Kwok Tiffany Jing Loo Wei Guenther Lyn

BACKGROUND:Psoriasis and multiple sclerosis (MS) are both autoimmune T cell–mediated diseases. Some case series have suggested an association.OBJECTIVE:To investigate the potential relationship between psoriasis and MS based on a systematic review of the literature.METHODS:Medline, Cochrane Library, and EMBASE searches were performed.RESULTS:T-helper 17 cells are involved in the pathogenesis of both psoriasis and MS. Both conditions have been associated with interleukin-23 receptor (IL23R) polymorphisms. Studies have reported psoriasis in 0.41 to 7.7% of individuals with MS. A higher rate of psoriasis compared to controls was noted in a few small MS cohorts, but the number of cases was too small to draw any firm conclusions. In two studies, including a large Canadian study of 5,031 patients with MS, there was no increased prevalence of psoriasis in patients over the control population. Family members of individuals with MS do not appear to be at increased risk for psoriasis in these studies. Psoriasis has developed during treatment for MS, and MS has developed during treatment for psoriasis.CONCLUSION:Although there are some common genetic linkages in psoriasis and MS, psoriasis does not appear to be more common in patients with MS or their relatives.

Tan Jerry K.L. Tang Jing Fung Karen Gupta Aditya K. Richard Thomas D. Sapra Sheetal Lynde Charles Poulin Yves Gulliver Wayne Sebaldt Rolf J.

BACKGROUND:Scarring is an important component of overall acne severity, but there are no global scales for its evaluation inclusive of the face and trunk.OBJECTIVE:Our objective was to develop a global scale for acne scar severity inclusive of the trunk and the face.METHODS:A six-category global severity scale (SCAR-S) was developed for assessment of acne scarring at each of the face, chest, and back. We evaluated SCAR-S against acne severity and patient-reported scar severity.RESULTS:Of 973 subjects, 73% reported acne scarring. Self-assessment of scarring was associated with facial SCAR-S and overall SCAR-S scores (p < .001, r = .31 and .30, respectively). Acne scarring was observed at the face in 87%, the back in 51%, and the chest in 38%. Clinically relevant scarring (mild or greater) at each of these regions was 55%, 24%, and 14%, respectively. Acne severity correlated with SCAR-S (p < .001) for the back (r = .612), the chest (r = .548), and the face (r = .514). Acne duration correlated with patient-reported severity of scarring (r = .244) and overall SCAR-S scores (r = .152). Clinically relevant scarring increased with acne duration.CONCLUSION:SCAR-S is a practical, validated, global system for acne scar evaluation and is clinically relevant in overall severity grading of acne.

Rallis Eustathios Gregoriou Stamatis Christofidou Eleftheria Rigopoulos Dimitrios

BACKGROUND:Published studies have evaluated a variety of therapeutic agents in frontal fibrosing alopecia (FFA); however, data on whether fibrosis is already established when the patients initially present are scarce.OBJECTIVE:To identify the prevalence of active disease in patients initially diagnosed with FFA and to evaluate the efficacy of therapeutic agents suggested in the medical literature.PATIENTS/METHODS:Eighteen postmenopausal women with FFA presented at the outpatient clinic of our hospital from June 2003 to August 2007. Five patients who also presented with androgenetic alopecia were treated with finasteride 2.5 mg/d plus minoxidil 5% for 12 months. One patient with a rapidly regressing disease received systemic corticosteroids. The remaining 12 patients were divided into two groups: 6 patients received topical clobetasol 0.05% solution once daily for 6 months and the rest received no treatment.RESULTS:Thirteen of 18 patients presented with stable disease. No significant improvement was observed in any of the patients.CONCLUSION:To date, there is no effective treatment proven with an appropriate level of evidence in the management of FFA. Exclusion criteria in future clinical studies should take into account patients presenting with stable disease. What needs to be established is whether treatment can halt or slow the progression of active disease.

Papp Kim Valenzuela Fernando Poulin Yves Bernstein Geula Wasel Norman

BACKGROUND:Limited data are available on the epidemiologic features of psoriasis in Canada.OBJECTIVE:To investigate the epidemiologic features and burden of moderate-to-severe psoriasis in a Canadian population.METHODS:An online survey was conducted using a consumer panel. Eligible respondents indicated a diagnosis of psoriasis and plaque-type psoriasis of at least moderate severity. Eligibility was validated according to self-reported body surface area (BSA) involvement, sensitive areas affected, and/or current treatment.RESULTS:Of the 514 respondents who completed the survey, 62% estimated a BSA involvement of ≥ 3% within the past 5 years. Onset of psoriasis occurred earlier in females than in males. Nail involvement was more commonly reported in individuals with psoriatic arthritis compared to those without. Several symptoms were more likely described as “constantly” or “near constantly” experienced by females than by males. Comorbidities commonly reported were hypertension, dyslipidemia, and overweight or obesity.CONCLUSIONS:The findings are consistent with a substantial burden attributed to moderate-to-severe plaque psoriasis in a Canadian population.

Serra David Pedro Reis José Mariano Angelina Machado Álvaro Figueiredo Américo

BACKGROUND:Scabies is a common infestation that usually presents as a pruriginous eruption consisting of erythematous papules, nodules, and excoriations. Diagnosis relies mostly on clinical features, including the identification of scabietic burrows. Several atypical clinical manifestations have been reported; bullous presentations are particularly rare and intriguing.OBJECTIVE:A case of recurrent bullous scabies is reported.METHODS AND RESULTS:An 87-year-old institutionalized woman developed a pruriginous eruption that mimicked bullous pemphigoid. Histopathologic examination revealed blistering at the subepidermal level and a mixed inflammatory infiltrate with numerous eosinophils. Scabies mites were identified on dermoscopy and on skin scrapings, allowing a diagnosis of bullous scabies. Despite effective treatment with topical lindane, failure to control scabies in her institution led to recurrences of her peculiar blistering infestation. Immunofluorescence studies were always negative.CONCLUSIONS:These observations underscore the mite's role in the pathogenesis of blister formation and illustrate current challenges in scabies' diagnosis and management.

O'Blenes Catherine A.E. Walsh Noreen M.G. Green Peter J. Tremaine Robert D.L.

BACKGROUND:Multinucleate cell angiohistiocytoma is a rare benign fibrohistiocytic and vascular proliferation, typically characterized by the development of solitary papules, in an acral distribution in otherwise healthy late middle-aged to elderly women.OBJECTIVE:Our objectives are to present a novel case of generalized multinucleate cell angiohistiocytoma and to review the current literature regarding the clinical and histologic findings in this condition, as well as its potential causes and treatments.OBSERVATIONS:We describe a 35-year-old man who presented with generalized asymptomatic firm violaceous papules. Histopathology revealed dermal vascular proliferation; a perivascular infiltrate of lymphocytes, histiocytes, neutrophils, and plasma cells; thickened surrounding collagen bundles; and characteristic multinucleate cells with scalloped borders.CONCLUSION:Our patient is one of three patients reported to date with generalized lesions of multinucleate cell angiohistiocytoma who were all in a younger age group (20–40 years old) than previously reported for solitary lesions.

Cetkovská Petra Benáková Nina

BACKGROUND:A severe generalized pustular eruption occurred several months after allogeneic hematopoietic stem cell transplantation for multiple myeloma in a patient being treated with antibiotics for respiratory infection. Neither he nor his donor had a history of psoriasis.METHODS:The patient was treated with drug withdrawal and administration of cyclosporine and methylprednisolone without improvement; later, acitretin and methylprednisolone were used successfully. The eruption slowly subsided, and therapy was discontinued. Four months later, the patient experienced a recurrent severe pustular eruption associated with fever and leukocytosis, and the same treatment was used successfully again.RESULTS AND CONCLUSION:The patient has not experienced relapses in the ensuing 3 years. Acute generalized exanthematous pustulosis is a rare cutaneous adverse reaction triggered most commonly by drugs with a tendency to resolve spontaneously. The surprisingly prolonged, refractory, and relapsing course of the eruption in our patient might be due to the immune alteration and the polypharmacologic therapy after stem cell transplantation.

Zhang Yao-Hua Zhou Youwen Ball Nigel Su Ming-Wan Xu Jin-Hua Zheng Zhi-Zhong

BACKGROUND:Pityriasis rubra pilaris (PRP) has unknown etiology and is often refractory to conventional therapies.OBJECTIVE:To document a PRP patient's response to adalimumab therapy and to highlight the potential role of tumor necrosis factor (TNF) in the development of PRP skin lesions.METHODS:A patient received adalimumab therapy at standard dosing intervals. In addition, the messenger ribonucleic acid (mRNA) of TNF in the lesional and perilesional normal skin was quantified in two patients with PRP.RESULTS:The patient responded to adalimumab therapy and achieved clinical remission by 4 months. There was a significant elevation of TNF mRNA in the lesional skin of PRP.CONCLUSION:TNF upregulation is detected in PRP lesional skin, consistent with the observed clinical efficacy of TNF blockade for the treatment of PRP.

Doiron Philip Pratt Melanie

BACKGROUND: Pemphigoid gestationis is an autoimmune blistering disease affecting pregnant women. Treatment often consists of topical corticosteroids, oral antihistamines, and oral prednisone followed by immunosuppressants. Refractory cases in antepartum patients present a particular therapeutic challenge as the majority of second-line agents are contraindicated until the patient has delivered.OBJECTIVE: The following report describes the case of a 34-year-old woman pregnant for the third time at 16 weeks' gestation. Her previous two pregnancies were complicated by pemphigoid gestationis but were successfully managed with oral prednisone and topical agents. During her third pregnancy, the initial lesions were controlled with oral prednisone, but attempts to decrease her dose resulted in disease flare.CONCLUSION:Monthly infusions of intravenous immunoglobulin (40 g intravenously for 3 consecutive days for 120 g total) proved to be successful in reducing the dose of oral prednisone required to maintain disease remission. A healthy baby was delivered at 37.5 weeks.

Tan Cheng Zhu Wen-Yuan

BACKGROUND AND OBJECTIVE:Poliosis is an inherited or acquired loss of pigment from a group of closely positioned hair follicles characterized by a patch of white hair. It is commonly seen in vitiligo, piebaldism, Waardenburg syndrome, Vogt-Koyanagi-Harada syndrome, Griscelli syndrome, and Apert syndrome. We investigated a male manifesting poliosis on the chin after repetitive plucking.CONCLUSION:To our knowledge, poliosis induced by repeated plucking has never been documented.

Balma-Mena Alexandra Ho Nhung