BackgroundPsoriasis is associated with an increased risk of cardiovascular disease (CVD) at younger ages that is not identifiable by traditional risk factors. Screening for subclinical atherosclerosis with ultrasound has only been investigated in carotid arteries. Femoral artery ultrasound has never been considered for this purpose. The link between psoriasis and accelerated atherosclerosis has not yet been established.ObjectiveTo study the usefulness of femoral artery ultrasound for the detection of subclinical atherosclerosis in psoriasis. We also investigated its possible relationship with changes in insulin resistance.MethodsWe conducted a cross-sectional study in 140 participants, 70 patients with moderate-to-severe psoriasis and 70 healthy controls, matched 1:1 for age, sex, and BMI. Femoral and carotid atherosclerotic plaques were evaluated by ultrasonography. Insulin resistance was assessed by the homeostasis model assessment method (HOMA-IR).ResultsFemoral atherosclerotic plaque prevalence was significantly higher in patients with psoriasis (44.64%) than in controls (19.07%) (p<0.005), but no significant difference was found in carotid plaque prevalence (p<0.3). Femoral plaques were significantly more prevalent than carotid plaques (21.42%) among patients with psoriasis (p<0.001). In the regression analysis, insulin resistance was the most influential determinant of atherosclerosis in psoriasis and C-reactive protein the most significant predictor of insulin resistance.ConclusionsUltrasound screening for femoral atherosclerotic plaques improves the detection of subclinical atherosclerosis in patients with psoriasis, whereas the study of carotid arteries is not sufficiently accurate. Insulin resistance appears to play a greater role in the development of atherosclerosis in these patients in comparison to other classical CVD risk factors.

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Frontal fibrosing alopecia (FFA) and lichen planus pigmentosus (LPP) frequently coexist. 1 The umbrella term "acquired dermal macular hyperpigmentation (ADMH)" encompasses disorders with clinicopathological overlap such as LPP and pigmented contact dermatitis. 2 Contact sensitization has been described in the contexts of both FFA and ADMH. [2][3][4] CASE REPORTA woman with Fitzpatrick skin phototype IV and hypothyroidism developed pruritic macular hyperpigmentation with punctate hypopigmentation symmetrically on her forehead (Figure 1A) at age 45 which she related to hair dyes. Gradually, the hyperpigmentation spread to the temples, preauricular areas, and upper lip. Melasma was suspected and treated with hydroquinone plus sunscreens. Pigmentation, however, progressively darkened and spread to the armpits, groin, retroauricular areas, and dorsal aspects of hands and feet. A biopsy showed lichenoid infiltrates around pilosebaceous units with Civatte bodies and melanophages, features compatible with LPP. Topical depigmenting agents (glycolic acid and kojic acid), calcipotriol, topical and oral corticosteroids, griseofulvin, laser, and hydroxychloroquine were applied without success and were suspended.Four years later, she experienced frontotemporal hairline recession associated with eyebrow, forearm, pubic, leg and axillary hair loss clinically compatible with FFA. Hyperpigmentation thereafter spontaneously improved in the face and completely resolved elsewhere. Subsequently, at the age of 58, she presented with acute facial eczema (Figure 1B). Patch tests showed positive reactions to nickel sulfate, cobalt chloride, propolis, gallates mix, dodecyl gallate, ethylhexyl salicylate, and two personal cosmetics "as is" (Eucerin Hyaluron-Filler +