, or BSA, again after adjusting for confounders. Conclusions A tertiary care cohort of psoriasis patients have a high prevalence of early atherosclerosis, increased hsCRP, and psoriasis remains a risk factor for the presence of atherosclerosis even after adjustment of key confounding clinical factors. Psoriasis may contribute to an accelerated systemic inflammatory cascade resulting in increased risk of CVD and CV events.

Boris Velichkov, Borislav Kapukaranov, Ivan Grozev, Jeni Karanesheva, Todor Mihaylov, Yasen Kiprov, Preslav Nakov, Ivan Koychev, Georgi Georgiev. Proceedings of the 8th International Workshop on Semantic Evaluation (SemEval 2014). 2014.

Psoriasis is an inflammatory immune-mediated disease that affects the skin and has pathogenic effects with systemic impact. The relationship between psoriasis and comorbidities remains controversial. The hypothesis of a causative role of psoriasis in its cardiovascular and metabolic comorbidities is based on pathophysiologic concepts establishing a link between chronic inflammation in psoriasis, endothelial dysfunction, formation of atherosclerotic plaques, and the different compounds of metabolic syndrome. Psoriasis management has to be multidisciplinary. It implicates identification and treatment of psychological disorders, addictions, and associated cardiovascular and metabolic diseases, together with improvement of quality of life of patients.

BACKGROUND:Recent studies report independent associations between psoriasis, cardiovascular (CV) events and risk factors. Blood Myeloperoxidase (MPO) from activated myeloid cells is associated with CV risk mainly through lipid oxidation, induction of endothelial dysfunction and release of IL-12 from macrophages.OBJECTIVES:To elucidate associations between psoriasis and conventional CV risk factors.METHODS:We performed a cross-sectional study of 100 psoriasis patients and 53 controls, group matched on age, gender and body mass index, to assess levels of MPO in serum, as well as immunohistochemical staining from psoriasis skin lesions, psoriasis uninvolved skin, and normal skin.RESULTS:Although the groups did not differ on waist circumference, glucose, cholesterol, triglycerides, creatinine or personal history of CV events, psoriasis patients had significantly higher waist-to-hip ratios, blood pressures, proportion of current smokers, and lower high density lipoprotein level than controls. Serum MPO level was elevated 2.5 fold (P<0.001) in psoriasis patients, even after adjusting for the CV risk factors on which the groups differed. MPO did correlate with coronary artery calcification, carotid plaque, carotid intima media thickness and flow mediated dilation, but did not correlate with psoriasis severity. However, MPO was highly expressed in lesional psoriatic skin and colocalized predominantly with CD45(+) CD11b(+) leukocytes. CD11b(+) cell density correlated with circulation MPO levels.CONCLUSION:Lesional skin CD11b(+) leukocytes activated to generate MPO may contribute to serum levels of MPO. Lesional CD11b(+) cell activity may be an alternative measure of disease burden to PASI that underlies the MPO biomarker for systemic inflammation related to Cardiovascular Disease.

Aim: To describe the psoriasis treatment patterns of community-based dermatologists in northeast Ohio. Materials and Methods: A prospective cross-sectional survey was performed among dermatologists in northeast Ohio. The survey was initiated by the Murdough Family Center for Psoriasis and members of LIFEDERMNET (Leaders Initiative For Excellence In Dermatology Network). A questionnaire was sent to all community-based dermatologists in northeast Ohio. Results: Forty-seven of 145 questionnaires were returned and analyzed. The annual mean number of psoriasis patients seen in the community-based dermatology practices was 250, representing approximately 4% of the total patients seen. Among the systemic treatment options for psoriasis, each of the following was used at least once to treat a patient with psoriasis in the previous year by the following percentage of community-based dermatology practices: methotrexate, 72%; acitretin, 68%; biologics, 66%; phototherapy, 55%; cyclosporine, 36%; and the excimer laser, 28%. Conclusion: Our findings demonstrate that dermatologists in northeast Ohio use both systemic and biologic agents for the treatment of patients with psoriasis.

The immunosuppressive properties of rifampicin have been discussed in the literature for more than 30 years. It is hypothesized that rifampicin acts as a mild immunosuppressive agent in psoriasis rather than an antibacterial one. We report our studies on the therapeutic efficacy of rifampicin in guttate psoriasis. We try to give light on the mechanism of action of rifampicin in psoriasis. Our therapeutic results together with data from the literature revealed rifampicin to be a mild immunosuppressive agent. Its best effectiveness is in the guttate type of the disease.

The Short Form-12 Health Survey (SF-12) is used to assess the patient's quality of life (QoL) using the physical component score (PCS) and the mental component score (MCS). The purpose of this study was to determine whether the SF-12 PCS and MCS are associated with psoriasis severity and to compare QoL between Murdough Family Center for Psoriasis (MFCP) patients and patients with other major chronic diseases included in the National Survey of Functional Health Status data. We used data from 429 adult patients enrolled in MFCP. Psoriasis Area Severity Index (PASI) was used to assess psoriasis severity at the time of completion of the SF-12 questionnaire. Other variables included age, sex, body mass index, psoriatic arthritis, psychiatric disorders, and comorbidities. Linear regression models were used to estimate effect sizes ±95% confidence intervals. For every 10-point increase in PASI, there was a 1.1±1.3 unit decrease in MCS (P=0.100) and a 2.4±1.3 unit decrease in PCS (P<0.001). Psoriasis severity was associated with PCS and MCS after adjusting for variables, although the strength of the relationship was attenuated in some models. Psoriasis severity is associated with decreased QoL. SF-12 may be a useful tool for assessing QoL among psoriasis patients.

Introduction: Palmoplantar psoriasis could hardly be differentiated from chronic tylotic eczema both clinically and histologically. The most commonly used therapeutic options for palmoplantar psoriasis are long-term therapy with topical corticosteroids and local PUVA. Frequently, it is a recalcitrant disease. We investigated the efficacy and tolerability of the combination of topical calcipotriol with local UVA radiation in comparison with local PUVA therapy.Methods: In a total of 43 patients with palmoplantar psoriasis, 33 were given 15 sessions of local UVA radiation and topical calcipotriol and the remainder received 15 sessions of local PUVA (psoralen + UVA radiation).Results: The statistical analyses of the results showed that the effect and tolerability of both therapeutic modalities are comparable.Conclusion: Combination of topical calcipotriol and local UVA radiation is an optional corticosteroid-free therapeutic modality for palmoplantar psoriasis. It has a comparable effectiveness and tolerability with local PUVA.