The exact prevalence of psoriatic arthritis (PsA) among patients with psoriasis is still not conclusive. Data in the literature vary between 5.8 and 30 %. Objective of this study was to gain more information on the prevalence of PsA among patients with psoriasis in Germany. Between 09/2010 and 05/2011, consecutive patients from dermatological private practices and a university hospital with psoriasis were asked to fill out the validated German Psoriatic Arthritis Diagnostic (GEPARD) Questionnaire. Patients who answered ≥4 questions with "yes" were invited to come for a rheumatological check up. Those patients who refused a rheumatological examination were counted as "absence of PsA". Laboratory tests for inflammatory markers as well as the severity of skin manifestations were assessed. The diagnosis of PsA was made according to the CASPAR criteria, and imaging was performed in addition. A total of 404 questionnaires were evaluated; 50.5 % answered ≥4 questions positively; 19.3 % had a history of PsA confirmed by a rheumatologist; and in 10.9 %, PsA or spondyloarthritis was newly diagnosed during the present study. This leads to an overall prevalence of PsA in patients with psoriasis of 30.2 %. The frequency of psoriatic arthritis in the present study is higher than expected from previous studies in Germany. The prevalence is consistent with findings of a large observational survey from Scandinavia. Using the CASPAR criteria and imaging in all patients, certainty of the diagnosis is very high. The GEPARD Questionnaire is a helpful tool to identify people at risk for psoriatic arthritis.

PerifoIIiculitis capitis abscedens et suffodiens (PCAS)is a rare scalp disease seen mostly in young males of Afi-o-American descent. The disease is characterized by perifollicular pustules, suppurative nodules and fluctuating abscesses, as well as by intercommunicating sinus tracts on the scalp. We report here an elderly Caucasian woman who fialfilled the clinical and histological criteria for diagnosis of PCAS.The patient was treated with initial prednisolone, systemic acitretin, topical tacrolimus and oral zinc. After 6 months, her condition was stable. CASE REPORTAn 86-year-old woman reported having had purulent scalp lesions for approximately one year. She denied trauma or a preceding herpes zoster. Topical corticosteroids, as well as systemic amoxicillin/clavulanic acid, produced no improvement. A large draining boggy mass evolved on her occiput.Clinically, a 5 x 5 cm weeping, ulcerated nodule, with a raised border and numerous sinus tracts, was seen (Fig. lA). In addition, pustules were scattered over her scalp; some of which had evolved into fluctuant nodules with overlying alopecia.Laboratory results showed a leukocyte count of 10.7/nl (normal range 4.0-10.0/nl) and a C-reactive protein concentration of 2.8 mg/dl (normal: <0.5 mg/dl). In addition, the hlood level of zinc was slightly decreased (8.9 |imol/l; normal 9.2-18.4 \xmo\l\). The remaining laboratory parameters were within the normal range.A search for circulating autoantihodies specific for pemphigus and pemphigoid hy ELISA was negative. The virus-specific antihody counts for varicella-zoster and herpes simplex virus were IgG positive and IgM negative. PCR failed to detect Treponema pallidum, Bartonella, Mycoplasma and Mycobacteria.A skin hiopsy of the occipital region showed dissecting dermatitis with ahscess formation (Fig. 2). The dermis was dominated hy a neutrophilic inflammatory infiltrate. Terminal hair shafts were variably destroyed and entered into a sinus tract. In the upper dermis there was a suppurative inflammation with abscess material and hair shaft fragments being discharged via a draining sinus. Periodic acid-Schiff (PAS) staining for fungi, as well as immunohistochemical staining with anti-Mycohacterium hovis (BCG) and for T. pallidum was negative. Direct immunofluorescence of the perilesional scalp skin was negative.Microbiological examinations failed to identify pathogenic organisms.Following the diagnosis of a PCAS, the patient was treated with 10 mg acitretin and 30 mg prednisolone daily as an inpatient. The prednisolone was reduced to 5 mg per day during the course of treatment. Because of the decreased level of zinc, 100 mg zinc aspartate was given daily. In addition, topical glucocorticoids and tacrolimus 0.1% were alternated.This regimen produced almost total healing within 11 days (Fig. IB). The systemic corticosteroids were further tapered and the topical corticosteroids were stopped.Six months after discharge the patient's skin condition was Stahle on a regimen of 10 mg acitretin and 100 mg zinc aspartate daily, supple...

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