There are several studies on the benefits of using TNFα antagonists in the treatment of psoriasis, but few studies addressing the interaction of these drugs with chronic infections. We report the case of a 52-year-old patient diagnosed with psoriasis refractory to traditional systemic agents, who was treated with biologic therapies. After one year of treatment with biologic agents, the patient was diagnosed with Chagas Disease.

Background Psoriasis is a chronic inflammatory skin disease associated with several important medical comorbidities. There are scant data available on the comorbidities of patients with psoriasis in South America. Aim To examine the comorbidity profile of adult patients with psoriasis in Chile and its association with severity of psoriasis. Methods This was a multicentre, cross‐sectional study involving 16 hospitals and clinics in Chile, which used a 48‐item questionnaire to study clinician‐ and patient‐reported outcomes and comorbidities. Inferential analyses were performed by psoriasis severity, using Fisher exact test, Student t‐test and multivariable logistic regression. Results In total, 598 adult patients with psoriasis were included (51.1% male; mean age 49.2 ± 15.1 years); 48.5% mild and 51.4% moderate to severe; Psoriasis Area and Severity Index 11.6 ± 11.5; body surface area 14.7 ± 18.2%. Plaque psoriasis was the most common phenotype (90.2%), followed by guttate (13.4%). Psoriatic arthritis occurred in 27.3% of patients. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes mellitus (T2DM) (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). After adjustment, significant associations were found between moderate to severe psoriasis and obesity, T2DM and nonalcoholic fatty liver disease (NAFLD) compared with mild psoriasis. Conclusions We report a large study of comorbidities, including depression, dyslipidaemia, T2DM and NAFLD, in people with psoriasis in Chile. The prevalence of comorbidities with psoriasis in Chile appears similar to that found in Western countries, and emphasizes the importance of assessing patients with psoriasis for risk factors for and presence of, comorbid disease in a multidisciplinary setting.

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Background Sufficient data on access to systemic treatment for patients with psoriasis living in Latin America (LA) including Chile and Brazil are lacking. Understanding the availability and limiting factors of access to treatments can help to improve patient care and decrease long-term healthcare costs. Objective In association with the Global Psoriasis Atlas, this cross-sectional survey study analysed the availability and insurance reimbursement of systemic treatments for adult psoriasis patients in Brazil and Chile. Methods A multi-centre, cross-sectional ‘Global Healthcare Study on Psoriasis’ (GHSP) was performed in Brazil and Chile in 2020. For each eligible adult psoriasis patient, doctors and nurses completed a 48-item questionnaire about clinical aspects of psoriasis including the Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI), as well as the availability of systemic treatments and insurance reimbursement status. Between-country differences were compared with Wilcoxon rank sum tests for continuous variables, and a chi-square test, or Fisher´s exact test where appropriate, for categorical variables. The median and inter-quartile range (IQR) was calculated for non-normal distributed data. Results A total of 1,424 psoriasis patients from 43 centres, 27 centres in Brazil (n = 826) and 16 in Chile (n = 598), were included with a mean age of 49.1 years (±16.3) and 49.2 years (±15.1) respectively. Unstratified analyses revealed that psoriasis patients in Chile had more severe disease than those in Brazil (PASI 11.7 vs. 8.4 (p < 0.001) and BSA 14.7 vs. 12.0 (p = 0.003) respectively). For patients with moderate-to- severe psoriasis, defined as PASI and/or BSA ≥ 10, systemic non-biologic drugs were available (81.2% in Brazil and 65.3% in Chile, p ≤ 0.001), but only 37.0% of patients in Brazil and 27.3% in Chile received biologics (p = 0.01). Lack of availability and/or lack of insurance reimbursement for biological drugs for moderate-to-severe psoriasis patients was reported for 22.2% (50 out of 357) in Brazil and 67.9% (148 out of 300) in Chile (p < 0.001). Patients with no access to biologic therapies due to lack of availability/insurance reimbursement had a median PASI of 9.15 (IQR 3.00, 14.25) in Brazil and 12.0 (IQR 5.00, 19.00) in Chile (p = 0.007), as well as a median BSA of 7.0 (IQR 3.00, 15.00) and 12.0 (IQR 5.00, 22.50) (p = 0.002), and median DLQI of 11.0 (6.00, 15.00) and 21.0 (6.50, 25.00) (p = 0.007) respectively. Conclusion Chilean patients had significantly more severe psoriasis compared to Brazilian patients in our study. While non-biologic treatments for moderate-to-severe psoriasis were available in both Latin American countries, there is a high need for an improvement in access to more effective psoriasis treatment including biologics. Our results highlight a significant gap between treatment recommendations in international psoriasis guidelines and real-world situations in Brazil and Chile.

Todos los autores declaran no tener conflictos de interés. Sin fuentes de financiamiento.Recibido: 15 de septiembre de 2021 / Aceptado: 20 de enero de 2022 ResumenLa enfermedad de Hansen o lepra es una enfermedad infecciosa crónica causada por Mycobacterium leprae, y que afecta principalmente la piel y nervios periféricos. En los últimos años, se ha logrado un mejor control de la enfermedad en forma global. Sin embargo, en Chile la incidencia de la lepra ha ido en aumento. Presentamos el caso clínico de un paciente de 40 años, haitiano, con lesiones e histopatología compatibles con una lepra tuberculoide. Se discute la importancia en la educación sobre enfermedades menos prevalentes en Chile y se hace una revisión sobre la fisiopatología, clínica y clasificación de la enfermedad de Hansen.